List of Contributors - Thieme Medical Publishers - Home · List of Contributors Hinrich Brunn, MD Friedrich Ebert Hospital Surgical Clinic Department of Vascular Surgery Neumünster

List of Contributors

Hinrich Brunn, MDFriedrich Ebert HospitalSurgical ClinicDepartment of Vascular SurgeryNeumünsterGermany

Ronald J. Elfeldt, MDAssociate ProfessorFriedrich Ebert HospitalSurgical ClinicDepartment of Thoracic SurgeryNeumünsterGermany

Michael Fuchs, MDAssociate ProfessorFriedrich Ebert HospitalTrauma and Orthopedic Clinic, Sports Trauma ClinicNeumünsterGermany

Jan M. Mayer, MDFriedrich Ebert HospitalSurgical ClinicNeumünsterGermany

Ingo L. Schmalbach, MDFriedrich Ebert HospitalSurgical ClinicNeumünsterGermany

Nicolas T. Schwarz, MDAssociate ProfessorFriedrich Ebert HospitalSurgical ClinicNeumünsterGermany

Alexander Selch, MDFriedrich Ebert HospitalSurgical ClinicDepartment of Vascular SurgeryNeumünsterGermany

Burkhard Thiel, MDFriedrich Ebert HospitalSurgical ClinicNeumünsterGermany

Michael Voelz, MDFriedrich Ebert HospitalSurgical ClinicNeumünsterGermany

List of Contributors V

aus: Schwarz u. a., General and Visceral Surgery Review (ISBN 9783131543110) © 2012 Georg Thieme Verlag KG

Preface

General and Visceral Surgery Review was originallypublished in German in 1996 as a revision aid forsurgery in general. Since then, as the individual sur-gical subspecialties continue to develop, and today’smedical training is built around the “CommonTrunk” (as it is called in Germany), with subsequentspecialist training, it has been necessary to continu-ally update and adapt the higher-training contentaccording to the various surgical specialties. Generaland Visceral Surgery Review was published in itssixth German-language edition in 2009.

Karl-Heinz Reutter, MD, created General and Vis-ceral Surgery Review and continued it through fivesuccessful editions in the German language. I am notonly happy to take over the task of editor from himfor further German language editions, I am alsohighly delighted to be able to present the first Eng-lish-language edition.

The purpose of this textbook is higher trainingand examination preparation in general and visceralsurgery. We have made every effort to include up-to-date information and to present this information in aconcise and succinct format, thus enabling col-leagues to acquire the necessary theoretical knowl-edge in the shortest possible time.

This book is designed to place emphasis on corestatements, and includes suggestions for furtherreading to help consolidate what has been learned.Contributions were provided by surgeons activelyworking in this field. By calling on their own practi-cal experiences they have produced an ideal learningtool suited to the current requirements of highertraining and examination preparation.

Nicolas T. Schwarz Neumünster, Germany

Acknowledgements

I thank my colleague K.-H. Reutter, MD, for giving methe opportunity to take over the editorship of thisbook. My special thanks also go to my medical col-leagues in the Departments of Surgery and TraumaSurgery in Neumünster. We owe the production of

this new edition to their enthusiasm for general andvisceral surgery and to their constant thirst forknowledge, coupled with the desire to pass on thisinterest and their love of the specialty to their manycolleagues.

PrefaceVI


Contents

1 Perioperative Medicine 1N.T. Schwarz

Preoperative Phase . . . . . . . . . . . . . . . . . . . . . . . . 1

Intraoperative Phase . . . . . . . . . . . . . . . . . . . . . . . 5

Postoperative Period . . . . . . . . . . . . . . . . . . . . . . . 6

Fast-Track Surgery . . . . . . . . . . . . . . . . . . . . . . . . . 7

2 Thyroid 9B. Thiel

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

General Epidemiology . . . . . . . . . . . . . . . . . . . . . . 12

General Diagnostic Approach . . . . . . . . . . . . . . . . 12

General Treatment Approach . . . . . . . . . . . . . . . . 17

Diseases of the Thyroid . . . . . . . . . . . . . . . . . . . . 26Euthyroid Goiter . . . . . . . . . . . . . . . . . . . . . . . . . 26Hyperthyroidism . . . . . . . . . . . . . . . . . . . . . . . . . 28Graves Disease, Immunogenic Hyperthyroidism 30Thyrotoxic Crisis . . . . . . . . . . . . . . . . . . . . . . . . . 33Thyroiditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Thyroid Carcinoma . . . . . . . . . . . . . . . . . . . . . . . 37

3 Parathyroid 44B. Thiel

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Primary Hyperparathyroidism . . . . . . . . . . . . . . . 45

Secondary Hyperparathyroidism . . . . . . . . . . . . . 51

Tertiary Hyperparathyroidism . . . . . . . . . . . . . . . 54

Parathyroid Carcinoma . . . . . . . . . . . . . . . . . . . . . 54

Hypoparathyroidism . . . . . . . . . . . . . . . . . . . . . . . 55

4 Thorax (Pleura, Lung) 57R.J. Elfeldt

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Pleural Effusion . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Pleural Empyema . . . . . . . . . . . . . . . . . . . . . . . . . 61

Chest Trauma: Blunt Chest Injuries . . . . . . . . . . . 62Chest Contusion . . . . . . . . . . . . . . . . . . . . . . . . . . 63Chest Compression . . . . . . . . . . . . . . . . . . . . . . . 63Rib Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Fracture of the Sternum . . . . . . . . . . . . . . . . . . . 65Lung Contusion . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Chest Trauma: Penetrating Chest Injuries . . . . . . 67Traumatic Pneumothorax . . . . . . . . . . . . . . . . . . 67Hemothorax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Chylothorax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70Tracheal and Bronchial Injuries . . . . . . . . . . . . . . 70

5 Mediastinum 72R.J. Elfeldt

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

Mediastinoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Subcutaneous Emphysema . . . . . . . . . . . . . . . . . . 74

Mediastinal Emphysema . . . . . . . . . . . . . . . . . . . . 74

Mediastinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Contents VII


6 Diaphragm 77I.L. Schmalbach

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Diaphragmatic Hernias . . . . . . . . . . . . . . . . . . . . . 78

Rare Disorders of the Diaphragm . . . . . . . . . . . . . 81

7 Hernias 83J.M. Mayer

Inguinal Hernias . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Femoral Hernias . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Incisional Hernias . . . . . . . . . . . . . . . . . . . . . . . . . 96

Umbilical Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Epigastric Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Internal Hernias . . . . . . . . . . . . . . . . . . . . . . . . . . 104

8 Esophagus 106M. Voelz

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Histology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Functional Disorders . . . . . . . . . . . . . . . . . . . . . . . 108Achalasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Other Functional Disorders . . . . . . . . . . . . . . . . . 109

Esophageal Diverticulum . . . . . . . . . . . . . . . . . . . 110Cervical Pulsion Diverticulum (ZenkerDiverticulum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110

Epiphrenic Pulsion Diverticulum . . . . . . . . . . . . 111Traction Diverticulum . . . . . . . . . . . . . . . . . . . . . 111

Gastroesophageal Reflux Disease (GERD) . . . . . . . 111

Esophageal Carcinoma . . . . . . . . . . . . . . . . . . . . . 115

Injuries of the Esophagus . . . . . . . . . . . . . . . . . . . 123Corrosive Injuries . . . . . . . . . . . . . . . . . . . . . . . . . 123Traumatic Perforation of the Esophagus . . . . . . . 124Spontaneous Esophageal Rupture (BoerhaaveSyndrome) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124

9 Stomach and Duodenum 126N.T. Schwarz

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Ulcer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

Bleeding from the Stomach andDuodenum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150

Gastric Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . 155

MALT Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . 173

10 Small Intestine 176I.L. Schmalbach

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176

Crohn Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176

Meckel Diverticulum . . . . . . . . . . . . . . . . . . . . . . . 184

Jejunal Diverticulum . . . . . . . . . . . . . . . . . . . . . . . 184

11 Vermiform Appendix 185I.L. Schmalbach

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

Acute Appendicitis . . . . . . . . . . . . . . . . . . . . . . . . 185

Rare Diseases of the Appendix . . . . . . . . . . . . . . . 193Endometriosis of the Appendix . . . . . . . . . . . . . 193Crohn Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . 193

Diverticulitis of the Appendix . . . . . . . . . . . . . . . 193Appendix Carcinoid . . . . . . . . . . . . . . . . . . . . . . . 193Mucinous Cystadenoma / PseudomyxomaPeritonei . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194Appendix Carcinoma . . . . . . . . . . . . . . . . . . . . . . 194

ContentsVIII


12 Colon 196J.M. Mayer

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196

Anastomosis Techniques . . . . . . . . . . . . . . . . . . . 197

Minimally Invasive Colon Surgery . . . . . . . . . . . . 199

Diverticulosis and Diverticulitis . . . . . . . . . . . . . . 200

Ulcerative Colitis . . . . . . . . . . . . . . . . . . . . . . . . . . 205

Polyps of the Colon . . . . . . . . . . . . . . . . . . . . . . . 212

Colon Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214

13 Rectum 230J.M. Mayer

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230

Rectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233

Pelvic Floor Insufficiency . . . . . . . . . . . . . . . . . . . 240

14 Anus 245J.M. Mayer

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

Perianal Vein Thrombosis . . . . . . . . . . . . . . . . . . . 250

Anal Fissure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250

Abscesses and Anal Fistulas . . . . . . . . . . . . . . . . . 251

Fecal Incontinence . . . . . . . . . . . . . . . . . . . . . . . . 255

Anal Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . 258

15 Intestinal Obstruction 263H. Brunn

16 Spleen 277H. Brunn

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277

Hypersplenism Syndrome . . . . . . . . . . . . . . . . . . . 277

17 Liver 281M. Voelz

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281

Benign Liver Tumors . . . . . . . . . . . . . . . . . . . . . . . 282Focal Nodular Hyperplasia (FNH) . . . . . . . . . . . . 282Hepatocellular Adenoma . . . . . . . . . . . . . . . . . . . 283Hepatic Hemangioma . . . . . . . . . . . . . . . . . . . . . 283Hepatic Cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284

Malignant Liver Tumors . . . . . . . . . . . . . . . . . . . . 284Primary Hepatic Carcinoma . . . . . . . . . . . . . . . . 284Liver Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . 286

Hydatid Disease of the Liver (Echinococcosis) . . . 297

Portal Hypertension . . . . . . . . . . . . . . . . . . . . . . . 299

Liver Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302

18 Gallbladder and Biliary Tract 304M. Voelz

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304

Cholecystolithiasis . . . . . . . . . . . . . . . . . . . . . . . . . 306

Acute Cholecystitis . . . . . . . . . . . . . . . . . . . . . . . . 315

Gallbladder Carcinoma . . . . . . . . . . . . . . . . . . . . . 316

Extrahepatic Bile Duct Carcinoma . . . . . . . . . . . . 319

Contents IX


19 Pancreas 321N.T. Schwarz

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323

Acute Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . 323

Chronic Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . 327

Pancreatic Pseudocysts . . . . . . . . . . . . . . . . . . . . . 331

Carcinoma of the Pancreas . . . . . . . . . . . . . . . . . . 332

Endocrine Pancreatic Tumors . . . . . . . . . . . . . . . . 336

Pancreatic Trauma . . . . . . . . . . . . . . . . . . . . . . . . 337

20 Transplantation 339N.T. Schwarz

21 Peritonitis 346B. Thiel

22 Neuroendocrine Tumors and Gastrointestinal Stromal Tumors 360J.M. Mayer

Neuroendocrine Tumors . . . . . . . . . . . . . . . . . . . . 360Stomach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364Duodenum and Pancreas—Insulinoma . . . . . . . . 364Duodenum and Pancreas—Gastrinoma . . . . . . . . 366Ileum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369

Vermiform Appendix . . . . . . . . . . . . . . . . . . . . . . 370Colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371Rectum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372

Gastrointestinal Stromal Tumors . . . . . . . . . . . . . 372

23 Soft-Tissue Tumors 377H. Brunn

24 Vascular Surgery 381A. Selch

Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381Vascular Injuries . . . . . . . . . . . . . . . . . . . . . . . . . 382Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383Acute Limb Artery Occlusion . . . . . . . . . . . . . . . 385Acute Mesenteric Artery Occlusion . . . . . . . . . . 387Chronic Arterial Disease of the Limbs . . . . . . . . 388

Subclavian Steal Syndrome . . . . . . . . . . . . . . . . . 390

Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391Varicose Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . 391Phlebothrombosis . . . . . . . . . . . . . . . . . . . . . . . . 392

25 Emergency and Trauma Surgery 395M. Fuchs

Polytrauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395

Head Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397

Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399

Dislocations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403

Soft-Tissue Injuries . . . . . . . . . . . . . . . . . . . . . . . . 405

Bone Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . 407

Nerve Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409

Tendon Rupture . . . . . . . . . . . . . . . . . . . . . . . . . . 410

lllustration Credits 413

Index 415

ContentsX


Indication

Indications for Surgery● Ulcerative esophagitis, strictures, Barrett esophagus● Failure or intolerance of drug therapy● Patient’s wish as an alternative to long-term drug therapy● Volume reflux with chronic bronchitis● Volume reflux with treatment-resistant regurgitation of food● An interdisciplinary decision with gastroenterologists should be made.

