Essay on Surgery Case Studies

Post 1: Laparoscopic Inguinal Hernia Repair Considerations

An inguinal hernia is an abdominal protrusion emanating from the abdominal cavity contents within the inguinal canal. Clinical assessments indicate that about 25% and 2% of males and females respectively develop this condition. In fact, it has been noted that this is the most common type of a hernia in men as well as women. Worth pointing out is that the indirect inguinal hernia remains the dominant case where a right-sided diagnosis is common.

During one of the duty sessions, a male patient was brought to the facility and was directed to our unit. The patient exhibited an abdominal bulge right side of the pubic bone. Upon examination, the patient confessed that there was a burning and sometimes gurgling sensation at the bump. According to the patient, the pain and discomfort in the groin were severe when bending or lifting something as well as when he coughed. To some extent, the pin extended to the scrotum. Based on the clinical assessment, examination, and imaging we noted that the case was an inguinal hernia.

During and after the surgery, it was evident that the post-operative success of laparoscopic inguinal repair depends on the extent to which the practitioners adhere to the procedures and precautions. Some of the fundamentals learned is that during the extraperitoneal (TEP) approach, the placing of the mesh fixation tacks will determine the magnitude of a nerve injury that could be experienced. Therefore, the setting of the tack-nails should be above the iliopubic tract. Although this is challenging in some cases, the drawing of a line from the pubic tubercle to the anterior superior iliac spine is essential in reducing the risk of nerve damage.

For the patient, we ensured that the first consideration was not to violate the peritoneum during repair. Putting more emphasis on this did not lead to the loss of insufflation into the peritoneal cavity from the preperitoneal space. The success of the procedure that we carried out was because we were keen not to compromise the initial stages of the operation since the collapse of preperitoneal space could jeopardize the surgery. According to Carter and Duh (2011), cases of a recurrent hernia is caused by the lack of accurate management of the initial stages of operation, which makes subsequent steps complex. One of the significant considerations learned in this experience is that the role of practitioners in improving the patient outcome during the treatment of an inguinal hernia depends on the adherence to the surgery protocol and efficiency. The postoperative experiences and occurrence of complications are all subject to the precautions undertaken by the practitioners. In fact, Carter and Duh (2011) recommended that one surgeon should be allowed to conduct the laparoscopy for an inguinal hernia to enhance outcome and concentration of experience. Therefore, in future will consider a single-surgeon approach for the laparoscopy process to improve efficiency.

References

Carter, J. and Duh, Q., 2011. Laparoscopic repair of inguinal hernias. World J Surg., Vol. 35, Iss. 7, pp. 1519 1525.

Post 2: Appendicitis Consideration in an Adolescent Male Patient

For appendicitis case, the patient is often characterized by frequent or spontaneous inflammation in the appendix. The human appendix is an extension of the large intestine with a limited role in the body unless for speculations around the immunity of the gut. However, scientific studies show that one can live without it due to its little or no apparent consequences to the body. As well, one in every 20 people is likely to experience cases of appendicitis with the susceptible age raging between 10 and 30. In such a consideration, the demonstration of appendicitis is considered a medical emergency that necessitates for immediate surgery to remove the appendix (Plumley, 2013). The therapeutic intervention is often perceived since the condition may worsen if the left untreated by either bursting or perforating to affect surrounding cells and tissues in the abdominal cavity. The fatality of the appendicitis is considerably low to high depending on the nature of the inflammation on the peritoneum lining. The condition is often enhanced by the blockage of the appendix by a foreign material or as a result of an infection.

As I was performing dayshift in operation, a case of a 14-year-old male patient was presented to me. The patient showed pain in the around the nave and the lower right abdomen. Episodes of vomiting and nausea were noted from the patient, especially after the appearance of the abdominal pains. The patient indicated reduced appetite and constipation with difficulties passing out gas and urine. From the physical examination, fever was detected from the high body temperatures of 100 degrees Fahrenheit. I noted scar tissues are peeling off the appendix in the abdominal cavity with the depiction of pus-filled abscesses surrounding the inflamed appendix. Such a scenario indicated progress in the infection that might have caused peritonitis, which is considered deadly if it could have perforated or exploded.

