The American surgeon
-
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.
-
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.
-
The American surgeon · Jul 2011
Nonoperative management of intra-abdominal hypertension and abdominal compartment syndrome: evolving concepts.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with significant morbidity and mortality. Nonoperative medical management strategies play an important role in the current treatment of IAH and ACS. There are five medical treatment options to be considered to reduce elevated intra-abdominal pressure (IAP): 1) improvement of abdominal wall compliance; 2) evacuation of intraluminal contents; 3) evacuation of abdominal fluid collections; 4) optimization of systemic and regional perfusion; and 5) correction of positive fluid balance. Nonsurgical management is an important treatment option in critically ill patients with raised IAP.
-
The American surgeon · Jul 2011
Intra-abdominal hypertension and abdominal compartment syndrome: the journey forward.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are recognized causes of significant morbidity and mortality among a wide variety of critically ill patient populations. Our understanding of IAH and ACS as causes of organ failure and patient death has increased significantly over the past two decades since their "rediscovery" as clinically important disease processes. The development of consensus definitions and recommendations for the diagnosis and management of IAH/ACS, patient care algorithms, an international clinical research working group, and other educational tools have advanced efforts to improve patient outcome. ⋯ Tremendous progress has been made in recent years with regard to our understanding of the diagnosis and management of IAH and ACS. Within this special supplement of The American Surgeon, you will find a series of "state-of-the-art" reviews authored by a number of the world's experts on IAH/ACS as well as abstracts of research that will be presented at the Fifth World Congress on the Abdominal Compartment Syndrome (Lake Buena Vista, Florida, August 10-13, 2011). This commentary will review where we were, where we are today, and where we are going with respect to the future of IAH and ACS.
-
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.