BOOK
Kirk's General Surgical Operations E-Book
Richard Novell | Daryll Baker | Nicholas Goddard
(2013)
Additional Information
Book Details
Abstract
General Surgical Operations is a highly-praised and comprehensive textbook of operative surgery. It is a practical manual aimed at the surgeon who is about to carry out an operation, rather than just a description of the principles suitable for an examiner.
Kirk’s General Surgical Operations continues to be aimed at a broad readership: the candidate preparing for the Intercollegiate FRCS in General Surgery or international equivalents; the trained surgeon faced, through necessity, with undertaking an infrequently performed procedure; and the many surgeons working in hospitals throughout the world without access to specialist services. It remains above all a practical text which will guide the surgeon in training, or one unfamiliar with a procedure, on how to perform it, but more importantly on how to manage the uncertainties which so often arise
This is a ‘What to do’ book. Using it the reader can aspire to gain diagnostic, decision making and operative surgical competence with confidence.
- The book is written in a clear and direct style and providing explicit instructions using descriptive headings for easy reference.
- The contents covers standard routine operations in full; non-routine and rarely performed operations are included only where appropriate and in lesser detail
- The text includes advice on topics such as patient selection; preparation and access to the site of operation; how to accomplish the procedure; closing and aftercare
- Difficulties are highlighted and advice given on how to respond to unexpected findings
- Each procedure is fully described thus avoiding repetitions and cutting cross-references to a minimum
- Regular summaries of key points in the decision making process are included.
- This Sixth Edition is now known as Kirk’s General Surgical Operations in recognition of its distinguished founding editor, Professor RM Kirk, who is now Editor Emeritus on the textbook.
- The new editorial team for the Sixth Edition comprises a colorectal surgeon, a vascular surgeon and an orthopaedic surgeon
- The contents have been restructured and radically revised into 42 chapters, the majority of which have been completely rewritten.
- Laparoscopic techniques have been incorporated into all relevant chapters.
- All the illustrations have been redrawn to improve their clarity.
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
Front Cover | Cover | ||
Kirk’s General Surgical Operations | iii | ||
Copyright | iv | ||
Contents | v | ||
Foreword | vii | ||
Preface | ix | ||
Contributors | xi | ||
Chapter 1: Choose well, cut well, get well | 1 | ||
CHOOSE WELL | 1 | ||
BACKGROUND KNOWLEDGE | 1 | ||
INDIVIDUAL PATIENTS | 2 | ||
LEARNING | 2 | ||
CUT WELL | 2 | ||
PREPARE | 3 | ||
PRACTISE | 3 | ||
SET UP | 3 | ||
IMPROVE PATIENT SAFETY | 4 | ||
PREVENT OR COMBAT INFECTION | 4 | ||
GET WELL | 5 | ||
RECOVERY PHASE | 5 | ||
Monitor | 5 | ||
INTERMEDIATE PHASE | 5 | ||
DAY CASE SURGERY | 5 | ||
AUDIT | 6 | ||
CONCLUSION | 6 | ||
REFERENCES | 6 | ||
Chapter 2: Anaesthesia-related techniques | 7 | ||
INTRODUCTION | 7 | ||
TECHNIQUES TO ASSESS PERIOPERATIVE RISK | 7 | ||
Appraise | 7 | ||
Background | 7 | ||
Aims of preoperative assessment in respect of the high-risk patient | 7 | ||
Assess | 7 | ||
Cardiac risk indices | 7 | ||
A step-by-step approach to risk assessment | 7 | ||
Assessing the risk of the surgical procedure | 7 | ||
Action | 8 | ||
Tests of functional capacity including cardiopulmonary exercise testing | 8 | ||
Other cardiac investigations | 9 | ||
Electrocardiography | 9 | ||
Assessment of resting left ventricular function | 9 | ||
Dobutamine stress echocardiography | 9 | ||
Coronary angiography | 9 | ||
Aftercare | 9 | ||