Conservative Treatment

● Weight reduction● Sleep with upper body elevated● Proton pump inhibitors, in ca. 80% freedom from symptoms, healing of the

reflux esophagitis almost without exception; often requires lifelong treat-ment

Surgical Treatment

● Laparoscopic Nissen–Rosetti fundoplication● Alternatively, hemifundoplication● Hiatoplasty: posterior narrowing of the esophageal hiatus that has been

stretched by the sliding hernia; additionally counteracts reflux by increasingthe angle at which the esophagus opens into the stomach

● Additional fundophrenicopexy indicated only for upside-down stomach● With very large sliding hiatal hernias or paraesophageal herniation, use of a

plastic mesh to close the hernia may be necessary.● Numerous other procedures are not established for use outside of clinical

studies. These include, for instance, heating by radiofrequency therapy, intra-luminal mucosal plication, and injection of plastic polymers.

Laparoscopic Fundoplication

Operative Technique

● Position the patient with legs on stirrups and with the buttocks supported.● Create a pneumoperitoneum and carry out diagnostic laparoscopy (Fig. 8.2).● Then place the patient in semi-seated position with feet lowered and turned

slightly to the right side. The surgeon stands between the patient’s legs.● The left lobe of the liver is retracted with a triangle over the trocar from the

right costal arch (T5).● Exposure of the gastroesophageal junction is by incision of the lesser omen-

tum proximal to the accessory left hepatic artery, which is often present.● Incision of the peritoneal fold over the esophagus● Dissection of the fundus along the greater curvature of the stomach from

adhesions to the spleen (caution: short gastric arteries) and in a retroperito-neal direction. Dissection with ultrasonic scissors has proven useful.

● Dissect the esophagus free at the junction with the gastric fundus, protectingthe vagal trunks.

● If appropriate, perform dissection of a hiatal hernia in the lower mediastinum.● Tighten the hiatus, usually by two or three sutures posteriorly using nonab-

sorbable suture material (hiatus repair; Fig. 8.3).● If appropriate, additional implantation of a plastic mesh after reduction of a

large hiatal hernia, paraesophageal hernia or upside-down stomach

Gastroesophageal Reflux Disease (GERD)

● Interdisciplinary indicationfor surgery

● Weight reduction, sleepingwith upper body elevated,proton pump inhibitors

● Standard treatment: lapa-roscopic fundoplicationand hiatoplasty

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● Create a loose fundal cuff around the distal esophagus, drawing the mobilizedfundus behind the esophagus.

● Introduction of a large gastric tube to prevent narrowing of the lumen by thefundoplication (this is done only at this time as it would interfere with dis-section beforehand)

● Fixation of the cuff by picking up the esophagus with the first suture toprevent the stomach from sliding proximally. Two further sutures are used toform a loose cuff (floppy Nissen; Fig. 8.4); all sutures are nonabsorbable.

● Remove the gastric tube and check that the cuff is loose.● Check for hemostasis, particularly on the spleen and liver.

Postoperative Management

● Removal of the gastric tube while still in the operating room● Light diet the following day, ensuring that it is well masticated● Check blood count on postoperative days 1 and 3.● Discharge on postoperative day 3. Reflux symptoms should be eliminated on

the day of surgery.

Complications

● Dysphagia and gas bloat syndrome (result of an excessively tight cuff)● Telescope phenomenon if cuff is not fixed to the esophagus● Denervation syndrome as a result of injury to vagal branches or vagus trunk● Reflux recurrence if the cuff loosens● Cicatricial stenosis at the esophageal hiatus with symptoms of narrowing

8 Esophagus

T4

T5T1 T2 T3

Fig. 8.2 Access routes forlaparoscopic fundoplication.T1: optic trocarT2: working trocar, surgeonT3: working trocar, assistantT4: working trocar, surgeonT5: working trocar, assistant,for holding the left lobe ofthe liver (triangle)

● Dysphagia● Gas bloat syndrome● Stenosis● Recurrence

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Esophageal Carcinoma

Epidemiology

● Incidence about 10 per 100 000 population/year● Predominantly squamous epithelial carcinomas, followed by adenocarcino-

mas; incidence of adenocarcinomas of the distal esophagus and gastroeso-phageal junction has been increasing in recent years.

● Ratio of men to women is 5 : 1.

Etiology

● Rapid metastasis to the local lymph nodes and extensive intramural growth(mucosal margin of the tumor often does not correspond to the tumor mar-gin in the esophageal wall)

Esophageal Carcinoma

Fig. 8.3 Hiatal repair

Stomach

Esophagus

Fig. 8.4 Nissenfundoplication

● Intramural growth● Early lymphatogenousmetastasis

● Lung and liver metastases● Peritoneal carcinomatosis

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● Distant metastases from proximal tumors especially to the lung and fromdistal tumors to the liver; skeletal metastases only occur later; with locallyadvanced distal tumors there is often peritoneal carcinomatosis

● Tumor localization is very important because of the different treatmentapproaches

Risk Factors● Smoking● Alcohol● Thermal injury (hot foods)● Cicatricial strictures, for example after acid or alkali corrosive injury, radia-

tion● Barrett esophagus: precancerous condition for adenocarcinoma of the

esophagus

Classification

● Squamous epithelial carcinoma: distinction between cervical, supra- andinfrabifurcation

● Adenocarcinoma of the distal esophagus is classified with proximal gastriccarcinoma as adenocarcinoma of the esophagogastric junction (AEG):► Type I: distal esophagus (Barrett carcinoma)► Type II: cardia carcinoma, at the gastroesophageal junction► Type III: subcardiac gastric carcinoma, infiltrating the cardia from below

● AEG type I tumors are classified as esophageal carcinomas in the TNM clas-sification, and AEG type II and III tumors are classified as gastric carcinomas(Tables 8.2 and 8.3).

8 Esophagus

Table 8.2 TNM classification

Tx Primary tumor not assessable

T0 No evidence of primary tumor

Tis Carcinoma in situ

T1 Infiltration of the lamina propria, muscularis mucosae, or submucosa

T2 Infiltration of the muscularis propria

T3 Infiltration of the adventitia

T4 Infiltration of neighboring structures

Nx Regional lymph nodes not assessable

N0 No regional lymph node metastases

N1 Regional lymph node metastases

M0 No distant metastases

M1 Distant metastases and nonregional lymph node metastases

Tumor in the upper thoracic esophagus

M1a Metastases in cervical lymph nodes

M1b Nonregional lymph nodes and/or other distant metastases

Tumor in the middle thoracic esophagus

M1a not possible


Tumor in the lower thoracic esophagus

M1a Celiac lymph nodes


● Assessment of lymphnodes crucial for staging,prognosis and treatment

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13 RectumJ.M. Mayer

Anatomy● The rectum extends from the upper border of the anal canal (dentate line) to

16 cm from the anus, measured with a rigid proctoscope.● It is divided into three levels:

► Upper third: 12–16 cm from the anus (intraperitoneal)► Middle third: 6–12 cm from the anus (extraperitoneal)► Lower third: < 6 cm from the anus (extraperitoneal)

● Rectal ampulla: lies against the concavity of the sacrum● Anal canal: at the level of the pelvic diaphragm, passes in a posterior direc-

tion

Fasciae in the Lesser Pelvis● Posterior: The parietal pelvic fascia lines the pelvis posteriorly. It extends

from the pelvic ring almost to the tip of the sacrum, meets the pelvic floor,and covers the mesorectum posteriorly as visceral pelvic fascia (investingfascia). Between them is the avascular Waldeyer space.

● Lateral: The paraproctium forms a ligamentous connection with the pelvis.● The Denonvillier fascia is anterior. In men, it clothes the posterior wall of the

bladder, the seminal vesicles and the posterior wall of the prostate. It isreflected at the urogenital diaphragm and covers the rectum anteriorly asthe visceral pelvic fascia (investing fascia).

Arteries (Fig. 13.1)● Superior rectal artery (unpaired) from the inferior mesenteric artery pro-

vides the blood supply to the major part of the rectum. It divides into threeterminal branches on the posterior wall of the rectum, which empty into thehemorrhoidal plexus at 3, 7, and 11 o’clock positions.

● Middle rectal arteries (paired, inconstant) from the internal iliac artery runabove the levators into the paraproctium and supply a small section of thedistal anterior rectal wall together with the inferior rectal arteries (paired,inconstant) from the pudendal arteries, which are branches of the internaliliac artery, running below the levators.

● Blood supply after low anterior rectal resection:► With ligature close to the trunk of the inferior mesenteric artery, the

proximal colon stump is supplied only through the anastomosis of theRiolan and Drummond arcade. It is therefore important to spare the mar-ginal arcade.

► The rectal stump can be supplied only by the inferior rectal arteries andpossibly the middle rectal arteries. The longer the rectal stump, the moreendangered is its blood supply. Intramural vascular anastomoses usuallyensure an adequate blood supply from distally.

13 Rectum

● Between the dentate lineand 16 cm from the anus,measured with a rigidproctoscope

● Anterior and posterior in-vesting fascia

● Lateral: paraproctiumforming ligamentous con-nection with the pelvis

● Main blood supply: superi-or rectal artery; no mar-ginal artery

● Middle and inferior rectalarteries: inconstant, supplythe distal anterior wall

● After resection, usually ad-equate blood supply fromdistally

230

13


Veins● The main venous drainage is to the liver through the unpaired superior rectal

vein and portal vein system.● In the lower quarter of the rectum, there may be venous drainage to the

lungs via the middle and inferior rectal veins and inferior vena cava (incon-stant).

Lymphatic Drainage● The main lymphatic drainage follows the branching of the superior rectal

artery to the locoregional lymph nodes in the mesorectum, and from therealong the main trunk of the superior rectal artery to the para-aortic lymphnodes.

● Because of the absence of a vascular arcade close to the bowel wall, there areno lymphatic pathways running proximally and distally along the bowel.Malignant cells are usually not found more than 4 cm from the primarytumor. Thus, smaller safety margins are sufficient in rectal surgery.

● The inferior quarter of the rectum has no lymph nodes because of the ab-sence of mesorectum. Lymphatic drainage is intramural in the cranial direc-tion.

● Lymphatic channels along the middle and inferior rectal arteries are presentonly rarely. Iliac lymph node metastases (lateral pelvic wall) therefore occurrarely, even with supraanal rectal cancer.

● The anal canal also drains to the inguinal lymph nodes.

Innervation● The distal quarter of the rectum has particularly pronounced innervation.● This is the site of the procontinence reaction for maintaining the anorectal

reflex.● The epicritic sensibility for distinguishing solid matter, liquid, and gas is

located in the anoderm.

Anatomy

1

2

3

4

5

7

8

11

910

6

Fig. 13.1 Blood supply ofthe rectum.1: Aorta2: Inferior mesenteric artery3: Levator ani with pubo-

rectalis sling4: Anal canal5. Inferior rectal artery6: Levator ani7: Middle rectal artery8: Internal iliac artery9: Superior rectal artery

10: Middle sacral artery11: Common iliac artery

● Main drainage is to theliver through the superiorrectal vein.

