Current Surgical Therapy E-Book

John L. Cameron; Andrew M. Cameron

BOOK

Current Surgical Therapy E-Book

John L. Cameron | Andrew M. Cameron

(2013)

Additional Information

Book Details

ISBN: 978-0-323-22511-3
Edition: 11
Language: English
Pages: 1504
Subjects: Surgery
General surgery

Abstract

Minimize the risks and maximize your surgical success with Current Surgical Therapy! Hundreds of preeminent general surgeons present you with today’s best treatment and management advice for a number of diseases and associated surgeries, discussing which approach to take, how to avoid or minimize complications, and what outcomes to expect. Current Surgical Therapy is indispensable for quick, efficient review prior to surgery, as well as when preparing for surgical boards and ABSITEs!

Find the answers you need quickly inside the user-friendly book.
Obtain dependable advice on patient selection, contraindications, techniques, pitfalls, and more from this best-selling surgical resource, trusted by generations of surgeons for decades as the definitive source on the most current surgical approaches.

Section Title	Page	Action	Price
Front cover	cover
Inside front cover	ifc1
Current Surgical Therapy, 11/e	i
Copyright page	iv
list of contributors	v
preface	xxix
Table of Contents	xxxi
The Esophagus	1
Esophageal Function Testing	1
Disorders of Esophageal Function	1
Gastroesophageal Reflux	1
Achalasia	1
Hypertensive Lower Esophageal Sphincter	1
Diffuse Esophageal Spasm	1
Hypercontractile “Nutcracker” Esophagus	2
Ineffective Esophageal Motility	2
Nonspecific Esophageal Motility	2
Hiatal Hernia	2
Diagnostic Tests for Esophageal Diseases	2
Radiographic Imaging	2
Endoscopy	4
Esophageal Manometry	5
Technical Considerations	5
Diagnostic Tests for Gastroesophageal Reflux	5
Esophageal Impedance	6
Summary	7
Acknowledgment	7
Suggested Reading	9
Gastroesophageal Reflux Disease	9
Introduction	9
Operative Indications	9
Preoperative Evaluation	9
Endoscopy	9
Upper Gastrointestinal Series	10
Esophageal Manometry	10
Ambulatory pH Monitoring	10
Surgical Treatment Options	11
Minimally Invasive Surgical Technique	11
Potential Operative Pitfalls	12
Bleeding	12
Short Esophagus	12
Esophageal or Gastric Perforation	12
Postoperative Care	13
Common Postoperative Problems	13
Dysphagia	13
Gas Bloat Syndrome	13
Reoperative Fundoplication	13
Emerging Surgical Therapies for Gastroesophageal Reflux Disease	13
Suggested Readings	14
Endoluminal Approaches to Gastroesophageal Reflux Disease	14
Introduction	14
Preoperative Considerations	14
Outcomes Assessment	14
Stretta	15
Background	15
Technique	15
Postoperative Care	15
Outcomes	15
EsophyX	16
Background	16
Technique	16
Postoperative Care	17
Outcomes	17
Future Methods	18
Summary	18
Suggested Readings	18
The Management of Barrett’s Esophagus	19
Introduction	19
Clinical Impact	19
Clinical Features	19
Treatment of Nondysplastic Barrett’s Esophagus	19
Medical Management and Treatment	19
Antireflux Surgery	20
Endoscopic Therapies	20
Treatment of Dysplastic Barrett’s Esophagus	21
Endoscopic Ablative Treatments	21
Endoscopic Mucosal Resection	22
Esophagectomy	23
Summary	23
Selected Readings	23
Endoscopic Treatment of Barrett’s Esophagus	23
Introduction	23
Histologic Features of Barrett’s Esophagus	24
Surveillance Algorithm for Barrett’s Esophagus	24
Endoscopic Ablation Therapies	24
Thermal Ablation	24
Photodynamic Therapy	25
Cryospray Ablation	25
Cryospray Ablation Technique	25
Radiofrequency Ablation	25
Radiofrequency Ablation Technique	25
Endoscopic Mucosal Resection	26
Endoscopic Mucosal Resection Technique	26
Snare Technique	26
“Suck and Cut” Technique	26
Ligation Technique	26
Cap Technique	26
Endoscopic Submucosal Dissection	26
Endoscopic Submucosal Resection Technique	27
Summary	27
Suggested Readings	27
Paraesophageal Hernia	27
Definition	27
Clinical Manifestation	29
Pathophisiology	29
Diagnosis	30
Therapy	30
Indications for Surgery	30
Surgical Anatomy	31
Surgical Approach	31
Excision of the Hernia Sac	32
Assessment of Adequate Intraabdominal Esophageal Length and Management of a Short Esophagus	32
Creating the Antireflux Barrier	32
Repairing the Hiatus	32
Gastropexy	33
Insights and Controversies in Paraesophageal Hernia Surgery	33
Surgical Management of Acute Paraesophageal Hernia	33
Laparoscopic Versus Open	33
A Novel Approach: Robotic-Assisted Surgery	33
“To Mesh or Not to Mesh?”	34
Collis Gastroplasty	34
Antireflux Procedure	35
Results	35
Summary	36
Suggested Readings	36
The Management of Pharyngeal Esophageal (Zenker’s) Diverticula	36
Introduction	36
History	36
Etiology	36
Symptoms	37
Diagnosis	37
Indications for Surgery	37
Operative Technique	38
Postoperative Care	38
Results	38
Conclusion	38
Suggested Readings	38
The Management of Achalasia of the Esophagus	39
Background	39
Diagnosis	39
Medical Therapy	39
Pharmacologic	39
Botulinum Toxin Injection	39
Esophageal Pneumatic Dilation	40
Per-Oral Endoscopic Myotomy	41
Surgical Treatment	41
Myotomy Technique and Outcomes	41
Further Discussion	42
Transthoracic Versus Transabdominal	42
Open Versus Laparoscopic Versus Thoracoscopic	42
Length of Myotomy	42
Concomitant Antireflux Procedure: Nissen/Toupet/Dor	42
Sigmoid Esophagus or Megaesophagus	42
Surgical Myotomy Versus Endoscopic Treatment	43
Summary	43
ACKNOWLEDGMENT	43
Suggested Readings	43
Disorders of Esophageal Motility	44
Introduction	44
Classes of Esophageal Motility Disorders	44
Spastic Dysmotility Disorders	44
Diffuse Esophageal Spasm	44
Hypercontracting Esophagus (Nutcracker Esophagus)	44
Hypertensive Lower Esophageal Sphincter	46
Ineffective Motility Disorder	46
Secondary Esophageal Motility Disorders	46
Suggested Readings	47
The Management of Esophageal Carcinoma	47
Assessment of the Extent of Disease and Selection of Treatment Options	47
Treatment	49
Neoadjuvant Chemotherapy and Chemoradiotherapy	49
Surgical Resection	50
High Probability of Localized Disease Confined to the Mucosa	50
High Probability of Regional Disease	50
High Probability of Systemic Disease	50
Options for Esophageal Resection	50
Perioperative Care: Morbidity and Mortality of Esophageal Resection	52
Management of Complications	53
Survival	53
Functional Outcomes	54
Conclusions	54
Suggested Readings	54
Neoadjuvant and Adjuvant Therapy of Esophageal Cancer	54
Introduction	54
Part I: Definition of Local-Regional Advanced Esophageal Cancer	54
Clinical T1 Tumors	54
Clinical T2 Tumors	55
Clinical T3 Tumors	55
Clinical N1-N2 Tumors	55
Restaging After Preoperative Therapy	55
Part II: Management of Local-Regional Advanced Esophageal Cancers	55
Near Consensus	55
Multimodality Therapy	55
Type of Chemotherapy	57
Controversial	57
Definitive Chemoradiation	57
Selective Definitive Chemoradiation	57
Selective Chemoradiation Versus Chemotherapy in Adenocarcinoma	57
Added Risks to Surgery of Chemoradiation	57
Optimal Radiation Dose	57
Different Approach to Siewert II and Siewert III Tumors	58
PET-Directed Therapy	58
Unknown	58
Summary	58
Suggested Readings	58
Esophageal Stents	58
Indications	59
Historical Aspects	59
Stent Design	60
Clinical Evaluation and Technique	60
Complications	62
Special Considerations	62
Conclusions	62
Suggested Readings	64
Esophageal Perforation	64
Initial Therapy	64
Management Decisions	64
Cervical Perforation	64
Thoracic Perforations	64
Abdominal Perforations	65
Special Situations	67
Perforation Through a Malignancy	67
Perforation With Achalasia	67
Perforation of the Esophagus After Nissen Fundoplication	67
Leakage of Esophagogastrostomy After Esophagectomy	68
Suggested Readings	68
The Stomach	69
The Management of Benign Gastric Ulcer	69
Introduction	69
Etiology	69
Presentation and Diagnosis	69
Gastric Ulcer Types and Location	69
Type I	69
Types II and III	70
Type IV	70
Type V	70
Stress-Related Mucosal Disease	71
Cancer Risk After Resection	71
Giant Ulcer	71
Obstruction	71
Perforation	71
Surgical Technique	71
Vagotomy and Drainage	71
Extent of Resection	73
Reconstruction Techniques	73
Billroth I	73
Billroth II	74
Roux-en-Y	75
Minimally Invasive Approach	75
Suggested Readings	76
The Management of Duodenal Ulcers	76
Introduction	76
Medical Management of Duodenal Ulcers	77
Surgical Management of Duodenal Ulcers	77
Perforated Duodenal Ulcers	77
Bleeding Duodenal Ulcers	78
Obstruction Duodenal Ulcers	79
Intractable Duodenal Ulcers	79
Atypical Indications	80
Duodenal Closure	80
Suggested Readings	80
Zollinger-Ellison Syndrome	80
Introduction	80
Epidemiology	80
Pathogenesis	81
Clinical Presentation	81
Diagnosis	81
Clinical Evaluation	81
Laboratory Testing	81
Imaging Modalities	81
Management	82
Medical Management	82
Surgical Management	82
Sporadic Disease	82
Multiple Endocrine Neoplasia Type 1	82
Metastatic Disease	83
Reoperation	83
Outcomes and Prognosis	83
Postoperative Surveillance	83
Areas of Controversies	83
Conclusion	84
Suggested Readings	84
Mallory-Weiss Syndrome	84
History	84
Incidence, Pathophysiology, and Associated Conditions	84
Diagnoses and Outcomes	85
Treatment	86
Surgery	86
Summary	86
Suggested Readings	87
Gastric Adenocarcinoma	87
Introduction	87
Epidemiology and Presentation	87
Pathology	88
Preoperative Evaluation	88
Staging	88
Surgery	88
Extent of Gastric Resection	88
Gastric Reconstruction	89
Nodal Station and Lymphadenectomy Definitions	89
Location of Metastatic Lymph Nodes	90
Potential Benefits of More Extensive Lymphadenectomy	90
D2 Lymphadenectomy Technique for Subtotal/Distal Gastrectomy	92
Greater Curvature (Station 4sb and 4d) Node Dissection	92
Infrapyloric (Station 6) Node Dissection	92
Hepatoduodenal Ligament Hepatic Artery (Station 12a) and Suprapyloric (Station 5) Node Dissection	92
Common Hepatic Artery Dissection (Station 8a), Celiac Axis (Station 9), Proximal Splenic Artery (Station 11p), and Left Gastric Artery (Station 7) Lymph Node Dissection	93
Lesser Curvature (Station 3) and Right Paracardial (Station 1) Node Dissection	93
Specimen Processing for Pathology	93
D2 Lymphadenectomy Technique for Total Gastrectomy	94
Neoadjuvant and Adjuvant Therapy	94
Follow-Up	95
Summary	95
Suggested Readings	96
Gastrointestinal Stromal Tumors	96
Introduction	96
Pathologic Features	96
Historical Background	96
Receptor Tyrosine Kinase Mutations	96
Epidemiology	97
Age	97
Hereditary Gastrointestinal Stromal Tumors	97
Incidence	97
Clinical Presentation	97
Diagnosis	97
Radiographic Studies	97
Endoscopy, Fine-Needle Aspiration, and Biopsy	98
Prognostic Factors	98
Therapy for Primary Disease	98
Surgery	98
Technique	98
Perioperative Therapy for Primary Disease	100
Therapy for Advanced Disease	100
Targeted Therapy	100
Surgery	102
Surveillance	102
Conclusion	102
Suggested Readings	102
NCCN Guidelines	102
Neoadjuvant Therapy	102
Adjuvant Therapy	102
Metastatic GIST: Imatinib Mesylate	103
Metastatic GIST: Sunitinib Malate	103
Metastatic Disease: Surgery	103
Predicting Outcomes	103
Background	103
Morbid Obesity	103
Overview	103
Patient Selection	103
Operative Procedures	103
Laparoscopic Roux-en-Y Gastric Bypass	104
Laparoscopic Adjustable Gastric Band	105
Laparoscopic Vertical Sleeve Gastrectomy	105
Laparoscopic Duodenal Switch With Biliopancreatic Diversion	106
Outcomes and Complications	106
Suggested Readings	107
Small Bowel	109
Small Bowel Obstruction	109
Overview	109
Evaluation and Diagnosis	109
Nonoperative Management	111
Operative Management	112
Technical Considerations	112
Adhesion Prevention	112
Suggested Readings	113
The Management of Crohn’s Disease of the Small Bowel	113
Overview	113
Medical Management	113
Indications for Surgical Management	115
Technical Considerations of Surgical Intervention	116
Recurrence of Disease	117
Selected Readings	117
Strictureplasty in Crohn’s Disease	118
Introduction	118
Overview	118
Indications and Contraindications	118
Preoperative Preparation	118
Intraoperative “Design of a Roadmap”	118
Strictureplasty Techniques	118
Short Strictureplasty	118
Intermediate Length Procedures	120
Long Enteroenterostomy	120
Results	120
Postoperative Short-Term Outcomes	120
Long-Term Outcomes	121
Summary	121
ACKNOWLEDGMENT	122
Suggested Readings	122
The Management of Small Bowel Tumors	122
Overview	122
Carcinoid/Neuroendocrine Tumors	122
Tumor Characteristics	122
Clinical Presentation	123
Diagnosis	123
Treatment	123
Adenocarcinoma	123
Tumor Characteristics	123
Clinical Presentation	124
