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 available

Subchapters 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.

 

Table of Contents:

 

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 StabWounds

6.3.1 Evaluating for “Hard Signs to Operate”

6.3.2 Selective Nonoperative Management

6.3.3 Operative Principles Unique to StabWounds

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 GunshotWounds

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 DiagnosticWorkup

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 Paraesophageal Hernias

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

 

An aparitie	10 Aug. 2020
Autor	Kimberly Davis, Raul Coimbra
Dimensiuni	22.35 x 2.03 x 28.45 cm
Editura	Thieme
Format	Hardcover
ISBN	9781684200580
Limba	Engleza
Nr pag	280