● Middle and inferior rectalveins usually absent.

● Main drainage along thesuperior rectal artery

● Only slight spread alongthe bowel because of theabsence of a marginal ar-tery

● Drainage to iliac and in-guinal lymph nodes usuallyabsent

231

13


Index

Note: ‘vs’ indicates differentialdiagnosis.

A

abdomen (abdominal cavity)acute see acute abdomenapproach to pelvic floor insuf-

ficiency surgery via 244cleansing 353, 354–357sepsis see sepsiswall

anatomy 96distension with obstructed

bowel 265, 269hernia see hernia

abdominal guarding in peritonitis349

abdominoperineal approachanal carcinoma 260rectal cancer

amputation of rectum 239intersphincteric resection of

rectum 238abdominothoracic esophagealresection 119–120

abscessesbowel

anus 251–254colorectal carcinoma surgery

and risk of 228Crohn disease 178, 181, 183

hepatic 307pleural (empyema) 61–62pyogenic see empyema

accessory spleen 277achalasia 108–109ACPP/SCCM Consensus Confer-ence, diagnostic criteria forsepsis and septic shock359

acute abdomen 349mesenteric artery occlusion vs

other causes of 387

acute lung injury or acute respi-ratory distress syndrome, ven-tilation 358

adenocarcinomaanal 258, 261esophagus 117, 119

distal 115, 116esophagogastric junction

(AEG) 116, 155, 166adenoma

colonic 213, 214progression to carcinoma 215

hepatocellular 283parathyroid 45, 46, 47, 48, 49

removal 48ultrasonography 15

thyroid 15, 16, 28, 29adenomatous polyposis, familial(FAP) 213, 214

adhesions, bowel 266, 275adhesive plastic drapes for tem-porary abdominal closure 356

adjunctive treatment in peritoni-tis 358

adjuvant (postoperative) therapycolon carcinoma 218gastric carcinoma 159–160gastric MALToma 175pancreatic carcinoma 334rectal cancer 234soft-tissue tumors 379

adventitiaarterial 381esophageal 108

afferent loop syndrome 147aftercare see postoperative careairway injury 70–71Aitken classification of epiphysealfractures 401

AJCC see American Joint Commit-tee on Cancer

alimentary tract see gastrointes-tinal tract

Altemeier operation in pelvicfloor insufficiency 244

alveolar echinococcosis 298American College of Chest Physi-cians/Society of Critical CareMedicine (ACPP/SCCM) Consen-sus Conference, diagnostic cri-teria for sepsis and septic shock359

American Joint Committee onCancer (AJCC) stagingesophageal carcinoma 117gallbladder and bile duct carci-

noma 317, 319American Society of Anesthesiol-ogists’ risk group classification1, 2

amine precursor uptake and de-carboxylation (APUD) system360

aminosalicylatesCrohn disease 180diverticulitis 203ulcerative colitis 207, 208

amputation, soft-tissue tumors380

anal canal see anusanal sphincters, internal andexternal 232dysfunction causing fecal

incontinence 255artificial sphincter implanta-

tion 258reconstructive surgery 257

incision (sphincterotomy)251

see also intersphincteric resec-tion

anaplastic (undifferentiated) thy-roid carcinoma 38, 41, 43

anastomosis (surgical)colorectal 197–199, 238

low anterior proctectomy237

proctocolectomy 210, 211,212

hepatic resections 292

Index 415


in pancreatic carcinoma pallia-tion 336

peptic ulcer surgeryleakage 147stenosis 147techniques 134–136

in portal hypertension surgery301

small bowel in Crohn disease182

transplantation, kidney–pan-creas 343

anastomosis of Riolan 197anesthesia 6

liver resection 289aneurysms 383–385angiographic embolization inupper GI bleeding 153, 154

angiographyacute limb artery occlusion 386acute mesenteric artery occlu-

sion 387bowel obstruction 271rib fractures 65subclavian steal syndrome 390see also computed tomography

angiographyanoderm 232

extent of loss in hemorrhoidec-tomy 247–249

antecolic Billroth II gastrectomy140

antibioticscholecystitis (acute) 316diverticulitis 203H. pylori eradication 132peritonitis 352–353

antibodies in autoimmune thy-roid disease 14, 30, 31

anticoagulation 3–5after deep vein thrombosis

treatment 393lifelong 394

antithyroid drugs 29, 32anus (and anal canal) 245–262

abscesses 251–254anatomy 232carcinoma 258–262fissure 250fistulas in or in region of

251–254Crohn disease 182

hemorrhoids 245–249

see also colo-anal pouch anas-tomosis; ileo-anal pouch;transanal procedures

AO classificationfractures 399soft-tissue injury 405

aortic hiatus 77aortoiliac occlusion 389APACHE-II score in peritonitis 350appendectomy

appendicitisconventional 192laparoscopic 190–191

carcinoid 194appendicitis, acute 183–193treatment 189–192

appendix (vermiform) 185–195rare conditions 186, 193–194

neuroendocrine tumors193–194, 370–371

APUD (amine precursor uptakeand decarboxylation) system360

arteries 381–391structure/anatomy 381supply to tissues/organs

colon 196–197diaphragm 77esophagus 106–107gallbladder/biliary tract 305liver 281–282pancreas 321peritoneum 346rectum 230spleen 277stomach/duodenum 126thyroid 9, 10

surgery 381–391arteriosclerosis 388arthroplasty prosthesis, infected409

ASA’s risk group classification 1, 2ascending colon 196aspiration, pleural 58aspiration biopsy/cytology (incl.fine needle)pancreatic carcinoma 333thyroid 16–17

carcinoma 39–41de Quervain’s thyroiditis 34goiter 27hyperthyroidism 28

aspirin-related peptic ulcers 130

atherogenesis, steps in 388–389atherosclerosis, risk factors 388Atlanta classification of acutepancreatitis 324

auscultationobstructed bowel 269peritonitis 350

autoimmune thyroid disease30–32diagnosis 14

autonomic adenoma 15, 16, 28,29

autotransplantation (grafts of au-tologous tissue)interposition graft in post-gas-

trectomy reconstruction 165,166, 167–168

parathyroid tissue 53skin graft with incisional hernia

103for vessel replacement 381

aneurysms 384see also bypass grafts

axonotmesis 409azathioprine

Crohn disease 181ulcerative colitis 208

B

B cell lymphoma, gastric 174bacteria in peritonitis pathogene-sis 347–348

bands, adhesive (bowel) 266, 275barium swallow

achalasia 109esophageal diverticulum 110

Barrett esophagus 111, 112, 113,116

Bassini herniotomy 88Beger operation 329, 330Best Crohn Disease Activity Index(CDAI) 177

bile, inspection for leaks withliver resection 292

bile ductsanatomy 304carcinoma (cholangiocarci-

noma) 284, 285, 318–320common 304

exploration 309, 314stone impacted in 307

Index416


biliary (gallstone) ileus 267, 275,307

biliary-enteric anastomosis (pro-cedure)hepatic metastases 292pancreatic carcinoma 336

biliary-enteric fistula (pathologi-cal) 307

biliary tract 304–320anatomy 304–305

Billroth I gastrectomy 133,138–140ulcer recurrence after 150

Billroth II gastrectomy 133afferent loop syndrome follow-

ing 147ulcer recurrence after 150

biopsyaspiration see aspiration biopsyesophageal 112liver, in portal hypertension

300soft-tissue tumors 378

for radical removal 378, 379bisegmental liver resection294–295

Bismuth–Corlette classification ofKlatskin tumors 319

bleeding see hemorrhageblood vessels see entries undervascular and specific types ofvessels

Blumberg sign 187blunt chest trauma 62–67Bochdalek hernia 77, 79Boerhaave syndrome 124–125bone

fractures see fracturesin hyperparathyroidism 46infection 407–409

bone scintigraphy, esophagealcarcinoma 118

Borrmann classification, ad-vanced gastric carcinoma 157

bowel see intestinebrachytherapy

anal carcinoma 261esophageal carcinoma 119

Braun anastomosis 140, 141, 171breast, video-endoscopic goiterresection approach via 24

bridging mesh 101bronchial injury 70–71

bronchoscopy, esophageal carci-noma 118

Brook terminal ileostomy, ulcera-tive colitis 209

Budd–Chiari syndrome 299budesonide, Crohn disease 180Buess transanal endoscopic mi-crosurgery 235

bypass grafts 381peripheral arterial occlusive

disease 390subclavian steal syndrome 391

C

C-cell carcinomas 38, 42CA-19-9 and pancreatic carcino-ma 333

calcitonin 12, 45measurement 14see also procalcitonin

calcium levelsabnormal see hypercalcemia;

hypocalcemiaregulation 46

Calot triangle 305cancer (malignant tumors)

appendiceal 193–194bile duct (cholangiocarcinoma)

284, 285, 319–320colorectal see colorectal cancer;

rectumesophageal 115–123gallbladder 316–320

gallstones predisposing to306, 316

gastric 134, 155–175lymph node metastases 127,

156, 157, 163in stump following gastrec-

tomy 149hepatic see liverpancreatic 332–336parathyroid 54–55pleural effusions in 58, 59soft-tissue, classification 377thyroid 36, 37–46see also metastases; precancer-

ous conditionscarcinoid syndrome 362, 369, 370carcinoid tumor

appendiceal 193–194

definition 360carcinoma

anal 258–262bile duct (cholangiocarcinoma)

284, 285, 319–320colorectal see colorectal cancer;

rectumesophageal 115–123gallbladder 316–318

gallstones predisposing to306

gastric 134, 155–173lymph node metastases 127,

156, 157, 163in stump following gastrec-

tomy 149hepatocellular 284, 285, 341neuroendocrine 360, 361pancreatic 332–336parathyroid 54–55thyroid 36, 37–46

carcinomatosis, peritoneal seeperitoneal cavity

cardia, achalasia of 108–109cardiac contusions 65, 66cardiopulmonary symptoms, dia-phragmatic hernia 79

caval filter 393cecum 196

reservoir construction from238

celiac trunk 126central liver resection 294central soft-tissue tumors 378cervical esophageal, resection121–122

cervical exploration, bilateral, inhyperparathyroidism 48

cervical lymph nodes see necklymph nodes

cervical pulsion diverticulum 110,110–111

chemical injury, esophagus123–124

chemoradiotherapyanal carcinoma 260, 261

prognosis 262esophageal carcinoma 118, 119gastric carcinoma 160rectal cancer 234

chemotherapyanal carcinoma 260, 261bile duct carcinoma 320

Index 417


colon carcinoma 218gallbladder carcinoma 318gastric carcinoma 158

adjuvant 159–160, 160palliative 171

gastric MALToma 175hepatic metastases 286, 287,

288neuroendocrine tumors 363

gastrinoma 368pancreatic carcinoma 334pancreatic endocrine tumors

337rectal cancer

adjuvant and neoadjuvant234

palliative 240soft-tissue tumors 379thyroid carcinoma 43

chest (thorax) 57–71anatomy 57drainage see drainstrauma see trauma

chest X-ray/radiographachalasia 109diaphragmatic hernia 80mediastinitis 76peritonitis 351Perthes syndrome (traumatic

asphyxia) 64pleural effusions 58

in pleurodesis 59sternal fractures 66thyroid carcinoma 39trauma 63

lung contusions 67rib fractures 65

Child classification of livercirrhosis 285, 286

childrenfracture classification 401inguinal hernia 85, 93intussusception 267large bowel obstruction 264

cholangiocarcinoma 284, 285cholangiography

intravenous 308percutaneous transhepatic 308

cholangiopancreatographyendoscopic retrograde see en-

doscopic retrograde cholan-giopancreatography

magnetic resonance see mag-netic resonance cholangio(pancreato)graphy

cholangitis, purulent, with stones307

cholecystectomycholecystitis (acute) 316choledocholithiasis 309,

309–315aftercare 313–314complications 314–315laparoscopic see laparoscopy,

interventionalopen see open cholecystec-

tomyliver metastases 290

cholecystitis 315–316acute 315–316

with choledocholithiasis 306,307

chronic, with choledocholithia-sis 307

choledocholithiasis 306, 309choledochoscopy 313choledochotomy 313choleliths see gallstonescholestasis, laboratory tests 308cholinesterase levels and liversurgery 285

