Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They are the first cause of small bowel obstruction. Diagnosis is based on clinical evaluation, water-soluble contrast followth...Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They are the first cause of small bowel obstruction. Diagnosis is based on clinical evaluation, water-soluble contrast followthrough and computed tomography scan. For patients presenting no signs of strangulation, peritonitis or severe intestinal impairment there is good evidence to support non-operative management. Open surgery is the preferred method for the surgical treatment of adhesive small bowel obstruction, in case of suspected strangulation or after failed conservative management, but laparoscopy is gaining widespread acceptance especially in selected group of patients. "Good" surgical technique and anti-adhesive barriers are the main current concepts of adhesion prevention. We discuss current knowledge in modern diagnosis and evolving strategies for management and prevention that are leading to stratified care for patients.展开更多
BACKGROUND Intraabdominal adhesions develop spontaneously or after an inflammatory process or surgical procedure in the abdomen.They are the most common cause of small bowel obstruction(SBO).SBO occasionally leads to ...BACKGROUND Intraabdominal adhesions develop spontaneously or after an inflammatory process or surgical procedure in the abdomen.They are the most common cause of small bowel obstruction(SBO).SBO occasionally leads to intestinal ischemia(In Is)which can be a life-threatening condition that requires management as soon as possible.We herein report a case of SBO with In Is presented in our institution and treated without intestinal resection.CASE SUMMARY A 34-year-old man presented at the emergency department after a 12-h-onset diffuse abdominal pain,bloating and nausea.He had a history of traumatic right hepatectomy 11 years ago as well as adhesiolysis and resection of a long part of small bowel 2 years ago.An abdominal computed tomography(CT)showed dilated loops that led to the diagnosis of SBO.Due to deteriorating lactic acidosis,the patient was operated.Torsion of the small bowel around an adhesion led to2.30 m of ischemic ileum.After the application of N/S 40°C for 20 min,the intestine showed signs of improvement and it was decided to avoid resection and instead temporary close the abdomen with vacuum-pack technique.At the second-look laparotomy 48 h later,the intestine appeared normal.The patient was discharged on the 8 th post-op day in excellent condition.CONCLUSION In case of SBO caused by adhesions,extreme caution is needed if In Is is present,as the clinical signs are mild and you should rely for diagnosis in CT findings and lactate levels.Conservative surgical approach could reverse the effects of In Is,if performed quickly,so that intestinal resection is avoided and should be used even when minimum signs of viability are present.展开更多
Surgical electrodes rely on thermal effect of high-frequency current and are a widely used medical tool for cutting and coagulating biological tissue.However,tissue adhesion on the electrode surface and thermal injury...Surgical electrodes rely on thermal effect of high-frequency current and are a widely used medical tool for cutting and coagulating biological tissue.However,tissue adhesion on the electrode surface and thermal injury to adjacent tissue are serious problems in surgery that can affect cutting performance.A bionic microstriped structure mimicking a banana leaf was constructed on the electrode via nanosecond laser surface texturing,followed by silanization treatment,to enhance lyophobicity.The effect of initial,simple grid-textured,and bionic electrodes with different wettabilities on tissue adhesion and thermal injury were investigated using horizontal and vertical cutting modes.Results showed that the bionic electrode with high lyophobicity can effectively reduce tissue adhesion mass and thermal injury depth/area compared with the initial electrode.The formation mechanism of adhered tissue was discussed in terms of morphological features,and the potential mechanism for antiadhesion and heat dissipation of the bionic electrode was revealed.Furthermore,we evaluated the influence of groove depth on tissue adhesion and thermal injury and then verified the antiadhesion stability of the bionic electrode.This study demonstrates a promising approach for improving the cutting performance of surgical electrodes.展开更多
文摘Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They are the first cause of small bowel obstruction. Diagnosis is based on clinical evaluation, water-soluble contrast followthrough and computed tomography scan. For patients presenting no signs of strangulation, peritonitis or severe intestinal impairment there is good evidence to support non-operative management. Open surgery is the preferred method for the surgical treatment of adhesive small bowel obstruction, in case of suspected strangulation or after failed conservative management, but laparoscopy is gaining widespread acceptance especially in selected group of patients. "Good" surgical technique and anti-adhesive barriers are the main current concepts of adhesion prevention. We discuss current knowledge in modern diagnosis and evolving strategies for management and prevention that are leading to stratified care for patients.
文摘BACKGROUND Intraabdominal adhesions develop spontaneously or after an inflammatory process or surgical procedure in the abdomen.They are the most common cause of small bowel obstruction(SBO).SBO occasionally leads to intestinal ischemia(In Is)which can be a life-threatening condition that requires management as soon as possible.We herein report a case of SBO with In Is presented in our institution and treated without intestinal resection.CASE SUMMARY A 34-year-old man presented at the emergency department after a 12-h-onset diffuse abdominal pain,bloating and nausea.He had a history of traumatic right hepatectomy 11 years ago as well as adhesiolysis and resection of a long part of small bowel 2 years ago.An abdominal computed tomography(CT)showed dilated loops that led to the diagnosis of SBO.Due to deteriorating lactic acidosis,the patient was operated.Torsion of the small bowel around an adhesion led to2.30 m of ischemic ileum.After the application of N/S 40°C for 20 min,the intestine showed signs of improvement and it was decided to avoid resection and instead temporary close the abdomen with vacuum-pack technique.At the second-look laparotomy 48 h later,the intestine appeared normal.The patient was discharged on the 8 th post-op day in excellent condition.CONCLUSION In case of SBO caused by adhesions,extreme caution is needed if In Is is present,as the clinical signs are mild and you should rely for diagnosis in CT findings and lactate levels.Conservative surgical approach could reverse the effects of In Is,if performed quickly,so that intestinal resection is avoided and should be used even when minimum signs of viability are present.
基金supported by the National Key R&D Program of China (Grant No.2019YFE0126300)the Natural Science Foundation of Guangdong Province,China (Grant Nos.2019A1515011530 and 2021B1515020087).
文摘Surgical electrodes rely on thermal effect of high-frequency current and are a widely used medical tool for cutting and coagulating biological tissue.However,tissue adhesion on the electrode surface and thermal injury to adjacent tissue are serious problems in surgery that can affect cutting performance.A bionic microstriped structure mimicking a banana leaf was constructed on the electrode via nanosecond laser surface texturing,followed by silanization treatment,to enhance lyophobicity.The effect of initial,simple grid-textured,and bionic electrodes with different wettabilities on tissue adhesion and thermal injury were investigated using horizontal and vertical cutting modes.Results showed that the bionic electrode with high lyophobicity can effectively reduce tissue adhesion mass and thermal injury depth/area compared with the initial electrode.The formation mechanism of adhered tissue was discussed in terms of morphological features,and the potential mechanism for antiadhesion and heat dissipation of the bionic electrode was revealed.Furthermore,we evaluated the influence of groove depth on tissue adhesion and thermal injury and then verified the antiadhesion stability of the bionic electrode.This study demonstrates a promising approach for improving the cutting performance of surgical electrodes.
