Current Surgical Therapy - Andrew Cameron

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The recommended age to start screening mammography for women at average risk was stated by the ACS at 45 years. This was based on an analysis of the risks of false positives in women younger than 45 years versus the small incremental benefits with respect to preventing breast cancer deaths in a relatively low-prevalence age group. Whereas previous recommendations suggested annual screening mammography start at 40 years of age, current recom mendations describe the use of mammography between 40 and 45 years as a decision that should be made with consideration of risks and benefits of screening.

The recommendation for annual screening TABLE 3 National Comprehensive Cancer Network Screening Recommendations for Persons at High Risk of Breast Cancer Clinical Encounter/Examination Screening Mammography Screening Breast MRI Lifetime risk >20% (as defined by models that are largely dependent on family history) Every 6–12 months over age 21 Consider referral to a genetic counselor Annual Consider tomography Start 10 years before the age at which the youngest family member was diagnosed, but not before age 30 Annual Start 10 years before the age at which the youngest family member was diagnosed, but not before age 25 If not able to have MRI, consider whole-breast US or contrast-enhanced mammography Thoracic radiation therapy between 10 and 30 years Every year before age 25 (start ing 8 years after RT) Every 6–12 months over age 25 (beginning 8 years after RT) Annual starting 8 years after RT but not age 30 Consider tomography Annual Start 8 years after RT but not before age 25 If not able to have MRI, consider whole-breast US or contrast-enhanced mammography 5-year risk of invasive breast cancer ≥1.7% in persons over age 35 years Every 6–12 months Annual Consider tomography Not included in recommendations LCIS/ALH or ADH and ≥20% lifetime risk Every 6–12 months Annual Not before age 30 Consider tomography Consider annual MRI Not before age 25 If not able to have MRI, consider whole-breast US or contrast-enhanced mammography Deleterious BRCA mutation Every 6–12 months starting at age 25 Annual between age 30 and 75 Consider tomography Consider on an individual basis over age 75 Annual, beginning at age 25 Consider on individual basis over age 75 Li Fraumeni syndrome Every 6–12 months starting at age 20 Annual between age 30 and 75 Consider tomography Consider on an individual basis over age 75 Annual between age 20 and 75.

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e. e. Place Peel Off Sticker Here c u r r e n t s u r g i c a l t h e r a p y c u r r e n t s u r g i c a l t h e r a p y 14th e d i t i o n John L.
Cameron MD, FACS, FRCS(Eng)(Hon), FRCS(Ed)(Hon), FRCSI (Hon) The Alfred Blalock Distinguished Service Professor Department of Surgery Johns Hopkins University School of Medicine Baltimore, Maryland Andrew M. Cameron MD, PhD, FACS Professor Director, Department of Surgery Chief, Division of Transplantation Johns Hopkins University School of Medicine Baltimore, Maryland ELSEVIER 1600 John F.
Kennedy Blvd. Ste. 1600 Philadelphia, PA 19103-2899 CURRENT SURGICAL THERAPY, FOURTEENTH EDITION ISBN: 978-0-323-79683-5 Copyright © 2023 by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies, and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions.
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This is a short excerpt from the opening of “Current Surgical Therapy” by Andrew Cameron, quoted for review and introduction purposes. All rights belong to the copyright holders.

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Title: Current Surgical Therapy
Author: Andrew Cameron
ISBN: 9780323796835, 1865844640
Pages: 1699
Language: English (en)
Digital Edition Created: 2022-11-15T10:38:53+05:30
Subject: Current Surgical Therapy, Fourteenth Edition (2023) 1-1654. 978-0-323-79683-5

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patients (9375), disease (3491), surgery (3488), management (3482), patient (3161), surgical (3146), risk (2948), treatment (2690), fig (2501), injury (2351), therapy (2318), cancer (2079), artery (2004), also (2001), used (1860), liver (1790), care (1750), associated (1743), use (1702), performed (1690), breast (1687), resection (1658), clinical (1649), trauma (1643), common (1592), bowel (1569), tissue (1540), approach (1486), diagnosis (1437), include (1430), however (1417), imaging (1413), often (1378), repair (1376), acute (1367), abdominal (1360), tumor (1252), vein (1247), blood (1243), pancreatic (1233), although (1229), small (1215), open (1203), primary (1185), time (1170), complications (1166), high (1148), pain (1145), injuries (1138), symptoms (1118), without (1104), vascular (1103), cases (1103), distal (1101), left (1095), one (1093), bleeding (1080), control (1072), tumors (1057), studies (1044), postoperative (1036), between (1022), considered (1000), early (995), rate (992), procedure (987), present (971), years (967), large (962), infection (962), placed (954), including (950), endoscopic (947), mortality (939), skin (929), wall (926), within (926), rates (923), gastric (921), increased (916), less (914), using (912), surg (910), lesions (902), renal (901), hepatic (897), right (897), outcomes (893), type (884), evaluation (884), placement (881), medical (874), proximal (870), significant (865), dissection (864), well (859), biliary (854), study (845), syndrome (842), tion (840).

