Surgical Decision Making in Acute Care Surgery

Description

Unique book provides comprehensive discussion of MIS versus traditional techniques in modern Acute Care Surgery The combination of a surgeon shortage and poor access to emergency surgical care led to establishment of the Acute Care Surgery paradigm and subspecialty in 2003. Concurrently, minimally invasive approaches revolutionized surgical practice in the 21st century. In the U.S., acute care surgeons stand at the front line of patient care for emergency general surgery, trauma, and surgical critical care, and thus are positioned to positively impact healthcare delivery and costs. Surgical Decision Making in Acute Care Surgery by renowned surgeons Kimberly Davis and Raul Coimbra is the first text that comprehensively discusses when to use minimally invasive techniques and advanced technology versus traditional open procedures in acute traumatic and non-traumatic surgical emergencies. The text begins with three opening chapters covering the background of the Acute Care Surgery subspecialty, anatomic and physiological considerations, and the impact of acute surgical illness on pre- and post-operative critical care decisions. Subsequent chapters outline surgical approaches for commonly encountered acute conditions. Trauma chapters cover interventions for cervical, blunt and penetrating abdominal, and thoracic injuries. Emergency general surgery topics run the gamut from appendicitis to emergency management of paraesophageal hernias and esophageal perforations. An impressive group of senior surgeons and younger rising stars in American surgery share their expertise throughout the book. Key Highlights Disease-specific chapters include epidemiology, pathogenesis, diagnostic tools, treatment strategies, surgical techniques, cost analyses, complications, and national guidelines where availableSubchapters feature expert commentary on preceding chapters, including clinical pearls and controversies (e.g. operative vs. nonoperative management)In-depth discussion of surgical decision making encompasses the type of surgical approach, as well as indications and contraindications for MIS The roles of MIS procedures such as laparoscopy, thoracoscopy, radiology-based percutaneous techniques, as well as endovascular surgery are examined The quintessential resource on contemporary Acute Care Surgery practice, this is a must-read for residents, junior faculty, and practicing surgeons in this discipline. This book includes complimentary access to a digital copy on https://medone.thieme.com. Surgical Decision Making in Acute Care Surgery Title Page Copyright Contents Foreword Preface Contributors 1 The Definition of Acute Care Surgery 1.1 Drivers for the Acute Care Surgery Model 1.2 Fellowship Training in ACS 1.3 Surgeon Satisfaction with ACS 1.4 Patient Throughput Improvements with ACS 1.5 Care Delivery Models 1.6 Standardizing Care: The Development of Grading Systems for EGS Diseases 1.7 Improving Patient Outcomes after Emergency General Surgery 1.8 Conclusion 2 Anatomic and Physiological Considerations 2.1 Introduction 2.2 Physiological Effects of Laparoscopy 2.2.1 Physiologic Effects of Increased Intra-abdominal Pressure 2.2.2 Physiologic Effects of Hypercarbia 2.3 Anatomic Considerations 2.4 Patient Populations 2.4.1 Pediatric Patients 2.4.2 Pregnant Patients 2.4.3 Geriatric Patients 2.5 Other Physiological Considerations of Minimally Invasive Surgery 