Kirby I. Bland Á Michael G. Sarr ÁMarkus W. Buchler Á Attila Csendes Á ¨O. James Garden Á John WongEditorsGeneral SurgeryPrinciples and International PracticeSecond EditionWith 190 Figures and 193 Tables
EditorsKirby I. Bland, MD Michael G. Sarr, MDFay Fletcher Kerner Professor and Chairman James C. Mason Professor of SurgeryDepartment of Surgery Department of SurgeryDeputy Director, Comprehensive Cancer Center Mayo Clinic College of MedicineUniversity of Alabama School of Medicine Rochester, MNBirmingham, AL USAUSA O. James Garden, MBChB, MD, FRCS (Ed), ¨Markus W. Buchler, MD FRCP (Ed), FRACS (Hon)Professor of Surgery and Chairman Regius Professor of Clinical SurgeryDepartment of General and Visceral Surgery Department of Clinical and Surgical SciencesUniversity of Heidelberg The University of EdinburghHeidelberg Royal Inﬁrmary of EdinburghGermany Edinburgh UKAttila Csendes, MD, FACS (Hon)Professor of Surgery and Chairman John Wong, BSc (Med (Syd)), MBBS (Syd),Department of Surgery PhD (Syd), MD (Hon (Syd)), FRACS, FRCS (Edin),University Hospital FRCS (Glasg), FACS (Hon)Santiago Chair ProfessorChile Department of Surgery The University of Hong Kong Queen Mary Hospital Hong Kong ChinaISBN: 978-1-84628-832-6 e-ISBN: 978-1-84628-833-3Print and e-bundle ISBN: 978-1-84800-139-8British Library Cataloguing in Publication dataA catalogue record for this book is available from the British LibraryLibrary of Congress Control Number: 2008937563ß 2009 Springer-Verlag London Limited1st edition published in 2001 by W.B. Saunders Co. LtdApart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under theCopyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form orby any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction inaccordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproductionoutside those terms should be sent to the publishers.The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a speciﬁcstatement, that such names are exempt from the relevant laws and regulations and therefore free for general use.Product liability: The publisher can give no guarantee for information about drug dosage and application thereofcontained in this book. In every individual case the respective user must check its accuracy by consulting otherpharmaceutical literature.Springer Science+Business Mediaspringer.comPrinted on acid-free paper9876543210
To the surgical residents and practicing general surgeons with whom we have had the privilege of teaching the art, science, and practice of surgery.
PrefaceThe editors of General Surgery: Principles and International Practice acknowledge the essential contri-bution for the general surgeon and resident-in-training of an accessible, concise, and state-of-the-artvolume that explores and documents evolutionary principles for the practice of surgery. The editorsfurther acknowledge the physical, psychologic, and socioeconomic importance of surgical diseases andtheir impact on society. These facts are evident in that the scientiﬁc community continues to witnessextraordinary advances in the therapy of both benign and malignant surgical diseases of various organsites. Much of this progress has been especially evident over the past decade. Implicit in these advancesare new concepts and techniques of management that allow the surgeon to integrate this disciplinewith medicine, pharmacology, immunology, biostatistics, pathology, genetics, medical and radiationoncology, and diagnostic radiology and imaging. Further, each of these major disciplines contributesa small component for the diagnostic and therapeutic approaches to clinical care; hence, the compre-hensive planning, integration, and provision of patient care throughout preoperative, intraoperative,and postoperative phases of care remains essential in the successful practice of our specialty. The editors, therefore, acknowledge that the aim of this work is to provide an illustrative,instructive, and comprehensive textbook that depicts the rationale of basic operative principlesessential to surgical therapy. Many treatises are available currently that integrate scientiﬁc rationale,clinical trials, multidisciplinary approaches, and outcomes with anatomic and technical maneuvers forthe management of surgical diseases. In organizing this textbook, the editors chose authors renownedin the disciplines for illustrating, informing, and depicting in a comprehensive fashion the surgicaltherapy expectant for metabolic, infectious, endocrine, and neoplastic derangements in adult andpediatric patients from a truly international and multi-continental perspective. The editors and authorswere chosen carefully from across geographies and also from multi-cultural and diverse locations.While the authors consider this text to be inclusive regarding the technical and operative considera-tions for preoperative, intraoperative, and postoperative care, its purpose should not be intended toreplace standard textbooks of surgery, nor should it be considered complete in its coverage ofpathophysiologic disorders. In contrast, this text is organized to familiarize practicing surgeons,residents, and fellows with state-of-the-art surgical principles and techniques that are essential tocontemporary practice. Therefore, the tenor of the book has been developed to co-exist with othermajor surgical reference texts that are dedicated – some in a more comprehensive fashion – to thetherapy of individual organs and systemic diseases. Our book is much more a ‘‘working text’’ for thepracticing surgeon with emphasis on diagnosis and treatment. All chapters in General Surgery: Principles and International Practice include a condensed bibliog-raphy of highly selective journal articles, reviews, and texts. In this manner of attempting to be concise,we hope to provide precise focus for the education of the reader relative to accepted surgical principlesinvolved in patient management. Moreover, the editors have sought to provide a counterviewpoint forthe selection of therapy by presenting at the opening of each chapter, a list of ‘‘Pearls and Pitfalls’’ thathighlight particular concerns. The organization of the text is designed for easy access. The editors have developed 13 sections,each representing an important branch of surgical science: General Principles, Trauma and Burns,# 2009 Springer Science+Business Media, LLC.