Page 1: Cover
Page 2: IFC
Page 3: Half Title
Page 5: Title
Page 6: Copyright
Page 7: Contributors
Page 31: Preface
Page 33: TOC
Page 41: Video Contents
Page 43: Section 1 – The American Board of Surgery Certifying (Oral) Examination
Page 43: The American Board of Surgery Certifying (Oral) Examination
Page 43: PRINCIPLE
Page 43: CONTENT
Page 43: PROCESS
Page 44: PREPARATION
Page 44: ASSESSMENT
Page 44: SUMMARY
Page 44: Suggested Readings
Page 45: Section 2 – Esophagus
Page 45: Subchapter 1 Esophageal Function Tests
Page 45: ESOPHAGEAL MANOMETRY
Page 47: ESOPHAGEAL pH MONITORING
Page 48: IMPEDANCE TESTING
Page 48: FUNCTIONAL LUMINAL IMAGING PROBE PANOMETRY
Page 48: CONCLUSION
Page 49: Subchapter 2 Surgical Management of Gastroesophageal Reflux Disease
Page 49: PRESENTATIONS OF GERD
Page 49: DIAGNOSIS AND PREOPERATIVE EVALUATION
Page 50: INITIAL MANAGEMENT AND INDICATIONS FOR SURGERY
Page 50: Indications for Surgical Management of GERD
Page 51: Contraindications to Antireflux Surgery
Page 51: SURGICAL TECHNIQUE
Page 51: Steps of the Procedure: Initial Setup, Hiatal Dissection, and Closure of the Crura
Page 53: Steps of the Procedure: Creating a 360-Degree Nissen Fundoplication
Page 53: Steps of the Procedure: Creating a 270-Degree Posterior Toupet Fundoplication
Page 54: POSTOPERATIVE CARE, SURGICAL COMPLICATIONS, AND OUTCOMES
Page 54: SPECIAL CONSIDERATIONS
Page 56: Subchapter 3 New Approaches to Gastroesophageal Reflux Disease (Linx)
Page 56: WHY A NEW SURGICAL ANTIREFLUX PROCEDURE?
Page 57: NEW SURGICAL APPROACH TO GERD
Page 57: LINX ANTIREFLUX DEVICE
Page 57: LINX IMPLANTATION PROCEDURE
Page 59: LONG-TERM CLINICAL OUTCOMES OF THE LINX MAGNETIC SPHINCTER AUGMENTATION DEVICE
Page 61: Subchapter 4 Management of Barrett’s Esophagus
Page 61: DEFINITION OF BARRETT’S ESOPHAGUS AND TREATMENT OBJECTIVES
Page 62: CLINICAL EFFECT AND FEATURES OF BARRETT’S ESOPHAGUS
Page 62: SCREENING AND EVALUATION OF BARRETT’S ESOPHAGUS
Page 62: Screening
Page 62: Evaluation
Page 62: SURVEILLANCE
Page 63: MANAGEMENT OF BARRETT’S ESOPHAGUS WITHOUT DYSPLASIA
Page 63: MANAGEMENT OF BARRETT’S ESOPHAGUS WITH LOW-GRADE DYSPLASIA
Page 63: MANAGEMENT OF BARRETT’S ESOPHAGUS WITH HIGH-GRADE DYSPLASIA
Page 63: Esophagectomy in High-Grade Dysplasia
Page 63: CONSIDERATIONS REGARDING ANTIREFLUX SURGERY IN BARRETT’S ESOPHAGUS
Page 64: CONCLUSION
Page 66: Subchapter 5 Endoscopic Treatment of Barrett’s Esophagus
Page 66: SURVEILLANCE AND MANAGEMENT ALGORITHM
Page 66: Screening
Page 66: Surveillance
Page 67: PRINCIPLES OF ENDOSCOPIC THERAPIES
Page 67: ENDOSCOPIC RESECTION TECHNIQUES
Page 67: Endoscopic Mucosal Resection
Page 68: Endoscopic Submucosal Dissection
Page 69: ENDOSCOPIC ABLATION TECHNIQUE
Page 69: Photodynamic Therapy
Page 69: Argon Plasma Coagulation
Page 71: Cryotherapy
Page 71: Radiofrequency Ablation
Page 71: CONCLUSION
Page 71: Subchapter 6 Management of Paraesophageal Hernia Repair
Page 72: SURGICAL INDICATIONS AND PREOPERATIVE EVALUATION
Page 72: SURGICAL TECHNIQUE
Page 72: Laparoscopic Repair of Paraesophageal Hernias
Page 72: Positioning of the Patient and Placement of Ports
Page 72: Dissection and Reduction of the Hernia Sac
Page 73: Esophageal Mobilization and Lengthening
Page 73: Closure of the Esophageal Hiatus
Page 74: Creation of the Fundoplication
Page 74: Open Repair of Large Paraesophageal Hernias
Page 74: Repair through an Upper Midline Laparotomy
Page 74: Repair through a Left Thoracotomy
Page 76: POSTOPERATIVE CARE
Page 76: OUTCOMES
Page 76: Acknowledgments
Page 76: Subchapter 7 Management of Zenker’s Diverticulum
Page 76: GENERAL CONSIDERATIONS
Page 76: PATHOPHYSIOLOGY
Page 76: DIAGNOSIS
Page 77: TREATMENT
Page 77: SURGICAL MANAGEMENT
Page 77: Surgical Anatomy and Access
Page 77: Dysmotility Treatment
Page 78: Diverticulum Treatment
Page 78: Outcome
Page 79: ENDOSCOPIC TREATMENT OF ZENKER’S DIVERTICULUM
Page 79: Rigid Endoscopic Technique
Page 80: Flexible Endoscopic Technique
Page 80: Endoscopic Septum Division
Page 80: Z-POEM
Page 81: Subchapter 8 Achalasia of the Esophagus
Page 81: TREATMENT
Page 81: Botulinum Toxin
Page 82: Pneumatic Dilation
Page 84: Myotomy: Laparoscopic Heller Myotomy and Peroral Endoscopic Myotomy
Page 84: Laparoscopic Heller Myotomy
Page 85: Peroral Endoscopic Myotomy
Page 86: TREATMENT FAILURE, ADVANCED DISEASE, AND FOLLOW-UP
Page 86: Robotic Heller Myotomy with Dor Fundoplication
Page 86: SUMMARY
Page 87: Subchapter 9 Management of Disorders of Esophageal Motility
Page 87: PRESENTATION
Page 88: Diagnostic Testing
Page 88: Classification of Disease
Page 89: Esophagogastric Outflow Obstruction
Page 90: Disorders of Peristalsis
Page 92: Nonoperative Management
Page 92: Dietary and Behavioral Modifications
Page 92: Pharmacologic Therapy
Page 93: Endoscopic Therapy
Page 93: Surgical Management
Page 94: Peroral Endoscopic Myotomy Operative Technique
Page 95: Postoperative Care
Page 95: Complications
Page 95: CONCLUSION
Page 95: Acknowledgment
Page 96: Subchapter 10 Management of Esophageal Cancer
Page 96: EPIDEMIOLOGY
Page 96: CLINICAL PRESENTATION
Page 96: DIAGNOSIS/STAGING
Page 97: STAGE-BASED TREATMENT STRATEGIES/ALGORITHMS
Page 98: OPERATIVE APPROACHES TO ESOPHAGEAL CANCER
Page 98: Surgical Resection
Page 98: Ivor Lewis Esophagectomy
Page 100: McKeown
Page 100: Transhiatal
Page 100: COMPLICATIONS
Page 101: CONCLUSION
Page 101: Subchapter 11 Multimodality Therapy in Esophageal Cancer
Page 101: OVERVIEW
Page 101: DEFINITIONS OF MULTIMODAL THERAPY AND INDICATIONS IN ESOPHAGEAL CANCER
Page 102: Traditional Multimodal Treatment
Page 102: Esophageal Adenocarcinoma and Gastroesophageal Junction Adenocarcinoma
Page 104: Esophageal Squamous Cell Carcinoma
Page 104: Immunotherapy in Neoadjuvant and Adjuvant Settings
Page 104: Multimodal Therapy for Recurrent and Oligometastatic Disease: A New Frontier for Surgery?
