This open access book looks at the dramatic history of ovariotomy, an operation to remove ovarian tumours first practiced in the early nineteenth century. Bold and daring, surgeons who performed it claimed to be initiating a new era of surgery by opening the abdomen. Ovariotomy soon occupied a complex position within medicine and society, as an operation which symbolised surgical progress, while also remaining at the boundaries of ethical acceptability. This book traces the operation's innovation, from its roots in eighteenth-century pathology, through the denouncement of those who performed it as 'belly-rippers', to its rapid uptake in the 1880s, when ovariotomists were accused of over-operating. Throughout the century, the operation was never a hair's breadth from controversy.
Aims and Objectives: the study was conducted to find out the incidence of postoperative wound infection among obstetric and gynaecological surgeries in the tribal area of Rajasthan region with the objective to identify various preventable risk factors and common responsible pathogen. Material and methods: It was a prospective study conducted in the department of Gynaecology in Government Medical College and Hospital, Dungarpur during the period of six months from August 2019 to January 2020. Results: Out of 300 surgeries performed, 210 surgeries were obstetrics and 90 surgeries were gynaecological. The mean age of obstetrics cases was 26.89±2.5 years and of gynaecological cases was 48.22±4.8 years. Frequency of wound infection in obstetrics cases was 5.23% (11 cases) and was 11.11% (10 cases) in gynaecological surgeries with a total frequency of 7% (21 cases). Mean postoperative day of wound infection was 9.81±5.6, mean postoperative hospital stay was 8.10±5.6 days and the mean duration of surgery was 1.29±0.45 hours. Body mass index (BMI) was >25 (obese) in 61.90% of infected cases. 15 patients (10.41%) out of 144 patients who did not receive antibiotic prophylaxis, developed wound infection. On culture, Escherichia Coli (E.coli) was found to be the most common responsible pathogen (38.09%) followed by Klebsiella species and Staphylococcus aureus (19.04%). Conclusion: Early identification of various risk factors for postoperative wound infection in obstetric and gynaecological surgeries is essential to prevent further morbidities.
The burden of surgical conditions and diseases is increasing in low-income and middle-income countries, but the capacity to meet the demands they present is not following pace. Ongoing initiatives, such as brief visits by surgeons from advantaged countries, sending surgical residents to spend time in a developing country as part of their training, or ships weighing anchor offshore and offering some limited on-shore or on-board services, have not proven successful. More comprehensive and sustainable solutions include the development of local training programs, better retention of trainees with adequate incentives particularly in rural areas, and engaging government and professional associations, as well as academic institutions, to develop and implement policies to address local training needs.
Background: Spinal anesthesia is commonly administered intraoperatively. However, relative short duration of action is associated with local anesthetics. A variety of adjuvants is used for prolongation of postoperative analgesia. Aims and Objectives: Comparative analysis of intravenous dexmedetomidine as a premedication and spinal anesthesia treatment with intrathecal isobaric ropivacain of 0.75% in elective lower limb surgery and lower abdominal surgery. Material and Methods: Following approval by the ethical committee, 60 patients scheduled for elective lower limb orthopedic surgery and lower abdominal surgery were chosen and randomized into two groups (n=30). The patient was then intrathecally administered 3 ml amount of 0.75 percent isobaric ropivacaine in lateral location. Another syringe containing dexmedetomidine was given after 10 minutes of placement, for 10 minutes using syringe pump. Comparison of sensory block initiation, analgesic effects and hemodynamic effects was made between the 2 classes. Results: Comparison of age distribution of (P=0.164) was not statistically important. In Group P, the median age was (40.96 ± 15.3 years) and in Group S (44.33 ± 12.66 years).
