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Abbreviations
xxiii
IPAA Ileal Pouch Anal Anastomosis
IPMN Intraductal Pancreatic Mucinous Neoplasm
IRA Ileorectal Anastomosis
ISGPF International Study Group of Pancreatic Fistulas
ITCs Isolated Tumor Cells
ITP Idiopathic Thrombocytopenic Purpura
IV Intravenous
IVC Inferior Vena Cava
IVF Intravenous Fluids
JVD Jugular Vein Distention
KCL Potassium Chloride
KDPI Kidney Donor Prole Index
K-RAS Kirsten Rat Sarcoma Virus
LAMN Low-Grade Appendiceal Mucinous Neoplasm
LAR Low Anterior Resection
LBO Large Bowel Obstruction
LCIS Lobular Carcinoma In Situ
LDH Lactate Dehydrogenase
LDLT Living Donor Liver Transplantation
LES Lower Esophageal Sphincter
LFTs Liver Function Tests
LH Luteinizing Hormone
LIFT Ligation of Intersphincteric Fistula Tract
LLL Left Lower Lobe
LLQ Left Lower Quadrant
LMA Laryngeal Mask Airway
LMWH Low Molecular Weight Heparin
LR Lactated Ringers
LRINEC Laboratory Risk Indicator for Necrotizing Fasciitis
LT Lateral Thoracic Artery
LUL Left Upper Lobe
LY30 Lysis at 30 minutes
M Male
MALT Mucosa-Associated Lymphoid Tissue
MAP Mean Arterial Pressure
MAT Multifocal Atrial Tachycardia
MC Most Common
MCN Mucinous Cystic Neoplasm
MELD (Score) Model for End-Stage Liver Disease
MEN Multiple Endocrine Neoplasia
MESS Mangled Extremity Severity Score
METs Metabolic Equivalents
MHC Major Histocompatibility Complex
MI Myocardial Infarction
MIBG Metaiodobenzylguanidine
MPD Main Pancreatic Duct
MRCP Magnetic Resonance Cholangiopancreatography
MRI Magnetic Resonance Imaging
xxiv
MRM Modied Radical Mastectomy
MRSA Methicillin-resistant Staphylococcus aureus
MSA Magnetic Sphincter Augmentation
MSKCC Memorial Sloan Kettering Cancer Center
MSLT Multicenter Selective Lymphadenectomy Trial
MTC Medullary Thyroid Cancer
MTP Massive Transfusion Protocol
MUDPILES Methanol, Uremia, Diabetic ketoacidosis,
Paraldehyde, Isoniazid, Lactic acidosis, Ethylene
Glycol, Salicylates, Strychnine
N/A Not Applicable
NaCl Sodium Chloride
N/V Nausea/Vomiting
NAAT Nucleic Acid Amplication Test
NAPSE North American Society of Pacing and
Electrophysiology
NAVEL Nerve, Artery, VEin, Lymphatics
NET Neuroendocrine Tumor
NEXUS National Emergency X-Radiography Utilization
Study
NGS Next Generation Sequencing
NGT Nasogastric Tube
NIFTP Noninvasive Follicular Thyroid Neoplasm with
Papillary-Like Nuclear Features
NK Natural Killer
NLST National Lung Screening Trial
NOM Non-operative Management
NPH Neutral Protamine Hagedorn Insulin
NPO Nil Per Os (Nothing By Mouth)
NS Normal Saline
NSABP National Surgical Adjuvant Breast and Bowel Project
NSAID Non-steroidal Anti-inammatory Drug
NSCLC Non-small-Cell Lung Carcinoma
NSQIP National Surgical Quality Improvement Program
OR Open Repair
p16 Protein 16
p53 Protein 53
PCC Prothrombin Complex Concentrate
PCI Peritoneal Cancer Index
PCO2 Partial Pressure of Carbon Dioxide
PCr Plasma Creatinine
