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General Surgical Operations
Dhiraj Choudhury
SECTION 1: GENERAL PRINCIPLES
CHAPTER 1:
Decision Making in Surgery
TIMING
PROCEDURE
APPROACH
CHAPTER 2:
Preparations for Operation
PREOPERATIVE PREPARATION OF THE PATIENT
Assessment of Fitness
Routine Preoperative Directions
Special Preparations
High-risk Patients
PREOPERATIVE PREPARATIONS OF SURGICAL TEAM: SCRUB-UP TECHNIQUE
Entry to Operation Theater
Scrubbing
Gowning
Gloving
Technique of Putting Gloves
CHAPTER 3:
An Operation: Step-by-step
CHECK IN OPERATING ROOM
ANESTHESIA
PATIENT POSITION
Supine Position
Lateral Position
Lithotomy Position
Trendelenburg's Position (Fig. 3.2)
Lloyd–Davies Position
Prone Position
Prone Jack-knife Position
SKIN PREPARATIONS
‘Prep’ and ‘Drape’
Position of Surgeon
OPERATIVE TECHNIQUE
Incision
Method of Making an Incision
EXPOSURE/DISSECTION
PROCEDURES
CLOSURE
Methods of Closure of Skin Wounds
CHAPTER 4:
Methods of Hemostasis in Surgery
PREOPERATIVE
INTRAOPERATIVE
COMPRESSION
LIGATION OR CLIPPING
FLUID INFILTRATION
THERMAL COAGULATION/DIATHERMY
ULTRASOUND
LASER
Photodynamic Therapy
LOCAL HEMOSTATS
Procedures
CHAPTER 5:
Sutures, Ligatures and Knots in Surgery
SUTURE AND LIGATURE MATERIALS
TYPES
Absorbable
Nonabsorbable
Advantages of Synthetic Polymeric Suture Materials
SURGICAL KNOTS
Principles of Knot Tying
Types of Knots
Granny Knot
Reef Knot
Triple-throw Knot
Surgeon's Knot
Aberdeen Knot (Figs 5.1 D to I)
Methods of Tying Knots
By Both Hands
By One Hand
By Instrument
Laparoscopic knot-tying
METHODS OF SUTURING SKIN
Closure of Wounds
Types of Skin Closure
Simple Interrupted Suturing
Simple Continuous Suturing
Continuous Locked Suturing
Mattress Suturing
Subcuticular Suturing
CHAPTER 6:
Role of Surgical Drains
INDICATIONS
TYPES OF DRAINS
Open Drains
Corrugated Rubber or Silastic Sheet
Closed Drains
Rubber Tube Drain
Silicon Tube Drain
Penrose Drain
Closed Suction Drain
Sump Drain
Percutaneous Drainage
Fixation of Drains
Removal of Drains
CHAPTER 7:
Techniques of Achieving Skin Cover
DIRECT CLOSURE BY SUTURING
SKIN GRAFTING
Indications
Types
Free Skin Graft
Partial Thickness/Split Graft/Thiersch Graft
OPERATIVE PROCEDURE
Anesthesia
Local
General
Preparation of Donor Site
Graft Cutting
Graft Treatment
Graft Application
Graft Fixation
Dressing of Donor Site
Full-thickness (Wolfe) Graft
Pinch Grafts
FLAPS
Indications
Types
Random Pattern Flaps
Axial Flaps
Myocutaneous Flaps
Rotation Flaps (Figs 7.7A and B)
TISSUE EXPANSION
CHAPTER 8:
Principles of Minimal Access Surgery/Minimally Invasive Surgery
NATURE OF MINIMAL ACCESS/MINIMALLY INVASIVE SURGERY
SCOPE OF MINIMAL ACCESS/INVASIVE SURGERY
ADVANTAGES
DISADVANTAGES/RISKS
FUNDAMENTALS OF LAPARO (INSIDE) SCOPIC (TO SEE) SURGERY
Indications
Diagnostic
Therapeutic
Contraindications
Absolute
Relative
Operation Room Setup
Equipment
Hand Instruments/Equipment
Operative Procedure
Anesthesia
OT Setup and Patient Position
Operative Technique
Problems
Operative Complications and its Avoiding
CHAPTER 9:
Principles of Day Case Surgery
ADVANTAGES
CRITERIA FOR SELECTION
BASIC NECESSITIES
SELECTION OF CASES
GENERAL SURGERY PROCEDURES
UROLOGICAL PROCEDURES
DISCHARGE PROTOCOL
SECTION 2: HEAD AND NECK
CHAPTER 10:
Burr Hole Procedures
INTRODUCTION
HISTORY
PROCEDURE
Sites of Placement
INDICATIONS AND PRESENT USAGE
Therapeutic Indications
Diagnostic Indications
Craniotomy Flaps (Fig. 10.4)
Chronic Subdural Collections (Fig. 10.5)
Aspiration of Brain Abscess
Stereotactic Procedures
CSF Diversion Procedures
Neuroendoscopic and Functional Neurosurgical Procedures
Monitoring of Intracranial Pressure
Ultrasound Navigation
Exploratory Burr Holes
Positions (Fig 10.7)
Choice of Initial Burr Hole
Rate of Positivity
RISKS OF BURR HOLES
CLOSURE OF BURR HOLES
CONCLUSION
CHAPTER 11:
Excision of Cervical Lymph Nodes
INDICATIONS
ANATOMY
PREOPERATIVE PREPARATIONS
OPERATIVE PROCEDURES
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 12:
Surgery for Parotid Tumors
SUPERFICIAL PAROTIDECTOMY
Indication
Preoperative Preparation
Anesthesia
Position of Patient/Draping
Incision
Procedure
Complications
EXCISION OF DEEP LOBE PAROTID TUMORS
Total Parotidectomy with Preservation of the Facial Nerve
Radial Parotidectomy
FOLLOW-UP/RESULTS OF TREATMENT
CHAPTER 13:
Simple Lithotomy for Submandibular Duct Stone
INDICATION
OPERATIVE PROCEDURE
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATION
