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Transanal Minimally Invasive Surgery (TAMIS)
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Intraperitoneal entry carries a risk of injuring intra-abdominal structures, of bacterial and potential cytologic contamination, and of anastomotic leak. Initially regarded as a complication, with experience, intraperitoneal excision with secure closure of the rectal defect can be performed without increased short-term morbidity [22]. If there is concern about the adequacy of an intraperitoneal closure, the patient may be observed overnight for signs of a leak and undergo a water-soluble contrast enema the following morning.
Upper GI Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Nicola C Tanner, Chris Collins
You proceed to order a CT that reveals a large amount of intraperitoneal air and fluid around the stomach, liver and spleen. What are the management options?This lady has a likely perforated stomach while on treatment for gastric lymphoma.This can occur due to the rapid response of the lymphoma to the chemotherapy with tumour necrosis and lysis causing a breach in the serosal layer.Conservative management is unlikely to be an option depending on the patient's other comorbidities. She should be considered for emergency laparotomy and gastric resection, with a sub-total or total gastrectomy.Complications would be significantly increased compared to the elective patient due to the presence of intraperitoneal contamination as well as patient factors including possible neutropenia while on chemotherapy. These include anastomotic leak, intra-abdominal abscess formation, duodenal leak as well as general complications including respiratory, cardiac and wound complications, in addition to sepsis.The patient should be appropriately counselled preoperatively about these risks and estimated mortality and morbidity probabilities calculated.
Colorectal peritoneal metastases
Published in Tom Cecil, John Bunni, Akash Mehta, A Practical Guide to Peritoneal Malignancy, 2019
By 2000, a robust evidence base had been established supporting the role of intraperitoneal chemotherapy in the adjuvant treatment of colorectal cancers at high risk of peritoneal dissemination. Nevertheless, partly due to the Dutch randomised trial on CRS and HIPEC in the treatment of CPM, focus shifted away from adjuvant and prophylactic strategies [11,12]. It would be approximately a decade before a series of non-randomised, prospective studies were published regarding the value of adjuvant intraperitoneal chemotherapy in high-risk patients [39–41]. These studies showed that, in selected patients, intraperitoneal chemotherapy was associated with increased long-term survival and/or lower peritoneal recurrence rates, as compared to patients who did not receive intraperitoneal chemotherapy [42].
Advances in the pharmacological management of bacterial peritonitis
Published in Expert Opinion on Pharmacotherapy, 2021
Daniel Pörner, Sibylle Von Vietinghoff, Jacob Nattermann, Christian P Strassburg, Philipp Lutz
Intraperitoneal application is the preferred route of administration for several reasons. The direct intraperitoneal application leads to high drug levels at the center of infection. For vancomycin, as an example, intravenous application leads to a higher rate of treatment failure than intraperitoneal administration [58,59]. Furthermore, intraperitoneal application can be performed by the patients themselves in an outpatient setting. For quinolones, oral application is a reasonable alternative. In patients with signs of sepsis, antibiotics should be applied intravenously [47]. However, as mentioned above, timely start of antibiotic therapy is crucial and therefore, decision on the application route should not delay antibiotic therapy [48,60]. Table 1 provides an overview on the recommended dosing for the intraperitoneal application of antibiotics in PDrP.
Doxorubicin hydrochloride loaded nanotextured films as a novel drug delivery platform for ovarian cancer treatment
Published in Pharmaceutical Development and Technology, 2020
Gökçen Yaşayan, Pınar Mega Tiber, Oya Orun, Emine Alarçin
Treatment regimens of this type of cancer include eliminating cancer cells mainly by surgical removal and intravenous chemotherapy. Even when patients respond well to treatment, there is a high recurrence rate at the resection site, and spread of the cancer within the peritoneal cavity (Rubin et al. 1991; Mathew et al. 1996; Woo et al. 2001). Since ovarian cancer is characterized to remain confined to the surface of peritoneal cavity, another treatment strategy is intraperitoneal (IP) chemotherapy. Studies suggest that IP chemotherapy could increase overall and progression-free survival compared to intravenous chemotherapy as a first-line treatment. By IP chemotherapy, high drug concentration inside the peritoneal cavity could eradicate cancer residuals after second look laparotomy, and cancer recurrence rates could be reduced. Furthermore, systemic side effects of intravenous therapy could be precluded by local administration. However, drawbacks of IP chemotherapy, mainly due to catheter related complications and gastrointestinal toxicity, should be considered carefully (Gadducci and Conte 2008; Jaaback et al. 2016).
A comparison between the mechanical properties of the hepatic round ligament and the portal vein: a clinical implication on surgical reconstruction of the portal and superior mesenteric veins
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Wentao Zhu, Rongqiang Song, Xuefeng Cao, Lei Zhou, Qiang Wei, Haibin Ji, Rongzhan Fu
Hepatic round ligament (HRL), also known as ligamentum teres, is the remnant of the embryonic umbilical vein, which degenerates after birth (Emre et al. 1993). It is located between the umbilicus and the left branch of the portal vein (PV), connecting the left hepatic vein or the inferior vena cava via the venous ligament. Anatomically, it can be divided into intraperitoneal and extraperitoneal segments. Structurally, it is organized into the inner, middle and outer layers and still retains the structural features of the blood vessel wall that is composed of collagen and elastic fibers, as well as smooth muscles. A distinct elastic muscle band enriched with smooth muscle, elastic and collagen fibers exist between the inner and middle layer. Blood supply to the HRL is sufficiently provided by the right hepatic artery and the umbilical vein. Clinically, narrowed or obstructed HRL can be widened to reconnect with the PV (Ikegami et al. 2008).