Pharmacological strategies to reduce risk | 9 | ||
β-blockers | 9 | ||
Other drugs | 9 | ||
Myocardial revascularization | 9 | ||
Management of antiplatelet therapy | 10 | ||
REFERENCES | 10 | ||
FURTHER READING | 10 | ||
OXYGEN THERAPY | 10 | ||
Appraise | 10 | ||
Rationale for oxygen therapy | 10 | ||
Factors contributing to postoperative hypoxaemia | 10 | ||
Assess | 11 | ||
Assessment and detection of hypoxaemia | 11 | ||
Pulse oximetry | 11 | ||
Arterial gases | 11 | ||
Action | 11 | ||
Oxygen therapy devices | 11 | ||
Variable performance devices | 11 | ||
Fixed performance devices | 12 | ||
Recognition and management of respiratory failure | 12 | ||
FURTHER READING | 12 | ||
PERIPHERAL VENOUS ACCESS | 12 | ||
Appraise | 12 | ||
Action | 12 | ||
Aftercare | 12 | ||
CENTRAL VENOUS ACCESS | 13 | ||
Appraise | 13 | ||
Prepare | 13 | ||
INSERTION TECHNIQUE | 13 | ||
COMPLICATIONS OF CENTRAL VENOUS ACCESS | 14 | ||
INTRAOSSEOUS ACCESS | 14 | ||
GENERAL ANAESTHESIA TECHNIQUES | 14 | ||
Appraise | 14 | ||
Action | 14 | ||
Basic principles of general anaesthesia | 14 | ||
Induction of anaesthesia | 14 | ||
Airway management | 15 | ||
Holding a facemask | 15 | ||
The laryngeal mask airway | 15 | ||
Endotracheal intubation | 15 | ||
Failed intubation | 15 | ||
Ventilation during anaesthesia | 15 | ||
Principles of monitoring | 15 | ||
Essential requirements | 15 | ||
Indications for invasive monitoring | 15 | ||
Aftercare | 16 | ||
The recovery room | 16 | ||
Levels of postoperative care | 16 | ||
Analgesic techniques | 16 | ||
The analgesic ladder | 17 | ||
REFERENCES | 17 | ||
FURTHER READING | 17 | ||
LOCAL ANAESTHESIA TECHNIQUES | 17 | ||
Appraise | 17 | ||
LOCAL ANAESTHETIC AGENTS | 17 | ||
LOCAL ANAESTHETIC TOXICITY | 17 | ||
Initial management | 18 | ||
Use of Intralipid ® | 18 | ||
CERVICAL PLEXUS BLOCK | 18 | ||
INTERSCALENE BLOCK | 18 | ||
FEMORAL NERVE BLOCK | 18 | ||
USE OF PERIPHERAL NERVE STIMULATORS AND ULTRASOUND | 19 | ||
INTRAVENOUS REGIONAL ANAESTHESIA | 19 | ||
REFERENCE | 19 | ||
CENTRAL NEURO-AXIAL BLOCKS | 19 | ||
SPINAL ANAESTHESIA | 19 | ||
EPIDURAL ANAESTHESIA | 19 | ||
Technique | 19 | ||
INDICATIONS FOR EPIDURAL ANAESTHESIA/ANALGESIA | 19 | ||
EFFECTS ON ORGAN SYSTEMS | 20 | ||
CONTRAINDICATIONS | 20 | ||
Absolute | 20 | ||
Relative | 20 | ||
EPIDURALS AND ANTICOAGULANT THERAPY | 20 | ||
Antiplatelet therapy | 20 | ||
Low-molecular-weight heparin | 20 | ||
MANAGEMENT OF SURGICAL PATIENTS RECEIVING LONG-TERM ANTICOAGULANT OR ANTIPLATELET THERAPY | 20 | ||
ANTICOAGULANT THERAPY | 20 | ||
Patients on oral anticoagulants undergoing elective surgery | 20 | ||
New oral anticoagulant drugs | 21 | ||
Emergency surgery in patients on anticoagulant therapy | 22 | ||
ANTIPLATELET THERAPY | 22 | ||
REFERENCE | 22 | ||
Chapter 3: The severely injured patient | 23 | ||
INTRODUCTION | 23 | ||
PRINCIPLES OF DAMAGE CONTROL | 23 | ||
Prepare | 24 | ||
Access | 24 | ||
Assess | 24 | ||
Action | 24 | ||
Checklist | 25 | ||
NECK AND THORACIC OUTLET | 25 | ||
Appraise | 25 | ||
Prepare | 25 | ||
Access | 26 | ||
CHEST | 26 | ||
THORACOTOMY | 27 | ||
Appraise | 27 | ||
Prepare | 27 | ||
Access | 27 | ||
Assess | 28 | ||
Action | 28 | ||
Checklist | 29 | ||
Closure | 29 | ||
Postoperative | 29 | ||
Complications | 30 | ||
ABDOMINAL TRAUMA | 30 | ||
LAPAROTOMY | 30 | ||
Appraise | 30 | ||
Prepare | 30 | ||
Access | 30 | ||
Assess | 30 | ||
Action | 31 | ||
Checklist | 33 | ||
Closure | 33 | ||
Postoperative | 34 | ||
Complications | 34 | ||
PELVIS | 34 | ||
Appraise | 34 | ||
Prepare | 34 | ||
Access | 34 | ||
Assess | 35 | ||
Action | 35 | ||
Closure | 35 | ||
Postoperative | 35 | ||
Complications | 35 | ||
SOFT-TISSUE WOUNDS | 35 | ||
Appraise | 35 | ||
Prepare | 36 | ||
Access | 36 | ||
Assess | 36 | ||
Action | 36 | ||
Checklist | 36 | ||
Open wound | 36 | ||
Closure | 36 | ||