CHAPTER 14:
Excision of Submandibular Salivary Gland
ANATOMY
INDICATIONS
PREOPERATIVE PREPARATION
OPERATIVE PROCEDURE
Position
Anesthesia
Draping
Incision
Exposure
Mobilization of Superficial Lobe (Fig. 14.4)
Ligation of Facial Artery at Lower Border
Ligation of Facial Artery at Upper Border (Figs 14.7A and B)
Mobilization of the Deep Lobe
Division of the Duct (Fig. 14.9)
Closure
RADICAL EXCISION
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATION
CHAPTER 15:
Operations for Cancer of Face and Lip
BASAL CELL CARCINOMA
SURGERY
TECHNIQUE: WIDE EXCISION
CARCINOMA OF LIP
TYPES OF SURGERY
CHAPTER 16:
Operations for Cancer of the Oral Tongue
INTRODUCTION
Staging of Carcinoma of the Tongue
CHOICE OF TREATMENT FOR T1 AND T2 LESIONS
ANESTHESIA AND OTHER PRELIMINARY STEPS
HEMIGLOSSECTOMY FOR T1 AND T2 LESIONS
Anatomical Basis for the Operation
Operative Steps
Incisions
Division of Nerve and Artery
Closure
Postoperative Care
Complications
SURGERY FOR T3 LESIONS
GLOSSECTOMY WITH EXCISION OF FLOOR MOUTH
CHAPTER 17:
Neck Dissections
INTRODUCTION
INDICATIONS AND CONTRAINDICATIONS
LEVELS OF LYMPH NODES
VARIANTS OF NECK DISSECTION: DEFINITIONS
Radical Neck Dissection
Elective or Prophylactic Neck Dissection
Partial Neck Dissections
Supraomohyoid Neck Dissection
ANESTHESIA AND POSITION OF THE PATIENT
Operative Steps for MND Type 1 (XI Nerve Sparing Procedure)
Choice of Skin Incision
STEP-BY-STEP OPERATIVE PROCEDURE
RADICAL NECK DISSECTION
POSTOPERATIVE CARE
INTRAOPERATIVE PROBLEMS
POSTOPERATIVE COMPLICATIONS
SUPRAOMOHYOID NECK DISSECTION
HISTOPATHOLOGICAL EXAMINATION
CHAPTER 18:
Commando Operation
INDICATION
PREOPERATIVE PREPARATION
ANESTHESIA
POSITION/DRAPING
INCISION
PROCEDURE
COMPLICATIONS
CHAPTER 19:
Surgery for Thyroid Cancer
INTRODUCTION
SURGICAL ANATOMY
Musculofascial Coverings
Vascular Anatomy
Superior Vascular Pedicle
Inferior Thyroid Artery
Inferior Thyroid Veins
Middle Thyroid Vein
Thyroidea Ima Artery
Important Close Surgical Relations of the Thyroid Gland
External Laryngeal Nerve
Recurrent Laryngeal Nerves
Parathyroid Glands
Lymphatics
TYPES OF THYROID OPERATIONS
PREOPERATIVE PREPARATION
PREOPERATIVE WORK-UP
THYROIDECTOMY TECHNIQUE
Positioning of the Patient
Incision
Management of Strap Muscles
Initial Mobilization of Gland
Identification of the Recurrent Laryngeal Nerve
Localization and Preservation of the Parathyroid Glands
Mobilization of Superior and Inferior Pole of Thyroid
Final Mobilization of the Gland
SPECIAL POINTS FOR THYROIDECTOMY IN CANCER
POSTOPERATIVE COMPLICATIONS
CHAPTER 20:
Subtotal Thyroidectomy
INDICATIONS
PREOPERATIVE PREPARATIONS
OPERATIVE PROCEDURE
CHAPTER 21:
Excision of Thyroglossal Cyst and Fistula
EXCISION OF THYROGLOSSAL CYST
Indications
Operative Procedure
EXCISION OF THYROGLOSSAL FISTULA
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATION
CHAPTER 22:
Parathyroidectomy
INDICATIONS
PREOPERATIVE PREPARATIONS
TECHNIQUE
CHAPTER 23:
Excision of Branchial Cyst and Fistula
ANATOMY
INDICATIONS
PREOPERATIVE STEP
OPERATIVE PROCEDURE
EXCISION OF BRANCHIAL FISTULA
Postoperative Care
Postoperative Complications
CHAPTER 24:
Tracheostomy
INDICATIONS
Upper Airway Obstruction
Prolonged Ventilatory Support
Neurological Impairment
Preoperative Steps
PREOPERATIVE PROCEDURE
Position
Emergency Procedure
Elective Procedure
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
SECTION 3: BREAST
CHAPTER 25:
Operation for Benign Breast Lesions
INCISION AND DRAINAGE OF BREAST ABSCESS
Indication
Preoperative Preparation
Operative Procedure
Postoperative
EXCISION OF FIBROADENOMA OF BREAST
Indications
Operative Procedure
Postoperative Care
Postoperative Complication
EXCISION OF GIANT FIBROADENOMA
Operative Procedure
EXCISION OF DUCTS
Excision of Single Duct Microdochectomy
Indication
Excision of Major Duct System: Hadfield's Operation
Indications
Operative Procedure
OPERATION FOR GYNECOMASTIA
Indications
Operative Procedure
Postoperative Care
Postoperative Complications
CHAPTER 26:
Surgery for Breast Cancer
INTRODUCTION
Anatomy of the Normal Breast
Surgery in Breast Cancer
Introduction
Contraindications to Breast Conservation Surgery
SURGERY IN BREAST CANCER
Excision Biopsy
Needle Localization Biopsy
Breast Conservation Surgery
Histopathological Evaluation
Modified Radical Mastectomy
Radical Mastectomy
Simple Mastectomy
Microdochectomy
POSTOPERATIVE CARE
BREAST RECONSTRUCTION
SECTION 4: THORAX
