Your Guide to a Laparotomy
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Janež J. Percutaneous Endoscopic Gastrostomy Tube Dislocation 2 Days After Insertion with Copyright© Janež J
1. Medical Journal of Clinical Trials & Case Studies ISSN: 2578-4838 Percutaneous Endoscopic Gastrostomy Tube Dislocation 2 Days after Insertion with Consequent Peritonitis Janež J* Case Report Department of Abdominal Surgery, University Medical Centre Ljubljana, Slovenia Volume 2 Issue 3 Received Date: April 22, 2018 *Corresponding author: Jurij Janež, Department of Abdominal Surgery, University Published Date: May 16, 2018 Medical Centre Ljubljana, Zaloška Cesta 7, 1525 Ljubljana, Slovenia, Tel: +38651315815; DOI: 10.23880/mjccs-16000151 Email: [email protected] Abstract Percutaneous endoscopic gastrostomy is a procedure that involves an endoscopic guided insertion of gastrostomy tube for purposes of enteral feeding. It is usually performed in patients after brain stroke or patients with malignant disease of throat that are unable of swallowing. In some cases, the gastrosotmy tube can become dislocated, allowing the gastric content to escape into the abdominal cavity, causing intra-abdominal abscess or peritonitis. This paper presented a case of a-80-year old male patient, who needed emergency operation due to displaced gastrostomy tube 2 days after insertion. Keywords: Percutaneous Endoscopic Gastrostomy; Tube Displacement; Emergency Surgery; Haemorrhage; Jejunostomy Abbreviations: PEG: Percutaneous Endoscopic [2]. In addition, patients who have trauma, cancer, or Gastrostomy; CT: Computed Tomography. recent surgery of the upper gastrointestinal tract the respiratory tract may require this procedure to maintain Introduction nutritional intake. Gut decompression may be needed in patients who have abdominal malignancies causing Percutaneous endoscopic gastrostomy (PEG) is a gastric outlet or small-bowel obstruction or ileus [3]. This procedure often needed in patients after brain stroke or paper presented a case of an 80-year-old male patient, with throat cancer that are unable of normal enteral who needed emergency operation 2 days after PEG feeding. -
Evidence Vs Experience in the Surgical Management of Necrotizing Enterocolitis and Focal Intestinal Perforation
Journal of Perinatology (2008) 28, S14–S17 r 2008 Nature Publishing Group All rights reserved. 0743-8346/08 $30 www.nature.com/jp ORIGINAL ARTICLE Evidence vs experience in the surgical management of necrotizing enterocolitis and focal intestinal perforation CJ Hunter1,2, N Chokshi1,2 and HR Ford1,2 1Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA and 2Department of Surgery, Childrens Hospital Los Angeles, Los Angeles, CA, USA bacterial colonization and prematurity.4 There is a subset of low Introduction: Necrotizing enterocolitis (NEC) and focal intestinal birth weight infants, however, that sustain focal intestinal perforation (FIP) are neonatal intestinal emergencies that affect premature perforation (FIP) without classic clinical, radiographic, or infants. Although most cases of early NEC can be successfully managed with histological evidence of NEC.5 FIP appears to be a distinct clinical medical therapy, prompt surgical intervention is often required for advanced entity that occurs in 3% of very low birth weight (VLBW) infants or perforated NEC and FIP. and accounts for 44% of gastrointestinal perforations in this 6 Method: The surgical management and treatment of FIP and NEC are population. Optimal surgical management of severe NEC and discussed on the basis of literature review and our personal experience. FIP has been the subject of ongoing controversy for many years. Result: Surgical options are diverse, and include peritoneal drainage, laparotomy with diverting ostomy alone, laparotomy with intestinal Presentation of NEC and FIP resection and primary anastomosis or stoma creation, with or without Infants with NEC typically present with feeding intolerance and second-look procedures. -
Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair: Lessons Learned from 3,100 Hernia Repairs Over 15 Years
