Part of the book: Inguinal Hernia
Objective: The basis of damage control surgery rests on quick control of life-threatening bleeding, injuries, and septic sources in the appropriate patients before restoring their physiological reserves as a first step followed by ensuring of the physiological reserves and control of acidosis, coagulopathy, and hypothermia prior to complementary surgery.
Part of the book: Actual Problems of Emergency Abdominal Surgery
Abdominal trauma accounts for 7–10% of hospital admissions due to trauma. Depending on the mechanism of occurrence, abdominal traumas are classified as either blunt or penetrating. The most important risk after trauma is hypovolemic shock. Deaths caused by blunt trauma are frequently the result of diagnostic difficulties and treatment delays. Abdominal surgery after traumatic injury is performed for two reasons; bleeding due to injury to vascular structures or a solid organ (e.g., spleen, liver, kidney) or injury due to perforation of a hollow organ (stomach, small intestine, colon, gallbladder). Patients may remain asymptomatic until they have lost 50–60% of their blood volume. Through inspection, auscultation, and palpation, the damaged organs and the presence of hemorrhage should be examined during the physical examination. The findings of peritoneal irritation are incredibly critical. Even though some studies indicate a mortality rate as high as 25.8% for abdominal injuries, the overall mortality rate is 10%. Other studies reveal mortality rates ranging from 15% to 17.1%. It should not be forgotten that the patient with abdominal trauma may have multi-trauma. The patient’s vital signs, abdominal examination, and hematocrit should be checked at frequent intervals. Early surgical evaluation is important. It is important to remember that the main source of bleeding and shock may be the abdomen.
Part of the book: Topics in Trauma Surgery
The incidence of incisional hernia after intra-abdominal surgery is approximately 10–15%. Midline incisions are riskier than other incisions. Smoking, surgical site infections, conditions that impair wound healing, and incorrect surgical technique are among the risk factors, especially obesity. It typically presents as swelling on or near the incision. Computed tomography or ultrasonography can be performed for incisional hernias that cannot be detected by physical examination. Preoperative CT scan is important for the surgical strategy, especially for ventral hernias larger than 10 cm and with loss of space. The surgical strategy may vary depending on the size of the hernia. Tension-free repair is accepted as the standard approach by many authors, and suture repair alone is rarely used. The technique of separating into anterior or posterior components can be used in hernias larger than 10 cm with loss of space. Reconstruction using prosthesis material placed preperitoneally (underlay or sublay) is the most commonly used method today.
Part of the book: Hernia Updates and Approaches