Diagnosis	124
Treatment	124
Gastrointestinal Stromal Tumors	124
Tumor Characteristics	124
Clinical Presentation	125
Diagnosis	125
Treatment	125
Non-Hodgkin’s Lymphoma	126
Tumor Characteristics	126
Clinical Presentation	126
Diagnosis	126
Treatment	126
Metastases	127
Benign Tumors	127
Adenomas	127
Lipomas	127
Hamartomas	127
Hemangiomas	127
Suggested Readings	128
The Management of Diverticulosis of the Small Bowel	128
Duodenal Diverticula	128
Jejuno-Ileal Diverticular Disease	130
Meckel’s Diverticulum	131
Summary	132
Suggested Readings	132
Motility Disorders of the Stomach and Small Bowel	132
Overview	132
Motility Disorders of the Stomach	132
Gastroparesis	132
Evaluation of Gastroparesis	133
Management of Gastroparesis	134
Postgastrectomy Dumping	135
Roux Stasis Syndrome	136
Postvagotomy Diarrhea	136
Motility Disorders of the Small Intestine	136
Ileus of the Small Intestine	136
Suggested Readings	137
The Management of Short Bowel Syndrome	137
Introduction	137
Initial Management of the Abdominal Catastrophe That Leads to Short Bowel Syndrome	138
Indications for Surgical Management of Short Bowel Syndrome	138
Longitudinal Intestinal Lengthening and Tailoring	139
Serial Transverse Enteroplasty Procedure	140
Conclusion	142
Suggested Readings	142
The Management of Enterocutaneous Fistulas	142
Overview	142
Definition and Etiology	142
Presentation	142
Physiologic Effect and Complications	143
Management	143
Stabilization and Sepsis Control	143
Resuscitation and Nutritional Support	144
Wound Care	144
Surgical Management	144
Summary	145
Suggested Readings	145
Large Bowel	147
Preoperative Bowel Preparation:	147
Overview	147
Historical Background	147
Mechanism of Action of Oral Antimicrobial Agents	147
Mechanical Bowel Preparation	147
Is Mechanical Bowel Preparation Still Warranted?	147
Summary	148
Suggested Readings	148
The Management of Diverticular Disease of the Colon	149
Diverticulitis: Clinical Presentation	149
Management	149
Role of Elective Surgery in Acute Uncomplicated Diverticulitis	149
Complicated Diverticulitis	149
Role of Elective Surgery in Acute Complicated Diverticulitis (Pericolic Abscess, Hinchey I and II)	149
Role of Elective Surgery in Acute Complicated Diverticulitis After Successful Treatment	149
Role of Emergent Surgery in Acute Complicated Diverticulitis	150
Free Perforation: Purulent and Fecal Peritonitis (Hinchey Stages III and IV)	150
Critical Care Management and Resuscitation	150
Surgical Management	150
Abbreviated Laparotomy in Unstable Conditions	150
Colostomy Versus Colocolostomy	150
Laparoscopic Irrigation and Drainage for Hinchey II and III	151
Summary and Conclusion	151
Diverticular Bleeding	151
Diagnosis and Management	151
Suggested Readings	153
The Management of Chronic Ulcerative Colitis	154
Introduction	154
Indications for Surgical Therapy	154
Medically Refractory Disease	154
Fulminant Colitis and Toxic Megacolon	154
Bleeding	154
Cancer	154
Extracolonic Manifestations	155
Growth Failure in Children	155
Surgical Options	155
Indications for a Subtotal Colectomy	155
Surgical Procedures	156
Total Colectomy	156
Laparoscopic	156
Open	156
Proctectomy	156
Laparoscopic Approach	156
Open Proctectomy	157
Perineal Approaches to Remove the Distal Rectum	157
Intersphincteric Proctectomy	157
Complications	157
Proctocolectomy with Ileal Pouch–Anal Anastomosis	157
J-Pouch Creation	157
Ileal Pouch–Anal Anastomosis	157
Double-Stapled Anastomosis	157
Mucosectomy and Hand-Sewn Anastomosis	158
Maneuvers to Ensure Reach of the J Pouch	158
Other Types of Pouches	159
Postoperative Course	159
Complications	159
Colectomy With Ileorectal Anastomosis	159
Total Proctocolectomy With Continent Ileostomy (Kock’s Pouch)	159
Conclusion	160
Suggested Readings	160
The Management of Toxic Megacolon	160
Overview	160
Incidence and Etiology	160
Diagnosis	160
Therapy	161
Medical Therapy	161
Management of Patients With Inflammatory Bowel Disease	161
Management of Patients Without Inflammatory Bowel Disease	162
Clostridium Difficile Colitis	162
Surgical Therapy	162
Outcomes	162
Summary	162
Suggested Readings	162
Crohn’s Colitis	163
Introduction	163
Clinical Features	163
Diagnosis	163
Histology	164
Serology	164
Treatment	164
Medical Management	164
Surgical Management	166
Stricture/Obstruction	166
Perforation, Fistulae, and Abscess	166
Massive Lower Gastrointestinal Bleeding	166
Severe Colitis/Fulminant Colitis/Toxic Megacolon	166
Extracolonic Manifestations of Crohn’s Disease	167
Operations for Crohn’s Colitis	167
Emergent Operation	167
Segmental Colectomy	167
Ileorectal Anastomosis	167
Total Proctocolectomy with End Ileostomy	168
Ileal Pouch Anal Anastomosis	168
Proctectomy	168
The Role of Laparoscopic and Robotic Surgery for Crohn’s Colitis	168
Suggested Readings	168
Ischemic Colitis	169
Overview	169
Anatomic Considerations	169
Clinical Presentation	169
Diagnosis	169
Treatment	171
Nonsurgical Management	171
Surgical Management	172
Summary	172
Suggested Readings	172
The Management of Clostridium Difficile Colitis	173
Overview	173
Clinical Manifestations	173
Diagnosis of Clostridium Difficile Infection	173
Medical Treatment	174
Surgery	175
Recurrent Infection	176
Clostridium Difficile Infection and Inflammatory Bowel Disease	176
Conclusion	177
Suggested Readings	177
Large Bowel Obstruction	177
Overview	177
Obstructions as a Result of Cancer	177
Obstructions as a Result of Inflammation	179
Obstructions as a Result of Colonic Volvulus	179
Obstructions as a Result of Intussusception	180
Obstructions as a Result of Hernia	181
Obstructions as a Result of Ogilvie’s Syndrome (PseudoObstruction)	181
Conclusion	181
Suggested Readings	181
Colonic Stenting	181
Introduction	181
Technique	182
Patient Preparation	182
Endoscopic Delivery	183
Proximal Lesions and Stent Delivery	183
Postplacement Care	184
Complications	184
Outcomes	184
Summary	184
Suggested Readings	185
Acute Colonic Pseudo-Obstruction (Ogilvie’s Syndrome)	185
Introduction	185
Presentation and Diagnosis	185
Management	185
Neostigmine	185
Colonoscopy	186
Tube Cecostomy	186
Surgery	186
Summary	187
Suggested Readings	187
The Management of Colonic Volvulus	187
Overview	187
Sigmoid Volvulus	187
Cecal Volvulus	188
Transverse Colon Volvulus	189
Splenic Flexure Volvulus	190
Suggested Readings	190
Rectal Prolapse	190
Etiology and Presentation	190
Evaluation	190
Treatment	191
Perineal Procedures	191
Thiersch’s Procedure	191
Mucosal Sleeve Resection (Delorme’s Procedure)	191
Perineal Rectosigmoidectomy (Altemeier’s Procedure)	192
Abdominal Procedures	192
Ripstein’s Procedure	192
Abdominal Rectopexy and Sigmoid Resection	193
Abdominal Rectopexy	193
Management of the Lateral Ligaments	193
Laparoscopy	193
Recurrent Prolapse	194
Summary	194
Suggested Readings	194
The Management of Solitary Rectal Ulcer Syndrome	194
Clinical Findings	195
Diagnosis	195
Histologic Findings	195
Etiology	195
Treatment	195
Suggested Readings	196
Surgical Management of Constipation	196
Etiology and Workup	196
Obstructed Defecation Syndrome	197
Stapled Transanal Rectal Resection	198
Slow-Transit Constipation	199
Antegrade Colonic Enemas	200
Sacral Nerve Stimulation	200
Ostomy Creation	200
Summary	200
Suggested Readings	200
Radiation Injury to the Small and Large Bowel	200
Overview	200
Radiation Dose Tolerance to the Small Intestine and Rectum	201
Pathophysiology of Radiation to the Intestinal Tract	201
Management of Radiation Enteritis	201
Management of Radiation Proctitis	203
Prevention of Radiation Enteritis and Proctitis	204
Suggested Readings	205
Hereditary Polyposis Syndromes	205
Introduction	205
Adenomatous Polyposis Syndromes	205
Familial Adenomatous Polyposis	205
Attenuated Familial Adenomatous Polyposis	205
Mut Y Homolog–Associated Polyposis	206
Turcot’s Syndrome	207
Genetics	207
Genotype-Phenotype Correlation in Familial Adenomatous Polyposis	207
Surgical Therapy	207
Timing of Surgery	207
Choice of Operative Procedure	207
Total Abdominal Colectomy and Ileorectal Anastomosis	207
Restorative Proctocolectomy With Ileal Pouch–Anal Anastomosis, Stapled or With Mucosectomy	208
Proctocolectomy With Permanent Terminal Ileostomy (or Kock’s Pouch)	209
Medical Therapy	209
Adenoma Chemoprevention	209
Extracolonic Disease	209
Upper Gastrointestinal Polyposis	209
Desmoid Disease	210
Clinical Scenarios	210
Hamartomatous Polyposis Types	210
Peutz-Jeghers Syndrome	210
Juvenile Polyposis	211
PTEN Tumor Hamartoma Syndromes	212
Cowden’s Syndrome	212
Bannayan-Riley-Ruvalcaba Syndrome	212
Serrated Polyposis	212
Conclusion	212
Acknowledgment	212
Suggested Readings	212
Colon Cancer	213
Background and Epidemiology	213
Screening Recommendations	213
Presentation, Diagnosis, and Workup	213
Surgical Resection and Staging	214
Open Versus Laparoscopic Colectomy	214
Challenging and Complicated Cases	215
Adjuvant Treatment	217
Surveillance and Follow-Up	217
Suggested Readings	217
The Management of Rectal Cancer	218
Introduction	218
Diagnosis	218
Treatment Approach by Stage	218
Localized Disease	218
Locally Advanced Disease	221
Disseminated Disease	222
Surgical Therapy	222
Transanal Excision	222
Total Mesorectal Excision	222
Reconstruction	223
Abdominoperineal Resection	223
Perineal Dissection and Closure	223
Laparoscopic and Robotic Proctectomy	223
Selected Readings	224
Tumors of the Anal Canal	224
General Considerations	224
Squamous Neoplasms	224
Condyloma Acuminatum (Anal Wart)	224
Anal Intraepithelial Neoplasia	227
Bowen’s Disease	228
Squamous Cell Carcinoma	228
Adenocarcinoma	230
Paget’s Disease	230
Melanoma	231
Neuroendocrine Tumors	231
Mesenchymal Tumors	231
Malignant Lymphoma	231
Suggested Readings	231
The Use of Positron Emission Tomographic Scanning in the Management of Colorectal Cancer	232
Introduction	232
Background	232
Detection of Colorectal Cancer	232
Screening for Colorectal Cancer	233
Tumor Staging and Treatment Planning	233
Assessment of Tumor Response	234
Recurrent Colorectal Cancer	235
Summary	235
Suggested Readings	235
The Use of Neoadjuvant and Adjuvant Treatment for Colorectal Cancer	236
Overview	236
Staging	236
Adjuvant Therapy for Colon Cancer	237
Stage III Colon Cancer	237
Stage II Colon Cancer	238
Neoadjuvant and Adjuvant Therapy for Rectal Cancer	239
Surveillance	240
Recommendations	241
Rectal Cancer.	241
Stage III Colon Cancer.	241
Stage II Colon Cancer.	241
Suggested Readings	241
The Management of Colorectal Polyps	241
Overview	241
Histopathology and Natural History of Polyps	242
Hyperplastic Polyps and Serrated Adenomas	242
Hamartomas	242
Adenomas	242
Colonoscopic Polypectomy	242
Approach to the Malignant Polyp	243
Suggested Readings	244
Management of Peritoneal Surface Malignancy	245
Introduction	245
Pseudomyxoma Peritonei and Peritoneal Metastases From Appendiceal Malignancy	245
Management of Appendiceal Neoplasms With Peritoneal Dissemination	245
Outcome With Histopathology as a Quantitative Prognostic Indicator	245
Outcome With Peritoneal Cancer Index as a Quantitative Prognostic Indicator	246
Outcome With Completeness of Cytoreduction as a Prognostic Indicator	246
Peritoneal Metastases of Colorectal Origin	246
Outcome of Peritoneal Metastases Treated With Modern Systemic Chemotherapy	246
Complete Cytoreductive Surgery With Hyperthermic Perioperative Chemotherapy for Colorectal Cancer Peritoneal Metastases	247
Outcome of Treatment for Peritoneal Metastases From Colorectal Cancer	247
Improving Survival With Treatment of a Minimal Extent of Disease	248
Diffuse Malignant Peritoneal Mesothelioma	248
Treatment of Diffuse Malignant Peritoneal Mesothelioma	249
Cytoreductive Surgery and Hyperthermic Perioperative Chemotherapy	249
Results of Treatment of Diffuse Malignant Peritoneal Mesothelioma	249
Treatment of Benign/Borderline Peritoneal Mesothelioma	249
Peritoneal Metastases From Epithelial Ovarian Cancer	249
Extent of Disease as a Prognostic Variable	249
Role for Intraperitoneal Chemotherapy	249
Peritoneal Metastases From Gastric Cancer	250
An Evolution of Curative Treatment Strategies for Gastric Cancer With Peritoneal Metastases	250
Importance of the Surgical Learning Curve	251
Prevention of Gastric Carcinomatosis	251
Suggested Readings	251
The Management of Acute Appendicitis	252
Overview	252
Historical Perspective	252
Anatomy and Pathophysiology	252
Patient Presentation and Diagnosis	252
