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Laparotomy - Science method

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Hello.
We are currently observing the in vivo environment of mice at different glucose levels and
For this reason, we are currently measuring blood glucose levels in mice that have been administered anesthesia beforehand and treated with an open abdomen.
When we perform the laparotomy, we inject 30% glucose through a needle into the stomach of the mice.
However, the blood glucose level did not rise at all even after waiting 30 minutes after administration, and the mice died during the procedure after being warmed up to the 38°C range with a heater.
We are looking for a way to raise the blood glucose level in order to finally observe the glucose uptake in the pancreas, but do you have any good ideas on how to administer it?
Incidentally, we are currently considering direct glucose administration via tail vein, but no one has tried it and we are still in the consideration stage.
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Applying 30% Glucose into the abdominal cavity should result in serious osmotic stress, but not in glucose uptake.
For simplicity, you could try to infuse a glucose solution by the tail vein, using a syringe pump (hospital style or homemade, e.g. taking advantage of sth like a Cavro XP-3000 with a small volume syringe, which you might find on the used market. They are quite easy to control from a laptop through a USB-to-serial converter and sending commands from a terminal program).
An alternative injection point might be the jugular vein, but this approach requires some surgery. For an example with rats, please refer to this paper:
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We managed a traumatic D2 injury patient with incredible difficulty. We finally managed with T-tube and NGJ tube placement during laparotomy. Recently NGJ tube dislodged. Is there any way to place it without introducing a scope that imposes a high risk of a leak from the D2 area?
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I agree with Haris ali, at this stage the better option is percutaneous jejunostomy
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In cases where prognosis is poor, should laparotomy be offered?
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It would appear that one would consider whether there are other electrocution injuries in addition. Perhaps consider rhabdomyolysis, jejunitis, ileitis, gastritis, ( in view of malaena), renal damage, pancreatitis, and retroperitoneal vascular damage.
Perhaps some imaging may be helpful before considering surgery.
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In a study there are some animal species need to implement a coronary stent from (femoral artery) and to undergo a laparotomy in order to place a telemetric transponder.
What are the recommended anesthetic drugs that induct anesthesia without affecting the cardiovascular system at the time of procedures for equine?
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Ketamine ,thiopentone has good cardiovascular safety profile .If monitor and anesthetic machine present propofol can be used cautiously.
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In a stab or gunshot wound, is peritoneal violation alone (without any intra-abd. organ injuries) an indication for laparotomy? Previously I was under the impression that any time a non-sterile object is introduced into the peritoneum, it WILL get infected and cause peritonitis, and so you had to wash out the abdomen. However, it seems some stab wounds can be managed conservatively, even if it enters the peritoneum. So what is the general principle here?
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As a General Surgeon, residing in a crisis ridden environment,
I have personally managed several cases of penetrating abdominal wound- Non-operatively. For such patients early; prompt and repeated assessment is mandatory with - CT scan, Focused Assessment with Sonography in Trauma (FAST)- Abdominal and Plain radiograph of the abdomen which showed non-peritoneal or very minimal peritoneal transversations- otherwise adjudged as minimal peritoneal contamination.
The Key to such NON-OPERATIVE CARE is based on 1) patient is hemodynamically stable, 2) Vital Signs like Temp.; Pulse rate and Respiratory rate and BP and other clinical parameters remain normal and stable over and above 72 hours of care.
The decision to embark on OPERATIVE CARE including Laparoscopy (Diagnostic & Therapeutic) or Emergency Laparotomy is hinged on deteriorating overall parameters regarded as Severe Peritoneal contamination== Generalized or Localized Peritonitis as the case may be.
Thanks for the nice question
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recurrent ectopic pregnancy.
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It depends on many factors if the patient hemodynamicaly unstable then laparotomy might be considered and because it is recurrent adhesions might be seen during laparoscopy this might make endoscopic salpigoplasty imopsible or difficult so every case should be individualized .
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What works better as pain control after laparotomy; Transversus abdominis plane (TAP) block with a single bolus or continuous infusion via TAP catheter?
Keen to hear what the experience of other users is.