CHOP regimen, gastric MALToma175

chromogranin A and neuroendo-crine tumors 362

chylothorax 70ciclosporin, ulcerative colitis 208cirrhosis, liver

cancer risk 284Child classification 285, 286portal hypertension in 299

closed dislocation 404closed fractures, soft-tissuedamage with, classification 400

closed pneumothorax 67–68closed postoperative peritoneallavage 355

coagulation therapy with livermetastases 291

cold thyroid nodule, scintigraphy15

colectomy (colon resection)219–227, 274carcinoma 219–227diverticulitis 204, 205

laparoscopic and laparoscopi-cally-assisted 199–200

transverse see transverse colonsee also hemicolectomy; proc-

tocolectomy; subtotal resec-tion

colitis, ulcerative see ulcerativecolitis

collagen metabolism and inci-sional hernia pathogenesis 97

collar mediastinoscopy 73colo-anal pouch anastomosis 238colo-colostomy 198colon 196–229

cancer see colorectal cancerfast-track surgery 7–8minimally invasive surgery

199–200neuroendocrine tumors 371pseudo-obstruction 267stenosis in Crohn disease 182

colonoscopycolorectal carcinoma, prophy-

lactic/screening 229in ulcerative colitis 208

diverticulitis 202esophageal carcinoma 118

color-coded Doppler, thyroid 14colorectal cancer (predominantlycarcinoma) 214–229,274–275classification 216definition 214diagnostic approach 216–217epidemiology 214etiology 214–215follow-up care 228hepatic metastases 218, 234,

286lymph node metastases 197,

215obstruction in 218–219,

274–275pathogenesis 215postoperative care 227screening 229

in ulcerative colitis 208surgery 218–227, 235–239

minimally invasive 199symptoms 216treatment 217–229, 231–240,

274–275conservative 218, 234

Index418


indications/contraindications217, 234

palliative 217, 219, 227,239–240

surgical see subheading abovesee also rectum

colostomyemergency, colorectal carcino-

ma 219terminal descending 239

compartment resection, soft-tissue tumors 379–380

complications of procedures incl.surgery, perioperative (incl.iatrogenic damage) and theirrisksfor appendicitis 192–193for bowel obstruction 276cholecystectomy 314–315for colon cancer 227–228

left hemicolectomy 224right hemicolectomy 222sigmoid colectomy 227

for esophageal carcinoma 123gastric resection 146–149for gastroesophageal reflux

disease 114ileostomy 210ileus as 264, 267–268,

272–273inguinal hernia repair 93for liver metastases 297for liver trauma 303parathyroid surgery 51peritonitis as 349proctocolectomy 212for rectal cancer 240splenectomy 280thyroid surgery 24–26vascular investigations 382for Zenker diverticulum 111

compound fractures, classification400

compression, chest 63–64computed tomography (CT)

appendicitis 188bile duct carcinoma 319bowel obstruction 271cholecystolithiasis 308diaphragmatic hernia 80diverticulitis 202esophagus

carcinoma 118

rupture 125gallbladder carcinoma 318hypersplenism 277liver

focal nodular hyperplasia 282hydatid cyst 298

liver cancer 285operative planning 289

neuroendocrine tumors 362pancreatitis (acute) 325parathyroid 47peritonitis 351Perthes syndrome (traumatic

asphyxia) 64pleural effusions 58portal hypertension 300thyroid 16

computed tomography angiogra-phy (angio-CT) 382, 383acute limb artery occlusion 386acute mesenteric artery occlu-

sion 387pancreatic trauma 337

congenital hypoparathyroidism55

consent, informed 3continence-preserving proctoco-lectomy 210–212

contrast-enhanced CTpancreatic carcinoma 333pancreatitis

acute 325chronic 327

contrast-enhanced radiographybowel obstruction 271Crohn disease 178diaphragmatic hernia 80mediastinitis 76peritonitis 351ulcerative colitis 207see also barium swallow

contrast-enhanced ultrasound ofliver in focal nodular hyperpla-sia 282

contusionscardiac 65, 66chest 63lung 66–67

corpus cavernosum of rectum232

corrosive injuries, esophagus123–124

corticosteroids see steroids

cricomyotomy 111criminal nerves 127Crohn disease 176–184

appendix 193Crohn Disease Activity Index(CDAI) 177

crural arterial occlusion 389cryoablation, hepatic metastases288

cutaneo-enteric fistulas, Crohndisease 183

CVI regimen, gastric MALToma175

cyst(s)diaphragmatic 82hepatic 284

hydatid 297, 298, 299cystadenoma of appendix, muci-nous 194

cystic artery 305, 306in laparoscopic cholecystec-

tomy 311cystic duct 304, 305

in laparoscopic cholecystec-tomy 311

Czerny method, inguinal hernia93

D

Dacron grafts for vessel replace-ment 381

de Quervain’s (subacute) thyroi-ditis 34

death see mortalitydecompression surgery

bowel 273endocrine orbitopathy 32–33mediastinitis 76pneumothorax 68, 69

deep venous thrombosis392–394

defecation 232deglutition (swallowing) 108delayed primary surgery, poly-trauma 397

Delorme operation in pelvic floorinsufficiency 244

Denonvillier fascia 230descending colon 196devascularization operations inportal hypertension 301

Index 419


development, thyroid 9see also embryogenesis

diabetes, pancreatic transplanta-tion 342

diaphragm 77–82hernia 77, 78–81, 113rare disorders 81–82

Dieulafoy ulcer 130, 153differentiated thyroid carcinoma37, 42, 43

digestive tract see gastrointestinaltract

dilation procedures, gastric 143dislocations 403–404dissecting aneurysms 383diverticular disease, definition200

diverticulitis 200–205appendiceal 193

diverticulumcolon 200, 201esophageal 110–112small bowel 184

dobutamine, peritonitis 358dome sign 202Doppler ultrasound

peripheral arterial disease 386thyroid 14see also duplex ultrasound

Dormia basket 313double-barrelled ileostomy

incisional hernia 101ulcerative colitis 209–210

double contrast enema, ulcerativecolitis 207

drain(s) 6anal fistulas and abscesses 254chest 59

hemothorax 69mediastinitis 76pleural empyema 61, 62pneumothorax 68–69polytrauma 396

in hepatic resection 292tube, wound dressings made of

357drainage operations/procedures

gastric 143–146resection procedures com-

bined with 330pancreatic 327

pseudocyst 331peritonitis 353

drapes (adhesive plastic) for tem-porary abdominal closure 356

dressings for temporary abdomi-nal closure 356–357

drug administration (pharma-ceuticals)choledocholithiasis 309Crohn disease 180–182gastroesophageal reflux disease

113hyperparathyroidism (secon-

dary) 52hyperthyroidism 29

immunogenic 32peptic ulcer 132–133peritonitis 358premedication 3ulcerative colitis 207–208

drug-induced conditionsparalytic ileus 265peptic ulcer 129, 130thyroiditis 36

drug monitoring with immuno-suppressive agents 345

ductal adenocarcinoma of pan-creas 332

Dukes staging, colorectal cancer216

dumping (gastric)early 148–149late 149

Dunhill operation 21–22duodenopancreatectomy

partial 320, 329, 333, 334–335total 329

duodenum 126–175anatomy 126–128bleeding from 150–153Kocher mobilization see Kocher

mobilizationneuroendocrine tumors 364–

369post-gastrectomy restoration of

passage to 166stenosis in Crohn disease 182ulcer see ulcer

duplex ultrasoundsubclavian steal syndrome 390thyroid 14

duplications, diaphragmatic 81–82

dynamic gracilis repair 257dystopic parathyroid glands 49

E

ECF regimen, gastric carcinoma171

ECG, peritonitis 352echinococcosis 297–299echocardiography, cardiac contu-sions 66

edema (fluid collection), pan-creatic necrosis 324, 325

efferent loop syndrome 147effusions, pleural 57–60elastic arteries 381electrocardiography (ECG), peri-tonitis 352

electrolyte administration, acutepancreatitis 326

embolism, arteriallimbs 385

removal 386mesenteric 387

removal 387embolization in upper GI bleed-ing, angiographic 153, 154

embryogenesis, neuroendocrinetumor classification accordingto 361see also development

emergency surgery 395–412diverticulitis 202malignant bowel occlusion 274portal hypertension 300, 301proctocolectomy 212thyroidectomy 34trauma 395–412ulcerative colitis 207

emesis see vomitingemphysema

mediastinal 74–75subcutaneous 74

empyemagallbladder 307pleural 61–62

endocrine pancreatic tumors336–337, 364–365see also neuroendocrine tumors

Endo-GIA stapler, liver metasta-ses 291

endometriosis, appendiceal 193endoscopic investigation

Crohn disease 178vs ulcerative colitis 180

Index420


gastrointestinal stromal tumors374

large bowel obstruction 271neuroendocrine tumors 363peritonitis 352ulcerative colitis 207see also bronchoscopy; chole-

dochoscopy; colonoscopy;esophagoscopy; gastroscopy;laparoscopy; laryngoscopy;mediastinoscopy; thoraco-scopy

endoscopic retrograde cholangio-pancreatography (ERCP)bile duct carcinoma 319gallbladder carcinoma 318gallstones 308, 309pancreatic carcinoma 333pancreatic trauma 337pancreatitis


endoscopic sonography, esopha-geal carcinoma 118

endoscopic treatment/surgerygastrointestinal

gastric carcinoma 159, 161rectal cancer 235rectal polyps 239upper GI bleeding 152,

153–154parathyroid 49thyroid 22–23see also laparoscopy, interven-

tional/operative; minimallyinvasive surgery

endothelial damage in athero-genesis 388

endotoxin (lipopolysaccharide)-binding protein levels in peri-tonitis 351

endovascular transluminal stentgraft 385

enteral nutrition, peritonitis 358entero-biliary anastomoses andfistulas see biliary-enteric anas-tomosis; biliary–enteric fistula

enterocele 242enterocutaneous fistulas, Crohndisease 183

entero-enteric fistulas, Crohndisease 183

enterogenital fistulas, Crohndisease 183

enterovesical fistulas, Crohndisease 183

enzymes, pancreatic 323epigastric hernia 104epiphrenic diverticulum 110, 111epiphyseal (growth plate) frac-tures in childrenclassification 401reduction and internal fixation

402erythrocyte concentrate, perito-nitis 358

esophageal hiatus 77hernia 78–79, 113

esophageal sphincter, lower 108esophagitis, reflux 111, 112, 113esophagogastric junction, adeno-carcinoma (AEG) 116, 155, 166

esophagogastrostomy in gastriccarcinoma palliation 171

esophagojejunostomy 168–169cancer 165, 166, 168–169peptic ulcer 143

esophagoscopyachalasia 109carcinoma 118diverticulum 110reflux esophagitis 112

esophagus 106–125anatomy 106–107carcinoma 115–123diverticulum 110–112function (physiology) 108

disorders 108–109histology 108injuries 123–125varices 150, 299, 300, 301

eventration, diaphragmatic 82excision biopsy, soft-tissuetumors 378, 379

external fixation, bone infectionfollowing 409

extracorporeal shock wave litho-tripsy 309

exudative pleural effusions 57with empyema 61, 62

eye opening in Glasgow ComaScale 398

F

false aneurysm 383familial adenomatous polyposis(FAP) 213, 214

familial hyperparathyroidism 49familial medullary thyroid carci-noma 38, 41, 42

Fansler–Arnold operation 246,248

fasciaduplication with incisional her-

nia 103pelvic 230

in rectal resection 236, 237fast-track review 7–8fasting 2–3fatty streaks 388feces

discharge/expulsion 232fistula producing, risk with

colorectal cancer surgery 228incontinence 255–258occult blood test 229

females see womenfemoral hernias 95–96femoral thrombosis 393femoropopliteal occlusion 389fibrinopurulent phase of pleuralempyema 61, 62

fibrosing phase of pleural em-pyema 61, 62

fibrous thyroiditis 36fine needle biopsy see aspirationbiopsy/cytology

finger fracture method with livermetastases 291

Finney gastroduodenostomy 145first aid at accident site 406fissure, anal 250–251fistula repair 254fistulas, gastrointestinal

