Challenging patient groups
This article focuses on those patients that don't necessarily fit a systems-based approach of classification. Many of these patients present challenges to the clinicians involved with perioperative care so it is important to have a good understanding of how they should be managed. This article will focus on elderly patients, pregnant patients presenting for non-obstetric surgery, obese patients, and immunocompromised patients. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - November 25, 2022 Category: Surgery Authors: Sneha Prasad Tags: Perioperative management – II Source Type: research
Intestinal obstruction
is a common surgical emergency, accounting for up to 20% of admissions with acute abdominal pain. Of these, 80% will have small bowel obstruction, the most common cause being adhesions. Colorectal cancer is the most common cause of large bowel obstruction. The cardinal features of obstruction are abdominal pain, vomiting, distension and absolute constipation. Initial management comprises adequate fluid resuscitation, decompression with a nasogastric tube and early identification of strangulation (signs of which may include tachycardia, tenderness, fever and leucocytosis) requiring operative intervention. (Source: Surgery ...
Source: Surgery (Medicine Publishing) - November 24, 2022 Category: Surgery Authors: Shelly Griffiths, Damian G. Glancy Tags: Intestinal Surgery – I Source Type: research
Pathology of colorectal polyps and cancer
This article highlights the pathology-related aspects of CRC that are most relevant to colorectal surgeons. This includes sections on epidemiology, aetiology, presentation, macroscopic and microscopic features, pathological staging, prognosis, precursor lesions and molecular pathways, follow-up and bowel cancer screening. The main section on CRC is preceded by a description of the types of colorectal polyp that are most commonly encountered in clinical practice, many of which are associated with the development of CRC. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - November 23, 2022 Category: Surgery Authors: Adrian C. Bateman Tags: Basic science Source Type: research
Updates in robotic colorectal surgery
Since the introduction of master-slave manipulators (otherwise known as telemanipulators) in 1990, minimally invasive surgery paved the way for the development of the first robotic surgical systems to overcome the limitations of laparoscopic surgery. The robotic system over the last decade has rapidly gained acceptance and popularity among surgeons, especially colorectal surgeons around the world. Advantages of robotic surgical systems includes superior instrumentation and stable field of vision which enable precise dissection in confined spaces such as the pelvis. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - November 23, 2022 Category: Surgery Authors: Mahmood Al-Dhaheri, Ibrahim Amer, Noof AL. Naimi, Amjad Parvaiz Tags: Intestinal surgery – I Source Type: research
Surgery for colorectal cancer
Colorectal cancer surgery represents a major component of the colorectal service workload. A solid understanding of key anatomical and oncological principles is essential for safe practice. In this article we discuss these fundamental aspects of colorectal cancer surgery. The first part of the article will deal with preoperative staging, surgical planning and principles of oncological surgery. The second part will focus on some of the most common operations. We will describe key intra-operative principles involved in performing a right hemicolectomy, left hemicolectomy, anterior resection and abdomino-perineal resection. (...
Source: Surgery (Medicine Publishing) - November 23, 2022 Category: Surgery Authors: Jason George, Timothy Rockall Tags: Intestinal Surgery – I Source Type: research
Preoperative optimization and enhanced recovery after surgery
Enhanced recovery pathways have been repeatedly shown to reduce length of stay and complication rates for patients undergoing elective major surgery across multiple surgical specialties. The success of the enhanced recovery approach relies on excellent patient preparation and reliable implementation of evidence-based, standardized care components at each stage of the surgical journey. Multidisciplinary team engagement and continuous audit of outcomes are crucial in sustaining a successful enhanced recovery after surgery programme. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - November 23, 2022 Category: Surgery Authors: Sarah L. Cooper, Paul Panesar, John Davidson Tags: Perioperative management - II Source Type: research
Test yourself: MCQ and single best answer
The MCQ and single best answer section in Surgery is designed to test your knowledge of selected topics in this issue of the journal. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - November 23, 2022 Category: Surgery Authors: Adrian Ben Cresswell Tags: TEST YOURSELF Source Type: research
Intestinal stomas
The formation of an intestinal stoma (usually ileostomy or colostomy) is an integral part of the surgical management of several pathologies of the gastrointestinal tract – in both emergency and elective patients. The basic underlying principle is that faecal flow is diverted from the site of the pathology by bringing the end or a loop of bowel through the anterior abdominal wall. A stoma may be created in a temporary or permanent role to reduce morbidity and morta lity associated with several conditions of the gastrointestinal tract including perforation, inflammatory bowel disease, bowel obstruction and elective cancer ...