Surg Endosc (2009) 23:482–486 DOI 10.1007/s00464-008-0118-3 Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3,100 hernia repairs over 15 years Jean-Louis Dulucq Æ Pascal Wintringer Æ Ahmad Mahajna Received: 30 November 2007 / Accepted: 14 July 2008 / Published online: 23 September 2008 Ó Springer Science+Business Media, LLC 2008 Abstract Mean operative time was 17 min in unilateral hernia and Background Two revolutions in inguinal hernia repair 24 min in bilateral hernia. There were 36 hernias (1.2%) surgery have occurred during the last two decades. The first that required conversion: 12 hernias were converted to was the introduction of tension-free hernia repair by open anterior Liechtenstein and 24 to laparoscopic TAPP Liechtenstein in 1989 and the second was the application of technique. The incidence of intraoperative complications laparoscopic surgery to the treatment of inguinal hernia in was low. Most of the patients were discharged at the sec- the early 1990s. The purposes of this study were to assess ond day of the surgery. The overall postoperative morbidity the safety and effectiveness of laparoscopic totally extra- rate was 2.2%. The incidence of recurrence rate was peritoneal (TEP) repair and to discuss the technical changes 0.35%. The recurrence rate for the first 200 repairs was that we faced on the basis of our accumulative experience. 2.5%, but it decreased to 0.47% for the subsequent 1,254 Methods Patients who underwent an elective inguinal hernia repairs hernia repair at the Department of Abdominal Surgery at Conclusion According to our experience, in the hands of the Institute of Laparoscopic Surgery (ILS), Bordeaux, experienced laparoscopic surgeons, laparoscopic hernia between June 1990 and May 2005 were enrolled retro- repair seems to be the favored approach for most types of spectively in this study. -
Exploratory Laparotomy.Docx
EXPLORATORY LAPAROTOMY CONSENT FORM Your physician has determined that you may have a disease or abnormality inside your abdomen which may be life threatening, preventing pregnancy or causing medical problems if not treated. An exploratory laparotomy is an operation in which the doctor makes a surgical “cut” in the belly. Sometimes this operation is done to make sure that no disease or abnormality exists. If the physician finds that a disease is found or if the physician doesn’t feel that corrective surgery should be done immediately, then he will close up the surgical cut. If major corrective surgery is done the risk will be greater than if no corrective surgery is done. It is possible that you will be worse after the operation. Your physician can make no guarantee as to the result that might be obtained from this operation. Complications from exploratory surgery of the abdomen without any corrective surgery are infrequent, but they do occur. As with any surgical procedure, complications from bleeding and infection can occur. These complications can result in prolonged illness, the need for blood transfusions, poor healing wounds, scarring and the need for further operations. Other uncommon complications of this operation include: Damage to the intestines, blocked bowels, hernia or “rupture” developing at the site of the surgical cut, heart attacks or stroke, blood clots in the lungs and pneumonia. Some complications of exploratory surgery of the abdomen may require further surgery, some can cause permanent deformity and rarely, some can even be fatal. Furthermore, there may be alternative therapeutic or diagnostic methods available to you in addition to exploratory surgery. -
A Rare Complication of Percutaneous Endoscopic Gastrostomy (PEG) and Its Successful Management
Case Report Published: 23 Jun, 2020 Journal of Otolaryngology Forecast Non-Necrotizing Abdominal Wall Fasciitis: A Rare Complication of Percutaneous Endoscopic Gastrostomy (PEG) and Its Successful Management Ah-See KL, Nath A, Gomati A, Shakeel M* and Ah-See KW Department of Otolaryngology-Head & Neck Surgery, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, Scotland, United Kingdom Abstract Background: We report a case of non-necrotizing abdominal wall fasciitis as a post-operative complication of percutaneous endoscopic gastrostomy insertion. Main Observations: A 57 year old man undergoing chemo-radiotherapy for head and neck cancer required a PEG tube insertion. The procedure was uneventful but he developed this complication associated with tube displacement into the anterior abdominal wall. The patient required multiple theatre visits for wound debridement, stayed in the intensive care unit but made a good recovery. Conclusion: All clinicians need to aware of possible gastrosotmy tube displacement, development of this life-threatening