Fischer’s Mastery of Surgery

 

Description:

For 40 years, Fischer’s Mastery of Surgery has provided expert, highly illustrated coverage of the procedures that general surgeons and trainees need to know. The fully revised eighth edition, under the editorial leadership of Drs. E. Christopher Ellison, Gilbert R. Upchurch Jr., Philip A. Efron, Steven D. Wexner, Nancy D. Perrier, V. Suzanne Klimberg, John H. Stewart IV, Valerie W. Rusch, Jon C. Gould, Susan Galandiuk, Timothy M. Pawlik, William C. Chapman, Benjamin K. Poulose, Peter K. Henke, Alicia M. Mohr, Saleem Islam, Anne M.R. Agur, Carol Scott-Conner, and David Renton continues the tradition of excellence with two full-color volumes that include the essentials of diagnosis, anatomy, and pre-operative planning while maintaining a focus on clear, step-by-step depictions and descriptions of procedures. 

 

 

Table of Contents:

 

VOLUME I

SECTION I: PERIOPERATIVE CARE OF THE SURGICAL PATIENT

CHAPTER 1: Metabolic and Inflammatory Responses to Trauma and Infection

INTRODUCTION

Acute Phase Response to Injury

Catabolism in Injury

Mitochondrial Dysfunction

Carbohydrate Metabolism

Hormonal Changes During Injury and Stress

Glucagon

Glucocorticoids

Adrenal Insufficiency

NEUROENDOCRINE CHANGES DURING TRAUMA AND INFECTION

ROLE OF THE AUTONOMIC NERVOUS SYSTEM DURING TRAUMA AND INFECTION

AUTONOMIC DYSFUNCTION

ADVERSE EFFECTS OF ADRENERGIC STRESS

OTHER NEUROENDOCRINE ALTERATIONS

Vasopressin

Thyroid

Growth Hormone

The Gonadal Axis

IMMUNE RESPONSE TO INJURY

OUTCOMES

CHAPTER 2: Perioperative Management: Practical Principles, Risk Determination and Future Directions

INTRODUCTION

GENERAL PRINCIPLES

The Physiologic Changes Due to the Surgical Stress Response and Anesthesia

Surgical Urgency and Risk Estimation

PERIOPERATIVE RISK ASSESSMENT

Surgery-Specific Risk

Patient-Specific Risk

Combined Risk Assessment

History and Physical Examination and Preoperative Laboratory Testing

A SYSTEM-BASED APPROACH TO PERIOPERATIVE EVALUATION

Cardiovascular

Pulmonary

Renal

Hepatobiliary

Rheumatologic

SPECIAL POPULATIONS

The Older Patient

The Pregnant Patient

The Patient for Whom Transfusion Is Not an Option

The Patient With a History of Malignancy or Immunocompromise

The Obese Patient

MEDICATION REVIEW

FUTURE DIRECTIONS

Artificial Intelligence and Surgical Decision Making

CHAPTER 3: Fluids, Electrolytes, and Renal Replacement Therapy

INTRODUCTION

TOTAL BODY WATER AND FLUID COMPOSITION (Fig. 3.1)

ASSESSMENT OF FLUID STATUS

INTRAVENOUS FLUIDS

ELECTROLYTE DISTURBANCES AND MANAGEMENT (FIGS. 3.2 AND 3.3)

Sodium

Potassium

Magnesium (Mg)

Calcium (Ca)

Phosphate

MANAGEMENT OF RENAL FAILURE: RENAL REPLACEMENT THERAPY AND DIALYSIS

DIAGNOSIS OF ACUTE RENAL FAILURE

PREVENTION AND MANAGEMENT OF EARLY ACUTE RENAL FAILURE

INDICATIONS FOR RENAL REPLACEMENT THERAPY

RENAL REPLACEMENT THERAPY PRINCIPLES

INTERMITTENT DIALYSIS (IHD) VERSUS CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT)

CHAPTER 4: Enteral Nutrition Support and Gastrointestinal Issues

INTRODUCTION

A History of Artificial Nutrition

NUTRITION ASSESSMENT

Anthropometric and Body Composition Assessment

BIOCHEMICAL ASSESSMENT

Serum Creatinine and Nitrogen Balance Studies

Serum Visceral Protein

Nutrition Assessment Tools

Summary: Nutritional Assessment of the Surgical Patient

METABOLIC RESPONSE TO STARVATION AND TO INJURY

Starvation

Surgical and Traumatic Injury

CALORIE AND PROTEIN REQUIREMENTS

Estimating Energy Expenditure

Protein Requirements

MACRONUTRIENTS: ABSORPTION AND UTILIZATION

Carbohydrates

Protein

Lipids

Vitamins and Minerals

ENTERAL NUTRITION

Overview of Nutritional Support Strategies

Advantages of Enteral Nutrition

Contraindications

Timing of Initiation

Dosing and Permissive Underfeeding Strategies

Alternatives to Continuous Feeding Strategies

Monitoring Tolerance

Enteral Formulations

DISEASE-SPECIFIC FORMULATIONS AND ADDITIVES

Pulmonary Formulas

Diabetic Formulas

Malabsorptive Formulas

Renal Formulations

Hepatic Formulations

Immune and Metabolic Modulation With Nutrition (Immunonutrition)

Antioxidant Additives/Supplementation

Probiotics and Prebiotics

SPECIAL CONSIDERATIONS IN THE ELECTIVE PERIOPERATIVE SETTING

Early Initiation of Enteral Support

Preoperative Carbohydrate Loading

SUMMARY

CHAPTER 5: Respiratory Care and Ventilation in the Surgical ICU

INTRODUCTION

NORMAL PULMONARY PHYSIOLOGY

IMPACT OF SURGICAL CARE ON PULMONARY FUNCTION

RISK FACTORS FOR ACUTE RESPIRATORY DISTRESS OR ACUTE RESPIRATORY FAILURE

PREOPERATIVE ASSESSMENT FOR POSTOPERATIVE PULMONARY COMPLICATIONS

PULMONARY PREHABILITATION FOR THE ELECTIVE SURGICAL PATIENT

INTRAOPERATIVE MECHANICAL VENTILATION

COMMON APPROACHES TO NONINVASIVE VENTILATION

RESPIRATORY PHYSIOLOGY DURING POSITIVE PRESSURE VENTILATION

VENTILATOR PRESCRIPTION ELEMENTS

Directly Set Elements

Measured Pressures

Derived Pressures

Essential Waveforms

Airway Pressure Release Ventilation (APRV) and Bilevel Ventilation (Figs. 5.11 and 5.12)

Pressure Support Ventilation

Non–ventilator-Based Assessment Tools

Postoperative Management

Adjuncts for Respiratory Care

CONCLUSIONS

CHAPTER 6: Cardiovascular Monitoring and Support

INTRODUCTION

CARDIOVASCULAR MONITORING

Physical Findings

Electrocardiography

Arterial Blood Pressure Monitoring

Central Venous Pressure Monitoring

Pulmonary Artery Catheter Monitoring

Noninvasive Cardiovascular Monitoring

CARDIOVASCULAR SUPPORT

Resuscitation

Inotropic Support

Vasoactive Modulation

MECHANICAL VENTRICULAR ASSISTANCE

CHAPTER 7: Best Practices in Endocrine Care in the Perioperative Period

INTRODUCTION

PINEAL GLAND

HYPOTHALAMUS/PITUITARY

PARATHYROID

THYROID GLAND

ENDOCRINE PANCREAS

Insulin

Glucagon

Somatostatin

Amylin, Ghrelin, Pancreatic Polypeptide, Motilin, Obestatin, Substance P, and Serotonin

Vasoactive Intestinal Peptide (VIP)

THE ADRENAL GLAND

CARCINOID SYNDROME AND OTHER FUNCTIONAL NEUROENDOCRINE TISSUE

TESTIS AND OVARY

THYMUS AND ADIPOSE TISSUE

CHAPTER 8: Hemorrhagic Risk, Blood Components, and Anticoagulation/DVT Prophylaxis

INTRODUCTION

ACQUIRED COAGULOPATHY

Trauma-Induced Coagulopathy

Coagulopathy of Liver Disease

Disseminated Intravascular Coagulation

Inherited Coagulopathies

MEDICATION-INDUCED COAGULOPATHY

Anticoagulants and Respective Reversal Agents

Antiplatelet Agents

Oral Anticoagulants

Warfarin Reversal

Direct Oral Anticoagulants (DOACs)

Emergency Reversal of DOACs

Viscoelastic Testing (VET)

WHOLE BLOOD TRANSFUSION

PACKED RED BLOOD CELLS (PRBC)

PLASMA

CRYOPRECIPITATE

PLATELETS

TRANEXAMIC ACID

TRANSFUSION-RELATED IMMUNOSUPPRESSION (TRIM)

TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI)

TRANSFUSION-ASSOCIATED CARDIAC OVERLOAD (TACO)

CHAPTER 9: Perioperative Antimicrobial Prophylaxis, Treatment of Surgical Infection and Sepsis

INTRODUCTION

PREVENTION OF SURGICAL SITE INFECTION

Epidemiology and Classification of SSI

Risk Factors for Developing SSI

Microbiology

General Measures to Prevent SSI

Perioperative Antimicrobial Prophylaxis

MANAGEMENT OF SEPSIS

MANAGEMENT OF SURGICAL INFECTIONS

COMPLICATED INTRA-ABDOMINAL SEPSIS

Diagnostic Workup

Empiric Antimicrobial Management

Microbiology in Patients With Community-Associated Infections

Microbiology in Patients With Health care-Associated Infections

Broad-Spectrum Antimicrobial Therapy for Severe Community-Associated Infection

Antimicrobials in Patients With Health care-Associated Intra-Abdominal Infections

Pharmacokinetic and Pharmacodynamic Considerations in Intra-Abdominal Sepsis

De-Escalation Approach for Polymicrobial Infections

Newer Antimicrobial Agents

Surgical Interventions and Nonoperative Procedures

Timing of Source Control

Adequacy of Source Control

Prognosis and Clinical Outcome

SKIN AND SOFT TISSUE INFECTIONS

Skin and Soft Tissue Infections Definitions

Microbiology of Uncomplicated SSTI

Microbiology of cSSTI

Antimicrobial Therapy

Principles of Surgical Intervention

Necrotizing Soft Tissue Infection

ANTIMICROBIAL STEWARDSHIP

CONCLUSION

CHAPTER 10: Sedation and Delirium in the Surgical Intensive Care Unit

INTRODUCTION

ICU SEDATION AND AGITATION

Historical Perspective

Assessment of Sedation and Agitation

Sedative Agents in the ICU

Treatment of Agitation

Specific Populations

DELIRIUM

Pathophysiology of Delirium and Its Risk Factors

Recognition and Diagnosis

Prevention and Treatment

SUMMARY

CHAPTER 11: Acute Postoperative Pain Management

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

PREOPERATIVE PLANNING

THERAPY OPTIONS

Acetaminophen

Alpha-2 Adrenergic Agonists

Gabapentinoids

Ketamine

Lidocaine Intravenous Infusion

Muscle Relaxants

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Opioids

Regional Analgesics

Tramadol

Multimodal THERAPY

DISCHARGE

SPECIAL POPULATIONS

Geriatric Patients

Chronic Pain Patients

CONCLUSION

CHAPTER 12: Surgeons and the Opioid Epidemic

INTRODUCTION

BRIEF HISTORY OF OPIOIDS

A REVOLUTION IN PHARMACEUTICAL ADVERTISING

MISCONSTRUED SCIENCE

PARADIGM CHANGE

A RAPID INCREASE IN PRESCRIPTION OPIOIDS

A MIDDLE-AMERICA PROBLEM

OPIOIDS AND THE SURGEON

Preoperative Chronic Opioid Use

Surgeons Are Overprescribing Opioids for Postoperative Pain

APPROACHES TO PREVENTION

Primary Prevention

Secondary Prevention

APPROACHES TO ADDICTION TREATMENT

Methadone

Buprenorphine

Naltrexone

HARM REDUCTIONS STRATEGIES

Needle Exchange Programs

Supervised Injection Facilities

MULTIMODALITY ADDICTION STRATEGIES

MAINTAINING ABSTINENCE

FINAL DISCUSSION

CONCLUSION

ACKNOWLEDGMENTS

CHAPTER 13: Surgery and Perioperative Care during the COVID-19 Pandemic

INTRODUCTION

PREADMISSION AND ADMISSION CONSIDERATIONS IN COVID-19 PANDEMIC

PREOPERATIVE PLANNING

INTRAOPERATIVE CONSIDERATIONS

POSTOPERATIVE CARE

COST OF DELAY

CHAPTER 14: Core Procedures in the Surgical Intensive Care Unit

INTRODUCTION

INDICATIONS AND CONTRAINDICATIONS

PREPROCEDURAL PLANNING AND EQUIPMENT

TECHNIQUE

COMPLICATIONS

INDICATIONS AND CONTRAINDICATIONS

PREPROCEDURAL PLANNING AND EQUIPMENT

TECHNIQUE

COMPLICATIONS

INDICATIONS AND CONTRAINDICATIONS

PREPROCEDURAL PLANNING AND EQUIPMENT

TECHNIQUE

COMPLICATIONS

INDICATIONS AND CONTRAINDICATIONS

PREPROCEDURAL PLANNING AND EQUIPMENT

TECHNIQUE

COMPLICATIONS

CHAPTER 15: Mastery Keys: Anatomy of Venous Access, Subclavian and Internal Jugular Veins

OVERVIEW OF VENOUS DRAINAGE OF NECK

SUBCLAVIAN VEIN

INTERNAL JUGULAR VEIN

SECTION II: Basic Surgical Skills and Emerging Technology

CHAPTER 16: Laparoscopic Suturing and Stapling

BACKGROUND

LAPAROSCOPIC SUTURING INSTRUMENTS

LAPAROSCOPIC SUTURING TECHNIQUES

Intracorporeal Suturing/Knot Tying

Extracorporeal Suturing/Knot Tying

Loop Ligature

Additional Laparoscopic Suturing and Ligature Techniques

LAPAROSCOPIC STAPLING

Laparoscopic Linear Staplers

Circular Staplers in Laparoscopy

Surgical Stapler Buttress Materials

Evidence for Surgical Stapling

LAPAROSCOPIC SIMULATION AND TRAINING

CONCLUSIONS

CHAPTER 17: Ultrasonography by Surgeons

INTRODUCTION

INDICATIONS FOR INTRAOPERATIVE ULTRASOUND

BASIC PHYSICS: THE PIEZOELECTRIC EFFECT

INSTRUMENTATION

Transducers (Probes)

Open US Probes

Laparoscopic US Probes

Robotic US Probes

Knobology

Ultrasound Terminology

SCANNING TECHNIQUES

General Considerations

Coupling

Probe Placement

Probe Movement/Manipulation

OPEN ULTRASOUND

Liver Scanning Method

Biliary Scanning Method

Pancreas Scanning Method

LAPAROSCOPIC ULTRASOUND

Liver Scanning Method

Biliary Scanning Method

Pancreas Scanning Method

ROBOTIC ULTRASOUND

ULTRASOUND-GUIDED PROCEDURES

Targeting

Ultrasound-Guided Procedure Planning

Ultrasound-Guided Tissue Dissection

TRAINING IN SURGICAL ULTRASOUND

CONCLUSIONS

CHAPTER 18: Tumor Ablation: Technologies and Clinical Applications

INTRODUCTION

POTENTIAL BENEFITS OF TUMOR ABLATION

Combination Therapy

Immunologic Benefit

TECHNOLOGIES USED FOR TUMOR ABLATION

Chemical Ablation (Nonenergy)

Energy-Based Ablation

Irreversible Electrocorporation

Cryoablation

TUMOR ABLATION IN CLINICAL PRACTICE

Liver

Prostate

Kidney

Breast

Other Uses

CONCLUSIONS

CHAPTER 19: Upper and Lower Gastrointestinal Endoscopy

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUE

Instrumentation

Advanced Imaging in Endoscopy

Technique of Esophagogastroduodenoscopy

Therapeutic Interventions During Upper Endoscopy

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Technique of Colonoscopy and Basic Colonoscopic Design

Snares

Advanced Techniques

Submucosal Injection

Endoscopic Mucosal Resection

Endoscopic Submucosal Dissection

Precut EMR and Hybrid ESD

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES AND LONG-TERM FOLLOW-UP

NOVEL ENDOLUMINAL PLATFORMS AND ENDOROBOTICS

CONCLUSION

Disclosures

CHAPTER 20: Mastery Keys: Endoscopic Anatomy of Upper and Lower Gastrointestinal Tract

ENDOSCOPIC ANATOMY OF UPPER GASTROINTESTINAL TRACT

Pharynx

Esophagus

Stomach

Duodenum

ENDOSCOPIC ANATOMY OF LOWER GASTROINTESTINAL TRACT

Rectum and Anal Canal (Fig. 20.2A,B)

Sigmoid Colon (Fig. 20.2C,D)

Descending Colon

Transverse Colon (Fig. 20.2E,F)

Ascending Colon and Cecum (Fig. 20.2G–I)

CHAPTER 21: Robotic Surgery

INTRODUCTION

HISTORY OF MINIMAL INVASIVE SURGERY

MIS AND ROBOTICS

ROBOTIC PLATFORMS AND EVOLUTION

THE DA VINCI SURGICAL SYSTEM

EQUIPMENT FUNDAMENTALS

EDUCATION AND SKILL ACQUISITION

LIMITATIONS

FUTURE DIRECTIONS

Flexible Robotics

Fluorescent Surgery

Artificial Intelligence and Machine Learning

CONCLUSION

CHAPTER 22: Surgical Energy

INTRODUCTION

TYPES OF ENERGY IN THE OPERATING ROOM

Monopolar Radiofrequency Energy

Bipolar Radiofrequency Energy

Ultrasonic Energy

Plasma Energy

Lasers

Microwave and Radiofrequency Energy Ablation

THE EIGHT REPRODUCIBLE PATTERNS OF ELECTROSURGICAL INJURY

Fires

Antenna Coupling

Insulation Failure

Residual Heat

Direct Application

Interaction With Electronic Devices

Direct Coupling

Capacitive Coupling

SPECIAL CONSIDERATIONS

Endoscopy

Pregnancy and Pediatric Surgery

Surgical Smoke and Infectious Risk

CONCLUSION

CHAPTER 23: Telemedicine for Surgeons

INTRODUCTION

DEFINITION OF TELEMEDICINE

DIFFERENT TYPES OF TELEMEDICINE

ORIGINS OF TELEMEDICINE

COVID-19 PANDEMIC AND ITS IMPACT ON TELEMEDICINE

TECHNOLOGY BEHIND TELEMEDICINE

THE VIRTUAL EXAMINATION

CLINICAL LOGIC BEHIND SURGICAL TELEHEALTH

USING TELEMEDICINE IN THE SURGICAL CARE CONTINUUM

FINANCIAL IMPLICATIONS OF TELEMEDICINE

OPERATIONAL MODEL FOR SURGICAL TELEMEDICINE

SURGICAL TELEMEDICINE IN A SERVICE LINE

COLLABORATIVE TELEMEDICINE OPPORTUNITIES AMONG SURGEONS AND OTHER SPECIALTIES

CRAFTING OUR SURGICAL TELEMEDICINE FUTURE

CONCLUSION

CHAPTER 24: Artificial Intelligence and Virtual Reality

ARTIFICIAL INTELLIGENCE

What Is Artificial Intelligence?

Types of Artificial Intelligence

Types of Learning

Subfields of Artificial Intelligence

Artificial Intelligence in Surgery

Limitations of AI

Ethical Considerations

VIRTUAL REALITY

What Is the Reality–Virtuality Continuum?