2.6 Future of Minimally Invasive Surgery 3 Impact of Acute Surgical Illness on Critical Care Decisions Pre- and Postoperatively 3.1 Preoperative Critical Care 3.1.1 Strategies to Optimize Organ Function and Intravascular Volume Preoperatively 3.2 Postoperative Critical Care 3.2.1 Role of the Surgical Team and Intensivist 3.2.2 Resuscitation Goals 3.2.3 Transfusion Strategies 3.2.4 Management of Sepsis 3.2.5 Respiratory Failure/ARDS 3.2.6 Acute Kidney Injury 3.2.7 Nutrition 3.2.8 Pain, Agitation, and Delirium 3.2.9 Prevention of Complications/Prophylaxis 4 Cervical Trauma 4.1 Penetrating Neck Trauma 4.1.1 Tracheal Injury 4.1.2 Cervical Esophageal Injury 4.1.3 Cervical Vascular Injury 4.2 Carotid Artery 4.3 Vertebral Artery 4.4 Subclavian Artery 4.5 Blunt Neck Trauma 4.5.1 Blunt Cerebrovascular Injury Management Expert Commentary on Cervical Trauma 5 Blunt Abdominal Trauma 5.1 Introduction 5.2 General Approach to Blunt Abdominal Trauma 5.3 Management of Specific Injuries After Blunt Abdominal Trauma 5.3.1 Solid Organ Injuries 5.3.2 Diagnosis 5.3.3 Management Strategy 5.3.4 Surgical Techniques 5.3.5 Complications 5.4 Hollow Viscus Injuries 5.4.1 Diagnosis 5.4.2 Management Strategy 5.4.3 Surgical Techniques 5.5 Gastroesophageal (GE) Junction Injuries 5.5.1 Stomach 5.5.2 Duodenum 5.5.3 Small Bowel and Colon 5.5.4 Rectum 5.5.5 Complications 5.6 Pancreatic Injuries 5.6.1 Diagnosis 5.6.2 Management Strategy 5.6.3 Surgical Techniques 5.6.4 Complications 5.7 Major Vascular Injuries 5.7.1 Diagnosis 5.7.2 Management Strategy 5.7.3 Surgical Techniques 5.7.4 Complications 5.8 Diaphragm Injuries 5.8.1 Diagnosis 5.8.2 Management Strategy 5.8.3 Surgical Techniques 5.8.4 Complications 5.9 Considerations for Abdominal Closure 5.10 Conclusion Expert Commentary on Blunt Abdominal Trauma 6 Penetrating Abdominal Trauma 6.1 Introduction 6.1.1 A Brief History of Penetrating Abdominal Trauma 6.1.2 Epidemiology of Penetrating Abdominal Trauma 6.1.3 Abdominal Anatomy 6.2 Basic Principles of Penetrating Abdominal Trauma 6.2.1 Mechanisms of Injury 6.2.2 Initial Evaluation 6.2.3 Basic Operative Principles 6.3 Evaluation and Management of Abdominal Stab Wounds 6.3.1 Evaluating for “Hard Signs to Operate” 6.3.2 Selective Nonoperative Management 6.3.3 Operative Principles Unique to Stab Wounds 6.4 Evaluation and Management of Gunshot Wounds 6.4.1 Evaluating for “Hard Signs to Operate” 6.4.2 Selective Nonoperative Management 6.4.3 Operative Principles Unique to Gunshot Wounds 6.5 Laparoscopy in Penetrating Abdominal Trauma 6.6 Special Scenarios 6.6.1 Penetrating Abdominal Trauma in Pregnancy 6.7 Damage Control Surgery 6.7.1 Damage Control Abdominal Procedures 6.7.2 Damage Control Resuscitation 6.8 Conclusion Disclaimer Expert Commentary on Penetrating Abdominal Trauma 7 Thoracic Trauma 7.1 Introduction 7.2 Initial Evaluation 7.3 Indications for Operative Intervention 7.3.1 Urgent/Emergent 7.3.2 Thoracic Damage Control 7.3.3 Elective 7.4 Video-assisted Thoracoscopic Surgery (VATS) 7.4.1 History of VATS 7.4.2 Advantages and Indications for VATS 7.4.3 VATS Operative Technique 7.4.4 VATS Indications 7.5 Contraindications and Complications of VATS 7.6 Open Thoracic Surgery 7.6.1 Operative Exposure 7.6.2 Airway Management 7.6.3 Operative Techniques 7.7 Complications 7.8 Cardiac Injuries 7.8.1 Presentation and Evaluation 7.8.2 Treatment Expert Commentary on Thoracic Trauma 8 Vascular Trauma 8.1 Introduction 8.2 Diagnostic Testing 8.3 