Postoperative | 36 | ||
FURTHER READING | 37 | ||
Chapter 4: Laparotomy: electiveand emergency | 38 | ||
INTRODUCTION | 38 | ||
OPENING THE ABDOMEN | 38 | ||
Preparation | 38 | ||
Incisions | 39 | ||
Making the incision | 40 | ||
RE-OPENING THE ABDOMEN | 40 | ||
Appraise | 40 | ||
Access through the old incision | 40 | ||
Access through a new incision | 40 | ||
ABDOMINAL ADHESIONS | 40 | ||
Prevention of adhesions | 41 | ||
Division of adhesions | 41 | ||
EXPLORATORY LAPAROTOMY | 41 | ||
Access | 41 | ||
Assess | 42 | ||
Action | 43 | ||
PERITONEAL LAVAGE | 44 | ||
CLOSING THE ABDOMEN | 44 | ||
Mass closure | 45 | ||
Layered closure | 45 | ||
Tension sutures | 45 | ||
Removal of skin sutures | 45 | ||
The difficult closure | 45 | ||
Delayed closure | 46 | ||
Abdominal dressings | 46 | ||
ABDOMINAL COMPARTMENT SYNDROME | 46 | ||
Prevention | 46 | ||
Treatment | 46 | ||
BURST ABDOMEN | 47 | ||
Management | 47 | ||
LAPAROTOMY FOR TRAUMA | 47 | ||
LAPAROTOMY FOR PERITONITIS | 47 | ||
Appraise | 47 | ||
Decision | 48 | ||
Prepare | 48 | ||
Access | 48 | ||
Assess | 48 | ||
Action | 48 | ||
Checklist | 48 | ||
LAPAROTOMY FOR INTESTINAL OBSTRUCTION | 49 | ||
Appraise | 49 | ||
Investigations | 50 | ||
Prepare | 50 | ||
Access | 50 | ||
Assess | 50 | ||
Action | 51 | ||
Closure | 51 | ||
Aftercare | 51 | ||
LAPAROTOMY FOR GASTROINTESTINAL BLEEDING | 52 | ||
Assess | 52 | ||
NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING | 52 | ||
Chapter 5: Principles of minimal access surgery | 57 | ||
GENERAL PRINCIPLES OF LAPAROSCOPY | 57 | ||
Preparation | 57 | ||
Basic laparoscopic equipment (excluding instruments) | 57 | ||
Access | 60 | ||
Assess | 62 | ||
Safe use of diathermy | 62 | ||
Dissecting technique | 62 | ||
Exposure | 63 | ||
HAEMOSTASIS | 63 | ||
Conversion | 64 | ||
Closure | 64 | ||
Postoperative | 65 | ||
Complications | 65 | ||
Natural Orifice Transluminal Endoscopic Surgery (NOTES) | 65 | ||
FURTHER READING | 65 | ||
Chapter 6: Abdominal wall and hernias | 66 | ||
GENERAL ISSUES IN HERNIA SURGERY | 66 | ||
INGUINAL HERNIA | 67 | ||
Appraise | 67 | ||
Inspect | 68 | ||
Prepare | 68 | ||
OPEN MESH INGUINAL HERNIA REPAIR (Lichtenstein Repair) | 68 | ||
Local anaesthesia for inguinal hernia repair | 68 | ||
Access | 68 | ||
Assess (Fig. 6.1) | 68 | ||
Hernia sac | 69 | ||
Indirect sac | 69 | ||
Large indirect sac | 69 | ||
Sliding indirect sac | 69 | ||
Direct sac | 70 | ||
Combined direct and indirect sac | 70 | ||
Posterior inguinal canal wall repair | 70 | ||
Action | 70 | ||
Postoperative management | 71 | ||
Complications of open inguinal hernia repair | 71 | ||
OPEN RECURRENT INGUINAL HERNIA REPAIR | 71 | ||
Appraise | 71 | ||
Access | 71 | ||
Chapter 7: Appendix and abdominal abscess | 93 | ||
OPEN APPENDICECTOMY | 93 | ||
Appraise | 93 | ||
PREPARE | 93 | ||
Access | 94 | ||
Opening the abdomen | 94 | ||
Assess | 94 | ||
Action | 95 | ||
Closure | 96 | ||
Postoperative | 96 | ||
Complications | 96 | ||
LAPAROSCOPIC APPENDICECTOMY | 97 | ||
Appraise | 97 | ||
Prepare | 97 | ||
Access | 97 | ||
Assess | 97 | ||
Action | 98 | ||
Checklist | 98 | ||
Closure | 99 | ||
Postoperative | 99 | ||
Complications | 99 | ||
REFERENCES | 99 | ||
FURTHER READING | 99 | ||
APPENDIX MASS | 99 | ||
Appraise | 99 | ||
Access | 100 | ||
Action | 100 | ||
REFERENCES | 100 | ||
SUBPHRENIC AND SUBHEPATIC ABSCESS | 100 | ||
Appraise | 100 | ||
Prepare | 101 | ||
Action | 101 | ||
Posterior approach | 101 | ||
Anterolateral approach | 101 | ||
Transperitoneal approach | 101 | ||
REFERENCES | 101 | ||
FURTHER READING | 101 | ||
Chapter 8: Oesophagus | 102 | ||
ENDOSCOPY | 102 | ||
Appraise | 102 | ||
Prepare | 102 | ||
FIBREOPTIC ENDOSCOPY | 102 | ||
Assess | 103 | ||
DILATATION OF STRICTURES (Fig.8.1) | 103 | ||
REMOVAL OF FOREIGN BODIES | 104 | ||
Chapter 9: Oesophageal cancer | 126 | ||
