Month: June 2017

Multidisciplinary Protocol Improves Management of GI Bleeding


Hollywood, Fla.—The findings of a new study suggest a standardized, multidisciplinary protocol helps improve the management of patients admitted to the hospital for acute gastrointestinal bleeding.

The protocol established patient ownership and facilitated communication among members of the health care team. After implementation of the protocol, patients had earlier interventions, required fewer packed red blood cell transfusions, had shorter hospitalizations and required fewer readmissions for acute GI bleeding.

“Doctors in several specialties noticed it was sometimes difficult to manage patients with acute GI bleeding because a lot of different services would be involved, and there often wasn’t a lot of communication among the different services,” said Tyler J. Loftus, MD, a surgical resident at the University of Florida, in Gainesville, and lead author of the study presented at the 2017 annual meeting of the Eastern Association for the Surgery of Trauma. Difficulties with communication were the impetus for developing the protocol.

To develop the protocol, a meeting was convened with representatives of different medical services: gastroenterology, interventional radiology, diagnostic radiology, critical care medicine and internal medicine. The attendees determined the best way to triage and manage a patient with acute GI bleeding, how to develop an agreed-upon treatment plan, and how to communicate that plan to their teams, patients and patients’ families.

Per the protocol, when a patient with acute GI bleeding is identified, the hospital transfer center coordinates a conference call between the gastroenterology, interventional radiology and acute care surgery teams. During the call, a treatment plan is developed that can be reassessed after procedural interventions or changes in patient status.

“The consensus plan is crucial because disagreement can occur regarding what tests should be ordered to diagnose the source of bleeding, and what procedures should be done to stop the bleeding,” Dr. Loftus said. This way, experts from different specialties can agree on the best way to diagnose and treat the patient.


From General Surgery News

What Is a Femoral Hernia?



What Is a Femoral Hernia?
Your muscles are usually strong enough to keep your intestines and organs in their proper place. Sometimes, however, your intra-abdominal tissues can be pushed through a weakened spot in your muscle when you overstrain. If a portion of tissue pushes through the wall of the femoral canal, it’s called a femoral hernia. A femoral hernia will appear as a bulge near the groin or thigh. The femoral canal houses the femoral artery, smaller veins, and nerves. It’s located just below the inguinal ligament in the groin.

A femoral hernia can also be called a femorocele.

Women are more likely than men to suffer from a femoral hernia. Overall, femoral hernias are not common. Less than 5 percent of all hernias are femoral. Most femoral hernias do not cause symptoms. However, they can occasionally lead to severe problems if the hernia obstructs and blocks blood flow to your intestines. This is called a strangulated hernia — it is a medical emergency and requires prompt surgery.


Causes of Femoral Hernias
The exact cause of femoral and other hernias are unknown most of the time. You may be born with a weakened area of the femoral canal, or the area may become weak over time.

Straining can contribute to the weakening of the muscle walls. Factors that can lead to overstraining include:

chronic constipation
heavy lifting
being overweight
difficult urination due to an enlarged prostate
chronic coughing


Signs and Symptoms of a Femoral Hernia
You may not even realize you have a femoral hernia in some cases. Small- to moderate-sized hernias don’t usually cause any symptoms. In many cases, you may not even see the bulge of a small femoral hernia.

Large hernias may be more noticeable and can cause some discomfort. A bulge may be visible in the groin area near your upper thigh. The bulging may become worse and can cause pain when you stand up, lift heavy objects, or strain in any way. Femoral hernias are often located very close to the hip bone and as a result may cause hip pain.

Severe Symptoms
Severe symptoms can signify that a femoral hernia is obstructing your intestines. This is a very serious condition called strangulation. Strangulation causes intestinal and bowel tissue to die, which can put your life in danger. This is considered a medical emergency. Severe symptoms of a femoral hernia include:

severe stomach pain
sudden groin pain
Call 911 and seek immediate medical attention if you suffer from these symptoms. If the hernia obstructs the intestines, blood flow to the intestines can be cut off. Emergency treatment can fix the hernia and save your life.


