Aetiology and Impact of Intra-abdominal Sepsis on Surgical Management

An overview of intra-abdominal sepsis is necessary at this time with new experimental studies and audits on management outcomes. The understanding of the pathophysiology of the peritoneum in the manifestation of surgical sepsis and the knowledge of the source of pathogenic organisms which reach the peritoneal cavity are crucial to the prevention of intra-abdominal infection. Recent advances in interventional techniques for peritonitis have significantly reduced the morbidity and mortality of physiologically severe complicated abdominal infection. Sepsis is an evolving process and the sequelae reflect the increasing severity of the systemic response to infection. Prevention entails early recognition, prompt resuscitation and early surgical intervention to abort the process. Sepsis represents a major clinical challenge and their management demands a multidisciplinary approach

Surgical Measures to Reduce Infection in Open Colorectal Surgery

Post-operative infection is an important complication of colorectal surgery and continued efforts are needed to minimize the risk of infection. A better understanding about susceptibility to infections will explain why a patient with minimal bacterial contamination at surgery may develop a pelvic abscess whereas another patient with massive faecal contamination after stercoral perforation of the colon may not develop infective complications. The most important factor in determining post-operative sepsis is the presence of viable organisms in the surgical field prior to wound closure. This review focuses on aspects of operative techniques that reduce infection in colorectal surgery. Despite antibiotic prophylaxis and therapy, the inadequate attention to technique and incorrect surgical decision making (i.e. surgeon-related factor) remain the single most important factor that can influence the morbidity and mortality from sepsis in colorectal surgery

The Systemic Response to Surgical Trauma – A review

Better understanding of the systemic response to surgical trauma will enhance the perioperative care of the patient. This will enhance recovery; reduce morbidity, length of hospital stay and cost. The new insight of enhanced recovery is based on the physiological principles of minimizing surgical stress by limiting the initiating factors. This is manifested by avoiding the stress hormones using thoracic epidural anaesthesia and minimally invasive (laparoscopic) surgery; avoiding stressinduced diabetes (hyperglycaemia) by pre-operative anabolic setting of the patient and avoiding fasting; treating hyperglycaemia with insulin; postoperative pain control with epidural analgesia and, early postoperative feeding and mobilization.Survival is determined by physiology rather than anatomy. Enhanced recovery has challenged traditional perioperative care