INTRODUCTION | 126 | ||
Appraise | 127 | ||
Prepare | 128 | ||
RESECTION OF CARCINOMA OF THE LOWER OESOPHAGUS (LEFT THORACO-ABDOMINAL APPROACH) | 128 | ||
Appraise | 128 | ||
Access | 129 | ||
Assess | 129 | ||
Resect | 129 | ||
Abdominal procedure | 129 | ||
Thoracic procedure | 129 | ||
Unite (Fig.9.2) | 129 | ||
Checklist | 130 | ||
Closure | 131 | ||
OPERATIONS FOR THORACIC OESOPHAGEAL CARCINOMA | 131 | ||
INTRODUCTION | 131 | ||
IVOR LEWIS RESECTION FOR MID-OESOPHAGEAL CARCINOMA | 131 | ||
Chapter 10: Stomach and duodenum | 145 | ||
ENDOSCOPY | 145 | ||
Appraise | 145 | ||
Prepare | 145 | ||
Access | 146 | ||
Assess | 146 | ||
Action | 147 | ||
Postoperative | 147 | ||
PERIOPERATIVE CARE | 148 | ||
Preoperative | 148 | ||
Action | 148 | ||
Aftercare | 148 | ||
ACCESS IN THE UPPER ABDOMEN | 149 | ||
GASTRIC CARDIA | 149 | ||
KOCHER´S DUODENAL MOBILIZATION | 149 | ||
Appraise | 149 | ||
Action | 150 | ||
EXAMINATION OF THE STOMACH AND DUODENUM | 150 | ||
SUTURING AND STAPLING THE STOMACH AND DUODENUM | 152 | ||
SUTURES | 152 | ||
LIGATURES | 152 | ||
STAPLES | 152 | ||
GASTROTOMYANDGASTRODUODENOTOMY | 152 | ||
Appraise | 152 | ||
Access | 152 | ||
Closure | 153 | ||
PYLOROMYOTOMY | 153 | ||
Chapter 11: Small bowel and operations for obesity | 185 | ||
EXAMINATION OF THE SMALL BOWEL | 185 | ||
Normal appearance | 185 | ||
Abnormalities | 185 | ||
Biopsy | 186 | ||
REFERENCES | 186 | ||
INTESTINAL ANASTOMOSIS | 186 | ||
General principles | 186 | ||
Hand-suturing techniques | 186 | ||
Mechanical stapling techniques | 188 | ||
Types of anastomosis | 189 | ||
End-to-end anastomosis | 189 | ||
Oblique anastomosis | 189 | ||
End-to-side anastomosis | 189 | ||
Side-to-side anastomosis | 189 | ||
ENTERECTOMY (SMALL-BOWEL RESECTION) | 190 | ||
Appraise | 190 | ||
Prepare | 190 | ||
Access | 190 | ||
Assess | 190 | ||
Action | 191 | ||
Standard resection | 191 | ||
Partial resection | 191 | ||
Checklist | 191 | ||
Aftercare | 192 | ||
Complications | 192 | ||
REFERENCES | 193 | ||
ENTERIC BYPASS | 193 | ||
Chapter 12: Colonoscopy | 205 | ||
DESCRIPTION OF OPERATION | 205 | ||
Appraise | 205 | ||
Prepare | 205 | ||
Access | 206 | ||
Assess | 209 | ||
Action | 209 | ||
Aftercare | 210 | ||
Complications | 210 | ||
FURTHER READING | 210 | ||
Chapter 13: Colon | 212 | ||
PREOPERATIVE ASSESSMENT OF THE LARGE BOWEL | 212 | ||
ELECTIVE OPERATIONS | 212 | ||
CARCINOMA | 212 | ||
Assess | 213 | ||
DIVERTICULAR DISEASE | 214 | ||
ULCERATIVE COLITIS | 215 | ||
CROHN'S DISEASE | 215 | ||
POLYPS AND POLYPOSIS | 216 | ||
URGENT OPERATIONS | 216 | ||
OBSTRUCTION | 216 | ||
PERFORATION | 217 | ||
ACUTE INFLAMMATORY OR ISCHAEMIC BOWEL DISEASE | 217 | ||
ACUTE MASSIVE HAEMORRHAGE | 217 | ||
PRINCIPLES OF COLECTOMY | 217 | ||
Appraise | 217 | ||
Prepare | 217 | ||
Action | 218 | ||
LAPAROSCOPIC COLECTOMY | 218 | ||
RIGHT HEMICOLECTOMY | 219 | ||
Appraise | 219 | ||
Action | 219 | ||
Resect | 219 | ||
Unite | 219 | ||
Technical points | 220 | ||
Checklist | 220 | ||
LAPAROSCOPIC RIGHT HEMICOLECTOMY | 220 | ||
Access | 220 | ||
Action | 220 | ||
LEFT HEMICOLECTOMY | 221 | ||
Appraise | 221 | ||
Prepare | 221 | ||
Access | 221 | ||
Assess | 221 | ||
Resect | 222 | ||
Unite | 222 | ||
LAPAROSCOPIC LEFT HEMICOLECTOMY | 222 | ||
Access | 222 | ||
Action | 223 | ||
CARCINOMA OF THE RECTUM | 224 | ||
Appraise | 224 | ||
ANTERIOR RESECTION OF THE RECTUM | 224 | ||
Prepare | 224 | ||
Access | 224 | ||
Assess | 225 | ||
Action | 225 | ||
Unite | 226 | ||
Sutured anastomosis | 226 | ||
Stapled anastomosis | 226 | ||
Checklist | 227 | ||
LAPAROSCOPIC ANTERIOR RESECTION | 227 | ||
Assess | 227 | ||
ACTION | 227 | ||
Aftercare | 228 | ||
HARTMANN'S OPERATION | 228 | ||
Appraise | 228 | ||
Chapter 14: Anorectum | 236 | ||
INTRODUCTION | 236 | ||
ANATOMY | 236 | ||
Sphincters | 236 | ||
Spaces | 236 | ||
Prepare | 237 | ||
