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222 Atlas of Complicated Abdominal Emergencies
This is a unique form of energy utilising ultrasound
waves (Fig. 23.24), allowing both cutting and coagulation at the precise point of impact with minimal
lateral thermal spreading. This allows dissection with
coagulation and cutting with less smoke and no electrical current. It is ideal for dividing and simultaneously sealing small and medium size vessels by
tamponade and heat.
• Tissue response generator (Fig. 23.25) (Ligasure
TM
,
Force TriadTM, Covidien , USA)
Figure 23.25.
Force TriadTM, Covidien, USA.
This system has a high-current, low-voltage output
generator that provides an excellent sealing of vessels
up to 7 mm in diameter. It recognises changes in tissue and automatically adjusts the voltage and the current in order to achieve the adequate sealing effect.
The tissue response generator has a unique tissue
sealing ability with significantly reduced thermal
spread as compared to a bipolar device. The seal
mechanism senses the body’s collagen and actually
changes the nature of the vessel walls by obliterating
the lumen. The collagen and elastin within the tissue
melt and reform to create the seal zone.
• High-velocity and high-pressure water-jet dissec-
tion/hydrodissection
This uses the force of irrigation with clear solutions
to separate tissue planes. However no haemostasis is
achieved by these methods and hence their use is
limited. But such methods are extremely useful in
severe and dense adhesion as can be encountered in
acute gallbladder, ovary torsion, endometriosis, etc.
A combination of powerful hydrojet and suction can
be useful to isolate structures and clear anatomy.
• Laser dissection
This is rarely used as it has no advantage over more
easily available and user-friendly devices.
Suggested Reading
• MacFayden B. (2004) Laparoscopic Sutregry of
the Abdomen. Springer-Verlag, New York.
• Neugebauer EAM, Sauerland S, Fingerhut A,
et al. eds. (2006) EAES Guidelines for Endoscopic
Surgery. Springer, Berlin; New York.
• Kriplani A, Bhatia P, Prasad A, et al. eds. (2007)
Comprehensive Laparoscopic Surgery. IAGES.
• Oshinsky GS, Smith Ad. (1992) Laparoscopic
needle and trocars: an overview of design and
complications. J Laparosc Surg 5:37–40.
• Zucker KA. (2001) Surgical Laparoscopy, USA
2nd ed. Quality Medical Pu, St Louis, MO.
• The SAGES Manual. (2005) Springer, New York.
• Tucker RD, Voyles CR. (1995) Laparoscopic
electrosurguical complications and their prevention. AORN J 62:51 –3.
• Lomanto D, Cheah WK eds. (2009) Manual
of Endo-laparoscopic and Single Port Surgery.
2nd ed.
Index
abdominal abscess 141, 142, 144, 145, 149, 153, 154
abdominal compartment syndrome 14, 15
abdominal pain 1–6
abscess 135, 137–140
acute cholecystitis 109, 110, 113
acute respiratory distress syndrome 13
antibiotics 7, 10, 11
antrectomy 59, 61, 62
appendicitis 81–83
argon plasma coagulation 22–24
ASA score 12
bariatric surgery 73, 74, 79
bile duct 117, 119–121
bile duct injuries 117, 120
biliary stricture 120, 121
Billroth I gastrectomy 64, 65
Billroth II gastrectomy 59, 63, 64
bipolar electrocoagulation 22, 23
bleeding 43–47, 49, 50
bleeding peptic ulcer 53, 54
blood transfusion 10, 14
Boari fl ap 170
Boey Score 13