Page 105: Additional Considerations to Multimodal Therapy
Page 106: CONCLUSIONS
Page 107: Subchapter 12 Use of Esophageal Stents
Page 107: STENTS THROUGH THE AGES
Page 107: STENT SELECTION
Page 108: PATIENT SELECTION
Page 108: INDICATIONS
Page 109: Malignant Esophageal Disease
Page 109: Malignant Esophageal Strictures
Page 109: Malignant Esophageal Fistulas
Page 109: Gastroesophageal Junction Tumors
Page 109: Bridge to Surgery
Page 110: Benign Esophageal Disease
Page 110: Benign Refractory Esophageal Strictures
Page 110: Benign Perforations, Anastomotic Leaks, and Fistulas
Page 110: Achalasia
Page 110: Refractory Esophageal Variceal Bleeding
Page 110: PROCEDURE
Page 112: COMPLICATIONS
Page 112: Tissue Erosion
Page 112: Vascular Erosion
Page 114: Aerodigestive Erosion
Page 115: Stent Migration
Page 116: CONCLUSION
Page 116: Subchapter 13 Management of Esophageal Perforation
Page 116: INTRODUCTION
Page 116: DIAGNOSIS
Page 117: Esophagram
Page 117: Computed Tomography
Page 117: Computed Tomography Esophagography
Page 117: Endoscopy
Page 118: Assessing Severity of Illness and Prognosis
Page 118: MANAGEMENT
Page 118: Nonoperative Management
Page 119: Endoscopic Stenting with Thoracoscopic Mediastinal and Pleural Drainage
Page 119: Endoscopic Techniques
Page 119: Open Repair
Page 120: Thoracic Perforations
Page 120: Cervical Perforations
Page 120: Abdominal Perforations
Page 121: Nutritional Management Following Repair
Page 121: Resection with Diversion
Page 121: Special Situations
Page 121: Malignancy
Page 122: Achalasia
Page 48: Suggested Readings
Page 56: Suggested Readings
Page 61: Suggested Readings
Page 65: Suggested Readings
Page 71: Suggested Readings
Page 76: Suggested Readings
Page 80: Suggested Readings
Page 87: Suggested Readings
Page 96: Suggested Readings
Page 101: Suggested Readings
Page 107: Suggested Readings
Page 116: Suggested Readings
Page 122: Suggested Readings
Page 123: Section 3 – Stomach
Page 123: Benign Gastric Ulcer
Page 123: TYPES OF BENIGN GASTRIC ULCER
Page 123: SURGICAL OPTIONS FOR GASTRIC ULCER
Page 124: INDICATIONS FOR OPERATION
Page 124: PERFORATED GASTRIC ULCER
Page 126: BLEEDING GASTRIC ULCER
Page 127: OBSTRUCTING GASTRIC ULCER
Page 127: NONHEALING GASTRIC ULCER (INTRACTABILITY)
Page 127: MARGINAL AND RECURRENT ULCER
Page 128: Management of Duodenal Ulcers
Page 128: INTRODUCTION
Page 128: MEDICAL MANAGEMENT OF DUODENAL ULCER
Page 128: Perforated Duodenal Ulcer
Page 129: Omental Patching
Page 129: Special Considerations for Large Ulcer Perforations
Page 130: Definitive Ulcer Surgery
Page 130: Minimally Invasive Surgery
Page 130: Postoperative Management
Page 131: BLEEDING DUODENAL ULCER
Page 131: Risk Stratification
Page 131: Surgery for Bleeding Duodenal Ulcer
Page 132: Oversewing of a Bleeding Duodenal Ulcer
Page 132: Definitive Ulcer Surgery
Page 132: Postoperative Management
Page 132: GASTRIC OUTLET OBSTRUCTION
Page 132: Surgery for Obstructing Duodenal Ulcer
Page 132: Vagotomy and Antrectomy
Page 133: INTRACTABLE DUODENAL ULCER
Page 133: MANAGEMENT OF THE DIFFICULT DUODENAL STUMP
Page 133: CONCLUSION
Page 134: Management of Zollinger-Ellison Syndrome
Page 134: CLINICAL PRESENTATION
Page 134: CLINICAL PATHOLOGIC CORRELATION
Page 135: DIAGNOSIS
Page 136: TUMOR LOCALIZATION
Page 136: SURGICAL MANAGEMENT OF GASTRINOMA
Page 137: SURGERY FOR ZOLLINGER-ELLISON SYNDROME
Page 137: SURGICAL EXPLORATION AND RESECTION TECHNIQUES
Page 138: Postoperative Management
Page 138: Results of Treatment
Page 138: Recurrent Gastrinoma
Page 138: Management of Metastatic or Locally Advanced Disease
Page 139: SUMMARY
Page 140: Management of Mallory-Weiss Syndrome
Page 140: PATHOPHYSIOLOGY AND RISK FACTORS FOR MWT
Page 140: DIAGNOSIS
Page 140: TREATMENTS FOR MWT: ENDOSCOPY, ANGIOGRAPHY, AND SURGERY
Page 141: Endoscopic Treatment
Page 141: Angiography
Page 142: Surgical Treatment
Page 142: SUMMARY
Page 142: Management of Gastric Adenocarcinoma
Page 142: INTRODUCTION
Page 142: RISK FACTORS
Page 143: PATHOLOGY
Page 143: DIAGNOSIS AND STAGING
Page 144: SURGERY
Page 145: Proximal Gastrectomy
Page 145: POSTOPERATIVE RECOVERY
Page 147: SYSTEMIC THERAPY
Page 148: TARGETED THERAPY
Page 148: SURVEILLANCE
Page 148: PALLIATION
