Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice

Front Cover
IFC
IFC
SABISTON TEXTBOOK of SURGERY The BIOLOGICAL BASIS
Copyright
Dedication
CONTRIBUTORS
PREFACE
FOREWORD
ACKNOWLEDGMENTS
CONTENTS
VIDEO CONTENTS
I - Surgical Basis Principles
1 - The Rise of Modern Surgery:: An Overview
THE BEGINNINGS
KNOWLEDGE OF ANATOMY
CONTROL OF BLEEDING
CONTROL OF PAIN
CONTROL OF INFECTION
OTHER ADVANCES THAT FURTHERED THE RISE OF MODERN SURGERY
X-Rays
Blood Transfusion
Frozen Section
ASCENT OF SCIENTIFIC SURGERY
Standardized Postgraduate Surgical Education and Training Programs
Experimental Surgical Research Laboratories
Specialty Journals, Textbooks, Monographs, and Treatises
Professional Societies and Licensing Organizations
THE MODERN ERA
DIVERSITY
THE FUTURE
SELECTED REFERENCES
2 - Ethics and Professionalism in Surgery
ETHICAL FRAMEWORKS
PHYSICIAN–PATIENT RELATIONSHIP
SURGICAL TRAINING AND INNOVATION
CONCLUSION
SELECTED REFERENCES
REFERENCES
3 - The Inflammatory Response
COMPONENTS OF THE INFLAMMATORY RESPONSE
Cells of the Immune System
Neutrophils
Macrophages
Dendritic Cells
T Cell
B Cell
Innate Immunity
Toll-Like Receptors
Inflammasome
High-Mobility Group Box Protein 1
Cytokines
Complement System
Adaptive Immunity
The Nervous System and Immunity
The Inflammatory Reflex Arc
The Neuroendocrine System and Inflammation
INFLAMMATION AND THE CRITICALLY ILL
Historical Perspective
Systemic Inflammatory Response Syndrome
Compensatory Antiinflammatory Response
Genomics and Understanding Inflammation
Diagnosis and Immunotherapy in Sepsis
Multiple Organ Failure
Persistent Inflammation, Immunosuppression, and Catabolism Syndrome
SELECTED REFERENCES
REFERENCES
4 - Shock, Electrolytes, and Fluid
HISTORY
Resuscitation
Shock
Fluids
Blood Transfusions
Bleeding
Shock Index
Lactate and Base Deficit
Compensatory Mechanisms
Lethal Triad
Acidosis
Hypothermia
Coagulopathy
Oxygen Delivery
Optimization (Supernormalization)
Global Perfusion Versus Regional Perfusion
Septic Shock
Bleeding
Trauma Immunology and Inflammation
Detrimental Impact of Fluids
Damage Control Resuscitation
Whole Blood Resuscitation
Resuscitation With 1:1:1
Massive Transfusion Protocol
Crystalloids
Hypertonic Saline
Colloids
Blood Substitutes
Perfluorocarbons
Novel Fluids
Dried Plasma
Pharmacologic Agents
Suspended Animation
Body Water
Maintenance Fluids
Adrenal Gland
Antidiuretic Hormone and Water
Sodium
Hyponatremia
Hypernatremia
Potassium
Hypokalemia
Hyperkalemia
Calcium
Hypocalcemia
Hypercalcemia
Magnesium
Hypomagnesemia
Hypermagnesemia
SELECTED REFERENCES
REFERENCES
5 - Metabolism in Surgical Patients
METABOLIC SCIENCE
History of Metabolism Research
Cellular Bioenergetics
Maintenance of Cell Structure and Function
SURGICAL METABOLISM
Assessment of Nutritional Status
Metabolism in Critical Illness
Inflammatory Diseases Without Hypermetabolism
Inflammatory Diseases With Hypermetabolism
CONCLUSION
SELECTED REFERENCES
REFERENCES
6 - Wound Healing
WOUND-HEALING PHASES
Inflammatory Phase
Hemostasis and Inflammation
Increased Vascular Permeability
Chemokines
Polymorphonuclear Cells
Macrophages
Lymphocytes
Proliferative Phase
Angiogenesis
Fibroplasia
Epithelialization
Extracellular Matrix
Maturational Phase
Remodeling
ABNORMAL WOUND HEALING
Hypertrophic Scars and Keloids
Prevention of Hypertrophic or Keloid Scars
Linear Hypertrophic Scars
Widespread Hypertrophic Scars
Keloids
Chronic Nonhealing Wounds
Other Causes of Abnormal Wound Healing
Hypoxia
Diabetes
Ionizing Radiation
Aging
Malnutrition
Drugs
Treatment of Chronic Wounds
WOUND DRESSINGS
OTHER THERAPIES
Hyperbaric Oxygen Therapy
Negative Pressure–Assisted Wound Therapy
FETAL WOUND HEALING
TISSUE ENGINEERING
GENE AND STEM CELL THERAPY
NEW HORIZONS
SELECTED REFERENCES
REFERENCES
7 - Regenerative Medicine
STEM CELL SOURCES
Embryonic Stem Cells
Somatic Cell Nuclear Transfer
Induced Pluripotent Stem Cells
Fetal Stem Cells
Adult Stem Cells
Hematopoietic Stem Cells
Mesenchymal Stem/Stromal Cells
Bone Marrow–Derived Stromal Cells
Adipose Tissue–Derived Stem/Stromal Cells
Endothelial Progenitor Cells
Skeletal Stem Cells
Miscellaneous Adult Stem Cells
Stem Cells and Cancer
BIOENGINEERING FOR REGENERATIVE MEDICINE
Biomaterials as Constructs for Cell Delivery and Cell Differentiation
Organ-Level Tissue Engineering
CLINICAL APPLICATIONS OF STEM CELLS
Embryonic Stem Cells
Somatic Cell Nuclear Transfer
Induced Pluripotent Stem Cells
Bone Marrow Transplant
Multipotent Adult Stem Cells
CONCLUSION
SELECTED REFERENCES
REFERENCES
8 - Critical Assessment of Surgical Outcomes and Health Services Research
EVIDENCE-BASED APPROACH TO SURGERY
Evaluating Research Study Questions
Study Design
Randomized Controlled Trials
Cross-Sectional Study
Case-Control Study
Cohort Study
Case Series and Reports
Synthetic and Systematic Outcome Studies
Meta Analyses
Cost-Effectiveness Analysis
Systematic Reviews
Qualitative Data Analysis
APPRAISING SURGICAL EVIDENCE
Evaluating Study Quality
Internal Validity
Hypothesis Testing
INTERPRETING AND APPLYING EVIDENCE TO SURGICAL PRACTICE
CONCLUSION
SELECTED REFERENCES
REFERENCES
9 - Safety in the Surgical Environment
FOSTERING A CULTURE OF SAFETY THROUGH LEADERSHIP
LOCAL ORGANIZATIONAL STRUCTURES TO PROMOTE PERIOPERATIVE SAFETY
NATIONAL AND HEALTH CARE SYSTEM–LEVEL SAFETY INITIATIVES
SYSTEM-LEVEL INTERVENTIONS IMPROVE SAFETY
CONCLUSION
SELECTED REFERENCES
REFERENCES
II - Perioperative Management
10 - Principles of Preoperative and Operative Surgery
Principles of Surgical Evaluation
Patient–Surgeon Relationship
Surgical Objectives
Elective, Urgent, and Emergent Indications
Risk Assessment
Informed Consent
Assessment of Geriatric Surgical Patients
Comprehensive Geriatric Assessment
Cognitive Impairment and Delirium
Depression
Medication Management
Functional Status and Frailty
Patient Counseling
Systems Approach to Preoperative Evaluation
Cardiovascular System
Risk Prediction Scales/Indices
Preoperative Testing (Electrocardiogram, Echocardiography, Stress Test, Angiography)
Surgery After Coronary Revascularization
Other High-Risk Cardiac Patients
Perioperative Cardiovascular Medications
Pulmonary System
Renal System
Hepatobiliary System
Hematologic System
Anemia
Inherited Coagulopathy
Antiplatelet Therapies
Anticoagulation
Oral Direct Thrombin and Factor Xa Inhibitors
Endocrine System
Diabetes Mellitus
Hyperthyroidism and Hypothyroidism
Adrenocortical System
Neoplastic Endocrinopathies
Nutrition and Obesity
Preoperative Nutrition Assessment
Nutrition Supplementation
Obesity
Patient Recovery Pathways
Antibiotic Prophylaxis
Review of Medications
Preoperative Fasting
Operating Room
Maintenance of Normothermia
Preoperative Skin Preparation
Hemostasis
Wound Closure
Surgical Adhesives
Electrosurgery and Electrocautery
Monopolar Electrosurgery
Bipolar Electrosurgery
LigaSure and Enseal
Saline-Cooled Radiofrequency Dissectors
Ultrasonic Dissectors
Harmonic Scalpel
Cavitron Ultrasound Surgical Aspirator
Ablation Technology
Radiofrequency Ablation
Microwave Ablation
Other Energy Devices
Argon Beam Coagulator
Surgical Staplers
Malignant Hyperthermia
Gas Embolus: Air and Carbon Dioxide
Myocardial Infarction, Pulmonary Embolus, and Pneumothorax
Hemorrhage
Outpatient Surgery
Selected References
References
11 - Surgical Infections and Antibiotic Use
SURGICAL SITE INFECTIONS
Classification of Surgical Site Infection
Risk Factors for Surgical Site Infection
Surgical Site Infection Prevention
NECROTIZING SOFT TISSUE INFECTIONS
Diagnosis
Imaging
Local Exploration
Treatment of Necrotizing Soft Tissue Infections
Surgery
Antibiotics
Resuscitation
Wound Care and Reconstruction
SPECIFIC INFECTIONS
Intraabdominal Abscess
Definition, Etiology, and Classification of Intraabdominal Abscess
Diagnostic Evaluation
Intrathoracic Abscess
Management of Pleural Empyema
Clostridium difficile Infection
Clostridium septicum and Colorectal Malignancy
HEALTH CARE–ASSOCIATED INFECTIONS
Catheter-Associated Bloodstream Infections
Catheter-Associated Urinary Tract Infections
Ventilator-Associated Pneumonia
ANTIBIOTIC RESISTANCE
CLINICALLY IMPORTANT PATHOGENS
Carbapenem-Resistant Enterobacteriaceae
Mode of Transmission
Reservoirs
Risk Factors for Carbapenem-Resistant Enterobacteriaceae Infections
Treatment
Vancomycin-Resistant Enterococcus
Mode of Transmission
VRE Reservoirs
Risk Factors for VRE Infection
Treatment
Fungal Infections in Surgical Patients
Mode of Transmission
Risk Factors
Diagnosis
Treatment of Invasive Fungal Infections
SELECTED REFERENCES
REFERENCES
12 - Surgical Complications
Wound Complications
Seroma
Hematoma
Presentation and Management
Acute Wound Failure (Dehiscence)
Causes
Presentation and Management
Surgical Site Infection
Prevention and Management
Thermal Regulation
Hypothermia
Causes
Presentation
Treatment
Malignant Hyperthermia
Postoperative Fever
Causes
Respiratory Complications
General Considerations
Atelectasis
Pneumonia
Diagnosis
Treatment
Aspiration Pneumonitis and Aspiration Pneumonia
Causes
Presentation and Diagnosis
Treatment
Pulmonary Edema and Acute Respiratory Distress Syndrome
Presentation and Diagnosis
Management
Venous Thromboembolism
Presentation and Diagnosis
Management
Cardiac Complications
Perioperative Myocardial Ischemia and Infarction
Cause
Presentation and Diagnosis
Prevention and Management
Postoperative Hypertension
Causes
Presentation and Management
Postoperative Arrhythmias
Presentation
Postoperative Heart Failure
Presentation and Management
Renal and Urinary Complications
Acute Kidney Injury
Urinary Retention29
Presentation and Management
Endocrine Dysfunction
Adrenal Insufficiency
Causes
Presentation
Management
Hyperthyroid Crisis
Causes
Presentation and Diagnosis
Treatment
Hypothyroidism
Causes
Presentation and Diagnosis
Treatment
Syndrome of Inappropriate Antidiuretic Hormone Secretion
Causes
Presentation
Treatment
Gastrointestinal Complications
Ileus and Early Postoperative Bowel Obstruction
Causes
Presentation
Treatment
Abdominal Compartment Syndrome
Cause
Presentation
Diagnosis
Treatment
Postoperative Gastrointestinal Bleeding
Causes
Presentation
Diagnosis and Treatment
Stomal Complications
Causes
Presentation and Diagnosis
Treatment
Clostridioides difficile Colitis
Clinical Presentation
Diagnosis
Prevention and Management
Anastomotic Leak
Causes