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Dear Colleague,
In my opinion and clinical experience none of them works efficiently for postoperative analgesia after laparatomy. Both aformentioned techniques may work well during rest but patient will still ask for extra analgesics for visceral pain. Rather than performing TAP block with multiple injections or a catheter, I prefer using erector spinae plane block with single injection on both sides. ESPB has a longer duration of action than TAP block. Moreover, you achieve analgesia for both visceral and somatic pain after laparatomy.
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The LACC trial results showed a significant difference on oncologic outcomes favoring laparotomy vs laparoscopy for radical hysterectomy in early stage cervical cancer.
I just wanted to hear your opinion on it? Do you agree? Do you think therr is some biases ? Will you change your habitudes?
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I think that this is not our choice, rather the patients'. Our obligation is just to inform the patients. Actually, I am very disappointed for the results of these two studies, and I still think that there may be methodological issues. Prof. Schneider and Prof. Kohler in Berlin, Germany had different approaches (vaginal combined with laparoscopy). They were first closing the vaginal cuff from below, then they were performing advanced laparoscopic radical surgery.
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A 65-year-old man with ductal adenocarcinoma in the head of the pancreas was operated elsewhere (laparotomy and biliary diversiobn) and he was considered inoperable. He was discharged and he came to see me for a second opinion. 6th postoperative day now. Analysis of CT scan was totally resectable. What to do next? Rush to the OR and perform a Whipple procedure or send him to neoadjuvant chemotherapy?
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Usually
1.the tumor size is not a key factor:
2. Artery involvement is a real key point:
3. Adhesions after by-pass surgery are not so heavy if there were no attepts to mobilize the tumor.
If the vein is involved, i think neoajuvant will be the best option
Best
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42 yrs who was treated for lymphoma 5yrs ago and is completely resolved developed symptomatic Gall bladder stones and small stones in the CBD(MRCP).He underwent diagnostic laparotomy and subsequently Gastro jejunostomy and cholecysto jejunostomy elswhere for gastric outlet obst and for CBD obst.History was that of upper abd pain ,mild fever on and off with shivering.LFT Bilirubin -N but ALP and GGTP are raised but not significantly.Diag lap was carried out showed extensive adhesions dueto previous open surgeries and chemo reaction causing tough layer over the tissues.
with difficulty C-J was dissected,stapled and devided followed by difficult cholecystectomy.CBD could not be explored or bypassed due to tecqnical problems.Pt developed biliary leak on day3 which is decresing from 350mls to 150 mls.CBC is -N,u/s is essentially N,Bulida isotope scan was done good liver uptake but no excretion in to the ducts,delayed films are awaited,Spect ct supplementation shows the intact CBD.Pt is well ,no jaundice,no fever abdmen is soft.He is on IV fluids,antibiotics.
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As long as the patient is vitally stable ie. Hemodynamically stable with no or low grade fever about 38.5 degrees and no signs of toxemia ie. No leucocytosis,  keep patient on conservative treatment and follow the output of the biliary fistula. You can even start oral feeding as long as the patient tolerate it. However, it is better to repeat pelvi-abdominal u/s every two to three days to exclude biliary obstruction and pelvic collection that may be due to internal leak. At any time patient become unstable, external biliary drainage and peritoneal lavage via laparotomy is indicated
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A young male 30 years old healthy BMI 29 ; no comorbid condition presents with superior mesenteric ischemia- what is left is T-colon and Duodenal stump;
On laparotomy; tube duodenostomy is being done; how to manage such a case ??
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Dear Ahmad.
You can get information on AMI here 
It is unclear which type of AMI you have met in that patient. Please, pay attention to NOMI and necessity of pharmacological correction. In any case, now you have to manage full duodenal external fistula and a short bowel syndrome. If so, then: 1. TPN and 2. anastomize asap. 
Sincerely Vladimir M.Khokha.
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52 years non diabetic non hypertensive, underwent laparoscopic cholecystectomy 2 weeks ago. Post operatively developed biliary leak. MRCP showed complete clipping of the CBD and leak from the CHD. Laparotomy was done on 9th post operative day. As per the records it was not possible to identify the hepatic duct except bile leak with a small opening. Roux en Y loop was fashioned and was anchored to the area of the bile leak with 4 sutures. Post operatively bile leak continued. Hence the patient was referred for further management. At present patient is stable and not in sepsis.
