Chassin's Operative Strategy in General Surgery: An Expositive Atlas

Foreword to the Third Edition
Preface to the Fifth Edition
Contents
Contributors
Part I: General Principles
1: Concepts and Strategies of Surgery
Developing a Concept
Establishing Strategy
Making the Operation Easy
Further Reading
2: Mechanical Basics of Operative Technique
Introduction
Before You Scrub
Preoperative Verification Process
Importance of Surgeon’s Foot and Body Position
Use of Instruments
Scalpel
Metzenbaum Scissors
Electrocautery as a Cutting Device
Forceps
Needle Holder
Hemostat
Further Reading
3: Incision, Exposure, Closure
Achieving Exposure
Incisions for Abdominal Surgery
Avoiding Wound Dehiscence and Hernia
Operative Technique for a Midline Incision
Making the Incision
Open Surgery
Port Insertion During Laparoscopic Surgery
Closure of Midline Incision
Modified Smead-Jones Technique
Standard Running Closure
Interrupted Closure
Skin Closure
Further Reading
4: Dissecting and Suturing
Art of Dissecting Planes
Sewing Technique
Use of a Needle Holder
Selection of Needle
Size of Bite
Distance Between Sutures
Size of Suture Material
Continuous Versus Interrupted Sutures
How Tight the Knot?
Catching Both Walls of Intestine with One Pass of the Needle Holder
Types of Stitches
Simple Everting Skin Stitch
Vertical Mattress (Stewart) Stitch
Continuous Subcuticular Stitch
Skin Staples
Simple Interrupted Fascial Stitch
Continuous Simple Over-and-Over Stitch
Smead-Jones Stitch
Horizontal Mattress Stitch
Hemostatic Figure-of-Eight Stitch
Single-Layer Bowel Anastomosis
Seromuscular Lembert Stitch
Cushing Stitch
Halsted Stitch
Continuous Locked Stitch
Connell Stitch
Technique of Successive Bisection
Intestinal Anastomoses
One Layer or Two?
End-to-End or End-to-Side Technique?
Sutured or Stapled Anastomosis?
Suture Material
Absorbable Sutures
Plain Catgut
Chromic Catgut
Polyglycolic Synthetics
Nonabsorbable Sutures
Natural Nonabsorbable Sutures
Synthetic Nonabsorbable Braided Sutures
Synthetic Nonabsorbable Monofilaments
Monofilament Stainless Steel Wire
Knot-Tying Technique
Further Reading
5: Surgical Stapling: Principles and Precautions
Characteristics of Staples
Surgical Stapling Technology
Linear Stapling Device
Linear Cutting Stapling Device
Circular Stapling Device
Tissue Properties of the Stapled Anastomosis
Causes of Failure Following Stapled Anastomosis
Ischemia
Tension
Tissue Quality
Instrument Failure
Technical Error
Microbiology
Patient Factors
Stapled vs. Hand-Sewn Anastomosis
Reducing Anastomotic Complications in Practice
Hemostasis
Intraoperative Leak Testing
Perfusion Testing
Summary
Further Reading
6: Control of Bleeding
General Principles of Resuscitation
Control of Hemorrhage
Thoracic Hemorrhage
Upper Mediastinum and Pulmonary Hilum
Lung Parenchymal Injuries
Abdominal Hemorrhage
Abdominal Aorta, IVC, and Their Branches
Zones of the Retroperitoneum
Medial Visceral Rotations
Solid Abdominal Viscera
Spleen and Kidney
Liver
Pelvic Hemorrhage
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)
Extremity and Junctional Hemorrhage
Techniques to Achieve Hemostasis
Hemostat and Ligature
Tying in Continuity
Suture Ligation
Clips
Staplers
Electrocautery
Ultrasonic Shears
Further Reading
7: Management of the Contaminated Operation
The Challenge
Preoperative Considerations
Timing of Surgery
Resuscitation Before Surgery
Antibiotic Management
Preoperative Imaging
Intraoperative Considerations
Supportive Measures and Fluid Management
Importance of Surgical Skills and Technique
Source Control
Containing the Contamination
Wound Irrigation
Other Considerations
Postoperative Considerations
Wound Closure
Wound Care
Further Reading
8: Damage Control Laparotomy
Indications
Damage Control Strategy and Decision-Making
Damage Control Laparotomy in Trauma
Damage Control Management of Selected Injuries
Damage Control in Nontrauma
Temporary Closure of the Open Abdomen
Postoperative Management and Return to the Operating Room
Further Reading
9: Mechanical Basics of Laparoscopic Surgery
Ergonomics and Operating Room Design
Equipment
Setup and Trouble Shooting
Access to Abdomen
Laparoscopic Hemostasis and Energy Sources
Hemostatic Products and Adjuncts
Tissue Approximation
Pitfalls and Danger Points
Access Injuries
Hypotension
Hemorrhage
Hypoxia
Postoperative Bowel Obstruction
Laparoscopy in Pregnancy
Preoperative Considerations
Intraoperative Considerations
Laparoscopy in Previous Abdominal Surgery
Further Reading
10: Rational Use of Drains
Purpose of Drains
Various Drains and Their Pros and Cons
Penrose Drain
Polyethylene or Rubber Tube Drain
Silicone Tube Drain
Sump Suction Drains
Closed Suction Drain
Gauze Packing
Prevention of Drainage Tract Infection
Management of Intraperitoneal Sepsis
Percutaneous Drainage of Abdominal Abscesses with Computed Tomography or Ultrasound Guidance
Negative Pressure Wound Therapy (NPWT)
Other Indications and Methods of Drainage
Abscess
Blood and Serum
Bile
Pancreatic Secretions
Anastomosis
Further Reading
11: Illustrated Glossary of Surgical Instruments
Introduction
12: Surgical Documentation, Informed Consent, and Operative Note
Defining Value of Documentation
Elements of Surgical Documentation
Provider Chart Entry
Informed Written Consent
Operative Note
Operative Note
Teaching Documentation
References
Part II: Esophagus
13: Concepts in Esophageal Surgery
Gastroesophageal Reflux Disease and Type I Paraesophageal Hernia
Anti-reflux Operations
Wrap Choice
Alternatives to Traditional Surgery
Paraesophageal Hiatus Hernia
Achalasia
Esophageal Perforation
Esophageal Diverticulum
Cricopharyngeal Diverticulum
Epiphrenic Diverticulum
Barrett’s Esophagus
Workup of Esophageal Cancer
Esophagectomy
Choice of Esophagectomy Technique
Anastomotic Leakage
References
14: Laparoscopic and Thoracoscopic Ivor Lewis Esophagectomy
Indications
Preoperative Preparation
Pitfalls and Danger Points
Abdominal Phase
Thoracic Phase
Documentation
Operative Strategy
Abdominal Tumor Dissection, Lymphadenectomy, and Mobilization of the Gastric Conduit
Abdominal Adjunct Procedures
Thoracic Resection
Thoracic Anastomosis
Operative Technique
Position and Incisions for the Abdominal Phase
Laparoscopic Lymphadenectomy and Gastric Mobilization
Pyloric Drainage and Feeding Jejunostomy
Transhiatal Dissection and Creation of the Gastric Conduit
Positioning for the Thoracic Phase
Thoracoscopic Dissection
Esophagogastric Anastomosis
Postoperative Care
Complications
Anastomotic Leak
Tracheoesophageal Fistula (TEF)
Conduit Necrosis
Chylothorax
Paraconduit Herniation
Cardiopulmonary Complications
Avoiding Postoperative Complications
Anastomotic Leak and Stricture
Tracheoesophageal Fistula (TEF)
Thoracic Duct Injury
Paraconduit Herniation
Pyloric Complications
Further Reading
15: Transhiatal Esophagectomy
Introduction
Preoperative Preparation
Patient Selection
Indications
Preoperative Preparation
Pitfalls and Danger Points
Contraindications
Pitfalls
Documentation
Operative Strategy
Avoiding Postoperative Complications
Operative Technique
Patient Preparation and Initial Steps
Abdominal Phase: Laparoscopy/Laparotomy
Cervical Phase
Transhiatal Mediastinal Dissection
Preparation of the Gastric Conduit and Transposition to the Neck
Cervical Esophagogastric Anastomosis
Handsewn Anastomosis
Construction of Anastomosis with an EEA Stapler
Total Mechanical Stapling with Modified Collard Technique
Hybrid Stapling Approach
Postoperative Care
Complications
Hemorrhage
Tracheal Tear
Pleural Complications
Chylothorax
Nerve Injury
Anastomotic Leaks
Splenectomy
Further Reading
16: Laparoscopic Heller Myotomy for Achalasia
Preoperative Preparation
Workup
Preoperative Nutrition and Optimization
Pitfalls and Dangers
Pseudoachalasia
Incomplete Myotomy
Bleeding
Esophageal Perforation
Vagal Injury
Gastroesophageal Reflux
Documentation
Operative Strategy
Division of the Short Gastric Vessels and Mobilization of the Fundus
Mobilization of the Esophagus and Removal of the Esophageal Fat Pad
Esophageal Myotomy Down to the Submucosal Layer Carried Down onto the Gastric Cardia
Anti-reflux Procedure
Avoiding Postoperative Complications
Operative Technique
Postoperative Care
Complications
Further Reading
17: Endoscopic Stent for Management of Esophageal Leaks
Indications
Preoperative Assessment
Pitfalls and Danger Points
Operative Strategy
Length and Diameter
Shape
Material
Coating
Positioning
Antibiotics
Documentation Basics
Operative Technique
Postoperative Care
Complications
Further Reading
18: Laparoscopic Nissen Fundoplication for Gastroesophageal Reflux Disease
Indications
Preoperative Preparation
Pitfalls and Danger Points
Documentation
Operative Strategy
