Emergency laparoscopic surgery in the elderly and frail patient

Foreword
Preface
Contents
Part I: Generalities
	1: How to Define an Elderly and Frail Patient?
		1.1	 How to Define Elderly?
		1.2	 How Often Do We Face an Elderly Patient in the General Population and Surgical Practice?
		1.3	 Should the Operative and Perioperative Approach Be Different in Elderly Patients?
		1.4	 How to Define Frailty?
		1.5	 How Often Can Do Face a Frail Patient in General Population and Surgical Practice?
		1.6	 How Does a Patient Become Frail?
		1.7	 Is an Older Patient Always Frail Too and Vice Versa?
		1.8	 What Is the Conceptual Difference Among Frailty, Multimorbidity, and Disability?
		1.9	 Are There Any Therapeutic Methods to Prevent, Contrast, or Treat the Frailty Process?
		1.10	 How Does Frailty Modify the Surgical Approach and Outcome?
		References
	2: Defining the Burden of Emergency General Surgery in the Elderly Today
		2.1	 Introduction
		2.2	 Older Patients and Emergency Surgery
			2.2.1	 Diagnostic and Therapeutic Challenges
			2.2.2	 Multidisciplinary Approach and Comprehensive Geriatric Assessment (CGA)
		2.3	 Screening and Assessment of Frailty in EGS
			2.3.1	 Frailty and EGS
			2.3.2	 Assessment of Frailty in EGS
		2.4	 Care Plan from Admission to Discharge
			2.4.1	 Clinical Assessment and Preoperative Optimization
			2.4.2	 Minimally Invasive Techniques in EGS in Elderly
		2.5	 Outcomes After EGS in Elderly
			2.5.1	 Acute Postoperative Monitoring
			2.5.2	 Cognitive Impairment
			2.5.3	 Loss of Independence and Recurrent Hospitalization
		References
	3: A Worldwide Overview of Emergency Laparoscopic Procedure in the Elderly
		3.1	 Introduction
		3.2	 Acute Calculous Cholecystitis (ACC)
		3.3	 Acute Appendicitis
		3.4	 Colorectal Cancer (CRC)
		3.5	 Acute Left-Side Colonic Diverticulitis (ALCD)
		3.6	 Small Bowel Obstruction
		3.7	 Perforated Peptic Ulcer
		References
			Appendix
	4: The Economic Burden of Emergency Abdominal Surgery in the Elderly: What Is the Role of Laparoscopy?