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This is a difficult case .I will do nothing for the next 4 weeks  unless the patient is jandice or septic After that time I will study the anatomy of biliary tree and the  posibility of arterial damage and after all if the patient still have colestase or biliary leak i will offer a new operation .In this procedure you may have several possibiloties : the  junction of rigth and left main biliary ducts are still present -we can perform a Couinaud procedure ;the right and left ducts are separated  ;we can  perform  two  separeted anastomosis
In the most serous cases there is   also rigth hepatic artery damage in this case a right hepatectomy may be needed  with  left duct jejunun anastomosis In all these case I never used transanastomotic drains
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During the long-term follow-up of children operated on by me for congenital diaphragmatic hernia, most by laparotomy, I found a moderate gastro-esophageal reflux with gaping of the cardia in half of them. At this point the conservative therapy affects the reflux symptoms. But, with two children of the 11 receiving surgery for the last 10 years, I found necessary to perform a antireflux procedure (probably Toupet). The reason for this decision is an expressed erosive esophagitis and moderate peptic stricture seen in these two children. My question is: Is it not necessary to perform in selected cases a antireflux procedure as a separate stage of the surgery for congenital diaphragmatic hernia?
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In infants operated on for CDH, the reported prevalence of gastroesophageal reflux ranges between 12% and 81%.
In patients with CDH, gastroesophageal reflux may be responsible (at least in part) for poorer outcomes, including delayed weaning from mechanical ventilation, longer hospital stay, failure to thrive, and oral aversion. As a consequence of  the high prevalence of gastroesophageal reflux and the severity of its sequelae, antireflux procedures are needed in as many as more than 60% of infants operated on for CDH. This has led some authors to propose preventive fundoplication at the time of CDH repair, however, few studies have assessed the efficiency of this procedure.
Chamond et al. performed preventive anti-reflux surgery in 17 out of 36 left-sided CDH patients. Significantly fewer patients who had undergone preventive anti-reflux procedure had proven pathological gastroesophageal reflux in the first year of life, and patients with preventive anti-reflux surgery needed nasogastric tube feeding for a significantly shorter time. In less severe patients, artificial ventilation, parenteral nutrition, and hospitalization lasted longer in  patients who had preventive anti-reflux surgery, reaching significance only in those with mild disease (defined as neither patch nor liver in the chest). Preventive anti-reflux surgery in more severe cases (liver in the chest and patch repair) was associated with shorter duration of artificial ventilation, parenteral nutrition, and hospitalization, although not reaching statistical significance due to the small numbers. Based on their findings the authors support preventive anti-reflux surgery only for severe cases, that is when the liver has protruded into the chest and when a patch repair is needed.
Guner et al. reported not any morbidity related to partial fundoplication at the time of CDH repair in 13 neonates and suggested improvement in post-operative oral feeding, although no mention is made of a control group. They recommend considering additional anterior fundoplication in high-risk cases, i.e. when the intra-abdominal oesophagus is absent, and when an obtuse His angle and a small and/or vertically oriented stomach are seen. They propose a modified Boix-Ochoa procedure, with no crural dissection, as microgastria is frequent in CDH patients. Apart from the high prevalence of gastroesophageal reflux in CDH patients, the suggested reasons for a preventive fundoplication are the increased difficulties in performing anti-reflux surgery later, after a previous laparotomy, due to adhesions, the presence of synthetic patch, and abnormal position of liver and spleen.
More recently, Dariel and colleagues reported the outcomes of 57 patients from the French CDH Study Group with patch repair of left CDH, 34 with preventive fundoplication and 23 without. They found improved growth in patients who had undergone preventive fundoplication. Therefore, they suggest that prophylactic fundoplication may prevent growth disorders in CDH patients requiring a patch repair.
The only prospective, randomized study on the efficacy of preventive fundoplication is from the University of Mannheim. The authors analysed the outcomes of 79 neonates with left-sided CDH, 36 randomized to receive preventive anti-reflux surgery and 43 without prophylactic fundoplication. At follow-up in the first two years of life they found no differences between the two groups in gastroesophageal reflux symptoms and severity and prevalence of failure to thrive. Based on their findings they do not recommend prophylactic anti-reflux surgery at the time of CDH repair.