PCV Pressure-Controlled Ventilation
PCWP Pulmonary Capillary Wedge Pressure
PD Pancreatic Duct
PD-1 Programmed Cell Death-1
PDGF Platelet-Derived Growth Factor
PDS Polydioxanone Suture
PEEP Positive End-Expiratory Pressure
Abbreviations
Abbreviations
xxv
PEG Percutaneous Endoscopic Gastrostomy
PET Positron Emission Tomography
PFO Patent Foramen Ovale
PFTs Pulmonary Function Tests
PJS Peutz-Jeghers Syndrome
PLR Passive Leg Raise
PNET Pancreatic Neuroendocrine Tumor
PO Per Os (“By Mouth”)
POEM Peroral Endoscopic Myotomy
PPI Proton Pump Inhibitor
PPO Predicted Postoperative
PPV Pulse Pressure Variation
PR Progesterone Receptor
PRBC Packed Red Blood Cell
PSA Prostate-Specic Antigen
PSC Primary Sclerosing Cholangitis
PTC Percutaneous Transhepatic Cholangiography
PTFE Polytetrauoroethylene
PTH Parathyroid Hormone
PTLD Post-transplant Lymphoproliferative Disorder
PUD Peptic Ulcer Disease
PVC Premature Ventricular Contraction
Q Every
QSOFA Quick Sepsis-related Organ Failure Assessment score
RAI Radioactive Iodine
RAS Renal Artery Stenosis
RBC Red Blood Cells
RCC Renal Cell Cancer
RCRI Revised Cardiac Risk Index
REBOA Resuscitative Endovascular Balloon Occlusion of the
Aorta
RFA Radiofrequency Ablation
RGEA Right Gastroepiploic Artery
RLL Right Lower Lobe
RLN Recurrent Laryngeal Nerve
RLQ Right Lower Quadrant
RML Right Middle Lobe
RNA Ribonucleic Acid
RPS Retroperitoneal Sarcoma
RQ Respiratory Quotient
RR Respiratory Rate
RSBI Rapid Shallow Breathing Index
RT Radiation Therapy
RUL Right Upper Lobe
RUQ Right Upper Quadrant
RV Right Ventricle
SAGES Society of American Gastrointestinal and Endoscopic
Surgeons
xxvi
SAN Spinal Accessory Nerve
SBO Small Bowel Obstruction
SCC Squamous Cell Carcinoma
SCLC Small Cell Lung Cancer
SCM Sternocleidomastoid
SCV Subclavian Vein
SEMS Self-Expanding Metallic Stents
SFA Supercial Femoral Artery
SGLT2 Sodium-Glucose Co-Transporter 2
SIADH Syndrome of Inappropriate Antidiuretic Hormone
SIEA Supercial Inferior Epigastric Artery
SIRS Systemic Inammatory Response Syndrome
SLNB Sentinel Lymph Node Biopsy
SMA Superior Mesenteric Artery
SMAS Supercial Musculocutaneous Aponeurotic System
SMV Superior Mesenteric Vein
SNAPP Sepsis Control, Nutrition, Anatomy, Protection of
Skin, Planned Denitive Surgery
SOFA Sepsis-related Organ Failure Assessment score
SPIKES Set Up Situation, Patient Perception, Invitation,
Knowledge, Emotional Response, Strategy and
Summary
SRE Serious Reportable Events
SSI Surgical Site Infection
STAR or P-2 Trial NSABP Study of Tamoxifen and Raloxifene
STSG Split-Thickness Skin Graft
SUV Standardized Uptake Value
SVC Superior Vena Cava
SVO2 Venous Oxygen Saturation
SVR Systemic Vascular Resistance
SVT Supercial Vein Thrombosis
T3 Triiodothyronine
TAC Total Abdominal Colectomy
TAMIS Transanal Minimally Invasive Surgery
TAPP Transabdominal Preperitoneal
TB Tuberculosis
TBI Traumatic Brain Injury
TBNA Transbronchial Needle Aspiration