Presentation and Diagnosis
Intestinal Fistulas
Causes
Presentation and Diagnosis
Treatment
Pancreatic Fistulas
Hepatobiliary Complications
Bile Duct Injuries
Causes
Presentation and Diagnosis
Treatment
Vasculobiliary Injury
Neurologic Complications
Postoperative Delirium
Cause and Risk Factors
Presentation
Prevention and Management
Perioperative Seizure
Perioperative Stroke
Causes and Presentation
Treatment
Ear, Nose, and Throat Complications
Epistaxis
Nosocomial Sinusitis
Acute Hearing Loss
Parotitis
The Geriatric Patient and Frailty
Treatment
Recommendations
Selected References
References
13 - Surgery in the Geriatric Patient
Outcomes of Surgery in Older Adults
Frailty and Physiologic Decline
Frailty
Organ-Specific Decline
Cardiovascular System
Respiratory System
Renal System
Hepatobiliary System
Immune Function
Glucose Homeostasis
Patient Counseling
Surgical Decision-Making
Advanced Directives
Palliative Care
Screening to Identify High-Risk Characteristics
Cognitive Assessment
Capacity
Delirium Risk
Depression
Functional Assessment
Mobility/Fall Risk Assessment
Nutritional Status and Swallowing Function
Medication Management
Multimodality Pain Control
Delirium
Aspiration
Deconditioning
Transitions of Care
Surgery of Major Organ Systems
Endocrine Surgery
Thyroid Disease
Parathyroid Disease
Breast Disease
Epidemiology
Presentation and Screening
Pathology and Treatment
Gastrointestinal Surgery
Esophagus
Stomach
Biliary Tract Disease
Liver
Small Bowel Obstruction
Appendicitis
Carcinoma of the Colon and Rectum
Abdominal Wall Hernias
Vascular Diseases
Abdominal Aortic Aneurysm
Carotid Artery Disease
Peripheral Vascular Disease
Cardiothoracic Diseases
Coronary Artery Disease
Valvular Disease
Lung Cancer
Trauma
Transplantation
Selected References
References
14 - Anesthesiology Principles, Pain Management, and Conscious Sedation
Pharmacologic Principles
Inhalational Agents
Nitrous Oxide
Isoflurane
Sevoflurane
Desflurane
Intravenous Agents
Induction Agents
Opioids
Neuromuscular Blockers
Anesthesia Equipment
Blood Pressure Monitoring
Electrocardiography
Ventilation Monitoring
Oxygenation Monitoring
Temperature Monitoring
Neuromuscular Blockade Monitoring
Central Nervous System Monitoring
Hemodynamic Monitoring (Transesophageal Echocardiography/Right Heart Catheter)
Point-of-Care Ultrasound
Preoperative Evaluation
Airway Examination
Cardiovascular Disease
Endocarditis Prophylaxis
Pulmonary Disease
Renal and Hepatic Disease
Nutrition, Endocrinology, and Metabolism
Fasting Before Surgery
Assessment of Physical Status
Risk of Anesthesia
Selection of a Specific Technique
Airway Management
General Anesthesia
Regional Anesthesia
Local Anesthetic Drugs
Spinal Anesthesia
Epidural Anesthesia
Peripheral Nerve Blocks
Abdominal Wall Blocks
Enhanced Recovery After Surgery Pathways
Conscious Sedation
Postanesthesia Care
Postoperative Agitation, Delirium, and Cognitive Decline
Respiratory Complications
Postoperative Nausea and Vomiting
Hypothermia
Circulatory Complications
Postoperative Visual Loss
Acute Pain Management
Mechanisms of Acute Pain
Methods of Analgesia
Opioids
Nonsteroidal Anti-inflammatory Drugs
Local Anesthetics for the Management of Acute Pain
Combination Analgesic Therapy
Neuraxial Analgesia
Intravenous Patient-Controlled Analgesia
Selection of Methods of Postoperative Analgesia
Chronic Pain
Specific Types of Acute Pain Patients
Patients With a History of Chronic Pain
Patients With a History of Substance Abuse
Pediatric Patients
Elderly Patients
Conclusion
Selected References
References
15 - Emerging Technology in Surgery: Informatics, Electronics
Recent Significant Advances in Surgical Technology
Continuing Evolution of Minimal-Access Surgery
Advances in Endoscopy as a Surgical Platform
Evolution of Minimally Invasive Robotic Surgery
Digitization and Augmentation of Surgery
Evolving Technologies in Surgery
3D Printing and Bioprinting
Artificial Intelligence
Intraoperative Diagnostic Tools for Targeted Surgery
Process of Innovation in Surgery
Conclusion
Selected References
References
16 - Robotic Surgery
Preface
History
Preparing for Robotic Surgery
Understanding da Vinci Si and Xi Surgical Systems
Operating Room Setup
Choosing Robotic Instruments
Current Status of Selected Robotic Operations
Robotic Ventral Hernia Repair With Mesh
Robotic Total Mesorectal Excision for Rectal Cancer
Robotic Pancreatic Surgery
Robotic Pancreaticoduodenectomy
Robotic Distal Pancreatectomy
Robotic Liver Resections
Robotic Versus Laparoscopic Liver Resections
Difference in Lesion Location
Conclusion
Selected References
References
III - Trauma and Critical Care
17 - Management of Acute Trauma
Overview and History
Trauma Systems
Injury Scoring
Prehospital Trauma Care
Initial Assessment and Management
Airway
Breathing
Circulation
Disability and Exposure
Resuscitative Thoracotomy and Endovascular Aortic Occlusion
Secondary Survey
Management of Specific Injuries
Damage Control Principles
Injuries to the Brain
Immediate Management
Evaluation
Management
Injuries to the Spinal Cord and the Vertebral Column
Immediate Management
Evaluation
Management
Injury to the Maxillofacial Region
Immediate Management
Evaluation
Management
Injuries to the Neck
Immediate Management
Evaluation
Management
Injuries to the Chest
Immediate Management
Evaluation
Management
Injuries to the Abdomen
Blunt Abdominal Trauma Evaluation
Penetrating Abdominal Trauma Evaluation
Management
Injuries to the Pelvis and Extremities
Rehabilitation
Selected References
References
18 - The Difficult Abdominal Wall
Suture Material
Closure Technique
Prophylactic Mesh
Abdominal Fascial Dehiscence
Temporary Abdominal Closure
Management of the Open Abdomen and Assessing Readiness for Abdominal Closure
Pharmacologic Adjuncts to Closure
Synthetic Mesh Failure
Challenges in the Contaminated Field
Seroma and Skin Necrosis
Perioperative Considerations
Summary
Selected References
References
19 - Emergency Care of Musculoskeletal Injuries
Epidemiology of Orthopedic Injuries
Terminology
Fracture Types
Other Injuries
Fixation Principles
Patient Evaluation
History
Trauma Room Evaluation
Diagnostic Imaging
Shoulder
Elbow
Forearm and Wrist
Pelvis and Acetabulum
Hip
Knee
Ankle
Foot
Spine
Vascular Injuries
Initial Management
Wound Management
Reduction and Immobilization
Traction
Prioritization of Surgical Care
Time-Dependent Orthopedic Injuries
Open Fractures
Classification
Initial Management
Limb Salvage Versus Primary Amputation
Fractures Secondary to Firearm Injury
Skeletal Stabilization
Acute Compartment Syndrome
Pathogenesis
Diagnosis
Surgical Treatment
Pelvic Ring Disruption
Classification
Management
Initial Stabilization
Definitive Management
Spinal Injuries
Evaluation
Management
Dislocations
A dislocated joint is considered an orthopedic emergency because of the possibility of neurovascular injury and damage to the ar...
Patient Evaluation
Special Considerations for the Trauma Setting
Treatment
Vascular Injuries
Incidence and Recognition
Management
Common Long Bone Fractures
Femur Fractures
Epidemiology and Significance
Initial Management
Definitive Stabilization
Tibial Shaft Fractures
Epidemiology and Significance
Blood Supply
Associated Soft Tissue Injuries
Management and Treatment
Humerus Shaft Fractures
Epidemiology, Acceptable Alignment, and Associated Injuries
Treatment
Challenges and Complications
Missed Injuries
Drug and Alcohol Use
Thromboembolic Complications
Pulmonary Failure: Fat Emboli Syndrome and ARDS
Postoperative Mobilization
Summary
Selected References
References
20 - Burns
General Considerations
Burn Units
Pathophysiology of Burns
Local Changes
Burn Depth
Burn Size
Systemic Changes
Inflammation and Edema
Effects on the Renal System
Effects on the Immune System
Hypermetabolism
Initial Treatment of Burns
Prehospital
Initial Assessment
Wound Care
Transport
Resuscitation
Escharotomies
Inhalation Injury
Wound Care
Antimicrobials
Synthetic and Biologic Dressings
Excision and Grafting
Minimizing Complications
Etiology and Pathophysiology
Prevention
Organ Failure
Renal Failure
Pulmonary Failure
Hepatic Failure
Hematologic Failure
Nutrition
Electrical Burns
Initial Treatment
Delayed Effects
Chemical Burns
Alkali
Acids
Hydrocarbons
Summary
Selected References
References
21 - Bites and Stings
SNAKEBITES
Epidemiology
Venomous Species Indigenous to United States
Pathophysiology
Clinical Manifestations
Management
Antivenin Therapy
Coagulopathy of Envenomation
Fasciotomy
MAMMALIAN BITES
Epidemiology
Treatment
Evaluation
Wound Care
Microbiology
Antibiotics
Rabies
ARTHROPOD BITES AND STINGS
Black Widow Spiders
Toxicology
Clinical Manifestations
Treatment
Brown Recluse Spiders
Toxicology
Clinical Manifestations
Treatment
Scorpions
Toxicology
Clinical Manifestations
Treatment
Ticks
Hymenoptera
Toxicology
Clinical Reactions
Treatment
MARINE BITES AND STINGS
Initial Assessment
Microbiology of Marine-Related Soft Tissue Infections
General Management
Wound Care
Antivenom
Injuries From Nonvenomous Aquatic Animals
Sharks
Moray Eels
Alligators and Crocodiles
Miscellaneous
Envenomation by Invertebrates
Coelenterates
Sponges
Echinodermata
Mollusks
Annelid Worms (Bristleworms)
Envenomation by Vertebrates
Stingrays
Miscellaneous Fish
Sea Snakes
SELECTED REFERENCES
REFERENCES
22 - Surgical Critical Care
NEUROLOGIC SYSTEM
Pain and Agitation
Altered Mental Status and Delirium
CARDIOVASCULAR SYSTEM
Cardiac Physiology
Cardiac Arrhythmias
Supraventricular Tachycardias
Bradycardia
Shock
Hypovolemic Shock
Hemorrhagic Shock
Cardiogenic Shock
Obstructive Shock
Myocardial Infarction
RESPIRATORY SYSTEM
Respiratory Physiology
Oxygen Therapy
Noninvasive Ventilation
Intubation and Mechanical Ventilation
Standard Modes of Mechanical Ventilation
Volume Assist Control
Synchronized Intermittent Mandatory Ventilation
Pressure Support Ventilation
Advanced Modes of Mechanical Ventilation
High-Frequency Oscillatory Ventilation
Airway Pressure Release Ventilation and Biphasic Positive Airway Pressure Ventilation
Pressure Regulated Volume Control and Adaptive Support Ventilation
Extracorporeal Membrane Oxygenation
Extubation or Tracheostomy
Pulmonary Pathology
Pulmonary Embolism
Pneumonia
Acute Respiratory Distress Syndrome
GASTROINTESTINAL SYSTEM
Nutritional Requirements of the Critically Ill Patient
