Mini-invasive Approach in Acute Care Surgery (Hot Topics in Acute Care Surgery and Trauma)

The minimally invasive approach in emergency and general trauma surgery is a key aspect of both scenarios. This book, the first comprehensive manual in the field, takes a global view of the subject and deals with it in depth, ranging from the historical perspective to the pathophysiological and therapeutic aspects in the various body compartments.Thanks to its user-friendly approach, this book will be a useful tool in the daily clinical practice of surgeons, doctors, anesthetists and nurses; thanks to its up-to-date review of the literature, it will remain relevant for several years. Finally, the participation of world opinion leaders in the field guarantees the comprehensive and scientific soundness of the work. Series Foreword Contents The History of Minimally Invasive Techniques in Acute Care Surgery 1 Background 2 History 3 Advantages 4 Disadvantages 5 History of Adoption 6 Today 7 MIS in Trauma 8 Endoscopy 9 Summary References History of Thoracoscopy in Emergency Surgery and Trauma References Role and Limitations of Mininvasive Approach in Abdominal Emergencies and Trauma 1 Introduction 2 Indications and Contraindications 3 Laparoscopic Technique 4 Laparoscopy Application in Trauma Cases: When to Convert It? 5 Complications 6 Conclusion References Role of MIS Approaches in Thoracic Emergencies and Trauma 1 Introduction 2 Role 1: Recurrent Spontaneous Pneumothorax 3 Role 2: Pericardial Window for Pericardial Effusion 4 Role 3: Retained Hemothorax 5 Role 4: Diaphragm Evaluation for Thoracoabdominal Penetrating Trauma 6 Role 5: Foreign Body Removal 7 Conclusions References Acute Appendicitis 1 Introduction 2 Preoperative Diagnosis and Indications for Surgery 3 Operative Technique for Laparoscopic and Robotic Appendectomy 4 Complicated Appendicitis 5 Conclusion References Acute Cholecystitis and Emergency Common Bile Duct Exploration 1 Background 1.1 Anatomy and Physiology 1.2 Pathogenesis 1.3 General Consideration 1.3.1 Symptoms 1.3.2 Laboratory Test 1.3.3 Imaging 2 Acute Calculus Cholecystitis (ACC) 2.1 Diagnosis of ACC 2.2 Imaging for ACC 2.3 Grading and Classification of ACC 3 Common Bile Duct Associated to ACC 3.1 Initial Evaluation 3.2 Risk Assessment of CBDS Associated with ACC 3.3 Clinical Implications of CBDS Risk Stratification 4 Treatment of ACC 4.1 Surgical Management of ACC 4.2 Alternative Treatment for ACC 4.3 Antibiotics for ACC References Acute Colonic Diverticulitis 1 Percutaneous Drainage 2 Laparoscopic Peritoneal Lavage 3 Laparoscopic Sigmoidectomy 4 Robotic Colonic Resection References Complicated Inflammatory Bowel Disease and Colonic Non-diverticular Emergencies 1 Introduction 2 Initial Assessment and Diagnosis 3 Acute Severe Colitis 4 Fulminant Colitis or Toxic Megacolon 5 Bowel Perforation 6 Acute Abscess 6.1 Intra-abdominal 6.2 Perianal Sepsis 7 Bowel Obstruction 8 Uncontrolled Intestinal Hemorrhage 9 Conclusions References Gastroduodenal Perforation 1 Introduction 2 Causes of Gastroduodenal