TBSA Total Body Surface Area
TBW Total Body Water
TCR T Cell Receptor
TEE Transesophageal Echocardiogram
TEF Tracheoesophageal Fistula
TEG Thromboelastogram
TEMs Transanal Endoscopic Microsurgery
TEP Total Extraperitoneal
TEVAR Thoracic Endovascular Aortic Repair
TG Triglyceride
Abbreviations
Abbreviations
xxvii
TGF Transforming Growth Factor
TI-RADS Thyroid Imaging Reporting and Data System
TIA Transient Ischemic Attack
TIPS Transjugular Intrahepatic Portosystemic Shunt
TMA Thrombotic Microangiopathy
TNB Triple-Negative (Basal) Tumors
TNF Tumor Necrosis Factor
TNM Tumor Nodes Metastasis
tPA Tissue Plasminogen Activator
TPC Total Proctocolectomy
TPN Total Parenteral Nutrition
TRAM Transverse Rectus Abdominus Myocutaneous
TRH Thyroid-Releasing Hormone
TSH Thyroid-Stimulating Hormone
TTF1 Transcription Termination Factor 1
TTM Targeted Temperature Management
TV Tidal Volume
TXA Tranexamic Acid
UC Ulcerative Colitis
UCr Urine Creatinine
UGIB Upper Gastrointestinal Bleeding
UGIS Upper Gastrointestinal Series
URI Upper Respiratory Infection
USA United States of America
USPSTF US Preventive Services Task Force
UTI Urinary Tract Infection
UW University of Wisconsin
V3 3rd Branch of Trigeminal Nerve
VAC Vacuum-Assisted Closure
VACTERL Vertebral, Anorectal, Cardiac, TEF, Renal, Limb
anomalies
VAP Ventilator-Associated Pneumonia
VATS Video-Assisted Thoracoscopic Surgery
VCV Volume-Controlled Ventilation
VEGF Vascular Endothelial Growth Factor
VHD Von Hippel Lindau Disease
VKA Vitamin K Antagonist
VO2 max Maximum Oxygen Volume
V/Q Ventilation/Perfusion
VTE Venous Thromboembolism
VVB Venovenous Bypass
vWD Von Willebrand Disease
VZV Varicella Zoster Virus
WBC White Blood Cell
XRT or RT Radiation Therapy
ZES Zollinger-Ellison Syndrome
Abdomen andHernia
LeoAmodu, HazimHakmi, andDavidHalpern
Abdominal Exploration
Abdominal exploration
1
Indications for diagnostic
laparoscopy
Contraindications
Key steps
L. Amodu (*) · H. Hakmi
General Surgery Residency Program, NYU Long
Island School of Medicine, NYU Langone—Long
Island Hospital, Mineola, NY, USA
e-mail: leo.amodu@nyulangone.org;
hazim.hakmi@nyulangone.org
• Acute abdomen
• Chronic abdominal pain
• Staging of intra-abdominal cancer
• Evaluating intraperitoneal implantation
• Malignancy of unknown origin (peritoneal biopsy is used for diagnosis)
• Endometriosis
• Patients unable to tolerate pneumoperitoneum
• Patients with an uncorrectable coagulopathy or uncorrectable hypercapnia
• Patients with severe abdominal distention
• Patients with extensive previous abdominal surgeries
Standard laparoscopic access into the abdomen
An angled scope is used to inspect intra-abdominal organs
Inspect the surface of the liver, gallbladder, stomach, small bowel from ligament of
Treitz to ileocecal fold, pelvic organs, and visible retroperitoneal surfaces
If lesser sac needs to be opened➔the gastrocolic ligament should be divided along