Page 148: CONCLUSION
Page 149: Familial Gastric Cancer
Page 149: PATHOLOGY OF GASTRIC CANCER
Page 149: Hereditary Diffuse Gastric Cancer
Page 150: Hereditary Nonpolyposis Colorectal Cancer
Page 150: Li Fraumeni Syndrome
Page 151: Polyp-Associated Gastric Cancer Syndromes
Page 151: Familial Adenomatosis Polyposis and MUTYH-Associated Polyposis Syndromes
Page 151: Peutz-Jeghers Syndrome
Page 152: Gastric Adenocarcinoma and Proximal Polyposis of the Stomach
Page 152: PREOPERATIVE WORKUP AND SURGICAL INTERVENTION
Page 152: POSTSURGICAL CARE
Page 153: Management of Gastrointestinal Stromal Tumors
Page 154: CLINICAL PRESENTATION
Page 154: WORKUP
Page 154: RISK STRATIFICATION
Page 155: SURGERY FOR PRIMARY DISEASE
Page 155: Indications
Page 156: General Technical Principles
Page 156: Minimally Invasive Approach
Page 156: Site-Specific Considerations
Page 158: ENDOSCOPIC MANAGEMENT OF GIST
Page 158: NEOADJUVANT THERAPY
Page 158: ADJUVANT THERAPY
Page 160: RECURRENT, METASTATIC, AND RESISTANT DISEASE
Page 160: CONCLUSION
Page 161: Gastrointestinal Tubes for Feeding and Decompression
Page 161: INTRODUCTION
Page 161: NASOGASTRIC TUBE
Page 162: Indications for Nasogastric Tube Placement
Page 162: Contraindications
Page 162: Placement of Nasogastric Tubes
Page 163: Confirmation of Nasogastric Tube Placement
Page 163: Complications
Page 163: FEEDING TUBES
Page 163: Nasoenteric Tubes
Page 163: Percutaneous Endoscopic Gastrostomy or Jejunostomy Tubes
Page 164: Endoscopic Placement Technique
Page 164: Routine Care
Page 165: Complications
Page 165: Tube Deterioration and Replacement
Page 165: Gastrostomy or Jejunostomy Tube Removal
Page 165: Management of Morbid Obesity
Page 166: PATIENT SELECTION
Page 166: OPERATIVE PROCEDURES
Page 166: Laparoscopic Roux-en-Y Gastric Bypass
Page 167: Laparoscopic Vertical Sleeve Gastrectomy
Page 168: Laparoscopic Duodenal Switch with Biliopancreatic Diversion
Page 168: Laparoscopic Single Anastomosis Duodenal Switch
Page 169: Intragastric Balloon
Page 169: Endoscopic Sleeve Gastroplasty
Page 169: ENHANCED RECOVERY AFTER SURGERY
Page 169: OUTCOMES AND COMPLICATIONS
Page 127: Suggested Readings
Page 133: suggested readings
Page 139: Suggested Readings
Page 142: Suggested Readings
Page 148: Suggested Readings
Page 153: Suggested Readings
Page 160: SUGGESTED READINGS
Page 165: Suggested Readings
Page 170: Suggested Readings
Page 171: Section 4 – Small Bowel
Page 171: Subchapter 23 Management of Small Bowel Obstruction
Page 171: INTRODUCTION
Page 171: CAUSES
Page 171: CLINICAL PRESENTATION
Page 171: DIAGNOSIS
Page 171: Laboratory Testing
Page 171: Imaging
Page 171: Plain Radiography
Page 172: Computed Tomography
Page 172: Magnetic Resonance Imaging
Page 172: CLASSIFICATION
Page 172: Partial Small Bowel Obstruction
Page 172: Complete Small Bowel Obstruction
Page 172: Complete Small Bowel Obstruction with Bowel Compromise
Page 172: MANAGEMENT
Page 172: Nonoperative Management
Page 173: Operative Management
Page 174: Laparoscopic Management
Page 174: SBO WITH CONFOUNDING CONDITIONS
Page 174: Closed-Loop SBO
Page 174: SBO with a Transition Point at the Site of a Hernia
Page 174: Geriatric Patients
Page 174: Pregnancy
Page 174: Obstruction Due to Inflammatory Bowel Disease
Page 175: Malignancy
Page 175: Virgin Abdomen
Page 175: Bariatric Surgery
Page 175: Early Postoperative Small Bowel Obstruction
Page 175: CONCLUSION
Page 176: Subchapter 24 Management of Crohn’s Disease of the Small Bowel
Page 176: MULTIDISCIPLINARY MANAGEMENT
Page 176: MEDICAL TREATMENT
Page 176: INDICATIONS FOR SURGERY
Page 176: Obstruction
Page 177: Perforation
Page 177: Failure of Medical Management
Page 177: PREOPERATIVE CONSIDERATIONS
Page 177: Timing
Page 177: Medications
Page 178: TECHNICAL CONSIDERATIONS FOR SURGICAL INTERVENTION
Page 178: Resection
Page 178: Ileostomy
Page 178: Disease of the Duodenum
Page 179: Strictureplasty
Page 179: Heineke-Mikulicz Strictureplasty
Page 179: Finney Strictureplasty
Page 179: Side-to-Side Isoperistaltic Strictureplasty (Michelassi Strictureplasty)
Page 179: POSTOPERATIVE CARE
Page 180: Subchapter 25 Use of Strictureplasty in Crohn’s Disease
Page 180: CLINICAL PRESENTATION
