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Kirk's General Surgical Operations E-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