Surgical complications cover.qxd 08/07/2013 14:00 Page 1 SCHEIN’S COMMON SENSE Schein’s books are always terrific reads, conveying pithy observations and practical advice and doing so with wit and scholarship. This latest is surely Prevention and Management a must for every surgeon’s bookshelf. Abraham Verghese MD, author of CUTTING FOR STONE of Surgical Complications Look at this image: do you understand the surgeon’s distress?We know Fo Sc For surgeons, residents, lawyers, and even r h tchoamt pyliocaut iodnos, . fYooru odnol yn otth wosaen t wtoh eox pdeor iennocte othpiesr sauterg edoon ’sn odte sepxapire, rbieunt caet surgeo ein’s C those who never have any complications n o some stage you will – complications are woven into the fabric of our trade s m and potential catastrophe overshadows all that we do. , res mo id n ents Sen Moshe Schein, Ladysmith , law se P yers reve , and ev ntion a e n n d th M o a se w nag Paul N. Rogers, Glasgow ho em n e e n ve t o r ha f Su ve rg a ic n a y c l C o o m m p p Ari Leppäniemi, Helsinki lications lications This book will help you, and your patients, avoid the misery of complications, and will provide advice on the management of those that are unavoidable. Like our previous international bestseller Schein’s Common Sense Emergency Abdominal Surgery, you will find that this book is rather informal – and definitely not politically correct: what is considered Danny Rosin, Tel Aviv taboo by others is not taboo for us; here we discuss everything! Moshe Schein Moshe Schein ISBN 978-1-903378-93-9 Paul N. Rogers Ari Leppäniemi Paul N. Rogers Danny Rosin Ari Leppäniemi tf m Danny Rosin 9 781903 378939 prelims_prelims.qxd 18-09-2013 18:18 Page i SCHEIN’S COMMON SENSE Prevention and Management of Surgical Complications For surgeons, residents, lawyers, and even those who never have any complications Moshe Schein MD FACS Paul N. Rogers MBChB MBA MD FRCS Ari Leppäniemi MD Danny Rosin MD prelims_prelims.qxd 18-09-2013 18:18 Page ii Schein’s Common Sense Prevention and Management of Surgical Complications tfm Publishing Limited, Castle Hill Barns, Harley, Nr Shrewsbury, SY5 6LX, UK Tel: +44 (0)1952 510061; Fax: +44 (0)1952 510192 E-mail: [email protected]; Web site: www.tfmpublishing.com Design & Typesetting: Nikki Bramhill BSc Hons Dip Law First edition: © October 2013 Cartoons: © 2013 Evgeniy E. (Perya) Perelygin, MD Front and back cover paintings: © 2013 Dan Schein (www.danschein.com) “Before the operation” and “The mortality”: oil on canvas Paperback ISBN: 978-1-903378-93-9 E-book editions: 2014 ePub ISBN: 978-1-903378-96-0 Mobi ISBN: 978-1-903378-97-7 Web pdf ISBN: 978-1-903378-98-4 The entire contents of Schein’s Common Sense Prevention and Management of Surgical Complications is copyright tfm Publishing Ltd. Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may not be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, digital, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher. Neither the authors, the editors nor the publisher can accept responsibility for any injury or damage to persons or property occasioned through the implementation of any ideas or use of any product described herein. Neither can they accept any responsibility for errors, omissions or misrepresentations, howsoever caused. Whilst every care is taken by the authors, the editors and the publisher to ensure that all information and data in this book are as accurate as possible at the time of going to press, it is recommended that readers seek independent verification of advice