Avoiding Postoperative Complications
Operative Technique
Room Setup, Trocar Placement, and Exposure of the Hiatus
Dissecting the Hiatus
Mobilizing the Esophagus
Closure of the Hiatus
Construction of the Fundoplication
Postoperative Care
Complications
Further Reading
19: Laparoscopic Magnetic Augmentation of the Lower Esophageal Sphincter
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Room Setup and Trocar Placement
Exposure of the Hiatus
Dissecting the Hiatus
Closure of the Hiatus
Identification and Dissection of the Posterior Nerve
Sizing of the LINX Device
Placing and Securing the Linx Device
Closure
Postoperative Care
Postoperative Complications
Further Reading
20: Laparoscopic Paraesophageal Hernia Repair
Preoperative Preparation
Pitfalls and Danger Points
Documentation
Operative Strategy
Reduction/Dissection
Diaphragmatic Repair
Reconstruction
Avoiding Postoperative Complications
Operative Technique
Postoperative Care
Complications
Short-Term Complications
Bleeding
Abscesses
Pneumothorax
Cardiac Arrhythmias
Long-Term Complications
Dysphagia
Recurrence
Gastroparesis
Further Reading
21: Laparoscopic Collis Gastroplasty
Indications
Preoperative Preparation
Pitfalls and Danger Points
Documentation
Operative Strategy
Operative Technique
Postoperative Care
Complications
Further Reading
22: Endoscopic Antireflux Procedures
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Nonablative Radiofrequency Therapy (Stretta)
Transoral Incisionless Fundoplication (TIF)
Documentation
Operative Technique
Nonablative Radiofrequency Therapy (Stretta)
Transoral Incisionless Fundoplication (TIF)
Complications
Nonablative Radiofrequency Therapy (Stretta)
Postoperative Care
Transoral Incisionless Fundoplication (TIF)
Further Reading
23: Peroral Endoscopic Myotomy for Achalasia
Preoperative Preparation
Pitfalls and Danger Points
Documentation
Operative Strategy
Avoiding Postoperative Complications
Mucosal Injuries and Tears of the Mucosotomy
Operative Technique
Endoscopic Measurements
Submucosal Tunnel
Circular Myotomy
Mucosotomy Closure
Postoperative Care
Complications
Gastroesophageal Reflux Disease (GERD)
Further Reading
Part III: Stomach and Duodenum
24: Concepts in Surgery of the Stomach and Duodenum
Operation for Morbid Obesity
Operation for Gastric Cancer
Subtotal Versus Total Gastrectomy
Extent of Lymphadenectomy
EUS and Diagnostic Laparoscopy
Laparoscopic Gastrectomy
Gastrointestinal Stromal Tumors (GISTs)
Surgery for Peptic Ulcer
Operation for Perforated Peptic Ulcer
The Role of Vagotomy in Peptic Ulcer Surgery
The Choice of Drainage Operation
The Role of Resection in Peptic Ulcer Surgery
Reconstruction after Distal Gastrectomy
Billroth I Versus Billroth II
Billroth II Versus Roux-En-Y
Other Reconstruction Options
Operation for Obstructing Peptic Ulcer
Operation for Bleeding Peptic Ulcer
Operation for Nonhealing Peptic Ulcer
Operation for Postoperative Recurrent Ulcer or Marginal Ulcer
Gastrostomy and Duodenostomy
Gastrostomy
Duodenostomy
Stapling the Stomach and Duodenum
Postoperative Complications
Pulmonary Problems
Anastomotic Leak
Wound Problems
Pancreatitis
Early Gastric Stasis
Dumping Syndrome
Diarrhea
Bile Reflux Gastritis
Chronic Gastric Stasis and Roux Syndrome
Metabolic Problems after Gastric Operation
References
25: Truncal Vagotomy: Surgical Legacy Technique
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Avoiding Esophageal Trauma
Avoiding Splenic Trauma
Preventing Incomplete Vagotomy
Hiatus Hernia
Documentation Basics
Operative Technique
Incision and Exposure
Left (Anterior) Vagal Trunks
Identification of the Right (Posterior) Vagus
Suture of Crural Musculature
Postoperative Care
Complications
Further Reading
26: Proximal Gastric Vagotomy: Surgical Legacy Technique
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Exposure
Prevention of Hematoma and Injury to Gastric Lesser Curve
Preserving Innervation of the Antrum
Adequacy of Proximal Vagotomy
Postoperative Gastroesophageal Reflux
Documentation Basics
Operative Technique
Incision and Exposure
Identification of Right and Left Vagal Trunks
Identification of Crow’s Foot
Dissection of the Anterior Nerve of Latarjet
Dissection of Posterior Nerve of Latarjet
Repair of the Lesser Curvature
Postoperative Care
Complications
Further Reading
27: Pyloroplasty (Heineke-Mikulicz and Finney), Operation for Bleeding Duodenal Ulcer: Surgical Legacy Technique
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Control of Bleeding
Choice of Pyloroplasty
Documentation Basics
Operative Technique
Kocher Maneuver
Pyloroduodenal Incision for Heineke-Mikulicz Pyloroplasty
Emergency Procedure for Bleeding Ulcer
Heineke-Mikulicz Pyloroplasty
Stapling
Finney Pyloroplasty
Postoperative Care
Complications
Reversal of Pyloroplasty or Gastrojejunostomy
Further Reading
28: Gastrojejunostomy
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique: Open
Incision
Freeing the Greater Curvature
Preparing the Jejunal Limb
Open Handsewn Technique
Open Stapled Technique
Operative Technique: Laparoscopic
Access
Preparation of the Jejunal Limb
Gastrojejunal Anastomosis: Laparoscopic Stapled Technique
Postoperative Care
Complications
Further Reading
29: Partial Gastrectomy
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Type of Resection
Choice of Reconstruction
Duodenal Stump Leak
Splenic Trauma
Documentation Basics
Operative Technique
Gastric Wedge Resection
Indications
Minimally Invasive Wedge Resection
Equipment
Laparoscopic Setup and Positioning
Operative Steps
Entry and Port Placement
Tumor Localization and Entry into Lesser Sac
Tumor Mobilization and Resection, Specimen Extraction, and Closure
Robotic Gastric Wedge Resection
Open Wedge Resection
Intragastric Resection
Distal Gastrectomy with Billroth I or II Reconstruction
Open Distal Gastrectomy
Incision and Exposure
Division of Left Gastric Vessels
Division of Stomach
Duodenal Dissection
Division of Duodenum
Billroth I Gastroduodenal Anastomosis
Billroth II: Closure of Duodenal Stump
Duodenal Closure with Surgical Staples
Billroth II Gastrojejunal Anastomosis, Handsewn
Billroth II Gastrojejunal Anastomosis, Stapled
Drainage and Closure
Postoperative Care
Complications
Duodenal Fistula
Gastric Outlet Obstruction
Afferent Loop Obstruction and Afferent Loop Syndrome
Dumping Syndrome
Marginal Ulcer
Further Reading
30: Perforated Duodenal Ulcer
Indications
Perforated Duodenal Ulcer
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Incision
Identification of Perforation
Patch Repair of Perforation
Abdominal Closure
Postoperative Care
Complications
Further Reading
31: Laparoscopic Plication of Perforated Duodenal Ulcer
Indications
Preoperative Preparation
Potential Pitfalls and Dangers Points
Documentation Tips
Operative Strategy
Operative Technique
Securing the Omental Patch
Omental Onlay Patch after Primary Closure
Omental Plug Technique
Omental Radial Patch Technique
Testing the Integrity and Security of the Perfortion Repair
Postoperative Care
Role of EGD
Complications
Further Reading
32: Enteral Access
Indications
Percutaneous Gastrostomy
Surgical Gastrostomy
Jejunostomy
Pitfalls and Danger Points
Operative Strategy
Operative Technique
Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement
Stamm Gastrostomy
Witzel Jejunostomy
Further Reading
33: Distal Gastrectomy with D2 Nodal Dissection
Indications
Preoperative Preparation
Pitfalls and Danger Points
Documentation Basics
Operative Strategy
Extent of Resection
Pancreatico-Splenectomy, Splenectomy
Blood Supply to Residual Gastric Pouch
Duct of Santorini
Operative Technique
Incision and Exposure
Resection
Omentectomy and Infrapyloric Nodal Dissection
Dissection of Suprapyloric Nodes
Division of the Duodenum
Hepatic Artery Node Dissection
Celiac Axis Dissection and Division of Left Gastric Vessels
Postoperative Care
Complications
Further Reading
34: Total Gastrectomy
Indications
Preoperative Preparation
Pitfalls and Danger Points
Documentation Basics
Operative Strategy
Exposure
Esophageal Anastomosis
Prevention of Reflux Alkaline Esophagitis
Extent of the Operation
Operative Technique
Incision and Exposure
Exploration and Determination of Operability
Omentectomy, Lymph Node Dissection, and Division of Duodenum
Splenectomy
Splenic Nodal Dissection without Splenectomy
Dissection of the Esophagocardiac Junction: Vagotomy
Preparation of the Roux-En-Y Jejunal Segment
End-to-Side Sutured Esophagojejunostomy
End-to-Side Stapled Esophagojejunostomy
Roux-En-Y Jejunojejunostomy
Sutured Version
Stapled Version
Modifications of Operative Technique for Patients with Benign Disease
Wound Closure
Postoperative Care
Complications
Further Reading