with biliary tract 307Crohn disease 183fecal, risk with colorectal can-

cer surgery 228fixation

bone infection following 409growth plate fractures 401

FLP regimen, gastric carcinoma171

fluid administration/volumereplacement

Index 421


intraoperative 6pancreatitis (acute) 326peritonitis 358

fluid collection (edema), pan-creatic necrosis 324, 325

focal nodular hyperplasia (liver)282–283

Fogarty catheter, embolectomy386

follicles, thyroid 9–10follicular thyroid carcinoma 37,39, 41, 43

Fontaine classification of periph-eral arterial occlusive disease389

Forrest classification of upper GIbleeding 151, 152

fractures 399–403rib 64–65sternal 65–66

French triple therapy, H. pylorieradication 132

Frey operation 330Frykmann and Goldberg opera-tion in pelvic floor insufficiency244

fundophrenicopexy 113fundoplication 113–114

G

gallbladder 304–320anatomy 304cancer see cancerremoval see cholecystectomystones 306–315

gallstones (biliary stones; chole-liths) 306–315carcinoma predisposition 306,

316in common bile duct (chole-

cystolithasis) 306in gallbladder 306–315ileus with 267, 275, 307

gastrectomy (gastric resection)133–146carcinoma 158–159, 161–162complications 146–149distal see subtotal resectionMALToma 175postoperative care see post-

operative care

ulcer 133–146gastric ... see stomachgastrin measurement 133gastrinoma 132, 149, 336,366–369post-gastrectomy 150

gastrocolic ligament division 221,222

gastroduodenal artery ligation154, 155

gastroduodenostomy 145gastroenterostomy, palliative

gastric carcinoma 171pancreatic carcinoma 336

gastroepiploic artery ligation,right 154, 155

gastroesophageal reflux disease(GERD) 111–114

gastrointestinal (gastroenterolog-ical/alimentary/digestive) tractor systemappendicitis vs other conditions

of 189diaphragmatic hernia effects 79hyperparathyroidism effects 46neuroendocrine tumors

364–372WHO classification 361

stromal tumors 372–376see also specific regions

gastrointestinal series (contraststudy), Crohn disease 178

gastrojejunostomy in Billroth IIgastrectomy 141

gastroscopycholedocholithiasis 308esophageal/gastric varices 300peptic ulcer 131

genetic factors/predispositioncolon cancer 215

screening 229immunogenic hyperthyroidism

30medullary thyroid carcinoma in

MEN II syndrome 39, 41, 42genetic testing or analysis

MEN I 361RET mutations 41

genitoenteric fistulas, Crohndisease 183

Glasgow Coma Scale 398Glisson triads 282glucagonoma 367

goiter 26–27euthyroid 26–27video-endoscopic resection

via axillo-bilateral breastapproach 24

Goodsall rule, anal fistulas 251,254

Gottstein–Heller myotomy 109gracilis muscle transposition infecal incontinence 257

grafts see autotransplantation;stent graft

Graves disease 30–32Grob method, inguinal hernia 93growth plate fractures see epi-physeal fractures

guarding in peritonitis 349Gütgemann post-gastrectomyreconstruction 167

gynecological disorders vsappendicitis 189

H

Haemoccult test 229hamartomas, colonic 213hanging maneuver, hemihepatec-tomy 292

Hansen–Stock classification,diverticulitis and diverticulosis201

Häring tube 171, 172Hartmann operation/discontinu-ity resectioncancer 274

colon 219rectum 239

diverticulitis 202Hashimoto disease 35hazards see complicationshead injury 397–399heart contusions 65, 66

see also cardiopulmonarysymptoms

Heidelberg–Allenberg classifica-tion of aneurysms 385

Heinecke–Mikulicz pyloroplasty144

Helicobacter pylorieradication

with MALToma 174with ulcer 132

Index422


in etiologygastric carcinoma 155ulcer 129, 130

hemangioma, hepatic 283–284hemicolectomy 220–224

left 274colorectal carcinoma

223–224right 274

appendiceal carcinoid 194appendiceal carcinoma 194colorectal carcinoma 219,

220–222hemifundoplication 113hemihepatectomy 292, 292–294exposure and ligation of large

vessels before 290hanging maneuver 292left 293

extended 294right 292

extended 293, 318hemithyroidectomy 17, 21

carcinoma 41goiter 27preventive replacement ther-

apy after 26with subtotal resection of con-

tralateral side 21–22immunogenic hyperthyroid-

ism 32hemorrhage/bleeding

diverticular 202, 205esophageal varices 300, 301gastroduodenal 150–153into pleural cavity 69postoperative

gastric resection 146–147thyroid surgery 24–25

hemorrhoids 245–249hemostasis

liverin resection 292traumatic 302

spleen without resection 279hemothorax 69heparin 5hepatectomy (hepatic resection)285, 287, 288–297general technique 289–292

hepatic arteries 281–282, 305right, mistaken for cystic artery

311

hepatic duct, common 304stone in 307

hepatic veins 282obstruction 299

hepatobiliary sequence scintigra-phy 308

hepatocellular adenoma 283hepatocellular carcinoma 284,285, 341

hereditary factors and disorderssee genetic factors

Herfarth operation 170hernia 78–81, 83–105

abdominal 83–105classification 83–84definition 83–84epidemiology 83etiology 83external 83, 85–104incarcerated see incarcerated

herniainternal 84, 104palpation 269

diaphragmatic 77, 78–81, 113herniotomy

femoral hernia 95–96inguinal hernia 88–90

children and infants 93heterotopic autotransplantationof parathyroid tissue 53

Heyrowsky method, gastric carci-noma palliation 171, 172

hiatus, diaphragmatic 77hernia 77, 78–79, 80, 81, 113

sliding 78, 133hiccup, postoperative 82histology

esophageal 108peritoneal 346thyroid 9–10

histopathologyanal carcinoma 258appendicitis, in classification

186colorectal carcinoma, in grad-

ing 216gastric carcinoma

in classification 156in grading 156

gastric MALToma 173in classification 164

history-taking in peritonitis 350homeostasis 1

hormone-secreting tumors seeendocrine pancreatic tumors;neuroendocrine tumors

hormonesparathyroid see parathyroid

hormonethyroid 12

laboratory test 13, 14postoperative preventive re-

placement therapy 25, 26hot thyroid nodule, scintigraphy15

Hunt (Hunt–Lawrence–Rodino)pouch 166, 170

hydatid disease 297–299hydrocortisone, peritonitis 3585-hydroxyindole acetic acid andneuroendocrine tumors 362

hypercalcemia in hyperpara-thyroidism 46, 47effects 46in secondary hyperpara-

thyroidism 52hyperparathyroidism 40, 45–54

familial 49primary 45–51secondary 46, 51–54tertiary 46, 54

hyperplasia, hepatic 281focal nodular 282–283

hyperplastic polyps 213hypersplenism 277–280hypertension, portal 299–301hyperthyroidism 28–29

immunogenic 30–32see also thyrotoxic crisis

hypertrophy, hepatic 281hypocalcemia

after parathyroid surgery 51after thyroid surgery 25

hypoparathyroidism 55–56after thyroid surgery 25

I

iatrogenic damage see complica-tions

ileo-anal pouch (ileal pouch-analanastomosis) 212

ileocolostomy 197, 198ileostomy, ulcerative colitis209–210

Index 423


ileumneuroendocrine tumors

369–370reservoir construction from

210–211terminal, Crohn disease involv-

ing 176endoscopy 178

ileusadvanced 264–265colorectal carcinoma 218–219definition 263gallstone 267, 275paralytic see paralytic ileuspostoperative 264, 267–268,

272–273imaging (diagnostic)

appendicitis 188arterial disease 382bile duct carcinoma 319–320bone infection 408bowel obstruction 270cholecystitis (acute) 315cholecystolithiasis 308colorectal cancer 217Crohn disease 178deep venous thrombosis 393diaphragmatic hernia 80diverticulitis 202esophagus

achalasia 109carcinoma 118

fractures 401–402gallbladder carcinoma 318gastrointestinal stromal tumors

374hypersplenism 277incisional hernia 98inguinal hernia 87liver

cancer 285focal nodular hyperplasia 282hepatic hemangioma 283

neuroendocrine tumors 362pancreatic carcinoma 333pancreatitis


parathyroid 15, 47peptic ulcer 131peritonitis 351–352portal hypertension 300soft-tissue tumors 378

thorax 58mediastinitis 76Perthes syndrome (traumatic

asphyxia) 64rib fractures 65sternal fractures 66

thyroid 14–15ulcerative colitis 207see also specific modalities

imatinib, gastrointestinal stromaltumors 374, 375

immunogenic hyperthyroidism30–32

immunosuppressive agents fortransplantation 345

immunosuppressive drugs, ulcer-ative colitis 208

immunotherapyCrohn disease 182hepatic cancer 286

incarcerated hernia 84, 266, 275inguinal 87, 88

incidentaloma, thyroid 13incision biopsy, soft-tissue tumors378

incisional hernia 96–103incontinence, fecal 255–258infants

inguinal hernia 85, 93intussusception 267see also neonates

infectionbone 407–409pancreatic necrotic areas 325,

326in peritonitis, eradication of

source of 354post-splenectomy 280see also sepsis

inflammatory bowel disease seeCrohn disease; ulcerative colitis

inflammatory polyps 213infliximab, Crohn disease 182informed consent 3infrahyoid neck muscles in thy-roid surgery 18

inguinal canal anatomy 85inguinal hernia 83inherited factors see genetic fac-tors

injury see traumainnervation see nerve supplyinspection (observation)

obstructed bowel 269peritonitis 350

insulin therapy in peritonitis358

insulinoma 336, 364–366, 367intensive unit/intensive therapy

head trauma 398polytrauma 396–397

interdisciplinary care see multi-disciplinary care

interleukin-6 levels in peritonitis351

internal fixationbone infection following 409growth plate fractures 401

International Union Against Can-cer (UICC) classificationcolorectal cancer 216

follow-up care and 228survival and 229

esophageal carcinoma 117gastric carcinoma 157, 173

interposition graft in post-gas-trectomy reconstruction 165,166, 167–168

intersphincteric resection of rec-tum 238

intestine (bowel) 176–276large see large intestineneuroendocrine tumors see

neuroendocrine tumorsobstruction 263–276

definition 263malignant 218–219,

274–275mechanical 263–264special forms 266–268see also stenosis (subheading

below)preparation 3small see small intestinestenosis in Crohn disease 182,

183intima see neointima; tunica inti-ma

intraoperative phase 5–6fast-track colon surgery 7neuromonitoring see neuromo-

nitoringintraperitoneal onlay mesh(IPOM), incisional hernia 100

intravenous cholangiography 308intussusception 267, 275

Index424


iodinedeficiency 12, 13radioactive see radioiodine

therapyirreducible hernia 84islets of Langherhans 323

carcinoma 332endocrine tumors 336endocrine tumors arising from

336–337Italian triple therapy, H. pylorieradication 132

J

J pouch 238continence-preserving procto-

colectomy 210, 211Jaboulay gastroduodenostomy145

jejunumdiverticulum 184in post-gastrectomy recon-

struction 165, 166, 167–168see also esophagojejunostomy

Johnson classification, gastriculcer 130

jointdislocations 403–404replacement (arthroplasty)

prosthesis, infected 409

K

kidneyhyperparathyroidism (primary)

affecting the 46hyperparathyroidism (secon-

dary), caused by 51transplantation 340

with kidney 343c-KIT and gastrointestinal stromaltumors 373, 374, 375

Klatskin tumors,Bismuth–Corlette classification319

Kocher mobilization of duode-num 136, 137, 321pancreatic trauma 338

Kremer operation 170–171

L

laboratory testsbile duct carcinoma 320bowel disorders

appendicitis 187Crohn disease 178diverticulitis 202obstructive 270ulcerative colitis 206–207

cholecystitis (acute) 315cholecystolithiasis 308diaphragmatic hernia 80esophageal carcinoma 117gastric MALToma 174hydatid disease 298hypersplenism 277liver cancer 285neuroendocrine tumors 362pancreatitis (acute) 324parathyroid

hypoparathyroidism 56primary hyperparathyroid-

ism 46secondary hyperparathyroid-

ism 52peptic ulcer 131peritonitis 351portal hypertension 300thyroid 13–14

acute purulent thyroiditis35

cancer 39chronic lymphocytic thyroi-

ditis 35de Quervain’s thyroiditis 34goiter 27hyperthyroidism 28, 31

Lanz point tenderness 187laparoscopy, interventional/oper-ativeappendicitis 190–191cholecystectomy 309–312

aftercare 313–314in cholecystitis (acute) 316in choledocholithiasis

309–312complications 314–315

colon carcinoma 199diverticulitis 204fundoplication 113–114gastric carcinoma 159, 161hiatal hernia 81

livercysts 384focal nodular hyperplasia

282, 283metastases 296

rectosigmoid resection 243splenectomy 279see also endoscopic treatment/

surgery; minimally invasivesurgery

laparoscopy, non-interventional/diagnosticesophageal carcinoma 118gallbladder carcinoma 318gastric carcinoma staging 158peritonitis 352portal hypertension 300

laparotomy vs minimally invasivesurgery 5see also relaparotomy

large intestine/bowel 196–262anatomy 196–197cancer see colorectal cancerobstruction 263, 264, 268,

