Surgery
Chapters
page 1 of 2 pages | next »Abdominal Compartment Syndrome in the Pediatric Patient
M. Ann Kuhn* and David W. Tuggle
For all practical purposes, the original clinical model for the abdominal compartment syndrome (ACS) involved the repair of congenital abdominal wall defects such as omphalocele (Fig. 1) and gastroschisis (Fig. 2). Closure or coverage of these defects is always associated with an increase in intr...
Abdominal Compartment Syndrome Provokes Multiple Organ Failure: Animal and Human Supporting Evidence
Christopher D. Raeburn and E.E. Moore
Damage control surgery has undoubtedly increased the survival of severely injured patients; however, a subset of these salvaged patients go on to develop the devastating complication of the abdominal compartment syndrome (ACS). Clinical studies have demonstrated a clear association of the ACS wit...
Abdominal Perfusion Pressure
Michael Cheatham, Manu Malbrain
Although initially recognized almost 150 years ago, the pathophysiologic implications of elevated intra-abdominal pressure (IAP) have essentially been rediscovered only within the past decade.1-15 Elevated IAP or “intra-abdominal hypertension” (IAH) is now commonly identified in the critically il...
Aggressive Surgery for Hepatocellular Carcinoma with Vascular and/or Biliary Involvement
Tsuyoshi Sano and Yuji Nimura
In patients with advanced hepatocellular carcinoma (HCC) presenting with vascular and/or biliary invasion, major hepatectomy is often indicated for curative resection. In HCC patients with portal vein tumor thrombus, limited anatomical resection such as sectionectomy is a possible alternative for a ...
Anesthetic Considerations in Abdominal Compartment Syndrome
Ingrid R.A.M. Mertens zur Borg, Serge J.C. Verbrugge and Karel A. Kolkman
The primary pathogenesis of intra-abdominal hypertension (IAH) involves an increase in intra-abdominal abdominal pressure (IAP) ranging from 12 mmHg to over 25 mmHg in the abdominal compartment syndrome (ACS).1,2 Increased IAP depresses hemodynamics, increases pleural and intrathoracic pressure a...
Cardiovascular Implications of Elevated Intra-Abdominal Pressure
Michael Cheatham and Manu Malbrain
Cardiovascular dysfunction and failure are commonly encountered in the patient with intra-abdominal hypertension (IAH) or abdominal compartment syndrome (ACS). Accurate assessment and optimization of preload, contractility, and afterload is essential to restoring end-organ perfusion and function ...
Central Nervous System
Giuseppe Citerio and Lorenzo Berra
In animal studies, increases in intraabdominal pressure (IAP) raise central venous pressure (CVP) and pleural pressure (PP) and, eventually, result in elevation of intracranial pressure (ICP) and decrease of cerebral perfusion pressure (CPP). Clinical studies documented similar correlations. Part...
Definitions
David J.J. Muckart, Rao Ivatury, Ari Lepp?niemi and R. Stephen Smith
Within any human body compartment a rise in pressure above physiological limits is detrimental. At pressures which still permit axial vessel flow, capillary perfusion may cease to exist resulting in cell death. The physiological sequelae and development of signs and symptoms is dependent upon a n...
Genetics of Hepatocellular Carcinoma
Andreas Teufel
Hepatocellular carcinoma (HCC) is among the most common malignancies worldwide. At present, approximately 550 000 new patients are diagnosed with HCC each year worldwide. However, regional differences in the incidence of HCC are significant. The highest prevalence is found in Southeast Asia an...
Hepatocyte Transplantation: A New Approach to Treat Liver Disorders
Javed Akhter, Loreena A Johnson and David L Morris
As demand for liver transplantation increases, hepatocyte transplantation will play an increasingly important role in the clinic. Clinically, hepatocyte transplantation has already shown its potential as a bridging adjunct to the standard clinical practice of Orthotopic Liver Transplantation (OLT). ...
Inferior Vena Cava Resection for Infiltrating Hepatic Malignancy
Gabriele Piffaretti, Gianlorenzo Dionigi, Matteo Tozzi, Patrizio Castelli and Renzo Dionigi
Liver tumors with involvement of the inferior vena cava (IVC) may demand the combined resection of the liver and IVC. This approach, even if it has become common for hepatic malignancies involving the IVC, still represents a high risk surgical procedure with a poor long‑term prognosis. The obj...
Intra Abdominal Hypertension and the Liver
Julia Wendon, Gianni Bianofiore and Georg Auzinger
There is increasing awareness of the deleterious consequences of intra abdominal hyper tension (IAH) and the abdominal compartment syndrome (ACS) on end organ func tion in critically ill patients. The pathophysiological implications of IAH and ACS in regard to functional impairment of the renal, ...
Intra-Abdominal Hypertension and Renal Impairment
Michael Sugrue, Ali Hallal and Scott D’Amours
Intra-abdominal hypertension (IAH) has been associated with renal impairment for over 150 years. It is only recently however that a clinically recognised relationship has been found. An increasing number of large clinical studies have identified that IAH (>=15mmHg) is independently associated wit...