35: Management of Gastrointestinal Stromal Tumor of the Stomach
Introduction
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy and Management
Documentation
Operative Strategy and Technique
Laparoscopic Wedge Resection
Postoperative Care
Complications
References
36: Exposure of the Third and Fourth Portions of the Duodenum
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Incision
Liberation of Right Colon
Liberation of Small Bowel Mesentery
Intraoperative Endoscopy
Resection of Duodenum
Closure
Minimally Invasive Approach
Postoperative Care
Complications
Further Reading
37: Laparoscopic Sleeve Gastrectomy
Indications
Contraindications
Relative Contraindications
Preoperative Preparation
Preoperative Optimization to Enhance Effectiveness and Decrease Complications
Pitfalls and Danger Points
Operative Strategy
Avoiding Operative Bleeding
Avoiding Postoperative Stenosis and Leak
Documentation Basics
Operative Technique
Positioning and Port Placement
Mobilization of the Stomach
Creation of the Sleeve
Leak Test
Postoperative Care
Complications
Further Reading
38: Laparoscopic Roux-en-Y Gastric Bypass
Preoperative Preparation
Indications
Preoperative Examination
Pitfalls and Danger Points
Documentation
Operative Strategy
Operative Technique
Trocar Placement
Division of the Jejunum and Creation of Jejunojejunostomy
Creation of the Gastric Pouch
Creation of the Gastrojejunostomy
Postoperative Care
Avoiding Complications
Late Complications
Further Reading
39: Laparoscopic Reoperative Bariatric Surgery
Introduction
Preoperative Preparation
Pitfalls and Danger Points
Documentation
Operative Strategy
Preoperative Preparation
Abdominal Entry and Initial Exposure
Adhesiolysis
Left Liver Lobe Mobilization
Diaphragmatic Hiatus Exposure
Avoiding Postoperative Complications
Operative Technique (Step by Step)
Patient Positioning and Trocar Placement
Exploration
Critical Anatomy Exposure
Gastroesophageal Junction Mobilization
Types of Reoperations
Postoperative Care
Complications
Further Reading
40: Endoscopic Intragastric Balloon
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Operative Technique
Placement
Diagnostic Endoscopy
Insertion of the Uninflated Balloon
Confirmatory Endoscopy
Balloon Filling
Endoscopic Reevaluation
Removal
Diagnostic Endoscopy
Balloon Deflation
Removal of the Balloon System
Postoperative Care
Avoiding Postoperative Complications
Complications
Minor Complications
Major Complications
Further Reading
Part IV: Small Intestine and Appendix
41: Concepts in Surgery of the Small Intestine and Appendix
Introduction
Diagnostics
Nonsurgical Treatments
Surgical Tools
Perioperative Management
Diseases
Small Bowel Obstruction
Small Bowel Tumors
Crohn’s Disease
Appendicitis
Small Bowel Diverticula
Mesenteric Ischemia
Gastrointestinal Bleeding from Small Bowel
Trauma
Further Reading
42: Small Bowel Resection and Anastomosis
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Open Versus Laparoscopic Technique
Successful Bowel Anastomosis Requirements
Contraindications to Anastomosis
Documentation Basics
Operative Technique
Small Bowel Anastomosis by Suturing
Access and Incision
Division of Mesentery and Bowel Resection
Open Two-Layer Anastomosis
Open One-Layer Anastomosis
Closure of Mesentery
Small Bowel Anastomosis Using Stapling Technique
Postoperative Care
Complications
Further Reading
43: Enterolysis for Intestinal Obstruction
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Open Versus Laparoscopic Technique
Timing of Intervention
Dissection
Bowel Decompression
Adhesion Prevention
Documentation Basics
Operative Technique
Access, Incision, and Bowel Mobilization
Approach to Dense Adhesions
Early Re-laparotomy
Operative Intestinal Decompression
Repair of Damage to Bowel Wall
Closure
Postoperative Care
Complications
Further Reading
44: Baker Tube Stitchless Plication: Surgical Legacy Technique
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Operative Technique
Postoperative Care
Postoperative Complications
Further Reading
45: Appendectomy (Open, Laparoscopic)
Indications
Possible Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Laparoscopic Appendectomy
Positioning
Incision and Exposure
Creating a Window
Division of the Meso-appendix
Division of Appendix Base
Specimen Removal
Management of the Retrocecal Appendix
Closure
Open Appendectomy
Incision
Delivery of Appendix
Division of Meso-Appendix
Division of Appendix and Ligation/Inversion of Appendiceal Stump
Closure of Incision
Postoperative Care
Complications
Further Reading
46: Management of Appendicostomy for Malone Antegrade Continence Enema (MACE)
Introduction
Indications
Primary Indication for MACE Procedure
Indications for Secondary MACE Management
Evaluation and Preparation
Pitfalls and Danger Points
Operative Strategy
Decision-Making
Definition of Access
Closure of Appendicostomy
Preoperative Marking
Anesthesia and Positioning
Documentation Basics
Operative Technique
General Considerations
MACE Creation: Open Approach
MACE Creation: Laparoscopic Approach
ACE Creation in Absence of Appendix
Revision for Appendicostomy Stricture
Appendicostomy Takedown
Postoperative Care
Complications
Further Reading
47: Management of Enterocutaneous and Enteroatmospheric Fistulas
Definitions and Classifications
Indications
Preoperative Preparation
Delineate Fistula Anatomy and Manage Any Intra-abdominal Infections
Reduce and Divert Fistula Output
Optimize Metabolic and Nutritional Status
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Anesthesia, Positioning, and Instruments
Incision and Entering the Abdominal Cavity
Abdominal Exploration, Adhesiolysis, and Resection of Enteric Fistulas
Abdominal Wall Closure
Postoperative Care
Complications
Further Reading
48: Stricturoplasty in Crohn’s Disease
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Access and Exploration
Heineke-Mikulicz Stricturoplasty
Finney Stricturoplasty
Isoperistaltic Side-to-Side Stricturoplasty
Wound Closure and Reconstruction
Postoperative Care
Complications
Further Reading
49: Placement of Feeding Tube Jejunostomy
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Anesthesia and Positioning
Mobilization of the Small Bowel and Purse-String Placement
Feeding Tube Placement and Securing the Jejunum to the Abdominal Wall
Documentation Basics
Operative Technique
Open Placement of Feeding Jejunostomy Tube
Laparoscopic Placement of Feeding Jejunostomy Tube
Postoperative Care
Complications
Further Reading
50: Creation of Ileostomy (Loop, End)
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Choice of Procedure and Site
Access
Proper Ileostomy Configuration
Documentation Basics
Operative Technique
End Ileostomy Creation
Preoperative Selection of Ileostomy Site
Incision and Creation of a Passage
Fashioning the Ileal Mesentery
Exteriorization and Closure of Mesenteric Gap
“Brooking” the Ileostomy (Eversion and Mucocutaneous Fixation)
Loop Ileostomy Creation
Incision and Creation of a Passage
Exteriorization and Proper Orientation
“Brooking” of the Afferent Limb
Postoperative Care
Complications
Further Reading
51: Closure of Loop Ileostomy
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Incision
Fascial Dissection
Peritoneal Dissection
Stapled Resection and Anastomosis of Ileostomy
Hand-Sewn Closure of Enterotomy
Closure of Abdominal Wall
Management of Skin Wound
Postoperative Care
Complications
Further Reading
52: Management of Problems Related to an Existing Continent Ileostomy
Indications
Evaluation and Preparation
Pitfalls and Danger Points
Operative Strategy
Difficult Stoma Intubation
Management During Non-related Surgeries or Incapacitation
Considerations for Unrelated Abdominal Surgery
Acute Pouch Surgery
Chronic Pouch Dysfunction
Documentation Basics
Operative Technique
Endoscopic Pouch Decompression
Pouchoscopy
Pouch Revision
Postoperative Care
Complications
Further Reading
Part V: Large Intestine
53: Concepts in Surgery of the Large Intestine
Introduction
Diagnostics
Nonsurgical Treatments
Surgical Tools
Perioperative Management
Diseases
Colorectal Polyps
Colorectal Cancer
Colon Cancer
Rectal Cancer
Hereditary Cancer Syndromes
Carcinomatosis
Colorectal Cancer Superimposed on Inflammatory Bowel Disease
Anal Cancer
Diverticulitis
Large Bowel Obstruction
Fistulization (Bladder, Vagina, Skin)
Lower GI Bleeding
Ischemia
Inflammatory Bowel Disease
Ulcerative Colitis
Crohn Disease
Indeterminate Colitis
C. difficile Colitis and Other Colitides
Volvulus
Pelvic Floor Dysfunction and Organ Prolapse
Stoma Creation and/or Takedown
References
54: Minimally Invasive Surgery (MIS) in Colorectal Surgery
Implementation and Benefits of MIS
How Is MIS Approach Different From Open Surgery?
