Operative Strategy in General Surgery
An Expositive Atlas Volume I
Erschienen am 21. Oktober 1980
Buch
Hardcover
558 Seiten
978-0-387-90452-8 (ISBN)
Beschreibung
This surgical atlas should be of great value to all clinical surgeons, both those in training and those in surgical practice, and Dr. Chassin is su- perbly qualified to author this work. During more than three decades as a member of the faculty of the New York University School of Medicine, he has taught countless residents many aspects of the art of surgical technique. One measure of Dr. Chassin's unusual teaching ability is that he is both Professor of Clinical Surgery at New Y or k University and Director of Surgery at Booth Memorial Hospital, where our fourth-year surgical residents have rotated regularly for the past 12 years. Booth Memorial is the only hospital outside the New York University Medical Center to which New York University residents rotate. This simple fact well underlines Dr. Chassin's remarkable capability for teaching. When a surgical complication develops after an operation, two or three possibilities should be considered. First, of course, was the diag- nosis correct? If it was, then the cause of the complication is usually either an inadequate operative technique or a flawed concept underlying the selection of the operative procedure.
When the surgical technique seems faultless, a postoperative complication would strongly indicate that the concept was erroneous, albeit cherished perhaps for decades. Unlike any other atlas on operative technique, this book specifically discusses the conceptual basis of the operation as well as the strategy that will help the surgeon avoid common pitfalls.
When the surgical technique seems faultless, a postoperative complication would strongly indicate that the concept was erroneous, albeit cherished perhaps for decades. Unlike any other atlas on operative technique, this book specifically discusses the conceptual basis of the operation as well as the strategy that will help the surgeon avoid common pitfalls.
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Inhalt
1 Concept and Strategy in Surgery.- Developing a Concept.- Establishing Strategy.- 2 Management of the Contaminated Operation.- Minimizing Bacterial Inoculum.- Enhancing Host Tissue Defenses.- Management of Contaminated Operative Wound.- Management of Infected Operative Wound.- Perioperative Antibiotics.- 3 Rational Use of Drains.- Purpose of Drains.- Pros and Cons of Various Drains.- Prevention of Drain-Tract Infection.- Management of Intraperitoneal Sepsis.- Other Indications and Methods of Drainage.- 4 Surgical Stapling: Principles and Precautions.- Principles of Stapling Gastric and Intestinal Anastomoses.- Instruments Used in Surgical Stapling.- Indications for Stapling an Anastomosis.- Contraindications.- Causes of Failure following Stapled Anastomosis.- Complications of Stapling Compared with Suturing.- 5 Incision, Exposure, and Closure.- Achieving Exposure.- Incisions for Abdominal Surgery.- Avoiding Wound Dehiscence and Hernia.- Modified Smead-Jones Wire Closure of Midline Incisions.- Operative Technique for Midline Incision.- Esophagus.- 6 Operations to Resect, Replace, or Bypass the Esophagus.- Concept: Selection of Operation for Carcinoma near Esophagogastric Junction.- Concept: Selection of Operation for Lesions of Mid- and Upper- Esophagus.- Concept: Colon or Jejunal Interposition following Resection of Lower Esophagus for Reflux Esophagitis.- 7 Esophagectomy: Right Thoracotomy and Laparotomy.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- Esophagogastric Anastomosis, Thoracic, Sutured.- Esophagogastric Anastomosis, Cervical, Sutured.- 8 Esophagogastrectomy: Left Thoracoabdominal.- Pitfalls and Danger Points.- Operative Strategy.- Thoracoabdominal Incision with Preservation of Phrenic Nerve Function.- End-to-End versus End-to-Side Anastomosis.- Avoiding Postoperative Reflux Esophagitis.- Efficacy of Stapling Techniques for the Esophagogastric Anastomosis.- Operative Technique.- Thoracoabdominal Incision.- Esophagogastric Anastomosis Performed by Stapling Technique, Supraaortic.- Stomach.- 9 Operations for Peptic Ulcer.- Concept: Selection of Operation for Duodenal Ulcer.- Concept: Selection of Operation for Gastric Ulcer.- 10 Truncal Vagotomy.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- 11 Proximal Gastric Vagotomy.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- 12 Pyloroplasty, Heineke-Mikulicz.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- 13 Pyloroplasty, Finney.- Operative Technique.- 14 Gastrojejunostomy.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- 15 Gastrectomy for Peptic Ulcer.- Pitfalls and Danger Points.- Operative Strategy.- Operative Techniques: Billroth I and II.- Evaluation of Duodenal Pathology; Control of Bleeding Ulcer.- Billroth I Gastroduodenal Anastomosis, Sutured.- Dissection of Difficult Duodenum.- Closure of Difficult Stump by Nissen-Cooper Technique.- Closure of Difficult Duodenal Stump-Catheter Duodenostomy.- Duodenal Closure with Surgical Staples.- Closure of Difficult Duodenal Stump by Billroth I Gastroduodenostomy.- Billroth II Gastrojejunal Anastomosis, Sutured.- Billroth II Gastrojejunal Anastomosis by Stapling Technique.- 16 Perforated Peptic Ulcer.- Concept.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique of Plication.- 17 Gastrostomy.- Concept.