EMERGENCY SURGERY

The experience and knowledge base of a general surgeon must include emergency surgery, which involves urgent treatment of a wide range of conditions, from polytrauma (best managed in tertiary hospitals due to multidisciplinary issues) to various conditions that require timely intervention (which can also be managed in private facilities). The most common procedures include appendectomies, strangulated abdominal hernias, cholecystitis (the most frequent complication of gallstone disease), perforations of hollow organs (e.g., gastroduodenal ulcers), intestinal bleeding, and bowel obstructions (often due to adhesions but also as a complication of tumors). Acute diverticulitis of the colon, with its possible and sometimes severe complications (peritonitis, obstruction, hemorrhage), is also an indication for emergency surgery. After preoperative evaluations (blood tests and imaging like ultrasound or CT) and a quick assessment by the anesthetist, the patient is taken to the operating room. The surgical access (open or minimally invasive) is determined by the operating surgeon based on the severity of the case, the type of patient (age, comorbidities, performance status), and the surgeon’s experience. Whenever possible, laparoscopic access is recommended due to the known advantages of minimally invasive surgery even in emergencies (as in cases of cholecystitis). Another indication for laparoscopy is acute appendicitis, especially in young women, where camera access allows for more accurate differential diagnosis and treatment of other conditions (e.g., acute tubo-ovarian pathologies like ectopic pregnancy, ovarian cyst torsions, salpingitis, etc.). Gastroduodenal perforations can also be resolved laparoscopically (closure). Using laparoscopy for intestinal obstructions is more difficult (but sometimes possible) due to the distension of intestinal loops, which complicates visibility in a “closed” abdomen. Surgical management of postoperative complications from elective surgeries requires expertise in emergency surgery, especially regarding the timing and intraoperative solutions for sometimes complex issues.