Minimally Invasive Surgery (MIS) Platforms
Conventional Laparoscopic Surgery (CLS)
Hand-Assisted Laparoscopic Surgery (HALS)
Three-Dimensional Laparoscopic Surgery
Single Incision Laparoscopic Surgery (SILS)
Robotic Surgery
Strategies About Selection of the Surgical Approach
Challenges
Training Aspects
Conclusion
Further Reading
55: Endoscopic Techniques for Colorectal Lesions
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Polyp Detection
Dye-Assisted Chromocolonoscopy
New Colonoscope Technology
Endoscopic Mucosal Resection
Documentation Basics
Operative Technique
EMR Technique
Recurrent or Remaining Adenoma
Hemostasis
Perforation
Tattoo Placement
Endoscopic Submucosal Dissection
Colonic Stent Placement
Postoperative Care
Complications
Further Reading
56: Right and Extended Right Hemicolectomy (Open, Laparoscopic)
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Localization of Target Lesion
Surgical Approach
Extent of the Resection
Vascular Transection
Colon Mobilization
Colon Resection
Documentation Basics
Operative Technique
Positioning
Operative Approach and Incisions
Minimally Invasive Surgery
Open Approach
Exploration
Identification of the Ureter
Division of the Ileocolic Vessels
Colon Mobilization
Division of the Middle Colic Vessels
Mesentery and Omentum Roundup
Division of Ileum and Colon
Ileo-colonic Anastomosis
Hand-Sewn End-to-End
Stapled Functional End-to-End Anastomosis
Stapled Isoperistaltic Side-to-Side Anastomosis
Wound Closure
Postoperative Care
Complications
Further Reading
57: Sigmoid Resection and Left Hemicolectomy (Open, Laparoscopic)
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Localization of Target Lesion
Surgical Approach
Extent of the Resection
Vascular Transection
Colon Mobilization
Colon Resection
The Difficult Reach
Technique of Anastomosis
Documentation Basics
Operative Technique
Positioning
Operative Approach and Incisions
Minimally Invasive Surgery
Open Approach
Exploration
Identification of the Ureter
Division of the Inferior Mesenteric Artery Pedicle
Colon Mobilization
Medial to Lateral Approach
Lateral to Medial Approach
Splenic Flexure Mobilization
Division of the Middle Colic Vessels
Mesentery and Omentum Roundup
Division of the Bowel
Anastomosis
Stapled End-to-End Anastomosis
Hand-Sewn End-to-End
Reversed Stapled Circular Stapler Anastomosis
Wound Closure
Postoperative Care
Complications
Further Reading
58: Discontinuous Colon Resection (Hartmann Procedure)
Indications
Acute
Elective
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Surgical Approach
Extent of the Resection
Bowel Control and Decompression
Colon Mobilization
Vascular Transection
Colon Resection
The Difficult Reach
Documentation Basics
Operative Technique
Positioning
Incision
Exploration
Colon Mobilization
Identification of the Ureter
Division of the Inferior Mesenteric Artery Pedicle
Division of Mesentery and Bowel
Hartmann’s Pouch Versus Mucous Fistula
End Colostomy
Wound Closure
Postoperative Care
Complications
Further Reading
59: Total Mesorectal Excision/Low Anterior Resection (Open, Laparoscopic)
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Localization of Target Lesion
Surgical Approach
Oncologic Extent of Resection
Mesorectal Dissection
Avoiding Collateral Damage
Prevention of Anastomotic Complications
The Difficult Reach
Technique of Anastomosis
Indications for Diverting Stoma (Colostomy or Ileostomy)
Documentation Basics
Operative Technique
Positioning
Operative Approach and Incisions
Minimally Invasive Surgery
Open Approach
Exploration
Initial Colorectal Mobilization
Identification of the Ureters
Division of the Blood Supply (IMA Pedicle, Mesentery)
Proximal Bowel Transection
Splenic Flexure Mobilization
Pelvic and Presacral Dissection
Pelvic Hemostasis
Distal Rectal Transection
Irrigation of Rectal Stump
Anastomosis
Double Stapled Anastomosis (Abdominal and Perineal Access)
Hand-Sewn Colo-anal Anastomosis (Perineal Access)
Reversed Stapled Circular Stapler Anastomosis (Abdominal Access)
Variations of Colo-anal Anastomosis (To Improve Short-Term Function)
Pitfalls, Danger Points, and Troubleshooting Stapled Anastomoses
Wound Closure
Postoperative Care
Complications
Further Reading
60: Abdominoperineal Resection (Open, Laparoscopic)
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Extent of the Perineal Resection
Abdominal Phase
Surgical Approach
Colostomy
Perineal Dissection
Pelvic Defect Management
Documentation Basics
Operative Technique
Positioning
Operative Approach and Incisions
Minimally Invasive Surgery
Open Approach
Abdominal Dissection and Colostomy Creation
Cylindrical Abdominoperineal Resection (Malignant)
Abdominal Part
Perineal Dissection
Management of Pelvic Floor
Abdominoperineal Resection (Benign)
Abdominal Part
Perineal Dissection
Closure of the Perineal Wound
Abdominal Wound Closure
Colostomy
Postoperative Care
Complications
Further Reading
61: Multivisceral Resections (Pelvic Exenteration)
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Anesthesia and Patient Positioning
Operative Phases
Documentation Basics
Operative Technique
Incision and Exploration
Peritoneal Incision and Identification of the Ureters
Ligation of the Inferior Mesenteric Artery
Proximal Division of the Sigmoid Colon
Pelvic Dissection
Posterior Pelvic Dissection
Lateral Pelvic Sidewall Dissection
Anterior Dissection
Distal Transection Versus Abdomino-Perineal Resection
Harvest of VRAM Flap and Abdominal Wall Reconstruction
Urinary Reconstruction
Creation of Intestinal Stoma
Wound Closure and Reconstruction
Postoperative Care
Complications
Further Reading
62: (Sub-)Total Colectomy with Ileostomy or Ileo-Rectal Anastomosis (Open, Laparoscopic)
Indications
Emergency
Staged
Elective
Preoperative Preparation
All
Elective
Emergency
Pitfalls and Danger Points
Operative Strategy
General
Surgical Approach
Bowel Manipulation
Extent and Steps of the Resection
Anastomosis Versus Ileostomy
Documentation Basics
Operative Technique
Positioning
Operative Approach and Incisions
Open Approach
Minimally Invasive Surgery
Exploration
Evacuation of Stool
Mobilization and Resection
Total Colectomy
Distal Bowel Transection
Anastomosis Versus Ileostomy
Ileo-Rectal (Ileo-Sigmoid) Anastomosis
End Ileostomy
Ileostomy and Mucous Fistula
Drains
Wound Closure
Postoperative Care
Complications
Further Reading
63: Proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA) or End Ileostomy (Open, Laparoscopic)
Indications for Proctocolectomy
Contraindications for Pouch Creation
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Surgical Approach
Extent and Steps of the Resection
Terminal Ileal Dissection
Rectal Dissection
Continence Factors
The Difficult Reach
Constructing the Ileal Reservoir (Pouch)
Technique of Pouch-Anal Anastomosis
Indications for Diverting Ileostomy
Documentation Basics
Operative Technique
Positioning
Operative Approach and Incisions
Minimally Invasive Surgery
Open Approach
Exploration
Mobilization and Resection
Total Colectomy
Proctectomy
Constructing the Ileal Reservoir (J-Pouch)
Ileoanal Anastomosis
Pitfalls, Danger Points, and Troubleshooting Stapled Anastomoses
Loop Ileostomy
Wound Closure
Postoperative Care
Complications
Further Reading
64: Cecostomy: Surgical Legacy Technique
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Tube Cecostomy
Skin-Sutured Cecostomy
Incision
Exploration of Cecum
Cecal Fixation
Mucocutaneous Suture
Postoperative Care
Complications
Further Reading
65: Creation of Transverse Colostomy (Loop, Prasad-Type)
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Choice of Procedure
Access
Diversion of Fecal Stream
Documentation Basics
Operative Technique
Incision
Identification and Exteriorizing of Transverse Colon
Choice of Bridge
Maturation of Colostomy
Prasad-Type Colostomy
Postoperative Care
Complications
Further Reading
66: Laparoscopic Versus Open Creation of Sigmoid Colostomy (Loop, Prasad-Type, End)
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Choice of Procedure and Site
Access
Type of Fecal Diversion
Documentation Basics
Operative Technique
Incision, Identification, and Mobilization of the Sigmoid Colon
Open—Through Laparotomy
Open—Through Colostomy Site Only
Laparoscopic
Stoma Orientation
Abdominal Wall Reinforcement (Hernia Prevention)
Choice of Bridge
Maturation of Colostomy
Loop Colostomy
Prasad-Type Colostomy
End Colostomy
Postoperative Care
Complications
Further Reading
67: Closure of Temporary Loop Colostomy or Ileostomy
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Anesthesia and Positioning
Incision
Fascial Dissection
Peritoneal Dissection
Strategies for the Difficult Dissection
Bowel Anastomosis
Resection with Stapled Side-to-Side (Functional End-to-End) Anastomosis
Simple Closure of Antimesenteric Bowel Wall Opening
Resection and End-to-End Anastomosis
Resection and Isoperistaltic Side-to-Side Anastomosis
Closure of Abdominal Wall
Management of Skin Wound
Postoperative Care
Complications
Further Reading
68: Hartmann Reversal (Open, Laparoscopic)