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- Stamm Gastrostomy, Sutured.- Janeway Gastrostomy, Stapled.- 18 Gastrectomy for Cancer.- Concept: How Radical an Operation for Gastric Cancer?.- Operative Strategy.- Operative Technique.- 19 Total Gastrectomy.- Pitfalls and Danger Points.- Operative Strategy.- Prevention of Reflux Alkaline Esophagitis.- Operative Technique.- Celiac Axis Dissection and Division of Left Gastric Vessels.- Hepatic Artery Node Dissection.- Dissection of the Esophagocardiac Junction: Vagotomy.- Preparation of Roux-Y Jejunal Segment.- End-to-Side Esophagojejunostomy.- Construction of Stapled Substitute Gastric Pouch.- Roux-Y Jejunojejunostomy, Sutured.- Stapled Roux-Y Jejunojejunostomy.- Small Intestine.- 20 Exposure of the Third and Fourth Portions of the Duodenum.- Concept.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- 21 Small Bowel Resection and Anastomosis.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique: Small Bowel Anastomosis by Suturing.- Open Two-Layer Anastomosis.- Open One-Layer Anastomosis.- Operative Technique: Small Bowel Anastomosis Using Stapling Technique.- 22 Enterolysis for Intestinal Obstruction.- Concept: When to Operate?.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- 23 Baker Tube Stitchless Plication.- Concept.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- Colon and Rectum.- 24 Appendectomy.- Concept.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- Incision, McBurney.- Ligation of Appendiceal Stump.- Inversion of Appendiceal Stump.- 25 Colon Resection.- Concept: Principles of Successful Colon Anastomosis.- Conditions Conducive to Anastomotic Leakage.- Operative Strategy: The Colon Anastomosis.- Strategy of Postoperative Care.- 26 Colon Resection for Cancer.- Concept: Extent of Colon Resection.- Concept: The No-Touch Technique.- Concept: Prevention of Suture-Line Recurrence.- 27 Right Colectomy for Cancer.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique of Right and Transverse Colectomy.- Division of Middle Colic Vessels.- Division of Ileocolic Vessels.- Division of Ileal Mesentery.- Division of Right Paracolic Peritoneum.- Ileocolon Two-Layer End-to-End Anastomosis, Cheatle Slit.- Ileocolon Anastomosis by Stapling.- 28 Left Colectomy for Cancer.- Pitfalls and Danger Points.- Operative Strategy.- Liberation of Splenic Flexure.- Operative Technique.- Liberation of Descending Colon and Sigmoid.- Splenic Flexure Dissection.- Ligation and Division of Inferior Mesenteric Artery.- End-to-End Two-Layer Anastomosis, Rotation Method of Chassin.- Stapled Colorectal Anastomosis, Technique of Weakley.- Stapled Colocolonic Functional End-to-End Anastomosis.- 29 Operations for Rectal Cancer.- Concept: Selection of Operation for Cancer 0-6 cm from Anal Verge.- Concept: Selection of Operation for Carcinoma 6-11 cm from Anal Verge.- 30 Low Anterior Resection for Rectal Cancer.- Pitfalls and Danger Points.- Operative Strategy.- Prevention of Anastomotic Complications.- Presacral Dissection: Prevention of Hemorrhage.- Presacral Dissection: Preservation of Hypogastric Nerves.- Operative Technique.- Presacral Dissection.- Pelvic Hemostasis.- Side-to-End Low Colorectal Anastomosis (Baker).- EEA Stapled Low Colorectal Anastomosis.- Pitfalls and Danger Points of EEA Colorectal Anastomosis.- 31 Abdominoperineal Proctosigmoidectomy for Cancer.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- Lymphovascular Dissection.- Presacral Dissection.- Perineal Dissection.- Management of Pelvic Floor.- Colostomy.- 32 Subtotal Colectomy with Ileoproctostomy or Ileostomy and Sigmoid Mucous Fistula.- Concept: Choice of Operation.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- 33 Subtotal Colectomy for Massive Colonic Hemorrhage.- Concept.- Operative Strategy.- Operative Technique.- 34 Ileostomy, End.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- 35 Ileostomy, Loop.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- 36 Abdominoperineal Proctectomy for Benign Disease.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique: Abdominal.- Operative Technique: Perineal.- 37 Operations for Colon Obstruction.- Concept: Primary Resection and Anastomosis versus Staged Procedures.- Concept: Cecostomy or Colostomy?.- 38 Cecostomy.- Concept.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- 39 Transverse Colostomy.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- 40 Closure of Temporary Colostomy.- Concept: When to Close a Colostomy.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- Closure of Colon Defect by Suture.- Closure of Colon Defect by Staples.- 41 Operations for Colonic Diverticulitis.- Concept: Selection of Operation.- Primary Resection and Anastomosis.- Operative Strategy.- Operative Technique.- Primary Resection, End Colostomy with Mucous Fistula.- Operative Strategy and Technique.- Emergency Sigmoid Colectomy with End Colostomy and Hartmann's Pouch.- Operative Technique.- 42 Operation for Rectal Prolapse (Ripstein).- Concept: Selection of Operation.- Pitfalls and Danger Points.- Operative Strategy.- Operative Technique.- Appendixes.- A Some Mechanical Basics of Operative Technique.- Importance of Surgeon's Foot and Body Position.- Use of Instruments.- B Dissecting and Sewing.- Sewing Technique.- The Art of Dissecting Planes.- C Control of Bleeding.- Techniques of Achieving Hemostasis.- Control of Hemorrhage, Temporary.- Control of Hemorrhage, Definitive.- D Glossary.