CHAPTER 27:
Basic Surgical Procedures
CHEST DRAINS
Indications
Technique
Intercostal Tube Drain (Closed Drainage)
DRAINAGE BY RIB RESECTION
THORACOTOMY
POSTEROLATERAL THORACOTOMY
Indications
Steps
ANTEROLATERAL THORACOTOMY
Indications
Steps
MEDIAN STERNOTOMY
SECTION 5: ESOPHAGUS
CHAPTER 28:
Open Esophagocardiomyotomy: Heller's Operation for Esophageal Achalasia
PNEUMATIC DILATATION
INTRASPHINCTERIC INJECTION OF BOTULINUM TOXIN
SURGICAL METHODS
Open Surgery
INDICATIONS
Preoperative Preparations
Operative Procedure: Transabdominal
Postoperative Care
COMPLICATIONS
Intraoperative
Postoperative
CHAPTER 29:
Laparoscopic Cardiomyotomy
PREOPERATIVE PREPARATION
OPERATIVE PROCEDURE
Anesthesia
Patient Positioning and Room Setup
Trocar Position
The Hiatal Dissection
The Myotomy
Antireflux Procedure
Dorprocedure (Anterior Fundoplication)
Postoperative Care
Complications
CHAPTER 30:
Nissen Fundoplications for Gastroesophageal Reflux Disease: Open Method
INDICATIONS
PREOPERATIVE PREPARATIONS
OPERATIVE PROCEDURE
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
Early
Late
CHAPTER 31:
Laparoscopic Repair of Gastroesophageal Reflux and Hiatus Hernia
INDICATIONS
AIMS OF OPERATION
PREOPERATIVE PREPARATION
OPERATIVE PROCEDURE
Anesthesia
Patient Position
Trocar Position (Fig. 31.1)
Technique of Nissen Fundoplication
Dissection of the Crura (Figs 31.5A to D)
Fundic Mobilization (Figs 31.6 A to C)
Crural Closure
Fundoplication (Figs 31.8A to D)
Laparoscopic Partial Fundoplication
POSTOPERATIVE CARE
COMPLICATIONS
CHAPTER 32:
Surgery for Carcinoma of the Esophagus
TNM STAGING
Stage Grouping
INVESTIGATIONS
Diagnostic Investigations
Staging Investigations
TREATMENT OPTIONS
Two Factors Determine the Treatment
Surgical Approaches
Transthoracic Esophagectomy with Cervical Anastomosis
Anesthesia
Thoracotomy
Esophageal Mobilization
Lymph Node Dissection
Abdomen
Gastric Mobilization
Lymph Node Dissection
Gastric Tube
Conduit Route
Neck
Infraomohyoid Neck Dissection
Ivor–Lewis Procedure
Operative Steps
Abdomen
Thorax
Anastomosis
Transhiatal Esophagectomy
Indications and Patient Selection
Anesthesia
Procedure
Gastric Mobilization
Cervical Dissection
Transhiatal Esophageal Dissection
Anastomosis
Esophagogastrectomy Through Left Thoracoabdominal (Garlock) Approach
Indications and Patient Selection
Anesthesia
Procedure
POSTOPERATIVE CARE AND COMPLICATIONS
PALLIATIVE PROCEDURE FOR CARCINOMA OF THE ESOPHAGUS
SECTION 6: ABDOMEN: GENERAL
CHAPTER 33:
Abdominal Incisions and Closure
VERTICAL INCISIONS
Midline Incisions
Upper Midline Incision (Fig. 33.1)
Steps
Lower Midline Incision (Fig. 33.2)
Paramedian Incision (Figs 33.3 and 33.4)
Steps
Rectus Splitting
OBLIQUE INCISIONS
Kocher's Subcostal Incision (Fig. 33.5A)
Steps
Roof-Top (Bilateral Subcostal) Incisions (Figs 33.5A and B)
Steps
McBurny's Gridiron Incision (Fig. 33.5C)
Steps
Rutherford-Morrison Incision (Fig. 33.5D)
Steps
TRANSVERSE INCISIONS
Upper Transverse incision (Fig. 33.6A)
Steps
Lanz Transverse Incision (Fig. 33.6B)
Steps
Pfannenstiel Incision (Fig. 33.6C)
Steps
Thoracoabdominal Incision
Indications
Steps
CLOSURE OF ABDOMINAL WOUNDS
Mass Closure
Layered Closure
All Layers Closure
Method of Closure of Burst Abdomen (Fig. 33.11)
CHAPTER 34:
Intestinal Anastomosis
METHODS: SEW OR STAPLE
HAND-SEWN METHODS
End-to-end Anastomosis: Between Two Mobile Segments
End-to-end Anastomosis (Between Mobile and Fixed Segments)
Techniques
End-to-side Anastomosis
Side-to-side Anastomosis
STAPLED ANASTOMOSIS
CHAPTER 35:
Intestinal Stomas
GASTROSTOMY
Indication
Percutaneous Endoscopic Gastrostomy
Steps
Stamm Gastrostomy
Steps
ENTEROSTOMY
Feeding Jejunostomy
Indications
Methods
Stamm Enterostomy
Witzel Method
Recent Methods
LOOP ILEOSTOMY
Operative Procedure
Formation of Loop Ileostomy
Closure of Loop Ileostomy
END ILEOSTOMY (BROOKE)
Indication
Procedure
Complications of Ileostomy
COLOSTOMY
Indications
Types
Loop Colostomy
Transverse Colostomy (Loop)
Pelvic (Loop) Colostomy
Operative Procedure
End/Terminal Colostomy
OTHER STOMAS
Cecostomy
Paul-Mikulicz Type
Closure of Colostomy
Preoperative
Methods
COMPLICATIONS OF STOMA
CHAPTER 36:
Laparotomy for Abdominal Trauma
INDICATIONS OF LAPAROTOMY
DIAGNOSTIC PERITONEAL LAVAGE
Contraindications of DPL
Technique (Open Method)
Results
PREOPERATIVE PREPARATIONS
OPERATIVE PROCEDURE: LAPAROTOMY
MANAGEMENT OF SPECIFIC INJURIES
Diaphragm
Liver