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Decision to Offer Hartmann Reversal
Choice of Approach: Open Versus Laparoscopic
Laparoscopic Access
Open Access
Colonic Mobilization
Rectal Stump Mobilization
Diverting Fecal Stream
Documentation Basics
Operative Technique
Open Hartmann Reversal
Laparoscopic Hartmann Reversal
Postoperative Care
Complications
Further Reading
69: Surgeries for Large Bowel Obstruction
Introduction
Preoperative Preparation
Pitfalls and Danger Points
Stenting
Non-resective Approach (Stent, Diverting Stoma)
Resection
Operative Strategy
Conservative Management
Decision for Surgery
Choice of the Platform
Specific Considerations for the Stated Options Are as Follows
Setup and Patient Positioning
Documentation Basics
Operative Technique
Positioning
Colonic Stenting
Creation of Colostomy
Discontinuous Resection with Creation of a Stoma
Segmental or Subtotal Resection
Segmental Resection with Intraoperative Colonic Lavage and Anastomosis
Postoperative Care
Complications
Further Reading
70: Surgery for Colonic Fistula to Bladder, Vagina, or Skin
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Decision for Surgery
Definitive Surgery
Access
Diversion
Documentation Basics
Operative Technique
Access
Definitive Bowel Resection
Management of the Other Organ
Malignant
Benign
Diversion
Postoperative Care
Complications
Further Reading
71: Abdominal Repair of Rectal Prolapse and Pelvic Organ Descent (Open, Laparoscopic)
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Concept of the Repair
Surgical Approach
Rectal Mobilization
Posterior
Anterior
Avoiding Collateral Damage
Selection of Implant
Documentation Basics
Operative Technique
Positioning
Operative Approach and Incisions
Minimally Invasive Surgery
Open Approach
Posterior Rectal Mobilization and Fixation
Posterior Rectopexy with Mesh (Wells)
Posterior Suture Rectopexy (without Implant)
Legacy Procedure: Ripstein Rectopexy (Obsolete)
Ventral Mesh Rectopexy
Segmental Colon Resection with Rectopexy
Multicompartmental Resuspension
Wound Closure
Postoperative Care
Complications
Further Reading
Part VI: Anus, Rectum, and Pilonidal Region
72: Concepts in Surgery of the Anus, Rectum, and Pilonidal Region
Introduction
Anatomy and Physiology
Diagnostics
Anorectal Examination
Imaging
Functional Testing
Management
Nonsurgical Treatments
Surgical Tools
Anesthesia and Positioning
Perioperative Management
Clinical Conditions
Anorectal Pain
Hemorrhoids
Anal Fissure
Anorectal Suppurative Diseases
Pilonidal Disease
Hidradenitis Suppurativa
Rectal Prolapse
Anorectal Stricture
Functional Disorders
Anorectal Skin Pathology
Further Reading
73: Office Procedures for Internal Hemorrhoids (Sclerotherapy, Infrared Coagulation, and Rubber Band Ligation)
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Sclerotherapy
Infrared Coagulation
Rubber Band Ligation
Postoperative Care
Complications
Further Reading
74: Excisional Hemorrhoidectomy (Ferguson, Milligan-Morgan, Whitehead)
Indications
Contraindications
Evaluation and Preparation
Pitfalls and Danger Points
Operative Strategy
Considering Alternative Pathologies
Anesthesia and Positioning
Avoiding Anal Stenosis
Achieving Hemostasis
Avoiding Fecal Incontinence
Documentation Basics
Operative Technique
General Setting
Positioning and Setup
Local Anesthetic Block
Excisional Hemorrhoidectomy
Ferguson Technique (Closed Wounds)
Milligan-Morgan Technique (Open Wounds)
Whitehead Hemorrhoidectomy
Postoperative Care
Complications
Further Reading
75: Stapled Hemorrhoidectomy/-opexy
Indications
Contraindications
Evaluation and Preparation
Pitfalls and Danger Points
Operative Strategy
Anesthesia and Positioning
Placement of the Retractor and Reduction of Prolapse
Purse-String Suture Placement and Transection of the Rectal Mucosa
Avoiding Postoperative Complications
Documentation Basics
Operative Technique
Stapler Sets and Instruments
Placement of the Retractor and Reduction of Prolapse
Purse-String Suture Placement and Transection of the Rectal Mucosa
Inspection for Hemostasis and Removal of Retractor
Postoperative Care
Complications
Further Reading
76: Doppler-Guided Hemorrhoidal Artery Ligation
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Selection of the Treatment Method
Anesthesia and Positioning
Documentation Basics
Operative Technique
Doppler-Guided Ligation
Mucopexy
Postoperative Care
Complications
Further Reading
77: Surgical Management of Anorectal Abscess and Fistula
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Choice of Anesthesia
Positioning
Localizing Fistula Tracts
Preserving Fecal Continence
Combining Fistula Surgery with Drainage of Anorectal Abscess
Anorectal Infections in Crohn’s Disease and Leukemia
Documentation Basics
Operative Technique
Perianal and Ischioanal Abscess
Intersphincteric Abscess
Supralevator Abscess
Anorectal Fistula
Fistulotomy Versus Seton Placement
Endorectal Advancement Flap (ERAF)
Insertion of Fistula Plug
Ligation of Intersphincteric Fistula Tract (LIFT)
More Extensive Surgeries
Postoperative Care
Complications
Further Reading
78: Rectovaginal Fistula Repair
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Timing of the Repair
Immediate Symptom Control
Common Local Rectovaginal Repairs
Radical Local Repair Operations
Abdominal Approach
Documentation Basics
Operative Technique
Perineal Approaches
General Considerations
Endorectal Advancement Flap (ERAF)
Episioproctotomy with Layered Closure
Perineal Access and Muscle Interposition
Miscellaneous Perineal Approaches
Abdominal Approach
Postoperative Care
Complications
Further Reading
79: Rectourinary Fistula Repair
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Immediate Symptom Control
Perineal Local Rectourinary Repair
Abdominal Local Rectourinary Repair
Abdominal and Abdomino-perineal Resection
Documentation Basics
Operative Technique
Perineal Approach
Transanal Access
Parasacral-Transsphincteric Access (York-Mason)
Perineal Access and Muscle Interposition
Abdominal Approach
Postoperative Care
Complications
Further Reading
80: Lateral Internal Sphincterotomy with/Without Fissurectomy for Chronic Anal Fissure
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Patient Selection
Goal of Surgery
Optional Steps
Documentation Basics
Operative Technique
Anesthesia and Positioning
Closed Sphincterotomy
Open Sphincterotomy
Fissurectomy and Removal of the Sentinel Pile and/or Hypertrophic Anal Papilla
Concomitant Hemorrhoidectomy
Postoperative Care
Complications
Further Reading
81: Anoplasty for Anal Stenosis
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Mucosal Advancement Flap
Anocutaneous Advancement Flap (V-Y Plasty)
Postoperative Care
Fluids
Wound Care
Regular Diet
Stool Management
Pain Management
Complications
Further Reading
82: Perineal Operations for Rectal Prolapse
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Altemeier Procedure
Delorme Procedures
Thiersch Procedure: Pitfalls and Danger Points
Operative Strategy
Choice of Procedure
Patient Positioning
Anesthesia
Operative Tactics
Perineal Proctosigmoidectomy (Altemeier Procedure)
Mucosal Sleeve Resection with Muscular Cuff Plication (Delorme Procedure)
Thiersch Operation (Surgical Legacy Procedure)
Documentation Basics
Operative Technique
Altemeier Procedure: Perineal Proctosigmoidectomy
Delorme Procedure: Mucosal Sleeve Resection with Muscular Plication
Thiersch Operation (Surgical Legacy Procedure)
Postoperative Care
Complications
Further Reading
83: Operations for Pilonidal Disease
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Abscess Drainage Without Excision
Excision of Sinus Pits with Lateral Drainage
Primarily Wide Open Excision with/Without Marsupialization
Excision with Primary Closure
Excision with Flap Closure
Postoperative Care
Complications
Further Reading
84: Overlapping Sphincteroplasty
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
General Considerations
Timing of the Repair
Technical Considerations
Measuring the Results
Persistent Incontinence
Documentation Basics
Operative Technique
General Setting
Positioning and Setup
Incision
Mobilization
Reconstruction
Wound Closure
Postoperative Care
Complications
Further Reading
85: Sacral Nerve Stimulation for Fecal and Urinary Incontinence
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
General Considerations
Anesthesia and Positioning
Phase 1
Phase 2
Documentation Basics
Operative Technique
Phase 1
Plan Incision
Localizing the Foramina
Confirming Needle Position
Introducing Wire, Dilator, and Lead
Wound Closure
Phase 2
Removing the Temporary External Lead Extension
Connecting the Lead to the Neurostimulator
Wound Closure
Postoperative Care
Complications
Further Reading
86: Transanal Local Excision of Rectal Lesions (TEMS, TAMIS, TAE)
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Depth of Excision
Choice of the Platform
Transanal Excision (TAE)
Transanal Endoscopic Microsurgery (TEMS)
Transanal Minimally Invasive Surgery (TAMIS)
Transanal Total Mesorectal Excision (taTME)
Anesthesia