complication and be familiar with the appropriate management options. Keywords: Head and neck cancer; Chemoradiotherapy; PEG; Fasciitis; Postoperative complications Introduction Percutaneous Endoscopic Gastrostomy (PEG) is a commonly performed procedure in patients with upper aerodigestive tract malignancies as well as in a range of other swallowing disorders. This OPEN ACCESS is generally regarded as a safe intervention to enable long-term enteral feeding. Procedure related mortality is reported at around 1% [1,2] and incidence of life threatening complications is low. The * Correspondence: procedure is simple and quick to complete [3]. Muhammad Shakeel, Department of Otolaryngology-Head & Neck Surgery, Necrotizing fasciitis is one of the most severe complications of abdominal surgery but is rare Aberdeen Royal Infirmary, Aberdeen, in association with PEG tube insertion [4,5]. -
Laparoscopy and Possible Laparotomy
Saint Mary’s Hospital Major Laparoscopy (and possible Laparotomy) Information For Patients Contents What is a Laparoscopy? 3 What is it used for? 4 Proceeding to a Laparotomy 5 Will I have pain following my operation? 5 Vaginal bleeding 6 When can I have sex again? 6 Will my periods be affected? 6 When can I return to normal activities? 6 Constipation following a Laparotomy 7 How will my wound be closed? 7 How should I care for my wound? 8 Will I have a scar? 8 Safety 8 Contact numbers 9 Other useful numbers 9 2 What is Laparoscopy? A laparoscopy is a surgical procedure that allows the surgeon to access the inside of the abdomen and the pelvis. He does this using a laparoscope, which is a small flexible tube that contains a light source and a camera. The camera relays images of the inside of the abdomen or pelvis to a television monitor. Laparoscopy is a minimally invasive procedure and is performed as keyhole, surgery, so the surgeon does not have to make large incisions (cuts) in the skin. A small incision is made in the skin, and the laparoscope is passed through the incision allowing the surgeon to study the organs and tissues inside the abdomen or pelvis. The advantages of this technique over traditional open surgery are that people who have a laparoscopy have: • A faster recovery time, • Less pain after the operation, • Minimal scarring. 3 What is it used for? • Diagnostic uses Sometimes scans and other tests can help us with diagnosing problems. However, sometimes the only way to confirm a diagnosis is to directly study the affected part of the body using a laparoscope. -
The Prevalence and Impact of Overlapping Rome IV-Diagnosed
see related editorial on page x The Prevalence and Impact of Overlapping Rome IV-Diagnosed Functional Gastrointestinal Disorders on Somatization, Quality of Life, and Healthcare Utilization: A Cross-Sectional General Population Study in Three Countries Imran Aziz , MBChB, MD 1 , Olafur S. Palsson , PsyD 2 , Hans Törnblom , MD, PhD 1 , Ami D. Sperber , MD, MSPH3 , William E. Whitehead , PhD 2 and Magnus Simrén , MD, PhD 1 , 2 OBJECTIVES: The population prevalence of Rome IV-diagnosed functional gastrointestinal disorders (FGIDs) and their cumulative effect on health impairment is unknown. METHODS: An internet-based cross-sectional health survey was completed by 5,931 of 6,300 general population adults from three English-speaking countries (2100 each from USA, Canada, and UK). Quota-based sampling was used to generate demographically balanced and population representative samples with regards to age, sex, and education level. The survey enquired for demographics, medication, surgical history, somatization, quality of life (QOL), doctor-diagnosed organic GI disease, and criteria for the Rome IV FGIDs. Comparisons were made between those with Rome IV-diagnosed FGIDs against non-GI (healthy) and organic GI disease controls. RESULTS: The number of subjects having symptoms compatible with a FGID was 2,083 (35%) compared with 3,421 (57.7%) non-GI and 427 (7.2%) organic GI disease controls. The most frequently met diagnostic criteria for FGIDs was bowel disorders ( n =1,665, 28.1%), followed by gastroduodenal ( n =627, 10.6%), anorectal ( n =440, 7.4%), esophageal ( n =414, 7%), and gallbladder disorders ( n =10, 0.2%). On average, the 2,083 individuals who met FGID criteria qualifi ed for 1.5 FGID diagnoses, and 742 of them (36%) qualifi ed for FGID diagnoses in more than one anatomic region. -
Are the Best Times Coming?