Major Liver Injuries: Gross Lacerations, Vena Caval Injuries
Complications of Liver Injuries
Gallbladder and Extrahepatic Biliary Track
Spleen
Conservative Treatment
Operative: Splenectomy
Splenorrhaphy (Splenic Salvage)
Stomach
Duodenum
Classification
Options for Treatment of Duodenal Rupture or Perforation
Closure
Diversion
Indications
Pyloric Exclusion with Gastrojejunostomy
CHAPTER 37:
Laparotomy for Intestinal Obstruction
INDICATIONS
PREOPERATIVE PREPARATIONS
OPERATIVE PROCEDURE
Decompression of Bowel
Irrigation of Bowel
MANAGEMENT OF SPECIFIC CAUSES
Bands
Adhesiolysis
Noble's Plication
Stricture
Strangulated (Nonviable) Small Bowel
Intussusception
Volvulus
Malignant Obstruction
CLOSURE
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 38:
Laparotomy for Peritonitis
INDICATIONS
PROCEDURES
CLOSURE
SECTION 7: STOMACH AND DUODENUM
CHAPTER 39:
Pyloromyotomy: Ramstedt's Operation
INDICATION
PREOPERATIVE PREPARATIONS
OPERATIVE PROCEDURE
OPERATIVE TECHNIQUE
CLOSURE
POSTOPERATIVE CARE
CHAPTER 40:
Vagotomy
TRUNCAL VAGOTOMY
Indications
Preoperative Preparations
Operative Procedure
Technique of Truncal Vagotomy
Mobilization of Esophagus
Anterior (Left) Truncal Vagotomy (Fig. 40.4)
Posterior (Right) Truncal Vagotomy (Fig. 40.5)
Difficulties
Closure
PROXIMAL GASTRIC VAGOTOMY: HIGHLY SELECTIVE VAGOTOMY
Operative Procedure
Exposure
Identification of Right and Left Vagal Trunks
Identification of Crow's Foot
Dissection of Anterior Nerve of Latarjet (Fig. 40.6)
Dissection of Posterior Nerve of Latarjet (Fig. 40.7)
Closure
Postoperative Care
Postoperative Complications
CHAPTER 41:
Pyloroplasty: Heineke-Mikulicz Type
INDICATIONS
CONTRAINDICATIONS
PREOPERATIVE PREPARATIONS
OPERATIVE PROCEDURE
Kocherization of Duodenum
Pyloroduodenal Incision
Closure
FINNEY'S PYLOROPLASTY
Closure of Abdomen
Postoperative Care
Complications
CHAPTER 42:
Gastrojejunostomy
INDICATIONS
PREOPERATIVE PREPARATIONS
OPERATIVE PROCEDURE: POSTERIOR GASTROJEJUNOSTOMY: POSTERIOR, RETROCOLIC, OBLIQUE ISOPERISTALTIC ANASTOMOSIS
Anesthesia—General
Anastomotic Technique
First Layer
Second Layer
Third Layer
Fourth Layer
Closure
ANTERIOR GASTROJEJUNOSTOMY
CHAPTER 43:
Partial Gastrectomy
TYPES
STEPS
CHAPTER 44:
Operation for Perforated Peptic Ulcer
INDICATION
PREOPERATIVE PREPARATIONS
OPERATIVE PROCEDURE
Exploration
Peritoneal Toilet
Identification of Site of Perforation
Simple Closure of Perforation
Omentoplasty
Other Procedures
Closure
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 45:
Operation for Bleeding Peptic Ulcer
INDICATIONS
PREOPERATIVE PREPARATIONS
OPERATIVE PROCEDURE
Exposure
Technique
Pyloroduodenotomy
Under-running
Pyloroplasty
Truncal Vagotomy
Bleeding Gastric Ulcer
Closure
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 46:
Radical Gastrectomy
RADICAL TOTAL GASTRECTOMY
Indications
Anesthesia
Position
Incision
Procedure
DISTAL RADICAL GASTRECTOMY
Indications
Anesthesia
Position
Incision
Procedure
Reconstruction
PROXIMAL RADICAL GASTRECTOMY WITH PARTIAL ESOPHAGECTOMY
Indications
Anesthesia
Patient Position
Incision
Procedure
Reconstruction
Editor's Comments
CHAPTER 47:
Bariatric Surgery
INDICATIONS
CONTRAINDICATIONS
PREOPERATIVE PREPARATIONS
TYPES OF SURGERY
APPROACHES
TECHNIQUE
LAPAROSCOPIC METHODS
SECTION 8: HEPATOBILIARY SURGERY
CHAPTER 48:
Operative Drainage of Subphrenic Abscess
ANATOMY OF SUBPHRENIC SPACES (FIG. 48.1)
INDICATIONS
OPERATIVE PROCEDURES
Anterior Extraperitoneal Approach for Anterior Abscess
Posterior Subpleural Approach for Posterior Abscess
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 49:
Surgery for Liver Infections
PYOGENIC LIVER ABSCESS
Technique
AMEBIC LIVER ABSCESS
Indications for Operative Drainage
Technique
HYDATID CYST OF LIVER
Contraindications
TYPES OF OPERATIONS
OPERATIVE TECHNIQUE
CHAPTER 50:
Liver Resection
INDICATIONS
Malignancy
Benign
SURGICAL ANATOMY OF THE LIVER
OPERATIVE APPROACHES TO THE LIVER
Bilateral Subcostal Incision
J Incision
Median Laparotomy
Thoracoabdominal Approach
RIGHT HEPATECTOMY
LEFT HEPATECTOMY
COMPLICATIONS OF LIVER RESECTION
Vascular Complications
Hepatic Vein or IVC Injury
Portal Vein Injury
Hemorrhage from Resected Liver Surface
Biliary Complications
Biliary Leaks
Bile Duct Injury
Hepatic Insufficiency
Infective Complications
SEGMENT-ORIENTED LIVER RESECTION
LAPAROSCOPIC LIVER RESECTION
CHAPTER 51:
Surgery for Portal Hypertension
INDICATIONS FOR SURGERY
Surgical Options
PORTOSYSTEMIC SHUNTS