		4.1	 Introduction
		4.2	 Emergency Surgery in the Elderly Patients
		4.3	 The Economic Burden
		4.4	 Common Postsurgery Consequences for Elderly
		4.5	 The Surgery Procedure Innovation
		4.6	 The Economic Impact of Emergency Abdominal Laparoscopic Surgery on the Elderly Patients
		4.7	 Concluding Remarks
		References
	5: Goals of Care in Emergency Abdominal Surgery in the Elderly and Frail Patient
		5.1	 Introduction
		5.2	 Frailty Degree and Preoperative Predictive Factors: Evaluation of Surgical Patient
		5.3	 What Kind of Procedure? Variables for Decision-Making Process
		5.4	 Goals of Care and Optimization of Therapeutic Management
			5.4.1	 Preoperative Conditions
			5.4.2	 Intraoperative Management
			5.4.3	 Postoperative Management
		5.5	 Complications in Frail and Elderly Patients
		5.6	 Conclusion
		References
	6: Wound Healing in Elderly and Frail Patients
		6.1	 Laparoscopy in the Elderly, Inflammatory Response, and Reduction of Complications in Emergency Surgery
		6.2	 Minimally Invasive Surgery in the Elderly and Choice of the Correct Surgical Incision
		References
Part II: Surgery
	7: Acute Cholecystitis
		7.1	 Introduction
		7.2	 Diagnosis
			7.2.1	 History and Physical
			7.2.2	 Systemic Signs of Inflammation
		7.3	 Should We Operate on Elderly and Frail Patients?
			7.3.1	 Does Advanced Age Increase the Risk for Surgery?
			7.3.2	 Is Age an Independent Risk Factor?
			7.3.3	 What Is the Risk of Not Operating?
				7.3.3.1	 Mortality and Morbidity
				7.3.3.2	 Recurrence and Readmission
		7.4	 Laparoscopic or Open Cholecystectomy in Advanced Age?
			7.4.1	 Could Open Surgery Be Advantageous?
		7.5	 Early or Delayed
			7.5.1	 Should we Delay Surgery in Elderly and Frail Patients?
		7.6	 Percutaneous Cholecystostomy
			7.6.1	 The Observational Studies
			7.6.2	 The Randomized Trials
		7.7	 Is a Tailored Approach Possible?
		7.8	 Conclusions
		References
	8: Cholangitis and Choledocholithiasis
		8.1	 Introduction
		8.2	 Choledocholithiasis
			8.2.1	 Diagnosis
			8.2.2	 Therapy
			8.2.3	 Is Cholecystectomy Necessary After CBD Clearance?
		8.3	 Acute Cholangitis
			8.3.1	 Diagnosis
			8.3.2	 Therapy
		References
	9: Gallstone Ileus
		9.1	 Introduction and Epidemiology
		9.2	 Clinical Presentation
		9.3	 Diagnosis
			9.3.1	 Abdominal X-ray
			9.3.2	 Computed Tomography (CT)
			9.3.3	 Abdominal Ultrasonography
			9.3.4	 Magnetic Resonance Imaging (MRI)
			9.3.5	 Esophagogastroduodenos copy
		9.4	 Treatment
		9.5	 Conclusions
		References
	10: Acute Pancreatitis Management in Elderly/Frail Patients
		10.1	 Introduction
		10.2	 Revised Atlanta Classification (RAC)
		References
	11: Acute Appendicitis
		11.1	 Introduction
			11.1.1	 Acute Appendicitis in the Elderly: The Scale of the Problem
			11.1.2	 Risk Factors for Perforation
			11.1.3	 Diagnostic Issues in Acute Appendicitis in the Elderly and Frail Patient
			11.1.4	 Timing of Appendectomy
			11.1.5	 Laparoscopic Appendectomy
				11.1.5.1	 Laparoscopic Appendectomy for Complicated Appendicitis with Phlegmon or Abscess
				11.1.5.2	 Technical Aspects
			11.1.6	 Risk Factors Predictive for Postoperative Morbidity Following Appendectomy
			11.1.7	 Nonoperative Treatment
				11.1.7.1	 The Risk of Missing Appendiceal Tumors
				11.1.7.2	 Interval Appendectomy
		References
	12: Non-specific Abdominal Pain
		12.1	 Definition and Epidemiology
		12.2	 Baseline Investigations
		12.3	 Imaging
		12.4	 Frailty Score
		12.5	 Management: Early Laparoscopy Versus Wait-and-See
		12.6	 Conclusions
		References
	13: Perforated Gastroduodenal Ulcer
		13.1	 Introduction
		13.2	 Clinical Presentation and Diagnostic Procedures
		13.3	 Management of the Patient
		13.4	 Selection of Patients for Surgery
		13.5	 Surgical Procedure
		13.6	 ERAS Programme
		References
	14: Gastric Outlet Obstruction in the Elderly
		14.1	 Introduction
		14.2	 Pathogenesis