Enteral and Parenteral Nutrition
Stress Ulcer Prophylaxis
HEPATIC SYSTEM
Perioperative Management of the Cirrhotic Patient
Management of Liver Injuries
RENAL SYSTEM
Physiology
Acid Base Disturbances
Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Electrolyte Abnormalities
Hyponatremia
Hypernatremia
Acute Kidney Injury
Hyperkalemia
Volume Overload
Metabolic Acidosis
Hypocalcemia and Hyperphosphatemia
HEMATOLOGIC SYSTEM
Thromboelastography
Heparin-Induced Thrombocytopenia
Venous Thromboembolism
Hemoglobin Transfusion Strategies
ENDOCRINE SYSTEM
Glucose Control
Adrenal Insufficiency
Thyroid Dysfunction
INFECTIOUS DISEASES
General Principles
Central Line–Associated Bloodstream Infections
Catheter-Associated Urinary Tract Infections
Diarrhea and Clostridioides difficile
Other Common Infectious Issues in the ICU
Intra abdominal Infections
Thrombophlebitis
SPECIAL ISSUES
The Open Abdomen
Palliative Care
Multisystem Organ Failure and Futility
SELECTED REFERENCES
REFERENCES
23 - Bedside Surgical Procedures
RATIONALE FOR BEDSIDE SURGICAL PROCEDURES
TAKING THE OPERATING ROOM TO THE BEDSIDE
BEDSIDE LAPAROTOMY
TRACHEOSTOMY
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY
BRONCHOSCOPY
SELECTED REFERENCES
REFERENCES
24 - The Surgeon’s Role in Mass Casualty Incidents
History
Key Definitions
Mascal Key Principles
Critical Mascal Lessons Learned
Training
Triage Systems
Readiness
Understanding the Hospital Incident Command System
Integration of Systems
Security
Communications
Regional
Local Integration
Documentation and Patient Tracking
Community Elements and Other Considerations
Adaptable
Grow (Elements of a Learning Health System)
Exsanguination Control Along the Spectrum
Conclusions
Selected References
References
IV - Transplantation andImmunology
25 - Transplantation Immunobiology and Immunosuppression
The Immune Response
Innate Immunity
Monocytes
Dendritic Cells
Natural Killer Cells
Acquired Immunity
Major Histocompatibility Locus: Transplant Antigens
Human Histocompatibility Complex
Class I Major Histocompatibility Complex
Class II Major Histocompatibility Complex
Human Leukocyte Antigen Typing: Implications for Transplantation
Cellular Components of the Acquired Immune System
T-Cell Receptor
T-Cell Activation
Costimulation
T-Cell Effector Functions
Cytokines
B Cells and Antibody Production
Transplant Immunity
Rejection
Hyperacute Rejection
Acute Rejection
Chronic Rejection
Immunosuppression
Induction Therapy
Antithymocyte Globulin
Anti–IL-2 Receptor Antibodies
OKT3
Alemtuzumab
Maintenance Immunosuppression
Corticosteroids
Antiplasma Cell Therapies
Novel Immunosuppressive Agents
Complications of Immunosuppression
Risk of Infection
Risk for Malignant Disease
Nonimmune Side Effects
Tolerance
Lymphocyte Depletion
Costimulation Blockade
Chimerism
Xenotransplantation
Concordant Xenografts
Discordant Xenografts
New Areas of Transplantation
Islet Cell Transplantation
Vascularized Composite Tissue Transplantation
Uterus Transplantation
Conclusion
Selected References
References
26 - Liver Transplantation
History
Indications
Noncholestatic Cirrhosis
Alcoholic
Nonalcoholic Fatty Liver Disease
Hepatitis C
Cryptogenic
Autoimmune
Hepatitis B
Cholestatic Liver Disease
Primary Biliary Cholangitis
Primary Sclerosing Cholangitis
Caroli Disease
Acute Liver Failure
Malignant Neoplasms
Hepatocellular Cancer
Cholangiocarcinoma
Other
Budd-Chiari Syndrome
Very Rare Causes of Liver Failure That Can Be Addressed With Liver Transplantation
Total Parenteral Nutrition/Hyperalimentation-Induced Liver Disease
Polycystic Liver Disease
Hepatic Adenoma
Metastatic Cancer
Hemangioendothelioma
Wilson Disease
Contraindications
Meld and Allocation
Donor Selection
Preoperative Evaluation
Surgical Considerations
Postoperative Management
Complications and Their Treatment
Immunosuppression
Donor
Recipient
Pediatric Liver Transplantation
Selected References
References
27 - Kidney and Pancreas Transplantation
HISTORICAL PERSPECTIVE
Kidney Transplantation
Indications
Patient Selection
Living Donor Selection
Laparoscopic Surgical Technique
Open Surgical Technique
Postoperative Care and Follow-up of Living Donors
Deceased Donor Surgical Technique
Preservation and Storage
Recipient Operation
Kidney Allocation
Postoperative Surgical Complications
Hemorrhage
Venous Thrombosis
Arterial Thrombosis
Arterial Stenosis
Urologic Complications
Lymphocele
Infections
Outcomes
Pancreas Transplantation
Patient Selection
Pancreas Donor
Pancreas Procurement, Preparation, and Transplantation
Drainage Techniques
Exocrine Drainage
Surgical Complications
Leak
Outcomes
Islet Transplantation
Isolation and Infusion Techniques
Outcomes
Selected References
References
28 - Small Bowel Transplantation
History
Indications for Intestine Transplantation
Evaluation
Recipient Evaluation
Donor Evaluation
Donor and Recipient Surgical and Technical Considerations
Isolated Intestine Transplantation
Intestine Allograft in Combination with Other Abdominal Organs
Other Technical Variations
Immunosuppression
Complications
Surgical and Perioperative Complications
Monitoring and Rejection
Infection
Outcomes
Patient and Graft Survival
Cost
Quality of Life
Conclusion
Selected References
References
V - Surgical Oncology
29 - Tumor Biology and Tumor Markers
Selected References
References
30 - Tumor Immunology and Immunotherapy
OVERVIEW OF TUMOR IMMUNOLOGY
IMMUNOTHERAPY
CONCLUSION
SELECTED REFERENCES
REFERENCES
31 - Melanoma and Cutaneous Malignancies
Melanoma
Epidemiology
Precursor Lesions
Pathogenesis
Initial Evaluation
Biopsy
Pathology
Staging
AJCC Staging
Beyond the AJCC TNM Staging
Additional Workup and Imaging
Treatment
Wide Local Excision
Evaluation and Management of Regional Lymph Nodes
Adjuvant Therapy
Surveillance
Treatment of Locoregional Recurrent Disease
Treatment of Metastatic Disease
Special Situations and Noncutaneous Melanoma
Unknown Primary Melanoma
Melanoma and Pregnancy
Noncutaneous Melanoma
Nonmelanoma Skin Cancers
Squamous Cell Carcinoma
Presentation and Risk Factors
Treatment
Basal Cell Carcinoma
Presentation and Risk Factors
Treatment
Merkel Cell Carcinoma
Other Cutaneous Malignancies
Cutaneous Angiosarcoma
Dermatofibrosarcoma Protuberans
Kaposi Sarcoma
Extramammary Paget Disease
Selected References
References
32 - Soft Tissue Sarcoma
EPIDEMIOLOGY
CORE CONCEPTS
Germline Mutations
Neurofibromatosis Type 1
Li-Fraumeni Syndrome
Familial Adenomatous Polyposis and Gardner Syndrome
Radiation
Carcinogens
Gene Fusions and Molecular Testing
Staging
Tumor Grade
Clinical Evaluation
Lipomatous Tumors
Malignant Fibrous Histiocytoma Reclassification
TRUNK AND EXTREMITY SARCOMA
Malignant Peripheral Nerve Sheath Tumors
Desmoid Tumor
Angiosarcoma
Dermatofibrosarcoma Protuberans
RETROPERITONEAL AND VISCERAL SARCOMA
Gastrointestinal Stromal Tumor
Leiomyosarcoma
SUMMARY
SELECTED REFERENCES
REFERENCES
33 - Bone Tumors
OVERVIEW
BONE MICROENVIRONMENT
BONE MACROENVIRONMENT
BIOPSY
STAGING
ONCOLOGIC RESECTION
SKELETAL RECONSTRUCTION
Skeletal Stabilization Utilized in Intralesional Resections
Skeletal Reconstruction Utilized in Wide Resections
Allograft
Arthroplasty
Amputation
BENIGN BONE TUMORS
Enchondroma
Osteochondroma
Osteoid Osteoma
Giant Cell Tumor
SKELETAL SARCOMAS
Osteosarcoma
Ewing Sarcoma
Chondrosarcoma
BONE METASTASES
CONCLUSION
SELECTED REFERENCES
REFERENCES
VI - HEAD AND NECK
34 - Head and Neck
NORMAL HISTOLOGY
Epidemiology
Carcinogenesis
Staging
Clinical Overview
Evaluation
Lymphatic Spread
Therapeutic Options
Anatomic Sites
Neck
Oral Cavity
Oral Cavity Malignancy
Oral Cavity Cancer Treatment
Subsites of the Oral Cavity
Oropharynx
Anatomy
Oropharyngeal Cancer and Treatment
Hypopharynx
Anatomy
Hypopharyngeal Cancer and Therapy
Larynx
Anatomy
Laryngeal Cancer and Therapy
Treatment of Larynx Cancer
Complications and Morbidity following Nonsurgical Treatment
Speech and Swallowing Rehabilitation
Salivary
Anatomy
Nonneoplastic Salivary Disease
Neoplasms of the Salivary Glands
Salivary Cancer and Therapy
Surgical Technique
Nasal Cavity and Paranasal Sinuses
Anatomy
Pathology of the Nasal Cavity and Paranasal Sinuses
Evaluation and Treatment of Sinonasal Cancer
Nasopharynx
Anatomy
Pathology of the Nasopharynx
Parasellar and Pituitary Skull Base Surgery
Ear and Temporal Bone
Anatomy
Pathology of the Ear and Temporal Bone
Evaluation of Ear and Temporal Bone Tumors
Treatment of Ear and Temporal Bone Tumors
Head and Neck Reconstruction
Reconstructive Goal 1: Separation of Upper Aerodigestive Tract From Sterile Compartments
Reconstructive Goal 2: Optimizing Function
Reconstructive Goal 3: Optimization of Form/Cosmesis
Reconstructive Options in Head and Neck Surgery
Secondary Intention
Primary Closure
Nonvascularized Grafts
Adjacent Tissue Transfer and Local Flaps
Regional Flaps
Free Tissue Transfer
Virtual Surgical Planning for Reconstruction of the Facial Skeleton
Selected References
Videos
References
VII - Breast
35 - Diseases of the Breast
ANATOMY
Microscopic Anatomy
Breast Development and Physiology
Normal Development and Physiology
Fibrocystic Changes and Breast Pain
Abnormal Development and Physiology
Absent or Accessory Breast Tissue
Gynecomastia
Nipple Discharge
Galactocele
Diagnosis of Breast Disease
Patient History
Physical Examination
Biopsy
Fine-Needle Aspiration
Core Needle Biopsy
Excisional Biopsy
Breast Imaging
Screening Mammography
Ultrasonography
Magnetic Resonance Imaging
Nonpalpable Mammographic Abnormalities
Image-Localized Surgical Excision of Nonpalpable Breast Lesions
Risk Factors for Breast Cancer
Age and Gender
Personal History of Cancer
Histologic Risk Factors
Family History of Breast Cancer and Genetic Risk Factors
Reproductive Risk Factors
Exogenous Hormone Use
Risk Assessment
Care of High-Risk Patients
Close Surveillance
Chemoprevention for Breast Cancer
Prophylactic Mastectomy
Summary: Risk Assessment and Management
Benign Breast Tumors and Related Diseases
Breast Cysts
Fibroadenomas and Other Benign Tumors
Hamartomas and Adenomas
Breast Infections and Abscess
Papillomas and Papillomatosis
Sclerosing Adenosis
Radial Scars
Fat Necrosis
Epidemiology and Pathology of Breast Cancer
Epidemiology
Pathology
Noninvasive Breast Cancer
Invasive Breast Cancer
Molecular Markers and Breast Cancer Subtypes
Staging of Breast Cancer
Surgical Treatment of Breast Cancer