HAEMORRHOIDS | 237 | ||
Appraise | 237 | ||
INJECTION SCLEROTHERAPY | 238 | ||
Chapter 15: Biliary tract | 257 | ||
INTRODUCTION | 257 | ||
CHOLECYSTECTOMY | 257 | ||
Appraise | 257 | ||
Prepare | 258 | ||
LAPAROSCOPIC TECHNIQUE | 258 | ||
Action | 258 | ||
OPEN TECHNIQUE | 260 | ||
Appraise | 260 | ||
Prepare | 260 | ||
Action | 260 | ||
SINGLE INCISION LAPAROSCOPIC SURGERY TECHNIQUE | 261 | ||
Action | 261 | ||
THE DIFFICULT GALLBLADDER | 262 | ||
PATIENT HABITUS | 262 | ||
ANATOMY | 262 | ||
PATHOLOGY | 263 | ||
CONVERSION | 263 | ||
SUBTOTAL CHOLECYSTECTOMY | 263 | ||
ENTERIC FISTULAE | 264 | ||
DUCTAL CALCULI | 264 | ||
INTRA-OPERATIVE COMPLICATIONS | 264 | ||
HAEMORRHAGE | 264 | ||
BILE LEAK | 264 | ||
VISCERAL INJURY | 265 | ||
INTRA-OPERATIVE IMAGING OF THE BILIARY TRACT | 265 | ||
Appraise | 265 | ||
CHOLANGIOGRAPHY | 265 | ||
LAPAROSCOPIC ULTRASOUND | 266 | ||
Appraise | 266 | ||
Action | 266 | ||
LAPAROSCOPIC CHOLEDOCHOSCOPY | 267 | ||
SURGICAL EXPLORATION OF THE COMMON BILE DUCT | 267 | ||
Appraise | 267 | ||
Prepare | 267 | ||
Action | 267 | ||
Laparoscopic duct exploration | 267 | ||
Trans-cystic | 267 | ||
Direct choledochotomy | 268 | ||
Open exploration | 268 | ||
TRANSDUODENAL SPHINCTEROPLASTY | 269 | ||
Appraise | 269 | ||
Prepare | 269 | ||
Action | 269 | ||
ROUX EN Y HEPATICO-JEJUNOSTOMY - BILIARY RECONSTRUCTION | 270 | ||
Appraise | 270 | ||
Prepare | 270 | ||
Action | 270 | ||
FURTHER READING AND REFERENCES | 272 | ||
Chapter 16: Pancreas | 274 | ||
INTRODUCTION | 274 | ||
EXPLORATION OF THE PANCREAS | 274 | ||
Access | 274 | ||
Assess | 275 | ||
PANCREATIC BIOPSY | 275 | ||
Appraise | 275 | ||
Action | 276 | ||
REFERENCES | 276 | ||
LAPAROTOMY FOR NECROTIZING PANCREATITIS | 276 | ||
Appraise | 276 | ||
Prepare | 276 | ||
Access | 276 | ||
Assess | 276 | ||
Action | 277 | ||
At laparotomy | 277 | ||
For infected pancreatic necrosis | 277 | ||
Aftercare | 277 | ||
Complications | 278 | ||
REFERENCES | 278 | ||
DRAINAGE OF PANCREATIC CYSTS | 278 | ||
Appraise | 278 | ||
Prepare | 279 | ||
Assess | 279 | ||
Action | 279 | ||
Cystgastrostomy (Fig. 16.2) | 279 | ||
Cystduodenostomy | 280 | ||
Cystjejunostomy (Fig.16.3) | 280 | ||
Complications | 280 | ||
REFERENCES | 280 | ||
DRAINAGE OF THE PANCREATIC DUCT | 280 | ||
Appraise | 280 | ||
Prepare | 281 | ||
Access | 281 | ||
Assess | 281 | ||
Action | 281 | ||
Pancreatic sphincteroplasty | 281 | ||
Longitudinal pancreaticojejunostomy (Fig. 16.4) | 281 | ||
Lateral pancreaticojejunostomy (Fig. 16.5) | 282 | ||
Intubated pancreaticogastrostomy (Fig. 16.6) | 282 | ||
Complications | 282 | ||
LAPAROTOMY AND BYPASS FOR PANCREATIC CANCER | 282 | ||
Appraise | 282 | ||
Prepare | 283 | ||
Access | 284 | ||
Assess | 284 | ||
Aftercare and complications | 284 | ||
REFERENCES | 285 | ||
DISTAL PANCREATECTOMY | 285 | ||
Appraise | 285 | ||
Prepare | 285 | ||
Access | 285 | ||
Assess | 285 | ||
Action | 285 | ||
Conventional distal pancreatectomy (Fig. 16.9) | 285 | ||
Conservative distal pancreatectomy (Fig. 16.10) | 286 | ||
Other techniques | 287 | ||
Aftercare | 287 | ||
Complications | 287 | ||
REFERENCES | 287 | ||
PANCREATICODUDENECTOMY | 287 | ||
Appraise | 287 | ||
Prepare | 289 | ||
Assess | 289 | ||
Access | 289 | ||
Action | 290 | ||
Conservative pancreatoduodenectomy | 290 | ||
Conventional pancreatoduodenectomy | 292 | ||
Closure | 292 | ||
Aftercare | 293 | ||
Complications | 293 | ||
REFERENCES | 293 | ||
TOTAL PANCREATECTOMY | 293 | ||
Appraise | 293 | ||
Assess | 294 | ||
Action | 294 | ||
Aftercare and complications | 294 | ||
REFERENCES | 294 | ||
LAPAROTOMY FOR ISLET CELL TUMOUR | 294 | ||
Appraise | 294 | ||
Assess | 295 | ||
Action | 295 | ||
REFERENCES | 295 | ||
MINIMALLY INVASIVE PANCREATIC SURGERY | 295 | ||
Appraise | 295 | ||
Access | 296 | ||
Action | 296 | ||
REFERENCES | 296 | ||
FURTHER READING | 296 | ||