		14.3	 Presentation and Workup
		14.4	 Goals of Palliative Intervention: Endoscopic and Surgical Management
		14.5	 Perioperative Care
		14.6	 Surgery
		14.7	 Laparoscopic Stomach Partitioning Gastrojejunostomy: Step-by-Step Technique
		14.8	 GOO for Acute Gastric Volvolus: A Surgical Emergency
		14.9	 Conclusion
		References
	15: Obstructing Colorectal Tumor
		15.1	 Introduction
		15.2	 Diagnostic Workup and Initial Care
		15.3	 Right-Sided Malignant Colonic Obstruction
		15.4	 Left-Sided Malignant Colonic Obstruction
			15.4.1	 Hartmann’s Procedure
			15.4.2	 Resection and Primary Anastomosis
			15.4.3	 Subtotal Colectomy
		15.5	 Bridging Strategies
			15.5.1	 Self-Expanding Metal Stent SEMS
			15.5.2	 Decompressing Stoma
			15.5.3	 Stent as a Bridge to Elective Surgery Versus Diverting Stoma as a Bridge to Surgery
		15.6	 Palliative Treatment
		References
	16: Acute Diverticulitis
		16.1	 Epidemiology in Elderly People
		16.2	 Surgery in Diverticulitis
		16.3	 Impact of Age over Treatment
		16.4	 Technical Considerations
			16.4.1	 Approach to Surgery: Laparoscopy or Laparotomy?
			16.4.2	 Colonic Resection: One-Stage or Two-Stage Procedure?
			16.4.3	 Laparoscopic Peritoneal Lavage
		References
	17: Small Bowel Obstruction
		17.1	 Introduction
		17.2	 Epidemiology
		17.3	 Pathophysiology
		17.4	 Clinical Presentation and Differential Diagnosis
		17.5	 Radiology
		17.6	 Management
		17.7	 Laparoscopic Surgical Strategy and Technique: Tips and Tricks
		References
	18: Incarcerated Inguinal and Crural Hernias
		18.1	 Incarcerated Inguinal and Crural Hernias
		References
	19: Incarcerated Incisional and Ventral Hernias in the Elderly and Frail Patient
		19.1	 Introduction
		19.2	 Pathophysiology
		19.3	 Diagnosis
		19.4	 Identification of the Presence of Incarceration
		19.5	 Preoperative Preparation
		19.6	 Laparoscopic Technique
		19.7	 Conclusions
		References
	20: Abdominal Trauma in the Elderly
		20.1	 Introduction
		20.2	 Changes in the Elderly
		20.3	 Mechanisms of Injury
		20.4	 Abdominal Trauma in the Elderly
		20.5	 Trauma Laparoscopy in the Elderly
		20.6	 Diagnostic Laparoscopy Technique
		20.7	 Anticoagulation
		References
			Further Reading
			Guidelines
	21: Laparoscopic Approach to Acute Mesenteric Ischemia in Elderly Patients
		21.1	 Introduction
		21.2	 Diagnostic Value of Laparoscopy in AMI
			21.2.1	 First-Look Exploration
			21.2.2	 Second-Look Exploration
		21.3	 The Role of Laparoscopy in the Treatment of AMI
		References
	22: Open Abdomen in the Elderly
		22.1	 Introduction
		22.2	 Technique
		22.3	 Results
		References
	23: Gynaecologic Emergencies
		23.1	 Introduction
		23.2	 Intra-abdominal Haemorrhage in the Elderly
		23.3	 Adnexal Torsion in Elderly
		23.4	 Traumatic Injuries and Cuff Dehiscence Post-hysterectomy
		23.5	 Pyometra Perforation
		References
	24: Bedside Laparoscopy in the Elderly and Frail Patient
		24.1	 Definition and Rationale for Use
		24.2	 History of Application
		24.3	 Advantages and Indications
		24.4	 Contraindications and Potential Adverse Effects
		24.5	 Results and Complications
		24.6	 Technique: Rules and Pitfalls
		References
	25: Emergency Video-Assisted Thoracoscopy in the Elderly
		25.1	 Introduction
		25.2	 Indications for Thoracoscopy
		25.3	 Hemothorax
		25.4	 Diaphragmatic Injury
		25.5	 Esophageal Perforation
		25.6	 Descending Necrotizing Mediastinitis
		References
	26: Palliative Surgery for Oncologic Elderly Patients in Emergency
		26.1	 Introduction
		26.2	 Epidemiology
		26.3	 Multidimensional Geriatric Evaluation in the Emergency Surgical Patient
		26.4	 An Overview of Palliative Cancer Surgery
		26.5	 Palliation for Colorectal Obstructions
		26.6	 Palliation for Gastric Cancer
		26.7	 Palliation for Pancreatic Cancer
		References
	27: Emergency Robotic Surgery for Acute Abdomen in the Elderly
		27.1	 Introduction
