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Atlas of General Surgery PDF

620 Pages·2009·231.216 MB·English
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Preview Atlas of General Surgery

Volker Schumpelick In collaboration with Reinhard Kasperk Michael Stumpf I Thieme Atlas of General Surgery Volker Schumpelick, MD Professor and Chairman Department of Surgery University Hospital Aachen Aachen, Germany With the collaboration of Reinhard Kasperk and Michael Stumpf 1223 illustrations Thieme Stuttgart · New York library of Congress Cataloging-in-Publication Data is available from Important note: Medicine is an ever-changing science under the publisher. going continual development. Research and clinical experience are continually expanding our knowledge, in particular our This book is an authorized and revised translation of the 2nd knowledge of proper treatment and drug therapy. Insofar as German edition published and copyrighted 2006 by Georg this book mentions any dosage or application, readers may Thieme Verlag, Stuttgart, Germany. Title of the German edition: rest assured that the authors, editors, and publishers have Operationsatlas Chirurgie. made every effort to ensure that such references are in accor dance with the state of knowledge at the time of production of the book. Nevertheless, this does not involve, imply, or express any guar antee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in Contributors: the book. Ewry user is requested to examine carefully the Reinhard Kasperk, MD manufacturers' leaflets accompanying each drug and to check, Professor if necessary in consultation with a physician or specialist, Director of the Surgical Clinic whether the dosage schedules mentioned therein or the con St. johannes-Hospital traindications stated by the manufacturers differ from the Catholic Clinic Duisburg statements made in the present book. Such examination is par Duisburg, Germany ticularly important with drugs that are either rarely used or have been newly released on the market Every dosage sche Michael Stumpf, MD dule or every form of application used is entirely at the user's Adj. Professor own risk and responsibility. The authors and publishers request Supervising Physician every user to report to the publishers any discrepancies or Department of Surgery inaccuracies noticed. If errors in this work are found after pub University Hospital Aachen lication, errata will be posted at www.thieme.com on the pro Aachen, Germany duct description page. Translator: Dr. Grahame Larkin, MD, East Sussex. UK Illustrator: Gisela Tambour, Adrian Cornford, and Rose Baumann © 2009 Georg Thieme Verlag, Some of the product names, patents, and registered designs Riidigerstra.Be 14, 70469 Stuttgart, Germany referred to in this book are in fact registered trademarks or http:lfwww.thieme.de proprietary names even though specific reference to this fact Thieme New York, 333 Seventh Avenue, is not always made in the text. Therefore, the appearance of a New York, NY 10001. USA name without designation as proprietary is not to be construed http://www.thieme.com as a representation by the publisher that it is in the public domain. Cover design: Thieme Publishing Group Typesetting by Druckhaus Gotz, Ludwigsburg This book, including all parts thereof, is legally protected by Printed in China by Everbest Printing, Hongkong copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the pub lisher's consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeograph ing, preparation of microfilms, and electronic data processing ISBN 978-3-13-144091-4 1 2 3 4 56 and storage. v Preface Surgery can no more be learned from text books than can cycling or tion. Its content is general surgery-not that which remains after swimming. Similarly, hardly any other discipline is both a teaching separation of the specialist disciplines, but rather that which a gen and learning profession with such a dose teacher-pupil relationship. eral surgeon from the respective specialist disciplines must learn in But rarely does the young surgeon of today have the opportunity to order to stand his ground as a surgeon. gain enough continuous practice under supervision to the point of reaching subcortical implementation. The restrictions of working We are glad that this concept has proven itself to the extent that an time reduction, rare opportunities to practice techniques on labora English edition is now available. The aim of this surgical atlas is to tory animals, and the early division of surgery into subspecialties serve