Minimal access technology has experienced an accelerated growth since its introduction into the field of diagnostic and therapeutic surgery over two decades ago. The progressive amalgamation of science and technology has lead to its ever-increasing applications in general surgery for increasingly complex procedures. Although sufficient educational material is available on minimal access surgery as textbooks and graphic atlases, here a ready reference guide in the form of surgical updates comes in handy to stay abreast with what’s new. This edition of minimal access surgery in gastrointestinal diseases is a conscientious effort by its dedicated contributors, some of the most capable persons in the field of minimal access gastrointestinal surgery. The contents of this ECAB series include topics which involve a degree of controversy and therefore are likely to be of immense help to surgical residents and practicing surgeons facing such dilemmas. The collective wisdom of these specialists is intended to yield safe and improved outcomes in the concerned patient.

There is no more technically demanding laparoscopic procedure than laparoscopic proximal gastric bypass. Furthermore, training and skill in advanced laparoscopy are inadequate background for developing a program since the bariatric patient presents many complex issues in management for the surgeon. Thus, the novice must master the skills of two disciplines: advanced laparoscopy and bariatric surgical care. The authors bring forward their significant experience in bariatric surgery and lessons learned from the development of their laparoscopic obesity surgery program in order to provide a resource to surgeons committed to bringing safe and effective laparoscopic treatment to their morbidly obese patients.

All surgeons are convinced that they provide the best possible care to their patients and fortunately most patients are happy with their surgeons. Where safety and quality were once considered to be self-evident, these issues need to be made more explicit in modern surgery. Doctors and the general public alike are nowadays more aware of the variations in quality that exist among surgeons and institutions and of the unwarranted harmful effects surgery can have. Super- or sub-specialization seems one way to improve both its quality and safety. Surgical Gastroenterology or Gastrointestinal Surgery is one of these new superspecialties. The path towards this specialization is not easy and turf battles between General Surgery and Surgical Gastroenterology are still being fought. Professor Kaushik recounts the history and development of this superspecialty in India. He recounts that although the history of Surgical Gastroenterology in this country is short, its future is bright but, as has happened in other countries, its further division into organ-based superspecialties can be expected. ‘Practice makes one perfect’ is the motto that is probably true for the high-risk surgery which is still being performed in small institutions or by surgeons with only little expertise. The inverse correlation between volume and outcome expressed as mortality and morbidity has been shown all over the world. Wouters et al systematically analyze the literature covering this topic. They also show that concentration and regionalization do not automatically lead to an improved quality of surgery, since other issues for quality assurance are of equal importance, such as adherence to evidence-based guidelines, feedback, and monitoring. Despite all the inputs in training and instruction by experts, a uniformly high quality of surgery is hard to achieve in day-to-day gastrointestinal surgery. Sudhir Joseph and his colleagues show that a dedicated checklist can save lives and reduce postoperative morbidity in many countries with different systems and levels of healthcare. A similar beneficial effect was found in The Netherlands using a more comprehensive checklist that covers the whole period of the hospital stay. The new type of surgeon is aware of the principles of evidence-based medicine and he/she will challenge the dogmas of the ‘old’ surgery. Over the years our surgical masters have told us about the importance of good pre-operative and postoperative care for our patients. The bowel should be put at rest before operation and oral feeding restored only slowly after surgery starting with nothing by mouth to sips of clear water. Bed rest was essential for recovery. He introduced the ERAS (Enhanced Recovery after Surgery) strategy also named Fast Track Surgery. Mitchell et al provide ample evidence that all surgeons should adopt the ERAS strategy. Implementation of this will lead to better and more cost-effective operations.

ECAB Gastrointestinal Hemorrhage - E-Book

Newer Technologies in Hepatopancreatobiliary Surgery - ECAB

There is no more technically demanding laparoscopic procedure than laparoscopic proximal gastric bypass. Furthermore, training and skill in advanced laparoscopy are inadequate background for developing a program since the bariatric patient presents many complex issues in management for the surgeon.

ECAB Surgery of the Bile Ducts - E-Book