Operative Considerations and Approaches 8.3.1 Thoracic Aorta and Great Vessels 8.3.2 Neck Exposure 8.3.3 Carotid Artery 8.3.4 Vertebral Artery Exposure 8.3.5 Axillary Artery Exposure 8.3.6 Brachial Artery 8.3.7 Abdominal Aorta and the Inferior Vena Cava (IVC) 8.3.8 Celiac Artery 8.3.9 Superior Mesenteric Artery (SMA) 8.3.10 Inferior Mesenteric Artery (IMA) 8.3.11 Portal Vein (PV) and Superior Mesenteric Vein (SMV) 8.3.12 Renal Artery and Vein 8.3.13 Common Femoral Artery (CFA) and Vein 8.3.14 Proximal SFA and Profunda Femoral Artery (PFA) 8.3.15 Distal SFA 8.3.16 Popliteal Artery 8.4 Extremity Injuries 8.5 Reconstructive Options 8.5.1 Saphenous Vein 8.5.2 Polytetrafluoroethylene (PTFE) 8.5.3 Other Conduits 8.6 Venous Injuries 8.7 Considerations After Repair of Extremity Injuries 8.8 Role of Endovascular Interventions 8.8.1 Shunts 8.8.2 Tourniquets 8.8.3 REBOA 8.9 Conclusion Expert Commentary on Vascular Trauma 9 Appendicitis 9.1 Introduction 9.2 Epidemiology 9.3 Pathogenesis 9.4 Diagnosis 9.4.1 Ultrasound 9.4.2 Computed Tomography 9.4.3 MRI 9.5 Treatment 9.5.1 Laparoscopic Versus Open Appendectomy 9.5.2 Alternative Minimal Invasive Techniques 9.5.3 Appendectomy Versus Antibiotics 9.5.4 Uncomplicated 9.5.5 Complicated Appendicitis 9.6 Appendicitis in the Elderly 9.7 Pregnancy Expert Commentary on Appendicitis 10 Acute Cholecystitis 10.1 Introduction 10.2 Diagnostic Evaluation 10.3 Indications and Timing for Operative Intervention 10.4 Symptomatic Gallbladder Disease 10.4.1 Acute Cholecystitis 10.4.2 Percutaneous Cholecystostomy 10.4.3 Chronic Cholecystitis 10.5 Complicated Biliary Disease 10.5.1 Choledocholithiasis 10.5.2 Cholangitis 10.5.3 Gallstone Pancreatitis 10.5.4 Gangrenous Cholecystitis 10.5.5 Acalculous Cholecystitis 10.5.6 External Compression of the Common Bile Duct: Mirizzi’s and Lemmel Syndrome 10.5.7 Hydrops 10.5.8 Cholecystenteric Fistula (Gallstone Ileus) 10.5.9 Porcelain Gallbladder 10.6 Special Populations 10.6.1 Cholecystitis in Pregnancy 10.6.2 Cirrhosis 10.6.3 Older Population with Cholecystitis 10.7 The Role of Minimally Invasive Surgery 10.7.1 Role of Intraoperative Cholangiogram (IOC), Intraoperative Ultrasound, and Indocyanine Green (ICG) 10.8 Contraindications to an MIS Approach 10.8.1 Open Cholecystectomy 10.9 The Role for Nonoperative Management 10.9.1 Percutaneous Cholecystostomy 10.9.2 Perforated Cholecystitis with Hepatic Abscess 10.10 The Management of Complications Expert Commentary on Acute Cholecystitis 11 Acute Diverticulitis 11.1 Introduction 11.2 Indications for Operative Intervention 11.3 Nonoperative Management 11.4 Emergent Operation 11.5 Nonemergent Surgery 11.6 Role of Minimally Invasive Surgery 11.7 Contraindications to MIS 11.8 Open Management Strategies 11.8.1 Hartmann’s Procedure 11.8.2 Primary Anastomosis (PA), With or Without, Diverting Loop Ileostomy (DLI) 11.9 Damage Control 11.9.1 Timing of Stoma Reversal 11.9.2 Management of Postoperative Complications Expert Commentary on Acute Diverticulitis 12 A Modern Approach to Complicated Pancreatitis 12.1 Terminology Matters 12.2 Necrosis and Infection Exist in a Continuum 12.3 Indications for Intervention 12.4 What is Our Goal? 12.5 Evolution of Strategies 12.5.1 Open Necrosectomy 12.5.2 Laparoscopic Debridement 12.5.3 Retroperitoneal Debridement 12.5.4 Two Trocar Technique 12.5.5 Primary Percutaneous Drainage 12.5.6 Transgastric Debridement 12.5.7 Endoscopic Transgastric Debridement 12.6 Conclusion Expert