Perforation 3 Presentation and Diagnosis 4 Management 4.1 Conservative Management 4.2 Surgical Management 4.2.1 Open Vs Laparoscopic Approach 5 Prognosis References Adhesive Small Bowel Obstruction (ASBO) 1 Introduction 2 Physiopathology of SMO 3 Clinical Presentation 4 Laboratory Findings 5 Radiologic Diagnosis 6 Treatment 6.1 Conservative Management 6.1.1 Patients’ Selection 6.1.2 Medical Treatment 6.2 Surgical Treatment 6.3 Prevention of Adhesion After Adhesiolysis and Classification Recommended Readings Large Bowel Obstructions 1 Introduction 1.1 Epidemiology 1.2 Etiology 1.3 Classification 1.4 Pathophysiology 2 Diagnosis 2.1 Clinical Presentation 2.2 Tests 2.2.1 Abdominal Plain Radiography and Ultrasound 2.2.2 Computed Tomography and Magnetic Resonance Imaging 2.2.3 Colonoscopy 3 Therapy 3.1 Medical Treatment 3.1.1 Endoscopy 3.1.2 Interventional Radiology 3.2 Surgery 3.2.1 Right-Sided Obstruction 3.2.2 Left-Sided Obstruction 3.3 Prognosis References Minimally Invasive Approach to Treatment of Acute Pancreatitis 1 Introduction 2 Prevalence and Etiology 3 Predicting Severity 4 Pancreatitis Classifications and Definitions 5 The Role of Contrast-Enhancing Imaging in Classification and Treatment 6 Advanced Imaging Severity Grading 7 Initial Management Strategies: Optimizing Medical Management 8 Intravenous Fluid Resuscitation 9 Nutrition 10 Role of Antibiotics 11 Types and Timing of Surgical Interventions 12 Minimally Invasive Step-up Approach Vs Open Necrosectomy 13 Which Minimally Invasive Technique Is Best? 14 Minimally Invasive Interventions 14.1 Percutaneous Catheter Drainage 14.2 Transoral Endoscopy 14.3 Video-Assisted Retroperitoneal Debridement (VARD) 14.4 Sinus Tract Endoscopy (STE) 14.5 Laparoscopic Transperitoneal 14.6 Laparoscopic Pseudocyst Treatment 14.7 Open Necrosectomy References Complicated Hiatal Hernia 1 Definition 2 Anatomy 3 Aetiology 4 Pathophysiology 5 Classification of HH 5.1 Endoscopic Evaluation 6 Presentation 6.1 Volvulus 6.2 Strangulation 6.3 Perforation 6.4 Delayed Presentation 7 Investigations 7.1 Computed Tomography (CT) Scan 7.2 Plain Chest Radiographs 7.3 Contrast Studies 7.4 Oesophagogastroduodenoscopy (OGD) 8 Treatment 8.1 Elective HH Repair 8.2 Emergent Surgical Intervention 9 In Summary References Inguinal and Incisional Hernia Emergency Management 1 Epidemiology and Classification 2 History [11, 12] 3 Inguinal Hernia Laparoscopic Repair 3.1 Indications (Table 2) 3.2 Technique 3.3 Results 3.4 Conclusions 4 Incisional Hernia Laparoscopic Repair 4.1 Indications (Table 3) 4.2 Technique 4.3 Results 4.4 Conclusions References Internal and Congenital Hernias 1 Introduction 2 Internal Hernias 2.1 Definition 2.2 Clinical Findings 2.3 Investigations 2.4 Prevention 2.5 Treatment 3 Congenital Hernias 3.1 Introduction 3.2 Omphalocele 3.2.1 Anatomical Definition and Epidemiology 3.2.2 Diagnosis 3.2.3 Management 3.2.4 Ruptured Omphalocele 3.3 Gastroschisis 3.3.1 Anatomical Definition and Epidemiology 3.3.2 Diagnosis 3.3.3 Management References Post-traumatic Diaphragmatic