PURPOSE: It is challenging to prepare military surgeons with the skills of combat damage control surgery (CDCS). The current study aimed to establish a damage control surgery (DCS) training platform for explosive combined thoraco-abdominal injuries. METHODS: The training platform established in this study consisted of 3 main components: (1) A 50 m × 50 m square yard was constructed as the explosion site. Safety was assessed through cameras. (2) Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group (accepted DCS) and the control group (have not accepted DCS). The mortality rate was observed. (3) The literature was reviewed to identify the key factors for assessing CDCS, and testing standards for CDCS were then established. Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Then, a 5-day training course with incorporated tests was used to test the efficacy of the established platform. In total, 30 teams attended the first training course. The scores that the trainees received before and after the training were compared. SPSS 11.0 was employed to analyze the results. RESULTS: The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall. No pig died within 24 h when DCS was performed, while 7 pigs died in the control group. After a literature review, assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts: leadership and team cooperation, resuscitation, surgical procedure, and final outcome. Expert questionnaire results showed that the scientific score was 8.6 ± 1.25, and the feasibility score was 8.74 ± 1.19. When compared with the basic level, the trainees' score improved significantly after training. CONCLUSION: The platform established in this study was useful for CDCS training.
The author srepresent the original clinical data devoting to the further progress in reconstructive surgery. The methodology of the staged anterior abdominal wall defect reconstruction using the Keystone method was used firstly.The aim of the work is to demonstrate the peculiarity of preoperative preparation of patients with the anterior abdominal wall wounds complicated by small intestinal fistulas.The article uses the clinical materials of the concrete patient treatment in the Department of surgical infection of the South Region Military Medical Clinical Centre (Odessa, Ukraine) using the principle of the reconstructive-restorative surgery.The clinical case of the successful surgical treatment of anterior abdominal wall eventration, resulting from numerous laparotomies with pronounced lateralization of the wound, has shown that the solution to this problem should be based on the principles of reconstructive surgery.Preoperative modelling of full-layer flaps using a combined technique (infrared camera FLIR and portable Doppler SONO Trax) reduces the risk of necrosis of the movable flap and accelerates the process of closing of the defect of the anterior abdominal wall. Staged ("step-by-step") surgical treatment of the postoperative wound of the anterior abdominal wall by reconstruction via to the Keystone method showed a positive and rapid result of solving such a difficult problem as eventration complicated by small intestinal fistula.Restoration of the integrity of the anterior abdominal wall should be considered from the standpoint of reconstructive-restorative features
The author srepresent the original clinical data devoting to the further progress in reconstructive surgery. The methodology of the staged anterior abdominal wall defect reconstruction using the Keystone method was used firstly.The aim of the work is to demonstrate the peculiarity of preoperative preparation of patients with the anterior abdominal wall wounds complicated by small intestinal fistulas.The article uses the clinical materials of the concrete patient treatment in the Department of surgical infection of the South Region Military Medical Clinical Centre (Odessa, Ukraine) using the principle of the reconstructive-restorative surgery.The clinical case of the successful surgical treatment of anterior abdominal wall eventration, resulting from numerous laparotomies with pronounced lateralization of the wound, has shown that the solution to this problem should be based on the principles of reconstructive surgery.Preoperative modelling of full-layer flaps using a combined technique (infrared camera FLIR and portable Doppler SONO Trax) reduces the risk of necrosis of the movable flap and accelerates the process of closing of the defect of the anterior abdominal wall. Staged ("step-by-step") surgical treatment of the postoperative wound of the anterior abdominal wall by reconstruction via to the Keystone method showed a positive and rapid result of solving such a difficult problem as eventration complicated by small intestinal fistula.Restoration of the integrity of the anterior abdominal wall should be considered from the standpoint of reconstructive-restorative features