trainee surgeons as a reference book, to allow them to learn have completely changed the face of mandatory training guidelines new things, and to arouse their curiosity to learn more. But even for basic surgical operations. As a result, the young surgeon rarely qualified surgeons may use the opportunity to recall a technique gets to see many an operation, and those operations in which he has they have already learned and to compare standards. For easy mem managed to gather a greater amount of personal experience are few orization and mental preparation of the respective operations, all the and far between. Even surgical simulators, which are becoming in operative stages are structured and schematized so that the conti creasingly available and provide excellent training opportunities, nuity of the operation is divided into labeled and reproducible single especially in the field of laparoscopic surgery, cannot convey the steps. just as racing drivers mentally prepare themselves before the entire spectrum of basic surgical operations. In some specific fields race by imagining each individual leg of the race course, the surgeon they do allow manual skills and tactile coordination to be practiced, should, before any operation, recall before his or her mind's eye each but cannot provide broad surgical expertise together with the under operative stage step by step so as to to proceed only along familiar standing and mastering of standard operative techniques. Alongside lines at the operating table. video films, surgical atlases are therefore the most important sources of information for the young surgeon when it comes to practicing all We are grateful to the staff of Thieme Publishers for their support the stages of certain operations. during the preparation of this English edition. But above all we should also like to thank Mr. Grahame Larkin for his excellent work The concept of this surgical atlas is directed toward presenting the in translating this atlas into English. We are looking forward to an most common 16 general and 150 special operations of everyday equally favorable English-speaking readership of this Atlas of Generol surgical practice to surgeons in training, to students as well as to Surgery. qualified surgeons. In this respect, it is neither my intention with this single-volume atlas to vie with the more detailed, multi-volume sur Volker Schumpelick gical atlases nor to undermine the essential principle of specializa- VI List of Abbreviations ASA Acetylsalicylic add DC Dynamic compression DIP Distal interphalangeal DSA Digital subtraction angiography EEA End-to-end anastomosis EPT Endoscopic papillotomy ERC Endoscopic retrograde cholangiography ERCP Endoscopic retrograde cholangiopancreatography FFP Fresh frozen plasma IORT Intraoperative radiotherapy MCP Metacarpophalangeal OPSI Overwhelming postsplenectomy infection ORIF Open reduction and internal fiXation PDS Polydioxanone suture PCA Polyglycolic acid PIP Proximal interphalangeal PTC Percutaneous transhepatic cholangiography PTCD Percutaneous transhepatic cholangiodrainage RBCC Red blood cell concentrate VII Table of Contents General Aspects 1 General Aspects .................................. 2 8 Venous Access ................................. 21 9 Central Venous Port ............................. 25 1 Preliminary Remarks on the Surgical Intervention .... 2 10 Venous Cutdown ............................... 26 2 Use of Scalpel, Needle Holder, Forceps, and Scissors ... 4 11 ]oint Punctures ................................ 28 3 Ugation and Suture Ugation ...................... 6 12 Pleural Punctures ("Thoracentesis) .................. 31 4 Knots ........................................ 8 13 Urinary Bladder Puncture ........................ 33 5 Skin Suture ................................... 11 14 Ascites Puncture (Paracentesis) . .................. 34 6 Drains ........................................ 14 15 Fine-Needle Aspiration Biopsy .................... 35 7 Urinary Catheter ............................... 17 16 Arterial Puncture and Arterial Catheterization . ...... 36 39 Skin and Soft Tissues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Thoracic Wall and Cavity . . . . . . . . . . . . . . . . . . . . . . . . . 98 17 Excision of Skin Lesions . . . . . . . . . . . . . . . . . . . . . . . . . 40 38 Axillary Lymph-Node Oearance . . . . . . . . . . . . . . . . . . . 98 18 Removal of Soft Tissue 1\unors . . . . . . . . . . . . . . . . . . . . 43 39 Breast Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 19 Removal of Inguinal Lymph Node . . . . . . . . . . . . . . . . . . 