Historical Perspective
Surgical Trials of Local Therapy for Operable Breast Cancer
Radical Mastectomy Versus Total Mastectomy With or Without Radiation Therapy
Mastectomy Versus Breast-Conserving Therapy
Planning Surgical Treatments
Selection of Surgical Therapy
Factors Influencing Eligibility for Breast Conservation
Tumor Size
Margins
Histology
Patient Age
Breast-Conserving Surgery
Technical Aspects
Cosmetic Challenges
Timing of Oncoplastic Surgery
Mastectomy
Indications
Postmastectomy Breast Reconstruction
Technical Details
Lymph Node Staging
Historical Perspective
Sentinel Lymph Node Dissection
Lymphatic Mapping Technique and Selection of Patients for Sentinel Lymph Node Dissection
Outcomes of Sentinel Lymph Node Dissection
Treatment of Ductal Carcinoma in situ
Mastectomy
Breast-Conserving Therapy
Role of Tamoxifen and Aromatase Inhibitors
Sentinel Node Surgery
Radiation Therapy for Breast Cancer
Radiation Therapy after Breast-Conserving Surgery
Postmastectomy Radiation Therapy
Systemic Therapy for Breast Cancer
Goals of Therapy and Assessment of Potential Benefits and Risks from Therapy
Chemotherapy
HER-2–Based Targeted Therapy
Endocrine Therapy
Tamoxifen
Aromatase Inhibitors
Ovarian Ablation
Neoadjuvant Systemic Therapy for Operable Breast Cancer
Treatment of Special Conditions
Breast Cancer in Older Adults
Paget Disease
Breast Cancer in Men
Selected References
References
36 - Breast Reconstruction
BREAST CONSERVATION THERAPY—ONCOPLASTIC TECHNIQUES
Reconstruction After Mastectomy
Contralateral Breast
Radiation
Quality Measurements and Outcomes
Alloplastic Reconstruction
Timing—Immediate Versus Delayed
Delayed
Immediate
Delayed-Immediate
Location of Implant—Prepectoral Versus Subpectoral
Complications
Autologous Breast Reconstruction
Pedicled Flaps (TRAM, Latissimus)
Complications
Combination of Reconstruction Techniques With or Without Implants
Nipple-Areola Reconstruction
Conclusion
Selected References
References
VIII - Endocrine
37 - Thyroid
Disclosures
History of Thyroid Surgery
Thyroid Embryology and Anatomy
Embryology
Median Thyroid Anlage
Lateral Thyroid Anlage
Thyroglossal Duct Cyst
Ectopic Thyroid Tissue
Anatomy
Blood and Lymphatic Supply
Nerves Associated With the Thyroid Gland
Thyroid Histology and Physiology
Histology
Normal Thyroid Physiology
Thyroid Hormone
Calcitonin
Thyroid Physiology in Pregnancy
Thyroid Physiology in Nonthyroidal Illness (Euthyroid Sick Syndrome)
Thyroid Biomarkers
Thyroid-Stimulating Hormone
Tetraiodothyronine and Triiodothyronine
Thyroid Autoantibodies
Thyroglobulin
Calcitonin
Thyroid Imaging
Neck Ultrasound
Nuclear Scintigraphy
Cross-Sectional Imaging
Positron Emission Tomography
Hypothyroidism
Autoimmune Thyroiditis
Subacute Thyroiditis
Riedel Thyroiditis
Acute Suppurative Thyroiditis
Iatrogenic Hypothyroidism
Hyperthyroidism
Graves Disease
Toxic Multinodular Goiter
Solitary Toxic Adenoma
Amiodarone-Induced Thyrotoxicosis
Nontoxic Goiter
Endemic (Diffuse) Goiter
Nontoxic Multinodular Goiter
Substernal Goiter
Workup
Management
THYROID NODULE
Clinical Presentation and Workup
Ultrasound Evaluation of Thyroid Nodules
Sonographic Risk Stratification of Thyroid Nodules
FNA Cytology
Molecular Testing of FNA Specimens
Thyroid Cancer
Incidence
Differentiated Thyroid Cancer
A New Entity: Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features
Thyroid Follicular Cell Neoplasia and Oncogenesis
Risk Factors
Clinical Presentation
Imaging Workup
Staging
Surgical Management
Active Nonoperative Surveillance of PTC
Postoperative Thyroid-Stimulating Hormone Suppression
Radioactive Iodine
Adjuvant Therapies
Medullary Thyroid Cancer
Clinical Presentation
RET and MTC
Workup
Surgical Treatment
Postoperative Surveillance and Adjuvant Therapies
Staging and Prognosis
Anaplastic Thyroid Cancer
Systemic Therapies for Advanced Thyroid Cancers
Thyroidectomy
Indications and Nomenclature
Thyroidectomy Outcomes
Preoperative Preparation
Assessment of Voice and Laryngeal Function
Technique
Anesthesia and Positioning
Incision and Initial Exposure of the Thyroid
Dissection and Release of the Superior Pole
Mobilization of Inferior Pole and Medial Rotation of the Thyroid Lobe
Identification of the RLN and Completion of Lobectomy
Closure
Postoperative Care and Complications
Complications
Adjunctive Technologies During Thyroidectomy
Energy Sealing Devices and Hemostatic Agents
Intraoperative Neuromonitoring
Fluorescent Imaging Aids for Parathyroid Identification
Alternative Approaches to Thyroidectomy
Selected References
References
38 - The Parathyroid Glands
History of the Parathyroid Glands
Embryology of the Parathyroid Glands
Histology of the Parathyroid Glands
Parathyroid Physiology
Primary Hyperparathyroidism
Etiology, Pathophysiology, and Risk Factors
Clinical Manifestations
Diagnosis and Evaluation
Management
Indications for Parathyroidectomy
Parathyroid Localization
Surgical Options and Intraoperative Adjuncts
Postoperative Management
Medical Management of Primary Hyperparathyroidism
Outcomes After Surgery
Secondary and Tertiary Hyperparathyroidism
Secondary Hyperparathyroidism
Tertiary Hyperparathyroidism
Calciphylaxis
Parathyroid Cancer
Familial Primary Hyperparathyroidism
Selected References
References
39 - Endocrine Pancreas
Embryology of the Endocrine Pancreas
Histomorphology of Islets
Endocrine Physiology
Glucose Homeostasis: Insulin and Glucagon
Insulin
Glucagon
Other Influences on Glucose Homeostasis
Somatostatin
Pancreatic Polypeptide
Other Peptide Hormones
Pancreatic Neuroendocrine Tumors
Overview and History
Histopathology and Staging
Molecular Genetics of PNETs
General Principles of Diagnosis and Treatment of PNETs
Diagnosis and Evaluation
Screening for Functional Tumors
Localization
Treatment of Nonmetastatic, Symptomatic PNETs Localized Preoperatively
Incidentally Found, Small, Nonfunctional PNETs
Nonmetastatic Pancreatic Neuroendocrine Tumors—Unlocalized Preoperatively
Metastatic Disease
Liver Surgery for Metastatic Disease
Liver-Directed Therapy for Metastatic Disease
Cytotoxic and Targeted Systemic Therapy
Liver Transplantation for Metastatic PNETs
Diagnosis and Treatment of Specific Functional Pancreatic Neuroendocrine Tumors
Insulin-Secreting Pancreatic Neuroendocrine Tumors (Insulinoma)
Gastrin-Secreting Pancreatic Neuroendocrine Tumor (Gastrinoma)
Vasoactive Intestinal Peptide–Secreting Pancreatic Neuroendocrine Tumor
Glucagon-Secreting Pancreatic Neuroendocrine Tumor (Glucagonoma)
Somatostatin-Secreting PNET (Somatostatin)
Other Functional Pancreatic Endocrine Tumors
Multiple Endocrine Neoplasia Type 1–Associated Pancreatic Neuroendocrine Tumor
Postgastric Bypass Noninsulinoma Pancreatogenous Hypoglycemia Syndrome
Endocrine Insufficiency After Surgical Resection
Surgical Treatment of Diabetes
Autologous Islet Cell Transplantation
Pancreatic Transplantation and Islet Allotransplantation
Selected References
References
40 - The Adrenal Glands
History
Anatomy and Embryology
General and Developmental Aspects
Relationships
Vasculature
Normal Histopathology
Biochemistry and Physiology
Adrenal Steroid Biosynthesis
Steroid Hormone Physiology and Metabolism
Glucocorticoids
Mineralocorticoids
Adrenal Sex Steroids
Catecholamine Biosynthesis and Physiology
Catecholamine Clearance
Adrenal Insufficiency
Types of Adrenal Insufficiency
Primary Adrenal Insufficiency (Addison Disease)
Secondary Adrenal Insufficiency
Adrenal Insufficiency in the Critically Ill
Adrenal Crisis
Diagnosis and Treatment
Diagnosis
Treatment
Perioperative Steroid Administration
Diseases of the Adrenal Cortex
Primary Hyperaldosteronism
Epidemiology and Clinical Features
Surgical Management and Outcomes
Cushing Syndrome
Epidemiology and Clinical Features
Biochemical Diagnosis and Localization
Surgical Management and Outcomes
Special Case: Subclinical Cushing Syndrome
Sex Steroid Excess
Adrenocortical Carcinoma
Diseases of the Adrenal Medulla
Pheochromocytoma
Epidemiology and Clinical Features
Special Case: Pheochromocytoma in Pregnancy
Biochemical Diagnosis and Localization
Perioperative Care
Surgical Management and Outcomes
Molecular Genetics of Pheochromocytoma
Malignant Pheochromocytoma
Other Adrenal Diseases
Incidentally Discovered Adrenal Mass (Incidentaloma)
Epidemiology and Differential Diagnosis
Clinical Evaluation and Surgical Management
Metastases to the Adrenal Gland
Epidemiology and Clinical Features
Clinical Evaluation and Surgical Management
Technical Aspects of Adrenalectomy
Choice of Operative Approach
Laparoscopic Lateral Transabdominal Adrenalectomy
Patient Preparation and Positioning
Posterior Retroperitoneoscopic Adrenalectomy
Complications and Postoperative Care
Open Anterior Transabdominal Adrenalectomy
Patient Preparation and Positioning
Complications and Postoperative Care
Selected References
References
41 - The Multiple Endocrine Neoplasia Syndromes
MULTIPLE ENDOCRINE NEOPLASIA TYPE 1
Incidence and Epidemiology
Genetics
Clinical Features and Management
Parathyroid Glands
Enteropancreatic NETs
Pituitary Gland
Other Tumors
MULTIPLE ENDOCRINE NEOPLASIA TYPE 2
RET Proto-oncogene
Multiple Endocrine Neoplasia Type 2A and Familial Medullary Thyroid Cancer
Multiple Endocrine Neoplasia Type 2B
Genetic Testing for Multiple Endocrine Neoplasia Type 2
Medullary Thyroid Cancer
Surgery for Medullary Thyroid Cancer
Recurrent and Metastatic Disease
Pheochromocytoma
Primary Hyperparathyroidism
CONCLUSION
SELECTED REFERENCES
REFERENCES
IX - Esophagus
42 - Esophagus
ANATOMY
Esophageal Inlet
Esophageal Layers
Anatomic Narrowing
Gastroesophageal Junction
Vasculature
Lymphatics
Innervation
PHYSIOLOGY
Swallowing
Reflux Mechanism
DIAGNOSIS AND MANAGEMENT OF ESOPHAGEAL MOTILITY DISORDERS
Diagnosis
Motility Disorders of the Esophageal Body
Diffuse Esophageal Spasm
Nutcracker Esophagus
Motility Disorders of the Lower Esophageal Sphincter
Hypertensive Lower Esophageal Sphincter
Motility Disorders Affecting Both Body and Lower Esophageal Sphincter
Achalasia
Ineffective Esophageal Motility
DIVERTICULAR DISORDERS
Pharyngoesophageal (Zenker) Diverticulum
Midesophageal Diverticula
Epiphrenic Diverticula
GASTROESOPHAGEAL REFLUX DISEASE
Medical Management
Workup
Surgical Therapy
Complicated GERD
ACQUIRED BENIGN DISORDERS OF THE ESOPHAGUS
Acquired Esophageal Disease