		27.2	 Robotic Surgery in the Emergency Setting
		27.3	 Robotic Surgery in Elderly Patients
		27.4	 Conclusions
		References
Part III: Perioperative Care
	28: Enhanced Recovery After Emergency Surgery in the Elderly
		28.1	 Introduction
		28.2	 Eras in Emergency and Frail Patients
		28.3	 Eras and Laparoscopy
		References
	29: Antibiotics in Emergency Abdominal Surgery in the Elderly
		29.1	 Introduction
		29.2	 The Management of Infections in Elderly People
		29.3	 Antibiotic Therapy in Elderly Patients
		29.4	 Elderly Patients and Antimicrobial Resistance
		29.5	 Conclusions
		References
	30: Imaging and Interventional Radiology in Emergency Abdominal Surgery in the Elderly
		30.1	 Imaging Approach to the Elderly Patients with Acute Abdominal Pain/Acute Abdomen
			30.1.1	 Abdominal Radiographs
				30.1.1.1	 Main Findings
				30.1.1.2	 Pros and Cons
			30.1.2	 Ultrasound
				30.1.2.1	 Main Findings
				30.1.2.2	 Pros and Cons
			30.1.3	 CT Scan
				30.1.3.1	 Pathological Findings
				30.1.3.2	 Pros and Cons
		30.2	 Role of Radiology in Patient Management
			30.2.1	 Acute Cholecystitis
			30.2.2	 Intestinal Diseases
				30.2.2.1	 Acute Appendicitis
			30.2.3	 Diverticulitis
			30.2.4	 Bowel Obstruction
			30.2.5	 Alimentary Tract Perforations
		References
	31: Anesthesia and Emergency Laparoscopy in the Elderly Patient
		31.1	 Physiology Considerations in the Elderly Patient
		31.2	 Laparoscopy and Organ and System Modification
		31.3	 Preoperative Care
		31.4	 Intraoperative Care
		31.5	 Anesthetic Technique
			31.5.1	 Premedication
			31.5.2	 Positioning on the Operating Table
			31.5.3	 Intraoperative Monitoring
		31.6	 General Anesthesia
			31.6.1	 Hypnotic Drugs and Anesthesia Induction
			31.6.2	 Opioid Analgesics
			31.6.3	 Dexmedetomidine
			31.6.4	 Neuromuscular Blocking Agents
		31.7	 Risk of Aspiration and Rapid Sequence Induction
		31.8	 Intraoperative Fluid Management
		31.9	 Regional Anesthesia Techniques
		31.10	 Postoperative Care
			31.10.1	 Pain Management
			31.10.2	 Postoperative Delirium
		31.11	 Conclusions
		References
	32: PONV and Pain Management
		32.1	 PONV
		32.2	 Pain Management
		References
	33: The Geriatrician Point of View
		33.1	 Introduction
		33.2	 Geriatric Patients: Clinical Characteristics
		33.3	 Establishing Goals of Care and Surgery
		33.4	 Preoperative Assessment: Risk Stratification
		33.5	 Postoperative Care and Prevention of Geriatric Complications
			33.5.1	 Function and Mobility Preservation
			33.5.2	 Delirium
			33.5.3	 Malnutrition
			33.5.4	 Postoperative Pain
			33.5.5	 Postoperative Pulmonary Complications
			33.5.6	 Postoperative Cardiovascular Complications
			33.5.7	 Urinary Tract Infection
			33.5.8	 Pressure Ulcers
		33.6	 Hospital Discharge and Continuity of Care
		33.7	 Conclusions
		References
	34: Perioperative Nutritional Management of Elderly Patients
		34.1	 Introduction
		34.2	 Preoperative Nutritional Screening and Assessment
		34.3	 Preoperative Nutritional Interventions
		34.4	 Intraoperative Strategies
		34.5	 Postoperative Nutritional Management
		34.6	 Post-discharge Follow-Up
		References
	35: Emergency Laparoscopy in the Elderly and Frail Patient: Perioperative Nursing Considerations
		35.1	 Introduction
		35.2	 Operative Nursing
		35.3	 Intraoperative Phase
		35.4	 Continuity of Care
		35.5	 Teamwork and Multidisciplinary
		References
	36: Shared Decision-Making at the End of Life
		36.1	 Introduction: The Age as a Decisional Criterion
		36.2	 The Ethical Value of Palliative Surgery at the End of Life (EOL)
		36.3	 Ethical Principles Governing Clinical Decisions at the EOL
		36.4	 “Shared Care Planning” as a Tool for Decision in EOL Setting
		36.5	 The Role of Clinical Ethics Consultation in Decision-Making
		36.6	 Concluding Remarks
		References
	37: Minimally Invasive Surgery in the Elderly and Frail Patient in the COVID-19 Era
		References