Role of VR/AR in Training and Planning

Role of VR/AR During Surgery

FUTURE DIRECTIONS

CHAPTER 25: Telepresence Surgery

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING OF THE WORLD’S FIRST TELESURGERY

Technical Challenges

Ethical and Medicolegal Aspects

Preclinical Proof-of-Concept for Safe Clinical Use

THE SURGICAL TECHNIQUE OF OPERATION LINDBERGH

POSTOPERATIVE CARE/COMPLICATIONS/MANAGEMENT

POST-LINDBERGH DEVELOPMENT OF TELESURGERY

New Technology for Democratized Telesurgery

TELESURGERY BEYOND EARTH

OUTLOOK

ACKNOWLEDGEMENTS

CHAPTER 26: An Effective Approach to Mastering Communication in Surgery

KEY PRINCIPLES IN EFFECTIVE COMMUNICATION

COMMUNICATION ACROSS THE SURGICAL PATHWAY

Effective Communication Critical to Patient Safety

Structured Communication Tools

TEAM COMMUNICATION

CASE SCENARIOS

Case #1

Case #2

Case #3

TECHNIQUES ACROSS DIFFERENT COMMUNICATION PLATFORMS

Parting Thoughts

CHAPTER 27: Fluorescence Imaging

INTRODUCTION

EQUIPMENT

SPECIFIC APPLICATIONS OF FLUORESCENCE TECHNOLOGY

Gastrointestinal Surgery

Hepatobiliary Surgery

Foregut Surgery

Bariatric Surgery

Colorectal Surgery

Abdominal Wall Reconstruction/Plastic Surgery

ENDOCRINE SURGERY

Parathyroid Glands

Adrenal

Pancreas

SENTINEL LYMPH NODE IDENTIFICATION

LYMPHATIC SURGERY

FINANCIAL IMPLICATIONS

FUTURE DIRECTIONS

CONCLUSIONS

CHAPTER 28: Video-Based Education

THE TRIPLE PARADIGM SHIFT

BASIC CONCEPTS, MODALITIES, AND SOURCES FOR LEARNING

Video-Based Learning (VBL)

Online Platforms: Virtual Repositories and Video Libraries

Live Surgery

Apps for Mobile Devices

Video-Based Review (VBR) and Assessment (VBA)

Video-Based Coaching (VBC)

Telementoring

Video Games

TECHNICAL REQUIREMENTS, TOOLS AND REGULATION

Telestration (Video 28.1)

Recommendations for Online Audiovisual Resources

EVALUATION METHODS SPECIFIC TO VBE

Objective Scales

Self-Assessment

Limitations and New Directions in Objective Assessment

RESULTS TO DATE

DIFFICULTIES FOR ITS INCLUSION IN TRAINING PROGRAMS

LIABILITY AND OTHER MEDICO-LEGAL ASPECTS

FUTURE TRENDS IN NON–FACE-TO-FACE SURGICAL EDUCATION

CHAPTER 29: Deferred Live Surgery

INTRODUCTION

HISTORY

LIVE SURGERY

Preoperative Concerns

Intraoperative Concerns

Postoperative Concerns

Policies on Live Surgical Broadcasting

Synchronized Deferred Live (dLIVE) Surgery

CHAPTER 30: Integrated Operating Room

INTRODUCTION

REVOLUTION OF MIS SURGERY—EMERGENCY OF “ENDOLAPAROSCOPIC” CONCEPT

DEVELOPMENT OF MINIMALLY INVASIVE SUITE

Patient Care

The Surgeon

OT Staff

FUTURE TRENDS OF MIS SUITE

Robotic Surgery

Navigational Surgery With Different Imaging Modalities

Voice Recognition or System

CHAPTER 31: Regenerative Medicine in Surgery

INTRODUCTION

COLORECTAL SURGERY

SOLID ABDOMINAL ORGAN TRANSPLANTATION

INFLAMMATION-DRIVEN PATHOLOGY OF UNKNOWN ETIOLOGY

ORTHOPEDIC SURGERY

PLASTIC SURGERY

LIMITATIONS OF CELL THERAPY

CONCLUSION

CHAPTER 32: Social Media as a Surgical Tool

INTRODUCTION TO SOCIAL MEDIA FOR SURGERY

THE SOCIOLOGIC BASIS OF SOCIAL MEDIA

HOW TO DETERMINE THE BEST PLATFORM FOR YOUR NEEDS

Twitter

Facebook

LinkedIn

Instagram

YouTube

TikTok

Surgical Education Platforms

Other Platforms

CONNECTING AND ENGAGING WITH SURGEONS ON SOCIAL MEDIA

MEASURING SOCIAL MEDIA IMPACT

BENEFITS, RISKS, AND LIMITATIONS OF SOCIAL MEDIA

SOCIAL MEDIA AS A TOOL FOR SURGICAL EDUCATION AND TRAINING

SOCIAL MEDIA FOR SURGICAL RESEARCH

CONCLUSION

CHAPTER 33: Hyperthermic Intraperitoneal Chemotherapy and Pressurized Intraperitoneal Aerosol Chemotherapy

INTRODUCTION

PATHOPHYSIOLOGY

CLINICAL PRESENTATION AND DIAGNOSIS

MULTIMODAL THERAPY, INDICATIONS, AND CONTRAINDICATIONS

Contraindications for HIPEC

Contraindications for PIPAC

Relative Contraindications

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Cytoreductive Surgery

HIPEC

PIPAC

POSTOPERATIVE CARE

COMPLICATIONS AND MANAGEMENT

OUTCOMES

Malignant Peritoneal Mesothelioma

Appendiceal Pseudomyxoma Peritonei

Colorectal

Ovarian, Fallopian Tube, and Primary Peritoneal Cancer

Gastric Cancer

CONCLUSIONS

SECTION III: Endocrine Surgery

Part A: Thyroid

CHAPTER 34: Indications for Surgical Management of Thyroid Disease

INTRODUCTION

DIAGNOSIS/CLINICAL PRESENTATION

Hyperfunctional Diseases

Toxic Multinodular Goiter/Toxic Adenoma

TREATMENT AND PROGNOSIS

Graves Disease

Toxic Multinodular Goiter/Toxic Adenoma

Hashimoto Thyroiditis

Benign Multinodular Goiter

SPECIAL CONSIDERATIONS FOR SUBSTERNAL DISEASE

INTRODUCTION

Well-Differentiated Thyroid Carcinoma (Papillary Thyroid Carcinoma, Follicular Thyroid Carcinoma, and Hurthle Cell Thyroid Carcinoma)

Medullary Thyroid Carcinoma

Anaplastic Thyroid Carcinoma

DIAGNOSIS/CLINICAL PRESENTATION

Well-Differentiated Thyroid Carcinoma (Papillary Thyroid Carcinoma, Follicular Thyroid Carcinoma, and Hurthle Cell Thyroid Carcinoma)

Medullary Thyroid Carcinoma

Anaplastic Thyroid Carcinoma

SURGICAL MANAGMENT

Well-Differentiated Thyroid Carcinoma (Papillary Thyroid Carcinoma, Follicular Thyroid Carcinoma, and Hurthle Cell Thyroid Carcinoma)

Medullary Thyroid Carcinoma

Anaplastic Thyroid Carcinoma

POSTOPERATIVE CARE

Postoperative Hematoma

Hypoparathyroidism

Postoperative Hoarseness

CHAPTER 35: Mastery Keys: Surgical Anatomy of Thyroid Gland and Midline Neck Structures

EXPOSURE

THYROID GLAND

VENOUS DRAINAGE

ARTERIAL SUPPLY

INNERVATION

Lymph Nodes

CHAPTER 36: Open Thyroidectomy

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

CLINICAL PRESENTATION

PLANNING, POSITIONING, AND TOOLS

SURGICAL TECHNIQUE

Incision, Exposure of Thyroid, Including Separation of Strap Muscles and Thyroid and Medialization of the Thyroid Gland

Exposure of the Pyramidal Lobe

Exposure of Superior and Ligation of Superior Pole Vessels

Medialization of the Thyroid, Identification of Parathyroid Glands, and Exposure of Recurrent Laryngeal Nerve

Ligation of the Inferior Thyroid Vessels

Fine Dissection Along the Laryngeal Nerve

Ligation of the Ligament of Berry

Completion and Division of the Isthmus

Hemostasis and Autotransplantation of Parathyroid Glands If Necessary

Closure

Special Cases

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 37: Neck Dissection for Thyroid Cancer

INTRODUCTION

SURGICAL TECHNIQUE

Lateral Neck Dissection

Central Neck Dissection

CONCLUSIONS

CHAPTER 38: Mastery Keys: Surgical Anatomy of Neck Dissection

LYMPHATIC DRAINAGE OF NECK

ANATOMY OF NECK

Superficial Fascia of Neck (Figs. 38.1, 38.2, and 38.3)

Deep Fascia of Neck (Fig. 38.2A)

Triangles of Neck (Fig. 38.2B)

Part B: Parathyroid

CHAPTER 39: Primary Hyperparathyroidism

INTRODUCTION

PATHOPHYSIOLOGY

Resorption of Bone

Reabsorption in the Kidney

Absorption in the Intestine

CLINICAL MANIFESTATIONS

DIAGNOSIS

RESPONSE TO SURGERY

INDICATIONS FOR SURGERY

IMAGING

Thyroid and Parathyroid Ultrasonography

Parathyroid Scintigraphy

4D-CT

MRI, PET, and Invasive Tests

SURGICAL STRATEGY AND PRINCIPLES

Adjuncts

FAILURE AND OTHER SURGICAL RISKS

Cure and Failure

Hypoparathyroidism

Hoarseness/Nerve Injury

Hematoma

Rare Complications

SPECIAL CONSIDERATIONS

Familial Hypocalciuric Hypercalcemia

Familial PHPT

Reoperative Parathyroid Surgery

CHAPTER 40: Mastery Keys: Surgical Anatomy of Parathyroid Glands

SUPERIOR PARATHYROID GLANDS

INFERIOR PARATHYROID GLANDS

CHAPTER 41: Minimally Invasive Parathyroidectomy

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE AND ADJUNCTS

Anesthesia and Patient Positioning

Surgical Approaches

Intraoperative Adjuncts to Identify Parathyroid Tissue

Confirmation of Excision of Hyperfunctional Parathyroid Tissue

CHALLENGING SITUATIONS

Intraoperative Troubleshooting

Failure of Adequate 10-Minute Intraoperative PTH Drop

Conversion to Unilateral or Bilateral Cervical Exploration

Concomitant Thyroid Disease

Reoperative Parathyroidectomy

POSTOPERATIVE CARE

OUTCOMES

CHAPTER 42: Standard Cervical Exploration for Primary Hyperparathyroidism

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Intraoperative Nerve Monitoring

Intraoperative PTH Monitoring

Parathyroid Identification

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 43: Secondary and Tertiary Hyperparathyroidism as a Consequence of End-Stage Renal Disease

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

MULTIMODAL THERAPY/MEDICAL MANAGEMENT

Phosphate Binders

Vitamin D Receptor Activators (VDRAs)

Calcimimetics

INDICATIONS FOR PARATHYROIDECTOMY

Preoperative Planning

SURGICAL TECHNIQUE/EXTENT OF SURGERY

SPECIAL CONSIDERATIONS FOR THE TECHNIQUE OF PARATHYROIDECTOMY IN PATIENTS WITH SHPT AND THPT

POSTOPERATIVE CARE

Complications/Management

Outcomes

CHAPTER 44: Parathyroid Carcinoma

INTRODUCTION

EPIDEMIOLOGY

ETIOLOGY AND PATHOPHYSIOLOGY

Molecular Pathogenesis

Germline Predisposition

DIAGNOSIS/CLINICAL PRESENTATION

Preoperative Suspicion of PC and Clinical Manifestations

Histologic Features and Immunohistochemical Panel

Atypical Presentations

MULTIMODAL THERAPY

Control of Hypercalcemic Crisis

Role of Adjuvant Radiotherapy

Medical Management of Metastatic PC

Role of Immunotherapy and Target Therapy

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

Imaging Assessment

Imaging

Staging (American Joint Committee on Cancer/Union for International Cancer Control)

Other Considerations for Preoperative Preparation

SURGICAL TECHNIQUE

Primary PC Tumor Resection

Lymph Node Dissection: Central and Radical

SPECIAL SURGICAL CONSIDERATIONS

Margins

Intraoperative Parathyroid Hormone Monitoring in PC

Parathyroid Tissue Confirmation

Recurrences and Metastatic Disease

POSTOPERATIVE CARE

Short-Term Follow-Up

Long-Term Follow-Up

OUTCOMES

Prognostics Factors

CONCLUSIONS

Part C: Adrenal

CHAPTER 45: Work Up of Adrenal Masses and Preoperative Management of Functional Adrenal Tumors

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/PRESENTATION

ADRENOCORTICAL CARCINOMA

BIOCHEMICAL EVALUATION

MULTIMODAL THERAPY

IMAGING

TUMOR SIZE

SPECIFIC ADRENAL TUMORS

Aldosteronoma

Cortisol-Producing Adenoma

Pheochromocytoma

Indications and Contraindications

GENETIC COUNSELING

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 46: Minimally Invasive Adrenalectomy (Laparoscopic and Retroperitoneoscopic)

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

General Preparation and Positioning for TLA

SURGICAL TECHNIQUE

Technique for Transabdominal Laparoscopic Adrenalectomy

Additional Technical Considerations During TLA

Surgical Technique for Posterior Retroperitoneal Adrenalectomy

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 47: Mastery Keys: Anatomy of Adrenal Glands

LEFT ADRENAL GLAND (FIGS. 47.4 TO 47.6)

Blood Supply

RIGHT ADRENAL GLAND (FIGS. 47.4 TO 47.6)

Blood Supply

LYMPHATIC DRAINAGE OF LEFT AND RIGHT ADRENAL GLANDS

CHAPTER 48: Robotic Adrenalectomy

INTRODUCTION

SURGICAL TECHNIQUE

Patient Positioning and Set-Up

Right Transabdominal Adrenalectomy

Left Transabdominal Adrenalectomy

SURGICAL TECHNIQUE

Right versus Left Robotic Retroperitoneal Adrenalectomy

COMPARATIVE OUTCOMES BETWEEN ROBOTIC AND LAPAROSCOPIC ADRENALECTOMY

CHAPTER 49: Open Adrenalectomy

INTRODUCTION

DIAGNOSIS/CLINICAL PRESENTATION

Disease-Specific Decision Making

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Open Surgical Approaches to the Adrenal Gland

Open Anterior Transabdominal

Open Flank—Transabdominal and Retroperitoneal

Open Posterior (Lumbotomy)

Thoracoabdominal Approach

Disease-Specific Considerations and Decision for Extent of Adrenalectomy

Bilateral Adrenalectomy

Partial Adrenalectomy

Disease-Specific Intraoperative Considerations

POSTOPERATIVE CARE

Pheochromocytoma

Primary Aldosteronism

Hypercortisolism

Adrenocortical Carcinoma

Bilateral Adrenalectomy

Nelson Syndrome

COMPLICATIONS/MANAGEMENT

Complications Associated With Operative Approach

Intraoperative Complications

Postoperative Complications

ADDITIONAL CONSIDERATIONS

Adrenalectomy in Pregnancy

Adrenalectomy in the Pediatric Population

OUTCOMES

Long-Term Follow-Up

SECTION IV: Breast

CHAPTER 50: Mastery of Benign Disease and Breast Pain

INTRODUCTION

PERCUTANEOUS CORE NEEDLE BIOPSY AND CONCORDANCE

BENIGN BREAST LESIONS—HISTOPATHOLOGY, MANAGEMENT AFTER CORE NEEDLE BIOPSY, AND LONG-TERM RISKS FOR BREAST CANCER DEVELOPMENT

Nonproliferative Disease

FAT NECROSIS

SUMMARY RECOMMENDATIONS FOR NONPROLIFERATIVE LESIONS (Table 50.1)

Proliferative Disease Without Atypia

SUMMARY RECOMMENDATIONS FOR PROLIFERATIVE LESIONS WITHOUT ATYPIA (Table 50.1)

Atypical Lesions (Papillomas, Hyperplasias, Classic Lobular Carcinoma in Situ)

SUMMARY RECOMMENDATIONS FOR ATYPICAL LESIONS (Table 50.1)

Risk Reduction Strategies

Summary of Benign Breast Disease

Breast Pain

CHAPTER 51: Mastery Keys: Surgical Anatomy of Breast

LYMPHATIC DRAINAGE OF BREAST (Fig. 51.2A,B)

BLOOD SUPPLY OF BREAST (Fig. 51.2C)

Arterial Supply

Venous Drainage

NIPPLE–AREOLAR COMPLEX (Fig. 51.1)

INNERVATION

BLOOD SUPPLY OF NIPPLE AREOLAR COMPLEX (Fig. 51.2C)

MALE BREAST

CHAPTER 52: Diagnostic Approach to Breast Abnormalities

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

PATHOPHYSIOLOGY SCREENING

MULTIMODALITY IMAGING

Mammography

Digital Breast Tomosynthesis (DBT)

Contrast-Enhanced Spectral Mammography (CESM)

Breast Ultrasound

Breast MRI

SURGICAL TECHNIQUE

Image-Guided Breast Procedures

POSTOPERATIVE BIOPSY CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 53: Breast-Conserving Therapy

INTRODUCTION

Margins

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Incision Placement

Surgical Dissection

Closure

Breast-Conserving Surgery Following Neoadjuvant Therapy

Oncoplastic Surgery

POSTOPERATIVE CARE

Indications for Re-Excision

Surveillance

COMPLICATIONS

OUTCOMES

Management of Local Recurrence After BCT

SUMMARY

CHAPTER 54: Postoperative Radiation Treatment for Management of Breast Cancer

INTRODUCTION

INDICATIONS

RADIATION PLANNING

RADIATION TECHNIQUES

Whole Breast Irradiation

Indications and Recommendations

PARTIAL BREAST IRRADIATION

Rationale and Background

Accelerated Partial Breast Irradiation

Multicatheter Brachytherapy APBI

Single Entry Device Brachytherapy ABPI

3DCRT and IMRT APBI

Indications and Recommendations

Intraoperative Partial Breast Irradiation

Electron IORT

kV IORT

Indications and Recommendations

Complications

CONCLUSIONS

ACKNOWLEDGMENT

CHAPTER 55: Ablative Techniques for Benign and Malignant Breast Tumors

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

PREABLATION PLANNING

ABLATIVE TECHNIQUES AND OUTCOMES

RADIOFREQUENCY ABLATION

OUTCOMES

CRYOABLATION

OUTCOMES

INTERSTITIAL LASER THERAPY

OUTCOMES

MICROWAVE ABLATION

OUTCOMES

HIGH-INTENSITY FOCUSED ULTRASOUND ABLATION

OUTCOMES

IRREVERSIBLE ELECTROPORATION

OUTCOMES

SUMMARY

CHAPTER 56: Treatment of the Axilla

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

Evaluation

SURGICAL TECHNIQUE

Positioning

Incision Planning

Sentinel Lymph Node Biopsy

Axillary Lymph Node Dissection

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Long-Term Follow-Up

Novel Techniques and Future Directions

Axillary Reverse Mapping

Immediate Lymphatic Reconstruction

De-escalation of Surgery

CHAPTER 57: Mastery Keys: Surgical Anatomy of Axilla and Pectoral Region

AXILLA

REGIONAL FASCIA

Pectoral Fascia (Fig. 57.2A)

Clavipectoral Fascia (Fig. 57.2B)

MUSCLES

Pectoralis Major Muscle (Fig. 57.2A)

Pectoralis Minor Muscle (Figs. 57.1A and 57.3)

Latissimus Dorsi (Figs. 57.1A and 57.4)

Serratus Anterior (Figs. 57.1A, 57.2A, and 57.4)

NERVES

Medial and Lateral Pectoral Nerves (Fig. 57.3)

Long Thoracic Nerve (Figs. 57.1A, 57.3, and 57.4)

Thoracodorsal Nerve (Figs. 57.3 and 57.4)

Intercostobrachial Nerve (Fig. 57.1A)

ARTERIES AND VEINS

Axillary Artery (Figs. 57.3 and 57.4)

Axillary Vein (Figs. 57.1A, 57.3, and 57.5A)

LYMPH NODES (Fig. 57.5)

Groups of Lymph Nodes

CHAPTER 58: Lymphedema—Pathophysiology, Prevention, and Treatment

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Incidence

RISK FACTORS

DIAGNOSING LYMPHEDEMA

STAGING AND EARLY DETECTION

PREVENTION

Prediction

Clinical Trials

Surgery

TREATMENT

Complex Decongestive Therapy

Exercise

Surgery

CHAPTER 59: Simple, Modified, and Radical Mastectomy

INTRODUCTION

INDICATIONS

PREOPERATIVE PLANNING

Preoperative Workup

SURGICAL TECHNIQUE: SIMPLE (TOTAL) MASTECTOMY

Positioning

Incision

Boundaries of Mastectomy

Flap Elevation and Parenchymal Dissection

SURGICAL TECHNIQUE: MODIFIED RADICAL MASTECTOMY

Positioning

Surgical Technique

Axillary Lymph Node Dissection

SURGICAL TECHNIQUE: RADICAL MASTECTOMY

Technique

MARGINS AFTER MASTECTOMY

POSTOPERATIVE MANAGEMENT

Drain Management

Complications

CHAPTER 60: Oncoplastic Techniques for Breast Cancer

INTRODUCTION

CLASSIFICATION OF TECHNIQUES

Volume Replacement Techniques

Volume Replacement Techniques

INDICATIONS/CONTRAINDICATIONS IN THE SELECTION OF PATIENTS

Selection of Patients

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Volume Displacement Techniques: Level I

Volume Displacement Techniques: Level II

Symmetrization

POSTOPERATIVE CARE

Complications/Management

OUTCOMES

Oncologic

Patient Reported Outcomes

TRAINING IN OPS

CONCLUSION

CHAPTER 61: Breast Reconstruction Following Mastectomy

INTRODUCTION

INDICATIONS

PREOPERATIVE PLANNING

Definition of the Mastectomy Deformity

PARTIAL MASTECTOMY/LUMPECTOMY

SURGICAL TECHNIQUES

TISSUE EXPANSION/IMPLANTS

RECONSTRUCTION WITH ACELLULAR DERMAL MATRIX

SURGICAL TECHNIQUE FOR TISSUE EXPANDER/ACELLULAR DERMAL MATRIX

SURGICAL TECHNIQUE OF MYOCUTANEOUS FLAPS

SURGICAL TECHNIQUE OF THE LATISSIMUS FLAP

SURGICAL TECHNIQUE OF THE THORACOEPIGASTRIC FLAP

SURGICAL TECHNIQUE OF THE TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS FLAP

ONCOPLASTIC SURGERY

RECONSTRUCTION WITH FAT GRAFTING

CONTRALATERAL BREAST CONSIDERATIONS

REDUCTION MAMMAPLASTY AND MASTOPEXY SURGICAL TECHNIQUE

NIPPLE RECONSTRUCTION TECHNIQUE

COMPLICATIONS

Reconstruction Postradiation

TIMING OF BREAST RECONSTRUCTION

CONCLUSIONS

CHAPTER 62: Salvage Surgery for Recurrent/Advanced Carcinoma of the Breast

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUES

General Principles

Ipsilateral Breast Tumor Recurrences

Chest Wall Recurrences

Nodal Recurrences

POSTOPERATIVE CARE

COMPLICATIONS

OUTCOMES

CONCLUSION

CHAPTER 63: Clinical Trials and Follow-up in Breast Cancer

INTRODUCTION

BREAST SURGERY

NSABP B-04: Radical Mastectomy versus Total Mastectomy

NSABP B-06: Mastectomy versus Breast-Conserving Surgery (BCS)

MILAN I: Radical mastectomy versus BCT

MARGINS

Margin Guideline Meta-Analysis and Consensus for Invasive and Mixed Cancer Subtypes

SHAVE trial

RADIATION TRIALS

EBCTCG 1081: Meta-Analysis of BCS with and Without RT

NCIC CTG MA.20: Adding Regional Nodal Irradiation to Whole Breast RT

CALGB 9343: Omission of Radiation for cT1 N0, ER+, >70 Years Old

PRIME II: Omission of Radiation for cT1-2 N0 ER +>65 Years Old

Partial Breast RT: TARGIT-A, ELIOT

NONINVASIVE (DCIS) BREAST CANCER

NSABP B-17, B-24, B-35: BCT for Patients with DCIS

EORTC 10853

ECOG-ACRIN E5194

Margin Guideline Meta-Analysis and Consensus for Noninvasive Breast Cancer

Future Directions (COMET, LORIS, LORD): Active Surveillance for Low-Risk DCIS

AXILLARY SURGERY

NSABP B-32: Safety of SLNB

ACOSOG Z0010: Safety of SLNB and Risk Factors for Regional Nodal Recurrences

ALMANAC: SLNB versus ALND on Arm Mobility and Quality of Life

SNAC: SLNB Reduces Arm Morbidity

IBCSG 23.01: Omission of ALND in Patients with Micrometastasis

ACOSOG Z0011: Omission of ALND in Patients with 1 to 2 Positive Nodes After SLNB

EORTC 10981 to 22023 AMAROS: ALND versus RT in Patients with Clinical N0 That are Found to be N+

SENTINA: Timing of SLNB in Relation to Neoadjuvant Chemotherapy

ACOSOG Z1071: SLNB Following NAC in cN+ Patients

Targeted Axillary Dissection (TAD)

SN FNAC: Using Immunohistochemistry (IHC) Reduces FNR

A11202: Noninferiority Trial Comparing RT to Surgery in N+ Patients After NAC

A221702: Axillary Reverse Mapping (ARM) Procedure to Prevent Lymphedema

SentiNot: Preoperative Injection of Superparamagnetic Iron Oxide Particles for Patients with DCIS Who May Benefit From Delayed Axillary Evaluation