45 40 Subcutaneous Mastectomy . . . . . . . . . . . . . . . . . . . . . . . 10 3 20 Wound Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 41 Mastectomy (Auchindos-Patey) . . . . . . . . . . . . . . . . . . . 105 21 Secondary Suture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 42 Chest Drain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 9 22 Carbuncle of the Neck........................... 51 43 Median Sternotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 23 Bursectomy (Elbow) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 44 Posterolateral Thoracotomy . . . . . . . . . . . . . . . . . . . . . . 11 6 24 V-Y Advancement Flap . . . . . . . . . . . . . . . . . . . . . . . . . . 55 45 Axillary Thoracotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 0 25 Z-plasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 46 Atypicallung Resection Open . . . . . . . . . . . . . . . . . . . . 12 3 26 Split-Skin Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 47 Atypical Thoracoscopic Lung Resection . . . . . . . . . . . . . 126 27 Ganglion (Wrist) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 48 Right Superior Lobectomy . . . . . . . . . . . . . . . . . . . . . . . . 12 9 28 Panaritium (Felon) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 49 Pneumonectomy ............................... 132 29 Paronychia (Run-around) . . . . . . . . . . . . . . . . . . . . . . . . 64 50 Thoracoscopic Pleurectomy . . . . . . . . . . . . . . . . . . . . . . . 135 30 Ingrown Toenail (Unguis lncarnatus; One-third Wedge Resection) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Abdominal Cavity: Diaphragm.................... 138 51 Rupture of the Diaphragm . . . . . . . . . . . . . . . . . . . . . . . 138 Neck ............................................. 69 31 Removal of Cervical Lymph Node... . . . . . . . . . . . . . . . 69 Abdominal Cavity: Esophagus . . . . . . . . . . . . . . . . . . . . 140 32 Tracheotomy (Open and Percutaneous Tracheostcma) . 71 33 Exposure of the Jugular Vein . . . . . . . . . . . . . . . . . . . . . 76 52 Hiatal Hernia Repair (Lortat-]acob Hiatoplasty)....... 140 34 Subtotal Thyroidectomy . . . . . . . . . . . . . . . . . . . . . . . . . 79 53 Fundoplication (Nissen-Rosetti and Toupet) . . . . . . . . . 144 35 Total Thyroidectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 54 Laparoscopic Fundoplication . . . . . . . . . . . . . . . . . . . . . . 148 36 Parathyroidectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 55 Cardiomyotomy for Achalasia (Gottstein-Heller) . . . . . . 154 37 Zenker Diverticulum . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Abdominal Cavity: Stomach . . . . . . . . . . . . . . . . . . . . . . 156 Abdominal Cavity: Large intestine. . . . . . . . . . . . . . . . 292 56 Percutaneous Endoscopic Gastrostomy (PEG) . . . . . . . . 156 92 Appendectomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292 57 Gastrostomy (Witzel) . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 93 Laparoscopic Appendectomy . . . . . . . . . . . . . . . . . . . . 300 58 Oosure of a Perforated Ulcer . . . . . . . . . . . . . . . . . . . . . 162 94 Loop Transverse Colostomy . . . . . . . . . . . . . . . . . . . . . . 305 59 Oversewing of a Bleeding Peptic Ulcer...... . . . . . . . . 165 95 End Sigmoidostomy (Hartmann Procedure) . . . . . . . . . 309 60 Gastrojejunostomy.............................. 168 96 Stoma Oosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315 61 Pyloroplasty (Heineke-Mikulicz, Finney, jaboulay) . . . . 172 97 Colotomy and Polypectomy . . . . . . . . . . . . . . . . . . . . . 318 62 Selective Proximal Vagotomy . . . . . . . . . . . . . . . . . . . . . 175 98 Palliative Anastomosis between the Distal Ileum and 63 Truncal Vagotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Transverse Colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321 64 Gastroduodenostomy (Billroth I) . . . . . . . . . . . . . . . . . . 182 99 Right Hemicolectomy . . . . . . . . . . . . . . . . . . . . . . . . . . 325 65 Gastrojejunostomy (Billroth II) . . . . . . . . . . . . . . . . . . . . 190 10 0 Ileocecal Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332 66 Roux-en-Y Gastrojejunostomy. . . . . . . . . . . . . . . . . . . . . 193 10 1 1\Jbular Resection of the Sigmoid Colon . . . . . . . . . . . . 334 67 Gastrectomy and Longmire Gastric Reconstruction.... 195 10 2 Radical Resection of the Sigmoid Colon . . . . . . . . . . . . 