University of Calgary, Foothills Medical Center, Calgary, Alberta, Canada.
Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
J Am Coll Surg. 2020 Nov;231(5):e1-e6. doi: 10.1016/j.jamcollsurg.2020.08.727. Epub 2020 Aug 15.
Reoperative abdominal surgery is one of the most challenging endeavors that general surgeons face. The aim of this narrative review is to offer a detailed and nuanced discussion of preoperative patient and surgeon preparation and intraoperative surgical technique.
The topics discussed in this review are based on both the current literature and the experiences of the authors with complex reoperations in general, trauma, acute care, and hepatopancreatobiliary surgery.
Ten essential steps for reoperative abdominal surgery include the following: 1. Review all previous operative notes and discharge summaries; 2. Review all prior outside and current in-house imaging; 3. Assess the patient's overall health status, reverse nutritional deficits, and explain risks of reoperation to the patient and family; 4. Refer the patient to a plastic surgeon when future skin coverage of a prosthesis in the abdominal wall may be needed; 5. Do a bowel preparation preoperatively; 6. Use selected Enhanced Recovery After Surgery protocols; 7. Operative technique matters; 8. Restoring gastrointestinal continuity simultaneously with abdominal wall reconstruction is not recommended; 9. Technical tips for complex reoperations; and 10. Plan well for the day of the operation.
Successful reoperative abdominal surgery in the most complex patients after previous trauma or acute care laparotomies demands adequate preoperative patient preparation, a clear-cut plan for operation, superb intraoperative technique, and solid decision-making; ie an unwavering commitment to making the patient whole again.
再次剖腹手术是普通外科医生面临的最具挑战性的任务之一。本综述的目的是详细而细致地讨论术前患者和外科医生的准备以及术中手术技术。
本综述中讨论的主题基于现有文献以及作者在普通外科、创伤、急性护理和肝胆胰外科中进行复杂再次手术的经验。
再次剖腹手术的十个基本步骤包括以下内容：1. 回顾所有之前的手术记录和出院总结；2. 回顾所有之前的外部和当前的内部成像；3. 评估患者的整体健康状况、纠正营养不足，并向患者和家属解释再次手术的风险；4. 如果未来需要在腹壁假体上覆盖皮肤，应将患者转介给整形外科医生；5. 术前进行肠道准备；6. 使用选定的术后快速康复协议；7. 手术技术很重要；8. 不建议同时恢复胃肠道连续性和腹壁重建；9. 复杂再次手术的技术技巧；10. 为手术日做好充分准备。
在经历过先前创伤或急性护理剖腹手术后，对最复杂的患者进行成功的再次剖腹手术需要充分的术前患者准备、明确的手术计划、精湛的术中技术和稳健的决策；即坚定地致力于使患者恢复完整。