Introduction: Major surgeries, such as upper abdominal, thoracic and cardiac surgeries are highly complex procedures. They have a higher incidence of respiratory morbidity and mortality compared to other types of surgery. In addition, postoperative pulmonary complications (PPC) are common after major surgeries and they are associated with increased hospital stay, health care costs and surgical patient mortality. Objective: To investigate the most commonly used physical therapy techniques for the prevention and treatment of PPC among thoracic and abdominal surgery patients in all regions of Brazil. Methods: A total of 489 randomly selected physiotherapists who provided perioperative care for patients undergoing elective abdominal, thoracic or cardiac surgeries participated in this study. A questionnaire with nine questions about routine care and therapeutic choices for the surgical population was developed and assessed by 10 specialists before being administered to the physiotherapists. Results: Among the physiotherapists (63% with at least 5 years of experience with surgical patients), 50.9% considered the patient's surgical risk in their treatment either always or often. A total of 53.8% of patients were treated by the physiotherapist following a physician's prescription. The most mentioned physical therapy techniques used to prevent PPC were postoperative mobilization/exercises (59.3%), postoperative lung expansion techniques (52.8%) and preoperative advice (50.7%). In addition, 80.6% of the physiotherapists believe that incentive spirometry prevents PPC, while 72.8% expected this effect from positive airway pressure devices. Conclusion: Most physiotherapists in Brazil who work with surgical patients offer preoperative professional advice and use postoperative early mobilization and lung expansion techniques to prevent PPC. Most physiotherapists consider the patient's surgical risk during treatment. In addition, some physical therapy sessions are routinely performed preoperatively. One worrying aspect is that, due to the current legislation, physiotherapists in Brazil do not have full autonomy to initiate physical therapy care by themselves.
BACKGROUND : Advances in intra-abdominal pressure (IAP) measurement have enabled better monitoring and physiological manipulation of patients with intra-abdominal hypertension or abdominal compartment syndrome. This study aimed to determine the correlation between transvesical (TV), transgastric (TG) and direct transperitoneal (TP) IAP monitoring at different IAPs in porcine models. OBJECTIVES : To assess the statistical agreement between TV, TG and TP pressure monitoring in a pneumoperitoneum and an intestinal obstruction intra-abdominal hypertension model at different IAPs. METHODS : Fifty-nine pigs were divided into six groups: a control group (Cr; n=5), three pneumoperitoneum groups at pressures of 20 mmHg, 30 mmHg, and 40 mmHg (Pn20, Pn30, Pn40; n=40), and two intestinal-occlusion groups at pressures of 20 mmHg and 30 mmHg (Oc20, Oc30; n=14). IAP was simultaneously measured in each pig using the three methods at different times. The control group did not have any intervention to increase the IAP. Intra-class correlation was used to assess agreement between the methods. RESULTS : At pressures >20 mmHg, all three methods showed good correlation with each other (Pn20=0.87; Pn30=0.96; Pn40=0.88; Oc20=0.69; Oc30=0.86). Correlation between TP and TG (Cr=0.0; Pn20=0.85; Pn30=0.94; Pn40=0.90; Oc20=0.78; Oc30=0.78); TP and TV (Cr=0.0; Pn20=0.83; Pn30=0.95; Pn40=0.86; Oc20=0.59; Oc30=0.88); and importantly between TV and TG (Cr=0.0; Pn20=0.95; Pn30=0.98; Pn40=0.88; Oc20=0.69; Oc30=0.91) was good. CONCLUSION : All three measurement methods showed good correlation at pressures >20 mmHg and were unaffected by the type of IAP model. These results suggest that either transvesical or transgastric pressure measurements can be used for IAP measurement when TP pressures are >20 mmHg. ; Grant from Extremadura Regional Government through the Plan Regional de Investigación de Extremadura (PRI09A161 to Minimally Invasive Surgery Center Jesús Usón). ; http://www.sajcc.org.za ; am2018 ; Statistics