greater curve of the stomach
D. Halpern
Department of Surgery, NYU Long Island School of
Medicine, NYU Langone—Long Island Hospital,
Mineola, NY, USA
General Surgery, NYU Langone Hospital—Long
Island, Mineola, NY, USA
e-mail: david.halpern@nyulangone.org
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
H. Ajouz et al. (eds.), The ABSITE Blueprints, https://doi.org/10.1007/978-3-031-32643-1_1
1
2
Research
Reference Findings
L. Amodu et al.
SAGES; diagnostic
laparoscopy guidelines
Rate of advanced disease during diagnostic laparoscopy when imaging does not reveal
advanced disease is esophageal, 50% to 60%; gastric, 30% (in those>T1); and
pancreas, 33% (10% will have positive cytology)
Laparoscopic ultrasound
Real-time B-mode system
Technical aspects
Uses Used as an adjunct to preoperative radiographic imaging studies and diagnostic staging
Anatomy Lymph nodes along the celiac axis are best seen through the left lobe of the liver or
Common ndings Benign lymph nodes are hyperechoic due to retained hilar fat within the node
Benet There is a 5% to 25% increase in cancer staging accuracy when laparoscopic
Port site malignancy New port site malignancy is very rare after diagnostic laparoscopy
Ultrasound probe: T-probe versus nger probe
High-frequency probes in the 7- to 10-MHz range using solid state linear array
transducers are optimal
laparoscopy for staging of select cancers
with direct placement of the probe onto the hepatoduodenal ligament
Benign lymph nodes are hyperechoic due
to retained hilar fat
ultrasound is used
Malignant lymph nodes are hypoechoic
Steps to prevent port site malignancy:
• Prevent CO2 leakage around ports
• Protect extraction sites
• Place specimens in a bag prior to removal
• Deate the abdomen with trocars in place
Research
Reference Findings
Rodgers MS, Windsor JA, Koea JB, McCall
JL.Laparoscopic staging of upper gastrointestinal
malignancy. ANZ J Surg. 2003;73(10):806–10
Santambrogio R, Opocher E, Costa M, Cappellani A,
Montorsi M.Survival and intra-hepatic recurrences after
laparoscopic radiofrequency of hepatocellular carcinoma in
patients with liver cirrhosis. J Surg Oncol. 2005;89(4):218–
25; discussion 225–6
Patel AC, Arregui ME.Current status of laparoscopic
ultrasound. Surg Technol Int. 2006; 15:23–31
Diagnostic laparoscopy with ultrasound upstages
gastric cancer patients in up to 40% of cases and
prevents laparotomy in roughly 25% of the patients
Diagnostic laparoscopy with ultrasound for colon
and rectal metastasis or hepatocellular cancer
staging identies 10–25% more additional tumors
than preoperative CT
Diagnostic laparoscopy with ultrasound has greater
than 90% accuracy in predicting the resectability
of pancreatic adenocarcinoma
1 Abdomen andHernia
Endometriosis
Denition
Management
Research
3
Endometrium growing outside uterus that manifests as peritoneal implants or cyst
formation (endometrioma)
Endometrioma can also occur in the abdominal wall along previous scars or in the
canal of Nuck
Cesarean scar endometriosis is the most common type of abdominal wall
endometriosis (AWE)
Indications for diagnostic laparoscopy: Part of the workup for the initial diagnosis
of endometriosis, persistent pain despite medical therapy, malignancy cannot be
excluded, and with bowel obstruction
Management for endometrial implants found during exploration:
• Thermal ablation or excision reduces pain by 50% and increases fertility
• Hysterectomy ± oophorectomy provides best symptom relief (reserved for
menopausal women or if debilitating symptoms)
Reference Findings
Zhang P, Sun Y, Zhang C, etal. Cesarean scar endometriosis:
presentation of 198 cases and literature review. BMC
Womens Health. 2019;19(1):14. https://doi.org/10.1186/
s12905- 019- 0711- 8. PMID: 30658623; PMCID: PMC6339338
Hart RJ, Hickey M, Maouris P, Buckett W.Excisional
surgery versus ablative surgery for ovarian endometriomata.
Cochrane Database Syst Rev. 2008;(2):CD004992
Mesenteric cyst
If found incidentally during surgery➔resection/enucleation can aid in the diagnosis
Management
of occult malignancy
Cysts should not be aspirated because the risk of recurrence is high
Pfannenstiel incisions carry a higher risk of
cesarean scar endometrioses (CSE) than vertical
midline incisions
Thorough cleaning at the conclusion of CS,
particularly of both corner sites of the adipose
layer and the fascia layer, is strongly
recommended for CSE prevention
There is debate regarding surgery for small
asymptomatic ovarian endometriomas
For large endometriomas: Ovarian-sparing
excision is appropriate
Surgical resection results in improved pain
control and less recurrence compared with
ablation, drainage, or observation
4
Research
L. Amodu et al.
Reference Findings
Yavuz Y, Varman A, Şentürk ÜM, Kafadar
MT.Mesenteric cyst in 22 cases. J Gastrointest
Cancer. 2021;52(3):993–6. https://doi.