PORTOSYSTEMIC SHUNT: CHOICE OF OPERATION
DISTAL SPLENORENAL SHUNT
CHAPTER 52:
Cholecystostomy
INDICATIONS
PROCEDURE
CHAPTER 53:
Open Cholecystectomy
ANATOMY
INDICATIONS OF OPEN CHOLECYSTECTOMY
PREOPERATIVE STEPS
OPERATIVE PROCEDURE
Exposure
Procedure
Neck-first Method
Fundus-first Method
Intraoperative Problems
GALLBLADDER CANCER
Operability in Gallbladder Cancer
Surgery for Operable Gallbladder Cancer
Revision Surgery for Incidental Gallbladder Cancer
Palliative Treatment for Gallbladder Cancer
Closure
Postoperative Care
Postoperative Complications
CHAPTER 54:
Laparoscopic Cholecystectomy
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
PATIENT PREPARATION
PREOPERATIVE LABORATORY TESTS
IMAGING
INFORMED CONSENT
STAFF LAYOUT AND POSITIONING OF PATIENT
ANESTHESIA
CREATION OF PNEUMOPERITONEUM
Closed Technique
Procedure
Open Technique (Hasson)
Procedure
Placement of Ports
GALLBLADDER RETRACTION
Gallbladder Exposure and Dissection
DISSECTION OF CALOT'S TRIANGLE
MOBILIZATION OF GALLBLADDER
INSERTION OF DRAIN
REMOVAL OF GALLBLADDER AND PORT CLOSURE
CONVERSION TO AN OPEN OPERATION IS INDICATED
POSTOPERATIVE COMPLICATIONS
CHAPTER 55:
Surgery of Bile Duct
ANATOMY
DUCTAL ANOMALIES
SURGERY OF BILE DUCT STONES
Choledocholithotomy
Steps of Choledocholithotomy
Note on Operative Cholangiogram
Technique
Biliary Drainage Procedure
Transduodenal Sphincterotomy/Sphincteroplasty
Technique of Sphincterotomy/Sphincteroplasty (Figs 55.1 to 55.3)
Complications
Choledochoduodenostomy (Figs 55.4 to 55.6)
Complications
BILE DUCT INJURIES
MANAGEMENT OF BILE DUCT INJURIES
When Detected during Surgery?
Treatment of Complications Detected During Postoperative Period
Bile Collections and Peritonitis
External Biliary Fistula
Biliary Stricture (Fig. 55.7)
Results of Biliary Reconstruction Procedures
Surgery of Choledochal Cysts in Adults
Resection of Choledochal Cyst
Complications of the Operation
SECTION 9: PANCREAS
CHAPTER 56:
Surgery of Pancreas
SURGERY FOR ACUTE PANCREATITIS
Introduction
Indications of Surgery
Infected Pancreatic Necrosis
Pancreatic Abscess
Preoperative Preparations
Operating Procedure
Incision
Exposure
Operative Technique
Summary of Problems Faced during Necrosectomy
Closure
Postoperative Care
Postoperative Complications
PANCREATICOJEJUNOSTOMY
Introduction
Indications
Preparations
Operative Procedures
Technique: First Part–Exposure of Duct and Lithotomy (Fig. 56.1)
Technique: Second Part–Anastomosis
Closure
Postoperative Care
Postoperative Complications
PSEUDOCYST OF PANCREAS
Indications
Preoperative Preparations
Operative Procedure: Transgastric Cystogastrostomy or Roux-en-Y (Cystojejunostomy)
Exposure
Techniques (Fig. 56.5)
Closure
Postoperative Care
Postoperative Complications
SURGERY OF PANCREATIC CANCER
PANCREATICODUODENECTOMY/ WHIPPLE'S PROCEDURE
Introduction
Indications
Preparations
Judging Operability
Minimizing Jaundice
Preparations for Jaundice
Operative Procedures
Exposure
Technique: First Part–Resection (Fig. 56.7)
Technique: Second Part–Reconstruction (Fig. 56.8)
Closure
Postoperative Care
Postoperative Complications
SECTION 10: SPLEEN
CHAPTER 57:
Surgery of Spleen
ANATOMY OF SPLEEN
SPLENECTOMY
Indications
Preoperative Preparations
Operative Procedure
Emergency Splenectomy
Elective Splenectomy
Closure
Postoperative Care
Postoperative Complications
SECTION 11: SMALL BOWEL
CHAPTER 58:
Operations on Small Bowel
SMALL BOWEL RESECTION AND ANASTOMOSIS
Indications
Operative Procedure
Technique
STRICTUREPLASTY
Indications
THE ROUX-EN-Y LOOP
Indications
Advantages
MECKEL'S DIVERTICULECTOMY
Indications
Operative Procedure
Technique
ILEOSTOMY
SECTION 12: APPENDIX
CHAPTER 59:
Appendectomy: Open Method
INDICATIONS
PREOPERATIVE PREPARATIONS
OPERATIVE PROCEDURE
Identification and Delivery of Appendix
Dealing with Appendicular Artery
Ligations of Appendicular Stump
Closure
SPECIAL PROBLEMS
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
Early
Late
CHAPTER 60:
Laparoscopic Appendectomy
HISTORY
INDICATIONS
CONTRAINDICATIONS
STEPS OF OPERATION
Steps
Identification of Cecum and Diagnostic Laparoscopy
Displaying the Whole Appendix (Fig. 60.3)
Lysis of Mesoappendix
Amputation of the Appendix
Extraction of the Appendix
The Final Look (Fig. 60.5)
Optional Extra Maneuvers
POTENTIAL ADVANTAGES OF LAPAROSCOPIC APPENDECTOMY
LAPAROSCOPIC APPENDECTOMY IN PREGNANCY
SUGGESTED PRINCIPLES
WHAT TO DO IF THE APPENDIX APPEARS NORMAL?
