tag:blogger.com,1999:blog-2760353953251845523.post112268133123700939..comments2024-02-10T02:14:39.898-05:00Comments on Buckeye Surgeon: Shifting Appendectomy ConsensusJeffrey Parks MD FACShttp://www.blogger.com/profile/15650563299849196122noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-2760353953251845523.post-40725768086017860882011-03-24T00:40:23.676-04:002011-03-24T00:40:23.676-04:00Are you concerned about possibly having to do a bi...Are you concerned about possibly having to do a bigger resection if you find a phlegmon of the cecum by this approach?just some surgery residentnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-54422339036088237932011-03-22T02:58:50.338-04:002011-03-22T02:58:50.338-04:00When do you decide that you prefer open to lap?
M...When do you decide that you prefer open to lap?<br /><br />My last hospital had a rule - no lap appendix under 12. I think a registrar (resident) stuck a trocar into a common iliac.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-68662622587462687562011-03-18T13:08:52.931-04:002011-03-18T13:08:52.931-04:00i personally take it out. but that's just me. ...i personally take it out. but that's just me. i like to cut.Bongihttps://www.blogger.com/profile/12918640034313468627noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-81579608496698216722011-03-17T10:09:37.316-04:002011-03-17T10:09:37.316-04:00I'm glad you hold these views as an America su...I'm glad you hold these views as an America surgeon. I think this represents a return to sanity, actually. We speak of observing, antibiotics, CT/US guided drainage, etc. - all of which are nicely summed-up as "dicking around" in these situations. However, these patients suffer. And they suffer longer and harder then they should, it's not just about "faster returning to normal activities". This "new" approach is actually the oldest, in agreement with the fundamental surgical principle of removing all infection and infection sources that are surgically accessible, as soon as the patient is ready. And the majority of patients are readier as they're ever going to be. I mean... perforated appendix.<br /><br />I think the "dicking around" you speak of is a trait of the well developed healthcare systems (i.e. the American one), which manifest the inherent tendency to rely heavily on the technology at hand and to push things further than necessary or advisable, just to put all that technology to use and, possibly, justify some costs.<br /><br />Eastern European schools of surgery have been succesfully using this "new" approach for decades, simply because there was no CT-guided drainage alternative at hand. And, beyond evidence-based literature, this approach was and still is the most succesful, if only because appendicectomy, peritoneal lavage and drainage IS the surgical treatment for peritonitis secondary to perforated appendicitis. Why "dick around"?Paracelsushttp://netarhia.com/paracelsusnoreply@blogger.com