History and Physical Examination	252
Laboratory Examination	252
Imaging	252
Management of Acute Appendicitis	253
Timing of Surgery	253
Laparoscopic Versus Open Appendectomy	253
Management of Nonperforated Appendicitis	253
Laparoscopic Appendectomy	253
Management of Perforated Appendicitis	254
Antibiotics in Perforated Appendicitis	254
Special Patient Situations	255
Elderly	255
Pregnancy	255
Negative Appendectomy	255
Suggested Readings	255
Hemorrhoids	255
Anatomy	255
Etiology and Pathophysiology	256
Incidence	256
External Hemorrhoids	256
Acute Thrombosis	256
Quiescent External Hemorrhoids	256
Internal Hemorrhoids	257
Nonoperative Techniques	257
Rubber Band Ligation	257
Injection Sclerotherapy	258
Infrared Coagulation	258
Operative Techniques	258
Open Hemorrhoidectomy	258
Closed Hemorrhoidectomy	258
Park’s Submucosal Excision	259
Fixation Procedures	259
Stapled Hemorrhoidopexy	259
Suture Hemorrhoidopexy	260
Partial Stapled Hemorrhoidopexy	261
Doppler Guided Transanal Hemorrhoidal Ligation	261
Special Situations	261
Strangulated Hemorrhoids	261
Hemorrhoids in Pregnancy	261
Hemorrhoids in Inflammatory Bowel Disease	261
Hemorrhoids in the Immunocompromised	261
Hemorrhoid Varices and Portal Hypertension	261
Suggested Readings	261
Anal Fissure	262
Treatment	262
Acute Anal Fissure	262
Medical Therapy for Chronic Anal Fissure	262
Surgical Therapy for Chronic Anal Fissure	263
Treatment Algorithm	264
Acknowledgment	265
Suggested Readings	265
Anorectal Abscess and Fistula	265
Introduction	265
Abscess	265
Diagnosis	265
Treatment	265
Fistulas	266
Diagnosis	267
Treatment	268
Primary Fistulotomy	268
Setons	268
Advancement Flaps	269
Fibrin Sealant	270
Fistula Plug	270
Ligation of Intersphincteric Fistula Tract	271
Choice of Procedure	271
Conclusion	271
Suggested Readings	274
Anorectal Stricture	274
Definition	274
Causes	274
Clinical Presentation	275
Diagnosis	275
Nonoperative Management	275
Medical Treatment	275
Mechanical Dilation	275
Operative Management	275
Stricturotomy and Stricturectomy for Rectal Stricture	275
Anoplasty for Anal Stricture	275
Summary	276
Suggested Readings	276
The Management of Pruritus Ani	277
Introduction	277
Etiology	277
Idiopathic Pruritus Ani	277
Secondary Pruritus Ani	277
Anorectal Conditions	277
Infectious Conditions	277
Dermatologic Conditions	277
Systemic Conditions	278
Patient Evaluation	278
Treatment	279
Idiopathic Pruritus Ani	279
Secondary Pruritus Ani	281
Summary	281
Suggested Readings	281
Surgical Treatment of Fecal Incontinence	281
Overlapping SpHincteroplasty	281
Sacral Nerve Stimulation	282
Injectables	282
Artificial Bowel Sphincter	282
Other	283
Suggested Readings	283
The Management of Rectovaginal Fistula	283
Introduction	283
Causes	283
Clinical Manifestation	283
Classification of Rectovaginal Fistulae	284
Preoperative Preparation	284
Surgical Management	284
Transanal Approach	284
Fistulotomy	284
Endorectal Advancement Flap	284
Rectal Sleeve Advancement	285
Kraske Approach	285
Fibrin Glue	285
Bioprosthetics	285
Transvaginal Approach	285
Vaginal Advancement Flap	285
Transperineal Approach	285
Episioproctotomy and Layered Closure	285
Overlapping Sphincteroplasty	285
Interposition Flaps	286
Transabdominal Approach	286
Omental Interposition	286
Treatment Guidelines	286
Fecal Diversion	286
Choice of Repair	286
Special Considerations	287
Radiation-Induced Fistulae	287
Crohn’s Disease	288
Malignancy	288
Acknowledgments	288
Selected Readings	288
The Management of Condyloma Acuminata	288
Presentation and Evaluation	289
Therapy	289
Topical Therapies	289
Podophyllin and Podophilox	289
Trichloroacetic acid	289
Cryotherapy	289
5-Fluorouracil	290
Miscellaneous Treatments	290
Surgery	290
Treatment Recommendations	290
Human Papilloma Virus Vaccine	291
Giant Condyloma Acuminata	291
Suggested Readings	293
The Management of Pilonidal Disease	293
Pilonidal Disease: Common and Challenging	293
Etiology and Characteristics	293
The Name	293
Causes	293
Not a Congenital Condition	293
Implications of Anatomy on Surgical Approach	294
Making the Diagnosis	294
A Changing Paradigm	295
The Difficult Environment of the Cleft	295
Diagnosis and Differential Diagnosis	295
Imaging	295
Acute Pilonidal Abscess Management	295
Chronic Pilonidal Sinus	296
Nonsurgical Approaches	296
Surgical Approaches	296
Unroofing	296
Pit Picking	296
The Goals of Surgery in Patients With Chronic Disease	297
Asymmetric Flap Techniques	297
The Karydakis Flap	297
The Cleft Lift Procedure	297
Differences Between the Cleft Lift Procedure and Other Flap Procedures	299
The Limberg Flap	300
Surgical Pitfalls	300
Who Should Perform Surgical Procedures on Pilonidal Disease	301
Cancer and Pilonidal Disease	301
Summary	301
Suggested Readings	301
Lower Gastrointestinal Bleeding	302
Definition	302
Etiology	302
Diverticulosis	302
Neoplasia	302
Colitis	302
Arteriovenous Malformation	302
Anorectal Disease	303
Small Bowel Bleeding	303
Iatrogenic Cause of Bleeding	304
Diagnostic Assessment and Therapy	304
Initial Evaluation and Resuscitation	304
Colonoscopy	304
Selective Mesenteric Angiography	305
Technetium-Labelled Red Blood Scanning	305
Other Options	305
Surgery	305
Summary	306
Suggested Readings	306
The Liver	307
Cystic Disease of the Liver	307
Overview and Clinical Presentation	307
Diagnostic Evaluation	307
Imaging Modalities	307
Simple Cysts	307
Polycystic Liver Disease	308
Neoplastic Cysts	309
Cystadenomas and Cystadenocarcinomas	309
Intraductal Papillary Mucinous Neoplasm of the Bile Duct	310
Traumatic Cysts	310
Pyogenic Liver Abscess	310
Suggested Reading	310
The Management of Echinococcal Cyst Disease of the Liver	311
Pathology and Classification	311
Presentation and Diagnosis	311
Laboratory Tests	311
Imaging	311
Treatment	313
Nonoperative Therapy	313
Benzimidazoles	313
Percutaneous Therapy	313
Operative Therapy	314
Scolecoidal Agents	314
Open Cyst Evacuation	314
Laparoscopic Cyst Evacuation	314
Pericystectomy	315
Liver Resection/Transplantation	315
Summary	316
Uncomplicated Disease	316
Complicated Disease	317
Results	317
Morbidity and Mortality	317
Long Term	317
Suggested Readings	317
Cavernous Hepatic Hemangioma	318
Pathophysiology and Clinical Presentation	318
Diagnosis	319
Management	321
Surgical Resection	321
Intraarterial and Ablative Therapies	321
Infantile Hepatic Hemangioma	321
Summary	322
Suggested Readings	322
The Management of Benign Liver Lesions	322
Diagnosis and Imaging of Benign Liver Lesions	322
Surgery for Benign Liver Lesions	325
Liver Cysts	325
Hepatic Hemangioma	326
Focal Nodular Hyperplasia	326
Hepatic Adenoma	327
Summary	327
Suggested Readings	327
The Management of Malignant Liver Tumors	328
Overview	328
Hepatocellular Carcinoma	328
Surgical Resection	328
Liver Transplantation	328
Thermal Ablation	328
Embolization	328
Fibrolamellar Hepatocellular Carcinoma	328
Intrahepatic Cholangiocarcinoma	329
Preoperative Assessment	329
General Preoperative Assessment	329
The Future Liver Remnant	329
Operative Approach to Resection of Primary Liver Malignancies	330
Incision and Access	330
Right Hepatectomy	330
Extended Right Hepatectomy	331
Left Lobectomy	331
Extended Left Hepatectomy	331
Caudate Resection	331
Segmental and Wedge Resections	331
Suggested Readings	332
Treatment for Hepatocellular Carcinoma:	332
Introduction	332
Evaluation	333
Imaging	333
Staging	333
Treatment	334
Liver Resection	334
Liver Transplantation	334
Suggested Readings	335
Radiofrequency Ablation of Hepatic Metastases	336
Overview	336
Indications and Preoperative Assessment	336
Technical Considerations	336
Radiofrequency Ablation Devices	336
Radiofrequency Ablation Approaches	337
Open or Laparoscopic Radiofrequency Ablation	337
Percutaneous Radiofrequency Ablation	337
Complications	338
Monitoring and Follow-Up	338
Laboratory Follow-up	338
Computed Tomographic Scan/Magnetic Resonance Imaging/Positron Emission Tomography	338
Results and Response Rates	339
Radiofrequency Ablation Versus Surgical Resection or Systemic Therapy	339
Newer Technologies	339
Microwave Ablation	339
High-Intensity Focused Ultrasound Scan	341
Computer-Assisted Soft-Tissue Surgery	341
Conclusion	341
Suggested Readings	341
The Management of Hepatic Abscess	341
Overview	341
Pyogenic Hepatic Abscess	342
Pathophysiology	342
Diagnosis	343
Treatment	343
Antibiotics	343
Drainage	343
Amebic Hepatic Abscess	344
Diagnosis	344
Treatment	345
Antibiotics	345
Drainage	345
Portal Hypertension	353
Portal Hypertension:	353
Management of Acute Variceal Hemorrhage	353
Endoscopic Diagnosis and Therapy	353
Luminal Tamponade	354
Radiologic Interventions	354
Transjugular Intrahepatic Portacaval Shunt	354
Balloon-Occluded Retrograde Transvenous Obliteration	355
Rebleeding Prophylaxis	355
Surgical Shunts	355
Total Portosystemic Shunts	355
Partial Portosystemic Shunts	356
Selective Shunts	356
Comparison of Transjugular Intrahepatic Portacaval Shunt with Shunt Surgery	356
Summary	357
Suggested Readings	357
The Role of Liver Transplantation in Portal Hypertension	357
Etiologies of Portal Hypertension	357
Pathophysiology of Portal Hypertension	357
Medical Management of Portal Hypertension	358
Surgical and Radiologic Management of Portal Hypertension	358
Liver Transplantation	358
Suggested Readings	359
Endoscopic Therapy for Esophageal Variceal Hemorrhage	359
Overview	359
Endoscopic Therapy	360
Endoscopic Band Ligation	360
Endoscopic Sclerotherapy	360
Other Endoscopic Methods	360
Results	360
Complications	361
Prevention of First Variceal Hemorrhage	361
Summary	361
Suggested Readings	361
Transjugular Intrahepatic Portosystemic Shunt	361
Overview	361
Indications	361
Variceal Bleeding	361
Ascites	362
Hepatic Hydrothorax	363
Hepatorenal Syndrome	363
Hepatopulmonary Syndrome	363
Budd-Chiari Syndrome	363
Portal Gastropathy	363
Technique	363
Patient Preparation	363
Access	363
Diagnostic Assessment	363
Shunt Placement	364
Shunt Evaluation	365
Special Cases	365
Budd-Chiari Syndrome	365
Parallel TIPS	367
Transumbilical or Direct Portal Access	367
TIPS Reversal/Revision	367
Clinical Outcomes	368
Clinical Response to TIPS	368
Complications and Management	368
Follow-up	370
Summary	370
Suggested Readings	370
The Management of Refractory Ascites	371
Introduction	371
Pathophysiology	371
Refractory Ascites	371
Diagnosis of Ascites	371
Paracentesis	371
Treatments of Ascites	371
Nonpharmacologic Therapies	372
Dietary Sodium Restriction	372
Fluid Restriction	372
Pharmacologic Therapies	372
Diuretics	372
Albumin	373
Vasoconstrictors	373
Interventional Therapies	373
Large Volume Paracentesis	373
Transjugular Intrahepatic Portosystemic Shunts	373
Peritoneovenous Shunts	374
Spontaneous Bacterial Peritonitis	375
Treatment of SBP	375
SBP Prophylaxis	375
Hepatic Hydrothorax	375
Suggested Readings	376
The Management of Hepatic Encephalopathy	376
Overview	376
Pathophysiology	376
Classification and Managementof Hepatic Encephalopathy	377
Overt Encephalopathy	377
Oral Disaccharides	377
Dietary Protein Restriction	378
Low-Absorbable Antibiotics	378
Other Therapies	378
Hepatic Encephalopathy Associated With Acute Liver Failure	378
Minimal Hepatic Encephalopathy	378
Suggested Readings	379
The Management of Budd-Chiari Syndrome	379
Overview	379
Presentation and Diagnosis	379
Treatment	380
Medical Therapy	380
Interventional Radiology	380
Surgical Therapy	381
Portosystemic Shunting	381
Liver Transplantation	382
Summary	382
Suggested Readings	382
Gallbladder and Biliary Tree	383
The Management of Asymptomatic (Silent) Gallstones	383
Overview	383
Epidemiology and Natural History	383
Prophylactic Cholecystectomy	384
Incidental Cholecystectomy	384
Special Populations	385
Diabetes	385
Hemoglobinopathy	385
Transplant	386
Gallbladder Cancer	386
Spinal Cord Injury	386
Total Parenteral Nutrition	386
Morbid Obesity	386
Suggested Readings	387
Acute Cholecystitis	387
Overview	387
Clinical Presentation and Evaluation	388
Differential Diagnosis	388
Management	388
Laparoscopic Cholecystectomy	388
Open Cholecystectomy	389
New Developments	390
Complications	390
Suggested Readings	390
The Management of Common Bile Duct Stones	391
Overview	391
Clinical Laboratory Findings	391
Imaging Workup	391
Transabdominal Ultrasonography	391
Endoscopic Retrograde Cholangiopancreatography	391
Magnetic Resonance Cholangiopancreatography	392
Management	392
Preoperative	392
Intraoperative	393