I classified the condition as emergency and recommended for an appendectomy as the standard treatment for the situation. Before I carried out the appendectomy, I injected the patient with antibiotics to fight against the occurrence of peritonitis and then administered general anesthesia. I, therefore, proceeded to the operation room for surgery to quickly remove the appendix preventing from possible rapture in the peritoneum. I conducted the operation using a four-inch incision. However, due to the formation of the abscess, I had to begin by draining the pus and fluid before removing the appendix.

During the surgical operation, I realized that the patient had engaged in massive eating and drinking before presenting the case, which challenged the surgery. In future, I would urge that patient are not supposed to eat before visiting the health facility or using over-the-counter drugs that might affect the validity of the outcomes. As well, upon detection of the first sign of abdominal pain, they should rush to the hospital for medical attention to avoid the worse situation of appendix rupture. More so, I would encourage my peers to use laparoscopy during the surgery to enhance the recovery process and minimize the incision cut.

References

Plumley, D. A. (2013). Miscellaneous: Acute Appendicitis. Handbook of Pediatric Surgical Patient Care, 759-768. doi:10.1142/9789814287890_0065

Post 3: Achalasia in a 12-year-old Female Adolescent

Rarely do an individual demonstrated cases of achalasia yet it is a condition of the muscle in the lower part of the esophagus and lower esophageal sphincter preventing muscle relaxation and contraction. Such a consideration preclude the occurrence of peristalsis in the esophageal body. The causative agents in the development of achalasia have not been adequately established, but researchers have speculated around the degeneration of esophageal muscles or nerves responsible for the regulation of the tissues. Some theories have suggested that achalasia is an autoimmune disease claiming that it is caused by abnormalities in the immune system. The nerves in the esophagus are responsible for the coordination of the relaxation to open the sphincters and peristaltic waves in the body. The disease can be experienced across different age groups. About 80-90% of patients with the condition are likely to report effective treatment after possible surgical operation making it a better option for most patients (Fisichella et al., 2016).

As I was attending to work duties during my work shift, I was presented with a case of female, adolescent, who had demonstrated chest pain, difficulty in swallowing food through the esophagus and chances of regurgitation on food and liquids intake. The patient described complications in breathing and from the records decline in weight loss had been experienced. With such examinations, I recommended for esophageal manometry to diagnose the presence of achalasia. The diagnostic report confirmed the abnormalities in the lower sphincter and esophageal body that accounted for the blockage of the esophagus depicted by the mild-pressure waves in the manometers by insufficient for pushing down food to the stomach.

In the treatment of the achalasia condition, I opted for surgery to assist in the removal of the sphincter, a process known as esophagomytomy. I performed the surgical operation using large abdominal incision to open for a sizeable cut. I consider the treatment more effective as opposed to forced constriction since it allows for the reduction of pressure in the lower sphincter. However, I suppose that better modalities of treatment should be developed since surgery is often challenged in some patients with the reflux of acid causing gastroesophageal reflux condition.

From the patients scenario, I would recommend that individual should seek early treatment of the detection of a possible problem with their regular swallowing habits that to avoid the complications. My peers should note the difference in achalasia, esophageal stricture, and esophageal cancer, where former shows difficulty in swallowing for both solid and liquid contents. In future, I would comprehend the use of laparoscopy in the surgical removal of the sphincter muscle by making small punctures in the abdomen, especially for complicated cases of achalasia. I would suggest that from the signs and symptoms presented in the patient, the health professional should limit the exposure of the patient to x-rays for diagnosis or recommend esophageal manometry during the early stages. Furthermore, due to possible complications after surgery, I can advise on the life-long oral medication among patients with the condition to avoid chances of acid reflux or a combination of esophagomyotomy with anti-reflux surgery.

References

Fisichella, P. M., Orthopoulos, G., Holmstrom, A., & Patti, M. G. (2016). The Surgical Management of Achalasia in the Morbid Obese Patient. Achalasia, 93-98.