The American surgeon
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Open abdomen treatment (OAT) is increasingly used, most often to prevent intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) after emergency abdominal surgery. The goal of temporary abdominal closure (TAC) techniques no longer is abdominal coverage alone, but fluid control and facilitation of early fascial closure are now important aspects. ⋯ Mesh-mediated vacuum-assisted wound closure is emerging as one of the most promising approaches for OAT. In the intensive care unit, continued attention to IAH/ACS and measures to prevent or treat these conditions is imperative.
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The American surgeon · Jul 2011
Single incision laparoscopic cholecystectomy using a "two-port" technique is safe and feasible: experience in 101 consecutive patients.
Single incision laparoscopic cholecystectomy (SILC) is a new minimally-invasive technique that has recently been developed to address several disease processes of the gallbladder. However, the safety and feasibility of this technique are still being evaluated. Utilizing a "two-port" technique with transabdominal suture retraction and a rigorous adherence to the critical view of safety, we evaluated our experience in a prospectively maintained database and compared this with standard laparoscopic cholecystectomy (SLC) over the same period. ⋯ Cholangiograms, obtained on a selective basis, were performed in 19 per cent of SILCs. No bile duct injuries occurred during SILC or SLC. Although our aggregate number is not enough to accurately assess the rate or safety of bile duct injuries, SILC seems to be safe and feasible when evaluating other metrics and does not seem to interfere with operative efficiency compared with SLC.
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This article is a concise summary of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) with an emphasis on factors relevant to their occurrence in children. It discusses the limitations in the direct application of the current World Society of Abdominal Compartment Syndrome consensus definitions and extrapolation of management practices derived from studying adult patients to the pediatric age group. Techniques that may be used for measuring intra-abdominal pressure (IAP) in children, normal IAP ranges, risk factors for developing ACS as well as current medical and surgical management options in children are discussed.
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The American surgeon · Jul 2011
ReviewResuscitation in intra-abdominal hypertension and abdominal compartment syndrome.
Resuscitation and the development of abdominal compartment syndrome (ACS) are closely associated and frequently overlapping critical care topics. Elevated intra-abdominal pressure (IAP) can cause major deterioration of cardiac function by affecting preload, contractility, and afterload. ⋯ Excessive or overzealous resuscitation in an attempt to restore perfusion and correct these organ dysfunctions and failures can worsen elevated IAP and increase the risk of ACS. The aim of this review is to discuss these multilevel interactions between resuscitation and ACS identifying appropriate resuscitative strategies for the patient with elevated IAP.