Patient Positioning
Documentation Basics
Operative Technique
Positioning
Anal Block
Surgical Excision
Transanal Excision
Transanal Endoscopic Microsurgery (TEMS)
Transanal Minimally Invasive Surgery (TAMIS)
Specimen Handling
Postoperative Care
Complications
Further Reading
Part VII: Hepatobiliary Tract
87: Concepts in Hepatobiliary Surgery
Biliary Surgery
Biliary Colic and Cholecystitis
Cholecystitis During Pregnancy
Cholecystitis in the Hospitalized Patient
Cholecystectomy
Intraoperative Cholangiography
Use of Drains
Iatrogenic Biliary Injury
Choledocholithiasis and Cholangitis
Ductal Drainage Procedures
T-Tube Management
Gallbladder Carcinoma
Cholangiocarcinoma
Hepatic Surgery
Hepatocellular Carcinoma
Colorectal Liver Metastases
Hepatic Trauma
Concepts in Liver Resection
Determining Resectability
Hemostasis
Use of Drains
Postoperative Management
References
88: Open Cholecystectomy
Indications
Relative Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Anomalies of the Extrahepatic Bile Ducts
Avoiding Injury to the Bile Ducts
Inadvertent Ligation of the Hepatic Artery
Avoiding Hemorrhage
Cholangiography
Common Errors of Operative Cholangiography
Decompressing the Gallbladder
Management of the Difficult Cystic Duct
Subtotal Cholecystectomy
Conversion to Open Cholecystectomy After Failed Laparoscopic Cholecystectomy
Operative Technique
Incision
Dissecting the Cystic Duct
Cystic Duct Cholangiography
Ligating the Cystic Artery
Dissecting the Gallbladder Bed
Drainage and Closure
Postoperative Care
Complications
Further Reading
89: Laparoscopic Cholecystectomy
Indications
Contraindications
Preoperative Preparation
Choledocholithiasis
Pitfalls and Danger Points
Operative Strategy
Avoiding Bleeding
Preventing Bile Duct Damage
Aberrant Anatomy
Ensuring Good Exposure
Intraoperative Cholangiography
Conversion to Open Cholecystectomy
Operative Technique
Initial Inspection of the Peritoneal Cavity
Insertion of Secondary Trocar Cannulas
Dissecting the Gallbladder to Expose the Cystic Duct
Cystic Duct Cholangiogram
Removing the Gallbladder
Postoperative Care
Complications
Needle or Trocar Damage
Insufflation-Related Complications
Bile Duct Damage: Injury of Common and Hepatic Ducts
Bile Leak
Intraoperative Hemorrhage from Cystic Artery
Further Reading
90: Open and Laparoscopic Common Bile Duct Exploration
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Avoiding Postoperative Pancreatitis
CBD Perforations
Locating and Removing Biliary Calculi
Documentation Basics
Open CBD Exploration: Operative Technique
Cholangiography
Kocher Maneuver
Choledochotomy Incision
Choledochoscopy
Transduodenal Sphincterotomy/Sphincteroplasty for Impacted Stones
Checking for Ampullary Stenosis
Insertion of the T-Tube
Completion Cholangiogram
Drainage and Closure
Laparoscopic CBD Exploration: Operative Technique
Postoperative Care
Complications
Bile Leak and Bile Peritonitis
Postoperative Acute Pancreatitis
Increasing Jaundice
Hemorrhage (Hemobilia)
Residual CBD Stone Postoperatively
Early Postoperative Treatment
Subsequent Postoperative Treatment
Further Reading
91: Sphincteroplasty
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Duodenotomy
Preventing Duodenal or CBD Leak
Identifying and Protecting the Pancreatic Duct
Closure of Duodenotomy
Operative Technique
Incision and Exploration
Mobilization of the Gallbladder and Kocher Maneuver
Location of the Ampulla of Vater and Duodenotomy
Mucosal Resection of Periampullary Adenoma
Bile Duct Sphincteroplasty
Pancreatic Ductoplasty and Septotomy
Completing the Cholecystectomy and Closing the Duodenotomy
Drainage and Abdominal Closure
Postoperative Care
Complications
Postoperative Acute Pancreatitis
Duodenal Leak and Fistula
Intraoperative and Postoperative Hemorrhage
References
Further Reading
92: Choledochoduodenostomy: Surgical Legacy Technique
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Size of Anastomotic Stoma
Location of the Anastomosis
Preventing the Sump Syndrome
Documentation Basics
Operative Technique
Incision
Choledochoduodenal Anastomosis
Alternative Method of Anastomosis
Drainage and Closure
Postoperative Care
Complications
Further Reading
93: Transduodenal Diverticulectomy
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Incision
Kocher Maneuver
Duodenotomy and Diverticulectomy
Closure and Drainage
Postoperative Care
Complications
Further Reading
94: Hepatic Resection
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Anatomic Basis for Liver Resection
Extent of Resection
Anatomic Liver Resections
Principles of Safe Liver Resection
Parenchymal Transection
Vascular Control
Preservation of Bile Ducts
Operative Technique
Incision and Exposure
Wedge (Nonanatomic, Subsegmental, or Peripheral) Resection
Anatomic Oriented Segmental Resections
Resection of Segments 2 and 3 (Left Lobectomy/Left Lateral Sectionectomy)
Anatomic Right Hepatectomy (Right Hepatic Lobectomy)
Anatomic Left Hepatectomy (Left Hepatic Lobectomy)
Laparoscopic Liver Surgery
Indications
Pitfalls and Danger Points
Special Equipment
Positioning
Laparoscopic Left Lateral Sectionectomy
Position and Port Placement
Totally Laparoscopic Right Lobectomy
Position and Port Placement
Hand-Assisted Laparoscopic Right Hepatectomy
Position and Port Placement
Postoperative Care
Complications
Further Reading
Part VIII: Pancreas
95: Concepts in Surgery of the Pancreas
Surgical Anatomy
Trauma
Acute Pancreatitis
Diagnosis
Treatment
Chronic Pancreatitis
Diagnosis
Treatment of Chronic Pancreatitis
Choice of Operation
Drainage Procedures
Resection Procedures
Nerve Ablation
Adenocarcinoma of the Pancreas
Diagnosis
Imaging
Determination of Resectability
Local Invasion
Distant Metastasis
Treatment
Operative Management
Neoadjuvant Therapy
Islet Cell Tumors
Cystic Neoplasms of the Pancreas
Complications of Pancreatic Surgery
Further Reading
96: Partial Pancreatoduodenectomy
Indications
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Assessment of Pathology to Determine Resectability
Avoiding and Managing Intraoperative Hemorrhage
Vascular Resections
Avoiding and Managing Postoperative Hemorrhage
Avoiding Leakage from the Pancreatojejunal Anastomosis
Operative Technique
Diagnostic Laparoscopy
Incision and Exposure
Kocherization of the Duodenum
Dissection of Portal Vein and Superior Mesenteric Vein
Cholecystectomy
Dissection of the Porta Hepatis
Antrectomy
Dissection and Division of Proximal Jejunum
Division of Pancreas
Dissection of Uncinate Process
Reconstruction Techniques
Hepaticojejunal Anastomosis
Pancreaticojejunal Anastomosis
Pancreaticojejunal Anastomosis by Invagination
Insertion of Drains
Gastrojejunostomy
Pylorus Preservation
Operative Technique
Closure
Postoperative Care
Complications
Further Reading
97: Total Pancreatoduodenectomy
Indications
Benign Conditions
Premalignant Conditions
Malignant Conditions
Contraindications
Preoperative Preparation
Operative Strategy
Operative Technique
Laparoscopic Exploration
Incision
Mobilization of Pancreatic Head, Determination of Resectability
Cholecystectomy and Hilar Dissection
Splenectomy
Mobilizing the Distal Pancreas
Antrectomy/Pylorus-Preserving Procedure
Mobilizing the Duodenojejunal Junction
Freeing the Uncinate Process
Reconstruction
Postoperative Care
Complications
Further Reading
98: Distal (Left) Pancreatectomy
Indications
Operative Strategy
Operative Technique
Laparoscopic Distal Pancreatectomy
Open Distal Pancreatectomy
Borderline Resectable Neoplasms
Radical Antegrade Pantreatico-Splenectomy
Distal Pancreatectomy with Celiac Axis Resection (DP-CAR, Appleby)
Robotic Distal Pancreatectomy
Postoperative Care
Complications
Further Reading
99: Operations for Pancreatic Pseudocyst
Operative Strategy
Background/Natural History
Operative Indications
Preoperative Preparation and Perioperative Considerations
Operative Strategy and Technique
Cyst-Enterostomy
Cystogastrostomy
Roux-en-Y Cystojejunostomy
Resection
Pancreatic Head Resection
External Drainage
Postoperative Care
Follow-Up
Pearls
Further Reading
100: Pancreaticojejunostomy for Chronic Pancreatitis
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Operative Technique
Exposure
Incising the Pancreatic Duct
Pancreatic Head Resection
V-Shape Resection of the Body and Tail
Roux-en-Y Reconstruction
Postoperative Care
Complications
Further Reading
Part IX: Spleen
101: Concepts in Splenic Surgery
Splenectomy for Disease
Perioperative Evaluation
Autoimmune Thrombocytopenic Purpura
Recurrent Symptoms After Splenectomy for Hematologic Disease
Choice of Surgical Approach: Open Versus Laparoscopic Procedure
Technical Considerations for Safe Laparoscopic Splenectomy
Laparoscopic Management of Splenic Cysts
Splenic Trauma
Nonoperative Splenic Salvage
Nonoperative Management of Splenic Trauma
Prognostic Indicators of Failure of Nonoperative Management
Follow-Up Imaging
Laparoscopy for the Management of Splenic Trauma
References
102: Open Splenectomy for Disease
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Choice of Approach: Open or Laparoscopic?