274–275causes 264diagnosis 270, 271malignant 218–219, 274–275treatment 272

Larrey hernia 77, 79laryngeal nerve

internal branch 11recurrent 11

exposure 19injury 25

superior 10laryngoscopy in thyroid cancer39

laser ablation, hepatic metastases288

Lauren classification, gastric car-cinoma 156

leg, lower, deep vein thrombosis393see also limbs

Lichtenstein herniotomy 89LigaSure, hepatic resection 291limbs

amputation with soft-tissuetumors 380

arterial occlusionsacute 385–386chronic 388–390

Index 425


deep vein thrombosis in lowerleg 393

injury including soft-tissuedamage 406

lipopolysaccharide-binding pro-tein levels in peritonitis 351

lithotripsy 309liver 281–303

abscesses 307acute failure indicating trans-

plantation 341advanced disease indicating

transplantation 340anatomy 281–282benign tumors 282–284malignant tumors 284–297,

340primary 284–286, 341secondary see metastasestransplantation with 284,

341liver transplantation 340–342

with hepatocellular carcinoma284, 340

living-donor for liver transplant342

lobes of liver 281excision (lobectomy), left-sided

294–295lobules, hepatic 282Loewe and Rehn skin graft, inci-sional hernia 103

Longmire post-gastrectomy re-construction 165, 166, 167

Longo operation 246, 249Lotheissen herniotomy 96lower leg, deep vein thrombosis393

lungsacute injury, ventilation 358anatomy 57contusions 66–67metastases from liver 284see also cardiopulmonary

symptomsluxations (dislocations) 403–404lymph node(s)

gastric area 126, 127liver hilum 288pancreas 322–323rectal area 231thyroid area 11

ultrasound assessment 15

lymph node dissection (lymph-adenectomy)appendiceal carcinoid 194appendiceal carcinoma 194colorectal cancer 199, 219, 220gastric carcinoma 158–159,

160–161, 163ileal neuroendocrine tumor 370thyroid carcinoma 41, 42, 43

lymph node metastasesbiliary carcinoma

bile duct 319gallbladder 317

colon cancer 197, 215esophageal cancer 115gastric carcinoma 127, 156,

157, 163hepatic cancer 284, 285, 290pancreatic carcinoma 332rectal cancer 233thyroid area 37, 38

lymphatic drainagecolon 197esophagus 107liver 282pancreas 322–323peritoneum 346rectum 231stomach/duodenum 127

lymphocytic thyroiditis, chronic35

lymphoma, gastric 173–175Lynch syndrome 215

M

McBurney point tenderness 186McVay herniotomy 96magnetic resonance cholangio(pancreato)graphy (MRCP)bile duct carcinoma 320cholecystolithiasis 308gallbladder carcinoma 318

magnetic resonance imaging(MRI)diaphragmatic hernia 80liver

focal nodular hyperplasia282

hepatic hemangioma 283neuroendocrine tumors 362parathyroid 47

thyroid 16male rectum, mobilization (foranterior resection) 236–237

malignant tumors see cancerMALT lymphoma 173–175Mannheim Peritonitis Index 350manometry (and pressure assess-ment)anal, in fecal incontinence

256esophageal, achalasia 109

Mason classification, rectal cancer233

Mayo–Dick fascial duplication103

MCF regimen, gastric carcinoma171

mechanical obstruction of bowel263–264

Meckel diverticulum 184media, arterial 381mediastinitis 75–76mediastinoscopy 73–74esophageal carcinoma 118

mediastinum 72–76anatomy 72, 73lymph nodes, thyroid surgery

and 11see also transmediastinal

esophageal resectionmedullary thyroid carcinoma 40

diagnosis 39, 40, 41familial 38, 41, 42sporadic 42

megacolon, toxic 212megadiaphragm 82men, mobilization of rectum(for anterior resection)236–237

6-mercaptopurine, Crohn disease181

Merendino operation 166mesalazine, Crohn disease 180mesenteric arteries 197

acute occlusion 387–388mesentericocaval anastomosis301

mesentery, divisionleft hemicolectomy 224right hemicolectomy 222transverse colectomy 225see also mesocolon; mesorectal

excision

Index426


mesh repairabdominal hernia

epigastric hernia 104incisional hernia 98, 99, 100,

101, 103inguinal hernia 87, 90, 91, 92umbilical hernia 104

hiatal hernia 81, 113mesocolon, division

in low anterior rectal resection236

in sigmoid colectomy 226mesorectal excision, total andpartial 235

metabolic causes of paralytic ileus265

metastases (distant)to liver 286–297

from colorectal cancer 218,234, 286

from neuroendocrine tumors361, 363, 364, 369, 370,371

to lung from liver 284source

bile duct carcinoma 319colon cancer 215, 216, 217,

218, 227, 228, 229esophageal carcinoma 116gallbladder carcinoma 317gastric carcinoma 156, 158,

159, 160, 171hepatic carcinoma 284, 285neuroendocrine tumors 361,

362, 363, 364, 365, 368,370, 371, 372, 373

pancreatic carcinoma 332rectal cancer 233, 234, 240soft-tissue tumors 378thyroid carcinoma 37

see also TNM classificationmetastases (lymph node) seelymph node metastases; TNMclassification

methotrexate, Crohn disease 181Milligan–Morgan operation 246,257–258

minilaparotomy in laparoscopiccholecystectomy 311

minimally invasive surgerycolon 199–200laparotomy vs 5pancreatic pseudocyst 332

parathyroid 49thyroid 22–24see also endoscopic treatment

Mirrizi syndrome 307monoclonal antibody therapy,Crohn disease 182

Moore classification of hepatictrauma 302

Morgagni hernia 77, 79mortality (death)

gastric ulcer perforation 129upper GI bleeding 151

motility, bowel, recovery afterabdominal surgery 267after bowel surgery 274

motor response in Glasgow ComaScale 398

MRI see magnetic resonanceimaging

mucinous cystadenoma of ap-pendix 194

mucosaesophageal 108gastroduodenal

protective agents 133resection of gastric mucosa

with carcinoma 159see also proctomucosectomy

mucosa-associated lymphoid tis-sue (MALT) lymphoma173–175

multidisciplinary (interdiscipli-nary) carefast-track surgery and 7postoperative period 6

multiple endocrine neoplasia 38,360–361type I (MEN I) 46, 360–361,

368, 369type II (MEN II) 39, 41, 42, 46

medullary thyroid carcinoma38

multiple trauma 395–397multivisceral resection

colorectal carcinoma 217, 219gastric carcinoma 163–165

multivisceral transplantation 344Murphy sign 308muscle

compartment resection, soft-tissue tumors 379–380

injury 405

transposition (gracilis) in fecalincontinence 257

muscular arteries 381muscularis, esophageal 108Musshoff staging of MALToma175

myotomyanterior, in achalasia 109cricopharyngeus 111

N

nasogastric tubes 6nausea and vomiting, postopera-tive 1

neck lymph nodes (incl. cervicalLN)metastases in thyroid carcino-

ma 38dissection (lymphadenec-

tomy) 41, 42, 43in thyroid surgery 11

assessment 15necrotizing pancreatitis 324, 325,326

needle aspiration biopsy see aspi-ration biopsy

neoadjuvant (preoperative) ther-apyesophageal carcinoma 118, 119gastric carcinoma 158, 160hepatic metastases 287rectal cancer 234

neointima formation 389neonates, large bowel obstruction264

neoplasms see tumorsnerve

injury 405, 409–410removal for pain after inguinal

hernia surgery 93nerve supply

diaphragm 77peritoneal 346rectum 231–232stomach/duodenum 127–128thyroid 10–11

injury 25neurapraxia 409neurectomy for pain after ingui-nal hernia surgery 93

Index 427


neuroendocrine tumors 360–372general aspects

definition 360diagnosis 362–363epidemiology 360etiology 360prognosis 364symptoms 361–362treatment 363–364

specific sites 364–372appendix 193–194, 370–371colon 371duodenum 364–369pancreas 336–337, 364–369stomach 364, 365

neurological examination in fecalincontinence 256

neuromonitoring (intraoperative)parathyroid surgery 50thyroid surgery 20, 22

neuromuscular effects of hyper-parathyroidism 46

neuron-specific enolase and neu-roendocrine tumors 362

neuropathic pain, inguinal herniasurgery 93

neurotmesis 409newborns (neonates), large bowelobstruction 264

Nissen fundoplication 113, 115nodule, thyroid

diagnosis 14, 15, 16, 17, 28enucleation 20, 26incidentally discovered 13malignant 39, 40, 41

non-Hodgkin lymphoma, gastric173–175

non-steroidal anti-inflammatorydrug-related peptic ulcers 129,130

norepinephrine, peritonitis 358Notaras lateral submucoussphincterotomy 251

nutritionacute pancreatitis 326peritonitis 358preoperative 2–3

Nyhus classification, inguinalhernias 86

O

observation see inspectiononlay technique, incisional hernia100

open cholecystectomy 312–313aftercare 313–314in cholecystitis (acute) 316in choledocholithiasis

312–313complications 314–315

open dislocation 404open minimally invasive para-thyroidectomy (OMIP) 49

open pneumothorax 68open postoperative peritoneallavage 355

open splenectomy 279orbitopathy, endocrine 31, 32organ transplantation see trans-plantation

orthotopic autotransplantation ofparathyroid tissue 53

osteitis and osteomyelitis 407,408

outpatient review of fast-trackcolon surgery, post-hospital 8

P

painacute abdominal see acute ab-

domenappendicitis, diagnostic exami-

nation for 186–187motor response in Glasgow

Coma Scale 398peritonitis 349postoperative, inguinal hernia

surgery 93thyroiditis 34–35venous thrombosis 393

palisade dressings for temporaryabdominal closure 357

palliative therapyanal carcinoma 260bile duct carcinoma 320colorectal carcinoma 217, 219,