SYSTEMIC CONSIDERATIONS

NSABP B-14, NSABP B-21: Introduction of Tamoxifen

TUMOR GENOMICS

Oncotype DX

TAILORx

RxPONDER

CONCLUSION

CHAPTER 64: Management of Breast Cancer in Special Presentations

INTRODUCTION

BREAST CANCER IN PREGNANCY AND LACTATION

BREAST CANCER IN MEN

AXILLARY LYMPHADENOPATHY WITH UNKNOWN PRIMARY

INFLAMMATORY BREAST CANCER

METAPLASTIC BREAST CANCER

PAGET’S DISEASE

BILATERAL BREAST CANCER

BREAST SARCOMA/ANGIOSARCOMA

PHYLLODES TUMORS

CHAPTER 65: Quality Measure and Outcomes in Breast Cancer

INTRODUCTION

THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY (ASCO)

AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT DATABASE PROGRAM

COMMISSION ON CANCER

AMERICAN COLLEGE OF SURGEONS AND COMMISSION ON CANCER OPERATIVE STANDARDS AND SYNOPTIC OPERATIVE REPORTING

CONCLUSION

CHAPTER 66: Molecular Staging and Its Implication in Treating Breast Cancer

INTRODUCTION

STAGING OF BREAST CANCER–DEFINING PROGNOSIS AND TREATMENT

LIMITATIONS OF ANATOMIC BREAST CANCER STAGING

BREAST CANCER AS A FAMILY OF SEPARATE CANCER TYPES

BREAST CANCER SUBTYPES

INCORPORATION OF MOLECULAR/NONANATOMIC FACTORS IN CANCER STAGING

PROGNOSTIC STAGING: THE AJCC APPROACH TO TNM STAGING

OTHER KEY ISSUES WITH PROGNOSTIC STAGING

CONCLUSION AND FUTURE DIRECTIONS

SECTION V: Melanoma and Soft Tissue Tumors

Part A: Cutaneous Lesions

CHAPTER 67: Workup of Suspicious Cutaneous Lesions to Melanoma and Soft Tissue Tumors

INTRODUCTION

DIAGNOSIS/CLINICAL PRESENTATION

Clinical Presentation/History

Physical Exam

Diagnostic Evaluation

Punch Biopsy

Shave Biopsy

Excisional Biopsies

Incisional Biopsy

Fine Needle Aspiration Biopsy (FNAB)

Core Needle Biopsy (CNB)

Next Steps After Tissue Diagnosis

CHAPTER 68: Malignant Melanoma

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

MULTIMODALITY THERAPY—SURGERY

MULTIMODALITY THERAPY—ADJUVANT THERAPY FOR STAGE II AND III MELANOMA

MULTIMODALITY THERAPY—NEOADJUVANT THERAPY FOR STAGE III AND IV MELANOMA

MULTIMODALITY THERAPY—SYSTEMIC THERAPY FOR STAGE III AND IV MELANOMA

MULTIMODALITY THERAPY—REGIONAL CHEMOTHERAPY FOR IN-TRANSIT DISEASE

OUTCOMES AND SPECIAL SITUATIONS

MELANOMA OF UNKNOWN PRIMARY

MELANOMA ARISING IN PREGNANCY

DESMOPLASTIC MELANOMA

HEAD AND NECK MELANOMA INCLUDING LENTIGO MALIGNA

HAND AND FOOT MELANOMA

PEDIATRIC MELANOMA AND ATYPICAL SPITZOID TUMORS

ANAL MELANOMA

CHAPTER 69: Merkel Cell Cancer

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

Staging

MULTIMODAL THERAPY

ADJUVANT AND NEOADJUVANT OPTIONS

Adjuvant Radiation

Immunotherapy

Adjuvant

Neoadjuvant

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Wide Local Excision

Sentinel Lymph Node Biopsy

Therapeutic Lymph Node Dissection

POSTOPERATIVE CARE

OUTCOMES

CHAPTER 70: Cutaneous Squamous Cell Carcinoma

INTRODUCTION

Etiology and Pathophysiology

DIAGNOSIS/CLINICAL PRESENTATION

PREOPERATIVE PLANNING

TREATMENT

Localized Disease

LOCAL TUMOR DESTRUCTION

SURGICAL TECHNIQUE

Conventional Excision and Management of the Nodal Basin

Total Margin-Controlled Excision (TMCE)/Mohs Micrographic Surgery (MMS)

Primary Radiation Therapy (RT)

ADVANCED DISEASE

Management of Regional/Systemic Disease

INDICATIONS/CONTRAINDICATIONS

Surgery

Radiation

Systemic Therapy

POSTOPERATIVE CARE

OUTCOMES

CHAPTER 71: Basal Cell Carcinoma

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

OUTCOMES

Part B: Soft Tissue Sarcomas

CHAPTER 72: Extremity Sarcomas

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

Confirming the Diagnosis

Staging

MULTIMODAL THERAPY

Radiation Therapy for High-Grade Tumors

Preoperative versus Postoperative Radiation

Radiation Therapy for Low-Grade Tumors

Chemotherapy

INDICATIONS/CONTRAINDICATIONS

Surgery

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Surgical Treatment of Locoregional Disease

Surgery After an Unplanned Excision

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Local Recurrence

Metastatic Disease

CHAPTER 73: Retroperitoneal Sarcoma

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Genetic Syndromes

Radiation Exposure

Histology

Specific Sarcoma Histologies and Associated Mutations and Translocations

CLINICAL PRESENTATION/DIAGNOSIS

Presentation

Diagnosis

Staging

MULTIMODAL THERAPY

Neoadjuvant Therapy

Adjuvant Therapy

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

Extent of Resection

Preoperative Optimization

Multidisciplinary Surgical Team

SURGICAL TECHNIQUE

Margin Status

Vascular Resection

POSTOPERATIVE CARE

Acute Postoperative Care

COMPLICATIONS/MANAGEMENT

Complications

Surveillance

OUTCOMES

Survival

Local Recurrence

Distant Recurrence

SUMMARY

Part C: Plastic and Reconstructive Surgery

CHAPTER 74: Plastic and Reconstructive Surgery for Melanoma and Soft Tissue Tumors

INTRODUCTION

HEALING BY SECONDARY INTENT

PRIMARY CLOSURE

SKIN GRAFTS

Split-Thickness Skin Graft

Full-Thickness Skin Graft

SKIN SUBSTITUTES

FLAPS

Local Flaps

Axial Flaps

Perforator Flaps

Regional Flaps

Free Flaps

PREOPERATIVE PLANNING

COMPLICATIONS/MANAGEMENT

OUTCOMES

Part D: Lymph Node Dissections

CHAPTER 75: Management of the Inguinal Lymph Node Basin for Melanoma

INTRODUCTION

SENTINEL LYMPH NODE BIOPSY

COMPLETION INGUINAL LYMPH NODE DISSECTION

THERAPEUTIC LYMPH NODE DISSECTION

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

LONG-TERM FOLLOW-UP

CHAPTER 76: Mastery Keys: Anatomy of Inguinal Lymph Node Dissection

SUPERFICIAL INGUINAL NODES (Fig. 76.1)

DEEP INGUINAL NODES (FIGS. 76.1 AND 76.2B)

Relationships of Lymph Nodes to Surrounding Structures

SECTION VI: CHEST WALL, ESOPHAGEAL CANCER, LUNG, AND MEDIASTINUM

CHAPTER 77: Airway Procedures

INTRODUCTION

BASIC PRINCIPLES

THE SCOPES

Rigid Bronchoscope

Flexible Bronchoscope

Linear Endobronchial Ultrasound (CP-EBUS)

Combination

EQUIPMENT AND TOOLS

Forceps

Brush

Needle

Radial Probe Endobronchial Ultrasound (RP-EBUS)

Airway Balloon

Basket

Bronchial Blocker

Endobronchial Valves

Thermal Airway Treatment

Cryotherapy

Brachytherapy

Phototherapy

AIRWAY PROCEDURES

Airway Stent

Transbronchial Needle Aspiration Guided by Endobronchial Ultrasound (EBUS-TBNA)

Foreign Body Removal

Airway Dilation

Tumor Debulking

EMERGING TECHNOLOGIES

Thin CP-EBUS/Next-Generation CP-EBUS

Navigational Bronchoscopy

Robotic-Assisted Bronchoscopy

CHAPTER 78: Mastery Keys: Bronchoscopic Anatomy of Tracheobronchial Tree

Right Bronchial Tree (Fig. 78.2)

Left Bronchial Tree (Fig. 78.2)

Bronchopulmonary Segments (Fig. 78.2)

CHAPTER 79: Resection and Reconstruction of the Trachea

INTRODUCTION

ETIOLOGY

CLINICAL PRESENTATION

INDICATIONS FOR TRACHEAL SURGERY

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Basic Principles

Anesthesia

Anterior Cervical Approach

Transthoracic Approach

Carinal Resection

Laryngotracheal Resection in Benign Stenosis

Laryngotracheal Resection for Tumor

Tracheoesophageal Fistula

Reoperative Tracheal Surgery

POSTOPERATIVE CARE

COMPLICATIONS OF TRACHEAL RESECTIONS

OUTCOMES

CHAPTER 80: Chest Wall Resection and Reconstruction

INTRODUCTION

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE FOR RESECTION AND RECONSTRUCTION OF THE BONY CHEST WALL

General Considerations

Principles Governing the Use of Prosthetic Materials

Synthetic Materials

Biologic Materials

Technical Details Related to the Location of the Chest Wall Resection

COMPLICATIONS OF BONY CHEST WALL RESECTION AND RECONSTRUCTION AND THEIR MANAGEMENT

SURGICAL TECHNIQUE FOR SOFT TISSUE RECONSTRUCTION

General Principles

Planning of Soft Tissue Reconstruction

Surgical Technique Related to the Location of Chest Wall Reconstruction

COMPLICATIONS OF SOFT TISSUE RECONSTRUCTION AND THEIR MANAGEMENT

OUTCOMES

CHAPTER 81: Mastery Keys: Surgical Anatomy of Chest Wall

SKELETON OF THORACIC WALL (Fig. 81.1)

INTRINSIC MUSCULATURE (Fig. 81.2)

EXTRINSIC MUSCULATURE (FIGS. 81.3 TO 81.5)

NERVES OF THORACIC WALL (Fig. 81.6)

VASCULATURE OF THORAX (FIGS. 81.2, 81.6, AND 81.7)

DIAPHRAGM (Fig. 81.8)

CHAPTER 82: Pulmonary Resection

INTRODUCTION

History of Pulmonary Resection for Lung Cancer

Future of “Minimally Invasive Surgery”

SURGICAL TECHNIQUE

Thoracotomy

Pulmonary Resection Procedures

POSTOPERATIVE CARE AND MANAGEMENT OF COMPLICATIONS

CHAPTER 83: Video-Assisted Thoracic Surgery (VATS) Resection

INTRODUCTION

History

Current Prevalence

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUE

Instrumentation

Anesthesia

Positioning

Port-Site Placement

Procedure

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Disparities in VATS

CHAPTER 84: Mastery Keys: Surgical Anatomy of Lungs

CHAPTER 85: Robotic-Assisted Thoracoscopic Surgery and Resection

INTRODUCTION

Adoption and Learning Curve

Robotic Platform and Instruments

Principles of Robot-Assisted Thoracic Surgery

INDICATIONS

CONTRAINDICATIONS

PREOPERATIVE AND INTRAOPERATIVE PLANNING

Preoperative Planning

Intraoperative Set Up

SURGICAL TECHNIQUE

Robotic Lobectomy

Robotic Segmentectomy

Upper Lobe Segmentectomy

Lower Lobe Segmentectomy

Superior Segmentectomy (S6)

Basilar Segmentectomy (S7–10)

Advanced Lung Cancer Resections: Sleeve Lobectomy and Bronchoplasty/Chest Wall

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

FUTURE DIRECTIONS

CONCLUSION

CHAPTER 86: Open Procedures for Esophagectomy

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Ivor Lewis Esophagogastrectomy

McKeown Esophagogastrectomy

Esophagogastrectomy via Left Thoracoabdominal Incision

Colon Interposition for Esophageal Reconstruction

Additional Procedures for Esophageal Reconstruction

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES AND FOLLOW-UP

CHAPTER 87: Mastery Keys: Surgical Anatomy of Thoracic and Abdominal Esophagus

ARTERIAL SUPPLY (Fig. 87.3)

VENOUS DRAINAGE

LYMPHATIC DRAINAGE (Fig. 87.1B)

INNERVATION (Fig. 87.2B)

CHAPTER 88: Minimally Invasive Esophagectomy

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY OF ESOPHAGEAL CANCER

CLINICAL PRESENTATION AND DIAGNOSIS

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Anesthesia Considerations

Minimally Invasive Ivor Lewis Esophagectomy

Thoracic Phase

Anastomosis

Completion

Minimally Invasive McKeown Esophagectomy

Lymph Node Harvest

Postoperative Care

Complications/Management

Outcomes

CHAPTER 89: Esophageal Cancer: Robotic-Assisted Minimally Invasive Esophagectomy

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Laparoscopy

Thoracoscopy

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Conduit-Airway Fistula

Bleeding

Recurrent Laryngeal Nerve Injury

Paraconduit Hernia

OUTCOMES

Operative Outcomes

Quality of Life Outcomes

Comparison With Other Approaches

Learning Curve

CHAPTER 90: Transhiatal Esophagectomy

INTRODUCTION

PATHOPHYSIOLOGY

INDICATIONS AND CONTRAINDICATIONS

PATIENT SELECTION AND PREOPERATIVE PREPARATION

SURGICAL TECHNIQUE

Abdominal Phase

Cervical Phase

Mediastinal (Transhiatal) Dissection

Cervical Esophagogastric Anastomosis

POSTOPERATIVE CARE

COMPLICATIONS AND THEIR MANAGEMENT

Mediastinal Bleeding

Tracheal Injury

OUTCOMES

CHAPTER 91: The Management of Pleural Disease

ANATOMY

Function of the Pleura

PLEURAL EFFUSION

DIAGNOSIS

Pleural Fluid Analysis

SURGICAL TECHNIQUE

Surgical Pleurodesis Technique

COMPLICATIONS/MANAGEMENT

Re-Expansion Pulmonary Edema

Hepatic Hydrothorax

Chylothorax

Empyema

Hemothorax

PNEUMOTHORAX

PRIMARY SPONTANEOUS PNEUMOTHORAX

Treatment of PSP

SECONDARY SPONTANEOUS PNEUMOTHORAX

Treatment of SSP

TRAUMATIC PNEUMOTHORAX

TENSION PNEUMOTHORAX

Special Circumstances

PLEURAL MESOTHELIOMA

PATHOGENESIS

HISTOLOGY

EPIDEMIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

Physical Examination

Imaging

Diagnosis

TREATMENT

Extrapleural Pneumonectomy

CHAPTER 92: Management of Mediastinal Masses

INTRODUCTION

DIAGNOSIS AND CLINICAL PRESENTATION: GENERAL PRINCIPLES

Imaging

Laboratory Studies

Role for Biopsy

Operative and Anesthetic Considerations

ANTERIOR MEDIASTINAL MASSES

Thymic Epithelial Neoplasms

Germ Cell Tumors

Lymphomas

Thyroid and Endocrine Lesions

Middle Mediastinal Masses

Posterior Mediastinal Masses

CHAPTER 93: Mastery Keys: Surgical Anatomy of Mediastinum (Noncardiac)

SUPERIOR MEDIASTINUM (Fig. 93.2)

GREAT VESSELS (FIGS. 93.2, 93.3 AND 93.6)

Nerves (Figs. 93.3, 93.4, and 93.8)

Trachea (Fig. 93.4)

Esophagus (Fig. 93.2)

ANTERIOR MEDIASTINUM (Fig. 93.1)

Thymus (Fig. 93.3A)

MIDDLE MEDIASTINUM (FIGS. 93.3 AND 93.5)

POSTERIOR MEDIASTINUM

Thoracic Aorta (Figs. 93.2, 93.4, and 93.6)

Esophagus (Figs. 93.2 and 93.6B)

Azygos System of Veins (Figs. 93.6 and 93.7)

Thoracic Duct (Fig. 93.7)

Lymph Nodes of Mediastinum (Fig. 93.8)

Thoracic Sympathetic Trunk (Fig. 93.9)

SECTION VII: BENIGN FOREGUT AND STOMACH

Part A: The Esophagus

CHAPTER 94: Minimally Invasive Antireflux Surgery—Fundoplication

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

Medical

Surgical

INDICATIONS/CONTRAINDICATIONS

A Note on Barrett Esophagus

PREOPERATIVE PLANNING

Anatomic Assessment

Functional Assessment

SURGICAL TECHNIQUE

Basic Tenets of Antireflux Surgery

Choice of Approach

Technical Principles of Fundoplication

Informed Consent

Patient Positioning and Equipment

Abdominal Access and Port Placement

Initial Dissection

Fundoplication

Port Removal and Closure

Minimally Invasive Partial Fundoplication

POSTOPERATIVE CARE

Pain Control

Mobilization

Oral Intake

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 95: Mastery Keys: Anatomy of Diaphragm

CHAPTER 96: Minimally Invasive Paraesophageal Hernia Repair

INTRODUCTION

CLINICAL PRESENTATION

DIAGNOSIS

INDICATION FOR TREATMENT

PRINCIPLES OF REPAIR

SURGICAL ANATOMY

SURGICAL TECHNIQUE

Preparation and Positioning

Incisions and Exposure

Hernia Sac Reduction and Crural Dissection

Assessing Esophageal Length

Crural Closure

Assessing for Tension and Relaxing Incisions

Fundoplication

CONCLUDING THE OPERATION

POSTOPERATIVE MANAGEMENT

OUTCOMES

CHAPTER 97: Endoluminal Therapies for Gastroesophageal Reflux Disease

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

MULTIMODALITY THERAPY

INDICATIONS AND CONTRAINDICATIONS

RADIO FREQUENCY ENERGY APPLICATION TO THE LOWER ESOPHAGEAL SPHINCTER (STRETTA)

SURGICAL TECHNIQUE

POSTOPERATIVE CARE AND COMPLICATIONS

OUTCOMES

TRANSORAL INCISIONLESS FUNDOPLICATION (ESOPHYX)

SURGICAL TECHNIQUE

POSTOPERATIVE CARE AND COMPLICATIONS

OUTCOMES

ANTIREFLUX MUCOSAL INTERVENTIONS

SURGICAL TECHNIQUE

OUTCOMES

SUMMARY

CHAPTER 98: Revisional Operations for Fundoplication Failure

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Step 1. Controlling the Hiatal Contents (Fig. 98.6)

Step 2. Performing the External Hiatal Dissection (Fig. 98.7)

Step 3. Dissecting the Mediastinum and Establishing Intra-Abdominal Esophageal Length (Fig. 98.8)

Step 4. Taking Down the Fundoplication and Restoring the Stomach to Normal Anatomy (Fig. 98.9)

Step 5. Identifying the GE Junction Definitively

Step 6. Closing the Hiatus (Fig. 98.13)

Step 7. Performing an Appropriate Antireflux Procedure (Fig. 98.14)

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Long-Term Follow-Up

CHAPTER 99: Magnetic Sphincter Augmentation for GERD

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS

Erosions

OUTCOMES

CHAPTER 100: Nissen–Rossetti Antireflux Fundoplication (Open Procedure)

INDICATIONS

PREOPERATIVE PLANNING

Preoperative Investigations

SURGICAL TECHNIQUE

Positioning and Instrumentation

Hiatal Dissection

Hiatal Repair

Fundoplication

POSTOPERATIVE CARE

TECHNIQUE FOR LARGE HIATAL HERNIA

ADDITIONAL PROCEDURES

REOPERATIVE SURGERY

COMPLICATIONS

Postfundoplication Side Effects

Failure

OUTCOMES

CONCLUSIONS

ACKNOWLEDGMENT

CHAPTER 101: Modified Hill Repair for Gastroesophageal Reflux

INDICATIONS AND PREOPERATIVE PLANNING

OPEN HILL OPERATION: SURGICAL TECHNIQUE

RESULTS

LAPAROSCOPIC HILL OPERATION: SURGICAL TECHNIQUE

DISCUSSION

ACKNOWLEDGMENT

CHAPTER 102: Minimally Invasive Treatment of Achalasia and Other Esophageal Dysmotility

INTRODUCTION

ETIOLOGY/PHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

HELLER MYOTOMY: INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PREPARATION

SURGICAL TECHNIQUE

Laparoscopic Esophagocardiomyotomy

Robotic-Assisted Laparoscopic Esophagomyotomy

Thoracoscopic Esophagomyotomy

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

OTHER ESOPHAGEAL MOTILITY DISORDERS

Primary Esophageal Motility Disorder

HYPERTENSIVE LOWER ESOPHAGEAL SPHINCTER

CONCLUSION

CHAPTER 103: Peroral Endoscopic Myotomy for Achalasia

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Setup

Diagnostic Endoscopy

Mucosotomy

Submucosal Tunnel Creation

Myotomy

Endoscopic Functional Luminal Imaging Probe

Mucosal Closure

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Symptomatic Outcomes and GERD

POEM as a Revisional Operation

When POEM Is Preferred Over Heller

When Heller Is Preferred Over POEM

CONCLUSION

Part B: The Stomach and Duodenum

CHAPTER 104: Pathology and Treatment of Zenker Diverticulum

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS/PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Positioning

Technique

Postoperative Care

Endoscopic Approaches

Positioning

Technique

COMPLICATIONS

Outcomes

CHAPTER 105: Mastery Keys: Surgical Anatomy of Cervical Esophagus

CHAPTER 106: Percutaneous Endoscopic Gastrostomy

INTRODUCTION

INDICATIONS AND CONTRAINDICATIONS

TECHNIQUE

POTENTIAL COMPLICATIONS

EXPANDED APPLICATIONS OF PEG TECHNIQUE

CONCLUSION

CHAPTER 107: Mastery Keys: Surgical Anatomy of Stomach

VASCULATURE (Fig. 107.4)

Left Gastric Artery

Splenic Artery

Common Hepatic Artery

INNERVATION

Parasympathetic Innervation

Sympathetic Innervation (Fig. 107.6C)

Intramural Plexuses

LYMPHATIC DRAINAGE

CHAPTER 108: Surgical Management of Gastroparesis

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

CLINICAL PRESENTATION/DIAGNOSIS

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUES

PEG Decompression/Feeding Tube

Per-Oral Pyloromyotomy

Pyloroplasty

Gastric Electric Stimulation

Sleeve Gastrectomy

Subtotal/Total Gastrectomy

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Per-Oral Pyloromyotomy

Laparoscopic Pyloroplasty

Implantable Gastric Stimulator

Sleeve Gastrectomy

Sub-Total, Total Gastrectomy

CONCLUSION

CHAPTER 109: Endoscopic Management of Gastroparesis

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Step 1: Submucosal Injection

