Role of Endoscopy and MIS for the Acute Care Surgeon


Faculty: Sharon Bachman, MD; Teresa LaMasters, Archana Ramaswamy, MD; and John Paige, MD

Keyword(s): 02 level, 10 mmHg, 10/12 mm trocar, 15 mmHg, 2D world, 30 day mortality, 3D world, 5 mm ports, ABD, abdominal entry, abdominal pain, abdominal wall, abdominal x-ray, absolute contraindications, accepted approach, access port, acid base, actue incarcerations, acute ABD, acute care surgeon, acute perforation, acute slip with ischemia, acute strangulated groin hernia, adhesiolysis, adhesions, adhesive disease, adjustable gastric banding, adult patient population, advanced bariatric life support course, aggressive IVF resusciation, agressive fluid resuscitation, algorithim, altered physiology, amylase, anastomosis, anastomotic stricture, anesthesia, angled laparoscope, anticoloic, apoptosis, appendectomy, arms tucked, atelectasis, atraumatic bowel graspers, balloon dilation, balloon tip, band overfill, band slip, bariatric emergencies, bariatric patient, bariatric specialist, benefits, beveled needle, bicarb, biliopancreatic diversion with duodenal switch, biliopancreatic limb, biologic mesh, bladder, bleeding, blind limb, bloated, bloating, blood flow, blood system, bowel, bowel diameter, bowel distention, bowel injury, bowel necrosis, bowel obstruction, bowel reduced, bowel resected, bradycardia, brittle, buckle, bypass leak, bypass patients, byproduct, carafate, cardiac index, cardiac irritability, cardiac output, cardiovascular system, case series, case study, causative agents, causes for conversion, CBC, cecum, cell, central adiposity, cerebral vasodilation, challenges, chemical, children, chronic pain, chronically incarcerated, cirrhosis, clinical diagnosis, clinical exam, clinical experience, clinical judgement, close monitoring, CMP, CNS, co-morbidities, CO2 absorption, CO2 uptake, cocaine use, cohort, commencement of enteral feeding, common bariatric procedures, common complication, complete obstruction, complex cases, complex pt, complication rate, concentric esophageal dilation, consent, consent patient appropriately, contained leak, contaminated field, contralateral side, contrast, conventional, conversion, convert to open, converted to open, Coopers ligament, COPD, cord structures, cost to benefit ratio, counter incision, cramping abdominal pain, CRP, CSF absorption, CT, CT scan, CT scan with contrast, CVP, dead space, death, decompress, decompressed, decreased venous return, defect enlarged, definitive test, definitive tx, dense adhesions, desufflate, diabetes, diabetic, diagnostic, diagnostic test, diagnostic tool, diaphragm, diet, different skill sets, differing patient populations, dilate, dilated bowel, dilated gastric remnant, direct hernia, dissasociates, distal obstruction, distended, diversion, divert, diverting G-tube, Dr. Dennis Bastug, drain placement, dusky, DVT, DVT prophylaxis, dx lap, dyspnea, early leak, early postop, early treatment, easily eliminated, edema, EGD, elective repairs, elevated WBC, emergency, emergency open hernia repair, emergency repairs, emergent femoral hernias, emergent surgery, endoscopically, endoscopy, endsocopic stenting for leak management, enhanced vagal reflex, enlarge defect, enlarged uterus, enterotomy rate, epigastric LUQ pain, epigastric pain radiating to back, epigastric vessels, equipment, ER, ergonimically appropriate, Erich Muhe, erosion, esophageal stents, etiology, ETOH, exacerbate, expert, exploration, explosion issues, exposure, extended prophylaxis, extensive monitoring, extravasation of contrast, failure to lose weight, fat apron, feeling of doom, female, femoral hernia, femoral space, fetal depression, FEV1, fever, fluid, Foley catheter, footboard, FRC, free air, full thickness ischemia, fundoplication wrap, fungal aspects, FVC, G-tube, G-tube placement, gangrene, gastric pouch, gastric remnant, gastric-gastric fistula, gastrojejunostomy, gastrojejunostomy leak, gastrotomy, genetic hypercoagulability, GFR, GI cocktail with antacid, gold standard, gradual onset, Graham patch, groin incision, gross contamination, gut, gyn literature, gynecologist, H. pylori, Hasson technique, Hasson trocar, head trauma, heart, heart disease, hemodynamic changes, hemodynamic instability, hemodynamic stability, hemodynamically stable, hemodynamics, hernia contents, hernia defect, hernia sac, hernioscopy, Hgb, high ABD, high cost, low yield, high dose PPIs, high risk, higher risk group, hole, HTN, Huber needle, hx, hypercapnia, hypercarbia, hypercoagulability workup, hypovolemia, iatrogenic injury, iatrogenic perforation, ICP, ileopubic tract, immune system, improved cosmesis, inability to adequately visualize, incarcerated inguinal hernia, incarceration, incisional complications, incisional hernias, increased CO2, increased pressure, indirect hernia, induction, inert gas, inexpensive, infertility, inflammation, inguinal hernia, inguinal incision, inguinoscrotal hernia, initial treatment, insufflating, internal hernia, interventional radiologist, intestinal anastomosis, intestinal ischemia, intra-abdominal pressure, intracorporeal bowel resection and anastomosis, intraoperative complications, intraoperative monitoring, invasive, irreducible, ischemic pathway, IV antibiotics, IVC, IVF resuscitation, jejunal aspect, jejunojejunostomy, jejunum, JJ defect, Kehrs sign, labs, lap appy, lap assisted, lap band, lap VP shunt placement, laparoscope, laparoscopic energy dissector, laparoscopic evaluation, laparoscopic exam, laparoscopic exploration, laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia, laparoscopic hernia repair, laparoscopic shears, laparoscopic sleeve gastrectomy, laparoscopy, laparotomies, laparotomy, late