The global population is aging rapidly, and as a result emergency abdominal surgery for acute abdomen in the elderly has become a global issue. Demographic changes in the population have also altered the profile of emergency abdominal surgery, with typical causes of acute abdomen in the elderly including acute cholecystitis, incarcerated hernia, bowel obstruction and appendicitis. In these patients, recovery from surgery is often complicated, leading to longer hospital stays compared with younger patients. Laparoscopy in the emergency setting is well established and offers a number of advantages over open surgical approaches, such as reduced postoperative pain, length of hospital stay and complication rates. While laparoscopic surgery for acute diverticulitis has become more widespread, in other conditions, like small bowel obstruction and perforated peptic ulcer, laparotomy is still used in about 70% of cases. Further, despite the urgent need for knowledge regarding surgical treatment of acute abdomen in the elderly, there is still a lack of evidence in this relevant clinical field.
This book analyzes the management strategies and critically evaluates the outcomes of laparoscopic emergency surgery for acute abdomen in the elderly according to the principles of evidence-based medicine. Discussing each topic clearly, and promoting the use of emergency laparoscopy in elderly patients, the book is intended for young general surgeons and surgeons in training with at least a basic knowledge of surgery for acute abdomen. It is also useful as a quick reference tool during on-call shifts.
Part 1.- How to Define an Elderly and Frail Patient ?.- 1 Defining the Burden of Emergency General Surgery in the Elderly Today.- 2 A Worldwide Overview of Emergency Laparoscopic Procedures in the Elderly.- 3 The Economic Burden of Emergency Abdominal Surgery in the Elderly: What is the Role of Laparoscopy?.- 4 Goals of Care in Emergency Abdominal Surgery in the Elderly and Frail Patient.- 5 Wound Healing in the Elderly and Frail Patient.- Part 2 Acute Cholecystitis.- 6 Gallstone Ileus.- 7 Acute Pancreatitis.- 8 Acute Appendicitis.- 9 Non-Specific Abdominal Pain.- 10 Perforated Gastro-Duodenal Ulcer.- 11 Gastric Outlet Obstruction.- 12 Obstructing Colonic Tumor.- 13 Acute Diverticulitis.- 14 Small Bowel Obstruction.- 15 Incarcerated Groin and Crural Hernias.- 16 Incarcerated Incisional and Ventral Hernias.- 17 Abdominal Trauma.- 18 Acute Mesenteric Ischemia.- 19 Gynecologic Emergencies.- 20 Bedside Laparoscopy in the Elderly and Frail Patient.- 21 Emergency Robotic Surgery for Acute Abdomen in the Elderly and Frail Patient.- 22 Enhanced Recovery After Emergency Surgery in the Elderly and Frail Patient.- 23 Antibiotics in Emergency General Surgery in the Elderly and Frail Patient.- 24 Anesthesia and Emergency Laparoscopy in the Elderly and Frail Patient.- 25 Imaging in Emergency Surgery in the Elderly and Frail Patient.- 26 Emergency Laparoscopy in the Elderly and Frail Patient: Perioperative Nursing Considerations
Ferdinando Agresta is Chief of the General Surgery Department of the Vittorio Veneto Hospital (North-Eastern Italy). His main field of interest is laparoscopic surgery, in particular in the emergency setting, and the analysis of the laparoscopic approach outcomes in both scheduled and emergency surgery in the elderly. He has been the main investigator in several studies on emergency and elective laparoscopy and is President of the Italian Society of Laparoscopic Surgery and New Technologies (SICE). Mauro Podda has been HPB honorary clinical fellow at the Department of Surgery of Ninewells Hospital and Medical School, Dundee (UK), and attending general surgeon with special interest in robotic gastro-intestinal surgery and acute care surgery at the Minimally Invasive Surgery Unit, San Francesco Hospital, Nuoro (Italy). He is now a consultant general and an emergency surgeon at Cagliari University Hospital. His main research fields are minimally invasive gastric, pancreatic, colorectal and general emergency surgery, and he is currently involved in the development of national and international surgical guidelines on acute appendicitis and laparoscopic ventral hernia repair. Carlo Bergamini works at the Emergency Surgery Unit of the University Hospital of Careggi, Florence, Italy, and is a specialist in general surgery, immunology and emergency medicine. He also worked as an immunologist at Careggi hospital and as an emergency doctor at Pistoia hospital and various territorial emergency services for six years. He is an expert on internal, surgical, vascular and interventional ultrasound. Fabio Cesare Campanile is Director of Surgery at the Hospital of Civita Castellana (Italy), a specialist in general surgery, fellow of the American Board of Surgery, and holds a Masters in Economics. He practices elective and emergency general surgery with a particular focus on laparoscopic and bariatric surgery. He regularly serves as a chairman or lecturer at national and international scientific meetings on laparoscopic, bariatric and emergency surgery. He is involved in the development of national and international surgical guidelines on emergency and laparoscopic surgery, and his work has been published in leading international journals. Gabriele Anania is an Associated Professor at the University of Ferrara, and teaches general surgery at the Medical School of the same University. Currently he is the Chief of the Laparoscopic Surgery Unit at the University Hospital of Ferrara and a member of the Academic Board of the PhD in Biomedical Sciences at the University of Ferrara. He has been involved in research studies on laparoscopic surgery at national and international centers (e.g. RIFT Study and IMAGINE Study).
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