Technique of Laparoscopic Common Bile Duct Exploration	394
Technique of Laparoscopic Direct Common Bile Duct Exploration	394
Postoperative	394
Summary	395
Suggested Readings	395
Acute Cholangitis	395
Overview	395
Epidemiology	395
Pathogenesis	395
Clinical Presentation	396
Diagnosis	396
Therapy	397
Techniques of Biliary Drainage	398
Endoscopic Drainage	398
Percutaneous Transhepatic Drainage	398
Surgical Drainage	399
Principles of Management of Cholangitis Caused by Proximal Obstruction	399
Suggested Readings	399
Benign Biliary Strictures	399
Iatrogenic Biliary Injuries	399
Risk Factors for Biliary Injuries	400
Patient-Related Factors	400
Inflammation	400
Acute Inflammation.	400
Severe Chronic Inflammation.	400
Congenital Abnormalities	400
Aberrant Right Hepatic Ducts.	400
Other Patient-Related Factors	400
Large Impacted Gallstones.	400
Obesity and Body Habitus.	401
Procedure-Related Factors	401
Misidentification: A Concept Problem	401
Infundibular Technique.	401
Intraoperative Cholangiography.	401
Dissection of the Cystic Duct to the Confluence with the Common Hepatic Duct/Common Bile Duct.	401
The Critical View of Safety Technique	401
Top-Down Cholecystectomy.	401
Technical Problems	402
Failure to Obtain Secure Closure of the Cystic Duct.	402
Thermal Injuries.	402
Tenting Injuries.	402
Surgeon-Related or Hospital-Related Factors	402
Learning Curve Effect	402
The Psychology of Human Error	403
Equipment	403
Vasculobiliary Injuries	403
Extreme Vasculobiliary Injuries	403
The Culture of Safety in Cholecystectomy	403
Presentation and Investigation	403
Pain and Sepsis	403
Jaundice	403
Bile Fistula	404
Management of Biliary Injuries	404
Management of Injuries Recognized at the Initial Operation	404
Management of Biliary Injuries Diagnosed After Surgery	404
Type A Injuries	404
Type B Injuries	404
Type C Injuries	404
Type D Injuries	404
Type E Injuries	404
Timing of Surgery	404
Preoperative Preparation	404
Technical Aspects of Repair	404
Exposure	404
Identification and Repair	405
Treatment of Vasculobiliary Injuries	405
Outcome of Treatment	406
Other Benign Biliary Strictures	406
Biliary Strictures Secondary to Pancreatitis	406
Stricture From Noniatrogenic Bile Duct Injuries	406
Strictures From Calculous Disease	406
Primary Sclerosing Cholangitis	406
Benign Inflammatory Pseudotumors	406
Suggested Readings	407
Cystic Disorders of the Bile Ducts	407
Overview	407
Classification	407
Etiology	407
Epidemiology	407
Diagnosis and Preoperative Evaluation	407
Management	408
Type I: Extrahepatic Bile Duct Cyst	408
Type II: Extrahepatic Biliary Diverticulum	408
Type III: Choledochocele	409
Type IV: Multiple Bile Duct Cysts	409
Type V: Caroli’s Disease	409
Prognosis	409
Suggested Readings	409
Primary Sclerosing Cholangitis	409
Demographics	409
Etiology	410
Associated Diseases and Complications	410
Natural History and Prognostic Models	410
Presentation	410
Diagnosis	411
Therapy	411
Medical Therapy	412
Nonoperative Interventional Therapy	412
Operative Therapy	412
Surgical Resection	412
Liver Transplant	412
Summary	413
Suggested Readings	413
86 Management of Cholangiocarcinoma	414
Overview	414
Clinical Presentation	414
Intrahepatic Cholangiocarcinoma	414
Perihilar and Distal Cholangiocarcinoma	414
Diagnosis	414
Perihilar and Cholangiocarcinoma	414
Ultrasound Scan	414
Contrast-Enhanced, Triple-Phase, Helical Computed Tomographic Scan	415
Magnetic Resonance Cholangiopancreatography	415
Endoscopic Ultrasound Scan	415
Tumor Staging	415
Preoperative Evaluation	415
Surgical Treatment and Outcomes	417
Perihilar Cholangiocarcinoma	417
Distal Cholangiocarcinoma	419
Palliation	419
Summary	419
Suggested Readings	419
Gallbladder Cancer	419
Overview	419
Natural History, Biology, and the Role of Surgical Treatment	420
Staging	420
Clinical Scenarios	420
Suspicion Prior to Surgery	420
Discovery at the Time of Surgery or Final Pathology	421
Radiologic Evaluation	421
Management	422
Polyps	422
Suspicious Findings Prior to Surgery	422
GBC Discovered at Time of Surgery	423
GBC Incidentally Found on Final Pathology	423
Definitive Surgical Therapy	423
Stage-Based Therapy	423
Adjuvant Therapy	424
Palliative Care	424
Suggested Readings	424
Gallstone Ileus	424
Pathogenesis	424
Diagnosis	424
Management	425
Suggested Readings	426
Obstructive Jaundice:	427
Introduction	427
Endoscopic Therapies for Obstructive Jaundice	427
Endoscopic Retrograde Cholangiopancreatography	427
Cholangioscopy	427
Endoscopic Ultrasound	427
Benign Biliary Obstruction	427
Choledocholithiasis	427
Postsurgical Complications	428
Postsurgical Bile Leaks	428
Postsurgical Strictures	428
Primary Sclerosing Cholangitis	429
Malignant Obstruction	429
Suggested Readings	429
The Pancreas	431
Acute Pancreatitis	431
Assessment of Severity	431
Complications of Pancreatitis	432
Management of Patients with Acute Pancreatitis	432
Supportive Care	432
Volume Resuscitation	432
Metabolic Imbalance in Acute Pancreatitis	432
Analgesia	434
Nutrition	435
Antibiotic Prophylaxis	436
Endoscopic Retrograde Cholangiopancreatography	436
Management of Complications of Acute Pancreatitis	436
Pancreatic and Peripancreatic Fluid Collections	436
Sterile and Infected Pancreatic Necrosis	436
Percutaneous Drainage	436
Endoscopic Necrosectomy	437
Videoscopic-Assisted Retroperitoneal Débridement	437
Laparoscopic Surgical Necrosectomy	437
Open Surgical Management of Acute Pancreatitis	438
Surgical Technique	438
Closed Packing	438
Open Packing, Planned Staged Relaparotomies With Repeated Lavage, and Continuous Lavage of Lesser Sac and Retroperitoneum	439
Summary	439
Demographics	439
Severity Assessment	439
Intensive Care Unit Admission	439
Supportive Care	439
Nutrition	439
Minimally Invasive Step-Up Approach	439
Suggested Readings	439
The Management of Gallstone Pancreatitis	440
Overview	440
Presentation and Diagnosis	440
Determination of Disease Severity	440
Treatment	441
Mild Disease	441
Choledocholithiasis and Cholangitis	442
Patients at High Risk	442
Pregnant Patients	443
Severe Disease	443
Medical Management	443
Intervention in Severe Pancreatitis	443
Management of Pancreatic Necrosis	443
Suggested Readings	444
Pancreas Divisum and Other Variants of Dominant Dorsal Duct Anatomy	444
Introduction	444
Pancreatic Embryologic Development	444
Clinical Significance	445
Diagnostic Strategies	445
Treatment	447
Endoscopic Therapy	447
Surgical Therapy	447
Surgical Technique	449
Conclusion	449
Suggested Readings	449
Pancreatic Necrosis	450
Introduction	450
Definitions and Diagnosis	450
Role of Prophylactic Antibiotics	450
Timing of Surgical Intervention	450
Therapeutic Intervention for Pancreatic Necrosis	450
Percutaneous Drainage	452
Endoluminal Drainage	452
Open Pancreatic Necronectomy	452
Videoscopic Surgical Techniques	453
Step-Up Approach	453
Summary	453
Suggested Readings	454
The Management of Pancreatic Pseudocyst	454
Overview	454
Pathophysiology	455
Presentation	455
Diagnostic Evaluation	455
Management	456
Pseudocysts (After Acute Interstitial Edematous Pancreatitis)	456
Walled-Off Pancreatic Necrosis (After Acute Necrotizing Pancreatitis)	457
Disconnected Left Pancreatic Remnant	457
Pseudocysts Associated With Chronic Pancreatitis	457
Conclusion	457
Suggested Readings	458
Pancreatic Ductal Disruptions Leading to Pancreatic Fistula, Pancreatic Ascites, or Pancreatic Pleural Effusion	458
Introduction	458
Etiology and Complications	458
Pancreaticocutaneous Fistulae	459
Postoperative Fistulae	459
The Spleen	517
Hematologic Indications for Splenectomy	517
Overview of Splenic Structure and Function	517
Erythrocyte Disorders	517
Membrane Defects	517
Hemoglobinopathies	517
Sickle Cell Anemia	517
Thalassemia	517
Autoimmune Hemolytic Anemias	518
Enzyme Deficiencies	518
Platelet Disorders	518
Idiopathic Thrombocytopenic Purpura	518
Thrombotic Thrombocytopenic Purpura	518
Myeloproliferative Neoplasia	518
White Blood Cell Disorders	518
Preoperative Considerations	519
Laparoscopic Splenectomy	519
Postoperative Considerations	519
Conclusion	519
Suggested Readings	520
Cysts, Tumors, and Abscesses of the Spleen	520
Cysts	520
Primary (True) Cysts	520
Parasitic	520
Nonparasitic	520
Secondary (False) Cysts or Pseudocysts	521
Treatment	521
Splenectomy	521
Partial Splenectomy	521
Unroofing or Fenestration	521
Tumors	521
Malignant	521
Lymphoproliferative Disease	521
Myeloproliferative Disease	522
Primary (Nonlymphoid) Neoplasms	522
Metastatic Tumors	522
Benign	522
Treatment	522
Abscesses	522
Splenic Rupture	523
Splenic Infarct	523
Treatment	523
Overwhelming Postsplenectomy Sepsis	523
Suggested Readings	524
Splenic Salvage Procedures:	525
Nonoperative Management	525
Guidelines for Nonoperative Management	525
Approach to Nonoperative Management	525
Role of Angioembolization	525
Progression of Care	526
Results of Nonoperative Management	526
Operative Splenic Salvage	526
Splenic Splenorrhaphy	527
Partial Splenectomy	528
Recommendations	529
Suggested Readings	529
Hernia	531
Inguinal Hernia	531
Overview	531
Diagnosis	531
Inguinal Hernia Repair	531
Tissue Repair	532
Mesh Repair	532
Chronic Postinguinal Herniorrhaphy Pain	535
Suggested Readings	535
Recurrent Inguinal Hernia	536
Introduction	536
Prevention	536
Anatomy	536
Diagnosis	536
Patient Preparation	537
Anesthesia	537
Repair Options	537
Emergent	537
Laparoscopic	537
Stoppa Procedure	537
Plug and Patch	538
Complications	539
Summary	539
Suggested Readings	539
Incisional, Epigastric, and Umbilical Hernias	539
Incisional Hernias (Ventral Hernias)	539
Umbilical Hernias	539
Epigastric Hernia	540
Approach to the Repair of Ventral Hernias	540
To Repair or Not to Repair	540
Techniques of Hernia Repair	540
Tensioned Repair	541
Tension-Free Repairs	541
Mesh	541
Combined Approach	541
Laparoscopic Repair	542
Open Repair/Abdominal Wall Reconstruction	543
Follow-Up	544
CONCLUSION	545
Suggested Readings	545
The Management of Semilunar Line, Lumbar, and Obturator Herniation	545
Introduction	545
Semilunar Line (Spigelian) Herniation	545
Lumbar Herniation	547
Obturator Herniation	550
Summary	552
Suggested Readings	552
Athletic Pubalgia:	553
Introduction	553
Background	553
Anatomy, Pathophysiology, and Differential Diagnosis	553
Etiology	553
People at Risk	553
Presentation and Differential Diagnosis	553
Diagnostic Approach	554
Management	554
Nonsurgical	554
Surgical	554
Laparoscopic Approach	554
Open Mesh Approach	556
Open Nonmesh Approaches	556
Postoperative Course	556
Clinical Quality Improvement	556
Summary	557
Suggested Readings	557
Abdominal Wall Reconstruction	557
Anatomy	557
Skin and Adipose Tissue	557
Fascia	558
Muscles	558
Peritoneum	558
Patient Evaluation	559
Approach to Repair	559
Fascial Closure	560
Fascial Defects	560
Prosthetic Materials	561
Synthetic Materials	562
Absorbable Materials	562
Bioprosthetics	562
Conclusions	563
Suggested Readings	563
The Breast	565
The Management of Benign Breast Disease	565
Evaluation of Benign Breast Complaints	565
Breast Masses	565
Fibroadenomas	566
Breast Cysts	566
Breast Pain	566
Nipple Discharge	566
Breast Infection	567
Abnormal Screening Mammograms	567
Summary	567
Suggested Readings	567
Screening For Breast Cancer	568
Overview	568
Screening Recommendations	568
Screening Modalities	568
Breast Self Examination	568
Clinical Breast Examination	568
Screening Mammography	568
Digital Mammography	569
Biopsies	569
High-Risk Screening	570
Other Imaging Modalities	570
Ultrasound Scan	570
Magnetic Resonance Imaging	570
Tomosynthesis	571
Future	571
Suggested Readings	571
The Role of Stereotactic Breast Biopsy in the Management of Breast Disease	571
Introduction	571
History	571
Certification	572
Patient Selection, Indications, and Contraindications	572
The Fundamentals	573
The Procedure	573
Challenging Clinical Scenarios	576
Pathologic Correlation	578
Conclusions and Future Directions	578
Selected Readings	579
Molecular Targets in Breast Cancer	579
Molecular Profiling	579
Luminal Subtypes	580
HER2-Enriched	580
Basal-Like	580
Clinical Gene Expression Assays	580
Estrogen Receptor Signaling Pathways	580
Growth Factor Recptor Pathways and Down Stream Pathways	582
PI3K/AKT Pathway	583
Angiogenesis	583
DNA Repair Pathways	583
Poly(ADP-ribose) Polymerase Inhibitors	583
Suggested Readings	583
Breast Cancer:	584
Introduction	584
Diagnosis and Workup	584
Treatment	584
Noninvasive and Invasive Breast Cancer	584
