The peritoneum, omentum, mesentery and retroperitoneal space
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
A leukocytosis of >30000/pL, with approximately 90% polymorphs, suggests pneumococcal peritonitis rather than another cause, e.g. appendicitis. After starting antibiotic therapy and correcting dehydration and electrolyte imbalance, early surgery is required unless spontaneous infection of pre-existing ascites is strongly suspected, in which case a diagnostic peritoneal tap is useful. Laparotomy or laparoscopy may be used. Should the exudate be odourless and sticky, the diagnosis of pneumococcal peritonitis is practically certain, but it is essential to perform a careful exploration to exclude other pathology. Assuming that no other cause for the peritonitis is discovered, some of the exudate is aspirated and sent to the laboratory for microscopy, culture and sensitivity tests. Thorough peritoneal lavage is carried out and the incision closed. Antibiotics and fluid replacement therapy are continued and recovery is usual.
Perforation of the esophagus
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
Patients in whom the perforation is diagnosed several days after occurrence are treated primarily by interventional radiological techniques, although some authors have used operative techniques. The strategy is to drain the cavity adjacent to the perforation and the abscesses as adequately as possible. This involves placing a transthoracic CT-guided drainage tube to aspirate the cavity. In addition, a percutane- ous gastrostomy is performed. Another option for drainage occasionally used is advancing a retrograde intraluminal catheter from the gastrostomy access to the esophagus and into the cavity. As the patient will not be able to eat for some time, a feeding jejunostomy catheter should be placed. This can be done laparoscopically to obviate the need for laparotomy.
Novel and Alternative Techniques in Surgery for Necrotizing Enterocolitis
David J. Hackam in Necrotizing Enterocolitis, 2021
There is a limited role for laparoscopy in the management of patients with NEC. Limitations in its use include the underlying hemodynamic instability of these infants and the risk of exacerbating their cardiopulmonary status by introducing pneumoperitoneum by CO2 (35, 36). That said, several case series suggest that laparoscopy is beneficial for assisting the surgeon in determining which cases meet indications for laparotomy as well as assisting with operative planning (37–39). A systematic review by Thakkar et al. examining outcomes for laparoscopy in NEC identified seven studies with 44 patients (40). By initially proceeding with laparoscopy, 18% of infants were spared a laparotomy for reasons that included the absence of NEC or perforation as well as NEC totalis (which, as described in Chapter 10, in the era of effective bowel management programs, may be managed by aggressive bowel resection followed by stoma closure). An important question concerning these findings remains whether those patients with a negative diagnosis were appropriately selected to begin with. Additionally, there was one case of a missed perforation at the time of laparoscopy, for which laparotomy was required later. Additional human clinical studies, as well as one pig model, have been performed, combining laparoscopy with the use of fluorescein dyes to detect hypoperfused bowel in early NEC with up to 100% specificity (41–43). However, given the validity of concerns surrounding the use of CO2 and pneumoperitoneum in this setting, careful patient selection and an experienced anesthesiology team are required to ensure laparoscopy can be safely performed.
Life quality of endometrioid endometrial cancer survivors: a cross-sectional study
Published in Journal of Obstetrics and Gynaecology, 2021
Volkan Karataşlı, Behzat Can, İlker Çakır, Selçuk Erkılınç, Oğuzhan Kuru, Mehmet Gökçü, Muzaffer Sancı
The institutional review board (University of Health Sciences, Tepecik Education and Research Hospital, Turkey, March 13, 2019) approved the study (Approval no. 2019/4-27). SPSS version 21 software (IBM Corp., Armonk, NY) was used for statistical analyses. Continuous variables were described as means and standard deviations and categorical variables were described as frequencies and percentages. The one-way ANOVA and the chi-square test were used to detect differences among groups. The correlation of BMI with domains of EORTC QLQ-C30 and FSFI were determined using Spearmen correlation coefficients. Multiple linear regression analyses were performed to assess the effects of clinicodemographic variables and BMI on EORTC QLQ-C30 and FSFI domains. Age, marital status, monthly income, time since last treatment, surgical approach, adjuvant treatment (radiotherapy and chemotherapy) were the main confounding variables, according to a previously published review (Smits et al. 2015). Marital status was categorised as married or unmarried (single, widowed or divorced). Monthly income was divided into categories according to the national minimum wage (NMW) and classified as low (≤US$422 = NMW), middle (US$422–US$844), and high (≥US$844). The surgical approach was categorised as laparotomy or laparoscopy. The significance threshold was set to .05 for all analyses.
Duodenal bulb obstruction caused by a gallstone (Bouveret syndrome) successfully treated with endoscopic measures
Published in Baylor University Medical Center Proceedings, 2020
Gilles Jadd Hoilat, Vanessa Sostre, Judie N. Hoilat, Ceren Durer, Seren Durer, Gowthami Kanagalingam, Divey Manocha
Bouveret syndrome can be treated through an endoscopic or surgical approach. Surgery can be done laparoscopically or through laparotomy. It includes enterolithotomy, duodenotomy, cholecystectomy, and fistula repair.1,2 Different methods of endoscopy can be done, such as direct removal with nets/baskets, mechanical lithotripsy, extracorporeal shockwave lithotripsy, laser lithotripsy, and intracorporeal electrohydraulic lithotripsy.3–5 Direct endoscopic removal of gallstones with nets or baskets is fast, simple, and works well for small gallstones. However, larger stones require some sort of lithotripsy before extraction.5 When simple removal of the stone fails with endoscopy net/basket, mechanical lithotripsy is the usual adjunct used to crush the stone, followed by extraction of all the stones.6
A novel internal cold circulation radiofrequency-assisted device for liver transection
Published in International Journal of Hyperthermia, 2021
Yanzhao Zhou, Jingzhong Ouyang, Zhengzheng Wang, Xun Chen, Ruili Zhu, Qingjun Li, Jinxue Zhou
The patient received laparotomy under general anesthesia. The liver was dissociated based on the location and range of the lesion. The relationship between the lesion and important anatomical structures such as blood vessels and biliary ducts was revealed by the ultrasound examination. Blood vessels to be preserved and the liver to be resected were marked under ultrasound guidance. The electrode was inserted along the marked line to coagulate the liver tissue, forming a ‘no blood circulation’ tissue plane (Figure 2). Then, we used vascular forceps or tissue scissors to excise the liver along the ‘no blood circulation’ tissue plane, close to and parallel to the outer edge of the liver tissue that needed to be preserved, remaining an ablation edge of about 0.8 cm (Figure 3). Blood vessels and biliary ducts with relatively large diameters were identified and ligated. Little hemorrhage was detected during the excision. A limited number of sutures or clips were required to control the blood flow of the trunk or the branches of the portal vein. Although there was no need to clamp the influx and efflux channels, we still preset a blocking band at the hepatic portal as a backup. The process obeyed the sequence of ‘coagulation to excision’, which allowed us to change the direction during the liver excision according to the position, size, and shape of the tumor (Figure 4). Besides, sufficient liver tissue would be preserved during the liver resection in this way.
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