viii Preface Critical Care, Head and Neck, Gastrointestinal, Pediatric, Oncology, Endocrine, Gynecology, Vascular, Endovascular Therapy, Geriatric, and Management of Surgical Specialties Requiring Care of the General Surgeon. The majority of chapters provide pertinent, though not exhaustive, summaries of anatomy and physiology, a history of the surgical illness, and stages of operative approaches with relevant technical considerations outlined in a manner that is easily understandable. Complications are reviewed typically when appropriate for the organ system, disease, or problem. The text is supported amply by line drawings and photographs that depict relevant anatomic or technical principles. Although some overlap exists among related chapters, the editors have made every attempt to minimize duplicative or repetitious discussions, except when controversial or state-of-the-art issues are presented. Moreover, the editors have also attempted to ensure that accurate presentations and illustrations depict properly the most complex problems confronted by the general surgeon. Finally, in an attempt to address advanced and contemporary concepts, this text has been organized to address in detail expeditious, safe, and anatomically accurate operations that incorporate standard as well as evolving surgical principles and techniques. These principles have been tested in the clinics for valid scientiﬁc knowledge and are well-supported by time-tested approaches that have been provided by practicing surgeons. The editors are grateful for the opportunity to respond to the challenge of developing this truly international text and are indeed hopeful that our readers will ﬁnd this book to be a repository of insightful, useful, and timely information. Kirby I. Bland Michael G. Sarr ¨ Markus W. Buchler Attila Csendes O. James Garden John Wong
AcknowledgementsThe editors are grateful to have been entrusted with the responsibility of developing this textbookfor the international world of surgery. The organization and publication of this text required theknowledge and assistance of many persons. To all our residents in surgery, research fellows, andinternational physicians in the ﬁve universities in which they were trained and practice, the editorsacknowledge an intellectual debt. We appreciate their reviews, critiques, and criticism that allowed theformulation of General Surgery: Principles and International Practice. We are grateful for their constantencouragement and assistance in the preparation of this tome. ¨ We thank our Co-Editors – Professors Buchler, Csendes, Garden, and Wong, who providedinvaluable critiques, overviews, and advised the assimilation and management of separate chaptersinto the sections to which they were assigned. Their services have been invaluable to the successfulorganization of this text, truly reﬂecting its international scope. Further, we acknowledge the assistanceof our Associate Editors: Dr. Loring W. Rue III (University of Alabama at Birmingham); Dr. Michael L.Kendrick (Mayo Clinic College of Medicine); Professor Chung-Mau Lo (The University of HongKong); and Dr. Jens Werner (University of Heidelberg), who provided incalculable time and effortoverseeing the accuracy and timeliness of this publication. The editors also acknowledge the signiﬁcant support offered by our individual editorial assistants,who provided the day-to-day contacts, oversight, and management of manuscripts that were submittedin each international ofﬁce. We speciﬁcally acknowledge Irmgard Alffermann in the ofﬁce of Professor ¨Buchler (Heidelberg, Germany), Leslie M. Benson and Kan Moore in the ofﬁce of Dr. Bland (Birming-ham, Alabama), Penny Earle in the ofﬁce of Professor Garden (Edinburgh, United Kingdom), DeborahI. Frank in the ofﬁce of Dr. Sarr (Rochester, Minnesota), and Isabel Zamorano in the ofﬁce of ProfessorCsendes (Santiago, Chile). Each of these editorial assistants provided invaluable service that isappreciated highly by the editors and allowed Springer to publish this tome in a timely and organizedfashion. Finally, the editors acknowledge the foresight and support provided by Melissa Morton of SpringerScience + Business Media who in conjunction with us, also saw the need of such an internationalapproach to a textbook on surgery and to suggest and allow us to begin the organization of this volume.The assistance and organizational skills of Stephanie Sakson are also to be speciﬁcally acknowledgeddue to her extraordinary attention and diligence to the task at hand. Ms. Sakson’s oversight allowed theassimilation of the book from its inception and ensured its completion.Kirby I. Bland, MDMichael G. Sarr, MD# 2009 Springer Science+Business Media, LLC.