Breast Incision and Procedure Selection	584
Localization	584
Surgical Margins	584
Staging the Axilla	585
Sentinel Lymph Node Technique	585
Axillary Lymph Node Dissection Technique	586
Mastectomy Technique	586
Reconstruction	586
Nipple-Sparing or Total Skin-Sparing Mastectomy Technique	586
Adjuvant Therapy	587
Prophylactic Surgery	587
Summary	587
Suggested Readings	587
Ablative Therapies in Benign and Malignant Breast Disease	587
Overview	587
Cryoablation	588
Ongoing Cryoablation Trials	588
Cryoablation Technique and Mechanism	588
Cryoablation Benefits	589
Radiofrequency Ablation	590
Suggested Readings	591
Lymphatic Mapping and Sentinel Lymphadenectomy	592
Introduction	592
Indications and Contraindications for Sentinel Lymph Node Biopsy	592
Technical Aspects	592
Special Considerations	593
Neoadjuvant Chemotherapy	593
Implications of Micrometastatic Disease and Isolated Tumor Cells Detected with Sentinel Lymph Node Biopsy	594
Alternatives to Axillary Lymph Node Dissection for Positive Sentinel Lymph Nodes	594
ACOSOG Z0011 Trial	594
IBCSG-23-01 Trial	594
AMAROS Trial	594
Complications	594
Future Directions	594
Conclusion	595
Suggested Readings	595
The Management of The Axilla in Breast Cancer	595
Overview	595
Clinically Node-Negative Invasive Breast Cancer	595
Management of Patients With Pathologically Negative Sentinel Nodes	596
Management of Patients With Sentinel Node Micrometastases	596
Management of Patients With Sentinel Node Macrometastases	596
Clinically Node-Positive Invasive Breast Cancer	596
Other Indications for Axillary Node Dissection	596
Axillary Management for Ductal Carcinoma in Situ	597
Axillary Management in Pregnant Patients	597
Axillary Management in the Elderly	597
Axillary Management in Male Breast Cancer	597
Positive Axillary Nodes with an Occult Primary Tumor	597
Axillary Management after Neoadjuvant Chemotherapy	597
Management after Prior Axillary Surgery	598
Management of Axillary Tumor Recurrence	598
Axillary Radiation after Axillary Dissection	598
Alternatives to Axillary Surgery	598
Technical Aspects of Axillary Lymph Node Dissection	599
Suggested Readings	599
Inflammatory Breast Carcinoma	599
Introduction	599
Clinical Presentation	599
Diagnosis and Staging	600
Treatment	600
Neoadjuvant Chemotherapy	600
Surgery	600
Radiation Therapy	601
Targeted Therapy With Trastuzumab	601
Hormonal Therapy	601
Prognosis and Follow-Up	601
Suggested Readings	601
Ductal and Lobular Carcinoma in Situ of the Breast	602
Ductal Carcinoma in Situ	602
Diagnosis	602
Treatment	602
Surgical Therapy	602
Radiation Therapy	603
Hormonal Therapy	604
Surveillance	604
Lobular Carcinoma in situ	604
Pathophysiology	604
Natural History	605
Diagnosis	605
Treatment	605
Specimen Evaluation	605
Treatment Options	606
Suggested Readings	606
Advances in Neoadjuvant and Adjuvant Therapy for Breast Cancer	607
Overview	607
Neoadjuvant Systemic Therapy	607
Neoadjuvant Chemotherapy	607
Neoadjuvant Endocrine Therapy	607
Surgery After Neoadjuvant Therapy	607
Adjuvant Therapy	608
Endocrine Therapy	608
Premenopausal Patients	609
Postmenopausal Patients	609
Adjuvant Chemotherapy	609
Molecular and Genomic Profiling	609
Chemotherapy	610
Her 2 neu–Targeted Therapy	610
Summary	611
Suggested Readings	611
The Management of Recurrent and Disseminated Breast Cancer	612
Introduction	612
Relapse Patterns and Definitions	612
Therapeutic Principles and Strategies	612
Ipsilateral Breast Tumor Recurrence After Breast-Conserving Therapy	612
Preoperative Considerations	612
Choice of Operation	613
Technical Factors During Mastectomy for In-Breast Tumor Recurrence	613
Complications and Their Prevention	613
Recurrence After Mastectomy	613
Preoperative Considerations	613
Technical Tips	614
Nodal Staging of Recurrent Breast Cancer after Breast Conservation or Mastectomy	615
Lymph Node Recurrence	616
Technical Tips	616
Axillary Lymph Node Dissection	616
Internal Mammary and Supraclavicular Lymph Node Metastasis	617
Metastatic Breast Cancer	617
Intact Primary Tumor in Patients with Metastatic Breast Cancer	617
Isolated Distant Metastatic Disease	617
Hepatic Breast Cancer Metastases	617
Pulmonary Metastases	618
Suggested Readings	618
Male Breast Cancer	618
Overview	618
Risk Factors	618
Presentation	619
Diagnosis	619
Treatment	619
Prognosis	620
Suggested Readings	621
Breast Reconstruction Following Mastectomy:	621
Indications	621
Reconstructive Techniques	622
Implants	622
Two Stages	622
One Stage	622
Tissue Matrices	622
Autologous Methods of Breast Reconstruction	622
Fat Grafting	623
Pedicled Flap Reconstruction	623
The Latissimus Flap	623
The TRAM Flap	623
Free Flap Breast Reconstruction	623
Suggested Readings	624
Endocrine Glands	625
Adrenal Incidentaloma	625
Overview/Clinical Problem	625
Imaging	625
Density/Hounsfield Unit Assessment	625
Size	625
Rapid Office Biochemical Evaluation (Summary)	627
Clinical EvAluation	627
Cortisol Production (Zona Glomerulosa)	627
History/Symptoms	627
Physical Examination	627
Biochemical Evaluation	627
Aldosterone Producing Adenoma (Zona Fasciculata)	628
Skin and Soft Tissue	693
Nonmelanoma Skin Cancers	693
Risk Factors and Precurser Lesions	693
Clinical Evaluation of Basal Cell and Squamous Cell Cancers	694
Clinical Appearance and Patient Examination	696
Complete Excision and Peripheral Margin Evaluation	697
Reconstruction of the Defect	697
Confirmation of Negative Margins	697
Enlarged Regional Nodes	697
Radiation Therapy as Primary or Adjunctive Treatment	697
Long-Term Follow-up of Basal and Squamous Cell Cancers	697
Dermatfibrosarcoma Protuberans	698
Treatment	698
Cutaneous T-Cell Lymphoma	698
Basal Cell Nevus Syndrome	698
Bowen’s Disease	698
Merkle Cell Carcinoma	699
Angiosarcoma	699
Adenexal Tumors of the Skin	699
CONCULSION	700
Acknowledgments	700
Suggested Readings	700
The Management of Cutaneous Melanoma	700
Overview	700
Biopsy Techniques	700
Treatment of Primary Lesion	700
Margins	700
Incision and Reconstruction	700
Special Sites	701
Nail Bed	701
Sole of Foot	701
Ear	702
Treatment of Regional Nodes	702
Sentinel Node Biopsy	702
Completion Lymphadenectomy	703
Neck Dissection	704
Axillary Dissection	704
Inguinal Dissection	704
Popliteal Dissection	704
Ectopic Sentinel Nodes	704
Adjuvant Radiotherapy and Adjuvant Interferon-alpha After Completion Dissection	705
In-Transit Disease	705
Local Therapies	705
Regional Therapies	705
Systemic Therapies	705
Metastatic Disease	705
Follow-Up	705
Management of Recurrent Disease	706
Conclusion	706
Suggested Readings	706
The Management of Soft Tissue Sarcoma	706
Overview	706
Etiology	707
Grading	707
Treatment	707
Imaging	707
Histology-Specific Treatment	707
Atypical Lipomatous Tumor/ Well-Differentiated Liposarcoma	707
Dermatofibrosarcoma Protuberans	708
Malignant Fibrous Histiocytoma	708
Myxofibrosarcoma	708
Low Grade Fibromyxoid Sarcoma	708
Angiosarcoma	708
Radiation-Induced Sarcomas	709
Malignant Peripheral Nerve Sheath Tumors	709
Extremity Soft Tissue Sarcoma	710
Clinical and Diagnostic Evaluation	710
Surgical Treatment	711
Adjuvant/Neoadjuvant Radiation Therapy and Chemotherapy	713
Retroperitoneal Soft Tissue Sarcoma	714
Clinical and Diagnostic Evaluation	714
Anatomic Features of Retroperitoneal Sarcomas	714
Technical Aspects of Retroperitoneal Sarcoma Resection	715
Radiation Therapy	715
Breast Sarcoma	716
Primary Angiosarcoma	716
Secondary Breast Angiosarcoma	716
Phyllodes Tumor	717
Desmoid Fibromatosis	717
Metastatic Disease	717
Summary	717
Suggested Readings	717
Evaluation of the Isolated Neck Mass	718
Overview	718
Differential Diagnosis	718
Workup	718
History	718
Physical Examination	718
Imaging	720
Tissue Diagnosis	720
Endoscopy and Biopsy	722
Surgical Considerations	723
Anesthesia and Airway Considerations	723
Incisions	723
Potential Nerve Injuries	723
Other Potential Complications	724
Suggested Readings	724
Hand Infections	724
Introduction	724
Microbiology	724
Methicillin-Resistant Staphylococcus Aureus	724
The Diabetic and Immunocompromised Hand	726
Bite Wounds	726
Finger Infections	726
Paronychia	726
Diagnosis	726
Treatment	726
Felon	727
Chest Wall, Mediastinum, Trachea	751
The Management of Primary Chest Wall Tumors	751
Overview	751
Diagnosis	751
Benign Bony and Cartilaginous Tumors	751
Fibrous Dysplasia	751
Osteochondroma	751
Chondroma	751
Malignant Bony and Cartilaginous Tumors	752
Chondrosarcoma	752
Osteosarcoma	752
Ewing’s Sarcoma	752
Solitary Plasmacytoma	753
Benign Soft Tissue Tumors	753
Lipomas	753
Fibromas (Desmoid Tumors) and Fibromatosis	753
Hemangiomas	753
Benign Peripheral Nerve Sheath Tumors	753
Malignant Soft Tissue Tumors	753
Malignant Fibrous Histiocytoma	753
Synovial Sarcomas	753
Rhabdomyosarcomas	753
Surgical Treatment of Chest Wall Tumors	753
Chest Wall Resection	753
Chest Wall Reconstruction	754
Options for Chest Wall Reconstruction	754
Summary	755
Suggested Readings	755
Mediastinal Masses	755
Introduction	755
Clinical Presentation and Diagnosis	756
Signs and Symptoms	756
Imaging	756
Tumor Markers	756
Biopsy Techniques	756
Diagnosis	756
Anterior Mediastinum	757
Thymic Tumors	757
Germ Cell Tumors	757
Mature Teratomas	758
Seminomas	758
Nonseminomatous Germ Cell Tumors	758
Lymphoma	758
Thyroid and Parathyroid	759
Middle Mediastinum	759
Castleman’s Disease	759
Mediastinal Lymphadenopathy	759
Mediastinal Cysts	760
Posterior Mediastinum	760
Conclusion	760
Selected Readings	760
Primary Tumors of the Thymus	761
Anatomy	761
Pathology	761
Evaluation	761
Staging	762
Principles of Therapy	762
Operative Management	762
Transsternal Thymectomy	763
Video-Assisted Thoracic Surgery: Thymectomy	763
Robotic Thymectomy	763
Summary	764
Suggested Readings	764
The Management of Tracheal Stenosis	764
Timing of Therapy	764
Indications for Resection	765
Factors to Consider for Tracheal Resection	765
Airway Management	765
Tracheal Resection and Reconstruction	765
Results	767
Suggested Readings	767
The Management of Acquired Esophageal Respiratory Tract Fistula	767
Overview	767
Benign Esophageal Respiratory Fistulas	767
Treatment of Benign Fistulas	768
Repair of Benign Tracheoesophageal Fistula	768
Repair of Benign Bronchoesophageal Fistulas	769
Malignant Esophageal Respiratory Tract Fistula	770
Esophageal Stents	770
Airway Stents	771
Summary	771
Suggested Readings	771
Repair of Pectus Excavatum	772
Evaluation of the Patient with Pectus Excavatum	772
Open Repair	772
Minimally Invasive Pectus Excavatum Repair (Nuss Procedure)	772
Complications of Minimally Invasive Repair	773
Outcome of Pectus Excavatum Repair	774
Suggested Readings	775
Vascular Surgery	777
Open Repair of Abdominal Aortic Aneurysms	777
Overview	777
Indications for Repair	777
Preoperative Planning	778
Surgical Repair	778
Surgical Approaches	778
Transperitoneal Approach	779
Retroperitoneal Approach	780
Operative Conduct	781
Complications	782
Conclusion	783
Suggested Readings	783
Endovascular Treatment of Abdominal Aortic Aneurysm	783
Introduction	783
Preoperative Considerations	783
Aortic Neck Anatomy	783
Iliofemoral Access	783
Technical Details of the Procedure	784
Postoperative Care and Follow-Up	785
Complications	785
Type I	786
Type II	786
Type III and Type IV	786
Endotension	786
Limb Thrombosis	786
Migration	786
Summary	786
New Devices on the Horizon	787
Suggested Readings	787
The Management of Ruptured Abdominal Aortic Aneurysm	788
Introduction	788
Diagnosis and Evaluation	788
Treatment	788
Endovascular Repair	788
Open Repair	789
Discussion	791
Summary	791
Suggested Readings	791
Abdominal Aortic Aneurysm and Unexpected Abdominal Pathology	791
Overview	791
Elective Abdominal Aortic Aneurysm Repair and Asymptomatic Abdominal Disease	792
Cholelithiasis	792
Appendix and Meckel’s Diverticulum	792
Gastrointestinal Malignancies	792
Genitourinary Malignancies	793
Solid Organ Tumors	793
Emergent Abdominal Aortic Aneurysm Repair and Concomitant Disease	794
Emergent Laparotomy for Symptomatic Abdominal Pathology with Incidental Asymptomatic Abdominal Aortic Aneurysm	794
Elective Laparotomy for Abdominal Pathology with Incidental Asymptomatic Abdominal Aortic Aneurysm	794
Summary	794
Suggested Readings	795
The Management of Thoracic and Thoracoabdominal Aortic Aneurysms	795
Introduction	795
Indications for Surgery	795
Preoperative Risk Assessment	796
Open Surgical Management	796
Adjuncts for Organ Protection	797