Chapter 17: Liver and portal venous system | 298 | ||
INTRODUCTION | 298 | ||
TRAUMA | 298 | ||
Appraise | 298 | ||
EXPLORATION OF A DAMAGED LIVER | 298 | ||
Prepare | 298 | ||
Access | 299 | ||
Assess | 299 | ||
Action | 299 | ||
Check | 300 | ||
Closure | 300 | ||
Chapter 18: Spleen | 315 | ||
Appraisal | 315 | ||
Prepare | 315 | ||
LAPAROSCOPIC SPLENECTOMY | 316 | ||
Access | 316 | ||
Assess | 317 | ||
Action | 317 | ||
Closure | 317 | ||
OPEN SPLENECTOMY | 318 | ||
ACCESS | 318 | ||
Assess | 318 | ||
Action | 318 | ||
Closure | 319 | ||
CONSERVATIVE SPLENECTOMY | 319 | ||
Appraise | 319 | ||
Assess | 319 | ||
Action | 319 | ||
Aftercare | 320 | ||
Complications | 320 | ||
FURTHER READING | 320 | ||
Chapter 19: Breast | 322 | ||
MANAGEMENT OF BREAST SYMPTOMS (Fig.19.1) | 322 | ||
Assessment | 322 | ||
BREAST BIOPSY | 323 | ||
FINE NEEDLE ASPIRATION CYTOLOGY | 323 | ||
Action | 323 | ||
CORE-CUT OR `TRU-CUT´ NEEDLE BIOPSY(Fig.19.2) | 324 | ||
Appraise | 324 | ||
Action | 324 | ||
OPEN BIOPSY | 324 | ||
NEEDLE-LOCALIZATION BIOPSY | 325 | ||
Prepare | 325 | ||
Access | 325 | ||
Action | 325 | ||
PUNCH BIOPSY | 326 | ||
Chapter 20: Thyroid | 341 | ||
Appraise | 341 | ||
Prepare | 342 | ||
MANAGEMENT OF THE SOLITARY THYROID NODULE AND THE DOMINANT NODULE WITHIN A MULTINODULAR GOITRE | 342 | ||
MANAGEMENT OF MALIGNANT THYROID DISEASE | 343 | ||
MANAGEMENT OF GRAVES´ THYROTOXICOSIS | 343 | ||
MANAGEMENT OF BENIGN MULTINODULAR THYROID DISEASE | 343 | ||
THYROID OPERATIONS | 344 | ||
Prepare | 344 | ||
Access | 344 | ||
Action | 344 | ||
Closure | 346 | ||
Postoperative care | 346 | ||
RETROSTERNAL MULTINODULAR GOITRE | 346 | ||
Appraise | 346 | ||
Action | 346 | ||
THYROGLOSSAL CYSTS | 347 | ||
Appraise | 347 | ||
Access | 347 | ||
Action | 347 | ||
Closure | 347 | ||
REFERENCES | 347 | ||
Chapter 21: Parathyroid | 348 | ||
HYPERPARATHYROIDISM AND PARATHYROIDECTOMY | 348 | ||
Appraise | 348 | ||
Prepare | 349 | ||
STANDARD OPERATION: FOUR-GLAND EXPLORATION | 349 | ||
Access | 349 | ||
Autotransplantation of parathyroid tissue | 351 | ||
Closure | 351 | ||
Postoperative | 351 | ||
MINIMALLY INVASIVE PARATHYROIDECTOMY | 351 | ||
THE LATERAL APPROACH | 351 | ||
OTHER MINIMAL ACCESS/MINIMALLY INVASIVE TECHNIQUES | 352 | ||
PARATHYROID CARCINOMA | 352 | ||
RE-OPERATION | 352 | ||
FURTHER READING | 352 | ||
Chapter 22: Adrenalectomy | 353 | ||
INTRODUCTION | 353 | ||
ANATOMY | 353 | ||
Appraise | 353 | ||
Indications for adrenalectomy | 353 | ||
Prepare | 354 | ||
Access | 354 | ||
Lateral approach (Fig.22.2) | 354 | ||
Laparoscopic lateral (transperitoneal) approach | 355 | ||
Open posterolateral approach | 356 | ||
Posterior (retroperitoneal) approach | 356 | ||
Endoscopic posterior (retroperitoneal) approach (Fig.22.5) | 356 | ||
Open posterior (retroperitoneal) approach | 356 | ||
Anterior approach | 357 | ||
Laparoscopic anterior approach | 357 | ||
Open anterior approach | 357 | ||
Postoperative | 357 | ||
Complications | 357 | ||
FURTHER READING | 357 | ||
Chapter 23: Arteries | 358 | ||
INTRODUCTION | 358 | ||
INDICATIONS FOR OPERATION | 358 | ||
GENERAL PRINCIPLES | 358 | ||
EQUIPMENT | 359 | ||
Instruments | 359 | ||
Solutions | 360 | ||
Grafts and stents | 360 | ||
GENERAL CONSIDERATIONS | 360 | ||
BASIC TECHNIQUES OF ARTERIAL REPAIR, ANASTOMOSIS AND TRANSLUMINAL ANGIOPLASTY | 360 | ||
Arteriotomy | 360 | ||
Simple suture | 360 | ||
Closure with a patch | 361 | ||
End-to-end anastomosis | 361 | ||
End-to-side anastomosis | 361 | ||
Transluminal angioplasty (Fig. 23.6) | 363 | ||
REFERENCES | 365 | ||
EXPOSURE OF THE MAJOR PERIPHERAL ARTERIES | 365 | ||
Common femoral artery | 365 | ||
Popliteal artery | 365 | ||
Tibial arteries | 366 | ||
Subclavian artery | 367 | ||
AXILLARYAND BRACHIAL ARTERIES | 368 | ||
TYPES OF OPERATION | 368 | ||
QUALITY CONTROL | 369 | ||
ARTERIAL OPERATIONS | 369 | ||
