“Duodenal trauma is a rare occurrence existing in 1–4.7% of all abdominal trauma. Its posterior and partially retroperitoneal location shields it from most traumatic mechanisms. Colloquially referred to as the ‘surgical soul’, its proximity to complex regional anatomy makes duodenal trauma particularly at risk for biliary, pancreatic and major vascular injury with 68–86.5% of patients sustaining an associated injury.”
“The overall incidence of duodenal injuries in severely injured trauma patients is between 0.2 to 0.6% and the overall prevalence in those suffering from abdominal trauma is 3 to 5% 1,2. Approximately 80% of these cases are secondary to penetrating trauma, commonly associated with vascular and adjacent organ injuries. These associated injuries create a significant challenge towards the early diagnosis and appropriate management. Therefore, defining the best surgical treatment algorithm remains controversial. Mild to moderate duodenal trauma is currently manage via primary repair and simple surgical techniques. However, severe injuries have required complex surgical techniques (duodenal diverticulization, pyloric exclusion with or without gastrojejunostomy and pancreatoduodenectomy) without significant favorable outcomes and consequential increase in the rates of mortality.”
“Complications are known to occur at each and every step of hernia surgery. Applying caution while performing each step can save the patient from a lot of morbidity. One starts by applying strict patient selection criteria for endoscopic hernia repair, especially in the initial part of ones learning curve. A thorough knowledge of anatomy goes a long way in avoiding most of the complications seen in hernia repair. This anatomy needs to be relearned from what one is used to, as the approach is totally different from an open hernia repair. And finally, learning and mastering the right technique is an essential prerequisite before one ventures into inguinal hernia repair.”
“The most important preoperative precaution is proper patient selection prior to surgery, especially in the initial part of the learning curve. Ideally, direct or small indirect hernias are best. Large hernias, obese patients and irreducible, obstructed hernias are best avoided. An absolute contraindication is strangulated hernia. Also a detailed work-up of elderly patients to assess cardiorespiratory status is mandatory to ensure a safe outcome.”
Continue reading“Management of blunt spleen injuries has evolved from mandatory splenectomy to non-operative management (NOM) allowing for splenic salvage. The Eastern Association for the Surgery of Trauma (EAST) practice management guideline for the management of blunt solid organ injury recommends NOM in splenic injury regardless of age, grade, or associated injuries.”
“Splenectomy continues to be the treatment of choice in patients with unstable hemodynamics and a known splenic injury. In the hemodynamically normal patient, current practice is to observe the patient and treat with NOM to save the patients the complications associated with surgery.”
Continue readingWith large cavitating wounds, there is a risk of sponge retention that may be all too easily
overlooked, particularly with the surgeons’ habit of cutting the sponge to the desired shape and the use of multiple fragments. We therefore recommend that a count is made of the number of sponges used – as is standard practise for swabs, needles and instruments.
“Parastomal hernia, defined as an incisional hernia at the abdominal wall defect resulting from stoma formation, is a frequent complication of enterostomy (ileostomy and jejunostomy), colostomy, and urostomy. A growing body of evidence supports the use of prophylactic mesh at the time of stoma creation to prevent the development of PSH. In particular, the use of permanent mesh has been supported in the creation of an end colostomy, and prophylactic mesh has been studied for use in other types of stoma.”
Continue reading“Hiatus hernia contributes to the pathophysiology of gastroesophageal reflux disease (GERD). Mesh-augmentation of surgical repair might be associated with a reduced risk of recurrence and GERD. However, recurrence rates, mesh-associated complications and quality of life after mesh versus suture repair are debated. The aim of this meta-analysis was to determine HH recurrence following mesh-augmentation versus suture repair.”
Surgical Focus 