Article

Unexpected Intra-operative Findings.

Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02110, USA. Electronic address: .
Surgical Clinics of North America (Impact Factor: 1.93). 02/2013; 93(1):45-59. DOI: 10.1016/j.suc.2012.09.008
Source: PubMed

ABSTRACT Abdominal surgeons are often asked to manage challenging pathologic conditions with limited preoperative information. As such, unexpected intraoperative findings are commonly encountered. Often, there is little peer-reviewed evidence on which to base management decisions. This article reviews common unexpected surgical challenges and provides recommendations based on the latest available literature.

0 Bookmarks
 · 
72 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Percutaneous abscess drainage (PAD) of the lower abdomen and pelvis has been reported to reduce morbidity and mortality, shorten hospital stay and cut costs compared to a surgical approach. However, the wide differences in outcome reported by different authors indicate the need for an overview and further evaluations. This review evaluates each point of the procedure to explain the possible causes for such discrepancies in results. We performed a PubMed search of outcomes for percutaneous abscesses drainage, focusing on deep pelvic collections, which represent the most difficult task, searching among papers published from 1981 to 2006. Ninety-nine papers were selected. Most authors emphasized that the most important steps of the care process are: (a) patient selection; (b) indications and contraindications; (c) choice of the best access route; (d) procedure performance; and (e) outcome (success and complication rates). PAD is a safe and effective alternative to surgery for draining deep infected fluid collections, with a higher success rate, lower complication rate and shorter hospital stay compared to surgical drainage. Meticulous technique and careful access planning seem to be the two most important factors affecting the outcome.
    Techniques in Coloproctology 10/2007; 11(3):197-208. · 1.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Endometriosis of the appendix is an entity of extragonadal endometriosis. It commonly affects women in the childbearing age with a wide spectrum of clinical manifestations. Women can present with symptoms mimicking acute appendicitis or chronic pelvic pain. The surgical management varies from simple appendectomy to right hemicolectomy depending on the clinical findings. We report 3 cases of endometriosis of the appendix presenting with appendiceal intussusception. The surgical literature is reviewed and current surgical management is discussed.
    International journal of surgery case reports. 01/2011; 2(2):16-9.
  • [Show abstract] [Hide abstract]
    ABSTRACT: After wide colorectal resection, some patients require colostomy due to the difficulty with performing primary colorectal anastomosis. For such patients, we have devised a novel technique of coloproctostomy or coloanal anastomoses through an extra-anatomical route, the retroperitoneal window (RPW), as a reconstruction route. The peritoneum over the inferior margin of the horizontal portion of the duodenum is incised, and the retroperitoneal route is dilated dorsal to the ileocolic artery and vein from the incision below the duodenum towards the right ventral aspect of the aortic bifurcation in the retroperitoneal space. This route is called RPW. After colorectal resection, the proximal stump of the colon is delivered through the RPW, and coloproctostomy or coloanal anastomoses is performed. Nine patients underwent this procedure during a three-year period from December 2007 to November 2010. This technique allowed coloproctostomy was performed in six and coloanal anastomoses in three patients. Without any complications, none of the nine patients required temporary colostomy. By using RPW, the necessity of colostomy would be reduced in patients who require wide colorectal resection.
    Hepato-gastroenterology 10/2011; 58(112):1983-4. · 0.91 Impact Factor