REPAIR OF ARTERIAL INJURY | 369 | ||
Appraise | 369 | ||
Prepare | 370 | ||
Access | 370 | ||
Assess | 370 | ||
Action | 370 | ||
Closure | 371 | ||
Aftercare | 371 | ||
Complications | 371 | ||
SURGICAL EMBOLECTOMY | 371 | ||
Appraise | 371 | ||
Prepare | 371 | ||
Access | 371 | ||
Action | 371 | ||
Closure | 372 | ||
Aftercare | 372 | ||
PERCUTANEOUS THROMBOLYTIC THERAPY AND THROMBECTOMY | 372 | ||
Appraise | 372 | ||
Prepare | 372 | ||
Action | 372 | ||
Complications | 373 | ||
REFERENCE | 373 | ||
AORTOBIFEMORAL BYPASS | 373 | ||
Appraise | 373 | ||
Prepare | 373 | ||
Access | 373 | ||
Assess | 374 | ||
Action | 374 | ||
Closure | 376 | ||
Aftercare | 376 | ||
Complications | 376 | ||
REFERENCES | 377 | ||
UNILATERAL AORTOFEMORAL/ILIOFEMORAL BYPASS | 377 | ||
Appraise | 377 | ||
Prepare | 377 | ||
Access | 377 | ||
Assess | 377 | ||
Action | 377 | ||
Closure | 378 | ||
Aftercare | 378 | ||
Complications | 378 | ||
MINIMALLY INVASIVE AND TOTALLY LAPAROSCOPIC AORTIC RECONSTRUCTION | 378 | ||
Chapter 24: Veins and lymphatics | 401 | ||
MANAGING LEG SUPERFICIAL VENOUS DISEASE (VARICOSE VEIN SURGERY) | 401 | ||
Appraise | 401 | ||
Preparation | 402 | ||
HIGH SAPHENOUS VEIN LIGATION (TRENDELENBURG'S OPERATION) AND STRIPPING OF LONG SAPHENOUS VEIN | 402 | ||
Appraise | 402 | ||
Prepare | 402 | ||
Access | 402 | ||
Action | 403 | ||
Closure | 404 | ||
Postoperative | 404 | ||
SAPHENOPOPLITEAL LIGATION AND STRIPPING | 405 | ||
Appraise | 405 | ||
Prepare | 405 | ||
Access | 405 | ||
Action | 405 | ||
Closure | 405 | ||
Complications | 405 | ||
ENDOVENOUS THERMAL ABLATION OF THE LONG SAPHENOUS VEIN | 406 | ||
Chapter 25: Sympathectomy and the management of hyperhidrosis | 415 | ||
ASSESSMENT OF HYPERHIDROSIS | 415 | ||
Appraise | 415 | ||
MANAGEMENT OF HYPERHIDROSIS | 415 | ||
SUBDERMAL INJECTION OF ATTENUATED BOTULINUS TOXIN (BOTOX) | 416 | ||
Appraise | 416 | ||
Action | 416 | ||
LOCALIZED AXILLARY SWEAT GLAND ABLATION | 417 | ||
HURLEY-SHELLEY OPERATION | 417 | ||
Chapter 26: Transplantation | 422 | ||
INTRODUCTION | 422 | ||
THE MULTIPLE ORGAN DONOR | 423 | ||
Appraise | 423 | ||
Donor screening and exclusions | 423 | ||
Prepare | 423 | ||
Access | 423 | ||
Assess | 423 | ||
Action | 423 | ||
ORGAN PRESERVATION | 424 | ||
TISSUE TYPING | 425 | ||
KIDNEY TRANSPLANTATION | 425 | ||
Chapter 27: Thorax | 434 | ||
Chapter 28: Head and neck | 447 | ||
GENERAL PRINCIPLES | 447 | ||
MINIMIZE BLOOD LOSS | 447 | ||
REPLACE BLOOD LOSS | 448 | ||
PAROTIDECTOMY | 448 | ||
Appraise | 448 | ||
Prepare | 448 | ||
Access | 449 | ||
SUPERFICIAL PAROTIDECTOMY | 450 | ||
Appraise | 450 | ||
Access | 450 | ||
Action | 450 | ||
Checklist | 451 | ||
Closure | 451 | ||
PAROTIDECTOMY FOR A LUMP IN THE PAROTID REGION | 451 | ||
Appraise | 451 | ||
Access | 451 | ||
Assess | 451 | ||
Action | 451 | ||
RADICAL PAROTIDECTOMY | 452 | ||
ACTION | 452 | ||
REFERENCES | 452 | ||
EXPLORATION OF THE LOWER POLE OF THE PAROTID | 452 | ||
Appraise | 452 | ||
Chapter 29: Orthopaedics and trauma: amputations | 471 | ||
INTRODUCTION | 471 | ||
Chapter 30: Orthopaedics and trauma: general principles | 481 | ||
PREOPERATIVE PREPARATION | 481 | ||
Chapter 31: Orthopaedics and trauma:upper limb | 495 | ||
THE ANTERIOR (DELTOPECTORAL) APPROACH TO THE SHOULDER | 495 | ||
Appraise | 495 | ||
Prepare | 495 | ||
Access | 495 | ||
Closure | 496 | ||
Aftercare | 496 | ||
APPROACHES TO THE UPPER ARM | 496 | ||
ANTEROLATERAL APPROACH | 496 | ||
Appraise | 496 | ||
Prepare | 497 | ||
Access | 497 | ||
Closure | 497 | ||
Chapter 32: Orthopaedics and trauma:lower limb | 511 | ||
APPROACHES TO THE HIP AND PROXIMAL FEMUR | 511 | ||
ANTEROLATERAL APPROACH | 511 | ||
Prepare | 511 | ||
Access (Fig.32.1) | 511 | ||
Closure | 512 | ||
LATERAL APPROACH TO THE PROXIMAL FEMUR | 512 | ||
Prepare | 512 | ||
Access (Fig.32.2) | 512 | ||