Perforation
Caustic Ingestion
Foreign Body Ingestion, Benign Tracheoesophageal Fistula, and Schatzki Ring
BENIGN AND RARE TUMORS OF THE ESOPHAGUS
Benign Tumors of the Esophagus
Rare Malignant Tumors of the Esophagus
ESOPHAGEAL CANCER
Epidemiology of Esophageal Cancer
Diagnosis and Staging of Esophageal Cancer
Approach to Early-Stage Esophageal Cancer
High-Grade Dysplasia and Superficial Cancers
Locally Advanced Esophageal Cancer
Principles of Multimodality Therapy for Locally Advanced Esophageal Cancer
The Role of Surgery in Trimodality Therapy and Salvage Surgery
Surveillance
Palliative Options for Esophageal Cancer
SUMMARY
ANNOTATED REFERENCES
REFERENCES
43 - Gastroesophageal Reflux Disease and Hiatal Hernia
GASTROESOPHAGEAL REFLUX DISEASE
Pathophysiology
Clinical Presentation
Typica Symptoms of GERD
Extraesophageal Symptoms of GERD
Pulmonary Disease, GERD, and Antireflux Surgery
Physical Examination
Preoperative Diagnostic Testing
Ambulatory pH and Impedance Monitoring
Esophageal Manometry
Esophagogastroduodenoscopy
Barium Esophagram
Additional Preoperative Considerations
Dysphagia
Obesity
Ineffective Esophageal Motility
Barrett Esophagus
Treatment of GERD
Medical Management
Surgical Management
Operative Technique
Creation of a 360-Degree Fundoplication
Creation of a Partial Fundoplication
Intraoperative Management of Short Esophagus
Postoperative Care and Recovery
Clinical Outcomes of Antireflux Surgery
Operative Complications and Side Effects of Antireflux Surgery
Alternative Operative Therapies for GERD
Transoral Incisionless Fundoplication
Magnetic Sphincter Augmentation
PARAESOPHAGEAL HERNIA
Pathophysiology
Clinical Presentation
Preoperative Evaluation
Operative Repair
Acute Gastric Volvulus
SUMMARY
SELECTED REFERENCES
REFERENCES
VIDEOS
X - Abdomen
44 - Abdominal Wall, Umbilicus, Peritoneum, Mesenteries, Omentum and Retroperitoneum
ABDOMINAL WALL AND UMBILICUS
Embryology
Anatomy
Subcutaneous Tissues
Muscle and Investing Fasciae
Preperitoneal Space and Peritoneum
Vessels and Nerves of the Abdominal Wall
Vascular Supply
Innervation
Abnormalities of the Abdominal Wall
Congenital Abnormalities
Malignant Neoplasms of the Abdominal Wall
Desmoid Tumor
Abdominal Wall Sarcoma
Metastatic Disease
Symptoms of Intraabdominal Disease Referred to the Abdominal Wall
PERITONEUM AND PERITONEAL CAVITY
Anatomy
Physiology
Peritoneal Disorders
Ascites
Malignant Neoplasms of the Peritoneum
MESENTERY AND OMENTUM
Embryology and Anatomy
Physiology
Diseases of the Omentum
Omental Cysts
Omental Torsion and Infarction
Omental Neoplasms
Omental Grafts and Transpositions
Diseases of the Mesentery
Mesenteric Cysts
Acute Mesenteric Lymphadenitis
Sclerosing Mesenteritis
Intraabdominal (Internal) Hernias
Internal Hernias Caused by Developmental Defects
Acquired Internal Hernias
Malignant Neoplasms of the Mesentery
Mesenteric and Intraabdominal Desmoid Tumors
RETROPERITONEUM
Anatomy
Operative Approaches
Retroperitoneal Disorders
Retroperitoneal Abscesses
Retroperitoneal Hematomas
Retroperitoneal Fibrosis
Retroperitoneal Malignant Neoplasms
Retroperitoneal Sarcoma
SELECTED REFERENCES
REFERENCES
45 - Hernias
INGUINAL HERNIAS
Incidence
Anatomy of the Groin
External Oblique Muscle and Aponeurosis
Internal Oblique Muscle and Aponeurosis
Transversus Abdominis Muscle and Aponeurosis and Transversalis Fascia
Pectineal (Cooper) Ligament
Inguinal Canal
Preperitoneal Space
Femoral Canal
Diagnosis
Classification
Treatment
Nonoperative Management
Complications and Results of Inguinal Hernia Repair
FEMORAL HERNIAS
SPECIAL PROBLEMS
Sliding Inguinal Hernia
Recurrent Inguinal Hernia
Strangulated Inguinal Hernia
Bilateral Inguinal Hernias
COMPLICATIONS AND RESULTS
Surgical Site Infection
Nerve Injuries and Chronic Pain Syndromes
Ischemic Orchitis and Testicular Atrophy
Injury to the Vas Deferens and Viscera
Inguinal Hernia Recurrence
Quality of Life
VENTRAL HERNIAS
Incidence
Anatomy
Diagnosis
Classification
Umbilical Hernia
Epigastric Hernia
Incisional Hernia
Treatment: Operative Repair
Results of Incisional Hernia Repairs
UNUSUAL HERNIAS
Types
Spigelian Hernia
Obturator Hernia
Lumbar Hernia
Interparietal Hernia
Sciatic Hernia
Perineal Hernia
Loss of Domain Hernias
Parastomal Hernia Repair
Complications
General Considerations
Mesh Infection
Seromas
Enterotomy
SELECTED REFERENCES
REFERENCES
46 - Acute Abdomen
ANATOMY AND PHYSIOLOGY
HISTORY
PHYSICAL EXAMINATION
LABORATORY STUDIES
DIAGNOSTIC IMAGING
INTRAABDOMINAL PRESSURE MONITORING
DIFFERENTIAL DIAGNOSIS
PREPARATION FOR EMERGENCY OPERATION
SPECIAL PATIENT POPULATIONS
Pregnancy
Pediatrics
Critical Illness
Immunocompromised
Cardiac Patients
Morbidly Obese
Elderly
Advanced Disease
SUMMARY
SELECTED REFERENCES
REFERENCES
47 - Acute Gastrointestinal Hemorrhage
ACUTE MANAGEMENT OF PATIENTS WITH GASTROINTESTINAL HEMORRHAGE
Initial Evaluation
Acute Exsanguination
Localization
Obscure Bleeding
SPECIFIC CAUSES OF UGIB
Nonvariceal Bleeding
Peptic Ulcer Disease
Esophagitis
Gastritis
Mallory-Weiss Tears
Gastric Antral Vascular Ectasia
Dieulafoy Lesion
Hemobilia
Malignancy
Inflammatory Bowel Disease
Aortoenteric Fistula
Hemosuccus Pancreaticus
Procedure-Related Bleeding
Variceal Hemorrhage
ACUTE LOWER GASTROINTESTINAL HEMORRHAGE
Diagnosis
Colonoscopy
Angiography
Surgical Management
Specific Causes of Lower Gastrointestinal Tract Bleeding
Diverticula
Colitis
Angiodysplasia/Arteriovenous Malformation
Neoplasms
Ischemia
Infectious
Diverticula
Radiation Therapy
SELECTED REFERENCES
REFERENCES
48 - Morbid Obesity
Obesity: The Magnitude of the Problem
Medical Versus Surgical Therapy
Bariatric Surgery Mechanism of Action
The Enteroencephalic Endocrine Axis
Enteroinsular Endocrine Axis
Preoperative Evaluation and Selection
Eligibility
General Bariatric Preoperative Evaluation and Preparation
Evaluation of Specific Comorbid Conditions
Special Equipment
Clinic
Operating Room
Operative Procedures
Laparoscopic Adjustable Gastric Banding
Roux-en-Y Gastric Bypass
Biliopancreatic Diversion
Duodenal Switch
Laparoscopic Sleeve Gastrectomy
Postoperative Care and Follow-Up
Laparoscopic Adjustable Gastric Banding
Roux-en-Y Gastric Bypass, Biliopancreatic Diversion, Duodenal Switch, and Laparoscopic Sleeve Gastrectomy
Bariatric Surgery Results
Laparoscopic Adjustable Gastric Banding
Roux-en-Y Gastric Bypass
Recovery After Roux-en-Y Gastric Bypass Is Improved After a Laparoscopic Approach
Biliopancreatic Diversion and Duodenal Switch
Laparoscopic Sleeve Gastrectomy
Complications of Bariatric Surgery
Laparoscopic Adjustable Gastric Banding
Roux-en-Y Gastric Bypass
Biliopancreatic Diversion and Duodenal Switch
Laparoscopic Sleeve Gastrectomy
Reoperative Surgery
Preoperative Use of Endoscopy
Intraoperative Endoscopy
Postoperative Endoscopy
Endoscopic Management of Complications After Bariatric Surgery
Strictures After Bariatric Surgery
Weight Regain After Bariatric Surgery
Primary Endoscopic Weight Loss Procedures
Controversies in Bariatric Surgery
Conclusion
Selected References
References
49 - Stomach
Anatomy
Gross Anatomy
Divisions
Blood Supply
Lymphatic Drainage
Innervation
Gastric Morphology
Gastric Microscopic Anatomy
Physiology
Regulation of Gastric Function
Gastric Peptides
Gastrin
Somatostatin
Histamine
Ghrelin
Gastric Acid Secretion
Stimulated Acid Secretion
Activation and Secretion by the Parietal Cell
Pharmacologic Regulation
Gastric Motility
Fasting Gastric Motility
Postprandial Gastric Motility
Abnormal Gastric Motility
Gastric-Emptying Studies
Treatment
Gastric Barrier Function
Peptic Ulcer Disease
Epidemiology
Pathogenesis
Helicobacter pylori Infection
Nonsteroidal Antiinflammatory Drugs
Gastric Ulcers
Clinical Manifestations
Diagnosis and Treatment
Duodenal Ulcer
Diagnosis
Medical Treatment
Complicated Ulcer Disease
Surgical Procedures for Peptic Ulcers
Stress Gastritis
Pathophysiology
Presentation and Diagnosis
Prophylaxis
Treatment
Postgastrectomy Syndromes
Dumping Syndrome
Metabolic Disturbances
Afferent Loop Syndrome
Efferent Loop Obstruction
Alkaline Reflux Gastritis
Gastric Atony
Gastric Cancer
Epidemiology
Risk Factors
Helicobacter pylori Infection
Dietary Factors
Hereditary Risk Factors and Cancer Genetics
Polyps
Proton pump inhibitors
Other Risk Factors
Pathology
Diagnosis and Workup
Signs and Symptoms
Screening
Staging
Staging Workup
Treatment
Surgical Therapy
Endoscopic Resection
Extent of Lymph Node Dissection
Locally Advanced Gastric Cancer
Adjuvant and Neoadjuvant Therapy
Palliative Therapy and Systemic Therapy
Outcomes
Recurrence
Gastric Lymphoma
Epidemiology
Pathology
Evaluation and Staging
Treatment
Mucosa-Associated Lymphoid Tissue Lymphomas
Treatment
Gastrointestinal Stromal Tumors
Adjuvant Therapy
Other Neoplasms
Gastric Neuroendocrine Tumors
Heterotopic Pancreas
Other Gastric Lesions
Hypertrophic Gastritis (Ménétrier Disease)
Mallory-Weiss Tear
Dieulafoy Gastric Lesion
Gastric Varices
Gastric Volvulus
Gastric Bezoars
Selected References
References
50 - Small Intestine
Embryology
Anatomy
Gross Anatomy
Neurovascular-Lymphatic Supply
Microscopic Anatomy
Physiology
Digestion and Absorption
Carbohydrates
Protein
Water, Electrolytes, and Vitamins
Motility
Endocrine Function
Gastrointestinal Hormones
Receptors
Immune Function
Obstruction
Causes
Pathophysiology
Clinical Manifestations and Diagnosis
History
Physical Examination
Laboratory and Radiologic Studies
Simple Versus Strangulating Obstruction
Treatment
Fluid Resuscitation and Antibiotics
Tube Decompression
Contrast Challenge
Operative Management
Management of Specific Problems
Recurrent Intestinal Obstruction
Acute Postoperative Obstruction
Ileus
Inflammatory and Infectious Diseases
Crohn Disease
History
Incidence and Epidemiology
Etiology
Pathology
Clinical Manifestations
Diagnosis
Prognosis
Typhoid Enteritis
Enteritis in the Immunocompromised Host
Protozoa
Bacteria
Mycobacteria
Viruses
Fungi
Neoplasms
General Considerations
Clinical Manifestations
Diagnosis
Benign Neoplasms
Stromal Tumors
Malignant Neoplasms
Neuroendocrine Neoplasms
Adenocarcinomas
Lymphoma
Gastrointestinal Stromal Tumors
Metastatic Neoplasms
Diverticular Disease
Duodenal Diverticula
Incidence and Cause
Clinical Manifestations
Treatment
Jejunal and Ileal Diverticula
Incidence and Cause
Clinical Manifestations
Treatment
Meckel Diverticulum
Incidence and Cause