Commentary on A Modern Approach to Complicated Pancreatitis 13 Inflammatory/Infectious Bowel Disease 13.1 Crohn’s Disease 13.1.1 Introduction 13.1.2 Indications for Operative Intervention 13.1.3 Special Considerations 13.1.4 Minimally Invasive Approaches in Crohn’s Disease 13.1.5 Conclusion 13.2 Ulcerative Colitis 13.3 Clinical Manifestations 13.3.1 Indications for Operative Intervention 13.3.2 The Role of Minimally Invasive Surgery 13.3.3 Contraindications to an MIS Approach 13.3.4 Open Management Strategies 13.3.5 The Management of Postoperative Complications 13.4 Clostridium Difficile Colitis 13.4.1 Indications for Operative Intervention 13.4.2 The Role of Minimally Invasive Surgery 13.4.3 Contraindications to an MIS Approach 13.4.4 Open Management Strategies 13.4.5 The Management of Postoperative Complications 13.4.6 Conclusion Expert Commentary on Inflammatory/Infectious Bowel Disease 14 Gastroduodenal Ulcers Requiring Surgery 14.1 Introduction 14.2 Risk Factors for Peptic Ulcer Disease 14.3 Disease Presentation 14.4 Diagnosis 14.5 Management of Complicated Peptic Ulcer Disease 14.6 Management of Hemorrhagic Peptic Ulcer Disease 14.7 Postoperative Management of Complicated Peptic Ulcer Disease 14.8 Conclusion Expert Commentary on Gastroduodenal Ulcers Requiring Surgery 15 Intestinal Bowel Obstruction 15.1 Introduction 15.2 Background 15.3 Diagnostic Workup 15.4 Small Bowel Obstruction 15.4.1 Indications for Operative Intervention 15.4.2 Minimally Invasive Surgery for Small Bowel Obstruction 15.4.3 Technical Considerations in Minimally Invasive Surgery for Small Bowel Obstruction 15.4.4 Early Postoperative Obstruction 15.5 Large Bowel Obstruction 15.5.1 Operative Intervention for Large Bowel Obstruction 15.5.2 Minimally Invasive Surgery for Large Bowel Obstruction 15.5.3 Technical Considerations in Minimally Invasive Surgery for Large Bowel Obstruction 15.5.4 Endoscopic Management of Large Bowel Obstruction Expert Commentary on Intestinal Bowel Obstruction 16 Surgical Management of Incarcerated Hernias 16.1 Introduction 16.2 Epidemiology 16.3 Differential Diagnosis 16.4 Diagnosis 16.5 Treatment 16.6 Inguinal Hernia 16.6.1 Examples 16.7 Umbilical Hernia 16.8 Epigastric, Ventral, and Incisional Hernias 16.9 Spigelian Hernia 16.10 Diaphragmatic Hernia 16.11 Flank Hernia 16.12 Pelvic Hernia 16.13 Internal Hernia Expert Commentary on Surgical Management of Incarcerated Hernias 17 Mesenteric Ischemia 17.1 Introduction 17.2 Anatomy of Mesenteric Circulation 17.3 Diagnosis of Acute Mesenteric Ischemia 17.3.1 History and Physical Examination 17.3.2 Laboratory Analysis 17.3.3 Imaging 17.4 Treatment of Acute Mesenteric Ischemia 17.4.1 Resuscitation 17.4.2 Operative Exposure of the Mesenteric Vessels 17.4.3 Thromboembolic Mesenteric Ischemia 17.4.4 Veno-occlusive Mesenteric Ischemia 17.4.5 Non-Occlusive Mesenteric Ischemia 17.5 Ischemic Colitis 17.6 Conclusion Expert Commentary on Mesenteric Ischemia 18 Esophageal Emergencies: Emergency Management of Paraesophageal Hernias and Esophageal Perforations 18.1 Introduction 18.2 Paraesophageal Hernias 18.2.1 Etiology 18.2.2 Classification 18.2.3 Incarceration and Strangulation 18.2.4 Diagnosis 18.2.5 Indications for Repair 18.2.6 Management of Acute Gastric Obstruction 18.2.7 Operative Technique 18.3 Esophageal Perforation 18.3.1 Etiology 18.3.2 Investigations 18.3.3 Management 18.3.4 Outcomes 18.3.5 Conclusion Expert Commentary on Esophageal Emergencies Index