Liu et al. World Journal of Surgical Oncology (2019) 17:81 https://doi.org/10.1186/s12957-019-1624-6 REVIEW Open Access Laparoscopic pancreaticoduodenectomy: are the best times coming? Mengqi Liu1,2,3, Shunrong Ji1,2,3, Wenyan Xu1,2,3, Wensheng Liu1,2,3, Yi Qin1,2,3, Qiangsheng Hu1,2,3, Qiqing Sun1,2,3, Zheng Zhang1,2,3, Xianjun Yu1,2,3* and Xiaowu Xu1,2,3* Abstract Background: The introduction of laparoscopic technology has greatly promoted the development of surgery, and the trend of minimally invasive surgery is becoming more and more obvious. However, there is no consensus as to whether laparoscopic pancreaticoduodenectomy (LPD) should be performed routinely. Main body: We summarized the development of laparoscopic pancreaticoduodenectomy (LPD) in recent years by comparing with open pancreaticoduodenectomy (OPD) and robotic pancreaticoduodenectomy (RPD) and evaluated its feasibility, perioperative, and long-term outcomes including operation time, length of hospital stay, estimated blood loss, and overall survival. Then, several relevant issues and challenges were discussed in depth. Conclusion: The perioperative and long-term outcomes of LPD are no worse and even better in length of hospital stay and estimated blood loss than OPD and RPD except for a few reports. Though with strict control of indications, standardized training, and learning, ensuring safety and reducing cost are still and will always the keys to the healthy development of LPD; the best times for it are coming. Keywords: Laparoscopic, Pancreaticoduodenectomy, Open surgery, Robotic, Overall survival Background pancreatic surgeries were performed in large, tertiary The introduction of laparoscopic techniques in the care centers. -
Pancreaticoduodenectomy for the Management of Pancreatic Or Duodenal Metastases from Primary Sarcoma JEREMY R
ANTICANCER RESEARCH 38 : 4041-4046 (2018) doi:10.21873/anticanres.12693 Pancreaticoduodenectomy for the Management of Pancreatic or Duodenal Metastases from Primary Sarcoma JEREMY R. HUDDY 1, MIKAEL H. SODERGREN 1, JEAN DEGUARA 1, KHIN THWAY 2, ROBIN L. JONES 2 and SATVINDER S. MUDAN 1,2 1Department of Academic Surgery, and 2Sarcoma Unit, The Royal Marsden Hospital, London, U.K. Abstract. Background/Aim: Sarcomas are rare and disease is complete surgical excision with or without heterogeneous solid tumours of mesenchymal origin and radiation. The prognosis for patients with retroperitoneal frequently have an aggressive course. The mainstay of sarcoma is poor, with 5-year survival of between 12% and management for localized disease is surgical excision. 70% (2), and the main cause of disease-related mortality Following excision there is approximately 30-50% risk of following surgery is local recurrence (3). However, there is developing distant metastases. The role of pancreatic a risk of up to 30% of developing distant metastases (4), and resection for metastatic sarcoma is unclear. Therefore, the in these patients, it is the site of metastatic recurrence rather aim of this study was to asses the outcome of patients with than of the primary sarcoma that determines survival (5). pancreatic metastases of sarcoma treated with surgical The commonest site for metastases of sarcoma are the lungs. resection. Patients and Methods: A retrospective analysis of Metastatic tumours arising in the pancreas are rare, a prospectively maintained single-surgeon, single-centre accounting for approximately 2% of all pancreatic cancer (6, database was undertaken. Seven patients were identified who 7). -
Disposable Free Three Port Laparoscopic Appendectomy – Low Cost Alternative for Emergency
Gastroenterology & Hepatology: Open Access Research Artilce Open Access Disposable free three port laparoscopic appendectomy – low cost alternative for emergency Abstract Volume 11 Issue 2 - 2020 Rationale: Video laparoscopic appendectomy does not have a single protocol on technical systematization, access routes, energy use, and staplers. The cost of disposable materials Carlos Eduardo Domene, Paula Volpe, may prevent its widespread use. Alternatives to lower the cost can help disseminate Frederico Almeida Heitor, André Valente laparoscopic access in appendectomy. Santana Integrated Center for Advanced Medicine and Unified Objective: This study aimed to introduce a method in performing video laparoscopic Treatment Center for the Obese, Brazil appendectomy at low cost and aiming at a good aesthetic result through the location of its incisions and show its viability through its application in 1552 cases of