Intra-Abdominal Hypertension and the Splanchnic Bed
Rao Ivatury and Lawrence Diebel
Intra-abdominal hypertension has profound effects on splanchnic organs, causing diminished perfusion, mucosal acidosis and setting the stage for multiple organ failure. If uncorrected, IAH will result in abdominal compartment syndrome and increase morbidity and mortality. The pathologic changes a...
Intra-Abdominal Pressure Measurement Techniques
Manu L. N. G. Malbrain* and Felicity Jones
The diagnosis of intra-abdominal hypertension (IAH) or abdominal compartment syndrome (ACS) is heavily dependant on the reproducibility of the intra-abdominal pressure (IAP) measurement technique. This chapter will discuss the gold standard direct IAP measurement, followed by the value of clinica...
Intraoperative Ultrasonic Examination in Liver Surgery
Junichi Arita, Norihiro Kokudo, Keiji Sano and Masatoshi Makuuchi
The safety of liver surgery has improved dramatically over the course of a few decades through the development of intraoperative ultrasonography, an imaging modality that is currently indispensable for hepatic resection. Although intraoperative ultrasonography is necessary at all stages and for a va...
Management of Abdominal Compartment Syndrome
Zsolt Balogh, Frederick A. Moore, Claudia E. Goettler, Michael F. Rotondo, C. William Schwab and M. Kaplan
With the evolution of “damage control” laparotomy and “goal directed” ICU resusci tation as standards of care for trauma patients arriving with life threatening hemor rhage, abdominal compartment syndrome (ACS) has emerged to be a virtual epidemic in busy trauma centers worldwide. Many alternativ...
Medical Management of Abdominal Compartment Syndrome
Michael Parr and Claudia Olvera
The medical management of intra-abdominal hypertension (IAH) has been described as of limited efficacy making expedient surgical decompression the treatment of choice for abdominal compartment syndrome (ACS).1A There is little doubt that prompt surgical decompression will decrease IAH and can lea...
Miscellaneous Conditions and ACS
Ari Leppaniemi, Andrew Kirkpatrick, Anastazia Salazar, Davis Elliot, Savvas Nicolaou and Martin Bjorck
Intra-abdominal hypertension and the abdominal compartment syndrome are increasingly recognized in non-traumatic conditions in the critically ill patient. This chapter deals with three of those situations: acute pancreatitis, renal transplant and abdominal aortic aneurysm (the condition in which ...
Morbid Obesity and Chronic Intra Abdominal Hypertension
Giselle Hamad and Andrew Peitzman
Morbid obesity has achieved epidemic proportions in the United States. A vast num ber of comorbid conditions are associated with morbid obesity, including metabolic syndrome, which consists of central obesity, insulin resistance, hypertension, and hyperlipidemia. An association between obesity an...
One Liver for Two: Split and Living Donor Liver Transplantation for Adult and Pediatric Patients
B. Gridelli, S. Gruttadauria, A. Luca, M. Spada, R. Volpes, W. Marsh and A. Marcos
The dramatic gap between need and availability of grafts for patients on liver transplantation waiting lists has prompted some of the most advanced technical evolutions in transplantation surgery. The knowledge derived from liver surgical anatomy, which has been first applied to liver resection for ...
Perioperative Blood Transfusion in Hepatocellular Carcinomas
Gianlorenzo Dionigi, Salvatore Cuffari, Giovanni Cantone, Alessandro Bacuzzi and Renzo Dionigi
Allogeneic blood transfusion during liver resection for malignancies has been associated with an increase incidence of different types of complications: infectious complications, tumor recurrence, decreased survival. Even if there is clear evidence of transfusion‑induced immunosuppression, it ...
Postinjury Secondary Abdominal Compartment Syndrome
Zsolt Balogh and Frederick A. Moore
Post-injury ACS is defined by the presence of intra-abdominal hypertension (IAH) with intra-abdominal pressure (IAP) greater than 25 mmHg accompanied by organ dysfunction(s) such as cardiac, respiratory and renal.1 ACS is referred to as “secondary” when there are no intra-peritoneal injuries. To ...
Preoperative Portal Vein Embolization for Hepatocellular Carcinoma
Taku Aoki, Hiroshi Imamura, Takuya Hashimoto, Norihiro Kokudo and Masatoshi Makuuchi
Preoperative portal vein embolization (PVE) has been introduced to increase the safety of major hepatic resection for hepatocellular carcinoma (HCC). PVE induces atrophy of the embolized portion of the liver to be resected with compensatory hypertrophy of the preserved liver remnant, even in chronic...
Prevalence and Incidence of IAH
Dries H. Deeren and Manu L.N.G. Malbrain
Prevalence and prevalence rate are respectively the number and the proportion of persons in a given population (an ICU for example) who have a particular disease (for example IAH) at a specified point in time or over a specified period of time. These terms are distinct from incidence, which refer...
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