on drug or other product usage, surgical techniques and clinical processes prior to their use. The authors, editors and publisher gratefully acknowledge the permission granted to reproduce the copyright material where applicable in this book. Every effort has been made to trace copyright holders and to obtain their permission for the use of copyright material. The publisher apologizes for any errors or omissions and would be grateful if notified of any corrections that should be incorporated in future reprints or editions of this book. Printed by Gutenberg Press Ltd., Gudja Road, Tarxien, PLA 19, Malta ii Tel: +356 21897037; Fax: +356 21800069 prelims_prelims.qxd 18-09-2013 18:18 Page iii Contents Contributors vii Foreword x Editors’ note xi Preface xiii Dedications xvi PART I — GENERAL CONSIDERATIONS 1 Chapter 1 3 What are complications? Definitions, classification and ruminations Moshe Schein, Paul N. Rogers, Ari Leppäniemi and Danny Rosin Chapter 2 13 Preventing morbidity and mortality (M&M): general principles Moshe Schein, Paul N. Rogers, Ari Leppäniemi and Danny Rosin Chapter 3 39 Hemostasis and bleeding Samir Johna and Moshe Schein Chapter 4 57 Postoperative infections Moshe Schein Chapter 5 77 The wound, the wound… Moshe Schein, Paul N. Rogers, Ari Leppäniemi and Danny Rosin iii prelims_prelims.qxd 18-09-2013 18:18 Page iv Schein’s Common Sense Prevention and Management of Surgical Complications Chapter 6 91 Leaking gastrointestinal anastomoses Section 1. Basic considerations 91 Moshe Schein Section 2. The esophagus 106 John Hunter Section 3. Stomach and duodenum 116 Wen-hao Tang Section 4. Small intestine 128 Moshe Schein and Mark Cheetham Section 5. Large bowel and rectum 134 Caitlin W. Hicks and Jonathan E. Efron Chapter 7 145 Abdominal wall dehiscence Moshe Schein, Paul N. Rogers, Ari Leppäniemi and Danny Rosin Chapter 8 155 Ileus and early postoperative small bowel obstruction (EPSBO) Moshe Schein Chapter 9 169 Minimal access surgery Danny Rosin Chapter 10 183 Dealing with patients, families, lawyers and yourself Avi Rubinstein and Moshe Schein Chapter 11 203 The developing ('Third') World B. Ramana Chapter 12 217 Going to the country: the rural situation Moshe Schein iv prelims_prelims.qxd 18-09-2013 18:18 Page v Contents PART II — SPECIFIC CONSIDERATIONS 229 Chapter 13 231 The Intensive Care Unit (ICU) Ronald V. Maier Chapter 14 257 Colon and rectum (and the humble anus) Mark Cheetham Chapter 15 291 Hernias Danny Rosin Chapter 16 315 The gallbladder and bile ducts Danny Rosin, Paul N. Rogers and Moshe Schein Chapter 17 345 The appendix Moshe Schein Chapter 18 361 The pancreas Gregory Sergeant, Mickaël Lesurtel and Pierre-Alain Clavien Chapter 19 377 The liver Erik Schadde and Pierre-Alain Clavien Chapter 20 393 The breast Danny Rosin Chapter 21 413 The thyroid, parathyroid and adrenal glands Saba Balasubramanian v prelims_prelims.qxd 18-09-2013 18:18 Page vi Schein’s Common Sense Prevention and Management of Surgical Complications Chapter 22 431 Vascular surgery Paul N. Rogers Chapter 23 451 Bariatric surgery Ahmad Assalia Chapter 24 471 Trauma Ari Leppäniemi Chapter 25 497 Pediatric surgery Graeme Pitcher Chapter 26 519 Urology Zohar A. Dotan Epilogue 535 Lessons learned from surgical complications David Dent Index 539 vi prelims_prelims.qxd 18-09-2013 18:18 Page vii Contributors Ahmad Assalia MD Chief of Advanced and Bariatric Surgery, Rambam Health Care Campus, Haifa, Israel ( Chapter 23) [email protected] Saba Balasubramanian MS FRCS PhD Consultant Endocrine Surgeon, Royal