complex surgery on global stage
VISAKHAPATNAM: Accident victims with multiple injuries are often known
to suffer serious complications due to intra-abdominal pressure, despite
there being no injury to the abdomen and despite them being under the
best medical care.
Doctors attribute this to a condition known as Abdominal Compartment Syndrome (ACS), which requires complex surgical management. ACS is a known cause of multiple-organ dysfunction in 20-30% of poly-trauma (multiple injuries) cases, where the patient may not have any injury on the abdomen but still succumbs because of pressure building up inside the abdomen that constricts blood flow to the heart. By the time the complex surgery is undertaken, the patient might suffer multiple organ failure and die.
A city-based doctor and an alumnus of Andhra Medical College and All India Institute of Medical Sciences, Delhi, who has done extensive research on this, will present a paper on ACS at an international surgical conference being held in Turkey by the European Society for Surgical Research between May 29 and June 1. Dr Subhash Chandra Dadhich has been successful in reducing mortality in poly-trauma cases by surgically reducing the pressure inside the abdomen and easing blood supply to vital organs at the appropriate time.
Dr Dadhich's research, published in the Indian Journal of Surgery, emphasized on the right timing of the surgery - the cutoff point is when the intra-abdominal pressure rises to 25 mm mercury (25 mm hg) and one needs to be prepared for surgical management when the pressure reaches 16 mm hg.
"This abdominal surgery, where the intestines are brought out of the abdomen to normalise pressure and blood flow, is done usually in trauma cases. But by the time the surgery is undertaken, it becomes too late and often the patient succumbs. The surgeon and his team should realise the correct time for the surgery," said Dr G Arjuna, a general and laparoscopic surgeon at King George Hospital.
"As intra-abdominal pressure rises in some poly-trauma cases, the blood vessels get compressed, reducing blood supply to vital organs and leading to kidney and liver failure. Therefore, when the pressure rises to 25 mm hg, the abdomen is opened up vertically from the xiphisternal joint (the meeting point of the chest and abdomen) to the pelvic bone," said Dr Dadhich.
"A catheter in the urinary bladder connected to the monitor is used to check the intra-abdominal pressure. The swelled up intestines pop out of the abdomen. The abdomen is kept open for a few days with special suction dressing applied to it while the patient is in the ICU," he said.
"After a few days, the patient is taken back to the operation theatre and an attempt is made to close the abdomen. If this is not possible because of swelling, a split skin graft is taken from the patient's thighs and the abdomen is closed. This results in a ventral or incisional hernia and the patient is sent home with all precaution," said the surgeon.
"After six months, when the patient's pressure normalises and the swelling subsides, the patient is readmitted, the skin covering removed, intestines put back and the abdomen closed normally," Dadhich explained.
Doctors attribute this to a condition known as Abdominal Compartment Syndrome (ACS), which requires complex surgical management. ACS is a known cause of multiple-organ dysfunction in 20-30% of poly-trauma (multiple injuries) cases, where the patient may not have any injury on the abdomen but still succumbs because of pressure building up inside the abdomen that constricts blood flow to the heart. By the time the complex surgery is undertaken, the patient might suffer multiple organ failure and die.
A city-based doctor and an alumnus of Andhra Medical College and All India Institute of Medical Sciences, Delhi, who has done extensive research on this, will present a paper on ACS at an international surgical conference being held in Turkey by the European Society for Surgical Research between May 29 and June 1. Dr Subhash Chandra Dadhich has been successful in reducing mortality in poly-trauma cases by surgically reducing the pressure inside the abdomen and easing blood supply to vital organs at the appropriate time.
Dr Dadhich's research, published in the Indian Journal of Surgery, emphasized on the right timing of the surgery - the cutoff point is when the intra-abdominal pressure rises to 25 mm mercury (25 mm hg) and one needs to be prepared for surgical management when the pressure reaches 16 mm hg.
"This abdominal surgery, where the intestines are brought out of the abdomen to normalise pressure and blood flow, is done usually in trauma cases. But by the time the surgery is undertaken, it becomes too late and often the patient succumbs. The surgeon and his team should realise the correct time for the surgery," said Dr G Arjuna, a general and laparoscopic surgeon at King George Hospital.
"As intra-abdominal pressure rises in some poly-trauma cases, the blood vessels get compressed, reducing blood supply to vital organs and leading to kidney and liver failure. Therefore, when the pressure rises to 25 mm hg, the abdomen is opened up vertically from the xiphisternal joint (the meeting point of the chest and abdomen) to the pelvic bone," said Dr Dadhich.
"A catheter in the urinary bladder connected to the monitor is used to check the intra-abdominal pressure. The swelled up intestines pop out of the abdomen. The abdomen is kept open for a few days with special suction dressing applied to it while the patient is in the ICU," he said.
"After a few days, the patient is taken back to the operation theatre and an attempt is made to close the abdomen. If this is not possible because of swelling, a split skin graft is taken from the patient's thighs and the abdomen is closed. This results in a ventral or incisional hernia and the patient is sent home with all precaution," said the surgeon.
"After six months, when the patient's pressure normalises and the swelling subsides, the patient is readmitted, the skin covering removed, intestines put back and the abdomen closed normally," Dadhich explained.
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