Step 2: Mucosal Incision

Step 3: Tunneling

Step 4: Division of the Pylorus

Step 5: Closure of the Mucosotomy

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 110: Selective and Nonselective Vagotomies

INTRODUCTION

INDICATIONS

ANATOMY

SURGICAL TECHNIQUE

Preoperative Preparation

Open Truncal Vagotomy

Open Selective Vagotomy and Pyloroplasty

Heineke–Mikulicz Pyloroplasty

Finney Pyloroplasty

Highly Selective Vagotomy Open

Laparoscopic

POSTOPERATIVE CARE

COMPLICATIONS

OUTCOMES

ACKNOWLEDGMENT

CHAPTER 111: Mastery Keys: Surgical Anatomy of Vagus Nerve

NECK (Fig. 111.2)

THORAX

ABDOMEN

CHAPTER 112: Distal Gastrectomy: Open and Minimally Invasive Techniques

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Resection

Reconstruction

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

CHAPTER 113: Gastric Cancer

INTRODUCTION

DIAGNOSIS/CLINICAL PRESENTATION

STAGING

MULTIMODAL THERAPY

PREOPERATIVE PLANNING

SURGICAL CONSIDERATIONS

Extent of Luminal Resection

Extent of Lymph Node Dissection

Extent of Adjacent Organ Resection

Minimally Invasive Approaches

SURGICAL TECHNIQUE

Subtotal or Total Gastrectomy and D2 Lymphadenectomy

Greater Curvature Mobilization

Infrapyloric Mobilization

Suprapyloric Mobilization

Duodenal Transection

D2 Lymphadenectomy

Gastric or Esophageal Transection

RECONSTRUCTION

POSTOPERATIVE CARE

COMPLICATIONS

OUTCOMES

CHAPTER 114: Gastrointestinal Stromal Tumors

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Role for Germline Testing

DIAGNOSIS AND CLINICAL PRESENTATION

STAGING

RISK STRATIFICATION

MULTIMODAL THERAPY

SURGICAL TECHNIQUE

Gastric GIST

Endoscopic Full Thickness Resection (EFTR)

Submucosal Tunneling Endoscopic Resection (STER)

Transgastric Resection of GIST/Laparoendoscopic Cooperative Surgery (LECS)

Duodenal GIST

Jejunal and Ileal GIST

Rectal GIST

Esophageal GIST

Unresectable, Recurrent, and Metastatic Disease

POSTOPERATIVE CARE

Surveillance

Adjuvant Therapy

OUTCOMES

CHAPTER 115: Postgastrectomy Syndromes and Related Bariatric Problems in the Current Era

INTRODUCTION

GENERAL REVIEW OF RELEVANT OPERATIONS

Gastric Resections

Therapeutic Vagotomy

Esophagogastrectomy Procedures

Nonresective Procedures at the Esophagogastric Junction

Bariatric Procedures

Mechanical Disorders

Functional Disorders

Metabolic

CHAPTER 116: Superior Mesenteric Artery Syndrome

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

Differential Diagnosis

MANAGEMENT

SURGICAL TECHNIQUE

Duodenojejunostomy

Division of the Ligament of Treitz

OUTCOMES

Part C: Bariatric and Metabolic Diseases

CHAPTER 117: Diabetes and Other Metabolic Diseases

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

Indications

Contraindications

Preoperative Considerations

SURGICAL TECHNIQUE

Common Surgical Procedures for Obesity and Metabolic Disease

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Safety and Complications of Metabolic Surgery

Mechanisms of Metabolic Change

OUTCOMES

Weight Loss

Diabetes

Dyslipidemia

Cardiovascular Disease

Life Expectancy and Mortality

CONCLUSIONS

CHAPTER 118: Minimally Invasive Roux-en-Y Gastric Bypass

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Jejunojejunostomy

Concomitant Operations

Final Steps

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CONCLUSIONS

CHAPTER 119: Minimally Invasive Vertical Sleeve Gastrectomy

INTRODUCTION

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS AND THEIR MANAGEMENT

OUTCOMES

CHAPTER 120: The Laparoscopic Gastric Band Technique of Placement

INTRODUCTION

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Perioperative Care

Operative Position and Port Placement

Dissection at the Angle of His

Dissection of the Anterior Fat Pad

Dissection on the Lesser Curve

Passing the Lap Band Placer

Selection of Lap Band Size

Positioning, Calibrating, and Closing the Lap Band

Anterior Fixation

Fixation of the Access Port

POSTOPERATIVE CARE

COMPLICATIONS

OUTCOMES

CHAPTER 121: Laparoscopic Biliopancreatic Diversion with Duodenal Switch

INTRODUCTION

History of the Procedure

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Laparoscopic BPD-DS Technique

Laparoscopic SADI-S Technique

Robotic Technique

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

BPD-DS Results

SADI-S Results

BPD-DS as a Revision after Failed Weight Loss

CHAPTER 122: Endoscopic Primary Bariatric Therapies

INTRODUCTION

ENDOLUMINAL SPACE-OCCUPYING DEVICES

Intragastric Balloons

Orbera (Apollo Endosurgery, Austin, TX)

Spatz3 (Spatz FGIA Inc., Fort Lauderdale, FL)

Obalon (ReShape Lifesciences Inc., San Clemente, CA)

ReShape Duo Integrated Dual Balloon System (ReShape Medical Inc, San Clemente, CA)

TransPyloric Shuttle (BAROnova, Goleta, CA)

RESTRICTIVE THERAPY

Endoscopic Sleeve Gastroplasty

Primary Obesity Surgery Endoluminal (POSE)

MALABSORPTIVE THERAPY

AspireAssist (Aspire Bariatrics, King of Prussia, PA)

EndoBarrier Gastrointestinal Liner System (GI Dynamics, Boston, MA)

Revita System (Fractyl Laboratories, Inc., Lexington, MA)

CONCLUSION

CHAPTER 123: Management of Acute Complications of Bariatric Surgery

INTRODUCTION

COMPLICATIONS AFTER SLEEVE GASTRECTOMY

Gastrointestinal Leak

Bleeding

Bowel Obstruction: Stenosis or Twisting

Portomesenteric Vein Thrombosis

COMPLICATIONS AFTER ROUX-EN-Y GASTRIC BYPASS

Gastrointestinal Leak

Bleeding

Bowel Obstruction

Marginal Ulcer

COMPLICATIONS FOLLOWING LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING PROCEDURES

Gastric Prolapse

Band Erosion

CONCLUSION

CHAPTER 124: Revisional Bariatric Surgery

INTRODUCTION

ETIOLOGY/PATHOPHYSIOLOGY

Diagnosis/Clinical Presentation

Preoperative Planning

Revisions and Conversions for Complications

Revisions for Complications of Roux-en-Y Gastric Bypass

Complications of Sleeve Gastrectomy

Revisions for Weight Regain and Weight-Related Comorbid Diseases

POSTOPERATIVE CARE

OUTCOMES

CHAPTER 125: Median Arcuate Ligament Syndrome (MALS)

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

RADIOLOGIC STUDIES

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Laparoscopic Technique (Video 125.1)

Robotic Technique

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Case 1

Case 2

Case 3

Patient Selection

OUTCOMES

SECTION VIII: Colon and Rectal Surgery

Part A: Small Intestine

CHAPTER 126: Clinical Anatomy for Procedures Involving the Small Bowel, Colon, Rectum, and Anus

INTRODUCTION

SMALL BOWEL ANATOMY FOR COLORECTAL PROCEDURES

CECUM AND APPENDIX

ASCENDING COLON

TRANSVERSE COLON

DESCENDING COLON

SIGMOID COLON

BLOOD SUPPLY OF THE COLON

LYMPHOID DRAINAGE AND INNERVATION OF THE COLON

THE URETERS

OMENTUM

RECTUM

ANUS

ANORECTAL BLOOD SUPPLY

LYMPHATIC DRAINAGE OF THE ANORECTUM

INNERVATION OF THE ANORECTUM

Replacement of Organ Function

Obtaining Extra Bowel Length

Buttressing Anastomoses/Repairs

Importance of Anatomical Knowledge in Avoiding Organ Injury

CHAPTER 127: Small Bowel Obstruction after Total Colectomy

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

CLINICAL PRESENTATION

CONSERVATIVE THERAPY

INDICATIONS/CONTRAINDICATIONS

Small Bowel Obstruction within 6 Weeks of a Prior Laparotomy

Small Bowel Obstruction Following a Remote Laparotomy

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Open Lysis of Adhesions

Laparoscopic Approach

Desmoids

Crohn’s Disease

Intra-abdominal Abscesses

Special Scenario of Small Bowel Adherent in the Pelvis after a Prior Pelvic Procedure

Radiation

Malignant Obstruction

Assessing for Ischemic Bowel

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 128: The Continent Ileostomy

INTRODUCTION

HISTORICAL BACKGROUND AND RATIONALE

CURRENT INDICATIONS AND CONTRAINDICATIONS

THE OPERATION

POSTOPERATIVE AND POSTHOSPITALIZATION CARE

RESULTS

REVISIONAL SURGERY

Pouch Malfunction from Valve Failure

Failed Ileoanal Anastomosis Converted to Kock Pouch

POUCHITIS SYNDROME

QUALITY OF LIFE

ACKNOWLEDGMENTS

CHAPTER 129: Technique of Ileostomy Construction and Closure

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

End Ileostomy

Loop Ileostomy

PREOPERATIVE PLANNING

Preoperative Consent

Ostomy Education

Ostomy Marking

SURGICAL TECHNIQUE

End Ileostomy

Loop Ileostomy

End Loop Ileostomy

Divided Loop Ileostomy

Trephine Ileostomy Creation

POSTOPERATIVE CARE

Output Management

Ostomy Care

COMPLICATIONS AND MANAGEMENT

Early Complications

After Discharge or Late Complications

ILEOSTOMY CLOSURE

Technique

Complications

CHAPTER 130: Gastrointestinal-Cutaneous Fistulas

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Surgical

Spontaneous

DIAGNOSIS/CLINICAL PRESENTATION

Clinical Presentation

Diagnostic Testing

MULTIMODAL THERAPY

Source Control

Wound Care

Measurement and Reduction of Fistula Output

Special Medication Considerations in Crohn’s Disease

Nutrition

INDICATIONS/CONTRAINDICATIONS

Likelihood of Nonoperative Closure

PREOPERATIVE PLANNING

Timing

Nutrition

Optimization of Additional Patient Risk Factors

Imaging

Bowel Preparation and Antibiotics

SURGICAL TECHNIQUE

Endoscopic

Surgical

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 131: Surgical Treatment of Small Bowel Crohn Disease

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Pathoetiology

Prevalence

Classification

Natural History

CLINICAL PRESENTATION/DIAGNOSIS

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

Hemorrhage

Intra-Abdominal Sepsis

Obstruction

Enteric Fistulas

Extraintestinal Manifestations

Growth Retardation

Neoplasia

Failed Medical Therapy

Preoperative Planning

SURGICAL TECHNIQUE

Operative Options and Tenets

Resection

Bypass

Strictureplasty

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Short-Term

Long-Term

CONCLUSIONS

CHAPTER 132: Neuroendocrine and Other Tumors

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Appendix

Small Bowel

Colon

Rectum

POSTOPERATIVE CARE

COMPLICATIONS AND MANAGEMENT

OUTCOMES

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Small Intestine

Colon and Rectum

POSTOPERATIVE CARE

COMPLICATIONS AND MANAGEMENT

OUTCOMES

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS AND MANAGEMENT

OUTCOMES

CHAPTER 133: Management of the Patient with Intestinal Failure

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Bowel Interposition

Techniques to Lengthen and Taper Bowel

Intestinal Transplantation

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Part B: Colon, Rectum, Anus

CHAPTER 134: Appendiceal Carcinoma

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS FOR SURGERY

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

MULTIMODALITY THERAPY

OUTCOMES

CHAPTER 135: Large Bowel Obstruction

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

Acute Large Bowel Obstruction

Obstruction due to Colorectal Cancer

Obstruction due to Intussusception

Subacute/Chronic Large Bowel Obstruction

Chronic Obstruction as a Result of Inflammatory Disease

Pseudoobstruction, Oglivie Syndrome

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Technique of Colonic Decompression in Sigmoid Volvulus

Technique of Colon Decompression with Self-Expanding Metallic Stent (SEMS)

The Steps Involved in the TTS Colonic SEMS Placement

On table Colonic Lavage with Segmental Colectomy and Primary Anastomosis

Resection with End Colostomy (Hartmann Procedure)

Loop Colostomy

Loop Ileostomy

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 136: Surgical Treatment of Colonic and Perianal Crohn Disease

INTRODUCTION

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

Surgery

PREOPERATIVE PLANNING

Endoscopic Assessment

Radiologic Assessment

Preoperative Optimization

Surgical Options

POSTOPERATIVE CARE

Postoperative Management

COMPLICATION/MANAGEMENT

OUTCOMES

Recurrence of Crohn Disease after Proctocolectomy

DIAGNOSIS/CLINICAL PRESENTATION

Nonfistulizing Manifestations of Crohn Disease

Fistulizing Manifestations–Perianal Abscess and Fistulas

CONCLUSION

CHAPTER 137: Surgery for Toxic Megacolon in Ulcerative Colitis

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Exploration and Planning

Diversion Procedure (Ileostomy–Colostomy)

Subtotal or Total Colectomy

Proctocolectomy with End Ileostomy/Restorative Procedure

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Wound Infection/Fascial Dehiscence

Intra-Abdominal/Pelvic Abscesses

Stoma Complications

Hemorrhage

OUTCOMES

CHAPTER 138: Total Proctocolectomy and Intersphincteric Proctectomy for Benign Disease

INTRODUCTION

INDICATIONS

Total Proctocolectomy

Total Proctocolectomy with Intersphincteric Proctectomy

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Total Proctocolectomy

Intersphincteric Dissection

POSTOPERATIVE CARE

Complications/Management

CONCLUSION

CHAPTER 139: Ileoanal Pouch Procedure for Ulcerative Colitis and Familial Adenomatous Polyposis

INTRODUCTION

Etiology and Pathophysiology

DIAGNOSIS/CLINICAL PRESENTATION

Inflammatory Bowel Disease

Familial Adenomatous Polyposis

“Other” Conditions

INDICATIONS AND CONTRAINDICATIONS

Fulminant Colitis

Toxic Megacolon

Primary Sclerosing Cholangitis

Incompetent Anal Sphincter

FAP Patients Requiring Whipple

PREOPERATIVE PLANNING

Inflammatory Bowel Disease Elective Versus Urgent

Familial Adenomatous Polyposis

Preoperative Planning in the Setting of Rectal Cancer

SURGICAL TECHNIQUE

Common Techniques to Obtain Small Bowel Mesenteric Length Regardless of Method of Access

Operations for Benign Versus Malignant Disease

Special Considerations for Robotic and Laparoscopic Surgery

POSTOPERATIVE CARE

COMPLICATIONS AND THEIR MANAGEMENT

OUTCOME

CHAPTER 140: Total Colectomy and Ileorectal Anastomosis

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

Inflammatory Bowel Disease

Colonic Neoplasia

Lower Gastrointestinal Hemorrhage

Chronic Constipation and Colonic Inertia

Restoration of Intestinal Continuity Following Subtotal Colectomy

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Open Resection

Laparoscopic Resection

POSTOPERATIVE MANAGEMENT

COMPLICATIONS

OUTCOMES

CHAPTER 141: Surgery for Diverticulitis

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS FOR SURGERY IN UNCOMPLICATED DIVERTICULITIS

Severity of Attacks and Current Symptoms

Risk of Subsequent Attacks of Diverticulitis

Risk of Developing Complicated Diverticulitis

Risk of Developing Free Perforation/Risk of Requiring Emergency Surgery and Stoma After Recovery From an Episode of Uncomplicated Diverticulitis

Young Patients and Diverticulitis

INDICATIONS FOR SURGERY IN COMPLICATED DIVERTICULITIS

Diverticular Fistulas

Diverticular Strictures

Diverticular Abscess

Perforated Diverticulitis With Purulent or Fecal Peritonitis

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Open Sigmoid Colectomy

Laparoscopic Colectomy

Robotic Sigmoid Colectomy

Hartmann Resection

Laparoscopic Lavage

Reoperative Surgery

POSTOPERATIVE CARE

OUTCOMES

Immediate Postoperative Adverse Events

Risk of Persistent Abdominal Symptoms After Resection

Risk of Recurrent Diverticulitis After Resection

CONCLUSIONS

CHAPTER 142: Technique of Colostomy Construction and Closure

INTRODUCTION

INDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Colonic Mobilization

Stoma Aperture

Colon Delivery

End Colostomy Maturation

Alternative Configurations: Loop-End, Blowhole, End-Loop, Diverting Colostomy

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Acute Postoperative Complications

COLOSTOMY CLOSURE

Closure of Diverting Loop Colostomy

End Colostomy Closure

OUTCOMES

CHAPTER 143: Care of Stomas

INTRODUCTION

STOMA ANATOMY AND PHYSIOLOGY

PREOPERATIVE PLANNING

Role of the Wound, Ostomy, and Continence Nurse

Ostomy Siting

POSTOPERATIVE CARE

Ostomy Appliances

Peristomal Skin Care

COMPLICATIONS/MANAGEMENT

Diet, Medications, Lifestyle

Perioperative Care Pathways to Reduce Hospital Readmission

Complications and Management

Stenosis

CONCLUSIONS

PATIENT RESOURCES

CHAPTER 144: Open and Minimally Invasive Right Hemicolectomy for Cancer

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

MULTIMODALITY THERAPY

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Open Right Hemicolectomy

Laparoscopic Right Hemicolectomy

Robotic Right Hemicolectomy

SURGICAL TECHNIQUE: EXTENT OF LYMPHADENECTOMY

POSTOPERATIVE CARE

OUTCOMES

CONCLUSION

COMPLICATIONS

CHAPTER 145: Open and Minimally Invasive Left Hemicolectomy for Neoplasms of the Descending Colon, Sigmoid, and Upper Rectum

INTRODUCTION

DIAGNOSIS/CLINICAL PRESENTATION

Preoperative Staging

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Positioning

Principles of Resection

Lateral to Medial Approach

Medial to Lateral Approach

Splenic Flexure Mobilization

Mesorectal Anterior Excision

Anastomosis and Extraction

Open Considerations

Laparoscopic Considerations

Robotic Considerations

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Anastomotic Leaks

Pulmonary Embolus/DVT

Urinary Retention

Retrograde Ejaculation

Outcomes

CHAPTER 146: Total Mesorectal Excision (TME)

INTRODUCTION

Reflections on the Importance of TME as the Prototype in Principle for All Visceral Cancer Operations

HISTORICAL CONSIDERATIONS

THE RECTAL CANCER WORLD IN 2022

GENERAL CONSIDERATIONS

TOTAL MESORECTAL EXCISION (TME)—AN EMBRYOLOGIC REDEFINITION OF MILES’ “HIGHLY DANGEROUS TISSUES”

PREOPERATIVE IMAGING

CANCER BOARD PLANNING (MULTIDISCIPLINARY TEAM—MDT)

Summary of the Cancer Board (MDT) Sequence

SPECIAL CONSIDERATIONS

Choice of Tissue Block to be Excised—TME or “TME Plus”, “TME Minus”, or Partial Mesorectal Excision (PME) or Local Excision

The Ultra-Low Rectal Cancer

Surveillance or Immediate Surgery After an Excellent Response to Neoadjuvant Therapy

THE SURGERY

BEFORE THE OPERATION IN THE OR

Bimanual Pelvic Examination

Surgical Technique—Principles Applicable to All Methods

The Holy Plane and the Confusions of Intraplanar Fat

Stepwise Detail for All Abdominal Approaches

ANTERIOR AND ANTEROLATERAL DISSECTION—DENONVILLIERS (RECTOGENITAL) SEPTUM

Anterior Dissection in the Female

Dissection of the Most Distal Mesorectum

MANAGEMENT OF THE ANORECTUM DISTAL TO THE CANCER—STAPLING TECHNIQUES—MORAN TRIPLE-STAPLING

Avoidance of a Permanent Colostomy

Colon Pouch or Coloplasty?

