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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
The commonest cause for free air under the diaphragm is recent abdominal surgery, hence the importance of a past surgical history. Air is typically absorbed after 1 week following abdominal surgery, though this is much quicker in laparoscopic procedures. Other causes not relevant to this patient include ventilated patients or those suffering from chronic obstructive airways disease where gas escapes from the tracheobronchial tree. Vaginal examination or tubal insufflation in gynaecological investigations can also introduce air visible on an erect CXR. Finally, the interposition of a gas-filled viscus, such as the transverse colon between the liver and diaphragm, can appear as free gas and this is called Chilaiditi's sign.
The Scale of the Problem
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
Samuel G. Parker, Xavier Chalhoub, Alastair C.J. Windsor
Over one-third of Western individuals undergo intra-abdominal surgery in their lifetimes3 and approximately 20% will develop a subsequent incisional (or ventral) hernia, the most common long-term complication after abdominal surgery.9 Despite the development of new operative techniques and mesh implants, recurrence rates after repair remain high; if operative repair fails, the chance of recurrence increases with each subsequent repair.10,11 This, together with an increase in the three main risk factors (age, obesity, and number of intra-abdominal procedures) has led to a surge in ventral hernia disease.
Abdominal surgery
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
Abdominal surgery involves surgery on or in the abdominal cavity, including surgery on the gastrointestinal tract, oesophagus, stomach, small bowel and large bowel. Traditionally, abdominal surgery was carried out by general surgeons but more surgeons are becoming specialists within the field of general surgery. The liver, pancreas, bladder and kidneys all reside within the abdominal cavity (Figure 7.1) and as such form part of general surgery. There has been a complete surgical revolution (not unlike the industrial revolution in terms of its impact on society) during the past 10 years. Many traditional abdominal surgical procedures are now carried out using laparoscopic or non-invasive techniques and a patient’s knowledge and expectations have increased dramatically. Surgery is not an exact science and even in the best hands the outcome is not totally predictable.
The fully engaged inspiratory muscle training reduces postoperative pulmonary complications rate and increased respiratory muscle function in patients with upper abdominal surgery: a randomized controlled trial
Published in Annals of Medicine, 2022
Yu-Ting Huang, Yih-Jyh Lin, Ching-Hsia Hung, Hui-Ching Cheng, Hsin-Lun Yang, Yi-Liang Kuo, Pei-Ming Chu, Yi-Fang Tsai, Kun-Ling Tsai
Upper abdominal surgery is the most common major surgery [1,2]. A major surgery under general anaesthesia causes a rapid decline in functional residual capacity (FRC) of up to 20% and impairs the normal activity of respiratory muscle groups, especially in the diaphragm [3]. Respiratory muscle dysfunction may reduce lung capacity, tidal volume, and coughing function. FRC and mucociliary clearance are likely to decrease. As a result, atelectasis in the base of the lung segment, diaphragm palsy, infection and hypoxia might develop [4]. The impairment of respiratory function after an operation is collectively referred to as postoperative pulmonary complications (PPCs) [1–3,5–7]. It is estimated that the frequency of PPCs after major surgical procedures ranges from 1 to 30% of the patients. In most cases, the risk of PPCs increases with the distance from the surgical site to the diaphragm [1,3]. Due to this unique physiological mechanism, the risk of PPCs after upper abdominal incision surgery may be up to 15 times higher than that after lower abdominal incision surgery [3]. PPCs increase the length of hospital stay, mortality rate, and medical consumption. It is even the main cause of postoperative death [1,2,7–11].
Impact on ovarian reserve and fertility using carbon dioxide laser for endometriosis treatment: a systematic review
Published in Gynecological Endocrinology, 2022
Andrea Giannini, Linda Tebache, Giacomo Noti, Giulia Cosimi, Michelle Nisolle, Tommaso Simoncini
Data regarding clinical outcomes after laparoscopic excision of DIE using CO2 laser are very limited, nearly mirrored a single center’s experience in Europe, focusing on colorectal endometriosis involvement. Ten years ago, Meuleman et al. [35] and colleagues reported the results of a retrospective cohort study that evaluated the clinical outcome of 56 women after multidisciplinary laparoscopic excision of deep endometriosis with colorectal extension. Patients were asked to complete questionnaires regarding Quality of life (QoL), sexual activity, and visual analog scale (VAS) assessments for dysmenorrhea, chronic pelvic pain, and deep dyspareunia to evaluate the potential positive effect of surgery on these aspects. The authors reported a significant improvement in gynecological pain, QoL, and sexual activity after a postoperative follow-up of 29 months. Postoperative complications occurred in six patients (11%) but were related to intra-abdominal surgery in only 5%. The cumulative re-intervention rate was 9, 17, and 23% at 1, 2, and 4 years. The cumulative recurrence rate of endometriosis was 2% after the first year and 7% in the fourth year of follow-up. The cumulative pregnancy rate was 31% and 70% at 1 and 4 years after surgery, respectively. This study was the first to assess that CO2 laser laparoscopic radical, fertility-sparing, excision of DIE with colorectal extension significantly improved pain, QoL, and sexual activity.
Knowledge of enhanced recovery after surgery and influencing factors among abdominal surgical nurses: a multi-center cross-sectional study
Published in Contemporary Nurse, 2022
Bing Xue, Huidan Yu, Xianwu Luo
A guideline suggested that prophylactic abdominal drainage should be omitted after major abdominal surgery (Melloul et al., 2016), but the results found that only half of the nurses agreed with this. Contrary to the traditional way is a contributory factor in nurses’ reluctance to adopt ERAS practices (Seow-En et al., 2021). Though the abandonment of abdominal drainage after abdominal surgery is safe and effective, and it will not increase the incidence of postoperative complications, especially abdominal infection and ascites exudation (Brustia et al., 2021). This indicates that the concept of ERAS has not been systematically introduced in China, and some perioperative treatment measures of ERAS may have been implemented in clinical practice. However, due to the lack of systematic and professional theoretical knowledge training, nurses lack profound understanding of knowledge, resulting in a low correct response rate of some items(Wang & Li, 2018).