Avoiding Intraoperative Hemorrhage
Preventing Postoperative Hemorrhage
Avoiding Pancreatic Injury
Avoiding Trauma to the Stomach
Preventing Postoperative Sepsis
Accessory Spleen
Operative Technique
Incision
Ligating the Splenic Artery
Exposing the Spleen
Mobilizing the Spleen
Ligating the Splenic Vessels
Achieving Hemostasis and Searching for Accessory Spleens
Imbricating the Greater Curvature of Stomach
Abdominal Closure
Postoperative Care
Complications
Further Reading
103: Operations for Splenic Trauma
Indications
Preparation
Pitfalls
Operative Strategy
Decision for Splenectomy or Repair of Spleen
Operative Technique
Exposure for Splenectomy
Mobilization of the Spleen
Temporary Control of Hemorrhage
Identification of the Splenic Injury
Removal of the Spleen
Techniques for Splenic Preservation
Iatrogenic Injuries
Abdominal Closure
Postoperative Care
Further Reading
104: Laparoscopic Splenectomy
Indications
Preoperative Evaluation and Preparation
Pitfalls and Danger Points
Operative Strategy
Operative Technique
Special Consideration: Splenomegaly (>11 cm)
Laparoscopic Management of Splenic Cysts
Postoperative Care
Complications
Further Reading
Part X: Hernia Repairs, Operations for Necrotizing Faciitis, Drainage of Subphrenic Abscess
105: Concepts in Hernia Repair, Surgery for Necrotizing Fasciitis, and Drainage of Subphrenic Abscess
Patient Selection
Selection of Anesthesia
Perioperative Antibiotics
Groin Hernia Repair
Primary Repair
Prosthetic Mesh Repair
Laparoscopic Technique
Repair of Femoral Hernia
Repair of Recurrent Inguinal Hernia
Repair of Large Ventral Hernias
Necrotizing Fasciitis
Subphrenic Abscess
References
106: Shouldice Repair of Inguinal Hernia
Indications
Preoperative Preparation
Pitfalls and Danger Points
Documentation
Operative Strategy
Anesthesia
Dissection
Reconstruction
Operative Technique
Local Anesthesia and Incision
Dissection
Inguinal Repair
The First Line of the Repair
The Second Line of the Repair
The Third and Fourth Lines of Repair
Complete Groin Repair Technique for Femoral Hernia
Closure of Superficial Layers
Postoperative Care
Avoiding Postoperative Complications
Infection
Hemorrhage
Testicular Atrophy and Hydrocele
Injury to Bladder and Bowel
Chronic Postoperative Pain
Ejaculatory Dysfunction (Dysejaculation)
Urinary Retention
Hernia Recurrence
Further Reading
107: Cooper’s Ligament (McVay) Repair of Inguinal Hernia
Indications
Operative Strategy
Documentation Basics
Operative Technique
Incision and Exposure
Making the Relaxing Incision
Inserting Cooper’s Ligament Sutures
Closing the External Oblique Aponeurosis
Postoperative Care
Complications
Further Reading
108: Mesh Repair of Inguinal Hernia
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Incision
Dissection and Identification of Direct and Indirect Sacs
Placement of Patch
Closure
Postoperative Care
Complications
Further Reading
109: Laparoscopic Inguinal Hernia Repair: Transabdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP) Repairs
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Operative Technique
Patient Position and Room Setup: TAPP or TEP
TAPP Approach
Placement of Mesh
Peritoneal Closure
Bilateral Hernias
TEP Approach
Complications
Vascular Injuries
Urinary Retention, Urinary Infection, Hematuria
Bladder Injury
Nerve Injury
Vas Deferens and Testicular Complications
Complications Related to the Mesh
Recurrence of the Hernia
Osteitis
Wound Infection
Further Reading
110: Operations for Recurrent Inguinal Hernia
Indications
Preoperative Preparation
Pitfalls and Danger Points
Documentation
Operative (Management) Strategy
Internal Ring Left Too Wide
Inadequate Reconstruction of the Inguinal Floor
Defect at Pubic Tubercle
Failure to Suture Transversalis Fascia or Transversus Arch
Failure to Excise Sac
Use of Absorbable Sutures
Subcutaneous Transplantation of Cord
Femoral Recurrence Following Inguinal Hernia Repair
Infection
Recurrent Indirect and Direct Inguinal Hernia
Choice of Approach
Anesthesia
Selecting the Optimal Technique for Repair of Recurrent Inguinal Hernia
Technique of Dissection
Avoiding Testicular Complications
Operative Technique
Inguinal Approach
Incision and Exposure
Repairing Recurrent Hernia Following Previous Halsted Operation Without Opening the Inguinal Canal
Dissecting the Inguinal Canal
Repairing a Localized Defect in the Inguinal Floor
Prosthetic Mesh Repair
Abandoning the Anterior Approach
Preperitoneal Approach Using Mesh Prosthesis (Surgical Legacy Technique)
Incision and Exposure
Suturing the Mesh
Closing the Abdominal Incision
Postoperative Care
Complications
References
Further Reading
111: Femoral Hernia Repair
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Inguinal Approach
Low Groin Approach
Preperitoneal Approach
Documentation Basics
Operative Technique
Low Groin Approach for Left Femoral Hernia
Low Groin Approach Using Prosthetic Mesh “Plug”
Preperitoneal Approach for Right Femoral Hernia (Nyhus)
Anesthesia
Incision
Mobilizing the Hernial Sac
Suturing the Hernial Ring
Postoperative Care
Complications
Further Reading
112: Operations for Large Ventral Hernia
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Avoiding Postoperative Complications
Infection
Occult Wound Dehiscence
Large Drain Exit Site at the Fascia
Failure to Close Laparoscopic Trocar Sites Adequately
Transverse Versus Vertical Incision
Suturing Technique
Type of Suture Material
Size of Tissue Bites
Suture Tension
Intercurrent Disease
Tissue Integrity
Tension During Repair
Role of Prosthetic Mesh
Types of Synthetic Prosthetic Material
Biologic Mesh (Biomesh)
Myocutaneous Flap
Separation of Components
Use of Drains
Operative Technique
Elective Ventral Hernia Repair
Dissecting the Hernial Sac
Resecting the Hernial Sac
Mesh Repair of Ventral Hernia
Sandwich Repair
Onlay Patch Mesh Repair
Postoperative Care
Complications
Further Reading
113: Laparoscopic Ventral Hernia Repair
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Technique
Patient Positioning and Preparation of the Defect
Sizing the Mesh
Management of the Fascial Defect
Postoperative Care
Complications
References
Further Reading
114: Operations for Infected Abdominal Wound Dehiscence, Necrotizing Fasciitis, and Intraabdominal Abscesses
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy: Infected Abdominal Wall and Dehiscence
Local Exploration
Wide Debridement
Managing the Abdominal Wall Defect
Repeat Laparotomy for Recurrence of Abdominal Sepsis
Management of Intestinal Stomas and Fistulas
Marsupialization and Open Abdomen Management
Intraabdominal Abscesses
Approaches to Abscess Drainage
Percutaneous Drainage
Lateral and Subcostal Extraperitoneal Approach
Laparoscopy
Laparotomy
Extraserous Approach
Operative Technique
Extraserous Subcostal Drainage of Right Subphrenic Abscess (Surgical Legacy Technique)
Incision and Exposure
Drainage and Closure
Laparotomy for Subphrenic and Abdominal Abscesses
Incision and Exposure
Drainage and Closure
Postoperative Care
Postoperative Care After Abscess Drainage
Further Reading
Part XI: Breast and Melanoma
115: Concepts in Breast Surgery
Introduction
Breast Cancer
Epidemiology
Breast Cancer Risk
Breast Cancer Screening
Imaging Modalities
Breast Biopsy: Obtaining a Tissue Diagnosis
Management of Common Benign Breast Lesions
Nipple Discharge
Breast Abscess
Benign Breast Mass or Cyst
Breast Lesions on CNB That May Require Excision
Breast Malignant Diseases
Ductal Carcinoma In Situ (DCIS)
Paget’s Disease of the Breast
Invasive Breast Cancer
Inflammatory Breast Cancer
Surgical Treatment of Breast Cancer
Considerations Prior to Surgery
Is the Patient a Surgical Candidate?
Is the Patient a Candidate for Breast Conservation?
Surgery First or Neoadjuvant Treatment Followed by Surgery?
Is the Patient a Candidate for Omitting SLN Biopsy?
Will the Patient Require Postmastectomy Radiation?
Are There Indications for Genetic Counseling?