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music is very commonly used for relaxation and probably acts by activation of parasympathetic nervous system. what is its effect on the return of bowel motility in a post laparotomy patient?
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ventral hernia diameter 5 cm. above umbilicus
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I think the better way in this pathologies is separating the two rencostruction, stoma closure and abdomninal  wall reconstruction separately. The polipropilene mesh, in our experience, is very good material, and only after failure polipropilene we used biological mesh
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Surgery in rabbit
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yes you can, but should be take inconsideration 2 facors anesthesia and aseptic technique
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During the last 3 years I have experienced 3 occurences of the stenosis in the colo-rectal end-to-end anastomisis following laparoscopic sigmoid or TME resections for sigmoid/upper rectal cancer. In two cases the stricture occluded the bowel completely. These two patients underwent stenting first. It failled due to the overgrow of the fibrotic tissue in the next 2-4 months leading to the complete obstruction. Thus why, they required emergency laparotomy with  excision of the stenosed portion of the bowel with end colostomy. Then, we recreated the continuity of the bowel with protective ileostomy (to make sure they do not go into obstruction). Around a half a year later we closed the ileostomy.
Now I diagnosed the stenosis in the third patient (the lumen of stenosis of 8 mm) and just wonder what other options are, as I do not want to go the same route again.
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In this setting, I confirm that the stenting is not ideal. The risk of perforation is important and the surgical morbidity  after stenting is important. The old method to perform multiple endoscopic dilatation is in the most of cases effective and not dangereous. You have to dilat at less 3 times with a dilatataion every 4-6 weeks. 
The stenosis is due to little colonic ischemia. I prefer the lateral-end anastomosis. The risk of ischemia seems less important.
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A 32-year-old women presented with pain radiating from loin to groin with frequency of micturition. USG detected left pelvic kidney with a heterogenous left adnexal sol. IVP showed left kidney in pelvis. SOL persisted after 3 cycles of OCP. During laparotomy the left ovary was found to be normal. A 5x5 cm chocolate cyst attached with the right ovary was found behind the uterus. 5 months after the laparotomy, 6x6 cm left ovarian cyst was found and cystectomy was done. HP diagnosis was endometrioma.
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PPV for pelvic ultrasound needs further studies, but as for as me concerned the PPV for pelvic ultrasound is not fixed. Either due to advancement in the Ultrasound modalities and operator skill. State of Art Ultrasound systems largely improved the Sensitivity and specificity of ultrasound in pelvic sonography. TAS and TVS are considered complementary to each other, for gross and relative appearance of pelvic organs TAS is used with full bladder but for detailed study TVS is used with empty balder.
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a 25y ,previous I cs ,+/- 36w gestation, history of previous laparotomy for ruptured Uterine artery pseudoaneurysm with repair and iliac artery ligation.
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I saw a case with a lot of blood vessels in the scar region and the placenta was further away from the scar - I think it was because the scar region had some increased vascularity in it. Doesn't seem like that would be the issue here. Seems like the issue here is the prior pseudo aneurysm and looks like there is abnormal vascularity in this region - maybe from the increased flow from the pregnancy or some AV malformation. Since she is 36 weeks, maybe you should just wait for her to deliver and then do a MR or just re-image with US.
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The vertical suture of the rectus abdominis sheaths was stronger than the horizontal suture because of the more transversal arrangement of its aponeurotic fibers. Thus, routine use of the vertical suture in plications of the aponeurosis of the rectus abdominis muscles is suggested.
And is mash insertion indicated to prevent this?
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Yes that is also my opinion. The idea for the question came to me after the data that significant percatage of incisional hernias after right subcostal incision develop in the most medial part.
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I need to find the rate of suppuration of laparotomy wounds in order to compare the rates in our country and worldwide.
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Most of the abdominal procedures are done by minimal access surgery in all teritiory care centres,I would expect the incidence of Laparatomy wound suppurations have become less.However it is worth while going through the literature as mentiond and audit our own cases.what is the significance as this depends on contaminted feild mostly.