STAPLED LOW PELVIC RECONSTRUCTION

Short Colon Pouch or a Side-to-End Anastomosis to Low Rectum or Anal Canal

Transanal Transection and Single Stapling (TTSS)

Pelvic Drainage

AUDIT OF THE EXCISED CANCER SPECIMEN

Open Surgery

Manual Palpation and Inspection—Laparotomy

CONCLUSION

Data

The Basingstoke Experience of Open TME—Total Mesorectal Excision 1978–1997

CHAPTER 147: Transanal Total Mesorectal Excision

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

PROCEDURE-SPECIFIC COMPLICATIONS

Urethral Injury

CO2 Embolism

OUTCOMES

TaTME Training and the Learning Curve

CONCLUSIONS

CHAPTER 148: The Assessment of Patients with Rectal Cancer After Neoadjuvant Therapy: Changing Surgical Paradigms

INTRODUCTION

Baseline Assessment

CLINICAL ASSESSMENT

Digital Rectal Examination

Endoscopic Assessment

Magnetic Resonance Imaging

THERAPY

Pathologic Findings

Neoadjuvant Treatment

Assessment of Tumor Response

Timing

Complete Clinical Response (cCR)

Radiologic Assessment

Near-Complete Clinical Response

FOLLOW-UP

Local Regrowths

Distant Metastases

FUTURE PERSPECTIVES

CHAPTER 149: Open and Minimally Invasive Sphincter- Preserving Radical Resection for Malignant Disease of the Middle and Lower Thirds of the Rectum

INTRODUCTION

ANATOMY

Perirectal Tissue Planes and Spaces

Autonomic Nervous System

Vascular Supply and Lymphatic Drainage

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Colon Mobilization and Division of Blood Supply

Total Mesorectal Excision and Autonomic Nerve Preservation

Transanal TME

Distal Resection

Reconstructive Techniques

Anastomotic Techniques

Immunofluorescence

Hydro-Pneumatic Testing

Diversion

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Anastomotic Leak

OUTCOMES

Oncologic Outcomes

Functional Outcomes

Outcomes of Open versus Minimally Invasive Proctectomy

CHAPTER 150: Abdominoperineal Resection of the Rectum for Rectal Cancer

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

Extent of Resection

Ostomy Marking

Abdominal Dissection–Minimally Invasive versus Open Technique

Perineal Dissection–Prone versus Lithotomy

Perineal Reconstruction Options

Pain Management

SURGICAL TECHNIQUE

Anatomical Relationships and Considerations

Open Abdominal Dissection

Minimally Invasive Abdominal Dissection

Perineal Part: Prone Position

Perineal Part: Lithotomy Position

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 151: The Approach to Reoperative Pelvic Surgery in Rectal Cancer

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE CONSIDERATIONS

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS, MANAGEMENT, AND OUTCOMES

SUMMARY

ACKNOWLEDGMENTS

CHAPTER 152: Sacral Resection for Recurrent Rectal Cancers

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

CLINICAL ASSESSMENT

Tumor Marker—Carcinogenic Embryonic Antigen (CEA)

Computed Tomography

Magnetic Resonance Imaging

Positron Emission Tomography

SURGICAL TECHNIQUE

Classification of Sacrectomy

Sacrectomy: The Abdominopelvic Phase

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 153: Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Cancers of the Appendix and Colon

INTRODUCTION

DIAGNOSIS/CLINICAL PRESENTATION

PREOPERATIVE EVALUATION

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Hyperthermic Intraperitoneal Chemotherapy Administration

Re-Exploration and Definitive Closure

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CONCLUSIONS

CHAPTER 154: Management of Retrorectal Tumors

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Congenital Tumors

Neurogenic Tumors

Osseous Tumors

CLINICAL PRESENTATION AND DIAGNOSIS

MULTIMODAL THERAPY

SURGICAL INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Posterior Approach

Anterior Approach

Combined Anterior and Posterior Approach

POSTOPERATIVE CARE

COMPLICATIONS AND THEIR MANAGEMENT

OUTCOMES

SUMMARY

CHAPTER 155: Rectal Prolapse

INTRODUCTION

ETIOLOGY AND PATHOGENESIS

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUES AND OUTCOMES

Anal Encirclement (Thiersch Procedure)

Mucosal Sleeve Resection (Delorme Procedure)

Perineal Proctosigmoidectomy (Altemeier Procedure)

Sutured Rectopexy

Mesh Rectopexy

Resection Rectopexy

POSTOPERATIVE CARE

COMPLICATIONS

CHAPTER 156: Anorectal Disorders

CLINICAL PRESENTATION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS

TREATMENT: CONSERVATIVE

Nonspecific Medical Therapy

Specific First-Line Therapy: Nitric Oxide Donors or Calcium Channel Blockade

Specific Second-Line Therapy: Botulinum Toxin

SURGICAL TECHNIQUE

Closed Lateral Subcutaneous Internal Sphincterotomy

Open Internal Sphincterotomy

CLINICAL PRESENTATION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS

Conservative Therapy

SURGICAL TECHNIQUE

Drainage of Perianal Abscess

Ischiorectal Abscess

Drainage of Intersphincteric Abscess

Drainage of Supralevator Abscess

Drainage of Submucous Abscess

CLINICAL PRESENTATION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS

SURGICAL TECHNIQUE

COMMON AVAILABLE TREATMENTS

Fistulotomy (Lay Open)

Staged Seton Fistulotomy

Flap Repair: Fistulectomy and Anorectal Advancement Flap

The LIFT Operation

VAFT

Anal Plug

Injectables

CLINICAL PRESENTATION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS

TREATMENT

Conservative Therapy

Outpatient Therapy

Rubber-Band Ligation

Hemorrhoid Artery Ligation

Cautery or Laser Hemorrhoidectomy

Suture Ligation of Hemorrhoids: LigaSure

Harmonic Scalpel Hemorrhoidectomy

Radiofrequency Ablation

Rectoanal Excision and Repair: Mucosectomy

MAJOR RESECTIONAL PROCEDURES

Hemorrhoidectomy

Open Hemorrhoidectomy

Closed Hemorrhoidectomy

COMPLICATIONS OF CONVENTIONAL HEMORRHOIDECTOMY/MANAGEMENT

Stapled Hemorrhoidopexy

CLINICAL PRESENTATION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS

TREATMENT

CLINICAL PRESENTATION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS

SURGICAL TECHNIQUE

Management of Pilonidal Abscess

Elective Treatment of Pilonidal Sinus

Fibrin Glue

CLINICAL PRESENTATION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS

SURGICAL TECHNIQUE

CLINICAL PRESENTATION

Obstetric RVF

ETIOLOGY AND PATHOLPHYSIOLOGY

Forniceal Fistulae

Septal Fistulae

Perineal Fistulae

DIAGNOSIS

SURGICAL TECHNIQUE

Preliminary Fecal Diversion

Definitive Treatment

CLINICAL PRESENTATION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS

CONSERVATIVE THERAPY

SURGICAL TECHNIQUE

Drainage of Pus

Defunction

Selective Treatment

CHAPTER 157: Management of Premalignant and Malignant Neoplasms of the Anal Canal and Perianal Area

INTRODUCTION

ANATOMY

ETIOLOGY AND PATHOPHYSIOLOGY

Nomenclature

Risk Factors

DIAGNOSIS/CLINICAL PRESENTATION

Screening

Anal Cytology

High-Resolution Anoscopy

Pathology

Topical Treatment

Vaccination

Ablative Treatment

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

Workup and Staging

MULTIMODAL THERAPY

OUTCOMES

Recurrent Disease and Salvage Surgical Treatment

PERIANAL PAGET DISEASE

DIAGNOSIS/CLINICAL PRESENTATION

Surgical Treatment

Topical and Nonsurgical Treatment

MELANOMA

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

SURGICAL TREATMENT

ANAL ADENOCARCINOMA

CHAPTER 158: Transanal Excision of Rectal Neoplasms

INTRODUCTION

DIAGNOSIS

INDICATIONS AND CONTRAINDICATIONS

Special Circumstances and Controversies

PREOPERATIVE PLANNING

SURGICAL TECHNIQUES

Parks Transanal Excision

Transanal Endoscopic Microsurgery

Transanal Endoscopic Operation

Transanal Minimally Invasive Surgery (TAMIS)

Robotic TAMIS (R-TAMIS)

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Clinical Outcomes

Functional Outcomes

CHAPTER 159: Functional Bowel Disorders

INCONTINENCE

Clinical Presentation

Etiology and Pathophysiology

Diagnosis

Conservative Treatment

Surgical Technique

RECTAL PROLAPSE

Clinical Presentation

Etiology and Pathophysiology

Diagnosis

Surgical Technique

MEGABOWEL

Clinical Presentation

Etiology and Pathophysiology

Diagnosis

Conservative Therapy

Surgical Treatment

SLOW TRANSIT CONSTIPATION

Clinical Presentation

Etiology and Pathophysiology

Diagnosis

Conservative Treatment

Surgical Treatment

OBSTRUCTIVE DEFECATION SYNDROME

Clinical Presentation

Etiology and Pathophysiology

Diagnosis

Conservative Treatment

Surgical Treatment

VOLUME II

SECTION IX: Biliary Tract, Liver, Pancreas, and Spleen

Part A: The Liver and Biliary Tract

CHAPTER 160: Diagnostic Considerations in Biliary and Liver Disease

DIAGNOSIS/CLINICAL PRESENTATION

BILIARY DISEASE

Gallbladder Pathologies

Biliary Dyskinesia

Acute Calculous Cholecystitis

Acalculous Cholecystitis

Porcelain Gallbladder

Adenomyomatosis of the Gallbladder

Gallbladder Polyps

Gallbladder Cancer

BILIARY OBSTRUCTION

Choledocholithiasis

Cholangitis

Biliary Obstruction Without Gallstones

DIAGNOSTIC APPROACH TO LIVER MASSES

Cystic Lesions

Benign Solid Lesions

Malignant Solid Lesions

LIVER METASTASIS FROM PRIMARY OF ANOTHER ORIGIN

Colorectal Metastasis

Neuroendocrine Metastasis

HEPATOBILIARY DISEASE IN THE PREGNANT PATIENT

CHAPTER 161: Approaches to Drainage of Hepatic, Perihepatic, and Subhepatic Abscesses

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

MULTIMODAL THERAPY

Antibiotic Therapy

Source Control

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

CHAPTER 162: Mastery Keys: Anatomy of Peritoneal Spaces

PERITONEAL REFLECTIONS OF DIAPHRAGM TO LIVER (Fig. 162.1)

SPACES/RECESSES RELATED TO LIVER (FIGS. 162.1 AND 162.2)

OMENTAL BURSA (FIGS. 162.2 AND 162.3)

INFRAMESOCOLIC COMPARTMENT (Fig. 162.2)

FOLDS AND FOSSAE OF PELVIS (Fig. 162.4)

FOLDS AND FOSSAE RELATED TO UMBILICUS

CHAPTER 163: Hepatic Abscess

ETIOLOGY AND PATHOPHYSIOLOGY

Pyogenic Liver Abscess

Amebic Liver Abscess

Cystic Echinococcosis

DIAGNOSIS/CLINICAL PRESENTATION

IMAGING

Pyogenic Hepatic Abscess

Hepatosplenic Candidiasis

Amebic Hepatic Abscess

Cystic Echinococcosis

MULTIMODALITY MANAGEMENT

Antimicrobial Management

INTERVENTIONAL MANAGEMENT

Pyogenic Hepatic Abscess

Hepatosplenic Candidiasis

Entamoeba Hepatic Abscess

Cystic Echinococcosis

CHAPTER 164: Cholecystostomy, Cholecystectomy, and Intraoperative Evaluation of the Biliary Tree

INTRODUCTION

SURGICAL ANATOMY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Open Cholecystectomy

Intraoperative Cholangiogram

Common Bile Duct Exploration

Subtotal Cholecystectomy

Open Cholecystostomy

Additional Procedures

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 165: Mastery Keys: Anatomy of Gallbladder and Extrahepatic Biliary Tract

GALLBLADDER

EXTRAHEPATIC BILIARY TRACT

CHAPTER 166: Laparoscopic Cholecystectomy, Intraoperative Cholangiography, and Common Bile Duct Exploration

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Cholelithiasis

Biliary Colic

Acute Cholecystitis

Biliary Dyskinesia

Choledocholithiasis

Cholangitis

Gallstone Pancreatitis

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

MULTIMODAL THERAPY

PREOPERATIVE PLANNING

Preoperative Testing

Operative Equipment

SURGICAL TECHNIQUE

Anesthesia

Pneumoperitoneum

Trocar Placement

Exposure of the Porta Hepatis

Stripping the Peritoneum

Pedunculation of the Gallbladder

The Critical View of Safety

Control of the Cystic Duct and Cystic Artery

Resection of the Gallbladder

Removal of the Gallbladder

Other Techniques

Other Special Considerations

Additional Operative Considerations

Methods to Delineate Anatomy

Bailout Maneuvers

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Hemorrhage

Stone or Biliary Contamination

Bile Duct Injury

Intraoperative Diagnosis

Postoperative Diagnosis

Common Bile Duct Stones

OUTCOMES

Post-Cholecystectomy Syndrome

Hernia

Future Directions

CHAPTER 167: Reconstruction of the Bile Duct: Anatomic Principles and Surgical Techniques

INTRODUCTION

INDICATIONS AND CONTRAINDICATIONS FOR BILE DUCT RECONSTRUCTION

ANATOMICAL CONSIDERATIONS

DIAGNOSIS/CLINICAL PRESENTATION

Clinical Presentation

Diagnoses

Preoperative Planning for BDR

Cross-Sectional Imaging

Preoperative Patient Preparation

SURGICAL TECHNIQUES

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 168: Current Application of Endoscopic Sphincterotomy, Lateral Choledocoduodenostomy, and Transduodenal Sphincteroplasty

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Anatomy of the Distal Common Bile Duct and Pancreatic Duct

Physiology of the Oddi Sphincter

Pathophysiology

DIAGNOSIS/CLINICAL PRESENTATION

Evaluation of Patients With Biliary-Type Pain

Sphincter of Oddi Dysfunction

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

ERCP and Endoscopic Sphincterotomy

Alternative Procedures

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

INDICATIONS/CONTRAINDICATIONS

TECHNIQUE

Postoperative Care

COMPLICATIONS/MANAGEMENT

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

TECHNIQUE

POSTOPERATIVE MANAGEMENT

COMPLICATIONS/MANAGEMENT

OUTCOMES

ACKNOWLEDGMENT

CHAPTER 169: Primary Sclerosing Cholangitis

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

EPIDEMIOLOGY

DIAGNOSIS

NATURAL HISTORY AND CLINICAL PRESENTATION

Overview

Nonmalignant Complications and Disease Associations

Malignant Complications and Disease Associations

MANAGEMENT

Overview

Medical Management

Role of Endoscopic Retrograde Cholangiopancreatography

PSC-Associated Neoplasia Surveillance

Liver Transplantation

CHAPTER 170: Cholecystojejunostomy and Choledochojejunostomy/Hepaticojejunostomy

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

MULTIMODAL THERAPY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Open Technique

Minimally Invasive Technique

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 171: Operative Treatment of Choledochal Cysts

INTRODUCTION

EPIDEMIOLOGY

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INVESTIGATIONS AND PREOPERATIVE PLANNING

CHOLEDOCHAL MALFORMATIONS CLASSIFICATION

MALIGNANCY RISK

SURGICAL TECHNIQUE

POSTOPERATIVE CARE AND COMPLICATIONS/MANAGEMENT

CHAPTER 172: Hepatic Resection for Primary and Metastatic Tumors

INTRODUCTION

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

Anesthetic Considerations

SURGICAL TECHNIQUE

Patient Positioning, Incision, and Exposure

Parenchymal Transection

Pringle Maneuver

Right Hepatectomy

Anterior Approach

Extended Right Hepatectomy

Left Hepatectomy

Extended Left Hepatectomy

Drainage

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 173: Mastery Keys: Anatomy of Liver

SURFACES AND FISSURES (Fig. 173.1)

RELATIONSHIPS OF LIVER (FIGS. 173.1 AND 173.2)

FUNCTIONAL SUBDIVISIONS AND HEPATIC SEGMENTATION (FIGS. 173.3B TO 173.5)

PORTA HEPATIS (FIGS. 173.1, 173.6 TO 173.8)

Hepatic Artery

Portal Vein

Bile Duct

HEPATIC VEINS (Fig. 173.9)

LYMPHATIC DRAINAGE (Fig. 173.10)

INNERVATION (Fig. 173.11)

CHAPTER 174: High Malignant Biliary Tract Obstruction

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

CLINICAL PRESENTATION

SURGICAL INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

Preoperative Biliary Drainage

Preoperative Portal Embolization

SURGICAL TECHNIQUES

Staging Laparoscopy

Hepatectomy: Rationale and Planning

Hepatectomy: Exposure and Portal Dissection

Hepatectomy: Optimizing the Hepatic Duct Margin, Parenchymal Transection, and Reconstruction

PALLIATIVE PROCEDURES

LIVER TRANSPLANTATION

POSTOPERATIVE CARE

Initial Hospital Course

Complications and their Management

Multimodal Therapy

OUTCOMES

SUMMARY

CHAPTER 175: The Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Approach

INTRODUCTION

PREOPERATIVE PLANNING

Patient Selection and Preoperative Evaluation

Future Liver Remnant Assessment

Surgical Technique

Classic Technique

Surgical Variants of the Classic ALPPS Procedure

PERIOPERATIVE PATIENT MANAGEMENT

OUTCOMES

ALPPS Safety: Morbidity and Mortality

Oncologic Results

CONCLUSIONS

CHAPTER 176: Minimally Invasive Hepatectomy

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Epidemiology

Benign Indications for Minimally Invasive Liver Surgery

Malignant Indications for Minimally Invasive Liver Surgery

Intrahepatic Cholangiocarcinoma

Hilar Cholangiocarcinoma

Colorectal Liver Metastases

MULTIMODAL THERAPY

Minimally Invasive Surgery and Chemoradiotherapy

OUTCOMES

Laparoscopic Advantages

Potential Laparoscopic Disadvantages

INDICATIONS/CONTRAINDICATIONS

Difficulty of Minimally Invasive Hepatectomy

Learning Curve for Minimally Invasive Hepatectomy

PREOPERATIVE PLANNING

Preoperative Considerations

Surgical Planning and Relevant Anatomy

Virtual Hepatectomy

Future Liver Remnant: Goals and Cutoffs

Portal Vein Embolization (PVE)

NONSURGICAL TECHNIQUES

Anesthetic Management

Postoperative Considerations

Bleeding Checklist

SURGICAL TECHNIQUE

Patient Positioning

Port Placement

Initial Evaluation

Inflow Control

Parenchymal Transection

Indocyanine Green (ICG) Utilization in Liver Resection

Vascular and Segmental Identification

Drain Placement

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Unplanned Conversion

Robotic Hepatectomies

CONCLUSION

Part B: The Pancreas

CHAPTER 177: Operative Interventions for Chronic Pancreatitis

ABSTRACT

INTRODUCTION

INITIAL CLINICAL EVALUATION

Etiology and Pathophysiology

PREOPERATIVE PLANNING

Physical Examination

Laboratory Tests

Imaging Studies

INDICATIONS

Anatomic and Morphologic Subtypes of Chronic Pancreatitis

SURGICAL TECHNIQUES

Resection Operations

Drainage Operation

Combined Resection and Drainage Operation

Total Pancreatectomy

COMPLICATIONS/MANAGEMENT

Drainage Operations

Resection and Drainage Operations

Total Pancreatectomy with Islet Autotransplantation

Minimally Invasive Surgery

OUTCOMES

CHAPTER 178: Mastery Keys: Surgical Anatomy of Duodenum and Pancreas

DUODENUM

PANCREAS

Parts of Pancreas

Pancreatic Ducts (Figs. 178.4 and 178.5)

Blood Supply of Duodenum and Pancreas

Lymphatic Drainage (Fig. 178.7A)

Innervation (Fig. 178.7B)

CHAPTER 179: Parenchyma-sparing, Duodenum-Preserving Pancreatic Head Resection for Inflammatory Tumor, Cystic Neoplasm and Neuroendocrine Adenoma of the Pancreatic Head

INTRODUCTION

PANCREATODUODENECTOMY OR DUODENUM-PRESERVING PANCREATIC HEAD RESECTION FOR BENIGN PANCREATIC HEAD TUMORS?

SURGERY-ASSOCIATED METABOLIC LATE MORBIDITY AND POSTOPERATIVE COMPLICATIONS FOLLOWING DPPHR

DUODENUM-PRESERVING SUBTOTAL PANCREATIC HEAD RESECTION FOR INFLAMMATORY TUMORS OF THE PANCREATIC HEAD IN CHRONIC PANCREATITIS

TECHNIQUES OF DPPHR FOR CHRONIC PANCREATITIS

RESULTS AFTER SUBTOTAL DUODENUM-PRESERVING PANCREATIC HEAD RESECTION FOR CHRONIC PANCREATITIS

ADVANTAGES OF DPPHR COMPARED TO PD FOR CHRONIC PANCREATITIS

INDICATION FOR DPPHR FOR BENIGN IPMN, MCN, AND SPN

PREOPERATIVE PLANNING

OUTCOMES

Results after Duodenum-Preserving Subtotal and Total Pancreatic Head Resection for Cystic Neoplasms

Contraindication to the Use of DPPHR

DPPHR for Pancreatic Neuroendocrine Tumors

Tumor Enucleation or DPPHR for PNETs?

Total DPPHR for Periampullary Tumors

CHAPTER 180: Minimally Invasive/Robotic Pancreatectomy

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

PREOPERATIVE PLANNING

Patient Selection

SURGICAL TECHNIQUE

Robotic Distal Pancreatectomy and Splenectomy

Robotic Pancreaticoduodenectomy

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Postoperative

CHAPTER 181: Management of Necrotizing Pancreatitis

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 182: Management of Complications of Acute and Chronic Pancreatitis: Endoscopic, Laparoscopic, and Open Approaches to Pancreatic Pseudocysts and Pancreatic Necrosis

INTRODUCTION

PANCREATIC PSEUDOCYSTS

Indications for Treatment

Procedural Interventions

PANCREATIC NECROSIS

Indications for Treatment

Procedural Interventions

Disconnected Pancreatic Duct Syndrome

Percutaneous Drainage or Dual Modality Drainage

Adverse Events of Endoscopic Drainage Techniques

SURGICAL MANAGEMENT OF PANCREATIC AND PERIPANCREATIC NECROSIS

Preoperative Planning

Surgical Techniques

Postoperative Care

Complications

CHAPTER 183: Pancreaticoduodenectomy and Total Pancreatectomy for Cancer

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

Pretreatment Diagnostic Evaluation and Workup

INDICATIONS/CONTRAINDICATIONS AND MULTIMODAL THERAPY

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Pancreaticoduodenectomy: Open Approach

Vascular Resection and Reconstruction

Management of the Jejunal and Ileal Branches

Important Arterial Anatomy Variations

Reconstruction

Closure

Pancreaticoduodenectomy: Robotic Approach

Total Pancreatectomy

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 184: Splanchnic Denervation of the Pancreas for Intractable Pain

INTRODUCTION

ANATOMY

PAIN MANAGEMENT AND INDICATIONS FOR SPLANCHNIC DENERVATION OF THE PANCREAS

OPERATIVE TECHNIQUES

Open CPN

Bilateral Thoracoscopic Splanchnicectomy

CONCLUSION

ACKNOWLEDGMENT

CHAPTER 185: Pancreatic Neuroendocrine Tumors

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

Symptoms and Diagnosis

Pathologic Diagnosis, Classification, and Grading

MULTIMODAL THERAPY

Systemic Therapy

Liver-Directed Regional Therapy

INDICATIONS FOR SURGERY

PREOPERATIVE PLANNING

Serum Tumor Markers

Preoperative Staging

SURGICAL TECHNIQUE

Surgery for Localized NF-PNET

Minimally Invasive Versus Open Technique

Surgery for Metastatic NF-PNET

Hepatic Resection and Ablation

Transplantation

RELATIVE CONTRAINDICATIONS TO SURGERY

Locally Advanced Disease

Incidental Small (

PNEC and High-Grade (G3) NF-PNET

DIAGNOSIS/CLINICAL PRESENTATION

Gastrinoma

Insulinoma

Rare Functional Endocrine Tumors

SURGICAL TREATMENT OF PNET IN INHERITED SYNDROMES

Multiple Endocrine Neoplasia Type 1 Syndrome

Von Hippel–Lindau Disease

Neurofibromatosis Type 1 (NF-1)

OUTCOMES

SUMMARY

Part C: The Spleen

CHAPTER 186: Benign Disease of the Spleen

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

COMPLICATIONS/MANAGEMENT

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

OUTCOMES

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

OUTCOMES

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUE

COMPLICATIONS

Outcomes

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MEDICAL THERAPIES

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 187: Mastery Keys: Surgical Anatomy of Spleen

VASCULAR SUPPLY

INNERVATION AND LYMPHATIC DRAINAGE

CHAPTER 188: Splenectomy for Hematologic Disease and Malignant Conditions of the Spleen

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

Diagnostic Biopsy for Lymphoma

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 189: Minimally Invasive Splenectomy

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Role in Infection and Immunity

INDICATIONS AND CONTRAINDICATIONS FOR SURGERY

DIAGNOSIS AND CLINICAL PRESENTATION

Benign Hematologic Conditions

Malignant Conditions

MULTIMODAL THERAPY

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Patient Positioning

Multiport Laparoscopic Splenectomy (LS)