Clinical Manifestations
Diagnostic Studies
Treatment
Miscellaneous Problems
Small Bowel Ulcerations
Ingested Foreign Bodies
Small Bowel Fistulas
Clinical Manifestations
Pneumatosis Intestinalis
Blind Loop Syndrome
Radiation Enteritis
Short Bowel Syndrome
Treatment
Vascular Compression of the Duodenum
Selected References
References
51 - The Appendix
Anatomy and Embryology
Videos
Appendicitis
History
Pathophysiology and Bacteriology
Differential Diagnosis
Presentation
History
Physical Examination
Laboratory Studies
Imaging Studies
Treatment of Appendicitis
Acute Uncomplicated Appendicitis
Perforated Appendicitis
Laparoscopic Versus Open Appendectomy
Delayed Presentation of Appendicitis
The Normal-Appearing Appendix at Operation
“Chronic” Appendicitis as a Cause of Abdominal Pain
Incidental Appendectomy
Appendicitis in Special Populations
Appendicitis in the Pregnant Patient
Appendicitis in the Elderly
Appendicitis in the Immunocompromised Patient
Neoplasms of the Appendix
Selected References
References
52 - Colon and Rectum
EMBRYOLOGY OF THE COLON AND RECTUM
ANATOMY OF THE COLON, RECTUM, AND PELVIC FLOOR
PHYSIOLOGY OF THE COLON
PREOPERATIVE EVALUATION
SELECTED REFERENCES
REFERENCES
53 - Anus
Anatomy
Physiology
Diagnosis
History
Physical Examination
Imaging
Common Benign Disorders of the Anus
Internal Hemorrhoids
Anal Fissure
Abscess/Fistula (Including Rectovaginal Fistula)
Pilonidal Sinus
Sexually Transmitted Diseases
Hidradenitis Suppurativa
Perianal Crohn Disease
Anorectal Emergencies
Fourth-Degree Hemorrhoids
Fournier Gangrene
Immunocompromised States
Horseshoe Abscess
Incarcerated Rectal Prolapse
Pelvic Floor
Neoplasms
Anal Intraepithelial Neoplasia
Squamous Cell Carcinoma
Perianal Paget Disease
Basal Cell Carcinoma
Malignant Melanoma
Adenocarcinoma of the Anal Canal
Selected References
References
54 - The Liver
Historical Perspective
Anatomy and Physiology
Anatomy
Gross Anatomy
Functional Anatomy
Functions
Energy
Functional Heterogeneity
Blood Flow
Bile Formation
Enterohepatic Circulation
Bilirubin Metabolism
Carbohydrate Metabolism
Lipid Metabolism
Protein Metabolism
Vitamin Metabolism
Coagulation
Metabolism of Drugs and Toxins (Xenobiotics)
Regeneration
Future Developments
Assessment of Liver Function
Routine Screening Tests
Specific Diagnostic Tests
Quantitative Tests
Portal Hypertension
Definition
Pathophysiology
Assessment of Chronic Liver Disease and Portal Hypertension
Variceal Hemorrhage
Treatment
Prevention of Recurrent Variceal Hemorrhage
Algorithm for Management of Variceal Hemorrhage
Infectious Diseases
Pyogenic Abscess
Epidemiology
Pathogenesis
Pathology and Microbiology
Clinical Features
Differential Diagnosis
Treatment
Outcomes
Amebic Abscess
Epidemiology
Pathogenesis
Pathology
Clinical Features
Differential Diagnosis
Treatment
Outcomes
Hydatid Cyst
Recurrent Pyogenic Cholangitis
Neoplasms
Solid Benign Neoplasms
Liver Cell Adenoma
Focal Nodular Hyperplasia
Hemangioma
Other Benign Tumors
Primary Solid Malignant Neoplasms
Hepatocellular Carcinoma
Intrahepatic Cholangiocarcinoma
Other Primary Malignant Neoplasms
Metastatic Tumors
Colorectal Metastases
Neuroendocrine Metastases
Noncolorectal, Nonneuroendocrine Metastases
Cystic Neoplasms
Simple Cyst
Cystadenoma and Cystadenocarcinoma
Polycystic Liver Disease
Bile Duct Cysts
Principles of Hepatic Resection
Hemobilia
Causes
Clinical Presentation
Diagnostic Workup
Treatment and Outcomes
Bilhemia
Viral Hepatitis and the Surgeon
Definition
Diagnosis
Epidemiology and Transmission
Pathogenesis and Clinical Presentation
Prevention
Treatment
Selected References
References
55 - Biliary System
Anatomy and Physiology
Vascular Anatomy
Biliary Tree Pathophysiology
Laboratory Tests
Imaging Studies
Plain Films
Ultrasound
Hepatic Iminodiacetic Acid Scan
Computed Tomography
Magnetic Resonance Imaging and Magnetic Resonance Cholangiopancreatography
Endoscopic Retrograde Cholangiopancreatography
Percutaneous Transhepatic Cholangiography
Intraoperative Cholangiography
Endoscopic Ultrasound
Fluorodeoxyglucose Positron Emission Tomography
Bacteriology
Benign Biliary Disease
Calculous Biliary Disease
Natural History
Nonoperative Treatment of Cholelithiasis
Chronic Cholecystitis
Diagnosis
Treatment
Acute Calculous Cholecystitis
Presentation
Diagnosis
Treatment
Choledocholithiasis
Diagnosis
Treatment
Gallstone Pancreatitis
Gallstone Ileus
Treatment
Noncalculous Biliary Disease
Acute Acalculous Cholecystitis
Biliary Dyskinesia
Sphincter of Oddi Dysfunction
Primary Sclerosing Cholangitis
Biliary Strictures
Biliary Cysts
Polypoid Lesions of the Gallbladder
Benign Biliary Masses
Surgery for Calculous Biliary Disease
Laparoscopic Cholecystectomy
Bailout Procedures
Open Cholecystectomy
Open CBD Exploration
Laparoscopic CBD Exploration
Postcholecystectomy Syndromes
Bile Duct Injury
Biliary Leak
Lost Stones
Postcholecystectomy Pain
Retained Biliary Stones
Acute Cholangitis
Recurrent Pyogenic Cholangitis
Malignant Biliary Disease
Gallbladder Cancer
Incidence
Cause
Pathology and Staging
Clinical Presentation
Diagnosis
Treatment
Adjuvant Therapy
Survival
Bile Duct Cancer
Risk Factors
Staging and Classification
Clinical Presentation
Diagnosis and Assessment of Resectability
Outcomes
Metastatic and Other Tumors
Selected References
References
56 - Exocrine Pancreas
ANATOMY
Arterial Blood Supply
Venous Drainage
EMBRYOLOGY
Annular Pancreas
Ectopic Pancreas
Pancreas Divisum
PHYSIOLOGY
Major Components of Pancreatic Juice
Phases and Regulation of Pancreatic Secretion
ACUTE PANCREATITIS
Pathophysiology
Risk Factors
Biliary or Gallstone Pancreatitis
Alcohol-Induced Injury
Anatomic Obstruction
Endoscopic Retrograde Cholangiopancreatography–Induced Pancreatitis
Drug-Induced Pancreatitis
Metabolic Factors
Miscellaneous Conditions
Clinical Manifestations
Diagnosis
Imaging Studies
Assessment of Severity of Disease
Treatment
Complications
Sterile and Infected Peripancreatic Fluid Collections
Pancreatic Necrosis and Infected Necrosis
Pancreatic Pseudocysts
Pancreatic Ascites and Pancreaticopleural Fistulas
Vascular Complications
Pancreatocutaneous Fistula
CHRONIC PANCREATITIS
Risk Factors
Alcohol Abuse
Smoking
Gene Mutations
Types of Chronic Pancreatitis
Autoimmune Pancreatitis
Tropical Pancreatitis
Idiopathic Pancreatitis
Clinical Manifestations
Diagnosis
Imaging Studies
Functional Tests
Treatment
Medical Treatment
Pain Management
Pancreatic Exocrine Insufficiency
Endocrine Insufficiency
Interventional Therapy: Endoscopic Treatment
Surgical Treatment
CYSTIC NEOPLASMS OF THE PANCREAS
Types of Cystic Neoplasms
Serous Cystic Neoplasm
Mucinous Cystic Neoplasm
Intraductal Papillary Mucinous Neoplasm
Management Strategies for Intraductal Papillary Mucinous Neoplasm
Treatment: Surgical Resection for Intraductal Papillary Mucinous Neoplasm
ADENOCARCINOMA OF THE EXOCRINE PANCREAS
Epidemiology
Risk Factors
Environmental Risk Factors and Causes
Hereditary Risk Factors
Pathogenesis of Sporadic Pancreatic Cancer
Genetic Progression of Pancreatic Intraepithelial Neoplasia to Invasive Pancreatic Ductal Adenocarcinoma
Clinical Presentation
Diagnosis
Laboratory Evaluation
Imaging Studies
Staging
Laparoscopy
Treatment
Surgery for Tumors of the Head of the Pancreas
Surgery for Tumors of the Body and Tail of the Pancreas
Laparoscopic Distal Pancreatectomy
Outcomes
Perioperative Mortality: Long-Term Survival
Morbidity
Controversies
Palliative Bypass in the Case of Unresectable/Metastatic Disease
Pylorus-Preserving versus Non–Pylorus-Preserving Whipple Procedure
Pancreaticojejunostomy Versus Pancreatogastrostomy
Use of Somatostatin Analogues to Reduce Pancreatic Fistula
Extent of Lymphadenectomy
Laparoscopic and Robotic Pancreaticoduodenectomy
Antecolic versus Retrocolic Duodenojejunostomy
Drain Versus No Drain
Irreversible Electroporation
Adjuvant Therapy for Pancreatic Cancer
Chemotherapy and Radiation Therapy
Role of Neoadjuvant Therapy
Chemotherapy for Metastatic Pancreatic Adenocarcinoma
Palliative Therapy for Pancreatic Cancer
Biliary Obstruction
Gastric Outlet Obstruction
Pain Relief
PANCREATIC TRAUMA
SELECTED REFERENCES
REFERENCES
57 - The Spleen
SPLENIC ANATOMY
SPLENIC FUNCTION
SPLENECTOMY
SELECTED REFERENCES
REFERENCES
XI - Chest
58 - Lung, Chest Wall, Pleura and Mediastinum
ANATOMY
Physiologic Evaluation
LUNG
Congenital Lesions of the Lung
Congenital Abnormalities of the Trachea and Bronchi
Congenital Vascular Disorders
LUNG CANCER
Pathology
Screening
Diagnosis
Staging
Evaluation of Tumor (T) Stage
Evaluation of Nodal (N) Stage
Evaluation of Metastasis (M) Stage
Current Lung Cancer Eighth Edition Staging System
Tumor (T)
Lymph Nodes (N)
Metastases (M)
Results of Treatment for Lung Cancer
Local Therapy for Early-Stage Non–Small Cell Lung Cancer
Neoadjuvant and Adjuvant Therapy
Treatment of Metastatic Disease
TRACHEA
Benign Stenosis of the Trachea
Primary Neoplasm of the Trachea
Tracheal Trauma
Principles of Tracheal Surgery
PULMONARY INFECTIONS
Bronchiectasis
Lung Abscess
Other Bronchopulmonary Disorders
Mycobacterial Infections
Fungal and Parasitic Infections
MASSIVE HEMOPTYSIS
EMPHYSEMA AND DIFFUSE LUNG DISEASE
Emphysema
Diffuse Lung Disease
Adult Respiratory Distress Syndrome
PULMONARY METASTASES
MISCELLANEOUS LUNG TUMORS
CHEST WALL
Congenital Deformities
Pectus Excavatum
Pectus Carinatum
Chest Wall Tumors
General
Bone Tumors
Soft Tissue Tumors
Metastatic Tumors
Chest Wall Infections
Chest Wall Trauma
THORACIC OUTLET SYNDROME
Diagnosis
Management
PLEURA
Pleural Effusions
Benign Pleural Effusions
Malignant Pleural Effusion
Empyema
Chylothorax
Pneumothorax
Mesothelioma
Solitary Fibrous Tumor of the Pleura
MEDIASTINUM
Anterosuperior Compartment
Middle Compartment
Posterior or Paravertebral Sulci Compartment
Clinical Manifestations and Diagnosis
Evaluation and Diagnostic Imaging
Histologic Diagnosis
PRIMARY MEDIASTINAL CYSTS
PRIMARY MEDIASTINAL NEOPLASMS
Thymoma
Germ Cell Tumors
Teratomas
Malignant Nonteratomatous Germ Cell Tumors
Seminomas
Nonseminomatous Tumors
Neurogenic Tumors
Neuroblastoma
Ganglion Tumors
Paraganglioma (Pheochromocytoma)
Lymphomas
Endocrine Tumors
Thyroid Tumors
Parathyroid Tumors
Neuroendocrine Tumors
SELECTED REFERENCES
REFERENCES
59 - Congenital Heart Disease
HISTORY AND OTHER CONSIDERATIONS
ANATOMY, TERMINOLOGY, AND DIAGNOSIS
Anatomy and Terminology