Diagnosing a Femoral Hernia
Your doctor will perform a physical examination by gently palpating, or touching, the area to determine if you have a femoral hernia. In many cases, the bulging can be felt.

Ultrasound of the abdominal and groin area can confirm the diagnosis. Imaging technology can show the hole in the muscle wall, as well as the protruding tissue.


Treatment for Femoral Hernias
Femoral hernias that are small and asymptomatic may not require specific treatment. Your doctor might monitor your condition until symptoms progress. Moderate- to large-sized femoral hernias require surgical repair, especially if they are causing any level of discomfort.

Surgical hernia repair is performed under general anesthetic. This means you will be asleep for the procedure and unable to feel pain. Femoral hernia repair can be done as an open, laparoscopic or robotic surgery.

Your surgeon will make incisions in your groin area to access the hernia. The intestine or other tissue protruding from the femoral area is returned to its proper position. The surgeon will sew the hole back together, and may reinforce it with a piece of mesh. The mesh strengthens the wall of the canal. Some procedures called “tension-free repairs” are minimally invasive and do not require the use of general anesthesia.


Outlook After a Femoral Hernia
Femoral hernias are generally not life-threatening medical conditions.

The recurrence of a femoral hernia is very low. The Royal United Hospital estimates that only 1 to 5 percent of people who have had a femoral hernia will have a recurring hernia.

Article Resources
Medically Reviewed by Steven Kim, MD on November 3, 2015 — Written by The Healthline Editorial Team


Robotic Surgery

Dr Johnson new portrait

Robotic surgery is a method to perform surgery using very small tools attached to a robotic arm. The surgeon controls the robotic arm with a computer.

You will be given general anesthesia so that you are asleep and pain-free.

The surgeon sits at a computer station and directs the movements of a robot. Small surgical tools are attached to the robot’s arms.

The surgeon makes small cuts to insert the instruments into your body.
A thin tube with a camera attached to the end of it (endoscope) allows the surgeon to view enlarged 3-D images of your body as the surgery is taking place.
The robot matches the doctor’s hand movements to perform the procedure using the tiny instruments.
Why the Procedure is Performed
Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. The small, precise movements that are possible with this type of surgery give it some advantages over standard endoscopic techniques.

The surgeon can make small, precise movements using this method. This can allow the surgeon to do a procedure through a small cut that once could be done only with open surgery.

Once the robotic arm is placed in the abdomen, it is easier for the surgeon to use the surgical tools than with laparoscopic surgery through an endoscope.

The surgeon can also see the area where the surgery is performed more easily. This method lets the surgeon move in a more comfortable way, as well.

Robotic surgery may be used for a number of different procedures, including:

Coronary artery bypass
Cutting away cancer tissue from sensitive parts of the body such as blood vessels, nerves, or important body organs
Gallbladder removal
Hip replacement
Kidney removal
Kidney transplant
Mitral valve repair
Pyeloplasty (surgery to correct ureteropelvic junction obstruction)
Radical prostatectomy
Radical cystectomy
Tubal ligation
Robotic surgery cannot be used for some complex procedures.


Before the Procedure
You cannot have any food or fluid for 8 hours before the surgery.

You may need to cleanse your bowels with an enema or laxative the day before surgery for some types of procedures.

Stop taking aspirin, blood thinners such as warfarin (Coumadin) or Plavix, anti-inflammatory medicines, vitamins, or other supplements 10 days before the procedure.

After the Procedure
You will be taken to a recovery room after the procedure. Depending on the type of surgery performed, you may have to stay in the hospital overnight or for a couple of days.

You should be able to walk within a day after the procedure. How soon you are active will depend on the surgery that was done.

Avoid heavy lifting or straining until your doctor gives you the OK. Your doctor may tell you not to drive for at least a week.

Outlook (Prognosis)
Surgical cuts are smaller than with traditional open surgery. Benefits include:

Faster recovery
Less pain and bleeding
Less risk of infection
Shorter hospital stay
Smaller scars