Operative Technique	797
Outcomes	803
Endovascular Surgical Management	804
Outcomes	805
Alternative Approaches	806
Suggested Readings	807
The Management of Acute Aortic Dissections	807
Overview	807
Classification	807
Presentation and Diagnosis	808
Management	808
Surgical Management of Stanford a Dissections	808
Surgical Results with Acute Type a Dissections	810
Management of Acute Type B Dissections	810
Suggested Readings	811
Carotid Endarterectomy	811
Overview	811
Clinical Presentation	811
Clinical Status	811
Imaging Studies	811
Indications	812
Carotid Endarterectomy Versus Carotid Stenting	813
Carotid Endarterectomy: Operative Technique	813
Preoperative Medical Regimen	813
Anesthesia	813
Patient Positioning	813
Skin Incision	814
Operative Technique	814
Eversion Endarterectomy	815
Completion Studies	816
Unexpected Intraoperative Findings of the Internal Carotid Artery	816
High Carotid Bifurcation	816
Hypoplastic Internal Carotid Artery	816
Thrombosed Internal Carotid Artery	816
Complications	816
Stroke	816
Nerve Injury	817
Myocardial Infarction	817
Hyperperfusion Syndrome	817
Recurrent Carotid Stenosis	817
Combined Carotid Endarterectomy–Coronary Artery Bypass	817
Suggested Readings	817
The Management of Recurrent Carotid Artery Stenosis	818
Incidence of Restenosis	818
Timing of Restenosis and Pathogenesis	818
Risk Reduction	819
Diagnosis of Restenosis	819
Indications for Reintervention	820
Intervention for Recurrent Carotid Stenosis	820
Reoperative Carotid Endarterectomy	820
Technical Details	820
Results	821
Carotid Angioplasty and Stenting	822
Technical Details	822
Results	822
Summary	822
Suggested Readings	822
Balloon Angioplasty and Stents in Carotid Artery Occlusive Disease	823
Background	823
Technical Considerations in Performance of Carotid Artery Stenting	823
Design of Carotid Stent Systems	825
Carotid Stents	825
Embolic Protection Devices	827
Periprocedural Management	829
Antiplatelet Therapy	829
Hemodynamic Instability	829
Periprocedural Neurologic Assessment	829
Follow-up	830
Summary and Perspective	830
Suggested Readings	830
The Management of Aneurysms of the Extracranial Carotid and Vertebral Arteries	830
Introduction	830
Carotid Artery Aneurysms	830
Etiology	830
Presentation and Diagnosis	831
Indications for Intervention	831
Treatment	831
Results	835
Vertebral Artery Aneurysms	835
Suggested Readings	835
Brachiocephalic Reconstruction	836
Introduction	836
Clinical Presentation	836
Diagnostic Evaluation	836
Treatment	837
Indication for Treatment	837
Treatment Options	838
Anatomic (Direct) Revascularization	839
Endarterectomy	839
Bypass Graft	839
ExtraAnatomic (Indirect) Revascularization	839
Arterial Transposition	840
Endovascular Treatment	841
Innominate Artery Interventions	841
Left Common Carotid Artery	841
Left Subclavian Artery	842
Summary	842
Selected Readings	843
Upper Extremity Arterial Occlusive Disease	843
Overview	843
Etiology	843
Systemic Disease	843
Embolism	844
Trauma	844
Evaluation	844
History and Physical Examination	844
Noninvasive Vascular Evaluation	845
Management	846
Medical Therapy	847
Endovascular Therapy	847
Surgical Therapy	847
Operative Exposure of the Subclavian Artery	847
Surgical Reconstruction for Proximal Subclavian Artery Lesions	848
Subclavian Artery Transposition	848
Carotid-Subclavian Bypass	848
Axillary Artery	848
Brachial Artery	849
Radial and Ulnar Arteries	849
Angioaccess-Induced Arterial Steal Syndrome	849
Summary	850
Suggested Readings	851
Aortoiliac Occlusive Disease	851
Introduction	851
Initial Evaluation and Indications for Intervention	851
Direct Surgical Revascularization	852
Aortobifemoral Bypass	854
Iliofemoral Bypass	856
ExtraAnatomic Bypass	857
Femorofemoral Bypass	857
Axillobifemoral Bypass	857
Other Surgical Revascularization Options	859
Complications of Surgical Revascularization	859
Results of Surgical Revascularization	860
Endovascular Interventions	860
Complications of Endovascular Interventions	861
Results of Endovascular Interventions	861
Summary	863
Suggested Readings	863
Femoropopliteal Occlusive Disease	863
Introduction	863
Evaluation	863
Treatment	864
Medical	864
Interventional	864
Endovascular Treatment	864
Surgical Treatment	865
Discussion	867
Summary	868
Suggested Readings	868
Tibioperoneal Arterial Occlusive Disease	869
Patient Assessment	869
Selection of Intervention	870
Surgical Bypass	870
Anesthesia and Positioning	870
Operative Exposures	871
Inflow Vessels	871
Outflow Vessels	871
Proximal Posterior Tibial and Peroneal Arteries	871
Anterior Tibial Artery and Dorsalis Pedis Artery	872
Conduit	872
Inflow Anastomosis	873
Tunnels for Bypass Grafts	874
Outflow Anastomosis	874
Endovascular Revascularization	874
Indications for Intervention	874
Vascular Access and Imaging	874
Balloon Angioplasty and Stent Placement	875
Other Technologies	875
Postintervention Management and Surveillance	875
Complications	875
Future Treatment: Cell-Based Therapies	875
Conclusion	877
Suggested Readings	877
Profunda Femoris Reconstruction	877
Profunda Femoris Artery	877
Basic Anatomy	877
Operative Role	877
Profunda Femoris as an Inflow Vessel	877
Outflow	878
Isolated Profundaplasty	878
Operative Approaches	878
Standard Anterior Approach	878
Standard Anterior Approach for Extended Profundaplasty	880
Anteromedial and Anterolateral Approach	880
Posteromedial Approach	881
Posterior Approach	881
Endovascular Therapy	881
Conclusion	882
Suggested Readings	882
Femoral and Popliteal Artery Aneurysms	883
Overview	883
Degenerative Femoral Aneurysms	883
Introduction	883
Clinical Presentation and Diagnosis	883
Treatment	883
Results	884
Iatrogenic Femoral Pseudoaneurysms	884
Introduction	884
Clinical Presentation and Diagnosis	885
Treatment	885
Results	886
Popliteal Aneurysms	886
Introduction	886
Clinical Presentation and Diagnosis	886
Treatment	887
Results	887
Suggested Readings	888
The Treatment of Claudication	888
The Initial Evaluation of the Patient with Suspected Claudication	888
Initial Management of the Patient with Claudication: Management of Limb Symptoms	889
Initial Management of the Patient with Claudication: Management of Generalized Atherosclerosis	889
Follow-Up after Initiation of Medical Management and Selection of Patients for Intervention	890
Treatment of the Arterial Occlusive Lesions That Cause Claudication	891
Summary	892
Suggested Readings	892
Pseudoaneurysms and Arteriovenous Fistulas	893
PSEUdoaneurysms	893
Definitions	893
Risk Factors	893
Diagnosis	893
Treatment	893
Observation	893
Ultrasound Scan–Guided Compression	893
Ultrasound Scan–Guided Thrombin Injection	894
Endovascular Repair	895
Open Surgical Repair	895
Noninfected Pseudoaneurysms	895
Infected Pseudoaneurysms	896
Anastomotic Pseudoaneurysms	896
Arteriovenous Fistula	897
Diagnosis	897
Treatment	898
Open Surgical Repair	898
Endovascular Repair	898
Suggested Readings	898
Axillofemoral Bypass	898
Introduction	898
Indications	898
Preoperative Evaluation	900
Techniques	900
Graft Configurations	901
Results	901
Complications	901
Postoperative Management	901
Conclusions	903
Suggested Readings	903
The Management of Peripheral Arterial Emboli	903
Overview	903
Classification, Site, and Source of Embolism	903
Pathophysiology	904
Clinical Presentation	904
Diagnostic Examination	906
Management	907
Medical Management	907
Surgical Management	907
Endovascular Approach	908
Compartment Syndrome	908
Postoperative Management	908
Outcomes/Results	909
Suggested Readings	909
Acute Peripheral Arterial and Bypass Graft Occlusion:	909
Overview	909
Patient Presentation and Workup	909
History and Physical Exam	909
Imaging	910
Medical Management	910
Catheter Directed Thrombolysis	910
Results of Thrombolysis	910
Techniques of Thrombolysis	911
Lytic Agents	911
Mechanical Thrombolysis	912
Suction Thrombectomy	912
Rheolytic Devices	912
Rotational/Infusion Devices	912
Ultrasonographic	912
Conclusion	914
Suggested Readings	914
Atherosclerotic Renal Artery Disease	914
Introduction	914
Incidence	914
Natural History of Renal Artery Stenosis	914
Anatomic Progression	914
Functional Progression	915
Treatment	915
Patient Selection	915
Medical Therapy	915
Hypertension Control	915
Lipid-Lowering Agents	915
Antiplatelet Therapy	915
Other Risk Modifications	915
Surgical Therapy	916
Unilateral Renal Artery Stenosis In patients with unilateral RAS, we prefer a retroperitoneal approach to renal revascularization. While direct aortorenal bypass is possible through this exposure, we prefer ileorenal bypass if the common iliac is free of plaque and calcific disease. With the patient in the lateral decubitus position, a curvilinear incision is performed extending from just lateral to the rectus muscle and sheath to the 12th rib (Figure 1). This incision is carried down through the subcutaneous tissue and fascia. The anterior sheath is divided, and the 12th rib is excised. The internal oblique and transversalis muscles are divided, and the retroperitoneum is entered just lateral to the junction of the rectus sheath in the lateral abdominal wall muscles. The peritoneum is then mobilized medially and cephalad. Once the peritoneum is mobilized, the ureter is identified and gently dissected down to the level of the distal common iliac artery inferiorly and superiorly to the level of the renal pelvis. If the dissection is being performed on the left side, it is often necessary to identify and ligate the gonadal vein as well as the inferior lumbar branch of the left renal vein. Once the ureter is mobilized, Gerota’s fascia is entered, and the kidney is circumferentially mobilized. The renal artery is identified and dissected to its junction with the aorta. At this point, the patient is systematically heparinized, the common iliac artery is clamped, and an end-to-side anastomosis is performed to our conduit. We prefer to use saphenous vein, but if deemed unsuitable (<3 mm, sclerotic), PTFE is used. Once the iliac anastomosis is performed, the renal artery is mobilized proximally and doubly ligated with silk suture. Iced slush is applied over the kidney to decrease its temperature, and an end-to-end anastomosis is performed between the conduit and the renal artery in a running or interrupted fashion, depending on the size of the renal artery. Doppler signals confirm flow in the renal artery and the renal parenchyma. In patients with right-sided RAS (Figure 2), it is important to circumferentially mobilize the right renal vein at the lateral border of the inferior vena cava in order to fully dissect the right renal artery. In instances where two small diseased renal arteries are identified (Figure 2, A), it may be necessary to surgically combine the two arteries into one larger orifice to facilitate revascularization (Figure 2,B).	916
Bilateral Renal Artery Stenosis	916
Other Surgical Options	916
Open Surgical Results	916
Endovascular Revascularization	917
Renal Artery Stenting	917
Endovascular Results	918
Summary	918
Suggested Readings	918
Raynaud’s Syndrome	918
Overview	918
Pathogenesis	918
Diagnosis and Presentation	919
Treatment	919
Conservative Treatment	919
Pharmacologic	920
Calcium Channel Blockers	920
Prostaglandins	920
Alpha-2 Adrenoreceptor Blockers	920
Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers	921
Phosphodiesterase Inhibitors	921
Endothelin-1 Receptor Antagonist	921
Selective Serotonin Reuptake Inhibitors	922
Surgical Intervention	923
Conclusions	923
Suggested Readings	923
Thoracic Outlet Syndromes	924
Overview	924
Anatomy of the Thoracic Outlet	924
Arterial Compression	924
Venous Compression (Paget-Schroetter Syndrome)	925
Nerve Compression	926
Transaxillary Approach	926
Preparation and Position	926
Operative Approach	926
Suggested Readings	927
The Diabetic Foot	928
Introduction	928
Pathophysiology	928
Presentation	928
Treatment	929
Conclusion	930
Disclaimer	931
Suggested Readings	931
Gangrene of the Foot	931
Overview	931
Risk Factors and Epidemiology	931
Evaluation	931
Clinical Presentation	931
Diagnostics	932
Ankle-Brachial Index	932
Toe-Brachial Index	932
Segmental Limb Pressures	932
Transcutaneous Oxygen Measurement	932
Duplex Ultrasonography	932
Multidetector Computed Tomographic Angiography	933
Magnetic Resonance Angiography	933
Assessment of Metabolic Status	933
Management	933