SPECIAL SITUATIONS
Retrograde Laparoscopic Appendectomy
Submucosal Appendectomy
Two-Port Appendectomy
Single Port Appendectomy
CURRENT STATUS OF LAPAROSCOPIC APPENDECTOMY
COMPLICATIONS OF LAPAROSCOPIC APPENDECTOMY
SECTION 13: LARGE BOWEL
CHAPTER 61:
Colectomy
INTRODUCTION
SURGICAL ANATOMY
INDICATIONS
SPECIAL PREPARATION
Right Hemicolectomy
Indications
Incision
Exposure and Assessment
Procedure
Mobilization of Right CoIon (Fig. 61.3) (Lateral to Medial)
Division and Ligation of the Vessels (Fig. 61.5)
Excision of Segment
Restoration of Continuity of Bowel
Stapled Anastomosis
Final Check
Drain
Closure
Complications
Extended Right Hemicolectomy
Indications
Conservative Right Hemicolectomy
Indications
Left Hemicolectomy
Indications
Mobilization of Left Colon
Division of Blood Vessels and Ligation
Closure
Radical Excision of Left Colon
Indications
Procedure
Sigmoid Colectomy
Indications
Procedure
Total Colectomy
POSTOPERATIVE CARE
COMPLICATIONS
FURTHER CARE
RECENT ADVANCES IN COLECTOMY AND COLON SURGERY
CHAPTER 62:
Total Colectomy with Mucosal Proctectomy and Ileal Pouch: Anal Anastomosis
INTRODUCTION
INDICATIONS
PREOPERATIVE PREPARATION
OPERATIVE PROCEDURE
General Principles
Incision
Total Colectomy and Proctectomy
Construction of the Ileal Pouch
Mucosectomy
Ileoanal Anastomosis
Closure
POSTOPERATIVE CARE
COMPLICATIONS AND THEIR MANAGEMENT
Early Complications
Late Complications
CHAPTER 63:
Subtotal Colectomy with Ileorectal Anastomosis, Ileostomy and Mucous Fistula
INTRODUCTION
EMERGENCY SURGERY
Colectomy with Ileostomy
Operative Procedure
Mucus Fistula/Closure of Rectal Stump
Length of Rectosigmoid Stump
Elective Surgery
Indications
Which Operation?
Subtotal Colectomy with Ileorectal Anastomosis
Technique
Anastomosis (Figs 63.3 to 63.5)
CHAPTER 64:
Operations for Diverticular Disease
SURGICAL MANAGEMENT OF DIVERTICULAR DISEASE
MANAGEMENT OF ACUTE DIVERTICULITIS
MANAGEMENT OF COLONIC OBSTRUCTION
MANAGEMENT OF MASSIVE COLONIC HEMORRHAGE
MANAGEMENT OF COLOVESICAL FISTULA
PRIMARY RESECTION AND ANASTOMOSIS
Operative Strategy
Preoperative Preparation
Operative Procedure
Incision
Dissection of the Sigmoid and Left Colon
Division of Mesocolon
Anastomosis
Abdominal Closure
Hartmann's Procedure
Laparoscopically-assisted Reversal of Hartmann's Procedure
Surgical Technique
CHAPTER 65:
Management of Rectal Cancer
INTRODUCTION
PREOPERATIVE PLANNING
Multidisciplinary Team (MDT)
Role of Radiologist
Role of Oncologist
Role of Surgeon
Local Recurrence
Sexual and Urinary Dysfunction
Sphincter Preservation for Low Rectal Cancer
Locally Advanced Rectal Cancer
Laparoscopic Considerations
OPERATIVE PROCEDURES
Local Excision
Radical Procedures
Preoperative Considerations
Colonic Dissection
Anterior Resection
Abdominoperineal Resection
‘Standard’ APE
ELAPE
Construction of Colostomy
Hartmann's Procedure
Closure of the Abdomen
THE POSTOPERATIVE PERIOD
Enhanced Recovery
Postoperative Follow-up
CHAPTER 66:
Operations for Rectal Prolapse
ABDOMINAL PROCEDURES
Indication
Preoperative Preparation
Operative Procedure: Wells Procedure: Rectal Fixation
Mobilization of Sigmoid Colon and Rectum
Rectopexy
Ripstein Procedure
PERINEAL PROCEDURES
Thiersch Operation
Procedure
Technique
Delorme's Procedure
Technique
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
SECTION 14: ANAL AND PERIANAL
CHAPTER 67:
Treatments of Hemorrhoids
SURGERY FOR HEMORRHOIDS
Treatment
HEMORRHOIDECTOMY—OPEN METHOD/MILLIGAN MORGAN METHOD
Indications
Preoperative Preparations
Contraindications
Operative Procedure
Postoperative Care
Postoperative Complications
MINIMALLY INVASIVE PROCEDURE FOR HEMORRHOIDS
Procedure
Steps
CHAPTER 68:
Surgical Procedures for Anal Fissure
ANAL STRETCHING
Procedure
Postoperative Care
LATERAL INTERNAL SPHINCTEROTOMY
Operative Procedure: Open Method
Technique
Closure
CLOSED LATERAL INTERNAL SPHINCTEROTOMY
Fissurectomy with Dorsal Sphincterotomy
Postoperative Care
CHAPTER 69:
Incision and Drainage of Anorectal Abscess
OPERATIVE PROCEDURE: INCISION AND DRAINAGE
Perianal and Ischiorectal Abscess
Technique
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 70:
Operation for Fistula in Ano
LOW FISTULA
Preoperative Preparations
Operative Procedure and Technique
Procedure
Technique
Closure
Operative Procedure for Horse-Shoe Fistula
HIGH FISTULA
Postoperative Care
Postoperative Complications
SECTION 15: HERNIAS
CHAPTER 71:
Operation for Epigastric Hernia
INDICATION
OPERATIVE PROCEDURE
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 72:
Operation for Umbilical Hernia in Infants and Children
INDICATION
OPERATIVE PROCEDURE