Page 180: INDICATIONS AND CONTRAINDICATIONS FOR STRICTUREPLASTY
Page 180: OPERATIVE PLANNING
Page 181: STRICTUREPLASTY TECHNIQUES
Page 181: Heineke-Mikulicz Strictureplasty
Page 182: Finney Strictureplasty (Fig. 5)
Page 183: Michelassi Strictureplasty or Side-to-Side Isoperistaltic Strictureplasty
Page 185: Results
Page 185: SUMMARY
Page 186: Subchapter 26 Management of Small Bowel Tumors
Page 186: PRESENTATION
Page 186: Predisposing Conditions
Page 186: Examination and Diagnostics for Patients Found to Have Small Bowel Tumors
Page 186: Imaging
Page 186: Endoscopy
Page 188: MANAGEMENT
Page 188: Benign
Page 188: Malignant
Page 188: Neuroendocrine Tumors
Page 189: Adenocarcinoma
Page 190: GIST
Page 190: Sarcoma
Page 190: Lymphoma
Page 191: Metastatic Disease
Page 191: SUMMARY
Page 191: Subchapter 27 Small Bowel Diverticulosis
Page 191: INTRODUCTION
Page 192: DETECTION AND MANAGEMENT OF ASYMPTOMATIC (INCIDENTALLY DISCOVERED) SMALL BOWEL DIVERTICULOSIS
Page 192: Duodenal Diverticula
Page 192: Jejunoileal Diverticula
Page 192: Meckel’s Diverticulum
Page 192: DETECTION AND MANAGEMENT OF SYMPTOMATIC SMALL BOWEL DIVERTICULOSIS
Page 193: Duodenal Diverticula
Page 193: Jejunoileal Diverticula
Page 193: Meckel’s Diverticula
Page 194: Subchapter 28 Diagnosis and Management of Motility Disorders of the Stomach and Small Bowel in the Current Era
Page 194: INTRODUCTION
Page 195: MOTILITY DISORDERS OF THE STOMACH
Page 195: Delayed Gastric Emptying/True Gastroparesis
Page 195: Clinical Presentation and Diagnosis
Page 196: Nonoperative Treatment
Page 197: Operative Treatment of Delayed Gastric Emptying
Page 198: GASTROPARESIS-LIKE SYNDROMES
Page 199: DIABETIC GASTROPARESIS
Page 199: RAPID GASTRIC EMPTYING
Page 199: Clinical Presentation and Diagnosis
Page 200: Treatment
Page 200: MOTILITY DISORDERS OF THE SMALL INTESTINE
Page 200: Adynamic Ileus
Page 200: Clinical Presentation and Diagnosis
Page 200: Treatment
Page 200: Postoperative Ileus
Page 201: Chronic Idiopathic Intestinal Pseudo-Obstruction
Page 201: Familial Visceral Myopathy
Page 201: Familial Visceral Neuropathy
Page 201: As Yet Undefined Neuromotor Dysmotility
Page 201: Clinical Presentation
Page 201: Diagnosis
Page 202: Treatment
Page 202: Scleroderma
Page 202: Postvagotomy Diarrhea
Page 202: Clinical Presentation
Page 203: Diagnosis and Treatment
Page 203: Subchapter 29 Management of Short Bowel Syndrome
Page 203: THERAPEUTIC GOALS
Page 203: Maintain Nutritional Status
Page 203: Maximize Enteral Nutrient Absorption
Page 204: Prevent Complications
Page 205: SURGICAL STRATEGIES
Page 205: Preserve the Intestinal Remnant
Page 205: Surgical Therapy for Short Bowel Syndrome
Page 205: Adequate Remnant Length with Dilated Bowel
Page 207: Moderate Remnant Length with Rapid Transit
Page 207: Patients with a Short Remnant and Dilated Bowel
Page 207: Short Remnant Length and Parenteral Nutrition–Related Complications
Page 207: MULTIDISCIPLINARY APPROACH
Page 208: Subchapter 30 Management of Enterocutaneous Fistulas
Page 208: OVERVIEW
Page 208: PRESENTATION
Page 208: CLASSIFICATION
Page 208: STABILIZATION AND SEPSIS CONTROL
Page 209: LONG-TERM MANAGEMENT
Page 209: Fluid and Electrolyte Repletion
Page 209: Nutritional Optimization
Page 210: Fistuloclysis
Page 210: Pharmacologic Management of Fistula Output
Page 210: Wound Care
Page 211: Define the Fistula Anatomy
Page 211: SPONTANEOUS CLOSURE
Page 211: OPERATIVE INTERVENTION
Page 212: SUMMARY
Page 213: Subchapter 31 Management of Radiation-Induced Injury to the Small and Large Bowel
Page 213: INTRODUCTION
Page 213: PATHOPHYSIOLOGY AND HISTOPATHOLOGY
Page 213: RISK FACTORS
Page 214: RADIATION THERAPY TOXICITY GRADING SYSTEMS
Page 214: CLINICAL FEATURES
Page 214: DIAGNOSIS
Page 214: MANAGEMENT STRATEGIES
Page 214: Medical Management
Page 215: Endoscopic Management
Page 215: Surgical Management
Page 216: PREVENTION
Page 175: Suggested Readings
Page 179: Suggested Readings
Page 185: Suggested Readings
Page 191: Suggested Readings
Page 194: Suggested Readings
Page 203: Suggested Readings
Page 207: Suggested Readings
Page 213: Suggested Readings
Page 217: Suggested Readings
Page 219: Section 5 – Large Bowel
Page 219: Preoperative Bowel Preparation: Is It Necessary?