onset vomiting, late postop, leak, leak zone, left pleural effusion, legs, length of sick leave, less pain, Level I penetrating injury to the ABD, ligament of Treitz, lightweight mesh, likely pathology, lipase, literature search, liver, local oxidative stress, long term tx, long-term follow up, loop of bowel, lovenox, low conversion rate, low risk, lower drain, lower extremity, lumbar spine, lung compliance, lungs, macrophages, male, malignancy, maneuvers of reduction, manual maneuver, MAP, marginal ulcer, massively distended, matted SB, mechanical, mentally prepared, mesenteric ischemia, mesentery, mesh overlap, mesh plugs, methamphetamine use, MI, midline, migrate, mini laparotomy, minimize amount of energy, minimize trauma to bowel, minute ventilation, MIS, MIS in emergency hernia repair, MIS physiology, MIS procedure, MIS revolution, miscarriage rates, mobidly obese population, monitors, morbidly obese, mortality, mortality reduction, multicenter, multiple organ systems, murky fluid, myopectineal orifice, N&V, nasea, nasojejunal tube, necrotic bowel, necrotic viscera, neoplasm, nervous system impact, new onset vomiting, NG tube, NGT, non-flammable, non-operative, non-operative management, non-reducable, non-reducable hernia, non-viable bowel, not well tolerated, NPO, NSAIDs, NSQIP, nutrition, obese, objective signs, obstruction of BP limb, obstruction operative technique, obstructive symptoms, obturator hernia, off legal use of stents, omentectomy, omentum, omentum buttress, open access, open approach, open bowel resection, open bypass, open entry technique, open exploration, open label, open surgery, open tray, operative, operative intervention, operative time, optimize outcomes, outcomes, oversew, overweight, paCO2, padding, pain out of proportion to exam findings, patient population, patient selection, PE, peak airway pressure, pediatric surgeons, PEEP, PEF, peptic ulcer disease, perforated marginal ulcer tx, perforation, perioperative management, peripheral damage, peritoneal cavity, peritoneal response, peritonitis, permanent suture, personal complication rates, Petersens space, pH, physiologic changes, physiologic impact, physiologic reserve, physiological consequences, plain film, plexus drainage, PMN, pneumoperitoneum, point of obstruction, polypropylene Lichenstein repair, poor healing, poor tissue apposition, port site hernia, port/tubing problems, portal veing thrombosis, positioning, post bariatric surgery, post bypass patient, post-op pain, postoperative M&M, potential for damage, pregnancy, pregnant women, preload, preop antibiotic, prep nipples to pubis, preparation, preperitoneal mesh, presented to ER, presents late, pressure situations, preterm labor, primary endpoint, primary repair, prior procedures, prognostic factors, prolapse, prolonged recovery, prospective randomized controlled trial, prospectively collected data, prosthetic wrap, provider, pulmonary changes, pulmonary reserve, pulmonary system, pursestring, quicker return to work, r/o, radiating pain, radiologist, randomized study, rapidly absorbed, rate of ventral hernia, reanastomosis, reasonable option, reasonable outcomes, rectus hernia, recurrence, recurrence rates, redness, reduce spontaneously, reflux, relaxing incision, releasing incisions, remnant, remove fluid, renal, renal bloodflow, renal vein, reoperation, requirements for resection, resected, respiratory rate, respiratory symptoms, retrocolic hernia, retrocolic pathway, retroperitoneum, retrospective, retrospective analysis, retrospective clinical control trial, retrospective evaluations, retrospective studies, retrospective study, return of GI function, reverse Trendelenberg, revisions, risk of conversion, risk of death, Rives repair, Roux limb, Roux-en-Y bypass, Roux-en-Y limb, run entire bowel, safe technical steps, saliva, SaO2, SBO, scar, screening pt, second trimester, secondary endpoints, selection bias, sensitive test, septic shock, serosal tears, serum creatinine, severe coagulopathy, severe pain, short LOS, signs & symptoms, single adhesion band, single band, single partial SBO, skin changes, skin necrosis, sleeve gastrectomy, sleeve leak, sliding hernia, slippage, small laparotomy, small stomach pouch, smoking, SMV thrombosis, specimen, spigelian hernias, spontaneously, standardize, statistically significant, steroids, strangulated, strangulation, stress, stricture, strong family hx, sucralfate, sudden onset, supine, supine position, supraumbilical 10 mm port, surgeon experience, surgeon skill, surgical team, surgical technique, surgically manage, suture repair, SV, SVR, synthetic mesh, systematic lit search, systemic, systemic oxidative stress, tachycardia, tactile sensation, TAPP approach, TAPP repair, technical difficulties, techniques, tenderness, tense ABD, TEP repair, terminal ileum, tertiary endpoints, therapeutic, tissue repair, TNF alpha, torsion, TPN, transverse mesocolon, treatment, Trendelenberg, Trendelenberg with left side down, triangulation, trocars, tubing related bowel obstruction, tuck arms, UGI, uncorrectable, unidentified pathology, upper drain, upper endoscopy, upper GI, upper GI procedure, urine output, uterine bloodflow, uterine irritability, varicosities, vascular compromise, vasopressin, venitlation, venous stasis, ventral hernias, Verres needle, viability, viable bowel, visceral injury, viscous lidocaine, volume, washout, water, watershed area, WBC, weak area, wedge resection, wide drainage, worse with eating, wound complications, wound infections, xcel trocar

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    Jose Espinel on Aug 2, 2016
    Great talk.

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