227, 239–240esophageal carcinoma 119, 123gallbladder carcinoma 318gastric carcinoma 159, 171

pancreatic carcinoma 336palpation

obstructed bowel 269–270peritonitis 350rectal cancer 269

pancreas 321–338anatomy 321–323peptic ulcer penetrating into

131, 142–143pseudocysts 324, 331–332transplantation 341–342trauma 337–338tumors 332–337

neuroendocrine 336–337,364–369

pancreatectomy 329combined with drainage oper-

ation 334distal see subtotal resectiontotal 333see also duodenopancreatec-

tomypancreatic duct

anatomy 305, 321drainage procedure 329obstruction 327see also ductal adenocarcinoma

pancreaticoduodenal arteries 321ligation 154, 155

pancreatitis 323–330acute 323–326chologenic 307chronic 327–330

pancreaticojejunostomy, Parting-ton–Rochelle side-to-side 329resection procedure combined

with 330pancreatoduodenectomy seeduodenopancreatectomy

papilla (duodenal/of Vater)incision (papillotomy) 308, 309local excision 333

papillary thyroid carcinoma 36,37, 41, 42, 43

paraesophageal hernia 77, 79, 80,113

parafollicular C-cell carcinomas38, 42

paralytic ileus 263, 264after gastric resection 147causes 265, 387treatment 272

paraproctium 230

Index428


parathyroid glands 44–56anatomy 44–45carcinoma 54–55dystopic 49imaging 15, 47physiology 45in thyroid surgery

dissection 19postoperative insufficiency

25parathyroid hormone (PTH;parathormone) 45abnormal levels see hyperpara-

thyroidism; hypopara-thyroidism

parathyroidectomy 53carcinoma 55minimally invasive 49subtotal 53with simultaneous autotrans-

plantation 53without autotransplantation 53

parenchyma, hepaticdissection with metastases 291injuries 302

parenteral nutrition in acutepancreatitis 326

parietal pelvic fascia 230parietal peritoneum 346

pain in peritonitis relating to349

Parks operation/procedurehemorrhoidectomy 246, 248transanal local excision in rec-

tal cancer 235, 238Partington–Rochelle side-to-sidepancreaticojejunostomy seepancreaticojejunostomy

pediatrics see childrenpelvic fascia see fasciapelvic floor insufficiency/dysfunc-tion 240fecal incontinence due to 255

surgery 257pelvic vein thrombosis 393penetrating chest injury 67–71penetrating peptic ulcer 128, 131

treatment 133peptic ulcer see ulcerpeptide hormones and neuro-endocrine tumors 362

percutaneous transhepatic chol-angiography 308

percutaneous transjugular intra-hepatic portosystemic shunt301

perforationbowel in Crohn disease 184esophagus, traumatic 124gastric ulcer 131, 132

periampullary carcinoma 332perianal, venous thrombosis 250perianal fistulas see anuspericystectomy 299perineal descent 242

see also abdominoperinealapproach

perioperative medicine 1–8peripheral arterial disease seelimbs

peripheral nerves see nerveperipheral soft-tissue tumors378

peristalsisexamination 269in peritonitis, disturbed 349

peritoneal cavitycarcinomatosis

esophageal cancer 116, 118,119

obstruction due to 266, 275lavage 354, 355pseudomyxoma (pseudomyxo-

ma peritonei) 194see also pneumoperitoneum

peritoneum, anatomy 346peritonitis 346–359classification 347–348definition 346diagnosis 349–352, 359diffuse 349, 353epidemiology 347etiology 347

acute mesenteric arteryocclusion 387

primary 347–348, 352risk in colorectal carcinoma

surgery 227–228secondary 348, 352–353symptoms 349tertiary 348treatment 348, 352–358

Perthes syndrome (traumaticasphyxia) 63

PET see positron emission tomog-raphy

pharmaceuticals see drug admin-istration

pheochromocytoma 40phlebothrombosis see veinsphlegmasia cerulea dolens 393phosphate

levels in hyperparathyroidism46

regulation 45plastic bag (sterile) for temporaryabdominal closure 357

plastic drapes for temporary ab-dominal closure 356

plastic zippers or slide fastenersfor temporary abdominal clo-sure 356

platelets, elevated levels (throm-bocytosis) after splenectomy280

pleural cavityair in 67–69anatomy 57chyle in 70effusions 57–60empyema 61–62hemorrhage into 69

pleurodesis 59pleuroperitoneal hernia 77, 79pneumoperitoneum for laparo-scopic cholecystectomy 311

pneumothorax, traumatic 67–69poliglecapron + polypropylenemesh 99

polyethylene terephthalate mesh99

polyglactin + polypropylene mesh99

polyp(s)colonic 212–214

screening following removal229

rectal, endoscopic removal 239polypropylene mesh 99polytetrafluorethylene(PTFE/ePTFE)grafts for vessel replacement

381, 381–382mesh for hernia repair 99

polytrauma 395–397poorly differentiated thyroid car-cinoma 37, 42

portal hypertension 299–301portal veins 282

Index 429


branch ligature, with livermetastases 287

pressure measurement 299thrombosis 299

portocaval end-to-side anasto-mosis 301

portosystemic shunt, transjugularintrahepatic 301

positron emission tomography(PET)cancer 285gastrointestinal stromal tumors

374neuroendocrine tumors 362

positron emission tomography-CT (PET-CT), esophageal carci-noma 118

post-hospital outpatient review offast-track colon surgery 8

postoperative care (aftercare) 6appendiceal carcinoid 194appendicitis 192bile duct carcinoma 320bowel obstruction 276cholecystectomy 313–314colorectal carcinoma 227deep vein thrombosis 393fast-track colon surgery 7–8fractures 403gallbladder carcinoma 318gastric resection

for cancer 173for ulcer 146

gastroesophageal reflux disease114

nausea and vomiting 1parathyroid surgery

primary hyperparathyroid-ism 50

secondary hyperparathyroid-ism 53

peritoneal lavage in 355proctocolectomy 212splenectomy 280tendon injury 411thromboprophylaxis 3–5thyroid surgery 24

postoperative complications seecomplications

postpartum thyroid disease 30,36

pouchpost-gastrectomy reconstruc-

tion 165, 166, 169, 170–171post-proctectomy reconstruc-

tion 238post-proctocolectomy recon-

struction 210, 211, 212pouch of Douglas tenderness 187precancerous/premalignant con-ditionscolon 213esophagus 112, 116, 118, 124stomach 155

prednisoloneCrohn disease 181ulcerative colitis 207, 208

pregnancyappendicitis diagnosis in 187Graves disease during/after 30

prehospital carefirst aid at accident site 406head trauma 398polytrauma 396

premalignant conditions see pre-cancerous conditions

premedication 3preoperative phase 1–5

colorectal carcinoma 218fast-track surgery 7parathyroid surgery for hyper-

parathyroidism 48splenectomy 278

preperitoneal mesh repair of in-guinal hernia, transabdominal(TAPP) 91

Pringle maneuver 291, 302procalcitonin levels in peritonitis351

proctectomy (rectal resection)235–237abdominoperineal intersphinc-

teric 238low anterior 235–237

blood supply after 230ulcerative colitis 208, 210–212

proctocele (rectocele) 242, 244proctocolectomy, ulcerative colitis208, 210–212

proctodeal glands 232proctomucosectomy, transanal210

proctopexy (rectopexy) 243programmed relaparotomy inperitonitis/abdominal sepsis355–357

prolapse, rectal 242protein C, recombinant activated,administration in peritonitis358

proton pump inhibitorsgastroesophageal reflux disease

113peptic ulcer 132

pseudoaneurysm (false aneu-rysm) 383

pseudoarthrosis 403pseudocysts, pancreatic 324,331–332

pseudodiverticulum see pulsiondiverticulum

pseudohypoparathyroidism 55pseudomyxoma peritonei 194pseudo-obstruction of colon 267psoas sign 187PTFE see polytetrafluorethylenepuerperal (postpartum) thyroiddisease 30, 36

pulmonary problems see cardio-pulmonary symptoms; lungs

pulsion diverticulum (pseudo-diverticulum)colon 200, 201esophagus 110, 110–111

purse-string suture, bleedingduodenal ulcer 154

purulent/pyogenic disorderscholangitis with stones 307thyroiditis (acute) 35

pyloromyectomy, extramucosal144

pyloroplasty, Heinecke–Mikulicz144

pyogenic lesions see empyema;purulent/pyogenic disorders

Q

quinodeoxycholic acid 309

Index430


R

radiation thyroiditis 35radiofrequency thermoablation,liver metastases 287, 288, 296

radiography (x-ray)appendicitis 188bowel obstruction 270chest see chest X-raycontrast see contrast-enhanced

radiographyCrohn disease 178, 180pancreatitis (chronic) 327peptic ulcer 131peritonitis 351ulcerative colitis 180

radioiodine therapyGraves disease 31–32, 32thyroid carcinoma 41, 43

radiology see imaging and specificmodalities

radionuclide scans see scintigra-phy

radiotherapyanal carcinoma 261esophageal carcinoma, pallia-

tive 119, 123gastric MALToma 175neuroendocrine tumors 363pancreatic carcinoma 334rectal cancer 234thyroid carcinoma 41see also chemoradiotherapy

Ramirez component separation102

RAP regimen, H. pylori eradica-tion 132

reconstructive surgeryfecal incontinence 257post-esophagectomy 121post-gastrectomy 138–143

in gastric carcinoma 162,165–169

post-partial duodenopan-createctomy 335

rectal arteries 230rectocele 242, 244rectopexy 243rectosigmoid resection, laparo-scopic 243

rectouterine (Douglas) pouchtenderness 187

rectum 230–244

amputation 239with anal carcinoma 261

anatomy 230cancer of (and not colon)

233–240cancer of colon and see

colorectal cancerexamination in peritonitis 350neuroendocrine tumors 372prolapse 242stenosis in Crohn disease 182ulcerative colitis involving 206see also entries under procto-

red cell (erythrocyte) concentrate,peritonitis 358

reducible hernia 84inguinal, reduction 88

reduction of fractures 401reflex causes of paralytic ileus265

refluxduodenogastric, after Billroth II

procedure 133gastroesophageal 111–114

regional chemotherapy, hepaticmetastases 288

relaparotomy in peritonitis/ab-dominal sepsis 355–357

relaxation, diaphragmatic 82renal organ see kidneyreoperation, parathyroid

in primary hyperparathyroid-ism 50

in secondary hyperpara-thyroidism 53

reservoircecal 238dysfunction, fecal incontinence

due to 255ileal 210–211

residual tumor (R) in gastric car-cinoma, classification of 156

respiratory distress syndrome,acute, ventilation 358

resuscitation room, polytrauma396

RET mutations 39, 40, 41, 42retrocolic Billroth I gastrectomy140

retromuscular mesh implantationfor incisional hernia 101

retroperitoneal fistulas, Crohndisease 183

rib fractures 64–65Riedel disease 36Riolan’s anastomosis 197Ripstein operation in pelvic floorinsufficiency 244

risk assessment 1–2risk factors

operation 2patient 2thrombosis 3–5

Roux-en-Y reconstruction/eso-phagojejunostomy 169with cancer 165, 166, 169with ulcer 143

Rovsing sign 187rubber band ligature, hemor-rhoids 247

S

sacral nerve stimulation 257Salter–Harris classification of epi-physeal fractures 401

Santorini duct 305, 321sarcoma, soft-tissue 377, 378,379, 380

scarring phase of pleural empye-ma 61, 62

Schlatter operation 166Schreiber post-gastrectomy re-construction 167

Schumpelick classification, ingui-nal hernias 86

scintigraphy (radionuclide scans)hepatobiliary sequence 308neuroendocrine tumors 362parathyroid 47skeletal, esophageal carcinoma

118thyroid 15, 16

carcinoma 39, 43chronic lymphocytic thyroi-

ditis 35goiter 27hyperthyroidism 28, 31

sclerotherapy, hemorrhoids 247screening for colorectal cancer seecolorectal cancer

segment(s), hepatic (vasculardivisions) 281

Index 431


segmental resectioncolon

in diverticulitis 205transverse, in gastric carci-

noma 165liver, with metastases 291, 295spleen 279see also bisegmental liver re-

sectionSeo post-gastrectomy reconstruc-tion 167

sepsisabdominal 346, 351

eradication of septic foci353–354

diagnostic criteria 359pancreatic necrosis complicated

by 325, 326splenectomy complicated by

280see also infection

septic shock, diagnostic criteria359

Seton drain 254Sherren triangle tenderness 186Shouldice herniotomy

femoral hernia 95–96inguinal hernia 89

shunt operations in portal hyper-tension 301

Siewert–Peiper Operation 166,170

sigmoid colon 196resection

colorectal carcinoma 219,226–227

laparoscopic, in diverticulitis204

see also rectosigmoid resec-tion

volvulus 266sigmoid mesocolon (mesosig-moid) division in low anteriorrectal resection 236

skeletal scintigraphy, esophagealcarcinoma 118

skeletonization of greater andlesser curvatures 136

skin graft with incisional hernia103

slide fasteners (plastic) for tem-porary abdominal closure 356

sliding herniaabdominal 84hiatal 78, 133

small intestine/bowel 176–184anatomy 176interposition in post-gastrec-

tomy reconstruction 165, 166obstruction 263, 266, 267, 268

causes 264imaging 270, 271treatment 272, 273–274

transplantation 342–343soft-tissue

injury see traumatumors 377–380see also specific soft tissues

somatostatin analogs with neu-roendocrine tumorsdiagnostic use (receptor detec-

tion) 362therapeutic use 363

yttrium-90-labelled 363somatostatinoma 367sonography see ultrasonographyspasm, esophageal, idiopathicdiffuse 109

spermatic cord pain after inguinalhernia surgery 93

sphincters see anal sphincters;esophageal sphincter

spleen 277–280anatomy 277hyperfunction 277–280physiology 277

splenectomy 277–279aftercare and complications

280distal pancreatectomy with

159, 333, 335gastric carcinoma 159

splenic artery 277splenic vein 277

thrombosis 299splenoportography 300spleno-renal anastomosis, distal301

squamous epithelial carcinomaanal 258, 260, 261esophagus 115, 116

management approach 118staging laparoscopy, gastric carci-noma 158

staplingcolon 198–199esophagojejunostomy 168hemorrhoidectomy (Longo

operation) 246, 249liver resection for metastases

291stomach and duodenum

134–136stent graft for aneurysms 385sterile plastic bag for temporaryabdominal closure 357

sternal fractures 65–66steroids (corticosteroids)