Page 219: TYPES OF BOWEL PREPARATION
Page 219: Mechanical Bowel Preparation
Page 219: Oral Antibiotics
Page 222: MECHANICAL BOWEL PREP VS ORAL ANTIBIOTICS VS NO BOWEL PREPARATION
Page 222: OUTCOMES OF SURGERY DEPENDENT ON TYPE OF SURGERY
Page 222: BOWEL PREPARATION IN ERAS
Page 222: CONCLUSION
Page 223: Management of Diverticular Disease of the Colon
Page 223: INTRODUCTION
Page 223: MANAGEMENT OF DIVERTICULITIS
Page 223: Clinical Presentation and Diagnosis
Page 223: Management of the Patient with Acute Diverticular Disease
Page 223: Uncomplicated Diverticular Disease
Page 225: Diverticular Disease with Pericolic Abscess
Page 226: Diverticular Disease with Perforation/Peritonitis
Page 226: Treatment of Sequelae of Complicated Diverticulitis
Page 226: Diverticular Stricture
Page 226: Diverticular Fistula
Page 226: Surgical Treatment
Page 226: Route of Access
Page 227: Common Surgical Themes Among All Routes of Access
Page 227: Most Common Surgical Errors
Page 227: MANAGEMENT OF DIVERTICULAR BLEEDING
Page 227: Clinical Presentation and Diagnosis
Page 227: Endoscopic Strategies for Diverticular Bleeding
Page 227: Radiologic Strategies for Diverticular Bleeding
Page 227: Surgical Strategies for Diverticular Bleeding
Page 228: CONCLUSION
Page 228: Management of Chronic Ulcerative Colitis
Page 228: INTRODUCTION
Page 229: EXTRACOLONIC MANIFESTATIONS OF UC
Page 229: RISK FACTORS
Page 229: DIAGNOSIS
Page 229: MEDICAL THERAPY
Page 229: SURGERY AND ULCERATIVE COLITIS
Page 229: Overview
Page 230: Total Abdominal Colectomy with End Ileostomy
Page 230: Completion Proctectomy/Total Proctocolectomy
Page 230: Creation of Ileal Pouch Anal Anastomosis
Page 232: PERIOPERATIVE AND POSTOPERATIVE CONSIDERATIONS
Page 232: Perioperative Management
Page 232: Ileal Pouch Complications
Page 232: SUMMARY
Page 232: Management of Toxic Megacolon
Page 233: CAUSE, INCIDENCE, AND PATHOGENESIS
Page 233: DIAGNOSIS
Page 234: THERAPY
Page 234: Medical Therapy
Page 234: Management of Patients with Inflammatory Bowel Disease
Page 235: Management of Patients with Clostridium difficile–Associated Disease
Page 235: Surgical Therapy
Page 236: OUTCOMES
Page 236: SUMMARY
Page 236: Surgical Management of Crohn’s Colitis
Page 236: INTRODUCTION
Page 237: MEDICAL MANAGEMENT
Page 238: INDICATION FOR SURGICAL INTERVENTION
Page 238: PREOPERATIVE OPTIMIZATION
Page 238: SURGICAL MANAGEMENT
Page 239: Total Abdominal Colectomy
Page 240: Total Proctocolectomy
Page 240: Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis
Page 240: Minimally Invasive Surgery
Page 240: Robotic Surgery
Page 240: SURGICAL PEARLS
Page 241: POSTOPERATIVE MANAGEMENT
Page 241: CONCLUSION
Page 242: Ischemic Colitis
Page 242: DEFINITION AND EPIDEMIOLOGY
Page 242: ETIOLOGY
Page 243: CLASSIFICATION
Page 243: PRESENTATION
Page 243: DIAGNOSIS
Page 244: SEVERITY
Page 245: SURGICAL APPROACH
Page 245: POSTOPERATIVE COURSE
Page 245: CONCLUSION
Page 246: Management of Clostridioides Difficile Colitis
Page 246: BACKGROUND
Page 246: Clinical Risk Factors for CDI
Page 246: CLINICAL PRESENTATION
Page 246: DIAGNOSIS
Page 247: Endoscopy
Page 247: Imaging
Page 247: MEDICAL TREATMENT
Page 248: SURGICAL MANAGEMENT
Page 248: Total Abdominal Colectomy with End Ileostomy
Page 249: Colonic Lavage and Diverting Loop Ileostomy
Page 249: SPECIAL POPULATION: PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Page 251: CONCLUSION
Page 251: Acknowledgments
Page 251: Management of Large Bowel Obstruction
Page 251: ETIOLOGY
Page 251: CLINICAL PRESENTATION
Page 251: DIAGNOSIS
Page 251: History and Physical Examination
Page 252: Imaging
Page 252: TREATMENT
Page 252: Initial Management
Page 252: Surgical Management
Page 252: Emergent Surgical Management
Page 253: Nonemergent Surgical Management
Page 253: Colonic Lavage
Page 253: Endoscopic Stenting
Page 255: SPECIFIC SITUATIONS
Page 255: Sigmoid Volvulus
Page 255: Cecal Volvulus or Bascule
Page 256: Acute Colonic Pseudo-Obstruction
Page 256: SUMMARY
Page 257: Enteral Stents in the Treatment of Colonic Obstruction
Page 257: INTRODUCTION
Page 257: INITIAL EVALUATION
Page 257: INDICATIONS FOR STENT PLACEMENT
Page 257: Malignant Colonic Obstruction
Page 257: Bridge to Elective Surgery
Page 258: Palliative Stenting
Page 258: Extrinsic Malignancy
Page 259: Benign Colonic Disease
Page 260: CONTRAINDICATIONS TO COLONIC STENTS
Page 260: Technical Considerations