CHAPTER 73:
Operation for Adult Umbilical Hernia or Paraumbilical Hernia
INDICATION
PREOPERATIVE STEPS
OPERATIVE PROCEDURE
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 74:
Operation for Incisional Hernia: Open Method
INDICATION
PREOPERATIVE PREPARATIONS
OPERATIVE PROCEDURE
Repair
Simple Anatomical Repair
Complex Anatomical Repair
Repair by Proline Mesh
Onlay Patch Repair
Extraperitoneal Mesh Repair: Rives Stoppa Techniques
Intraperitoneal Mesh Repair
Closure
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 75:
Operation for Inguinal (Groin) Hernias: Open Method
GENERAL PRINCIPLES
TYPES OF REPAIR
Tension Repair/Pure Tissue Repair/Sutured Techniques
Tension Free Repair/Mesh Repair
INGUINAL HERNIOTOMY IN INFANTS AND CHILDREN
Operative Procedure
Exposure
Dissection of the Cord
Isolation of the Sac
Herniotomy
Repair
Closure
HERNIA REPAIR: PROCEDURES IN ADULTS
Preoperative Preparations
Operative Procedure
Incision
Exposure
Dissection of the Cord (Fig. 75.8)
Dissection of the Sac
Dealing with the Sac
Repair
Pure Tissue Repairs
Additions and Alterations of Bassini Method
Tension-free Repair
Plug and Patch Repair
Three-dimensional Mesh Repair
Postoperative Care
Postoperative Complications
STRANGULATED HERNIA
Preoperative Preparations
Salient Steps
Dealing with Sac
Repair
Closure
Postoperative Care
Postoperative Complications
Concluding Remarks about Surgery of Groin Hernia
CHAPTER 76:
Operations for Femoral Hernia
SURGICAL ANATOMY
INDICATION FOR OPERATION
OPERATIVE PROCEDURE
Approaches
Low Approach
Preperitoneal Approach: McEvedy
High Approach—Lothisen
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 77:
Inguinal Hernia: Laparoscopic Repair
INTRODUCTION
ANATOMY
CONVENTIONAL ANATOMY
Laparoscopic Anatomy
Triangle of Doom
Triangle of Pain
LAPAROSCOPIC HERNIOPLASTY
Transabdominal Preperitoneal Hernioplasty
Operative Technique
Extraperitoneal Approach
Operative Technique
POSTOPERATIVE MANAGEMENT
CONCLUSION
SECTION 16: GENITOURINARY SURGERY
CHAPTER 78:
Surgical Approaches to Kidney
ANATOMY
SURGICAL APPROACHES TO KIDNEY
Posterolateral Approach
Nagamatsu's Thoracolumbar Approach
Anterior Transperitoneal Approach
CHAPTER 79:
Nephrostomy
INDICATIONS
Percutaneous Nephrostomy
INSERTION OF J-STENT
OPEN NEPHROSTOMY
Preoperative Preparations
Steps
CHAPTER 80:
Treatment of Renal Stones
PERCUTANEOUS NEPHROLITHOTOMY
Open Surgical Removal
Procedure
Technique
Pyelolithotomy
Extended Pyelolithotomy
Nephrolithotomy
Pyelonephrolithotomy
Nephrectomy
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 81:
Pyeloplasty: Anderson-Hynes
INDICATION
OPERATIVE PROCEDURE
Approach
Technique
Closure
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 82:
Nephrectomy
INDICATIONS
OPERATIVE PROCEDURE: SIMPLE NEPHRECTOMY
Anesthesia
Position
Incision for Posterolateral Approach
Exposure
Dealing with Renal Pedicle (Fig. 82.6)
Closure
RADICAL NEPHRECTOMY
Operative Technique: Transabdominal Approach
Right-sided Nephrectomy
Dealing with Venacaval Involvement
Left-sided Nephrectomy
Closure
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 83:
Treatment of Ureteric Stones
ANATOMY
TREATMENT OF URETERIC STONES
OPEN URETEROLITHOTOMY
Indication
Preoperative Preparation
Operative Procedure
Stone in the Upper Third of Ureter
Stone in the Middle Third of Ureter
Stone in Lower Third of Ureter
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 84:
Total Radical Cystectomy
INDICATION
AIMS
PREOPERATIVE CARE
OPERATIVE PROCEDURE
Procedure
Ligation of Internal Iliac Artery
Transection of Ureters
Mobilization of Bladder
Dealing with Membranous Urethra
Urinary Diversion (Figs 84.3A to D)
Pelvic Lymphadenectomy
Closure
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
Immediate
Late
CHAPTER 85:
Meatotomy/Meatoplasty
INDICATION
OPERATIVE PROCEDURE
Technique
Meatotomy
Meatoplasty
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 86:
Circumcision
INDICATIONS
Contraindications: Hypospadias
OPERATIVE PROCEDURE IN CHILDREN
Guillotine Method/Forceps-guided
OPERATIVE PROCEDURE IN ADULT
Dorsal Slit Technique/Dissection Method
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
Early
Late
CHAPTER 87:
Amputation of Penis/Penectomy
INDICATIONS
OPERATIVE PROCEDURE
Partial Amputation of Penis/Penectomy
Exposure and Technique
Fashioning of Urethral Opening
Total Amputation of Penis/Penectomy
Exposure
Closure
Fashioning Urethrostomy
Dealing with Inguinal Lymph Nodes
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
Early
Late
CHAPTER 88:
Orchidopexy/Orchiopexy
INDICATIONS
PREOPERATIVE PREPARATIONS
OPERATIVE PROCEDURE
Problem
