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Posterior Component Separation
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
Care must be taken to avoid enterotomy because of its significant impact on subsequent surgical site infection and damage to the posterior abdominal wall, which needs to be intact to perform the TAR easily. Some case series report enterotomy rates at laparotomy as high as 40%;23 in our 35-year institutional experience, with an unpublished enterotomy rate of less than 1%, we believe the majority of enterotomies can be avoided by opening the abdomen under direct vision, using sharp dissection with a scalpel and avoiding traction injury through blunt dissection.
Complications in Laparoscopic Colorectal Surgery
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Sanjiv Haribhakti, Shobhit Sengar
The incidence of small bowel injury during colorectal surgery is between 1% and 3% for open and laparoscopic techniques [3,4]. The risk of an inadvertent enterotomy increases with previous abdominal surgery, while injury to the duodenum is most likely to occur during right colon mobilization (Figure 10.1). Injury to the small bowel with the laparoscopic technique occurs in less than 1% of cases [5]. The therapeutic approach varies with the type and extent of injury. Veress needle injury to the small bowel rarely requires further intervention and can be managed conservatively. In contrast, a trocar injury to the small bowel requires primary operative repair, either laparoscopically or open. Full-thickness small bowel enterotomies are repaired in one or two layers. Serosal tears are repaired with seromuscular sutures. Technically, the most challenging repair is of an enterotomy of the duodenum. A primary repair should not compromise the duodenal lumen.
Restorative Proctocolectomy in Colitis
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Colin Peirce, Feza Remzi, Michael R.B. Keighley
The J pouch is constructed with the terminal 30 to 40 cm of small intestine, folded on itself to create two 15- to 20-cm limbs. A small enterotomy is created in the most dependent portion of the intestine. Determining the most dependent part of the distal small bowel is the most critical component, as this allows for the pouch-anal anastomosis to be created without tension. This may result in varying lengths of the pouch itself, with overall pouch length far less important to the authors than prevention of tension on the pouch-anal anastomosis. However, the aim is to create a J pouch of 15 to 20 cm in length. A side-to-side stapled anastomosis is created using a longitudinal stapling device (usually two loads of a 100-mm stapler, occasionally three are required), creating a common channel reservoir. The terminal end of the ileum is closed with a short linear stapler, and the staple line undersewn with a running 3/0 Vicryl suture. The pouch is inverted on itself to ensure no internal staple line bleeding. For a stapled anastomosis, a 0 Prolene purse-string suture is inserted at the pouch apex, and then the pouch is insufflated with a betadine solution to ensure adequate capacity and no leaks (Figure 66.6). If a leak is detected, it is closed with 3/0 Vicryl sutures, and then the leak test repeated. When the leak test is negative, the previously sited purse-string suture is tied to secure the anvil of the stapling device.
Is occlusion of the main pancreatic duct by thermal ablation really safe? A surgical innovation assessed according to IDEAL recommendations
Published in International Journal of Hyperthermia, 2023
Xavier Moll, Dolors Fondevila, Félix García-Arnas, Juan J. Pérez, Benedetto Ielpo, Patricia Sánchez-Velázquez, Luis Grande, Sofía Jaume, Aleksandar Radosevic, Luis Barranco, Enrique Berjano, Fernando Burdio, Anna Andaluz
Fifteen female Landrace pigs (85.1 ± 8.8 kg weight) were used in this study. The animal research protocol followed the guidelines approved by the Ethical Commission of the Universitat Autònoma de Barcelona (Authorization Number CEEAH 3487 and DMAH 9583) and the Government of Catalonia’s Animal Care Committee. Three groups were established according to the postoperative follow up: 0-day (n = 3), 7-day (n = 6) and 30-day (n = 6). All the surgical procedures were performed by the same surgical team (AA and XM), via open laparotomy and enterotomy. After locating the pancreatic papilla, the ablation catheter was gently advanced as far as possible into the MPD (see Figure 2). After conducting thermal ablation, the enterotomy and laparotomy were closed in the conventional manner. The animals in the 0-day Group were sacrificed immediately after ablation, while those in the 7- and 30-day Groups were kept alive for 7 and 30 days.
Developments in the Diagnosis and Management of Cholecystoenteric Fistula
Published in Journal of Investigative Surgery, 2022
Ying-Yu Liu, Shi-Yuan Bi, Quan-Run He, Ying Fan, Shuo-Dong Wu
Although spontaneous excretion of gallstone ileus has been reported, most patients still require medical intervention [48]. Patients with gallstone ileus are often vulnerable elderly patients with multiple diseases who cannot tolerate general anesthesia or intestinal resection. In this case, most surgeons believe that the main therapeutic goal is to resolve intestinal obstruction [35]. Endoscopic lithotomy is the preferred treatment, and enterotomy is feasible when endoscopic lithotomy fails [49]. An earlier study reported low morbidity after enterolithotomy alone, with only 10% of patients requiring a repeat operation due to persistent symptoms, demonstrating the effectiveness of this treatment regimen [50]. Some studies have recommended treating gallstone ileus caused by large stones by removing stones with an intestinal polyp ligator after mechanical lithotripsy under endoscopy [13].
Challenges in surgical video annotation
Published in Computer Assisted Surgery, 2021
Thomas M. Ward, Danyal M. Fer, Yutong Ban, Guy Rosman, Ozanan R. Meireles, Daniel A. Hashimoto
Annotation of clinically meaningful events is one of the foremost challenges in surgical video annotation given that there is limited consensus on what constitutes clinically meaningful. Consider the case of bleeding as an example. Bleeding occurs when blood moves from the lumen of a blood vessel into the surgical field; however, clinical context is extremely important in judging if this movement of blood is potentially deleterious to the patient or an expected ooze of little consequence to clinical outcome, especially if bleeding is to be used as an event to help guide or assess surgeons. For example, while performing an anastomosis, there may be bleeding from the edge of an enterotomy: this can be an expected or even positive sign, as it indicates the tissue has adequate perfusion. However, if bleeding occurs a few millimeters away, say from tearing of the bowel or the mesentery by a grasper, this could be considered an adverse event. Other questions include: how much blood loss is potentially harmful to the patient? What rate of blood loss can be temporarily ignored or otherwise expected to be self-limited? This necessitates understanding of context as, for example, the amount of expected bleeding in an appendectomy is significantly different than a liver resection. Additionally, even in the context of a single procedure type, patient factors such as inflammation can significantly affect the judgment of which episodes of bleeding are considered expected versus unexpected.