Page 260: Types of Colonic Stents
Page 262: Stent Dimensions
Page 262: Stent Material
Page 262: Covered versus Uncovered Stents
Page 262: Technical Aspects of Stent Deployment (Box 1)
Page 262: Pre-stent placement
Page 263: Stent Deployment Process
Page 265: FOLLOW-UP CARE
Page 265: OUTCOMES AND ADVERSE EVENTS
Page 266: Early Complications
Page 266: Perforation
Page 266: Stent Migration and Failure
Page 266: Abdominal/Rectal Pain and Incontinence
Page 266: Late Complications
Page 266: Occlusion by Fecal Impaction and/or Tumor Ingrowth
Page 267: CONCLUSION
Page 268: Management of Acute Colonic Pseudo-Obstruction (Ogilvie’s Syndrome)
Page 268: CLINICAL MANIFESTATIONS AND DIAGNOSIS
Page 268: MANAGEMENT
Page 270: COLONOSCOPIC DECOMPRESSION
Page 270: PERCUTANEOUS CECOSTOMY
Page 271: SURGICAL THERAPY
Page 271: SUMMARY
Page 271: Management of Colonic Volvulus
Page 271: INTRODUCTION
Page 271: SIGMOID VOLVULUS
Page 272: CECAL VOLVULUS
Page 273: Rare Types of Volvulus
Page 274: SUMMARY
Page 274: Management of Rectal Prolapse
Page 274: ETIOLOGY
Page 274: PRESENTATION
Page 275: EVALUATION
Page 275: MANAGEMENT/SURGICAL APPROACH
Page 275: PARTIAL THICKNESS PROLAPSE
Page 275: Mucosal Sleeve Resection
Page 275: FULL THICKNESS PROLAPSE
Page 275: Perineal Rectosigmoidectomy
Page 277: Abdominal Approaches
Page 277: Suture Rectopexy
Page 277: Ventral Mesh Rectopexy
Page 278: Recurrent Prolapse
Page 278: CONCLUSION
Page 278: Surgical Management of Constipation
Page 278: ANATOMY AND PHYSIOLOGY
Page 279: DIAGNOSIS
Page 279: Clinical Assessment
Page 279: Radiologic Testing
Page 279: Sitz Marker Study (Radiopaque Marker Study)
Page 279: Defecography
Page 280: Anorectal Physiology Testing
Page 280: MANAGEMENT
Page 280: Medical Management
Page 280: Noninvasive Techniques
Page 280: Surgical Management
Page 280: Colonic Slow-Transit Constipation
Page 281: Total Abdominal Colectomy with Ileorectal Anastomosis
Page 281: Preoperative
Page 281: Intraoperative
Page 283: Cecorectal Anastomosis
Page 283: Completion Proctectomy with Ileal Pouch–Anal Anastomosis (IPAA)
Page 284: Diverting Ileostomy
Page 284: Outlet Obstruction Constipation
Page 284: Rectocele Repair
Page 284: Preoperative
Page 284: Intraoperative
Page 285: Colostomy Creation
Page 285: Other Surgical Options
Page 285: Colonic Disimpaction
Page 285: Malone Antegrade Colonic Enema
Page 285: Sacral Nerve Stimulation
Page 285: ADULT HIRSCHSPRUNG’S DISEASE
Page 286: CONCLUSION
Page 286: Surgical Management of the Polyposis Syndromes
Page 286: INTRODUCTION
Page 286: ADENOMATOUS POLYPOSIS SYNDROMES
Page 286: Familial Adenomatous Polyposis
Page 286: Extracolonic Intestinal Disease
Page 287: Extraintestinal Manifestations
Page 288: Desmoid Tumors
Page 288: Attenuated Familial Adenomatous Polyposis
Page 288: Mutation Y-Homolog Associated Polyposis
Page 288: CHEMOPREVENTION
Page 288: SURGERY
Page 289: Proctocolectomy with End Ileostomy
Page 289: Proctocolectomy with Continent Ileostomy
Page 289: Total Abdominal Colectomy with Ileorectal Anastomosis
Page 289: Restorative Proctocolectomy/Ileal Pouch Anal Anastomosis
Page 290: Double-Stapled Technique
Page 290: Handsewn Technique
Page 290: Postoperative Surveillance
Page 291: OTHER POLYPOSIS SYNDROMES
Page 291: Peutz-Jeghers Syndrome
Page 292: Juvenile Polyposis Syndrome
Page 292: Cowden’s Syndrome
Page 292: Bannayan-Riley-Ruvalcaba Syndrome
Page 293: Cronkhite-Canada Syndrome
Page 293: Hereditary Mixed Polyposis Syndrome
Page 293: Serrated Polyposis Syndrome
Page 293: Surgical Management of Colon Cancer
Page 293: CLINICAL PRESENTATION AND SCREENING
Page 294: PREOPERATIVE EVALUATION AND STAGING
Page 294: SURGICAL MANAGEMENT
Page 294: Preoperative Preparation
Page 294: Operative Approach
Page 294: Colon Resection
Page 295: SPECIAL SCENARIOS
Page 295: Malignant Polyp
Page 295: Locally Advanced Cancer
Page 295: Stage IV Cancer
Page 296: TUMOR-RELATED EMERGENCIES
Page 296: Perforation
Page 296: Bowel Obstruction
Page 296: ADJUVANT THERAPY
Page 296: SURVEILLANCE
Page 296: CONCLUSION
Page 297: PET Scanning in the Management of Colorectal Cancer
Page 297: INTRODUCTION
Page 299: POSITRON EMISSION TOMOGRAPHY CONCEPTS AND DEFINITIONS
Page 299: INITIAL DIAGNOSIS, WORKUP, AND STAGING OF COLORECTAL CANCER
Page 299: THE ROLE OF PREOPERATIVE FDG-PET CT IN COLORECTAL MALIGNANCY
Page 299: POSTTREATMENT EVALUATION OF COLORECTAL MALIGNANCY