Diagnosis
Physical Examination
PERIOPERATIVE CARE
Anesthesia Pitfalls
Neurologic Outcomes
LESION OVERVIEW
Defects Associated With Increased Pulmonary Blood Flow
Persistent Arterial Duct (Patent Ductus Arteriosus)
Aortopulmonary Septal Defect (Aortopulmonary Window)
Atrial Septal Defect
Ventricular Septal Defect
Perimembranous Ventricular Septal Defect
Muscular Ventricular Septal Defect
Subarterial (Supracristal or Outlet) Ventricular Septal Defect
Atrioventricular Septal Defect (Atrioventricular Canal Defect)
Adult Patients With Atrioventricular Septal Defect
Persistent Arterial Trunk (Truncus Arteriosus)
Abnormalities of Venous Drainage
Total Anomalous Pulmonary Venous Return
Anomalous Systemic Venous Drainage
Cyanotic Congenital Heart Disease
Tetralogy of Fallot
Pulmonary Atresia and Intact Ventricular Septum
Pulmonary Atresia With Ventricular Septal Defect
Valvular Pulmonic Stenosis
Conotruncal Anomalies
Transposition of the Great Arteries
Double-Outlet Right Ventricle
Congenitally Corrected Transposition of the Great Arteries (l-Transposition)
Left Ventricular Outflow Tract Obstruction
Valvular Aortic Stenosis
Fibromuscular Subaortic Stenosis
Tunnel Subaortic Stenosis
Aortic Arch Anomalies
Aortic Coarctation
Interrupted Aortic Arch
SINGLE VENTRICLE
Tricuspid Atresia
Hypoplastic Left Heart Syndrome
Neonatal Cardiac Transplantation
Norwood Reconstruction
Sano Modification of the Norwood Operation
Hybrid Procedure
Fontan Operation
MISCELLANEOUS ANOMALIES
Vascular Rings and Pulmonary Artery Slings
Vascular Rings
Pulmonary Artery Slings
Diagnosis and Indications for Intervention
Surgery
Coronary Artery Anomalies
Anomalous Left Coronary Artery Rising From the Pulmonary Artery
Coronary Arteriovenous Fistula and Aneurysms
Ebstein Anomaly of the Tricuspid Valve
Diagnosis and Intervention
Surgery
Mitral Valve Anomalies
Mitral Stenosis
SUMMARY
SELECTED REFERENCES
REFERENCES
60 - Acquired Heart Disease: Coronary Insufficiency
CORONARY ARTERY ANATOMY AND PHYSIOLOGY
Anatomic Considerations
ATHEROSCLEROTIC CORONARY ARTERY DISEASE
Pathogenesis
Fixed Coronary Obstructions
CLINICAL MANIFESTATIONS AND DIAGNOSIS OF CORONARY ARTERY DISEASE
Clinical Presentation
Physical Examination
Diagnostic Testing
Biochemical Studies
Chest Radiography
Resting Electrocardiography
Functional (Stress) Tests
Echocardiography
Multidetector Computed Tomography
Magnetic Resonance Imaging
Cardiac Catheterization and Intervention
Fractional Flow Reserve
Intravascular Ultrasonography
Hybrid Imaging
Coronary Artery Bypass Grafting Versus Contemporaneous Medical Therapy
Percutaneous Coronary Intervention Versus Medical Therapy
Coronary Artery Bypass Grafting Versus Balloon Angioplasty or Bare-Metal Stents
Coronary Artery Bypass Grafting Versus Drug-Eluting Stents
Left Main Coronary Artery Disease
CABG or PCI Versus Medical Therapy for Left Main CAD
Studies Comparing PCI Versus CABG for Left Main CAD
Revascularization Options for LCA CAD
Proximal LAD Artery Disease
Completeness of Revascularization
Left Ventricular Systolic Dysfunction
Revascularization Options for Previous CABG
Unstable Angina/Non–ST-Segment Elevation Myocardial Infarction
ST-Segment Elevation Myocardial Infarction–Acute Myocardial Infarction
Percutaneous Coronary Intervention Versus Medical Management for Acute Myocardial Infarction
Role of Coronary Artery Bypass Grafting
Preoperative Evaluation
Technique of Myocardial Revascularization: Conventional On-Pump Cardiopulmonary Bypass
Positioning and Draping
Cardiopulmonary Bypass
Neurologic Protection During Cardiopulmonary Bypass
Median Sternotomy
Total Arterial Revascularization
Cannulation for Cardiopulmonary Bypass
Cardiac Arrest and Myocardial Protection
Target Identification and Distal Anastomosis
Separation from Cardiopulmonary Bypass
Hemostasis
Sternal Closure and Completion of Surgery
ADJUNCTS TO CORONARY ARTERY BYPASS GRAFTING
Transesophageal Echocardiography
Inotropes and Pharmacotherapy
Intraaortic Balloon Pump
POSTOPERATIVE CARE
Pulmonary Care
Discharge From the Intensive Care Unit
Outcomes
Hospital Mortality
Long-Term Survival
Medical Adjuncts for Postoperative Management
ALTERNATIVE METHODS FOR MYOCARDIAL REVASCULARIZATION
On-Pump Beating-Heart Bypass
Off-Pump Coronary Artery Bypass Grafting
Minimally Invasive Direct Coronary Artery Bypass
Robotics: Totally Endoscopic Coronary Artery Bypass
Transmyocardial Laser Revascularization
Hybrid Procedures
Technical Aspects of Reoperative Coronary Artery Bypass Grafting
MECHANICAL COMPLICATIONS OF CORONARY ARTERY DISEASE
Left Ventricular Aneurysm
Ventricular Septal Defect
Mitral Regurgitation
CORONARY ARTERY BYPASS GRAFTING AND SPECIAL POPULATIONS OF PATIENTS
Patients With Diabetes
Older Patients
Women
Patients With Renal Disease
Obese Patients
ACKNOWLEDGMENTS
SELECTED REFERENCES
REFERENCES
61 - Acquired Heart Disease: Valvular
HISTORY OF HEART VALVE SURGERY
VALVE ANATOMY
Surgical Anatomic Relationships
Mitral Stenosis
Rheumatic Heart Disease
Aortic Stenosis
Mitral Regurgitation
Aortic Insufficiency
Endocarditis
Right-Sided Valvular Disease
PATHOPHYSIOLOGY OF VALVULAR HEART DISEASE
VALVE DISEASE SYNDROMES
Mitral Stenosis
Interventional Management
Percutaneous Balloon Mitral Commissurotomy
Open Mitral Commissurotomy
Mitral Valve Replacement
Mitral Regurgitation
Diagnostic Testing
Natural History
AORTIC STENOSIS
Diagnosis of Aortic Stenosis
Symptoms and Signs
Physical Exam
Diagnostic Testing
Natural History
Surgical treatment
Aortic Insufficiency
Diagnostic Testing
Natural History
Surgical Treatment
Tricuspid Regurgitation and Other Right-Sided Valve Disease
Natural History
Mixed Valve Disease
OPERATIVE APPROACHES
Conduct of Heart Valve Surgery
Mitral Valve Replacement and Repair
Mitral Valve Replacement
Mitral Valve Repair
Surgical Aortic Valve Replacement and Aortic Valve Repair
Prosthetic valves
Transcatheter Aortic Valve Replacement and Other Emerging Technologies
Percutaneous Mitral Interventions
SELECTED REFERENCES
REFERENCES
XII - Vascular
62 - The Aorta
EMBRYOLOGY, ANATOMY, AND NOMENCLATURE
PATHOLOGY, MANAGEMENT, AND OUTCOMES
Acute Aortic Syndromes
Aortic Dissection, Intramural Hematoma, and Penetrating Aortic Ulcers
Aortic Dissection
Intramural Hematoma
Penetrating Aortic Ulcer
Blunt Thoracic Aortic Injury
Acute Type A Aortic Dissection
Aortic Root Replacement
Open Surgery of the Descending Thoracic Aorta
Thoracoabdominal Aortic Aneurysms
Open Infrarenal Abdominal Aortic Aneurysm Repair
Endovascular Principles
Endovascular Approaches to the Thoracic Aorta
REFERENCES
63 - Peripheral Arterial Disease
EPIDEMIOLOGY AND DEMOGRAPHICS
PATIENT PRESENTATIONS AND NATURAL HISTORY
PATHOPHYSIOLOGY AND ANATOMY
EVALUATION OF THE PATIENT WITH PERIPHERALARTERY DISEASE
MEDICAL MANAGEMENT
ASSESSMENT OF OUTCOMES
SELECTED REFERENCES
REFERENCES
64 - Vascular Trauma
Mechanism of Injury and Pathophysiology
Clinical Presentation
Diagnosis
Endovascular Management
Endovascular Operating Rooms
Endovascular Management of Torso Vascular Injuries
Endovascular Management of Cerebrovascular Vascular Injuries
Endovascular Management of Extremity Vascular Injuries
Who Should Perform Endovascular Repairs
Open Surgical Management
Preparation for Operative Management
Vascular Exposure and Control
Vascular Damage Control
Choice of Repair and Graft Material
Intraoperative Imaging and Noninvasive Evaluation
Role of Tissue Coverage
Role of Fasciotomy
Role of Immediate Amputation
Common Errors and Pitfalls
Specific Injuries
Head, Neck, and Thoracic Outlet
Intrathoracic Great Vessels
Abdominal Vascular Injury
Upper Extremity
Lower Extremity
Operative Techniques for Extremity Fasciotomy
Postoperative Management
Outcomes and Follow-Up
General Surgery Training
Vascular Fellowship Training
Vascular Trauma Realities
Need for Remedial Training and Review
The Need for Action
Selected References
References
65 - Venous Disease
Videos
Anatomy
Superficial Venous System
Deep Venous System
Venous System Perforators
Normal Venous Histology and Function
Venous Insufficiency
Risk Factors
Pathology
Mechanical Abnormalities
Symptoms
Physical Examination
Diagnostic Evaluation of Venous Dysfunction
Phlebography and Venography
Magnetic Resonance and Computed Tomography Venous Imaging
Classification Systems
Treatment of Superficial Venous Insufficiency
Nonoperative Management
Treatment Options for Telangiectasias
Ultrasound-Guided Sclerotherapy
Nontumescent Ablation and Future Modalities for Axial Vein Incompetence
Treatment of Branch Varicosities
Secondary Venous Insufficiency
Deep Venous Thrombosis
Lower Extremity Deep Venous Thrombosis
Causes
Stasis
Hypercoagulable State
Venous Injury
Diagnostic Considerations
Incidence
Clinical Diagnosis
Imaging Studies and Laboratory Tests
Venography
Impedance Plethysmography
Fibrin and Fibrinogen Assays
Duplex Ultrasound
Magnetic Resonance Venous Imaging
Prophylaxis
Treatment
Upper Extremity Deep Venous Thrombosis
Treatment
Superficial Thrombophlebitis
Conclusion
Selected References
References
Videos
66 - The Lymhatics
EMBRYOLOGY AND ANATOMY
FUNCTION AND STRUCTURE
PATHOPHYSIOLOGY AND STAGING
DIFFERENTIAL DIAGNOSIS
CLASSIFICATION
DIAGNOSTIC TESTS
New Diagnostic Tests
THERAPY
General Therapeutic Measures
Elevation and Compression Garments
Complex Decongestive Physical Therapy
Compression Pump Therapy
Drug Therapy
Molecular Lymphangiogenesis
Operative Treatment
CHYLOTHORAX
CHYLOPERITONEUM
TUMORS OF THE LYMPHATICS
SELECTED REFERENCES
REFERENCES
XIII - Specialties in General Surgery
67 - Pediatric Surgery
NEONATAL PHYSIOLOGY
Cardiopulmonary
FLUIDS, ELECTROLYTES, AND NUTRITION
Fluid and Electrolytes
Nutrition
HEAD AND NECK LESIONS
Dermoid and Epidermoid Cysts
Lymphadenopathy
Cystic Hygroma
Thyroglossal Duct Cyst
Branchial Cleft Remnants
EXTRACORPOREAL LIFE SUPPORT
Indications
Physiology
DIAPHRAGMATIC CONDITIONS
Congenital Diaphragmatic Hernia
Pathogenesis
Clinical Presentation
Management
Surgical Repair
Eventration of Diaphragm
BRONCHOPULMONARY MALFORMATIONS
Bronchogenic Cyst
Congenital Pulmonary Airway Malformation
Pulmonary Sequestration
Congenital Lobar Emphysema
ALIMENTARY TRACT CONDITIONS
Esophageal Atresia and Tracheoesophageal Fistula
Gastroesophageal Reflux
Hypertrophic Pyloric Stenosis
Intestinal Atresia
Intestinal Malrotation and Midgut Volvulus