Hand-Assisted Laparoscopic Splenectomy (HALS)

Single-Port Access Splenectomy (SPA)

Robotic Splenectomy

POSTOPERATIVE CARE

COMPLICATIONS AND MANAGEMENT

COMPARATIVE OUTCOMES

SECTION X: Solid Organ Transplantation

Part A: General Considerations in Organ Transplantation

CHAPTER 190: Immunosuppression in Organ Transplantation

INTRODUCTION

PHYSIOLOGIC IMMUNITY AND ALLOIMMUNITY

Innate Immunity

Antigen Recognition

T-Cell Production

T-Cell Function and Immune Regulation

Costimulation

B-Cell Maturation and Function

COMPLICATIONS/MANAGEMENT

Rejection

IMMUNOSUPPRESSION

Corticosteroids

Purine Analogs

Calcineurin Inhibitors

Mechanistic Target of Rapamycin Inhibitors

Lymphocyte-Depleting Agents

Costimulation Blockade

Additional Immunomodulating Therapies

OUTCOMES

CHAPTER 191: Multiorgan Donor Recovery

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Positioning

Preparation

Surgery

Liver Recovery

Pancreas Recovery

Kidney Recovery

Vessel Recovery/Closure

Part B: Portal Hypertension

CHAPTER 192: Anatomy of the Portal System and Experience With Portacaval Shunt

INTRODUCTION

DESCRIPTIVE ANATOMY

APPLIED ANATOMY

Portosystemic Shunts

AUTHOR’S EXPERIENCE WITH PORTACAVAL SHUNT

Emergency Portacaval Shunt

Elective Portacaval Shunt

Extrahepatic Portal Hypertension

Budd–Chiari Syndrome

EXPLODING SOME MYTHS

PANCREATICODUODENECTOMY

HEPATIC RESECTION

IMAGING PORTAL ANATOMY

ACKNOWLEDGMENT

CHAPTER 193: Mastery Keys: Surgical Anatomy of Portal Venous System

CHAPTER 194: Endoscopic Therapy in the Management of Esophageal Varices

PORTAL HYPERTENSION

Cause

Natural History

Treatment Principles

MANAGEMENT OF ACUTE VARICEAL BLEEDING

Choice of Therapy

General Strategy

Initial Measures

PHARMACOLOGIC THERAPY

Emergency Endoscopy and Immediate Endoscopic Therapy

FAILED EMERGENCY ENDOSCOPIC THERAPY

BALLOON TUBE TAMPONADE

ESOPHAGEAL STENT PLACEMENT

ALTERNATIVE EMERGENCY MANAGEMENT OPTIONS

LONG-TERM MANAGEMENT

Evaluation of Liver Function

Injection Sclerotherapy

Esophageal Variceal Ligation

ALTERNATIVE LONG-TERM MANAGEMENT OPTIONS

Pharmacologic Therapy

SURGICAL SHUNTS

Devascularization and Transection Operations

Transjugular Intrahepatic Portosystemic Shunt

LIVER TRANSPLANTATION

INJECTION SCLEROTHERAPY

Technical Variants

Elective Sclerotherapy Technique

EMERGENCY SCLEROTHERAPY

Intravariceal Injection

Combined Paravariceal and Intravariceal Injection

COMPLICATIONS

ENDOSCOPIC VARICEAL BAND LIGATION

Single Band Application

Multiband Application

COMPLICATIONS

GASTRIC VARICES

Endoscopic Therapy for Gastric Varices

CONCLUSION

CHAPTER 195: Small-Diameter Prosthetic Interposition Shunt

OPERATIVE INDICATIONS FOR SMALL-DIAMETER PROSTHETIC H-GRAFT PORTACAVAL SHUNTS

SURGICAL TECHNIQUE

ACKNOWLEDGMENT

CHAPTER 196: Distal Splenorenal Shunts: Hemodynamics of Total Versus Selective Shunting

INTRODUCTION

INDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

MODIFICATION OF THE DSRS OPERATION

Temporary Clamping of the Splenic Artery

Renosplenic End-to-Side Shunt

Splenocaval Shunt

POSTOPERATIVE MANAGEMENT

QUESTIONS FREQUENTLY ASKED ABOUT THE SELECTIVE SHUNT

How Effective is the Shunt in Preventing Rebleeding?

What is the Incidence of Shunt Occlusion?

Is There a Role for the Selective Shunt in Patients with Ascites?

What is the Incidence of Encephalopathy After the Selective Shunt?

How Durable is Selectivity of the Selective Shunt?

Is There a Difference in Survival after Selective as Opposed to Total Shunt Operation?

Operative Technique for CSRS

POSTOPERATIVE MANAGEMENT

ACKNOWLEDGMENT

CHAPTER 197: Central Splenorenal Shunts

INTRODUCTION

CENTRAL SPLENORENAL SHUNT

ACKNOWLEDGMENT

CHAPTER 198: TIPS and Other Direct Treatments of Portal Hypertension for Solid Organ Transplantation

INTRODUCTION TO PORTAL HYPERTENSION

COMPLICATIONS OF PORTAL HYPERTENSION

Ascites

Gastrointestinal Bleeding

Other Complications of Portal Hypertension

ABDOMINAL SURGERIES IN PATIENTS WITH PORTAL HYPERTENSION

TIPS PROCEDURE

Indications and Contraindications

Outcomes of TIPS

Preprocedural Planning for TIPS

TIPS Technique

Postprocedural Care After TIPS

Direct Inferior Vena Cava to Portal Vein Shunt (DIPS)

Variceal Embolization Techniques: Balloon-Occluded Retrograde Transvenous Obliteration (BRTO), Plug-Assisted Retrograde Transvenous Obliteration (PARTO), Coil-Assisted Retrograde Transvenous Obliteration (CARTO)

Complications of TIPS

PORTAL VEIN THROMBOSIS, ACUTE AND CHRONIC

Epidemiology

Liver Transplant in PVT

Impact of TIPS and PVT Recanalization on Liver Transplant

SUMMARY

ACKNOWLEDGMENT

Part C: The Liver and Biliary Tract

CHAPTER 199: Complex Hepatic Resection for Primary and Metastatic Tumors

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

ANESTHETIC CONSIDERATIONS

SURGICAL TECHNIQUE

Patient Positioning Incision and Exposure

Hepatic Artery Resection

Portal Vein Reconstruction

Hepatic Vein Reconstruction

IVC Reconstruction

Cold Perfusion Techniques

In Situ Hypothermic Perfusion

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 200: Regional Therapies for Hepatic Malignancies

INTRODUCTION

IMAGE-GUIDED LOCOREGIONAL CANCER THERAPIES

Thermal Ablation

Transarterial Embolization

Transarterial Chemoembolization

Transarterial Radioembolization

BRIDGING TO LIVER TRANSPLANT

Bridging With Thermal Ablation

Bridging With TACE

Bridging With TARE

DOWNSTAGING TO TRANSPLANT

Downstaging With Thermal Ablation

Downstaging With TACE

Downstaging With TARE

CONVERSION TO RESECTION CANDIDACY

DEFINITIVE REGIONAL TREATMENTS FOR PATIENTS UNABLE TO RECEIVE RESECTION OR TRANSPLANTATION

Definitive Treatment With Thermal Ablation

Definitive Treatment With TACE

Definitive Treatment With TARE

CONCLUSION

CHAPTER 201: Management of Hilar Cholangiocarcinoma

INTRODUCTION

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

Preoperative Planning

Portal Vein Embolization

Preoperative Drainage of FLR

MULTIMODAL THERAPY

Role of Neoadjuvant Treatment

SURGICAL TECHNIQUE

Resection

Liver Transplantation

COMPLICATIONS/MANAGEMENT

Inclusion and Exclusion Criteria

Waitlist Management

Technical Considerations

Allograft Selection

Common Complications

OUTCOMES

CHAPTER 202: Liver Transplantation for HCC

INTRODUCTION

EPIDEMIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

Transplant Eligibility

Bridge to Transplant

Transplant Prioritization

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

CONCLUSION

CHAPTER 203: Liver Transplant for Non-HCC Malignancy

INTRODUCTION

Perihilar Cholangiocarcinoma (pCCA)

Hepatoblastoma

Hepatic Epithelioid Hemangioendothelioma

Liver Metastasis from Neuroendocrine Tumors (MNETs)

Colorectal Liver Metastasis

INDICATIONS/CONTRAINDICATIONS

OUTCOMES

CHAPTER 204: Living Donor Liver Transplant

INTRODUCTION

MULTIMODAL THERAPY

Indications/Contraindications

PREOPERATIVE PLANNING

Donor Evaluation

Recipient Evaluation

SURGICAL CONSIDERATIONS

Donor Surgical Considerations

Recipient Surgical Considerations

SURGICAL TECHNIQUE

Donor Surgical Technique

POSTOPERATIVE CARE

Donor Postoperative Care

Recipient Postoperative Care

COMPLICATIONS/MANAGEMENT

Donor Complications

Recipient Complications

OUTCOMES

Donor Outcomes and Long-Term Follow-Up

Recipient Outcomes and Long-Term Follow-Up

CHAPTER 205: Liver Transplant in Children

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

Indications

Contraindications

PREOPERATIVE PLANNING

Waitlist Ranking and Listing

SURGICAL TECHNIQUE

Recipient Operation

Graft Implantation

Reduced-Size and Split Liver Transplantation

POSTOPERATIVE CARE

Immunosuppression

COMPLICATIONS/MANAGEMENT

Rejection

CHAPTER 206: Early and Late Complications of Liver Transplant

INTRODUCTION

SURGICAL COMPLICATIONS

Primary Allograft Nonfunction

Bleeding and Coagulopathy

Vascular Complications

Arterial Complications

Portal Venous Complications

Hepatic Venous Complications

Biliary Complications

Biliary Leaks

Biliary Strictures

MEDICAL COMPLICATIONS

Renal Complications

Immunologic Complications

Malignancy

Infectious Complications

Metabolic Complications

Neurologic and Psychiatric Complications

Recurrent Disease

SUMMARY

Part D: Pancreas

CHAPTER 207: Pancreas Transplantation

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

Indications and Types of Pancreas Transplant

PREOPERATIVE PLANNING

Evaluation of the Recipient

Evaluation of the Donor

SURGICAL TECHNIQUE

Donor Pancreatectomy

BACK TABLE PREPARATION OF THE PANCREAS ALLOGRAFT

Pancreas Allograft Implantation

POSTOPERATIVE CARE

Immunosuppression and Monitoring of Graft Function

COMPLICATIONS AND MANAGEMENT

Vascular Thrombosis

Infectious Complications

Bowel Obstruction

Bleeding

OUTCOMES

CONCLUSION

Part E: Renal

CHAPTER 208: Renal Transplantation: Living Donor and Cadaveric

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

INDICATIONS/CONTRAINDICATIONS

Assessing Risk of Surgery

Assessing Suitability for Arterial and Venous Anastomoses

Bladder Functionality

Risk of Immunosuppression

Psychosocial Considerations

Immunologic Assessment

LIVING DONOR EVALUATION

SURGICAL TECHNIQUE

Allograft Preparation

Standard Retroperitoneal Approach

Special Considerations

SURGICAL TECHNIQUE

Open Living Donor Nephrectomy

Laparoscopic Live Donor Nephrectomy

POSTOPERATIVE CARE

Immunosuppression

Hemodialysis in the Perioperative Setting

Follow-Up

COMPLICATIONS/MANAGEMENT

Role for Biopsies

Technical Complications

OUTCOMES

CHAPTER 209: Peritoneal Dialysis

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

Type of PD Catheters

SURGICAL TECHNIQUE

PD Catheter Insertion Techniques

Catheter Length Selection

Insertion Site and Tunnel Marking

Open Surgical Technique

Laparoscopic Technique

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Early Technical Complications

Other Catheter-Specific Early Complications

Special Considerations

Complications of Peritoneal Dialysis

Use of Peritoneal Dialysis in the Perioperative Setting/Post Kidney Transplantation

Removal of PD Catheter

OUTCOMES

SECTION XI: Abdominal Core Health

Part A: Practical Considerations

CHAPTER 210: Abdominal Core Health—A Holistic Approach to an Old Problem

CHAPTER 211: Optimizing Patients for Abdominal Core Surgery

INTRODUCTION

OBESITY

SMOKING

DIABETES

PREOPERATIVE CHLORHEXEDINE SOAP

BOWEL PREPARATION

LOSS OF DOMAIN ADJUNCTS

BOTULINUM TOXIN

PROGRESSIVE PREOPERATIVE PNEUMOPERITONEUM

CONCLUSIONS

CHAPTER 212: Abdominal Core Rehabilitation

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

MULTIMODAL THERAPY

OUTCOMES

Part B: Optimizing Abdominal Wall Closure and Hernia Prevention to Reduce Abdominal Core Dysfunction

CHAPTER 213: Hernia Prophylaxis of the Midline Abdominal Incision

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Incisional Hernia Formation and Fascial Closure

Suture Material Choice

Interrupted and Continuous Techniques

Needle Selection

Suture Gauge

Knot Selection

Suture Length to Wound Length Ratio

INDICATIONS/CONTRAINDICATIONS

Indications

Contraindications

PREOPERATIVE PLANNING

Identifying the High-Risk Patient for Midline Incisional Hernia Formation

Managing Midline Laparotomies in the High-Risk Patient

SURGICAL TECHNIQUE

Small Bites Technique With a High Suture Length to Wound Length Ratio

Self-Locking Knot Technique

Prophylactic Mesh Augmentation

Retention Sutures

POSTOPERATIVE CARE

Abdominal Binders

Lifting Restrictions

Abdominal Core Health Programs

COMPLICATIONS/MANAGEMENT

Small Bite Technique With a High Suture Length to Wound Length Ratio

Prophylactic Mesh Augmentation

OUTCOMES

Small Bite Technique With a High Suture Length to Wound Length Ratio

Prophylactic Mesh Augmentation

CHAPTER 214: Mastery Keys: Surgical Anatomy of the Anterolateral Abdominal Wall

COMPONENTS OF ANTEROLATERAL ABDOMINAL WALL

INNERVATION

Lateral Cutaneous Branches

Anterior Cutaneous Branches

Arterial Supply

Venous Drainage

Lymphatic Drainage

MUSCLES

External Oblique

Internal Oblique

Transversus Abdominis

Rectus Abdominis

Pyramidalis

CHAPTER 215: Hernia Prophylaxis of Stoma Sites

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Part C: Intrinsic Diseases of the Abdominal Wall

CHAPTER 216: Open Approaches for Ventral Hernia

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

Preoperative Optimization

Imaging and Operative Review

Surgical Adjuncts to Increase Abdominal Space

Mesh Use and Indications

Concurrent Surgeries

PERIOPERATIVE CARE

Infection Prophylaxis

Pain Control

SURGICAL TECHNIQUE: PRIMARY REPAIR

Umbilical and Epigastric Hernias

Primary Umbilical Hernia Repair

Primary Epigastric Hernia Repair

Open Primary Incisional Hernia Repair

SURGICAL TECHNIQUE: MESH-BASED REPAIRS

Mesh Position

Mesh Fixation

Mesh-Based Umbilical and Epigastric Hernia Repair

Open Preperitoneal Repair

Open Intraperitoneal Repair

Open Midline Incisional Hernias

Open Mesh Incisional Hernia Repair

MYOFASCIAL RELEASE TECHNIQUES

External Oblique Release

Rives–Stoppa Retrorectus Release

Transversus Abdominis Release

Off-Midline Hernias

POSTOPERATIVE CARE

Pain Control

Activity

Abdominal Binder

Drain Management

COMPLICATIONS/MANAGEMENT

Seroma and Hematoma

Mesh infection and Erosion

Hernia Recurrence

Respiratory Decompensation

OUTCOMES

Factors Affecting Recurrence After Repair

Long-Term Outcomes

CHAPTER 217: Minimally Invasive Approaches for Ventral Hernia

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS

CONTRAINDICATIONS

Relative Contraindications

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Laparoscopic Intraperitoneal Onlay Mesh

Robotic-Assisted Approaches to Minimally Invasive Ventral Hernia Repair

Robotic IPOM

Robotic-Assisted Single-Dock Rives–Stoppa

Robotic eTEP

Robotic Transversus Abdominis Release (TAR)

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Linea Semilunaris Disruption

Missed Enterotomy

Intraparietal Hernia

OUTCOMES

CHAPTER 218: Complex Situations in Abdominal Wall Reconstruction

CONTAMINATED OPERATIVE FIELD

PARASTOMAL HERNIA

Stoma Reversal

Permanent Stoma

SUMMARY

CHAPTER 219: Diastasis of the Abdominal Wall

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Etiology

Pathophysiology

DIAGNOSIS/CLINICAL PRESENTATION

Patient-Reported Physical Symptoms

Clinical Findings

Radiologic Findings

Self-Report Forms

Concomitant Hernias

MULTIMODAL THERAPY

Abdominal Core Stabilizing Training

Surgery

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

Patient Selection

SURGICAL TECHNIQUE

Open Repairs

Minimally Invasive Repairs

POSTOPERATIVE CARE

Postoperative Drainage

Pain Management

Nutrition

Postoperative Rehabilitation

Abdominal Binder

POSTOPERATIVE COMPLICATIONS

OUTCOMES

ACKNOWLEDGMENTS

CHAPTER 220: Open Approaches With Mesh for Inguinofemoral Hernia

INTRODUCTION

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Lichtenstein–Amid Repair Technique

PLUG AND PATCH TECHNIQUE

PROLENE HERNIA SYSTEM REPAIR

OPEN PREPERITONEAL REPAIRS

TRANSINGUINAL/TRANSRECTUS SHEATH PREPERITONEAL SUBLAY REPAIR (TIPP/TREPP)

TRANSRECTUS SHEATH PREPERITONEAL (TREPP) REPAIR

OUTCOMES

CHAPTER 221: Mastery Keys: Anatomy of Inguinal and Femoral Hernias

HERNIAS

Inguinal Hernias

Femoral Canal and Femoral Hernias

CHAPTER 222: Open Tissue-Based Approaches for Inguinofemoral Hernia

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY OF INGUINAL HERNIA

DIAGNOSIS AND CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Common Steps

Detailed Descriptions

Full Shouldice

SURGICAL TECHNIQUE—PURE TISSUE INGUINAL HERNIA—CRITICAL STEPS

Mobilization of the External Oblique

Nerve Identification and Handling

Role of Neurectomy

Separation and Division of the Cremaster Muscle

High Ligation of the Hernia Sac

Relaxing Incision and Suturing Techniques

POSTOPERATIVE CARE

COMPLICATIONS

After Inguinal Hernia Repair

OUTCOMES

Long-Term Results and Value

ACKNOWLEDGMENT

CHAPTER 223: Minimally Invasive Approaches for Inguinofemoral Hernia

INTRODUCTION

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Totally Extraperitoneal Approach

Transabdominal Pre-Peritoneal Approach

Preperitoneal Anatomy

Critical View of the Myopectineal Orifice

Mesh Placement

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 224: Mastery Keys: Minimally Invasive Inguinal or Femoral Hernia Repair

CHAPTER 225: Athletic Pubalgia and Core Muscle Injury

INTRODUCTION

TERMINOLOGY

ANATOMY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

Pubis-Related

Inguinal-Related

Adductor-Related

Iliopsoas-Related

Hip-Related

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUE AND OUTCOMES

Open Primary Tissue Repair

Open Tension-Free Mesh Repair

Laparoscopic Posterior Mesh Repairs

POSTOPERATIVE MANAGEMENT/REHABILITATION

Part D: Extrinsic Diseases of the Abdominal Wall

CHAPTER 226: Prosthetics, Fixation, and Treatment Related Complications

INTRODUCTION

MESH CONSTRUCTION AND TERMINOLOGY

COMPLICATIONS COMMONLY RELATED TO MESH PLACEMENT

Seroma

Migration

Eventration

Mesh Infection

Chronic Groin Pain After Inguinal Hernia Repair

Chronic Pain after Ventral and Incisional Hernia Repair

Primary Mesh Failure

Secondary Mesh Failure

FIXATION METHODS AND COMPLICATIONS

FUTURE DIRECTIONS

CHAPTER 227: Chronic Inguinal Pain: Treatment and Prevention

INTRODUCTION

ETIOLOGY

Inguinal Neuroanatomy

CLINICAL PRESENTATION AND DIAGNOSIS

Clinical Evaluation of CPIP

Imaging

NONOPERATIVE MANAGEMENT

MULTIMODAL THERAPY

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Open Neurectomy

Open Inguinal Mesh Removal

Minimally Invasive Inguinal Mesh Removal

Laparoscopic Retroperitoneal Triple Neurectomy

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

PREVENTION

CONCLUSION

Part E: Tumors of the Abdominal Wall

CHAPTER 228: Benign Tumors of the Abdominal Wall

INTRODUCTION

ETIOLOGY AND PATHOGENESIS

Benign Histopathologic Tumors

Abdominal Wall Hernia

Infections and Inflammatory Masses

Hematoma

Epidermoid Cyst (Sebaceous Cyst)

Gynecologic Pathology

CLINICAL ASSESSMENT, DIAGNOSTIC EVALUATION, AND TREATMENT

Historical Assessment

Examination

Adjunctive Imaging and Diagnostic Testing

OPERATIVE CONSIDERATIONS

CONCLUSION

CHAPTER 229: Malignant Tumors of the Abdominal Wall

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS TO SURGERY

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CLINICAL CASE

SECTION XII: Vascular Surgery

Part A: Cerebrovascular Disease

CHAPTER 230: Carotid Bifurcation Disease: Carotid Endarterectomy, Transfemoral Stenting, and Transcarotid Artery Revascularization

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Epidemiology

Etiology

Pathophysiology

Risk Factors

CLINICAL PRESENTATION

TIA

Stroke

Amaurosis Fugax

Miscellaneous Circumstances

BEST MEDICAL THERAPY

Antiplatelet Therapy

Antihypertensive Therapy

Statin Therapy

Other Risk Factor Modifications

INDICATIONS AND CONTRAINDICATIONS OF SURGERY AND STENTING

Symptomatic Carotid Artery Disease

Asymptomatic Carotid Artery Disease

Special Circumstances

Timing of Intervention

CEA Versus TFCAS Versus TCAR

PREOPERATIVE PLANNING

History and Physical Examination

Preoperative Assessment

Preoperative Medications

Radiologic Imaging

SURGICAL AND ENDOVASCULAR TECHNIQUES

CEA

TFCAS

TCAR

POSTOPERATIVE CARE

Postoperative Course

Postoperative Surveillance

COMPLICATIONS

Complications of CEA

Complications of TFCAS

Complications of TCAR

Recurrent Carotid Stenosis

OUTCOMES

CEA + BMT Versus BMT Alone

CEA Versus TFCAS

TCAR

CONCLUSIONS

CHAPTER 231: Mastery Keys: Surgical Anatomy of Carotid Arteries

COMMON CAROTID ARTERY AND CAROTID BIFURCATION

SUPERFICIAL STRUCTURES AND SURGICAL EXPOSURE

INTERNAL JUGULAR VEIN (Fig. 231.2)