video laparoscopic Correspondence: Carlos Eduardo Domene, A study appendectomy performed between 2000 and 2019 with three portals, with extremely low conducted at the Integrated Center for Advanced Medicine and cost in inputs used. Unified Treatment Center for the Obese, São Paulo, Brazil, Email Methods: Three punctures were performed – one umbilical puncture to introduce the camera (5 or 10mm in diameter), one 10mm puncture in the right iliac fossa, and one Received: March 08, 2020 | Published: April 28, 2020 5-mm puncture in the left iliac fossa. The last two punctures were performed medially to the epigastric vessels, which can be visualized with the aid of the laparoscopic camera externally, by transparency, or internally, under direct vision. The materials– trocars, grasping forceps, hooks, scissors, and needle holders, are of permanent use, without the need for any disposable material. -
Duodenal Perforation Caused by Eyeglass Temples: a Case Report
Case Report Annals of Clinical Case Reports Published: 27 Jan, 2020 Duodenal Perforation Caused by Eyeglass Temples: A Case Report Zhiyong Dong1#, Wenhui Chen1#, Jin Gong1, Juncan Zhang1, Hina Mohsin2 and Cunchuan Wang1* 1Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, China 2Department of Neurology, California University of Science and Medicine, USA #These authors contributed equally to this work Abstract Background: While some foreign bodies in the digestive system can be egested spontaneously or after ingesting lubricants, generally long, large, sharp, irregularly shaped, hardened and/or toxic foreign bodies frequently remain in the digestive system. These foreign bodies may cause obstruction or damage the gastrointestinal mucosa leading to bleeding, perforation, and/or acute peritonitis, and may even cause local abscess, fistula formation, or organ damage. Case Report: A 30-year-old Chinese man was presented with acute abdominal pain while intoxicated with alcohol and swallowed two eyeglass temples. Conservative measures including ingesting lubricants to egest the foreign bodies failed. He underwent two exploratory laparotomy that showed a duodenal perforation and eventually the two eyeglass temples retrieved. Conclusion: This is the first report describing a patient who had swallowed eyeglass temples. Patients who swallow such objects must be promptly examined and diagnosed by ultrasound, X-ray, and/or CT, and foreign bodies removed by laparoscopy or laparotomy. Keywords: Duodenal perforation; Foreign body; Exploratory laparotomy OPEN ACCESS Introduction *Correspondence: Cunchuan Wang, Department of The effects of foreign bodies in the digestive system depend on their texture, shape, size, toxicity, Gastrointestinal Surgery, The First retention site, and duration [1]. Report of foreign bodies includes dentures, glass beads, coins, pens, Affiliated Hospital of Jinan University, fish bones [2]. -
Approaches to Abdominal Colorectal Surgery
To make an appointment or ask a question, continued from other side call the Division of Colon and Rectal Surgery and occasionally a laparoscopic procedure must be at 617-636-6190. Approaches converted to an open laparotomy by making a longer incision. This might be necessary if there is bleed- For urgent problems, call the Tufts Medical Center to Abdominal ing, the small bowel cannot be kept out of the way, operator at 617-636-5000 and ask for the there are extensive adhesions or scar tissue, or the on-call physician for Colon and Rectal Surgery. problem cannot be clearly seen or managed. Above Colorectal Surgery all, the surgeon must feel that the operation is going well and is as safe as possible. to robotic surgery including a better view than with a laparoscope. The robotic videoscope is binocular – it uses The operation is performed through several 1 inch two cameras, one for each eye, which gives the surgeon incisions. Metal or plastic tubes (ports) with a seal- Surgical Options a three-dimensional view and better depth perception. ing cap are placed through these incisions, and the The robotic instruments have a “wrist” which bends in abdomen is distended with carbon dioxide gas like 6 directions. This mimics the natural movement of the a tent or dome. A laparoscope attached to a camera surgeon’s wrist and is more flexible than laparoscopic is placed through one of the ports and connected to instruments, allowing the surgeon to get around corners, a video monitor to allow the surgeon and assistants to sew and to retract much better than possible with to see inside the abdomen.