Necrotizing Enterocolitis
Short Bowel Syndrome
Meconium Ileus
Meconium Plug Syndrome
Hirschsprung Disease
Anorectal Malformation
Intussusception
Meckel Diverticulum
Appendicitis
HEPATOPANCREATICOBILIARY CONDITIONS
Extrahepatic Biliary Atresia
Choledochal Cyst
Hereditary Pancreatitis and Pancreas Divisum
Biliary Dyskinesia
ABDOMINAL WALL CONDITIONS
CHEST WALL DEFORMITIES
GENITOURINARY TRACT CONDITIONS
Cryptorchidism
Testicular Torsion
Testicular Tumors
PEDIATRIC SOLID TUMORS
Neuroblastoma
Wilms Tumor
Rhabdomyosarcoma
Liver Tumors
Teratoma
Sacrococcygeal Teratomas
Ovarian Tumor
Germ Cell Tumors
Sex Cord Tumors
Epithelial Tumors
PEDIATRIC TRAUMA
Head and Spine Injuries
Thoracic Trauma
Abdominal Trauma
Pancreatic Injury
Renal Injury
SELECTED REFERENCES
REFERENCES
68 - Neurosurgery
Intracranial Dynamics
Cerebrovascular Disorders
Arteriovenous Malformations
Cavernous Malformations
Capillary Telangiectasia
Developmental Venous Anomaly: Venous Angioma
Traumatic Fistula
Aneurysms
Saccular Aneurysms
Spontaneous Intracerebral Hemorrhage
Mycotic Aneurysms
Moyamoya Disease
Dural Arteriovenous Malformations
Ischemic Strokes
Central Nervous System Tumors
Intracranial Tumors
Clinical Presentation
Imaging Studies
Surgery
Primary Brain Tumors
Intraaxial Brain Tumors
Oligodendroglioma
Ependymoma
Choroid Plexus Papilloma and Carcinoma
Pediatric Brainstem Gliomas
Neuronal and Mixed Neuronal-Glial Tumors
Ganglioglioma and Gangliocytoma
Central Neurocytoma
Dysembryoplastic Neuroepithelial Tumor
Paraganglioma
Pineal Region Tumors
Pineocytoma
Pineoblastoma
Papillary Tumor of the Pineal Region
Primitive Neuroectodermal Tumors
Tumors of Cranial and Spinal Nerves
Schwannoma
Neurofibroma
Tumors of the Meninges
Meningiomas
Hemangioblastoma
Lymphomas and Hematopoietic Tumors
Primary Central Nervous System Lymphoma
Plasmacytoma
Germ Cell Tumors
Tumors of the Sellar Region
Central Nervous System Metastasis
Traumatic Brain Injury
Epidemiology
Pathophysiology
Prehospital and Emergency Department Management
Treatment
Degenerative Disorders of The Spine
Degenerative Disease of the Lumbar Spine
Lumbar Radiculopathy
Lumbar Spinal Stenosis
Lumbar Instrumentation and Fusion
Degenerative Diseases of the Cervical Spine
Cervical Radiculopathy
Cervical Myelopathy
Diagnosis and Treatment
Functional And Stereotactic Neurosurgery
Stereotactic Surgery
Brain Stimulation
Implantable Pumps
Destructive Lesions
Epilepsy
Trigeminal Neuralgia
Hydrocephalus
Hydrocephalus and Pregnancy
Abdominal Surgery in Patients With Ventriculoperitoneal Shunts
Pediatric Neurosurgery
Central Nervous System Infections
Intracranial Infections
Cranial Epidural Abscess
Subdural Empyema
Meningitis
Brain Abscess
Ventriculitis
Postoperative Infections
Posttraumatic Meningitis
Spinal Infections
Vertebral Osteomyelitis
Discitis
Spinal Epidural Abscess
Acquired Immunodeficiency Syndrome
Selected References
References
69 - Plastic Surgery
Reconstructive Techniques
Primary and Secondary Wound Closure
Skin Grafts
Tissue Expansion
Alloplastic Materials
Flaps
Local Flaps
Muscle and Musculocutaneous Flaps
Fascia and Fasciocutaneous Flaps
Perforator Flaps
Microvascular Free Tissue Transfer
Supermicrosurgery
Pediatric Plastic Surgery
Craniofacial Surgery
Congenital Ear Deformities
Craniofacial Microsomia
Cleft Lip and Palate
Vascular Anomalies
Pediatric Neck Masses
Melanocytic Nevi
Plastic Surgery of the Head and Neck
Maxillofacial Trauma
Emergent Management
Evaluation and Diagnosis
Soft Tissue Injuries
Craniofacial Fractures
Scalp Reconstruction
Facial Reconstruction
Facial Transplantation
Facial Aesthetic Surgery
Brow Lift
Blepharoplasty
Rhinoplasty
Facelift
Hair Transplant
Breast Surgery
Reduction Mammoplasty
Mastopexy
Breast Augmentation
Implant Selection
Fat Grafting to the Breast
Breast Implant-Associated Anaplastic Large Cell Lymphoma
Gynecomastia
Abdominoplasty
Body Contouring After Bariatric Surgery
Liposuction
Gender Affirmation Surgery
Wound Management/Pressure Wounds
Wounds
Wound Healing
Chronic Wounds
Wound Assessment
Diabetic Wound
Peripheral Arterial Disease
Venous Stasis and Ulcer
Radiation Wound
Infected Wound
Pressure Injury
Reconstruction of the Lower Extremity
Soft Tissue Coverage of Traumatic Wounds
Soft Tissue Reconstruction in the Groin and Thigh
Soft Tissue Coverage of the Knee, Leg, and Foot
Conclusion
Selected References
References
70 - Hand Surgery
BASIC ANATOMY
EXAMINATION AND DIAGNOSIS
PRINCIPLES OF TREATMENT
TRAUMA
SELECTED REFERENCES
REFERENCES
71 - Gynecologic Surgery
External Reproductive Anatomy (Vulva)
Internal Reproductive Anatomy (Vagina, Cervix, Uterus, Fallopian Tubes, Ovaries)
Vagina
Cervix
Uterus
Fallopian Tubes
Ovaries
Other Relevant Pelvic Anatomy
Anatomic Spaces
Vascular Structures
Neurologic Structures
Urinary Tract Structures
Intestinal Tract Structures
Common Vulvar and Vaginal Surgical Diseases
Bartholin Gland Cyst or Abscess
Vulva Intraepithelial Neoplasia
Vulvar Cancer
Vaginal Intraepithelial Neoplasia
Vaginal Cancer
Pelvic Organ Prolapse
Common Vulva and Vaginal Surgical Procedures
Incision and Drainage of Bartholin Gland Cyst or Abscess
Marsupialization of Bartholin Gland Cyst or Abscess
Wide Local Excision/Laser of the Vulva
Laser of the Vagina/Partial Vaginectomy
Radical Vulvectomy With Sentinel Node Mapping and Biopsy or Inguinal Femoral Lymphadenectomy
Common Cervical Surgical Diseases
Cervical Intraepithelial Neoplasia
Cervical Cancer
Common Cervical Surgical Techniques
Conization/Loop Electrosurgical Excision Procedure
Radical Hysterectomy/Radical Trachelectomy With Pelvic Lymphadenectomy
Common Uterine Surgical Diseases
Abnormal Uterine Bleeding
Uterine Polyps
Leiomyoma
Adenomyosis
Endometrial and Other Uterine Cancers
Common Uterine Surgical Procedures
Hysteroscopy, Dilation and Curettage, Endometrial Ablation
Myomectomy
Vaginal Myomectomy
Hysteroscopic Myomectomy
Laparoscopic and Open Myomectomy
Hysterectomy
Total Abdominal Hysterectomy
Minimally Invasive Hysterectomy
Vaginal Hysterectomy
Supracervical Hysterectomy
Elective Bilateral Salpingo-Oophorectomy and Opportunistic Salpingectomy
Postoperative Cystoscopy after Hysterectomy
Sentinel Node Biopsy and Lymphadenectomy for Endometrial Cancer
Common Fallopian Tube/Ovarian Surgical Diseases
BRCA Mutation Carrier
Desires Sterilization
Ectopic Pregnancy
Torsion
Endometrioma
Benign Ovarian Masses
Malignant Ovarian Neoplasms
Common Fallopian Tube/Ovarian Surgical Procedures
Tubal Sterilization
Salpingectomy/Salpingostomy for Ectopic Pregnancy
Ovarian Detorsion
Ovarian Cystectomy
Salpingo-Oophorectomy
Fallopian Tube/Ovarian Cancer Cytoreduction
Summary
Selected References
References
72 - Surgery in the Pregnant Patient
PHYSIOLOGIC CHANGES OF PREGNANCY
SAFETY CONCERNS IN PREGNANCY
Radiologic Concerns
Medication Concerns
Analgesics
Over-the-Counter Medications
Prescription Medications
Antibiotics
Aminoglycosides
Tetracyclines
Metronidazole
Penicillins
Cephalosporins
Lincosamide (Clindamycin)
Macrolides (Azithromycin)
Sulfonamide Derivatives
Fluoroquinolones
Other Gram Positive Agents
Summary of Antibiotic Use
Antithrombotic Agents Thrombotic Agents
Anticoagulants
Antiplatelet Agents
Aspirin
Clopidogrel
Thrombolytic Agents
Sedatives
Benzodiazepines
Anesthesia Concerns
PREVENTION OF PRETERM LABOR
MINIMALLY INVASIVE SURGERY IN PREGNANCY
BREAST MASSES IN PREGNANCY
Imaging and Biopsy During Pregnancy
Pregnancy-Associated Breast Cancer
SURGERY FOR DISEASES IN PREGNANCY
Hepatobiliary Disease
Cholelithiasis
Endocrine Disease
Adrenal Disease
Thyroid Disease
Small Bowel Disease
Appendix, Colon, and Rectal Disease
Vascular Disease
TRAUMA IN PREGNANCY
CONTROL OF MAJOR HEMORRHAGE
Mechanical Hemorrhage Control
Surgical Ligation
Resuscitative Endovascular Balloon Occlusion of the Aorta
Intrauterine Balloon Tamponade
Adjuncts for Major Hemorrhage
Cell Salvage
Damage Control Techniques
Benign Disease
Bariatric Surgery
Ileal Pouch–Anal Anastomosis
Malignant Disease
SUMMARY
SELECTED REFERENCES
Anchor 380
REFERENCES
73 - Fetal Surgery
The Birth of a New Surgical Specialty
Maternal Considerations and Morbidity
Fetal Surgery by System
Neurologic System
Myelomeningocele or Spina Bifida
Sacrococcygeal Teratoma
Neck/Chest
Cervical Teratoma
Ex Utero Intrapartum Treatment Procedure
Congenital Lung Lesions
Congenital Diaphragmatic Hernia
Cardiac
Congenital Cardiac Lesions
Twin-Twin Transfusion Syndrome
Abdomen
Gastroschisis
Genitourinary
Lower Urinary Tract Obstruction
In Utero Stem Cell Transplantation
Fetal Tissue Engineering
In Utero Gene Therapy
Artificial Placenta
Acknowledgements
Selected References
References
74 - Urologic Surgery
Urologic Anatomy for the General Surgeon
Upper Abdomen and Retroperitoneum
Adrenal
Kidney
Ureter
Pelvis
Bladder and Prostate
Urethra, Male Genitalia, and Perineum
Endoscopic Urologic Surgery
Urologic Infectious Disease
Uncomplicated Urinary Tract Infection
Premenopausal Patients
Postmenopausal Patients
Complicated Urinary Tract Infection
Urinary Tract Infection in Men
Specific Complicated Genitourinary Infectious States
Pyelonephritis
Male Genital Organ Infection
Fournier Gangrene
Atypical Urinary Tract Infections
Fungal Infection
Tuberculosis
Parasitic Infection
Neurogenic Bladder
Urinary Incontinence
Benign Prostatic Hyperplasia
Basic Laboratory Assessment
Treatment
Male Sexual Dysfunction and Treatment
Urolithiasis
Background
Acute Presentation and Management
Elective Diagnostic Evaluation and Management
Elective Surgical Management
Urologic Trauma
Renal Injuries
Imaging
Management: Operative Versus Nonoperative
Surgical Exploration and Operative Approach
Ureteral Injuries
Imaging
Management
Surgical Exploration and Operative Approach
Bladder Injuries
Imaging
Management: Operative Versus Nonoperative
Surgical Exploration and Operative Approach
Urethral Injuries
Imaging
Management
Surgical Exploration and Operative Approach
Genital Injuries
Imaging
Management
Damage Control Techniques for Urologic Injuries
Nontraumatic Urologic Emergencies
Testicular Torsion
Priapism
Urologic Oncology
Renal Cancer
Staging
Management
Bladder Cancer
Nonmuscle Invasive Bladder Cancer
Muscle Invasive Bladder Cancer
Prostate Cancer
Evaluation
Treatment
Testicular Cancer
Treatment
Selected References
References
INDEX
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
IBC