Crohn disease 180–181refractoriness to 181

peritonitis 358ulcerative colitis 207, 208

stomach 126–175anatomy 126–128atony, postoperative 147bleeding from 150–153carcinoma see carcinomaneuroendocrine tumors 364,

365substitute (post-gastrectomy)

170–171functions 165–166

ulcer see ulcerupside-down 79

stools see fecesstrangulated obstruction of bowel263

stromal tumors, gastrointestinal372–376

subclavian steal syndrome390–391

subcutaneous emphysema 74sublay technique, incisional her-nia 99–100

submucosa, esophageal 108subtotal (partial/limited) resec-tioncolon 212

in malignancy 219, 274–275pancreas, distal (distal pan-

createctomy) 163–165chronic pancreatitis 329gastric carcinoma 159pancreatic carcinoma 333splenectomy with 159, 333,

335

Index432


pancreas, proximal (incl. head)329, 333, 335–336

parathyroid 53stomach (distal)

carcinoma 158, 162MALToma 175ulcer 136

thyroid 17, 21on contralateral side, hemi-

thyroidectomy with seehemithyroidectomy

goiter 27Sudeck operation in pelvic floorinsufficiency 244

Sudeck point 197supportive therapy, peritonitis357–358

suturescolon 197, 198esophagojejunostomy 168small bowel in Crohn disease

182stomach and duodenum 134

Billroth I gastrectomy 139,140, 141

Billroth II gastrectomy 141,142, 143

bleeding ulcer 154leakage 147

swallowing 108symptomatic hernia 78synaptophysin and neuroendo-crine tumors 362

synthetic vessel replacement381–382

T

T-cell lymphoma, gastric 174TASC II classification of peripheralarterial occlusive disease 389

temperature in peritonitis 350tendon injury 405, 410–411tension pneumothorax 68terminal ileostomy, ulcerativecolitis 209

thermoablation, liver metastases287, 288, 296

thoracoscopy, video-assisteddebridement with pleural em-

pyema 62dystopic parathyroid glands 49

thoracotomyepiphrenic pulsion diverticu-

lum 111esophageal carcinoma 119, 121esophageal rupture 125pleural empyema 62

thorax see chestthrombocytosis, post-splenec-tomy 280

thromboendarterectomy 390thrombosis

arteriallimbs, and its removal 385,

390mesenteric, and it removal

387, 388perioperative, and its preven-

tion 3–5venous see veins

thyroglobulin 12measurement 14

thyroid (gland) 9–43anatomy 9–11complications of surgery

24–26diseases/disorders 26–43

diagnostic approach 12–17indications for surgery 17postoperative care 24recurrence of benign condi-

tions, follow-up and pre-vention 25

treatment (in general)17–26

physiology 12thyroid arteries

inferior 10, 106superior 10

thyroid ima artery 10thyroid plexus, unpaired 10thyroid-releasing hormone seethyroliberin

thyroid-stimulating hormone seethyrotropin

thyroid veins 10, 107thyroidectomy (thyroid resection)

subtotal see subtotal resectiontotal/near total 22

carcinoma 41, 42, 43emergency 34goiter 27immunogenic hyperthyroid-

ism 32

preventive replacement ther-apy after 26

see also hemithyroidectomythyroiditis 34–37

autoimmune see autoimmunethyroid disease

painful 34–35painless 35–36

thyroliberin (TRH; thyroid-re-leasing hormone; thyrotropin-releasing hormone) 12measurement 13

thyrotoxic crisis 33–34thyrotropin (TSH; thyroid-stimu-lating hormone) 12measurement 13suppression of stimulation 16,

27in thyroid carcinoma, post-

operative use 43thyrotropin-releasing hormonesee thyroliberin

thyroxine (T 4) 12measurement 13suppression 16

thyroid carcinoma 41TNFα, monoclonal antibody to,Crohn disease therapy 182

TNM classification/staginganal carcinoma 259biliary carcinoma

bile duct 319gallbladder 317

colorectal cancer 216treatment approach depend-

ing on 217, 234esophageal carcinoma

116–117indicating treatment ap-

proach 118–119gastric carcinoma 156hepatic cancer 285pancreatic carcinoma 332thyroid carcinoma 38

tomographycomputed see computed to-

mographyconventional, sternal fractures

66total extraperitoneal herniarepair (TEP) 92

toxic megacolon 212tracheal injury 70–71

Index 433


traction diverticulum 110, 111transabdominal preperitoneal(TAPP) hernia repair 91

transanal procedurespouch advancement 212rectal resection

in cancer 235, 244full-thickness 235, 244mucosal 210in prolapse 244

transjugular intrahepatic porto-systemic shunt 301

transmediastinal esophagealresection 122–123

transplantation 339–345autologous tissue see auto-

transplantationliver see liver transplantationmultivisceral 343pancreatic 341–342renal see kidney

transudative pleural effusions 57transverse colon

anatomy 196resection 225

colorectal carcinoma 219,225

segmental 165trauma (injury) 395–412

chest 62–71blunt 62–67diaphragmatic hernia due to

79, 80, 81emphysema due to 74, 75penetrating 67–71pleural empyema following

61–62esophageal 123–125head 397–399hepatic 302–303multiple 395–397pancreatic 337–338soft-tissue 405–407

with closed fractures, classi-fication 400

nerve 405, 409–410tendon 405, 410–411

splenic 279vascular 382–383, 405see also fractures

Treitz hernia 84triiodothyronine (T 3) 12

measurement 13

suppression 16tube drains, wound dressingsmade of 357

tubular adenoma 213tubulovillous adenoma 213tumor(s) (neoplasms) 360–382

diaphragmatic 82malignant see cancerneuroendocrine see neuro-

endocrine tumorspancreatic see pancreasparathyroid, ultrasonography

15soft-tissue 377–380thyroid 15, 16, 28, 29, 37–46

tumor markersesophageal carcinoma 117pancreatic carcinoma 333

tumor necrosis factor-alpha(TNFα), monoclonal antibodyto, Crohn disease therapy 182

tunica adventitia, arterial 381tunica intima, arterial 381

see also neointimatunica media, arterial 381Turnbull procedure for toxicmegacolon 212

tyrosine kinase inhibitors withgastrointestinal stromal tumors374, 375

U

UICC see International UnionAgainst Cancer

ulcer, peptic/gastroduodenal128–149acute 130bleeding 150chronic 130classification 130–131definition 128diagnostic approach 131–132epidemiology 129etiology 129–130postoperative care 146recurrence 149symptoms 131treatment 132–140

conservative 132–133indications 132surgical 133–149

ulcerative colitis 205differential diagnosis 207

Crohn disease 179, 180ultrasonic dissectors/scissors

hepatic resection 291laparoscopic colon surgery 199

ultrasonographyappendicitis 188bowel obstruction 270–271cholecystitis (acute) 315cholecystolithiasis 308colorectal cancer 217Crohn disease 178diaphragmatic hernia 80esophageal carcinoma 118gallbladder carcinoma 318hypersplenism 277liver

focal nodular hyperplasia 282hepatic hemangioma 283hydatid cyst 298

liver cancer 285pancreatic carcinoma 333pancreatic trauma 337pancreatitis


parathyroid 15, 47peritonitis 351pleural effusions 58portal hypertension 300rib fractures 65sternal fractures 66thyroid 14–15, 16

acute purulent thyroiditis 35carcinoma 39chronic lymphocytic thyroi-

ditis 35de Quervain’s thyroiditis 34goiter 27hyperthyroidism 28, 31

ulcerative colitis 207see also Doppler ultrasound;

duplex ultrasound; endo-scopic sonography

umbilical hernia 103–104undifferentiated thyroid carcino-ma 38, 41, 43

urease rapid test 131urological disorders vs appendi-citis 189

ursodeoxycholic acid 309

Index434


V

vacuum dressings for temporaryabdominal closure 356

vagus nerve 127–128division (vagotomy) 134, 146

varicose veins (varices) 391–392esophageal 150, 299, 300, 301

vascular (blood) supplycolon 196–197diaphragm 77esophagus 106–107gallbladder/biliary tract 305injury 382–383, 405liver 281–282

in hepatectomy, exposureand ligation 290

peritoneum 346rectum 230–231spleen 277stomach/duodenum 126thyroid 9, 10

ligation 19vascular surgery 381–393vascularization of thyroid, ultra-sound 14see also devascularization

operationsvasoactive intestinal polypeptide(VIP)-secreting tumor 336, 367

vasopressors, peritonitis 358veins

as bypass graft material 381draining various tissues/organs

colon 197diaphragm 77esophagus 107gallbladder/biliary tract 305liver 282pancreas 321peritoneum 346rectum 231spleen 277stomach/duodenum 126thyroid 9, 10

structure/anatomy 391thrombosis (phlebothrombosis)

392–394

deep 392–394perianal 250portal or splenic 299

varicose see varicose veinsvena cava (inferior) filter 393ventilation in acute lung injury oracute respiratory distress syn-drome 358

verbal response in Glasgow ComaScale 398

vermiform appendix see appendixvesicoenteric fistulas, Crohn dis-ease 183

vibration pain in appendicitis 187video-assisted surgery

parathyroid 49thoracoscopic see thoracoscopythyroid 23, 23–24

video-endoscopic goiter resectionvia axillo-bilateral breast ap-proach 24

villous adenoma 213VIPoma 336, 367Virchow triad 392visceral pelvic fascia 230visceral peritoneum 346

pain in peritonitis relating to349

vitamin B12 replacement aftergastrectomy 162

vitamin D 45use in parathyroid insufficiency

after thyroid surgery 25vocal cord paralysis due to cancer39

Vollmar classification of vascularinjuries 382, 383

volume therapy see fluid admin-istration

volumetry, thyroid 14volvulus 266–267, 275vomiting (emesis)

in bowel obstruction 269postoperative nausea and 1violent, causing esophageal

rupture 124–125

W

Warren shunt 301water jet dissection of liver 291wedge excision/resection

gastric carcinoma, laparo-scopic/endoscopic 159, 161

hepatic metastases 295Wells operation in pelvic floorinsufficiency 244

Werner syndrome (MEN I) 46,360–361, 368, 369

Whipple operation (partial duo-denopancreatectomy) 329, 333,334–335

Whipple triad 366WHO see World Health Organiza-tion

Winslow’s foramen 305Wirsung duct 305, 321Witzel fistula 171, 172women

pelvic floor insufficiency,pathologies causing 241

rectal mobilization (for anteriorresection) 237

World Health Organization(WHO) classificationgastric carcinoma 156goiter 26neuroendocrine tumors of

digestive tract 361thyroid carcinoma 37–38

X

x-ray see radiography

Z

Zenker diverticulum 110,110–111

zippers (plastic) for temporaryabdominal closure 356

Zollinger–Ellison syndrome 131,132, 149, 150

Index 435


List of Contributors - Thieme Medical Publishers - Home · List of Contributors Hinrich Brunn, MD Friedrich Ebert Hospital Surgical Clinic Department of Vascular Surgery Neumünster

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