Abstract
Initial nonoperative management of patients with acute pathology is commonplace for several disorders. Inherent in this decision is the belief that surgery is best performed in a delayed fashion (when conditions are more favorable, both for the patient and the surgeon) or that surgery can be avoided altogether. However, despite our best intentions, nonoperative management will fail in a certain subset of patients initially believed to benefit from such an approach. In this chapter, we will discuss when to consider operative management (and, consequently, how to recognize that nonoperative management has failed) for several common conditions seen by general and acute care surgeons. Since these topics have already been described elsewhere in the text, details regarding epidemiology, diagnostic evaluation, and specific operative approaches will only briefly be discussed.
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Bibliography
Busch OR, van Delden OM, Gouma DJ. Therapeutic options for endoscopic hemostatic failures: the place of the surgeon and radiologist in gastrointestinal tract bleeding. Best Pract Res Clin Gastroenterol. 2008;22(2):341ā54.
Cappell MS. Therapeutic endoscopy for acute upper gastrointestinal hemorrhage. Nat Rev Gastroenterol Hepatol. 2010;7(4):214ā29.
Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, Pepin J, Wilcox MH, Society for Healthcare Epidemiology of America, Infectious Diseases Society of America. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431ā55.
Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010;97:141ā50.
Hayanga AJ, Bass-Wilkins K, Bulkley GB. Current management of small-bowel obstruction. Adv Surg. 2005;39:1ā33.
Hirota M, Takada T, Kawarada Y, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg. 2007;14:78ā82.
Jacobs DO. Clinical practice. Diverticulitis. N Engl J Med. 2007;357(20):2057ā66.
Millward SF. ACR appropriateness criteria on treatment of acute nonvariceal gastrointestinal tract bleeding. J Am Coll Radiol. 2008;5(4):550ā4.
Olivas AD, Umanskiy K, Zuckerbraun B, Alverdy JC. Avoiding colectomy during surgical management of fulminant Clostridium difficile colitis. Surg Infect (Larchmt). 2010;11(3):299ā305.
Rafferty J, Shellito P, Hyman NH, Buie WD, Standards Committee of American Society of Colon and Rectal Surgeons. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006;49(7):939ā44.
Sosa J, Gardner B. Management of patients diagnosed as acute intestinal obstruction secondary to adhesions. Am Surg. 1993;59(2):125ā8.
Strasberg SM. Clinical practice. Acute calculous cholecystitis. N Engl J Med. 2008;358:2804ā11.
Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, Carter R, Di Magno E, Banks PA, Whitcomb DC, Dervenis C, Ulrich CD, Satake K, Ghaneh P, Hartwig W, Werner J, McEntee G, Neoptolemos JP, Buchler MW, International Association of Pancreatology. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology. 2002;2(6):565ā73.
Whitcomb DC. Clinical practice. Acute Pancreatitis. N Engl J Med. 2006;354(20):2142ā50.
Zielinski MD, Eiken PW, Bannon MP, Heller SF, Lohse CM, Huebner M, Sarr MG. Small bowel obstruction-who needs an operation? A multivariate prediction model. World J Surg. 2010;34(5):910ā9.
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Watson, G.A., Peitzman, A.B. (2016). When to Operate After Failed Nonoperative Management. In: Fingerhut, A., LeppƤniemi, A., Coimbra, R., Peitzman, A., Scalea, T., Voiglio, E. (eds) Emergency Surgery Course (ESCĀ®) Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-21338-5_6
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DOI: https://doi.org/10.1007/978-3-319-21338-5_6
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