Gastrointestinal Operations and Technical Variations 1st ed. 2017 Edition

Gastrointestinal Operations and Technical Variations 1st ed. 2017 Edition PDF ebook Free

Gastrointestinal Operations and Technical Variations

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By Michael Korenkov (Editor),‎ Christoph-Thomas Germer (Editor),‎ Hauke Lang (Editor)
In this book, leading experts provide step-by-step, illustrated descriptions of their standard surgical techniques (open and laparoscopic) for diverse gastrointestinal indications and their preferred modifications when confronted by challenging circumstances associated with an increased risk of intra- or postoperative complications. The provision of several points of view for each surgical indication ensures that approaches from the conservative to the more radical are conveyed. It is clearly explained in which situations use of the described technical variations may be indicated, and practical tips are provided on the avoidance of complications. In addition, important medicolegal issues are discussed and guidance is offered on risk assessment and decision analysis within the surgical setting. The book will be an invaluable aid to decision making and practice for every gastrointestinal surgeon.

 


Product details
  • Hardcover:444 pages
  • Publisher:Springer; 1st ed. 2017 edition (October 28, 2017)
  • Language:English
  • ISBN-10:3662498766
  • ISBN-13:978-3662498767
Preface:

Since the establishment of the abdominal surgery as an independent field, every operation will be  performed according to the certain technical stan- dards. These standards have been appropriately  adapted for the new knowledge and technical developments. However deals a practical surgeon  frequently with situations, in these originally simi- lar operations can have very different develop- ment. A lot of predisposing factors can influence it:  different anatomy and morphology of operational areas, different effects of the similar intraoperative steps (bleeding after tissue transection, organs injured during the abdominal opening), surgical experience, manual skill, drop out of instruments and devices, strategic problems, mental condition from every team member, as well as a quality of  assistance. All these factors can make the perfor- mance of every operation difficult, especially in  cases when a surgeon is “programmed” to achieve certain technical standards. Until today, there is no definition of what constitutes a difficult surgical situation, but every practical surgeon knows very well what it means and how important it is. We  define the difficult surgical situation as an intraop- erative surgical problem, which increases the like- lihood of intraoperative and postoperative  complications, if the initially planned surgical pro- cedure was carried out without modifications. In a  difficult surgical situation, the surgeon gets into  dilemma whether to continue the intended opera- tion “at all costs” or to deviate from the initially  planned surgical procedure to some alternative technique. Choosing the first option can increase the risk of intra- and postoperative complications. For example, performance of a complete instead of “subtotal” cholecystectomy by severe fibrotic changes in Calot’s triangle can lead to bile duct injury. Enforcement of hemithyroidectomy in case  of the difficult surgical anatomy can have a recur- rent lesion as a result. There are further examples  on this subject. The consequence of the second alternative might be a lower risk of short-term complications but at the expense of worse results  in the long term. In oncologic surgery, for exam- ple, earlier recurrences due to R1 resection status  or unsatisfactory functional results represent typi- cal problems. When making the decision to oper- ate or not, but also when selecting the best surgical  technique, it would be important to know a  patient’s individual risk of intraoperative difficul- ties. From a surgeon’s perspective, intraoperative  difficulties are therefore more than just a surrogate  parameter for postoperative morbidity, because the prediction of such difficulties could directly lead to modifications of the surgical indication,  improved selection of the surgical team, and intra- operative changes in surgical techniques.  Ultimately, mortality and morbidity could be reduced by avoiding an operation with a high grade of intraoperative difficulty, by anticipating it and preplanning alternative surgical options, or by  modifying the surgical strategy during the opera- tion. Intraoperative changes in surgical strategies  are of course not uncommon. In most cases, how- ever, the surgeon has no objective facts to justify  his or her decision. The need to justify one’s actions may lead to some pressure not to deviate from the preoperative planning. Thus, surgeons tend to stick to the standards of surgical practice, even if the risk-benefit ratio in an individual patient changes intraoperatively. The present results should be seen as a stimulus for surgeons to take  their “gut feelings” seriously. If the surgeon’s sub- jective impression points toward an increased dif- ficulty of surgery, it may be justified to deviate  from the surgical textbook.

Gastrointestinal Operations and Technical Variations 1st ed. 2017 Edition ebook free
Gastrointestinal Operations and Technical Variations 1st ed. 2017 Edition ebook pdf free
Gastrointestinal Operations and Technical Variations 1st ed. 2017 Edition ebook pdf download free

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