Search results for ""author jaime ruiz-tovar""

Postoperative pain is a common problem in clinical practice that becomes chronic in approximately 10% to 30% of adults who undergo surgery, being severe in 5 to 10% of them. It is one of the main causes of chronic pain, which makes it a major public health problem. It generates in patients who suffer it a worsening of their quality of life, their psychological well-being, and disability with the consequent incapacity for work. Given that both its aetiology and its consequences are complex and multifactorial, postoperative pain must be approached from a multimodal perspective: preventive, pharmacological, nutritional, rehabilitative, nursing intervention, psychological and, in those refractory cases, through surgical approaches or nerve block techniques. This book aims at first to analyse the pathophysiological and psychological bases that underlie its aetiology. Next, it aims to carry out an updated review of the multidisciplinary programs for the treatment of postoperative pain that have been carried out and what their results have been. Moreover, the contribution of each of these disciplines in the ambulatory management of postoperative pain will be reviewed. Finally, we want to study the peculiarities of the management of this type of pain in the oncological patient, as well as the personal and socioeconomic consequences and the increase in other comorbidities of this important reason for consultation.

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Diverticular disease is one of the most common problems encountered by gastroenterologists, emergency physicians and surgeons, with a higher prevalence in elderly patients and a dramatic rising of incidences in young people, which involve an increase in health care costs, according to ambulatory visits and hospital admissions. Acute diverticulitis, the most important complication of diverticular disease, has a broad spectrum of severity, which involves many treatment options, ranging from outpatient-based antibiotic treatment, or even isolated nonsteroidal anti-inflammatory drugs, to parenteral antibiotic regimen, percutaneous drainage or surgery (lavage and drainage, Hartmann procedure or resection with anastomosis with or without a diverting stoma). The American Society of Colon and Rectal Surgeons recommended in their guidelines a routine follow-up colonoscopy after recovery from an acute episode to rule out malignancy, which is being re-evaluated in recent studies, including the alternative CT-colonography, especially in cases of incomplete colonoscopy or in high-risk patients. After an episode of acute diverticulitis, there is a significant risk of recurrence and a negative impact on quality of life. In order to decrease it, there are many treatments that are being evaluated such as fiber-rich diet, mesalazine, rifaximin, probiotics and elective colon resection, which should be decided individually. The aim of this book is to revise the current evidence about the diverticular disease and acute diverticulitis.

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Enhanced recovery after surgery (ERAS) programs are a multidisciplinary approach in the perioperative care of the patient undergoing major surgery, including pre, intra and postoperative measures, based on the actual evidence published in literature (evidence-based medicine), to improve the postoperative recovery of the patient. ERAS protocols have been widely developed in colorectal surgery, but, given their excellent results, new protocols and guidelines have been developed in other surgical fields, including abdominal and extra-abdominal areas. In the last decade, several ERAS protocols have been implemented worldwide in bariatric surgery, confirming their safety and advantages of ERAS approaches, even on morbidly obese patients. The aim of this book is to update the actual evidence about ERAS protocols on bariatric surgery, analysing separately the different components and multidisciplinary approach of the ERAS programs.

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The use of electrical stimulators with medical aims has increased exponentially in the last years. The uses are very different. Though the most widely known are referred to as the approaches performed by neurosurgeons, evidence has recently appeared, supporting its use by many other medical specialties. Electrical stimulation can be applied transcutaneously (TENS) or percutaneously (PENS). The target of electrical stimulation can be a nerve, inducing electric conductivity and finally acting over the innervated structure, which is activated, or starting a reflex with the involvement of the spinal cord. The stimulation can also act directly over a muscle, inducing a contraction. The effects of electrical stimulation are very diverse, ranging from the development of an artificial reflex and consequently activating the stomach, the pancreas or a sphincter, to a continuous muscular contraction, provoking hypertrophia of the structure and hyperfunction, or to the identification of a laryngeal recurrent nerve during a thyroidectomy, avoiding its damage. Moreover, electrical stimulation has been also used to reduce the feeling of pain, as the stimulation of somatic fibers somehow masks the transmission of nociceptive ones. The aim of this book is to revise the actual evidence about the different uses of electrical stimulation by digestive and endocrine surgeons.

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Surgical site infection (SSI) is one of the most frequent complications after abdominal surgery as abdominal procedures are often clean-contaminated, contaminated or even dirty procedures, so long the gastrointestinal tract, plenty of microorganisms, is entered. SSI is associated with morbidity and mortality, and reduces the patients' quality of life after surgery. Moreover, it prolongs hospital stay and requires increased instrumentation, medication and complementary tests, altogether representing an economic burden for the Health Services. This has led to the development of several Guidelines and Consensus documents, including prophylactic measures to prevent SSI. Different scientific societies, including the World Health Organization (WHO), the Center for Disease Control (CDC), the American College of Surgeons (ACS) and the Surgical Infection Society (SIS), have published recommendations for the prevention of SSI in the last years. All the documents agree with most of the recommendations. However, the evidence grade of these recommendations is often low to moderate and with the aim to generalise these measures to all the surgical procedures, the extrapolations lead to a lowered evidence power. Thus, in some cases the force of the recommendations is based on the opinion of experts in the field. The aim of this book is to revise the actual evidence about these prophylactic measures in abdominal surgery.

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