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 89:
Orchidectomy
SIMPLE ORCHIDECTOMY/SCROTAL ORCHIDECTOMY
Indications
Operative Procedure
RADICAL ORCHIDECTOMY/INGUINAL ORCHIDECTOMY
Indication
Operative Procedure
SUBCAPSULAR ORCHIDECTOMY
Indication
Procedure
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 90:
Operation for Hydrocele
INDICATIONS FOR OPERATION
PREOPERATIVE PREPARATIONS
OPERATIVE PROCEDURE
Technique
Eversion of Sac (Fig. 90.4): Jaboulay's Operation
Hydrocelectomy/Sac Excision
Lord's Plication
Closure
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 91:
Vasectomy
INDICATION
PREOPERATIVE PREPARATION
OPERATIVE PROCEDURE
Conventional Method/Scalpel
Incision
Exposure
Vasectomy
Closure
No Scalpel Vasectomy
Advantages
Disadvantage
Steps
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
Short Term
Long Term
CHAPTER 92:
Varicocelectomy
INDICATIONS FOR INTERVENTION
TYPES OF INTERVENTION
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
CHAPTER 93:
Excision of Epididymal Cyst
INDICATIONS FOR OPERATION
STEPS
SECTION 17: ADRENALS
CHAPTER 94:
Surgery of Adrenals
ADRENALECTOMY
Indications
PREOPERATIVE PREPARATION
METHODS
OPEN ADRENALECTOMY
Posterolateral Approach
SECTION 18: VASCULAR SURGERY
CHAPTER 95:
Exposure of Major Peripheral Arteries
INDICATIONS
Emergency
Elective
COMMON CAROTID ARTERY
Indications
Operative Procedure
Closure
EXTERNAL AND INTERNAL CAROTID ARTERIES
Operative Procedure
SUBCLAVIAN ARTERY
Indications
Operative Procedure
AXILLARY ARTERY
Indications
Operative Procedure
BRACHIAL ARTERY
In Arm
Operative Procedure
In Cubital Fossa
RADIAL ARTERY
Operative Procedure
FEMORAL ARTERY
Indications
Operative Procedure
In Hunter's Canal
POPLITEAL ARTERY
Indications
Operative Procedure
CHAPTER 96:
Vascular Trauma
INTRODUCTION
TECHNIQUE OF GREAT SAPHENOUS VEIN HARVEST (Fig. 96.3)
CHAPTER 97:
Vascular Access
SHORT-TERM DIALYSIS CATHETERS
LONG-TERM DIALYSIS CATHETERS
COMPLICATIONS OF CENTRAL VENOUS CATHETERS
SURGICAL ACCESS
COMPLICATIONS OF SURGICAL VASCULAR ACCESS
OPERATIVE TECHNIQUE: THE RADIOCEPHALIC ARTERIOVENOUS FISTULA
CHAPTER 98:
Acute Lower Limb Ischemia
ASSESSMENT AND DECISION MAKING
Initial Management (Parallel with Assessment and Definitive Decision-making)
ENDOVASCULAR APPROACH
Complications
Contraindications to Thrombolysis
SURGICAL APPROACH
Femoral Embolectomy
CHAPTER 99:
Treatment of Varicose Veins
TREATMENT OPTIONS FOR VARICOSE VEINS
Conservative Method
Indications
Injection Method
Indications
Operative Methods
Indications
Types of Operations
TRENDELENBURG'S OPERATION: JUXTA-FEMORAL FLUSH LIGATION
HIGH LIGATION OF THE LONG SAPHENOUS VEIN
STRIPPING OF LONG SAPHENOUS VEIN
Steps
Problem
Closure
Compression Bandage
SAPHENO-POPLITEAL LIGATION AND STRIPPING
Indication
Operative Procedure
AVULSIONS OR MULTIPLE PHLEBECTOMY
Indication
Operative Procedure
SUBFASCIAL LIGATION (COCKET AND DODD'S)
Operative Procedure
Postoperative Care
POSTOPERATIVE COMPLICATIONS
ENDOVASCULAR OPTIONS
Endovascular/Venous Laser Ablation
Complications
SECTION 19: MISCELLANEOUS
CHAPTER 100:
Sympathectomy
CERVICODORSAL SYMPATHECTOMY
Indications
Preoperative Preparations
Approaches
Anterior Supraclavicular Approach
Axillary Approach
Closure
TRANSTHORACIC APPROACH ENDOSCOPIC
Preoperative Preparation
Procedure
LUMBAR SYMPATHECTOMY
Indications
Preoperative Preparations
Extraperitoneal Approach
Exposure
Technique
Closure
Postoperative Care
Postoperative Complications
CHAPTER 101:
Amputations and Disarticulations
INTRODUCTION AND DEFINITION
DISARTICULATION
Indications
Principles
General Considerations
An Ideal Amputation Stump
Optimum Levels of Lengths of Amputation
Basic Methods
General Steps and Basic Techniques
Choice of Levels in Different Diseases
AMPUTATION OF LOWER LIMB
Amputation and Disarticulation of the Toes
Amputation in the Foot
Amputation at the Ankle Joint
Amputation Through Leg
Below Knee Amputation
Applied Anatomy
Surgical Technique
Amputation Through Knee Joint
Amputation Through Thigh
Above-knee Amputation
Amputation (Disarticulation) at the Hip
Interinnomino–abdominal Amputation (Hind-Quarter)
AMPUTATION OF UPPER LIMB
Amputation in the Fingers and Hand
Disarticulation at the Wrist Joint
Amputation through the Forearm
Krukenberg Amputation
Disarticulation at the Elbow Joint
Amputation through Arm
Amputation at the Shoulder (Disarticulation)
Interscapulo-thoracic Amputation (Fore-Quarter)
Preoperative Preparation
Postoperative Management
Complications
Rehabilitation and Prostheses
Prosthesis
Prognosis
CONCLUSION
INDEX
TOC
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