VAGUS NERVE, CAROTID ARTERIES, AND RELATED STRUCTURES (FIGS. 231.2, 231.3, 231.4B)

INTERNAL CAROTID ARTERY (FIGS. 231.1B, 231.2, 231.3)

EXTERNAL CAROTID ARTERY (FIGS. 231.1B, 231.2, 231.3, 231.4B)

CHAPTER 232: Brachiocephalic Reconstruction: Open and Endovascular

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

CLINICAL PRESENTATION

DIAGNOSIS

PATIENT SELECTION FOR INTERVENTION

OPEN SURGICAL RECONSTRUCTION

MEDIAN STERNOTOMY

EXPOSURE OF BRACHIOCEPHALIC VESSELS

CLAMPING THE AORTA

INNOMINATE ENDARTERECTOMY

BYPASS GRAFTS

DIRECT RECONSTRUCTION OF BRACHIOCEPHALIC ANEURYSM

CAROTID SUBCLAVIAN BYPASS

SUBCLAVIAN ARTERY TRANSPOSITION

ENDOVASCULAR RECONSTRUCTION

LEFT SUBCLAVIAN INTERVENTION

INNOMINATE ARTERY INTERVENTION

LEFT COMMON CAROTID ARTERY INTERVENTION

COMBINED INTERNAL AND COMMON CAROTID DISEASE

POSTOPERATIVE MANAGEMENT

OUTCOMES

Part B: Aneurysm Disease

CHAPTER 233: Open Thoracoabdominal Aortic Aneurysm Repair

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Degenerative

Chronic Aortic Dissection

Connective Tissue Disorders

Less Common Etiologies

CLASSIFICATION AND NATURAL HISTORY

Classification

Natural History

Indications for Intervention

DIAGNOSIS AND CLINICAL PRESENTATION

Clinical Presentation

PREOPERATIVE PLANNING

Diagnostic Imaging

Patient Selection

Preoperative Evaluation

SURGICAL MANAGEMENT

Treatment Options

Perioperative Mechanical Circulatory Support

Spinal Cord Protection

TECHNICAL CONDUCT OF OPERATION

Operating Room Setup

Operative Exposure

Cannulation and Initiation of Cardiopulmonary Bypass

Conduct of Deep Hypothermic Circulatory Arrest and Proximal Reconstruction

Management of Intercostal Arteries

Visceral Reconstruction

Distal Reconstruction

Cardiopulmonary Bypass Termination and Hemostasis

Closure

POSTOPERATIVE CARE

COMPLICATIONS AND MANAGEMENT

Operative Mortality

Spinal Cord Ischemia

Pulmonary Complications

Acute Kidney Injury

Long-Term Outcomes

CHAPTER 234: Mastery Keys: Anatomy of Aorta

THORACIC AORTA

Ascending Aorta (Fig. 234.1)

Arch of Aorta (Figs. 234.1, and 234.2)

Thoracic (Descending) Aorta (Figs. 234.2 to 234.4)

Abdominal Aorta (Figs. 234.5, 234.6 and 234.7)

Iliac Arteries (Figs. 234.5 and 234.6)

CHAPTER 235: Open Infrarenal and Pararenal Aortic Aneurysm Repair

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Transabdominal Approach

Retroperitoneal Approach

POSTOPERATIVE CARE AND COMPLICATIONS

CHAPTER 236: Endovascular Repair of Abdominal Aortic Aneurysm

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS, CLINICAL PRESENTATION, AND MEDICAL MANAGEMENT

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

Imaging

ANATOMIC CONSIDERATIONS

Aortic Neck

Distal Aorta

Access Vessels

Common Iliac Arteries/Distal Seal Zone

SURGICAL TECHNIQUE

Device Selection

Operative Technique

Adjuncts

COMPLICATIONS

POSTOPERATIVE CARE

POSTOPERATIVE SURVEILLANCE

OUTCOMES

CHAPTER 237: Femoral and Popliteal Artery Aneurysms

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

Surgical Therapy and Preoperative Planning

SURGICAL TECHNIQUE

OUTCOMES

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUE/TREATMENT

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUE

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUE/TREATMENT

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUE/TREATMENT

Open Surgical Technique

Endovascular Surgical Approach

OUTCOMES

CHAPTER 238: Mastery Keys: Anatomy of Femoral and Popliteal Arteries

FEMORAL ARTERY

POPLITEAL ARTERY

CHAPTER 239: Treatment of Splenic Artery Aneurysms: Open and Endovascular

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

OPEN SURGICAL TECHNIQUE

ENDOVASCULAR SURGICAL TECHNIQUE

COMPLICATIONS/MANAGEMENT

OUTCOMES AND LONG-TERM FOLLOW-UP

Part C: Chronic Lower Extremity Occlusive Disease

CHAPTER 240: Treatment of Aortoiliac Occlusive Disease: Open Operations

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MEDICAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Aortofemoral Bypass

Retroperitoneal Approach to the Aorta

Femoral–Femoral Bypass

Axillofemoral Bypass

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Long-Term Follow-Up

CHAPTER 241: Aortoiliac Occlusive Disease: Endovascular Including FERIS

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE: ENDOVASCULAR TREATMENT OF ILIAC ARTERY DISEASE

Candidacy for a Percutaneous Endovascular Approach

Positioning

Access

Crossing the Lesion

Treatment of Common Iliac Disease

Isolated Common Iliac Artery Disease

Treatment of External Iliac Artery Disease

Closure Devices

SURGICAL TECHNIQUE: FERIS

Candidacy for FERIS

Positioning

Surgical Incision

Exposure of the Common Femoral Artery

Wire Access

Femoral Endarterectomy

SURGICAL TECHNIQUE: TREATMENT OF INFRARENAL AORTIC OCCLUSIVE DISEASE

Endovascular Treatment of the Infrarenal Aorta

Endologix AFX Device

Other Techniques

SURGICAL TECHNIQUE: ADJUNCTIVE TECHNIQUES

Reentry Devices

Contralateral Femoral Access

Brachial Artery Access

Balloon Inflow Control

POSTOPERATIVE CARE

COMPLICATIONS AND MANAGEMENT

Iliac Artery Rupture

Thrombosis

Hematoma

Wound Infection

OUTCOMES

CHAPTER 242: Peripheral Arterial Occlusive Disease: Open

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

Diagnosis

Clinical Presentation

PREOPERATIVE ASSESSMENT

INDICATIONS/CONTRAINDICATIONS

Indications for Infrainguinal Bypass

PREOPERATIVE PLANNING

Selection of Inflow Artery

Selection of Outflow (Target) Artery

Preoperative Assessment of Vein Quality

Conduit Selection

ANATOMY

Surgical Anatomy of the Femoral, Popliteal, and Tibial Arteries

SURGICAL TECHNIQUE

Operative Technique for GSV, SSV, and Arm Vein Harvest

Construction of a Spliced Vein Bypass

Operative Technique for Femoral to Above-Knee Popliteal Bypass

Operative Technique for Femoral to Below-Knee Popliteal Bypass

Operative Technique for Tibial Bypass

Intraoperative Bypass Graft Assessment

Wound Closure

Alternative Inflow Sources

Intraoperative Troubleshooting and Pitfalls

COMPLICATIONS/MANAGEMENT

Graft Thrombosis

Bleeding

Infection and Lymphatic Leak

POSTOPERATIVE MANAGEMENT

OUTCOMES

In Situ or RSVG

CONCLUSIONS

CHAPTER 243: Endovascular Therapy for Infrainguinal Arterial Occlusive Disease

INTRODUCTION

DIAGNOSIS/CLINICAL PRESENTATION

PREPROCEDURE PLANNING

PROCEDURAL TECHNIQUE

Arterial Access and Diagnostic Imaging

Crossing the Lesion

Intervention

Postprocedure Care

COMPLICATIONS/MANAGEMENT

OUTCOMES

Femoropopliteal Disease Outcomes

Tibial Disease Outcomes

SUMMARY

CHAPTER 244: Major and Minor Lower Extremity Amputation

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

TREATMENT

Multidisciplinary Approach

Avoiding Amputation

Timing of Revascularization in the Setting of Minor Amputation

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

Determination of Amputation Level

SURGICAL TECHNIQUE

Basic Principles

MINOR AMPUTATIONS

Preoperative Considerations

Partial Toe Amputation

Ray Amputation

Transmetatarsal Amputation

MAJOR AMPUTATIONS

Preoperative Considerations

BELOW-KNEE AMPUTATION (OR TRANSTIBIAL AMPUTATION)

Guillotine Amputation

Long Posterior Myocutaneous Flap (Burgess)

Skew Flap Transtibial Amputation

ABOVE-KNEE AMPUTATION

Through-Knee or Knee Disarticulation

Transfemoral Amputation

POSTOPERATIVE MANAGEMENT/COMPLICATIONS

Minor Amputations

Major Amputations

OUTCOMES

ACKNOWLEDGMENT

CHAPTER 245: Mastery Keys: Anatomy of Lower Extremity Amputations

ABOVE-KNEE AMPUTATION (Fig. 245.1)

Below-Knee Amputation (Fig. 245.2)

CHAPTER 246: The Prevention and Treatment of Problems With the Diabetic Foot

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

MANAGEMENT

IMPORTANCE OF PREVENTION

MULTIDISCIPLINARY CARE OF THE DIABETIC FOOT WOUND

SUMMARY

Part D: Acute Lower Extremity Ischemia

CHAPTER 247: Arterial Embolectomy and Lower Extremity Fasciotomy

INTRODUCTION

ETIOLOGY

DIAGNOSIS, PRESENTATION, AND CLASSIFICATION

OPEN VERSUS ENDOVASCULAR THERAPY

PERIOPERATIVE MEDICAL THERAPY FOR ACUTE LIMB ISCHEMIA

SURGICAL TECHNIQUES

Embolectomy Catheter Basics

Surgical Technique for Embolectomy

Surgical Technique for Fasciotomy

Postoperative Care and Complications

CHAPTER 248: Mastery Keys: Anatomy of Fascial Compartments of Lower Extremity

THIGH

Anterior Compartment

Medial (Adductor) Compartment

Posterior Compartment

Leg

ANTERIOR COMPARTMENT

LATERAL COMPARTMENT

POSTERIOR COMPARTMENT

Superficial Posterior Compartment

Deep Posterior Compartment

Part E: Mesenteric and Renal Artery Disease

CHAPTER 249: Renal Artery Occlusive Disease: Open and Endovascular Management

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY: RENOVASCULAR HYPERTENSION

PATHOPHYSIOLOGY: ISCHEMIC NEPHROPATHY

CLINICAL PRESENTATION

Epidemiology

History and Physical Examination

Initial Laboratory Findings

Natural History

PREOPERATIVE PLANNING

Diagnostic Evaluation: Functional Studies

Diagnostic Evaluation: Noninvasive Imaging

Diagnostic Evaluation: Invasive Imaging

SURGICAL TECHNIQUE

Endovascular Repair

Open Repair

RESULTS OF RENAL ARTERY INTERVENTION AND OUTCOMES

CHAPTER 250: Acute Mesenteric Artery Ischemia: Open and Endovascular

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE—OPEN

SURGICAL TECHNIQUE—ENDOVASCULAR

Endovascular Access

Endovascular Diagnostic and Revascularization Techniques

Acute Embolus

Acute Thrombosis in the Setting of Chronic Occlusive Disease

Retrograde Open Mesenteric Stenting

POSTOPERATIVE CARE

COMPLICATIONS AND THEIR MANAGEMENT

OUTCOMES

CHAPTER 251: Mastery Keys: Anatomy of Mesenteric Arteries

CELIAC ARTERY (Fig. 251.1)

SUPERIOR MESENTERIC ARTERY (FIGS. 251.1 to 251.3)

INFERIOR MESENTERIC ARTERY (FIGS. 251.1 and 251.4)

CHAPTER 252: Open and Endovascular Revascularization for Chronic Mesenteric Ischemia

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

CLINICAL PRESENTATION AND DIAGNOSIS

TREATMENT STRATEGIES AND PREOPERATIVE PLANNING

SURGICAL TECHNIQUE: OPEN REVASCULARIZATION

Outcomes, Complications, and Management

SURGICAL TECHNIQUE: ENDOVASCULAR REVASCULARIZATION

SURGICAL TECHNIQUE: HYBRID REVASCULARIZATION

Outcomes, Complications, and Management

SUMMARY

Part F: Venous Disorders

CHAPTER 253: Contemporary Operative Venous Thrombectomy

INTRODUCTION

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

The Technique of Operative Venous Thrombectomy

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 254: Chronic Deep Vein Thrombosis/Postthrombotic Syndrome: Open and Endovascular Treatment

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MEDICAL THERAPY

INDICATIONS FOR ENDOVASCULAR SURGERY

ENDOVASCULAR SURGERY TECHNIQUES AND OPTIONS

IVC FILTER-INDUCED VENOCAVAL OBSTRUCTIVE DISEASE

Surgical Technique

Extra-Abdominal Reconstructions

Intra-Abdominal Reconstructions

Endophlebectomy

Adjunctive Procedures

Postoperative Care

Complications/Management

Outcomes

ACKNOWLEDGMENT

CHAPTER 255: Vena Cava Filter Placement and Removal

INTRODUCTION

INDICATIONS/CONTRAINDICATIONS

Filter Placement

Types of Available Vena Cava Filters

PREOPERATIVE PLANNING

Anatomic Considerations

Duplication of the IVC

Isolated Left-Sided IVC

Circumaortic and Retroaortic Left Renal Veins

Megacava

SURGICAL TECHNIQUE

Standard Fluoroscopy-Guided IVC Filter Placement

Ultrasound-Guided IVC Filter Placement

IVC Filter Retrieval

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Early Complications

Late Complications

OUTCOMES

The Prepic Trials

ACKNOWLEDGMENT

CHAPTER 256: Venous Insufficiency Treatments, Including Medical Management

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

Medical Management/Conservative Measures

INDICATIONS/CONTRAINDICATIONS

Intervention

Preoperative Planning

SURGICAL TECHNIQUE

Treatment of Truncal Veins

Thermal Ablation (Radiofrequency and Laser)

Nontumescent/Nonthermal Ablation

Surgical Therapies

Treatment of Tributary Veins

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Deep Venous Insufficiency

OUTCOMES

Part G: Dialysis Access

CHAPTER 257: Autogenous and Prosthetic Arteriovenous Hemodialysis Access

INTRODUCTION

“Life-Plan”

CLINICAL PRESENTATION AND GENERAL PRINCIPLES

SURGICAL TECHNIQUES

Anesthetic Choice and General Principles

Autogenous Radio-Cephalic Access

Autogenous Radio-Basilic Access

Autogenous Brachio-Cephalic Access

Autogenous Brachio-Basilic Access (Single- and Two-Stage Procedures)

Forearm Loop Prosthetic Access

Brachial Artery or Axillary Artery-to-Axillary Vein Graft

POSTOPERATIVE CARE

COMPLICATIONS AND MANAGEMENT

Hematoma

Thrombosis

Infection

Edema and CVOD

(Pseudo)Aneurysm

Neuropathic Pain Syndromes, IMN, ARHI

OUTCOMES

CHAPTER 258: Mastery Keys: Vascular Anatomy of Upper Extremity

RADIAL ARTERY

BRACHIAL ARTERY

ARTERIOVENOUS FISTULA

Part H: Thoracic

CHAPTER 259: Thoracic Outlet Syndrome

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

Neurogenic TOS

Arterial TOS

Venous TOS—Paget–Schroetter Syndrome

MULTIMODAL THERAPY

Neurogenic TOS

Arterial TOS

Venous TOS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Supra/Infraclavicular

Transaxillary

POSTOPERATIVE MANAGEMENT

COMPLICATIONS

Neuropraxia and Brachial Plexus Injury

Lymphatic Leak

Bleeding

Pneumothorax

OUTCOMES

CHAPTER 260: Mastery Keys: Anatomy of the Thoracic Outlet

CHAPTER 261: Blunt Thoracic Aortic Injury (BTAI)

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

BTAI CLASSIFICATION

INITIAL MANAGEMENT

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Part I: Trauma

CHAPTER 262: Vascular Injuries to the Neck, Including the Subclavian Vessels

INTRODUCTION

HISTORICAL PERSPECTIVE

GENERAL APPROACH—ANATOMIC ZONES

ETIOLOGY/EPIDEMIOLOGY

MANAGEMENT

Operating Room Setup/Hybrid Setup

ZONE I

ZONE II

ZONE III

Blunt Vascular Injury

VERTEBRAL ARTERY TRAUMA

SUMMARY

CHAPTER 263: Injury to the Abdomen: Open and Endovascular

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Mechanism

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Open Surgical Management

Injuries in the Porta Hepatis

Endovascular

Angioembolization

Stent-Grafting

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT/OUTCOMES

CHAPTER 264: Injury to the Extremities: Open and Endovascular Management

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

EPIDEMIOLOGY, AMPUTATION, AND MORTALITY

Civilian

Military

PEDIATRIC INJURY

INDICATIONS FOR INTERVENTION

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

General Operative Topics

TEMPORARY VASCULAR SHUNTING (TVS)

Conduit Selection

Arterial Repair

Vein Repair

Fasciotomy

Wound Management

Upper Extremity

Lower Extremity

Endovascular Treatment

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Long-Term Follow-Up

SECTION XIII: Trauma, Burn, and Acute Care Surgery

CHAPTER 265: Initial Assessment and Airway Management

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

INITIAL ASSESSMENT

Trauma Team

Prehospital Handoff

Primary Survey

Airway

Breathing

Circulation

Disability

Exposure

Monitoring

Primary Survey Adjuncts

Secondary Survey

Additional Diagnostic Studies

Resuscitative Emergency Department Thoracotomy

AIRWAY MANAGEMENT

Airway Anatomy

Airway Assessment

Definitive Airway Measures

Emergency Surgical Airway

OUTCOMES

CHAPTER 266: Focused Assessment with Sonography in Trauma (FAST)

INTRODUCTION

HISTORICAL PERSPECTIVES

TECHNICAL CONSIDERATIONS

Physics of Ultrasound

Transducer Types

COMPLETING THE EXAM

Right Upper Quadrant View

Pericardial View

Left Upper Quadrant View

Pelvic

Incorporation of Extended FAST

CLINICAL APPLICATION

ADDITIONAL CONSIDERATIONS, PEARLS, AND PITFALLS

FUTURE DIRECTIONS

OUTCOMES

CHAPTER 267: Management of Neck Injuries

INTRODUCTION

ANATOMY

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

ETIOLOGY/PATHOPHYSIOLOGY

INJURY GRADING

MANAGEMENT

DIAGNOSIS/CLINICAL PRESENTATION

MANAGEMENT

DIAGNOSIS/CLINICAL PRESENTATION

MANAGEMENT

INTRODUCTION

The “No-Zone” Approach

DIAGNOSIS/CLINICAL PRESENTATION

Airway and Breathing

Circulation

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Management of Zone I Injury

Management of Vascular Injury

Management of Penetrating Laryngotracheal Injuries

Management of Penetrating Pharyngoesophageal Injury

SUMMARY

CHAPTER 268: Mastery Keys: Surgical Anatomy of Lateral Neck Exploration for Trauma

EXPOSURE

EXPLORATION OF VASCULAR STRUCTURES

EXPLORATION OF MIDLINE STRUCTURES

ADDITIONAL EXPOSURE OF THORACIC INLET

CHAPTER 269: Neurosurgical Emergencies

INTRODUCTION

Etiology and Pathophysiology

DEFINITION

PATHOGENESIS AND PATHOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

IMAGING STUDIES

COMPLICATIONS/MANAGEMENT

Primary and Secondary Survey

Patients with GCS Score 3–8

Intracranial Pressure, Cerebral Perfusion Pressure, and Pressure Reactivity Index

Patients with Diffuse Axonal Injury

Patients with Brain Contusion

Craniotomy or Decompressive Craniectomies for Hematomas or Diffuse Axonal Injuries

Acute on Chronic SDH

Surgical Management of CSF Fistulas

OUTCOMES

Patients With Penetrating Brain Injury

INTRODUCTION

PATHOGENESIS AND PATHOLOGY

DIAGNOSIS, CLINICAL PRESENTATION

IMAGING STUDIES

COMPLICATIONS/MANAGEMENT

OUTCOMES

Prognosis

CHAPTER 270: Thoracic Trauma and Injury to the Diaphragm

INTRODUCTION

INITIAL EVALUATION

RESUSCITATIVE THORACOTOMY

Indications/Contraindications

Surgical Technique

SECONDARY EVALUATION, DIAGNOSIS, AND CLINICAL PRESENTATION

Indications for Urgent Intervention in Thoracic Trauma

Surgical Technique: Incisions and Approaches

RIB FRACTURES

Clinical Presentation and Diagnosis

Treatment

STERNAL FRACTURES

PULMONARY INJURIES

LACERATIONS

Operative Indications and Approach

Treatment

CONTUSIONS

Clinical Presentation and Diagnosis

Treatment

CLINICAL PRESENTATION OF PENETRATING AND BLUNT CARDIAC INJURY

OPERATIVE APPROACHES

TREATMENT

MYOCARDIAL CONTUSION: DIAGNOSIS AND TREATMENT

CLINICAL PRESENTATION AND DIAGNOSIS

OPERATIVE PLANNING, APPROACHES, AND TREATMENT

CLINICAL PRESENTATION AND DIAGNOSIS

Operative Approach

Treatment

CLINICAL PRESENTATION AND DIAGNOSIS

OPERATIVE APPROACH

TREATMENT

CLINICAL PRESENTATION AND DIAGNOSIS

TREATMENT

POSTOPERATIVE MANAGEMENT

ANATOMY

ETIOLOGY AND PATHOPHYSIOLOGY

CLINICAL PRESENTATION AND DIAGNOSIS

OPERATIVE INDICATIONS, PLANNING, AND TREATMENT

OPERATIVE TREATMENT

Laparotomy

Laparoscopy

Thoracoscopy (VATS)