Source: Surgery (Medicine Publishing) - November 22, 2022 Category: Surgery Authors: James Pine, Lynn Stevenson, Jason On Tags: Intestinal Surgery – I Source Type: research
Test yourself: MCQ and single best answer
For questions 1 –4, select the statements which are true. The correct answers are given below. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - November 22, 2022 Category: Surgery Authors: Adrian Ben Cresswell Tags: TEST YOURSELF Source Type: research
Preoperative cardiopulmonary exercise testing: physiological basis and investigation
The number of cardiopulmonary exercise testing (CPET) centres has doubled in the UK since 2011. Approximately 30,000 tests are performed every year in the UK now. It is a useful tool helping preoperative risk stratification. Patients with poor exercise tolerance are more likely to suffer perioperative complications and death. Interpretation of a large amount of data generated during the test requires a good understanding of basic exercise physiology and its clinical application. Incorporation of CPET data in a global preoperative assessment provides a personalized risk estimate for a patient. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - November 21, 2022 Category: Surgery Authors: Anurag Vats Tags: Basic Science Source Type: research
Safe sedation practice for surgeons
This article uses this guidance as a framework to discuss the generic principles and practice of sedation and should not be seen as a substitute for more formal training. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - November 17, 2022 Category: Surgery Authors: Jon Walton Tags: Perioperative management - II Source Type: research
Management of patients with musculoskeletal disease and burns
Musculoskeletal disorders include a wide range of disorders which affect the locomotor system, i.e. muscles, bones, joints, and associated connective tissues like tendons and ligaments, which are listed in Chapter XIII of the International Classification of Diseases (ICD-10). While the primary pathology affects locomotor system, a number of these disorders are associated with systemic complications, resulting in increased morbidity and mortality in the perioperative period.Burns are an acute emergency and require anaesthetic or critical care input for assessment of injuries, early surgical intervention or organ support. (S...
Source: Surgery (Medicine Publishing) - November 14, 2022 Category: Surgery Authors: Rakesh Bhandary Tags: Perioperative management – II Source Type: research
Day case surgery
, where the patient is admitted, undergoes intervention and is discharged on the same day, is an important aspect of service provision in the NHS. This chapter addresses the recommendations and logistics of provision of day case surgery in present day NHS. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - November 14, 2022 Category: Surgery Authors: Khalid Zahir, Rakesh Bhandary Tags: Perioperative Management – II Source Type: research
Neurological conditions in the perioperative period
The wide spectrum of neurological disorders and their effects on the function of the central and peripheral nervous system can cause an extensive array of symptoms and significant morbidity and mortality. Morbidity and mortality are often amplified in the perioperative period with an elevated risk of anaesthetic complications and adverse events. However, the number of patients with neurological disease requiring surgery is unlikely to diminish, and therefore this anaesthetic risk needs to be met and managed effectively. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - November 13, 2022 Category: Surgery Authors: Natalie Jones, Christopher Johnson Tags: Perioperative management - II Source Type: research
The patient with renal disease
The incidence of chronic renal failure is increasing throughout the world. The perioperative management of patients with chronic kidney disease (CKD) is complicated by both the underlying renal dysfunction, with associated disturbances of fluid and electrolyte homeostasis and altered drug clearance, and the presence of associated comorbid conditions. Preoperative assessment for these complex patients requires multidisciplinary approach from anaesthetic, surgical and nephrology teams. Preservation of normal physiology along with prevention of further kidney injury are central to the management of patients with CKD. (Source:...
Source: Surgery (Medicine Publishing) - November 13, 2022 Category: Surgery Authors: Kapil Arora, Ian Nesbitt Tags: Perioperative Management – II Source Type: research