Antibiotics and Medical Management	933
Débridement	933
Revascularization	933
Amputations	933
Toe Amputation	934
Great Toe Amputation	934
Lesser Toe Amputations	934
Ray Amputation	934
Transmetatarsal Amputation	934
Syme Amputation	935
Transtibial Amputation	935
Transfemoral Amputation	936
Summary	936
Suggested Readings	936
Buerger’s Disease (Thromboangiitis Obliterans)	937
Introduction	937
Clinical Presentation	937
Diagnosis	937
Treatment	938
Prognosis	939
Summary	939
Suggested Readings	939
Acute Mesenteric Ischemia	939
Overview	939
Anatomy and Collateralization	939
Pathophysiology	940
Clinical Presentation and Diagnosis	940
Treatment	942
Initial Management	942
Embolism of Mesenteric Artery	943
Thrombosis of Mesenteric Artery	943
Nonocclusive Mesenteric Ischemia	944
Mesenteric Venous Thrombosis	944
Endovascular Treatment	946
Conclusion	946
Suggested Readings	946
The Management of Chronic Mesenteric Ischemia	947
Arterial Disease	947
Reconstruction Options	947
Endovascular Techniques	947
Endarterectomy	949
Bypass	950
Antegrade Bypass	950
Retrograde Bypass	951
Extent of Visceral Artery Reconstruction	951
Outcome of Open Revascularization	952
Suggested Readings	952
Hemodialysis Access Surgery	953
Introduction	953
Historical Notes	953
National Practices and Guidelines	954
Preoperative Evaluation	954
Operative Techniques	955
Autogenous Arm Fistulae	955
Radiocephalic Fistula	955
Upper-Arm Fistula	955
Prosthetic Arteriovenous Grafts	956
Special Considerations	957
Complications and Management	957
Conclusions	957
Selected Readings	957
Venous Thromboembolism:	958
Introduction	958
Impact	958
Risk Factors	958
Prevention and Prophylaxis	958
Diagnosis	959
Screening of Asymptomatic Patients	960
Treatment	961
Deep Venous Thrombosis	961
Pulmonary Embolism	961
Inferior Vena Cava Filters	962
Conclusion	963
Suggested Readings	963
Deep Venous Thrombosis	963
Risk Factors	964
Diagnosis	964
Therapy	964
Anticoagulation	965
Surgical Thrombectomy	965
Thrombolytic Therapy	965
Catheter-Directed Thrombolytic Therapy	965
Mechanical Thrombectomy	965
Permanent Inferior Vena Cava Filters	966
Retrievable Inferior Vena Cava Filters	966
Special Considerations	966
Phlegmasia Alba Dolens and Phlegmasia Cerulea Dolens	966
External Compression of Deep Veins	966
Internal Jugular Vein/Axillosubclavian Vein Thrombosis	966
Superficial Vein Thrombosis	966
Suggested Readings	967
Vena Cava Filters	967
Introduction	967
Indications and Contraindications for Inferior Vena Cava Filter Placement and Retrieval	967
Filter Selection	968
Special Considerations: Suprarenal Inferior Vena Cava Filter	970
Special Considerations: Superior Vena Cava Filters	970
Contraindications for Placement of Inferior Vena Cava Filter	970
Technique	970
Filter Retrieval	971
Complications	971
Discussion	971
Suggested Readings	972
The Prevention of Venous Thromboembolism	972
Epidemiology	972
Risk Factors	972
Venous Thromboembolism Prophylaxis	973
Venous Thromboembolism Diagnosis	974
Venous Thromboembolism Treatment	974
Inferior Vena Cava Filter	975
Catheter-Directed Thrombolytic Therapy	975
Systemic Thrombolysis	975
Complications	975
Summary	975
Suggested Readings	976
Lymphedema	976
Diagnosis	976
Treatment	977
Nonoperative Management	977
Operative Treatment	978
Debulking Procedures	978
Physiologic Procedures	979
Summary	979
Suggested Readings	979
Trauma and Emergency Care	981
Initial Assessment and Resuscitation of the Trauma Patient	981
Initial Assessment and Resuscitation of the Trauma Patient	981
Stop the Harm and Do No (Further) Harm	981
Preparation of the Team and Resuscitation Area	981
Primary Survey	981
Airway (With Cervical Spine Control)	981
Breathing	982
Circulation (With Hemorrhage Control)	982
Disability (Neurologic Assessment)	982
Exposure (With Environmental Control)	982
Focused Assessment With Sonography for Trauma	983
Resuscitation and Monitoring	983
Secondary Survey	983
Next Steps	983
Suggested Readings	984
Airway Management in the Trauma Patient	984
Initial Airway Assessment and Therapy	984
Rapid Sequence Induction and Intubation	984
Endotracheal Intubation	986
Supraglottic Airway Devices	987
Awake Fiberoptic Intubation	987
Airway Management Decision Making	987
Surgical Airway	987
When and Where to Intubate? Field Versus Emergency Department or Trauma Unit Endotracheal Intubation	988
Suggested Readings	990
The Surgeon’s Use of Ultrasound in Thoracoabdominal Trauma	990
Focused Assessment for the Sonographic Evaluation of the Trauma Patient	990
Technique	990
Accuracy of the FAST	991
Recent Advances and Organ Specificity	992
Traumatic Hemothorax	993
Technique	993
Preoperative and Postoperative Care	1153
Fluids and Electrolytes	1153
Introduction	1153
Fluid Compartments and Osmolality	1153
Daily Requirements and Choice of Maintenance Fluids	1154
Assessment of Fluid Status and Choice of Replacement Fluids	1154
Diagnosis and Treatment of Electrolyte Disorders	1155
Sodium	1155
Potassium	1156
Calcium	1157
Magnesium	1158
Phosphorus	1158
Suggested Readings	1159
Preoperative Assessment of the Older Patient:	1159
Overview	1159
Older Surgical Patients	1159
Frailty	1159
Frailty, Comorbidity, and Disability	1160
Frailty and Surgical Risk Prediction	1161
Alternative Measures of Frailty and Surgical Outcomes	1161
Sarcopenia and Surgery	1162
Logisitics of Preoperative Measurement of Frailty	1162
Conclusion	1162
Suggested Readings	1162
Preoperative Preparation of the Surgical Patient	1163
Introduction	1163
Oral Intake Guidelines	1163
Preoperative Testing	1163
Electrocardiograms and Other Cardiac Testing	1163
Chest Radiographs	1163
Blood Tests	1164
Urine Testing	1165
Comorbidities	1165
Cardiac Disease	1165
Ischemia and Stents	1165
Pacemakers and Defibrillators	1166
Pulmonary Disease	1166
Liver Disease	1166
Diabetes	1166
Renal Disease	1167
Obesity	1167
Medication Management	1167
Angiotensin Converting Enzyme Inhibitors	1167
Anticoagulants	1167
Beta-Blockers	1168
Herbal Medications	1168
Opiates	1168
Proton Pump Inhibitors and Histamine-2 Blockers	1168
Summary	1168
Suggested Readings	1169
Is a Nasogastric Tube Necessary After Alimentary Tract Surgery?	1169
Suggested Readings	1171
Surgical Site Infections	1172
Overview	1172
Definition	1172
Risk Factors	1172
Prevention	1172
Patient Preparation	1172
Immediate Preoperative Prevention	1172
Prophylactic Antibiotics (SCIP INF 1 to 3)	1172
Appropriate Hair Removal (SCIP INF 6)	1173
Postoperative Normoglycemia (SCIP INF 4)	1173
Postoperative Normothermia (SCIP INF 10)	1174
Performance Measures	1175
Intraoperative and Postoperative Incision Management	1176
Special Considerations	1176
Treatment	1176
Summary	1177
Suggested Readings	1177
The Management of Intra-abdominal Infections	1177
Introduction	1177
Definitions	1177
Diagnostics	1178
Intra-abdominal Infections Following Abdominal Trauma or Surgery	1178
Management of Intra-abdominal Infections	1179
Source Control: Operation Versus Percutaneous Drainage Alone	1179
Suggested Readings	1181
Occupational Exposure to Human Immunodeficiency Virus and Other Bloodborne Pathogens	1181
Progress in the Field	1181
Occupational Exposure to Bloodborne Pathogens	1182
Occupational Exposure to Human Immunodeficiency Virus	1182
Risk	1182
Efficacy of Zidovudine	1183
Management of an Exposure	1183
Testing the Source	1183
Counseling	1183
Timing of Initiation of Antiretroviral Drugs	1183
Healthcare Worker Counseling	1183
Antiretroviral Regimens	1184
Management of the Injury Site	1184
Source Testing	1184
Monitoring the Exposed Healthcare Worker	1184
Expert Opinion	1184
Occupational Exposure to Hepatitis B	1184
Occupational Exposure to Hepatitis C	1185
Healthcare Worker with Hepatitis C Virus RNA	1185
Suggested Readings	1185
Antifungal Therapy in the Surgical Patient	1186
Introduction	1186
Antifungal Agents	1186
Polyenes	1186
Amphotericin B	1186
Azoles	1188
Fluconazole	1188
Voriconazole	1188
Posaconazole	1188
Itraconazole	1188
Echinocandins	1189
Specific Infections	1189
Candidiasis	1189
Mucocutaneous Disease	1190
Cutaneous Candidiasis	1190
Vulvovaginal Candidiasis	1190
Oropharyngeal and Esophageal Candidiasis	1190
Invasive Candidiasis	1190
Filamentous Fungi	1191
Aspergillosis	1191
Zygomycetes	1191
Conclusions	1192
Suggested Readings	1192
Measuring Outcomes in Surgery	1192
Introduction	1192
Donabedian Model of Quality	1192
Variation in Outcomes	1193
Current Measures of Outcomes	1193
Mortality	1193
Morbidity	1194
Composite Measures	1194
Patient-Centered Outcomes	1194
Integrating Outcome Measurement Into the Current Practice of Surgery	1195
Benchmarking and Performance Feedback	1195
Quality Collaboratives	1196
Maintenance of Certification	1196
The Importance of Outcome Measurement in Research	1197
Comparative Effectiveness Research	1197
Patient-Centered Outcomes Research	1197
Conclusion	1197
Suggested Readings	1197
Comparative Effectiveness Research in Surgery	1198
Introduction	1198
What is Comparative Effectiveness Research?	1198
Effectiveness Versus Efficacy	1198
Which Treatment?	1198
Which Patients?	1199
Which Outcome?	1199
How is Comparative Effectiveness Research Done?	1200
Comparative Effectiveness Research in the National and International Spotlight	1201
Controversy	1201
Future Directions	1202
Suggested Readings	1202
Surgical Critical Care	1203
Surgical Palliative Care	1203
Suggested Readings	1211
Cardiovascular Pharmacology	1211
Overview	1211
Tachyarrhythmias	1211
Narrow QRS Dysrhythmias	1211
Wide QRS Dysrhythmias	1212
Bradydysrhythmias	1212
Control of Cardiac and Systemic Vascular Performance	1212
Control of Preload	1212
Control of Myocardial Contractility	1212
Left Ventricular Failure	1212
Chronic Systolic Heart Failure	1213
Acute Systolic Heart Failure	1213
Acute Myocardial Ischemia	1214
Right Ventricular Failure	1214
Left Ventricular Diastolic Dysfunction	1215
Control of Afterload	1215
Treatment of Systemic Hypertension	1215
Pharmacologic Reduction of Perioperative Cardiac Risk	1216
Suggested Readings	1217
Glucose Control in the Postoperative Period	1217
Introduction	1217
Indications	1217
Techniques	1218
Results	1218
Summary	1218
Suggested Readings	1218
Postoperative Respiratory Failure	1219
Introduction	1219
Acute Respiratory Failure	1219
Classification and Epidemiology	1219
ARF Treatment: Noninvasive Ventilation	1219
ARF Treatment: Intubation	1219
Treatment: VAP Prevention	1220
Treatment: Mechanical Ventilation	1221
Modes of Mechanical Ventilation	1224
Volume Modes	1224
Pressure Modes	1224
Advanced Modes of Mechanical Ventilation in the ICU	1225
Mechanical Ventilation Strategies for ALI and ARDS	1225
Adjuncts to Mechanical Ventilation in Patients with ARDS and Severe Hypoxemia	1227
Incremental Approach to the Management of Severe ARDS	1227
Weaning and Liberation From Mechanical Ventilation	1229
Tracheostomy	1230
Suggested Readings	1230
Ventilator-Associated Pneumonia	1230
Introduction	1230
Diagnosis	1230
Treatment	1231
Summary	1232
Suggested Readings	1232
Extracorporeal Membrane Oxygenation for Respiratory Failure in Adults	1233
Introduction	1233
The Extracorporeal Membrane Oxygenation System	1233
Indications	1233
Contraindications	1233
Technique	1233
Management	1235
Ventilator Management	1235
Systemic Anticoagulation	1235
Sedatives and Analgesia	1235
Renal	1235
Infection	1236
Troubleshooting the ECMO	1236
Recirculation	1236
Superior Vena Cava Syndrome	1236
Persistent Hypoxia	1236
Hemolysis	1236
Thrombocytopenia	1236
Weaning and Lung Recovery	1237
Discussion	1237
Suggested Readings	1238
Tracheostomy	1238
Introduction	1238
Indications and Contraindications	1238
Timing	1238
Open Tracheostomy	1239
Percutaneous Dilatational Tracheostomy	1239
Emergent Cricothyroidotomy	1240
Complications	1240
Early Complications	1240
Late Complications	1241
Tracheostomy Types, Postoperative Care, and Decannulation	1241
Summary	1241
Suggested Readings	1241
Acute Kidney Failure	1242
Overview	1242
Definitions	1242
Diagnosis of Acute Kidney Injury	1242
Radiologic Imaging	1243
Medication Review	1244
Differential Diagnosis	1244
Prerenal Azotemia	1244
Postrenal Azotemia	1245
Intrinsic Renal Disease	1245
Glomerular Disease	1245
Interstitial Disease	1245
Tubular Disease	1245
Renal Protective Strategies	1245
Prevention of Contrast-Induced Nephropathy	1245
Other Preventive Strategies	1246
Treatment	1246
Renal Replacement Therapy	1246