Hernia 1 Introduction 1.1 Surgical Anatomy 1.2 Epidemiology and Etiopathogenesis of Traumatic Injuries 1.3 Post-traumatic Diaphragmatic Hernia: Etiology 2 Presentation 2.1 Clinical Presentation 2.2 Associated Injuries 3 Diagnosis 4 Management 4.1 Surgical Principles and Technique of Repair 4.2 Different Approaches 4.3 Acute vs. Chronic Hernia 5 Outcomes References Minimally Invasive Approach to Intestinal Bleeding 1 Upper GI Bleeds 2 Lower GI Bleed 3 Small Bowel Bleeding References Further Reading Bowel Ischemia 1 Acute Mesenteric Ischemia 1.1 Introduction 1.2 Etiopathogenesis 1.3 Clinical Presentation and Diagnosis 1.4 Treatment 1.5 Role of Laparoscopy 2 Colonic Ischemia 2.1 Introduction 2.2 Etiopathogenesis 2.3 Clinical Presentation and Diagnosis 2.4 Treatment 2.5 Role of Laparoscopy 2.6 Conclusions References General Surgery Emergencies in Pregnancy 1 General Considerations 2 Acute Appendicitis 2.1 Indications 2.2 Treatment 2.3 Prognosis 3 Acute Cholecystitis 3.1 Indications 3.2 Treatment 3.3 Prognosis 4 Acute Pancreatitis 4.1 Indications 4.2 Treatment 4.3 Prognosis 5 Visceral Perforation 5.1 Perforated Peptic Ulcer 5.1.1 Treatment 5.1.2 Prognosis 5.2 Bowel Perforation 5.2.1 Treatment 5.2.2 Prognosis 6 Symptomatic Abdominal Wall Hernia 6.1 Treatment 6.2 Prognosis 7 Symptomatic Diaphragmatic Hernia 7.1 Indications 7.2 Treatment 7.2.1 Open Approach 7.2.2 Laparoscopic Approach 8 Intestinal Obstruction 8.1 Treatment 8.1.1 Intussusception 8.1.2 Small Bowel Volvulus 8.1.3 Sigmoid Volvulus 9 Acute Crohn’s Disease 9.1 Indications 9.2 Treatment 9.2.1 Terminal Ileitis/Acute Appendicitis 9.3 Prognosis 9.3.1 Maternal Outcome 9.3.2 Fetal Outcome 10 Splenic Rupture 10.1 Treatment 10.1.1 Traumatic Splenic Rupture 10.1.2 Splenic Pregnancy 10.2 Prognosis 10.2.1 Spontaneous Splenic Rupture 10.2.2 Splenic Pregnancy References Nonspecific Abdominal Pain 1 Epidemiology 2 First Stage: Baseline Investigations 3 Second Stage: Imaging Studies 4 Wait and See Policy 5 Third Stage: Diagnostic Laparoscopy 6 Conclusions References Management of Bariatric Surgery Early and Delayed Complications 1 Introduction 1.1 General 1.2 Epidemiology 1.3 Types of Bariatric Surgery 1.3.1 Sleeve Gastrectomy (SG) 1.3.2 Roux-En-Y Gastric Bypass (RYGB) 1.3.3 Omega Anastomosis Gastric Bypass/Mini Gastric Bypass (OAGB/MGB) 1.3.4 Adjustable Gastric Banding (AGB) 1.3.5 Other Bariatric Surgeries 2 Classification of Bariatric Surgery Complications 2.1 Early Complications 2.1.1 Nonsurgical Complication 2.1.2 Surgical Complication Bleeding Obstruction Systemic Inflammatory Response Syndrome (SIRS)/Sepsis 2.2 Late Complications 2.2.1 Nonsurgical Complication 2.2.2 Surgical Complication Bleeding Obstruction SIRS/Sepsis Abdominal Pain/Discomfort 3 Diagnosis 3.1 Clinical Presentation 3.1.1 Airway 3.1.2 Breathing 3.1.3 Circulation 3.1.4 History 3.1.5 Physical Examination 3.2 Tests 3.2.1 Laboratory Tests 3.2.2 Imaging Studies 3.2.3 Endoscopy 4 Differential Diagnosis 5 Treatment 5.1 Medical Treatment 5.1.1 Bleeding 5.1.2 Obstruction 5.1.3 Sepsis 5.2 Surgical Treatment 