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 |