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๐—ก๐—ฎ๐—ฟ๐—ฟ๐—ฎ๐˜๐—ฒ๐—ฑ ๐—ฉ๐—ถ๐—ฑ๐—ฒ๐—ผ: ๐—˜๐—บ๐—ฒ๐—ฟ๐—ด๐—ฒ๐—ป๐—ฐ๐˜† ๐—Ÿ๐—ฎ๐—ฝ๐—ฎ๐—ฟ๐—ผ๐˜€๐—ฐ๐—ผ๐—ฝ๐—ถ๐—ฐ ๐—ฅ๐—ฒ๐—ฝ๐—ฎ๐—ถ๐—ฟ ๐—ผ๐—ณ ๐—ฆ๐˜๐—ฟ๐—ฎ๐—ป๐—ด๐˜‚๐—น๐—ฎ๐˜๐—ฒ๐—ฑ ๐—™๐—ฒ๐—บ๐—ผ๐—ฟ๐—ฎ๐—น ๐—›๐—ฒ๐—ฟ๐—ป๐—ถ๐—ฎ ๐˜„๐—ถ๐˜๐—ต ๐—ฆ๐—บ๐—ฎ๐—น๐—น ๐—•๐—ผ๐˜„๐—ฒ๐—น ๐—ฅ๐—ฒ๐˜€๐—ฒ๐—ฐ๐˜๐—ถ๐—ผ๐—ป ๐—ฎ๐—ป๐—ฑ ๐—œ๐—–๐—š #FOAMed #GITwitter #MedEd #SurgEd #SoMe4Surgery #EGS #Hernia #ICG

24,802 views โ€ข 9 months ago โ€ขvia X (Twitter)

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๐™‡๐™–๐™ฅ๐™–๐™ง๐™ค๐™จ๐™˜๐™ค๐™ฅ๐™ž๐™˜ ๐™๐™š๐™ฅ๐™–๐™ž๐™ง ๐™ค๐™› ๐™‹๐™š๐™ง๐™›๐™ค๐™ง๐™–๐™ฉ๐™š๐™™ ๐˜ฟ๐™ช๐™ค๐™™๐™š๐™ฃ๐™–๐™ก ๐™๐™ก๐™˜๐™š๐™ง ๐™ฌ๐™ž๐™ฉ๐™ ๐™‹๐™ง๐™ž๐™ข๐™–๐™ง๐™ฎ ๐˜พ๐™ก๐™ค๐™จ๐™ช๐™ง๐™š & ๐™Š๐™ข๐™š๐™ฃ๐™ฉ๐™–๐™ก ๐™‹๐™–๐™ฉ๐™˜๐™ Presentation: ๐Ÿ”ต1 day history of sever upper abdominal pain ๐Ÿ”ตSmoker and excess ETOH ๐Ÿ”ตCXR โžก๏ธPneumoperitoneum ๐Ÿ”ตCT โžก๏ธPerforated duodenal ulcer ๐Ÿ”ตTime from EDโžก๏ธtheatre 3 hours Operative Approach: ๐Ÿ”ดThorough peritoneal lavage โžก๏ธLap washout allows for thorough removal of intra-abdominal contamination โžก๏ธModern OR table tilting can provide better view then open in select cases ๐Ÿ”ดIf fragile tissue then omental patch only โžก๏ธThis approach is a modified version of Grahams patch repair โžก๏ธWhen suitable, we prefer primary closure with patch after ๐Ÿ”ดFor large perforations kocherisation of duodenum may be indicated ๐Ÿ”ดConvert to open if: โžก๏ธLarge ulcer โžก๏ธAssociated ulcer bleed ๐Ÿ”ดH. Pylori eradication therapy on discharge ๐Ÿ”ดOGD in 6-8 weeks to confirm healing Key Points: ๐ŸŸขTimely intervention critical ๐ŸŸขLap approach in EGS should be encouraged ๐ŸŸขCompared to open, advantages of lap are: โžก๏ธReduced pain โžก๏ธReduced LOS โžก๏ธReduced incisional hernia rate ๐ŸŸขTrainees should be exposed to lap EGS early to develop skills and confidence #FOAMed #GITwitter #MedEd #SurgEd #EGS #SoMe4Surgery

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