5.3 Prognosis References Gynecological Emergencies 1 Introduction 1.1 History and Examination 2 Pelvic Inflammatory Disease 2.1 Overview 2.2 Clinical Presentation 2.3 Investigation 2.4 Management 3 Tubo-ovarian Abscess 3.1 Overview 3.2 Investigation 3.3 Management 3.4 Fitz-Hugh-Curtis Syndrome 4 Ectopic Pregnancy 4.1 Overview 4.2 Clinical Presentation 4.3 Investigation 4.4 Management of Ectopic Pregnancy 4.4.1 Expectant Management 4.4.2 Medical Management 4.4.3 Surgical Management 5 Ovarian Cysts 5.1 Overview 5.2 Cyst Rupture and Hemorrhage 5.2.1 Clinical Presentation 5.2.2 Investigation 5.2.3 Management 5.3 Other Ovarian Cysts 5.3.1 Endometriotic Cysts 5.3.2 Dermoid Cysts 5.3.3 Ovarian Cysts in Postmenopausal Women 6 Adnexal Torsion 6.1 Overview 6.2 Clinical Presentation 6.3 Investigation 6.4 Management 7 Summary References Role of Emergency Laparoscopy in Pediatric Patients 1 Background 2 General Considerations 3 Appendicitis 4 Inguinal Hernia 5 Intussusception 6 Meckel’s Diverticulum 7 Pyloric Stenosis 8 Ovarian Pathology 9 Conclusion References Minimally Invasive Surgery for Emergency General Surgery in Elderly 1 Introduction 2 Esophagus 3 Stomach and Peptic Ulcer Disease 4 Hepato-Pancreato-Biliary System 5 Small Bowel Obstruction and Hernias 6 Appendicitis in Elderly 7 Colon and Rectum 8 MIS for Traumatic Intra-abdominal Surgical Emergencies 9 Laparoscopic vs. Robotically Assisted Emergency Surgery References Role of Emergency Laparoscopy in Surgical and Endoscopic Complications 1 Introduction 2 Complications After Colorectal Surgery 2.1 Incidence and Risk Factors 2.2 Anastomotic Leaks 2.3 Other Complications 3 Complications After Other Surgical Procedures 3.1 Upper Gastrointestinal Surgery 3.2 Hepatobiliary Surgery 3.3 Appendectomy 3.4 Urologic Surgery 4 Iatrogenic Perforations During Colonoscopy 4.1 Background 4.2 Surgical Management 4.3 Role of Laparoscopy 5 Iatrogenic Perforations During Upper Digestive Endoscopy 5.1 Esophageal Perforations 5.2 Complications Following Endoscopic and Percutaneous Gastrostomy 6 Summary References Role of Bedside Laparoscopy 1 Target Patient Populations and Indications 2 Benefits 3 Potential Disadvantages 4 Conclusions and Future Directions References Anesthesia Considerations for MIS in Emergency and Trauma Surgery 1 Introduction 2 Decision-Making for Using MIS in the Emergency General Surgery and Trauma Setting 2.1 Emergency General Surgery 2.2 Trauma Surgery 3 Positioning 4 Anatomic and Physiologic Considerations with Insufflation 4.1 Ventilation 4.2 Management of Fluids 4.3 Risk of Arrythmias with Thoracic Manipulation 4.4 Laparoscopy 4.5 Complications of Laparoscopy 5 Postop Pain Control 6 Conclusions References Utility of Video-Assisted Thoracoscopic Surgery (VATS) in Acute Care Surgery 1 Introduction 2 VATS Principles 2.1 Single-Lung Ventilation 2.2 Contraindications to Thoracoscopy 3 Standard Operative Approach 3.1 Operating Room Setup and Equipment 3.2 Patient Preparation, Positioning, and Bronchoscopy 3.3 Standard Port Placement 4 Conclusion References