cancer 99, 100, 104
cholangitis 123–127, 130
cholecystectomy 109, 110, 112, 113
choledocholithiasis 117, 119
clipping (endoscopic) 24, 25
coagulopathy 18
coagulopathy 9, 10
coaptive coagulation 22, 23
colon 85–90, 92
colorectal cancer 99
complicated 86–88, 95
complication 73, 74, 78
component separation 194–196, 199, 200
crash laparotomy 182
cyanoacrylate glue 34–37
cystectomy 162, 163, 166
damage control surgery 183, 190
diffi cult biliary cannulation 121
direct anastomosis 169, 170
dissection 216–218, 221, 222
diverticulitis 85–88, 95
drainage 135–140, 160–162
duodenal ulcer 25, 54–57, 59–62, 64
ectopic pregnancy 157–159
embolisation 26
emergency 85–87, 95
emergency department 1, 6
endoscopic band ligation 35, 36
endoscopy 17–19, 21, 26, 29, 32, 33, 36, 38
energy devices 221
epinephrine injection 21, 22, 25
ERCP 117–121
erythromycin 21
esomeprazole 19
EUS 117, 120
fl uids and electrolytes 14
Forrest classifi cation 19, 21
gallbladder 109–115
gallstones 109
gastric antral vascular ectasia 17, 24
gastric band 75, 76, 78, 79
223
224 Atlas of Complicated Abdominal Emergencies
UPLOADED BY [STORMRG]
gastric bypass 73–79
gastric cancer 69, 70
gastric ulcer 17, 20, 23–25, 54, 55, 64
gastric varix 31, 36
gastro-enterostomy 56, 57, 64
gastrointestinal 43
Glasgow–Blatchford scores 18
glue injection 35–37
guillotine cold snare 21
heater probe 22, 23
hematemesis 17
hemoclip 24
hepatic venous pressure gradient (HVPG) 29
intestinal atresia 206
investigations 43
laparoscopic drainage 135–140
laparoscopic appendectomy 82
laparoscopic cholecystectomy 109
laparoscopic surgery 211–213, 216, 219, 221
lithotripsy 119
liver 135–140
malignancy 99–101, 106
malrotation 203, 205–208
management 43, 45, 50, 52
melaena 17, 18, 19
mesh 196–199
midazolam 18
multipolar electrocoagulation 22, 23
necrotising enterocolitis 202
nutrition 13–15
peptic ulcer 67, 69
percutaneous drainage 141, 142, 144–147, 152–154
perforation 67–70
perforative 85, 86, 87
perioperative management 7
Portosystemic shunt 29, 39, 40
prokinetic therapy 21
proton pump inhibitor 19
psoas hitch 168–170
pyloroplasty 55, 56, 57
radiological drainage 141, 142, 145, 149, 153, 154
radiology 43, 50
resuscitation 7–10, 13–15
retraction 217, 221
Rockall score 18, 19
salpingectomy 157–159
Sengstaken–Blakemore tube 38, 39
sepsis 7, 11, 13–15
sigmoid 85–90, 92–95
skin fl aps 195–197
skin grafts 194, 197
sleeve gastrectomy 73–75, 79
somatostatin 33
sphincterotomy 119, 121
surgery 67, 68, 70, 85–89, 91, 93, 96, 99–101, 104–106
temporary abdominal closure 177
temporary abdominal closure 184, 189
terlipressin 33
thermal therapy 22, 23, 25
transjugular intrahepatic portosystemic shunt (TIPS) 29
trauma laparotomy 184
tubo-ovarian abscess 157, 160, 162
obstructive (obstructed) colon 99–106
octreotide 33
oesophageal varix 30, 32, 34, 35
oliguria 14
omeprazole 19
open appendectomy 81
ovarian cyst 157, 162, 163, 165
pancreatic necrosectomy 127, 129
pancreatic necrosis 127, 129
pancreatic trauma 123, 131
pantoprazole 19, 21
upper gastrointestinal bleeding 17, 19, 21, 25, 26
upper gastrointestinal haemorrhage 29, 34
upper gastrointestinal treat 67
ureteric injuries 167–171
variceal band ligation 34, 35
variceal haemorrhage 29, 31–33, 35
varix 31, 34–37
vasopressin 33
visible vessel 18–21, 25
workup 2