Damage Control Surgery
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
Surgical Recovery of Intestinal Obstructions: Pre- and Postoperative Care and How Could it Be Prevented?
Although initial data on intestinal obstructions are based on Hippocrates, there is still no consensus on approaches today. However, parallel to the development of medical technology and the increasing experience of us surgeons, morbidity and mortality rates due to intestinal obstruction have decreased. Obstruction can occur at any point in the gastrointestinal tract. The main thing is to make a correct diagnosis and to treat the patient in the most correct way. Intestinal obstructions usually present with colic abdominal pain, nausea, vomiting, and constipation. Intestinal obstructions may be present due to various reasons. Surgeons have an important role in preventive mechanical obstructions due to adhesions. Patients must be hospitalized. If there is no emergency surgical indication, conservative methods can be applied. Patients should be mobilized early, and fluid-electrolyte balance should be adjusted and followed closely.
Part of the book: Surgical Recovery
Rectus Sheath Hematoma
A hematoma is a collection of blood in an extravascular space and is named according to its location. Rectus sheath hematoma (RSH) was first described by Hippocrates and Galen about 25 centuries ago due to abdominal trauma, which is a rare cause of acute abdomen. It is uncommon, which may lead to delayed diagnosis in patients with acute abdomen. This condition arises due to trauma or hypertension in patients with bleeding disorders, using anticoagulants, doing heavy physical exercise, pregnant women, connective tissue diseases, and hematological diseases. The diagnosis can be made by detailed anamnesis, physical examination, ultrasonography, and contrast-enhanced abdominal tomography. For a accurate diagnosis, first of all, the medical history of these patients should be carefully questioned. CT and ultrasonography (USG) are used in the diagnosis of this condition. In many patients, conservative treatment by eliminating the predisposing factor is sufficient. In conclusion, with the increase in use of anticoagulation, the incidence of RSH is expected to increase. Every physician in the surgical field should keep rectus sheath hematoma at the top of the differential diagnosis list in patients presenting with acute abdominal pain and palpable abdominal mass.
Part of the book: Trauma and Emergency Surgery
Laparoscopic Hiatal Hernia Repair during in-Sleeve Gastrectomy
Obesity is one of the most important health problems in developed and developing countries. Morbid obesity is defined as having a body mass index (BMI) of more than 40 kg/m2. Obesity does not only predispose to gastroesophageal reflux, but is also an important independent risk factor for the development of hiatal hernia (HH). There are articles advocating about half of obese patients have a hiatal hernia. Hiatal hernia not only exacerbates reflux symptoms, but may also lead to incomplete removal of the gastric fundus during laparoscopic sleeve gastrectomy (LSG). When hiatal hernias are seen preoperatively or intraoperatively for bariatric surgery, surgical correction should ideally be made with mesh reinforcement to prevent further clinical progression.
Part of the book: Hernia Surgery
Obesity and Breast Cancer
Obesity is associated with a higher risk of chronic diseases. Breast cancer is one of the malignancies, which has been related to obesity. Patients with a BMI more than 35 kg/m2 had an 86% greater risk of having breast cancer than those with a normal BMI. Every 5 kg/m2 rise in BMI has also been demonstrated to increase the risk of postmenopausal breast cancer. Obese people have poorer outcomes in terms of lymph node positivity, disease-free survival, and overall survival, according to research. Leptin, whose circulating levels rise in proportion to BMI and body fat reserves, is usually regarded as the primary driver of the intricate web that connects obesity and breast cancer. The number of studies examining the association between leptin activity and breast cancer genesis and behavior is growing. The effectiveness of bariatric surgery on lessening the risk of developing breast cancer has been proven.
Part of the book: Breast Cancer Updates
Laparoscopic Sleeve Gastrectomy – Technical Tips and Pitfalls
Today, bariatric surgery is the most effective treatment for obesity, and the techniques continue to evolve. Laparoscopic sleeve gastrectomy, which is only one step of biliopancreatic diversion/duodenal switch surgery, has become the most common bariatric procedure due to its efficacy when performed alone. Additionally, the rate of complications has decreased as a result of increased technical experience and the development of stapler technology. The widespread adoption of laparoscopic sleeve gastrectomy is also attributable to its technical simplicity. Although it is assumed to be a simple procedure, mistakes at specific stages significantly increase the risk of complications. We focus on our method in detail, including all operative steps, which we believe is the simplest and most effective technique after performing over 5000 surgeries at our institution. Paying attention to the sleeve size, selecting the appropriate stapler, not narrowing the incisura angularis, resecting the fundus without getting too close to the esophagus, creating a smooth, non-rotating staple line, and suturing the staple line are highlighted.
Part of the book: Bariatric Surgery
Abdominal Trauma View all chapters
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