340 68 Gastrectomy and Roux-en-Y Gastric Reconstruction . . . 206 10 3 Laparoscopic Resection of the Sigmoid Colon . . . . . . . 342 104 Left Hemicolectomy............................ 347 10 5 Anterior Rectum Resection . . . . . . . . . . . . . . . . . . . . . . 355 Abdominal Cavity: Gallbladder and Bile Ducts . . . . 208 10 6 Rectum Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369 69 Cholecystectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 70 Laparoscopic Cholecystectomy . . . . . . . . . . . . . . . . . . . . 212 Retroperitoneum................................. 375 71 Exploration of the Common Bile Duct . . . . . . . . . . . . . . 217 72 Hepaticojejunostomy............................ 221 107 Adrenalectomy................................ 375 108 Laparoscopic Adrenalectomy . . . . . . . . . . . . . . . . . . . . 379 Abdominal Cavity: Liver . . . . . . . . . . . . . . . . . . . . . . . . . . 225 Proctology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381 73 Wedge Resection of the Uver . . . . . . . . . . . . . . . . . . . . . 225 74 Hepatic Cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 109 Hemorrhoidectomy (Miles-Gabriel) . . . . . . . . . . . . . . . 381 75 Left Hepatic Lobectomy.......................... 231 11 0 Perianal Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385 76 Hepatic Rupture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236 111 Fistula-In-Ano (Including Sliding Flap). . . . . . . . . . . . . 388 77 Port Catheter of the Hepatic Artery . . . . . . . . . . . . . . . . 240 112 Perianal Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 392 113 Lateral Sphincterotomy (Parks).. . . . . . . . . . . . . . . . . . 395 114 Pilonidal Sinus (Schrudde-Olivari) . . . . . . . . . . . . . . . . 397 Abdominal Cavity: Pancreas . . . . . . . . . . . . . . . . . . . . . . 243 78 Necrosectomy of the Pancreas . . . . . . . . . . . . . . . . . . . . 243 External Genital Organs . . . . . . . . . . . . . . . . . . . . . . . . . . 401 79 Pseudocystojejunostomy . . . . . . . . . . . . . . . . . . . . . . . . . 246 80 Resection of the Tail of the Pancreas . . . . . . . . . . . . . . . 250 115 Testicular Hydrocele . . . . . . . . . . . . . . . . . . . . . . . . . . . 401 116 Vasectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404 Abdominal Cavity: Spleen . . . . . . . . . . . . . . . . . . . . . . . . 254 Hernias. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406 81 Splenectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254 82 Partial Splenectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 117 Local Anesthesia for Inguinal Hernia Repair . . . . . . . . 406 83 Splenic Rupture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 118 Dissection for Inguinal Hernia Repair . . . . . . . . . . . . . . 409 84 Laparoscopic Splenectomy . . . . . . . . . . . . . . . . . . . . . . . 261 119 Inguinal Hernia Repair (Shouldice)................ 417 120 Inguinal Hernia Repair (Bassini) . . . . . . . . . . . . . . . . . . 421 121 Inguinal Hernia Repair (lichtenstein).............. 424 Abdominal Cavity: Peritoneum . . . . . . . . . . . . . . . . . . . 264 122 Transinguinal Preperitoneal Mesh Repair (TIPP) . . . . . 427 85 Peritonitis and Laparostoma . . . . . . . . . . . . . . . . . . . . . . 264 123 Preperitoneal Inguinal Hernia Repair . . . . . . . . . . . . . . 431 86 Peritoneovenous Shunt . . . . . . . . . . . . . . . . . . . . . . . . . . 268 124 Laparoscopic Inguinal Hernia Repair . . . . . . . . . . . . . . 438 125 Femoral Hernia Repair (Crural Approach) . . . . . . . . . . 443 126 Femoral Hernia Repair (Inguinal Approach; Abdominal Cavity: Small Intestine. . . . . . . . . . . . . . . . 272 I.otheissen, McVay) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446 127 Femoral Hernia Repair (Inguinocrural Approach) . . . . 451 87 Segmental Resection of the Small Intestine . . . . . . . . . . 272 128 Epigastric Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454 88 Intraluminal Stenting of the Small Intestine (Dennis 129 Umbilical Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456 1\Jbe) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276 130 Incisional Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460 89 Meckel Diverticulum . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280 131 Spigelian Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464 90 End Ileostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283 91 Loop Ileostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289

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