Chapter 33: Plastic surgery | 522 | ||
GENERAL PRINCIPLES | 522 | ||
Prepare | 522 | ||
Technique | 523 | ||
Sutures | 523 | ||
Instruments | 523 | ||
Drains | 523 | ||
Diathermy | 523 | ||
SKIN COVER | 523 | ||
SKIN CLOSURE | 523 | ||
Appraise | 523 | ||
Action | 523 | ||
SKIN GRAFTS | 524 | ||
Chapter 34: Paediatric surgery | 561 | ||
GENERAL CONSIDERATIONS IN PAEDIATRIC SURGERY | 561 | ||
INTRODUCTION | 561 | ||
ASSESSMENT OF THE `SURGICAL´ CHILD | 561 | ||
ASSESSMENT OF THE `SURGICAL´ NEWBORN | 561 | ||
PRE-NATAL DIAGNOSIS | 562 | ||
NEONATAL TRANSPORT | 562 | ||
INTRAVENOUS FLUIDS - THE STANDARD MAINTENANCE | 562 | ||
Postoperative fluid requirement | 562 | ||
GENERAL PAEDIATRIC SURGICAL TECHNIQUES | 563 | ||
THE ABDOMINAL OPERATION IN INFANTS AND CHILDREN | 563 | ||
Prepare | 563 | ||
Access | 563 | ||
Closure | 563 | ||
LAPAROSCOPY IN INFANTS AND CHILDREN | 563 | ||
Preoperative preparations (in addition to those for laparotomy) | 563 | ||
Access | 564 | ||
Closure | 564 | ||
INTESTINAL ANASTOMOSIS (Fig. 34.1) | 564 | ||
Prepare | 564 | ||
Action | 564 | ||
STOMA FORMATION | 565 | ||
LOOP COLOSTOMY (Fig. 34.2) | 565 | ||
Action | 565 | ||
Chapter 35: Neurosurgery | 578 | ||
INTRODUCTION | 578 | ||
THE ETHOS OF NEUROSURGERY | 578 | ||
TRAUMA | 578 | ||
INTRACRANIAL PRESSURE | 579 | ||
CEREBRAL BLOOD FLOW | 579 | ||
CEREBRAL PERFUSION PRESSURE | 579 | ||
INITIAL MANAGEMENT OF THE OBTUNDED HEAD INJURED PATIENT | 579 | ||
ANAESTHETIC CONSIDERATIONS | 580 | ||
Specific considerations for anaesthetic drugs | 580 | ||
Specific considerations for craniotomy | 580 | ||
SCALP LACERATIONS | 580 | ||
Appraise | 580 | ||
Action | 580 | ||
DEPRESSED SKULL FRACTURE | 581 | ||
Chapter 36: Upper urinary tract | 591 | ||
INTRODUCTION | 591 | ||
ACUTE PYONEPHROSIS (OBSTRUCTED INFECTED KIDNEY) | 591 | ||
Appraise | 591 | ||
OPEN NEPHROSTOMY FOR ACUTELY OBSTRUCTED KIDNEY | 591 | ||
Prepare | 591 | ||
Access | 591 | ||
Action | 592 | ||
Aftercare | 592 | ||
REFERENCE | 592 | ||
OBSTRUCTED KIDNEY CAUSED BY A STONE | 592 | ||
Appraise | 592 | ||
CYSTOSCOPIC INSERTION OF A URETERIC STENT | 593 | ||
Prepare | 593 | ||
Action | 593 | ||
DEFINITIVE STONE MANAGEMENT | 593 | ||
RENAL TRAUMA | 593 | ||
Appraise | 593 | ||
NEPHRECTOMY FOR TRAUMA | 594 | ||
Access | 594 | ||
REPAIR OF A DAMAGED URETER | 595 | ||
Assess | 595 | ||
END-TO-END ANASTOMOSIS OF A DIVIDED URETER | 595 | ||
Chapter 37: Lower urinary tract | 598 | ||
SUPRAPUBIC CATHETER INSERTION | 598 | ||
Appraise | 598 | ||
Anatomical considerations | 598 | ||
Action | 598 | ||
CYSTOSCOPY | 599 | ||
Chapter 38: Male genitalia | 605 | ||
CIRCUMCISION | 605 | ||
Appraise | 605 | ||
Prepare | 605 | ||
Action | 605 | ||
ADULT CIRCUMCISION | 606 | ||
Chapter 39: Gynaecological surgery | 613 | ||
GENERAL CONSIDERATIONS | 613 | ||
INTRODUCTION | 613 | ||
Perioperative care | 613 | ||
Prepare | 613 | ||
BARTHOLIN'S ABSCESS (OR CYST) | 614 | ||
Chapter 40: Ear, nose and throat | 628 | ||
INTRODUCTION | 628 | ||
FOREIGN BODY IN THE EAR | 628 | ||
Appraise | 628 | ||
Action | 628 | ||
REMOVAL OF NASAL FOREIGN BODY | 629 | ||
Chapter 41: Oral and maxillofacial surgery | 633 | ||
GENERAL PRINCIPLES OF ORAL SURGERY | 633 | ||
Preparation | 633 | ||
Anaesthesia | 633 | ||
Haemostasis | 633 | ||
Suturing | 634 | ||
Aftercare | 634 | ||
TOOTH EXTRACTION | 634 | ||
Appraise | 634 | ||
Prepare | 634 | ||
Action | 634 | ||
Aftercare | 635 | ||
JAW INFECTIONS | 635 | ||
DENTAL ABSCESS | 635 | ||
Chapter 42: Ophthalmology | 641 | ||
INTRODUCTION | 641 | ||
Prepare | 641 | ||
PROTECTING THE EYE | 641 | ||
Assess | 641 | ||
TARSORRHAPHY | 641 | ||
Appraise | 641 | ||
Action | 642 | ||
EYELID INJURIES | 642 | ||
INJURIES OF THE GLOBE | 643 | ||
LACERATIONS | 643 | ||
Appraise | 643 | ||
Closure | 643 | ||
BLUNT INJURIES | 644 | ||
EVACUATION OF HYPHAEMA | 644 | ||
Index | 651 |