The Role of Shared Decision-Making
Surgical Treatment of the Breast
Breast Conservation Therapy (BCT)
Mastectomy
Lymph Node Surgery
Adjuvant Systemic Therapy
Treatment of Local Recurrence
Metastatic Disease
Breast Problems in Men
References
116: Excision of Benign Palpable Breast Mass
Indications
Preoperative Preparation
Operative Strategy
Operative Technique
Choice of Incision
Local Anesthesia
Dissection
Repair
Postoperative Care
Complications
Further Reading
117: Excision of Ducts, Operations for Breast Abscess
Excision of Ducts
Indications
Preoperative Preparation
Physical Examination
Ductography
Ductal Endoscopy
Operations for Breast Abscess
Indications
Preoperative Preparation
Documentation
Operative Strategy
Single Duct Excision Versus Total Duct Excision
Strategic Approach to Breast Abscesses
Avoiding Postoperative Complications
Prevention of Skin Necrosis with Ductal Excision
Operative Technique
Single Duct Excision
Incision
Identification and Excision
Closure
Total Duct Excision
Incision
Excising the Ductal System
Reconstruction
Simple Breast Abscess
Recurring Subareolar Abscess/Lactiferous Duct Fistula
Postoperative Care
Complications
Further Reading
118: Lumpectomy for Breast Cancer
Indications
Preoperative Preparation
Pitfalls and Danger Points
Documentation
Operative Strategy
Localization
Incision
Extent of Excision, Orienting the Specimen and Additional Margins
Closure
Special Techniques
Intraoperative Radiation Therapy
Oncoplastic Lumpectomy
Avoiding Postoperative Complications
Operative Technique
Basic Lumpectomy
Techniques for Localization
Palpation-Guided Lumpectomy
Wire-Localized Lumpectomy
Ultrasound-Guided Lumpectomy
Lumpectomy Using Implanted Localization Marker
Postoperative Care
Complications
Further Reading
119: Mastectomy: Simple (Total), Modified, and Classical Radical
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Sequencing the Operation
Simple Versus Modified Radical Mastectomy
Modified Radical Mastectomy
Radical Mastectomy
Incision and Skin Flaps
Thickness of Skin Flap
Alternative Incisions for Mastectomy
Avoiding Dog Ears
Axillary Lymph Node Anatomy for Breast Surgeons
Documentation Basics
Operative Technique
Clearing the Pectoral Fascia
Axillary Dissection: Unroofing the Axillary Vein
Axillary Vein Dissection
Radical Mastectomy
Irrigation and Closure
Postoperative Care
Postoperative Complications
Ischemia of Skin Flap
Wound Infection
Seromas
Lymphedema
Further Reading
120: Skin and Nipple Sparing Mastectomy
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Skin Sparing Versus Nipple Sparing Mastectomy
Axillary Lymph Nodes
Extent of Mastectomy
Incision and Skin Flaps
Skin Flap Techniques
Visualization
Incisions
Documentation Basics
Operative Technique
Develop the Skin Flaps (Anterior)
Skin Sparing Mastectomy
Nipple Sparing Mastectomy
Release the Breast from the Chest Wall (Posterior)
Finishing the Mastectomy
Postoperative Care
Postoperative Complications
Ischemia of Skin Flap
Ischemia of Nipple
Wound Infection
Further Reading
121: Sentinel Lymph Node Biopsy and Axillary Staging for Breast Cancer
Indications
Contraindications
Preoperative Preparation
Operative Strategy
Sentinel Lymph Node Biopsy
Axillary Node Dissection
Targeted Axillary Dissection
Axillary Reverse Mapping
Pitfalls and Danger Points
Documentation Basics
Operative Technique
Sentinel Lymph Node Biopsy
Axillary Node Dissection
Postoperative Care
Complications
Further Reading
122: Concepts in Melanoma
Introduction
Diagnosis
Risk Factors
Biopsy
Staging
Primary Lesion: Wide Local Excision (WLE)
Management of the Regional Lymph Nodes
Sentinel Lymph Node Biopsy
Adjuvant Therapy
In-Transit Melanoma
Metastatic Disease
References
123: Wide Local Excision and Sentinel Lymph Node Biopsy for Melanoma
Indications
Wide Local Excision
Sentinel Lymph Node Biopsy
Contraindications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Biopsy
Wide Local Excision
Sentinel Lymph Node Biopsy
Documentation Basics
Operative Technique
Wide Local Excision
Sentinel Lymph Node Biopsy
Postoperative Care
Complications
Further Reading
124: Axillary Lymphadenectomy for Melanoma
Indications
Preoperative Preparation
Pitfalls and Danger Points
Documentation
Operative Strategy
Operative Technique
Incision
Exposing the Axillary Contents
Clearing the Axillary Vein
Dissecting the Chest Wall
Subscapular Space
Drainage and Closure
Postoperative Care
Complications
Further Reading
125: Superficial and Deep Groin (Femoroinguinal and Pelvic) Dissection
Indications
Preoperative Evaluation
Pitfalls and Danger Points
Documentation
Operative Strategy
Preventing Wound Infection and Wound Dehiscence
Reducing Incidence of Lymphedema
Indications for Deep Groin Dissection and Exposure
Adequacy of Nodal Dissection
Operative Technique
Incision and Exposure
Dissection in the Femoral Triangle
Supra Inguinal Ligament Dissection
Deep Groin (Pelvic) Dissection
Sartorius Muscular Flap
Skin Closure and Drainage
Postoperative Care
Complications
Further Reading
Part XII: Thyroid, Parathyroid, and Adrenal, Parotidectomy, and Tracheal Procedures
126: Concepts in Thyroid, Parathyroid, and Adrenal Surgery
Thyroid
Benign Thyroid Disease
Hyperthyroidism
Multinodular Goiter
Thyroid Carcinoma
Ultrasound, Fine-Needle Aspiration, and Molecular Testing
Surgical Treatment of Thyroid Cancer
Well-Differentiated Thyroid Cancer
Medullary Thyroid Cancer
Parathyroid
Primary Hyperparathyroidism
Secondary and Tertiary Hyperparathyroidism
Parathyroidectomy
Adrenal
Adrenal Incidentalomas
Primary Aldosteronism
Cushing’s Syndrome
Pheochromocytoma/Paraganglioma
Surgical Approaches to the Adrenal Gland
Further Reading
127: Thyroidectomy
Indications
Preoperative Preparation
Pitfalls and Danger Points
Documentation
Operative Strategy
Preserving the Superior Laryngeal Nerve
Identification and Preservation of Recurrent Laryngeal Nerve
Preserving Parathyroid Glands
Operative Technique
Intraoperative Preparation
Incision and Exposure
Identification and Ligation of the Isthmus and Middle Thyroid Vein
Dissecting the Superior Pole and Superior Parathyroid Gland
Identification of Inferior Pole Vessels
Identification of the Recurrent Laryngeal Nerve and Inferior Parathyroid Gland
Reimplantation of Parathyroid Glands
Subtotal Thyroid Lobectomy
Total Thyroid Lobectomy
Partial Thyroid Lobectomy
Closure
Postoperative Care
Complications
Minimally Invasive Thyroidectomy
Further Reading
128: Neck Dissection for Thyroid Cancer
Indications
Preoperative Preparation
Pitfalls and Danger Points
Scarring Due to Prior Surgery
Nerve Injuries
Injury to the Thoracic Duct
Seroma
Documentation
Operative Strategy
Operative Technique
Central Compartment Neck Dissection
Lateral Compartment Neck Dissection
Avoiding Postoperative Complications
Postoperative Care
Complications
Further Reading
129: Parathyroidectomy
Indications
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Curing the Disease
Preserving the Recurrent Laryngeal Nerve
Preserving the Superior Laryngeal Nerve
Preserving Normal Parathyroid Tissue
Operative Technique
Incision and Exposure
Identify Crossing of the Inferior Thyroid Artery and the Recurrent Laryngeal Nerve
Identifying Inferior and Superior Parathyroids
Resecting the Adenoma
Biopsying Normal Parathyroid
Subtotal Parathyroidectomy
Total Parathyroidectomy with Autotransplantation
Sequence for an Unfound Parathyroid Gland
Closure
Reoperation
Posterior Approach
Postoperative Care
Complications
References
130: Minimally Invasive Parathyroidectomy
Indications and Preoperative Preparation
Pitfalls and Danger Points
Documentation
Operative Strategy
Intraoperative PTH Monitoring (IOPTH)
Avoiding Postoperative Complications
Preserving the Recurrent Laryngeal Nerve
Operative Technique
Incision and Exposure
Postoperative Care
Complications
References
131: Open Adrenalectomy
Indications
Preoperative Preparation
Pitfalls and Danger Points
Documentation
Operative Strategy
Operative Technique: Right Adrenalectomy
Left Adrenalectomy
Postoperative Care
Complications
Further Reading
132: Laparoscopic Adrenalectomy
Indications
Relative Contraindications
Preoperative Preparation
Special Considerations
Pitfalls and Danger Points
Preoperative
Intraoperative
Postoperative
Documentation
Operative Strategy
Avoiding Postoperative Complications
Operative Technique
Transabdominal Approach
Retroperitoneoscopic Approach
Special Circumstances
Postoperative Care
Complications
Further Reading
133: Parotidectomy
Indications
Pitfalls and Danger Points
Operative Strategy
Extent of Resection
Locating and Preserving the Facial Nerve
Documentation Basics
Operative Technique
Incision and Exposure
Exposing the Posterior Margin of the Parotid Gland
Locating the Facial Nerve
Dissecting Facial Nerve Branches
Removing Deep Lobe of Parotid Gland (When Indicated)
Drainage and Closure
Postoperative Care
Complications
Further Reading
134: Cricothyroidotomy
Indication
Preoperative Preparation
Pitfalls and Danger Points
Operative Strategy
Documentation Basics
Operative Technique
Postoperative Care
Complications
References
Further Reading
135: Tracheostomy
Indications
Preoperative Preparation
Pitfalls and Danger Points
Introduction
Operative Strategy
Documentation Basics
Operative Technique: Formal Tracheostomy
Endotracheal Tube
Incision and Exposure
Identifying the Tracheal Rings
Checking the Tracheostomy Equipment
Opening the Trachea
Inserting the Tracheostomy Tube
Closure
Percutaneous Tracheostomy
Positioning and Setup
Procedure
Postoperative Care
Complications
Further Reading
Index