" Background and Aim: Abdominal compartment syndrome is a life-threatening complication that can occur in trauma patients and greatly increase their mortality. Although there is a better scientific understanding of the general phenomena involved in the pathogenesis of this complication, the particular risk factors and their implications in the trauma patient population are yet to be deciphered. Methods: The authors conducted research through 3 electronic databases (PubMed, Scopus, and ScienceDirect) using the following search formula: "(ACS OR abdominal compartment syndrome) AND (*trauma*) AND (risk factor)". Subsequently, additional search formulas were used, including the risk factors taken into consideration (i.e. "shock", "hypotension", "acidosis", "base deficit", "coagulopathy", "retroperitoneal hematoma", "HOB elevation", "fluid resuscitation", "damage control laparotomy"). Results: Throughout the 41 articles analyzed in this paper, 7 risk factors transcended and were further discussed: head of bed elevation/patient positioning, fluid resuscitation, the "lethal triad" of acidosis hypothermia and coagulopathy, Damage Control Laparotomy, shock/hypotension, retroperitoneal hematoma and demographics (age, gender, and race). Conclusions: To summarize, many potential risk factors were evaluated for the envisagement of the present paper, but the ones that prevailed the most were excessive fluid resuscitation, shock/hypotension, retroperitoneal hematomas, and the lethal triad. Consistent with other studies, no connection was found between age, gender, or race and the development of ACS. Further studies should focus more on the likely involvement of damage control laparotomy and patient positioning, as well as hypocalcemia, in the unfolding of ACS in trauma patients"
In: Alcohol and alcoholism: the international journal of the Medical Council on Alcoholism (MCA) and the journal of the European Society for Biomedical Research on Alcoholism (ESBRA), Band 55, Heft 5, S. 497-511
AbstractAimsThis meta-analysis aimed to define the perioperative risk of mortality in patients with alcoholic liver disease (ALD) undergoing extrahepatic gastrointestinal surgery.MethodsSystematic searches of Embase, Medline and CENTRAL were undertaken to identify studies reporting about patients with ALD undergoing extrahepatic gastrointestinal surgery published since database inception to January 2019. Studies were only considered if they reported on mortality as an outcome. Pooled analysis of mortality was stratified as benign and malignant surgery and specific operative procedures where feasible.ResultsOf the 2899 studies identified, only five studies met inclusion criteria, representing cholecystectomy (one study), umbilical hernia repair surgery (one study) and oesophagectomy (three studies). The total number of patients with ALD in these studies was 172. Therefore, any study on liver disease patients undergoing extrahepatic surgery that crucially included a subset with alcohol aetiology was included as a secondary analysis even though they failed to stratify mortality by underlying aetiology. The total number of studies that met this expanded inclusion criteria was 62, reporting on 37,703 patients with liver disease of which 1735 (4.5%) had a definite diagnosis of ALD. Meta-analysis of proportions of in-hospital mortality in patients with ALD undergoing upper gastrointestinal cancer surgery (oesophagectomy) was 23% [95% confidence interval (CI) 14–35%, I2 = 0%]. In-hospital mortality following oesophagectomy in liver disease patients of all aetiologies was lower, 14% (95% CI 9–21%, I2 = 41.1%).ConclusionPostoperative in-hospital mortality is high in patients with liver disease and ALD in particular. However, the currently available evidence on ALD is limited and precludes definitive conclusions on postoperative mortality risk.
Abstract Background A normal retractor often interferes with the ribs and/or thighs of the ipsilateral side when the skin and abdominal muscles are towed while performing the lumboperitoneal shunt (LPS) procedure in the lateral position. To overcome this, we developed an obtuse-angled retractor. Methods We modified the traditional retractors into oblique-angled retractors. The blade of the new retractors was bent to 60 degrees, the entire blade was thinned, and the tip of the blade was tapered. Results To date, we have performed approximately 30 LPS procedures in the lateral position using the new oblique-angled retractor and confirmed its usefulness. Conclusion An oblique-angled retractor helps confirm the accurate placement of the tip of the retractor blades, even in obese patients in whom the retractor often interferes with the ribs and/or thighs.