Hallamshire Hospital, Sheffield, UK ( Chapter 21) [email protected] Mark Cheetham BSc MD FRCS Consultant General and Colorectal Surgeon, Royal Shrewsbury Hospital, Shrewsbury, Shropshire, UK ( Chapters 6 and 14) [email protected] Pierre-Alain Clavien MD PhD FACS FRCS (Ed.) Professor and Chairman of Surgery, Swiss HPB Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland ( Chapters 18 and 19) [email protected] David Dent ChM FRCS (Eng) FCS(SA) FRCP&S (Glas. Hon) Emeritus Professor of Surgery, University of Cape Town, South Africa ( Epilogue) [email protected] Zohar A. Dotan MD PhD Head of Uro-oncology Service, Department of Urology, Sheba Medical Center, Tel Hashomer, Israel ( Chapter 26) [email protected] Jonathan E. Efron MD FACS FASCRS Associate Professor of Surgery, The Mark M. Ravitch MD Endowed Professorship in Surgery; Chief, Ravitch Division, Johns Hopkins University, Baltimore, Maryland, USA ( Chapter 6, section 5) [email protected] Caitlin W. Hicks MD MS Resident in Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA ( Chapter 6, section 5) vii prelims_prelims.qxd 18-09-2013 18:18 Page viii Schein’s Common Sense Prevention and Management of Surgical Complications John Hunter MDFACS Mackenzie Professor and Chairman of Surgery, Oregon Health & Science University, Portland, Oregon, USA ( Chapter 6, section 2) [email protected] Samir Johna MD FACS FICS Staff Surgeon, Southern California Permanente Medical Group; Clinical Professor of Surgery, Loma Linda University School of Medicine; Director, Arrowhead Regional — Kaiser Fontana General Surgery Residency Program, California, USA ( Chapter 3) [email protected] Ari Leppäniemi MD Head of Trauma and Emergency Surgery, University of Helsinki, Finland ( Chapters 1, 2, 5, 7 and 24) [email protected] Mickaël Lesurtel MD PhD SNF Förderungsprofessor, Swiss HPB Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland ( Chapter 18) [email protected] Ronald V. Maier MD FACS Jane and Donald D. Trunkey Professor and Vice- Chair of Surgery, University of Washington; Surgeon-in-Chief, Harborview Medical Center, Seattle, USA ( Chapter 13) [email protected] Graeme Pitcher MD FACS Pediatric Surgeon, Associate Professor of Surgery, University of Iowa, Iowa City, USA ( Chapter 25) [email protected] B. Ramana MS DNB FRCS Advanced Laparoscopic & Bariatric Surgeon, BMI (Bariatrics & Metabolism Initiative), Belle Vue Clinic, Kolkata, India ( Chapter 11) [email protected] Paul N. Rogers MBChB MBA MD FRCS Consultant General and Vascular Surgeon, Western Infirmary, Glasgow, UK ( Chapters 1, 2, 5, 7, 16 and 22) [email protected] viii prelims_prelims.qxd 18-09-2013 18:18 Page ix Contributors Danny Rosin MD Attending General and Advanced Laparoscopic Surgeon, Sheba Medical Center, University of Tel Aviv, Israel ( Chapters 1, 2, 5, 7, 9, 15, 16 and 20) [email protected] Avi Rubinstein MD MSc Neurosurgeon, Advocate, Law Offices Rubinstein- Yakirevtch, Ramat Gan, Israel ( Chapter 10) [email protected] Erik Schadde MD FACS Director HPB Fellowship, Swiss HPB Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland ( Chapter 19) [email protected] Moshe Schein MD FACS General Surgeon, Marshfield Clinic, Ladysmith, Wisconsin, USA ( Chapters 1-8, 10, 12, 16 and 17) [email protected] Gregory Sergeant MD PhD HPB Fellow, Swiss HPB Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland ( Chapter 18) [email protected] Wen-hao Tang MD PhD Professor & Chief Surgeon, Zhongda Hospital, Southeast University, Nanjing, P. R. China ( Chapter 6, section 3) [email protected] ix