Timing of Initiation of Renal Replacement Therapy	1246
Frequency and Rate of Renal Replacement Therapy	1246
Modalities for Renal Replacement Therapy	1247
Prognosis	1247
Suggested Readings	1247
Electrolyte Disorders	1247
Overview	1247
Sodium	1248
Homeostasis	1248
Hyponatremia	1248
Hypernatremia	1250
Potassium	1251
Homeostasis	1251
Hypokalemia	1251
Hyperkalemia	1251
Magnesium	1252
Minimally Invasive Surgery	1305
Laparoscopic Cholecystectomy	1305
Introduction	1305
Indications for Cholecystectomy	1305
Imaging Diagnosis	1305
Complicated Gallstone Disease	1305
Biliary Dyskinesia/Chronic Acalculous Cholecystitis	1306
Gallbladder Polyps	1306
Laparoscopic Cholecystectomy Technique	1307
Initial Access	1307
Basic Technique	1307
Critical View of Safety Method of Ductal Identification	1307
Intraoperative Cholangiography	1308
The Difficult Cholecystectomy	1309
Multiple Prior Abdominal Operations	1309
Acute Cholecystitis	1309
Percutaneous Cholecystostomy	1309
Portal Hypertension and Cirrhosis	1310
Alternative Approaches: Single-Incision Laparoscopic and Notes Cholecystectomy	1310
Complications	1310
Summary	1310
Suggested Readings	1310
Laparoscopic Common Bile Duct Exploration	1311
Introduction	1311
Intraoperative Evaluation of Common Bile Duct Stones	1311
Techniques	1312
After Cholecystectomy	1315
Efficacy of Laparoscopic Common Bile Duct Exploration	1315
Alternative Management	1315
Summary	1316
Suggested Readings	1316
Laparoscopic 360-Degree Fundoplication	1317
Background	1317
Symptoms and Complications	1317
Medical Therapy	1317
Diagnostic Workup	1317
Endoscopy	1317
Barium Swallow	1317
pH Testing	1317
Impedance Testing	1317
Surgical Therapy	1317
Reasons for Surgery	1317
Patient Selection and Predictors of Success	1318
Technique	1318
Positioning	1318
Port Placement	1318
Early Gastric Mobilization	1319
Left to Right Crural Dissection and Esophageal Mobilization	1319
Crural Closure	1319
Creation of Tension-free Fundoplication	1320
Additional Maneuvers and Controversy	1321
Postoperative Care	1321
Complications	1321
Outcomes	1321
Conclusion	1321
Suggested Readings	1322
Laparoscopic Appendectomy	1322
Introduction	1322
Pathophysiology	1322
Diagnosis	1322
Indications	1323
Techniques	1323
Results	1324
Special Considerations	1324
Pregnancy	1324
Incorrect Diagnosis	1325
Complicated Appendicitis	1325
Interval Appendectomy After Nonoperative Management	1325
Summary	1325
Suggested Readings	1325
Laparoscopic Inguinal Herniorrhaphy	1325
Overview	1325
Evaluating the Patient	1326
Relevant Anatomy	1326
Indications and Contraindications	1326
Preparing the Patient	1327
Totally Extraperitoneal	1328
Transabdominal Preperitoneal	1331
Management of Complicated Hernia	1332
After Surgery	1332
Complications	1332
Summary	1333
Acknowledgment	1333
Suggested Readings	1334
Laparoscopic Repair of Recurrent Inguinal Hernias	1334
Overview	1334
Indications and Choice of the Repair	1334
Laparoscopic Repair of Recurrent Inguinal Hernias	1335
TEP Versus TAPP	1335
Operative Considerations	1335
Outcomes	1336
Suggested Readings	1337
Laparoscopic Ventral Hernia Repair	1337
Introduction	1337
Indications	1337
Preoperative Workup	1338
Operative Technique	1338
Patient Positioning	1338
Access of the Reoperative Abdomen and Trocar Positioning	1338
Adhesiolysis	1339
Sizing the Hernia Defect	1339
Mesh Positioning	1340
Postoperative Care	1341
Special Circumstances	1341
Subxiphoid Hernia	1341
Suprapubic Hernia	1341
Defect Closure	1341
Complications	1341
Outcomes	1342
Suggested Readings	1342
Laparoscopic Repair of Peristomal Hernias	1342
Background	1342
Indications and Contraindications	1342
Preoperative Planning	1343
Preoperative Preparation	1343
Surgery	1343
Patient Positioning and Preparation	1343
Instrument/Monitor Positioning	1343
Port Selection and Placement	1343
Operative Technique	1343
Division of Adhesions and Reduction of Hernia	1343
Postoperative Management	1344
Complications	1344
Results	1344
Conclusions	1345
Suggested Readings	1345
Laparoscopic Splenectomy	1345
Overview	1345
Indications and Contraindications	1345
Preoperative Preparation	1345
Techniques	1345
Right Lateral Approach	1346
Anterior Approach	1348
Laparoscopic Hand-Assisted	1348
Postoperative Care	1348
Complications	1348
Results	1349
Summary	1349
Suggested Readings	1349
Laparoscopic Gastric Surgery	1349
Overview	1349
Indications and Rationale for Laparoscopic Gastrectomy	1349
Contraindications	1350
Preoperative Workup and Preparation	1350
Surgical Principles for Laparoscopic Gastrectomy	1350
Pitfalls during a Laparoscopic Gastrectomy	1350
Extent of Lymphadenectomy	1350
Omentectomy and Bursectomy	1350
Technique of Laparoscopic Gastrectomy	1350
Room Setup and Patient Position	1351
Placement of Ports	1351
Dissection of Greater Omentum and Left Gastroepiploic Vessels (Nos. 4d and 4sb Lymph Nodes)	1351
Dissection of Greater Omentum and Right Gastroepiploic Arcade (No. 4d Lymph Nodes)	1351
Infrapyloric Dissection (No. 6 Lymph Nodes)	1353
Suprapyloric Dissection of Right Gastric Artery and Proper Hepatic Artery (Nos. 5 and 12a Lymph Nodes)	1353
Suprapancreatic Dissection of Left Gastric, Common Hepatic, Celiac Trunk, and Proximal Splenic Artery Lymph Nodes (Nos. 7, 8a, 9, and 11p Lymph Nodes)	1356
Dissection Along Lesser Curvature of Stomach (Nos. 1 and 3 Lymph Nodes)	1356
Techniques of Reconstruction	1356
Techniques of Billroth I Anastomosis	1358
Extracorporeal Modified Double-Stapled Circular End-to-End Gastroduodenostomy	1358
Extracorporeal Side-to-End Circular Gastroduodenostomy	1359
Intracorporeal Delta-Shaped Gastroduodenostomy	1359
Billroth II Reconstruction	1359
Roux-en-Y Reconstruction	1361
Special Considerations	1362
Laparoscopic Total Gastrectomy	1362
Total Omentectomy	1362
Robot-Assisted Gastrectomy	1362
Suggested Readings	1363
Laparoscopic Management of Crohn’s Disease	1363
Overview	1363
Stomach and Duodenum	1364
Operative Technique: Laparoscopic Gastrojejunostomy	1364
Outcomes	1364
Small Bowel	1364
Operative Technique: Laparoscopy-Assisted Small Bowel Resection	1364
Operative Technique: Laparoscopy-Assisted Ileocolic Resection	1365
Outcomes	1365
Colon and Rectum	1365
Operative Technique: Laparoscopy-Assisted Total Abdominal Colectomy	1365
Operative Technique: Totally Laparoscopic Total Proctocolectomy	1367
Outcomes	1368
Perineum	1368
Operative Technique: Laparoscopic Fecal Diversion	1368
Outcomes	1369
Summary	1369
Suggested Readings	1369
Laparoscopic Colon and Rectal Surgery	1369
Background	1369
Operative Principles and Technical Pearls	1370
Crohn’s Disease	1375
Ulcerative Colitis	1375
Diverticulitis	1376
Colon Cancer	1376
Rectal Cancer	1376
Complications and Learning Curve of Laparoscopic Colectomy	1377
Suggested Readings	1377
Minimally Invasive Esophagectomy	1378
Overview	1378
Indications	1378
Preoperative Preparation	1378
Minimally Invasive Ivor Lewis Esophagectomy	1378
Surgical Technique	1378
Laparoscopic Transhiatal Esophagectomy	1380
Thoracoscopic and Laparoscopic Esophagectomy with Cervical Anastomosis	1381
Postoperative Care	1384
Results	1384
Summary	1384
Suggested Readings	1384
Laparoscopic Treatment of Esophageal Motility Disorders	1384
Introduction	1384
Laparoscopic Heller Myotomy and Partial Fundoplication for Achalasia	1385
Revisional Surgery after Heller Myotomy	1387
Laparoscopic Treatment of End-Stage Achalasia	1387
Laparoscopic Treatment of Epiphrenic Diverticula	1387
Summary	1388
Suggested Readings	1388
Laparoscopic Adrenalectomy	1389
Introduction	1389
Indications	1389
Techniques	1389
Patient Position	1389
Lateral Approach	1389
Posterior Approach	1390
Complications	1390
Postoperative Care	1391
Outcomes	1391
The Future: Even LESS Invasive Surgery	1391
Single-incision Laparoscopic Surgery Approach	1392
Mini-Laparoscopy	1393
Robot-Assisted Laparoscopic Adrenalectomy	1393
NOTES Adrenalectomy	1393
Selected Readings	1393
Minimally Invasive Parathyroidectomy	1393
Preoperative Parathyroid Localization	1394
Intraoperative Adjuncts	1395
Surgical Approach	1396
Postoperative Management	1398
Suggested Readings	1398
Laparoscopic Liver Resection	1398
Overview	1398
Preoperative Evaluation	1399
Systems-Based Clinical Evaluation	1399
Axial Imaging Preoperative Planning	1399
Relative Contraindications to Laparoscopy	1399
Anesthesia and Intraoperative Monitoring	1400
Operative Techniques	1400
Pure Laparoscopy	1400
Hand-Assisted Technique and the Hybrid Technique	1400
Right Hepatectomy Using the Hybrid Technique	1401
Left Hepatectomy Using the Hybrid Technique	1402
Operative Metrics	1402
Conclusion	1402
Suggested Readings	1402
Staging Laparoscopy for Gastrointestinal Cancer	1403
Overview	1403
General Technique	1403
Esophageal Cancer	1403
Gastric Adenocarcinoma	1403
Colorectal Liver Metastasis and Hepatobiliary Primary Tumors	1404
Pancreatic and Periampullary Adenocarcinomas	1404
Lymphoproliferative Diseases	1405
Natural Orifice Transluminal Endoscopic Surgery	1405
Summary	1405
Suggested Readings	1405
Laparoscopic Pancreas Surgery	1405
Laparoscopic Whipple	1406
Technique	1406
Laparoscopic Distal Pancreatectomy	1407
Preoperative Tattooing	1408
Technique	1408
Laparoscopic Distal Pancreatectomy With Splenectomy	1409
Patient Outcomes	1409
Laparoscopic Central Pancreatectomy	1409
Laparoscopic Total Pancreatectomy with Islet Autotransplantation	1409
Older and High-Risk Patients	1409
Conclusion	1409
Acknowledgments	1410
Suggested Readings	1410
Laparoscopic Bypass for Pancreatic Cancer	1410
Background	1410
Gastric Outlet Obstruction	1410
Laparoscopic Gastrojejunostomy	1410
Laparoscopic Biliary Bypass Procedures	1411
Laparoscopic Cholecystojejunostomy	1412
Laparoscopic Choledochoduodenostomy	1412
Laparoscopic Choledochojejunostomy	1412
Conclusions	1413
Suggested Readings	1413
Laparoscopic Management of Pancreatic Pseudocyst	1414
Overview	1414
Clinical Features	1414
Preoperative Workup	1414
Operative Indications	1414
Procedure Selection	1414
Preoperative Planning	1415
Laparoscopic Cystgastrostomy	1415
Anterior Approach	1415
Posterior Approach	1417
Laparoscopic Cystjejunostomy	1417
Postoperative Care	1418
Outcomes and Complications	1418
Brief Comment on Walled-Off Necrosis	1418
Suggested Readings	1418
Video-Assisted Thoracic Surgery	1418
Introduction	1418
Indications for Video-Assisted Thoracic Surgery and Patient Selection	1418
Surgical Setup and Equipment	1419
Anesthesia	1419
Patient Positioning	1419
Equipment	1419
Port Site Placement	1421
Basic Technique and Emergency Conversion to Thoracotomy	1422
Basic Technique of Video-Assisted Thoracic Surgery	1422
Conversion to Thoracotomy	1422
Summary	1422
Suggested Readings	1422
Laparoscopic Surgery for Morbid Obesity	1422
Preoperative Evaluation	1423
Preparing the Patient in the Operating Room	1424
Techniques	1424
Laparoscopic Antecolic Antegastric Roux-en-Y Gastric Bypass Operative Technique	1424
Laparoscopic Adjustable Gastric Band	1426
Laparoscopic Vertical Sleeve Gastrectomy	1427
Laparoscopic Biliopancreatic Diversion With Duodenal Switch	1429
Laparoscopic Gastric Plication	1430
Postoperative Management	1430
Outcomes and Complications	1432
Endoscopic Approaches to the Management of Obesity	1433
Comments	1433
Suggested Readings	1433
Laparoscopic Donor Nephrectomy	1434
Overview	1434
Evaluation of the Live Kidney Donor	1434
Contraindications	1434
Operative Approach	1434
Postoperative Management	1435
Risks	1436
Conclusion	1436
Selected Readings	1436
Laparoendoscopic Single-Site Surgery as an Evolving Surgical Approach	1436
Training and Learning Curve	1436
Devices and Instruments	1437
Transumbilical Approach	1438
Nephrectomy	1438
Cholecystectomy	1438
Bariatric Surgery	1440
Colectomy	1440
Urgent Indications	1440
Urologic Surgery	1440
Gynecologic Surgery	1440
Robotic Single-Port Approach	1440
Cost Considerations	1441
Consent Issues	1441
Strategies for Successful Incorporation of the Single-Port Technique	1442
Conclusions	1443
Suggested Readings	1443
NOTES:	1443
Overview	1443
Treatment and Methods	1443
NOTES: What Will be Possible in the Near Future?	1445
Suggested Readings	1446
index	1447
A	1447
B	1451
C	1453
D	1458
E	1460
F	1462
G	1464
H	1466
I	1468
J	1471
K	1471
L	1471
M	1473
N	1475
O	1476
P	1476
Q	1482
R	1482
S	1484
T	1489
U	1492
V	1492
W	1493
Z	1493

Current Surgical Therapy E-Book

Additional Information

Book Details

Abstract

Table of Contents

Contact Us

Quick Navigation