Thoracotomy

POSTOPERATIVE CARE AND COMPLICATIONS

CONCLUSION

CHAPTER 271: Retained Hemothorax, Pleural Effusion and Traumatic Empyema

DEFINITION

DIAGNOSIS/CLINICAL PRESENTATION

Plain Radiography

Computed Tomography

Ultrasonography

MULTIMODAL THERAPY

Standardized Approach

DIAGNOSIS/CLINICAL PRESENTATION

Plain Radiography

Ultrasonography

Computed Tomography

MULTIMODAL THERAPY

Antibiotic Therapy

Pleural Drainage

Fibrinolytics

PERIPROCEDURAL MANAGEMENT AND TECHNIQUE

POSTOPERATIVE CONSIDERATIONS

COMPLICATIONS

Inadequate Drainage or Recurrence

Persistent Air Leak

Trapped Lung

CONCLUSION

CHAPTER 272: Management of Cardiac Injuries

INTRODUCTION

ETIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

OPERATIVE MANAGEMENT AND NONOPERATIVE THERAPY

Preoperative Planning

SURGICAL TECHNIQUES

Pericardial Window

Positive Pericardial Window and Management with Pericardial Drain Only

Decision on Incision—Thoracotomy versus Sternotomy

VENTRICULAR INJURIES

ATRIAL INJURIES

CORONARY ARTERIES

INTRA- AND POSTOPERATIVE CARE

Resuscitation

Postoperative Management

Complications

Outcomes

CHAPTER 273: Mastery Keys: Surgical Anatomy of Median Sternotomy and Heart

MEDIAN STERNOTOMY

HEART

External Anatomy (Figs. 273.1 to 273.4)

Blood Supply (Figs. 273.3A, 273.4 to 273.6)

CHAPTER 274: Damage Control Laparotomy

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSTICS/CLINICAL PRESENTATION

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE OF DAMAGE CONTROL LAPAROTOMY

Resuscitation in the ICU

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 275: Treatment of Major Hepatic and Splenic Trauma

INTRODUCTION

OPERATIVE ANATOMY

Liver and Biliary Tree

Spleen

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

NONOPERATIVE MANAGEMENT OF IPSO INJURIES

OPERATIVE MANAGEMENT OF IPSO INJURIES

Operative Preparations

DEFINITIVE OPERATIVE TECHNIQUES

Liver

Hemostasis of Hepatic Injuries

Spleen

ENDOVASCULAR MANAGEMENT OF IPSO INJURIES

Spleen

COMPLICATIONS AND MANAGEMENT

Hemorrhage

Abscess

Splenic Necrosis

Hepatic Necrosis

Hemobilia

Biloma, Biliary Fistula, Bile Leak, Bile Peritonitis

Hepatic Arteriovenous Fistula Formation

POSTOPERATIVE CARE AND FOLLOW-UP

CHAPTER 276: Abdominal Vascular Injury and Use of REBOA

INTRODUCTION

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

PREOPERATIVE PLANNING

INDICATIONS AND CONTRAINDICATIONS FOR REBOA USE

Zone 1 REBOA

Zone 3 REBOA

Zone 2 REBOA

SURGICAL TECHNIQUE

First Step: Get Access

Open Cut-Down Technique

Placement of Balloon

Determining Definitive Control of Hemorrhage

Deflation of Balloon Occlusion

Partial REBOA

POSTOPERATIVE CARE

COMPLICATIONS

OUTCOMES AFTER REBOA

CONCLUSIONS

CHAPTER 277: Duodenal and Pancreatic Trauma

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

Classification of Injury—American Association for the Surgery of Trauma (AAST) Duodenum Organ Injury Scale (OIS)

SURGICAL TECHNIQUE

Exposure of the Duodenum

Factors in Repair

Nonoperative Management of Organ Injury Scale Grade I Duodenal Hematoma

Management of Organ Injury Scale Grades II, III, and Selected Grade IV Injuries (Table 277.2)

Adjunctive Procedures for Selected Patients Undergoing Duodenal Repair

Management of Organ Injury Scale Grade IV Injury Involving the Ampulla or Distal Common Bile Duct and Grade V Injury (Table 277.2)

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTINODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

Classification of Injury—American Association for the Surgery of Trauma Pancreas Organ Injury Scale

SURGICAL TECHNIQUE

Exposure of the Pancreas

Factors in Repair

Nonoperative Management of Organ Injury Scale Grade I, II, and Select Grade III Injuries

Management of Organ Injury Scale Grades I and II Injuries Found Incidentally at Laparotomy (Table 277.5)

Management of Organ Injury Scale Grade III Injury (Table 277.5)

Management of Organ Injury Scale Grade IV Injury (Table 277.5)

Management of Organ Injury Scale Grade V Injury (Table 277.5)

SUMMARY OF OPERATIVE MANAGEMENT FOR PANCREATIC INJURIES

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

COMBINED PANCREATODUODENAL INJURIES

Complications/Mortality

CHAPTER 278: Abdominal Compartment Syndrome and Management of the Open Abdomen

INTRODUCTION

ETIOLOGY AND DIAGNOSIS

MANAGEMENT

INDICATIONS

TEMPORARY ABDOMINAL CLOSURE

POSTOPERATIVE CARE IN THE OPEN ABDOMEN

CLOSURE TECHNIQUES

STAGE 1: ATTEMPTED DELAYED PRIMARY CLOSURE

STAGE 2: STAGED SPLIT-THICKNESS SKIN GRAFTING

COMPLICATIONS (OPEN ABDOMEN)

STAGE 3: DEFINITIVE ABDOMINAL WALL RECONSTRUCTION

OPERATIVE TECHNIQUE: MODIFIED COMPONENTS SEPARATION

Step 1: Skin Graft Removal

Step 2: Full-Thickness Skin-Flap Creation

Step 3: External Oblique Component of Anterior Rectus Fascia Release

Step 4: Posterior Rectus-Sheath Dissection

Step 5: The Memphis Modification—Internal Oblique Component of Anterior Rectus-Fascia Release

Step 6: Anterior Fascia and Muscle Translocation

Step 7: Midline Closure

POSTOPERATIVE CARE (ABDOMINAL WALL RECONSTRUCTION)

COMPLICATIONS (ABDOMINAL WALL RECONSTRUCTION)

OUTCOMES

SUMMARY

CHAPTER 279: Pelvic Fractures and Retroperitoneal Hematoma

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Anatomy

Injury Classification

DIAGNOSIS/CLINICAL PRESENTATION

Primary and Secondary Survey

Imaging Adjuncts

Management of Concomitant Injuries

Additional Considerations in Special Populations

MULTIMODAL THERAPY

Temporary Hemostasis

Definitive Hemostasis

SURGICAL TECHNIQUE

Preperitoneal Packing

Open Vascular Control

External Fixation

Approach to Retroperitoneal Injuries

Management of Urologic Injuries

Definitive Pelvic Fixation

Anterior–Posterior Compression Injuries

Lateral Compression Injuries

Open Pelvic Fractures

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Pelvic Sepsis

Venous Thromboembolism

Fat Embolism Syndrome

OUTCOMES

CHAPTER 280: Genitourinary Tract Trauma

INTRODUCTION

RENAL TRAUMA

Staging of Renal Injuries

Radiographic Staging

INDICATIONS FOR SURGICAL EXPLORATION

PARENCHYMAL INJURY

VASCULAR INJURY

RENAL EXPLORATION AND RECONSTRUCTION

Proximal Vascular Control

Principles of Reconstruction

Specific Techniques

VASCULAR INJURY AND REPAIR

POSTOPERATIVE CARE AND COMPLICATIONS

USE OF INTERVENTIONAL RADIOLOGY TECHNIQUES IN RENAL TRAUMA

Angioembolization

Endovascular Stents

COMPLICATIONS OF RENAL INJURIES

URETERAL INJURY

Staging

Principles of Reconstruction

Techniques of Reconstruction

Bladder Trauma

Principles of Reconstruction

Urethral Trauma

Anterior Urethral (Straddle) Injuries

Posterior Urethral Injuries

External Genital Trauma

Testicular Trauma

PENILE TRAUMA

Penile Fracture

Penile Amputation

Penetrating Penile Injury

Skin Loss to Genitals

Genital Burn Injuries

CONCLUSIONS

CHAPTER 281: Mastery Keys: Surgical Anatomy of Urogenital System

KIDNEYS

Fasciae (Fig. 281.2)

Location and Parts

Blood Supply

Lymphatic Drainage (Fig. 281.8A)

Innervation (Fig. 281.8C)

URETERS

Vasculature (Fig. 281.7A)

INNERVATION (Fig. 281.8C)

URINARY BLADDER

Parts

Vasculature

Innervation

Urethra

CHAPTER 282: Burn and Inhalation Injury

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

Risk Factor

Burn Wound Evaluation

Diagnosis of Inhalation Injury and Respiratory Poisoning

Other Concomitant Injuries

Prognosis

MULTIMODAL THERAPY

Triage

Initial Medical Treatment

IMMEDIATE SURGICAL TREATMENT: ESCHAROTOMY AND FASCIOTOMY

Escharotomy

Fasciotomy

INDICATION FOR SURGICAL TREATMENT

Specific Considerations:

PREOPERATIVE PLANNING: TIMING AND WOUND COVERAGE STRATEGY

Surgical Timing

Wound Coverage Strategy

Definitive Coverage

SURGICAL TECHNIQUE

Wound Care

Excision

Autologous Skin Graft

Expansion

Alexander Technique

Allo- and Xenograft as Temporary Coverage

Dermal Regenerative Template

Cultured Epithelial Autograft

POSTOPERATIVE CARE

OUTCOMES

Acute Complications

Long-Term Results

CONCLUSION

CHAPTER 283: Management of the Acute Abdomen

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUE

Laparoscopy

Open laparotomy

Damage Control in Emergency General Surgery

SPECIAL PATIENT POPULATIONS AND CONSIDERATIONS

Transplant Patients

COVID-19

Postoperative/Postprocedural Patients

Abdominal Pain in Pregnancy

Acute Abdomen in the Medical Intensive Care Unit

Acute Abdomen after Bariatric Surgery

COMPLICATIONS/OUTCOMES

SUMMARY

CHAPTER 284: Gastrointestinal Bleeding

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Upper Gastrointestinal Bleeding:

Lower Gastrointestinal Bleeding

Occult GI Bleeding

Obscure Gastrointestinal Bleeding

Common Etiologies of Upper GI Bleeding

Common Etiologies of Lower GI Bleeding

DIAGNOSIS/CLINICAL PRESENTATION

Bleeding Localization

MULTIMODAL THERAPY

Upper GI Bleeding Procedures and Interventions

Lower GI Procedures and Interventions

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Long-Term Followup

CHAPTER 285: Gastric and Duodenal Perforations

INTRODUCTION

CLINICAL PRESENTATION/DIAGNOSIS

Laboratory Studies

Imaging Studies

MANAGEMENT PRINCIPLES

Principles of Nonoperative Management

Principles of Operative Management

SURGICAL TECHNIQUES

Patient Positioning and Operative Equipment

Incision

Irrigation

Role of Intraoperative Biopsy

Gastric Perforations

Duodenal Perforations

COMPLICATIONS/MANAGEMENT

Postoperative Management

Postoperative Care/Complications

CHAPTER 286: Acute Biliary Tract Disease

INTRODUCTION

SURGICAL ANATOMY

CLINICAL PRESENTATION

DIAGNOSIS AND TREATMENT

INDICATIONS

Cholecystostomy

Open Cholecystectomy

Operative Cholangiogram

Operative Ultrasonography

Subtotal Cholecystectomy

Common Bile Duct Exploration

Other Maneuvers

POSTOPERATIVE MANAGEMENT

CHAPTER 287: Small Bowel Obstruction

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

Indications for Surgery

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Long-Term Follow-Up

CHAPTER 288: Appendicitis

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

THERAPY

Nonoperative Management

Complicated Appendicitis

OPERATIVE MANAGEMENT

Indications/Contraindications

Preoperative Planning

SURGICAL TECHNIQUE

Open Appendectomy

LAPAROSCOPIC APPENDECTOMY

ROBOTIC-ASSISTED APPENDECTOMY

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

SPECIAL CONSIDERATIONS

Appendicitis in Pregnancy

Appendiceal Diverticulitis

Appendicitis in Elderly

Periappendicitis

Incidental Appendectomy

CHAPTER 289: Management of Toxic Megacolon and C. difficile Colitis

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Exploration and Planning

Diversion Procedure (Ileostomy–Colostomy)

Colonic Lavage Through Diverting Loop Ileostomy

Subtotal or Total Colectomy

Proctocolectomy with End Ileostomy/Re-Establishment of Intestinal Continuity

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Wound Infection/Fascial Dehiscence

Intra-Abdominal/Pelvic Abscesses

Stomas

Hemorrhage

Antibiotics

OUTCOMES

CHAPTER 290: Complication of Bariatric Surgery

INTRODUCTION

EARLY COMPLICATIONS

Leak

Bleeding

Thromboembolic Complications

Cardiopulmonary Complications

Early Bowel Obstruction

LATE COMPLICATIONS

Strictures and Stenosis

Marginal Ulcer

Gastrogastric Fistula

Bowel Obstruction

Gastroesophageal Reflux Disease

COMPLICATIONS ASSOCIATED WITH OTHER BARIATRIC PROCEDURES

Adjustable Gastric Band Complications

Duodenal Switch/Biliopancreatic Diversion, and Single Anastomotic Procedures

OTHER CONSIDERATIONS

Biliary Disease

Nutritional Deficiencies

Weight Recidivism

Psychiatric Considerations

CONCLUSION

CHAPTER 291: Surgical Infections of Skin and Soft Tissue

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS AND CLINICAL PRESENTATION

INDICATIONS AND CONTRAINDICATIONS FOR SURGERY

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

NSTI

Prognosis and Futility for NSTI

CHAPTER 292: Management of Incarcerated Hernias

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Inguinal Hernia

Ventral Hernia

Parastomal Hernia

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Inguinal Hernia

Ventral Hernia

Other Hernias

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CONCLUSION

SECTION XIV: Pediatric Surgery

CHAPTER 293: Congenital Neck Masses

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

PREOPERATIVE PLANNING

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUE

POSTOPERATIVE CARE, COMPLICATIONS, AND OUTCOMES

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS, CLINICAL PRESENTATION, AND PREOPERATIVE PLANNING

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUE

Open Excision: General Concepts

First Branchial Cleft Anomalies

Second, Third, and Fourth Branchial Cleft Anomalies

Endoscopic Obliteration

POSTOPERATIVE CARE, COMPLICATIONS, AND OUTCOMES

ETIOLOGY AND PATHOPHYSIOLOGY

Infectious Etiologies

Neoplastic Etiologies

Inflammatory and Miscellaneous Etiologies

DIAGNOSIS AND CLINICAL PRESENTATION

Infectious Lymphadenopathy

Neoplastic Lymphadenopathy

PREOPERATIVE PLANNING AND INDICATIONS

Laboratory Evaluation

Imaging

Biopsy

SURGICAL TECHNIQUE

Excisional Lymph Node Biopsy

POSTOPERATIVE CARE, COMPLICATIONS, AND OUTCOMES

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS, CLINICAL PRESENTATION, INDICATIONS FOR SURGERY, AND PREOPERATIVE PLANNING

Subglottic Hemangiomas

Lymphatic Malformations

SURGICAL TECHNIQUE

POSTOPERATIVE CARE, COMPLICATIONS, OUTCOMES, AND MULTIMODAL CARE

CHAPTER 294: Esophageal Atresia and Tracheoesophageal Fistula

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Open

Thoracoscopic

Magnets

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Anastomotic Leak

Anastomotic Stricture

Recurrent Tracheoesophageal Fistula

Tracheobronchomalacia

Gastroesophageal Reflux Disease and Esophageal Dysmotility

Long Gap Esophageal Atresia

H-Type Tracheoesophageal Fistula

OUTCOMES

CHAPTER 295: Mastery Keys: Embryology of the Development of the Esophagus and Trachea

CHAPTER 296: Congenital Diaphragmatic Hernia

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

CLINICAL PRESENTATION

Fetal Presentation/Risk Prediction

Postnatal Presentation/Risk Prediction

MULTIMODAL THERAPY AND PREOPERATIVE PLANNING

Neonatal Management

Extracorporeal Life Support

PREOPERATIVE PREPARATION

SURGICAL TECHNIQUE

Open Repair via Left Subcostal Approach

Nuances for Operating on ECLS

Nuances for Approaching Right CDH

Minimally Invasive Surgical (MIS) Repair via Thoracoscopic Approach

COMPLICATIONS

OUTCOMES

CHAPTER 297: Chest Wall Deformities

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

Pain

Metal Allergy Screening

Constipation

SURGICAL TECHNIQUE

Choice of Operation

Anesthetic Considerations

Minimally Invasive Repair of Pectus Excavatum (Modified Nuss Procedure)

Procedure

Open Pectus Repair

Positioning

POSTOPERATIVE CARE

Activity Restriction

Bar Removal

COMPLICATIONS AND THEIR MANAGEMENT

Pneumothorax

Bar Rotation

Infection

Metal Allergy

Pleural Effusion

Bleeding at Bar Removal

Recurrence

OUTCOMES

CHAPTER 298: Gastroesophageal Reflux Disease in Infants and Children

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Gastrostomy/Gastrojejunostomy

Nissen Fundoplication

Open Nissen Fundoplication

Gastro-Esophageal Disassociation/Disconnection

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Gastrojejunostomy

Fundoplication

OUTCOMES

Long-Term Follow-Up

CHAPTER 299: Hypertrophic Pyloric Stenosis and Congenital Duodenal Obstruction

INTRODUCTION

Hypertrophic Pyloric Stenosis

Congenital Duodenal Obstruction

EPIDEMIOLOGY

Hypertrophic Pyloric Stenosis

ETIOLOGY AND PATHOPHYSIOLOGY

Hypertrophic Pyloric Stenosis

Congenital Duodenal Obstruction

DIAGNOSIS AND CLINICAL PRESENTATION

Hypertrophic Pyloric Stenosis

Congenital Duodenal Obstruction

MULTIMODAL THERAPY

Hypertrophic Pyloric Stenosis

Congenital Duodenal Obstruction

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

Hypertrophic Pyloric Stenosis

Congenital Duodenal Obstruction

SURGICAL TECHNIQUE

Hypertrophic Pyloric Stenosis

Congenital Duodenal Obstruction

POSTOPERATIVE CARE

Hypertrophic Pyloric Stenosis

Congenital Duodenal Obstruction

COMPLICATIONS/MANAGEMENT

Hypertrophic Pyloric Stenosis

Congenital Duodenal Obstruction

OUTCOMES

Hypertrophic Pyloric Stenosis

Congenital Duodenal Obstruction

CHAPTER 300: Malrotation

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

Ultrasonography

Upper Gastrointestinal Study

Other Imaging Modalities

Considerations in Patients with Congenital Heart Disease

SURGICAL TECHNIQUE

Open Ladd procedure

Laparoscopic Ladd Procedure

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

ACKNOWLEDGMENT

CHAPTER 301: Mastery Keys: Embryology of Gastrointestinal Tract

CHAPTER 302: Biliary Atresia and Choledochal Cysts–Obstructive Jaundice in the Pediatric Population

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

Anatomic Classification

CLINICAL PRESENTATION

INDICATIONS AND PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Initial Fibrous Remnant Dissection

Extended Lateral Dissection

Enteric Drainage

Laparoscopic Portoenterostomy

POSTOPERATIVE CARE

COMPLICATIONS AND MANAGEMENT

OUTCOMES

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

CLINICAL PRESENTATION

INDICATIONS AND PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS AND OUTCOMES

CHAPTER 303: Intussusception

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

Resuscitation

Radiographic Management

Surgical Management

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 304: Congenital Abdominal Wall Defects

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

PREOPERATIVE PLANNING

INDICATIONS AND CONTRAINDICATIONS

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS AND MANAGEMENT

OUTCOMES

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

INDICATIONS/CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

Staged Neonatal Closure

Scarification Treatment

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Ruptured Omphalocele

OUTCOMES

CHAPTER 305: Mastery Keys: Embryology of Formation of Thoracic and Abdominal Wall and Cavities

DEVELOPMENT AND DIFFERENTIATION OF SOMITES

DEVELOPMENT OF BODY CAVITIES

CHAPTER 306: Neonatal Necrotizing Enterocolitis and Short Bowel Syndrome

INTRODUCTION

NEONATAL NECROTIZING ENTEROCOLITIS

ETIOLOGY AND PATHOPHYSIOLOGY

CLINICAL PRESENTATION AND DIAGNOSIS

TREATMENT

INDICATIONS FOR SURGERY

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

COMPLICATIONS

ETIOLOGY, PATHOPHYSIOLOGY, AND CLINICAL PRESENTATION

TREATMENT

COMPLICATIONS OF SHORT BOWEL SYNDROME AND INDICATIONS FOR SURGERY

SURGICAL TECHNIQUES

POSTOPERATIVE CARE

COMPLICATIONS OF INTESTINAL LENGTHENING

INTESTINAL TRANSPLANT

ACKNOWLEDGEMENT

CHAPTER 307: Neonatal Bowel Obstruction

INTRODUCTION

PRENATAL HISTORY

PERINATAL MANAGEMENT

DIAGNOSTIC ALGORITHM

SURGICAL MANAGEMENT OF SPECIFIC NEONATAL BOWEL OBSTRUCTIONS

ETIOLOGY AND PATHOPHYSIOLOGY

Medical Therapy and Perinatal Management

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

OUTCOMES AND COMPLICATIONS

ETIOLOGY AND PATHOPHYSIOLOGY

CLINICAL PRESENTATION

MEDICAL THERAPY

INDICATIONS AND CONTRAINDICATIONS

PREOPERATIVE PLANNING

SURGICAL TECHNIQUE

POSTOPERATIVE CARE

OUTCOMES AND COMPLICATIONS

CHAPTER 308: Hirschsprung Disease

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

Radiographic Evaluation

Rectal Biopsy

Anorectal Manometry

PREOPERATIVE PLANNING

SURGICAL TECHNIQUES

Leveling Colostomy or Ileostomy

Pull-Through for Recto Sigmoid HD

Soave Pull-Through

Duhamel

Pull-Through With Intestinal Derotation

Pull-Through for Total Colonic HD

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

Obstruction

Enterocolitis

Soiling

OUTCOMES

CHAPTER 309: Anorectal Malformations

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

PREOPERATIVE PLANNING

Staged Reconstruction

SURGICAL TECHNIQUES

Neonatal Surgical Management

Cloacal Malformation

Imperforate Anus in Setting of OEIS

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

CHAPTER 310: Cryptorchidism

INTRODUCTION

ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS/CLINICAL PRESENTATION

MULTIMODAL THERAPY

INDICATIONS/CONTRAINDICATIONS

SURGICAL TECHNIQUE

Palpable Testis

Nonpalpable Testis

Fowler–Stephens Orchidopexy

POSTOPERATIVE CARE

COMPLICATIONS/MANAGEMENT

OUTCOMES

Malignancy

CHAPTER 311: Mastery Keys: Descent of Testis

APPENDIX: Figure Credits: Anatomy Chapters

Index

 

An aparitie	01/11/2023
Autor	E. Christopher Ellison; Gilbert R. Upchurch
Dimensiuni	213 x 276 mm
Editura	LWW
ISBN	9781975176433
Limba	Engleza
Nr pag	2810
Versiune digitala	DA