org/10.1007/s12029- 020- 00522- 9. Epub 2020 Sep
24. PMID: 32970308
Desmoids/Fibromatoses
Desmoid tumors
Abdominal wall is a very common anatomic site for desmoid tumors
Intra-abdominal desmoid tumors arise in the small bowel mesentery, with the
retroperitoneum being the second most common site
Desmoid tumors are very rare accounting for 3% of soft tissue neoplasms
Most desmoid tumors occur sporadically
Characteristics
Desmoid is associated with familial adenomatous polyposis (FAP) due to APC
gene mutation
Association between desmoid tumors and FAP is particularly strong in patients
with Gardner syndrome (osteomas, cutaneous lesions, and intestinal polyposis)
Other risk factors include pregnancy, intra-abdominal surgery, use of hormones,
and local trauma or surgery
The mesenteric cysts were located in the small intestine in 18
cases and colon in 4 cases. In the histopathological examination
of the surgical specimens, simple cyst was detected in 17 cases,
lymphangioma in 4 cases, colon adenocarcinoma and simple
cyst in 1 case
Presentation
Diagnosis
Management
Desmoid type Presentation
Abdominal wall desmoid Firm mass around rectus abdominis
Mesenteric desmoid SBO, GI bleeding, or acute abdomen due to
perforation
Retroperitoneal desmoid Ureteral obstruction
Best imaging for desmoid: CT of the abdomen and pelvis
Tissue diagnosis: Image-guided core needle biopsy
A substantial proportion of desmoid tumors stabilize in size and 10–15%
spontaneously regress➔“watch and wait” approach is recommended especially
if the tumor involves unresectable structures
Radiation therapy➔effective in patients with unresectable tumors and also as an
adjuvant therapy after re-resection for recurrent disease
Options for systemic therapy include noncytotoxic therapies, such as nonsteroidal
anti-inammatory drugs and tamoxifen, and tyrosine kinase inhibitors, such as
imatinib➔ these agents are associated with a low response rate
1 Abdomen andHernia
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Research
Reference Findings
5
Grignol VP, Pollock R, Howard JH.Management
of desmoids. Surg Clin North Am.
2016;96(5):1015–30
Peritoneal Neoplasms
Peritoneal neoplasms
Primary peritoneal
neoplasm
Peritoneal metastases
Peritoneal mesothelioma is the most common primary peritoneal malignancy. It arises
from peritoneal mesothelial cells
Metastases from appendix: Appendiceal origin: Pathology can vary from low-grade
appendiceal mucinous neoplasm (LAMN) to high grade-invasive mucinous
adenocarcinoma
Metastases from colorectal cancer: 5–15% of colorectal cancer patients have peritoneal
metastasis at diagnosis
Gastric cancer origin: Peritoneal spread is the most common pattern if disease
metastasizes or recurs. Peritoneal carcinomatosis is found in 5–20% of gastric cancer
patients presenting for surgery
Metastases from ovary or breast
Most common presentations for pseudomyxoma peritonei from a mucinous neoplasm of
the appendix: Increasing abdominal girth, inguinal hernia, ovarian mass palpated on
pelvic examination, early satiety, weight gain
Treatment algorithms are evolving for desmoid tumors with
the observation that many tumors remain stable under a
program of watchful waiting, and spontaneous regression
has been observed
Presentation
Diagnosis
Peritoneal Cancer
Index (PCI) for staging
peritoneal
mesothelioma
Most common presentation for peritoneal carcinomatosis: Abdominal pain, increasing
abdominal girth or distention, and symptoms of obstruction
Sister Mary Joseph sign: Palpable nodule around the umbilicus due to metastasis from
pelvic or abdominal malignancy
CT ndings: Mucin causes scalloping of the liver, spleen edges, and mesentery. In more
aggressive cases, segmental obstruction of the small bowel is also seen. Omental caking,
peritoneal nodules, or thickening
Imaging has low sensitivity for lower disease burden
Image-guided biopsy to obtain tissue for pathologic diagnosis
Gold standard for diagnosis: Diagnostic laparoscopy to visualize peritoneum and evaluate
disease burden. Inspect all visceral and peritoneal surfaces, including Cul-de-sac and
undersurface of diaphragm
Cancer biomarkers: CEA, CA 125, CA 19-9
PCI is a quantitative index which correlates with outcome
PCI score calculation is based on the size and distribution of peritoneal disease. It is an
intraoperative estimate of tumor burden throughout the abdomen and pelvis
For malignant peritoneal mesothelioma➔T stage is based on PCI score
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