Page 299: COLORECTAL CANCER SURVEILLANCE
Page 300: THE ROLE OF PET CT IN COLORECTAL LIVER METASTASES
Page 300: FDG-PET MRI
Page 300: CONCLUSION
Page 301: Neoadjuvant and Adjuvant Therapy for Colorectal Cancer
Page 301: STAGING
Page 301: Colon Cancer
Page 301: Stage II Colon Cancer
Page 302: Stage III Colon Cancer
Page 302: RECTAL CANCER
Page 302: Adjuvant Therapy for Rectal Cancer
Page 303: Neoadjuvant Therapy for Rectal Cancer
Page 304: SURVEILLANCE
Page 305: Management of Colorectal Polyps
Page 305: OVERVIEW
Page 305: HISTOPATHOLOGY OF POLYPS
Page 305: Adenomas
Page 305: Serrated Polyps
Page 305: Hamartomas
Page 306: TECHNIQUES FOR EXCISING POLYPS
Page 306: Colonoscopic Approach
Page 307: Endoscopic Mucosal Resection
Page 307: Endoscopic Submucosal Dissection
Page 307: Combined Endo-Laparoscopic Surgery
Page 307: Surgical Approach
Page 307: Conventional Transanal Excision
Page 308: Transanal Endoscopic Microsurgery
Page 308: Transanal Minimally Invasive Surgery
Page 308: APPROACH TO THE MALIGNANT POLYP
Page 309: Management of Peritoneal Surface Malignancies
Page 309: EPIDEMIOLOGY AND CLASSIFICATION
Page 309: Appendiceal Neoplasm
Page 309: CLINICAL MANIFESTATION
Page 309: PREOPERATIVE WORKUP
Page 309: PATIENT SELECTION
Page 310: COLORECTAL CANCERS
Page 311: Epidemiology
Page 311: Clinical Manifestations
Page 311: Preoperative Workup
Page 311: Patient Selection for Surgery
Page 312: GASTRIC CANCER
Page 312: Epidemiology and Clinical Manifestation
Page 312: Preoperative Workup
Page 312: Patient Selection for Surgery
Page 313: PERITONEAL MESOTHELIOMA
Page 313: Epidemiology and Clinical Manifestation
Page 313: Perioperative Workup
Page 313: Patient Selection for Surgery
Page 313: OVARIAN CANCER
Page 313: Epidemiology and Clinical Manifestation
Page 313: Preoperative Workup
Page 314: Patient Selection for Surgery
Page 314: Intraoperative Management and Technique
Page 314: Postoperative Management
Page 316: Management of Lower Gastrointestinal Bleeding
Page 316: INTRODUCTION
Page 316: Etiology
Page 316: Epidemiology
Page 316: History and Physical Examination
Page 317: MANAGEMENT
Page 317: Resuscitation and Transfusion
Page 317: Special Hematologic Considerations
Page 317: Localization
Page 317: Nasogastric Lavage
Page 317: Anoscopy/Rigid Sigmoidoscopy
Page 318: Colonoscopy
Page 319: Computed Tomographic Angiography
Page 319: Nuclear Scintigraphy with Technetium-99m
Page 319: Angiography
Page 320: Capsule Endoscopy
Page 321: Double Balloon Enteroscopy
Page 321: Management Algorithm for LGIB
Page 322: SURGICAL CONSIDERATIONS
Page 322: Indications
Page 322: Operative Technique
Page 322: CONCLUSION
Page 323: Appendicitis: Diagnosis and Management
Page 323: ANATOMY OF THE APPENDIX
Page 323: PATHOLOGY OF ACUTE APPENDICITIS
Page 323: CLINICAL PRESENTATION AND DIAGNOSTIC WORKUP
Page 323: History and Physical Examination
Page 324: Laboratory Examination
Page 324: Diagnostic Imaging
Page 324: MANAGEMENT OF ACUTE APPENDICITIS
Page 324: Timing of Surgery
Page 326: Laparoscopic Appendectomy
Page 326: Open Appendectomy
Page 326: Management of Perforated (Complicated) Appendicitis
Page 326: CURRENT CONTROVERIES
Page 326: Nonoperative Management of Nonperforated Appendicitis
Page 328: Interval Appendectomy
Page 328: SUMMARY
Page 222: Suggested Readings
Page 228: Suggested Readings
Page 232: Suggested Readings
Page 236: Suggested Readings
Page 241: Suggested Readings
Page 245: Suggested Readings
Page 251: Suggested Readings
Page 256: Suggested Readings
Page 267: Suggested Readings
Page 271: Suggested Readings
Page 274: Suggested Readings
Page 278: Suggested Readings
Page 286: Suggested Readings
Page 293: Suggested Readings
Page 297: Suggested Readings
Page 300: Suggested Readings
Page 305: Suggested Readings
Page 309: Suggested Reading
Page 315: Suggested Readings
Page 322: Suggested Readings
Page 328: Suggested Readings
Page 329: Section 6 – Anorectal
Page 329: Subchapter 53 Management of Hemorrhoids
Page 329: INTRODUCTION
Page 329: ETIOLOGY AND SYMPTOMS
Page 329: TREATMENT
Page 329: Dietary and Lifestyle Modifications
Page 329: Office-Based Procedures
Page 329: Rubber Band Ligation
Page 331: Sclerotherapy
Page 331: Other Office-Based Procedures
Page 331: Operative Treatment
Page 332: Acute Hemorrhoidal Crisis
Page 332: Ferguson Hemorrhoidectomy
Page 333: Milligan-Morgan Hemorrhoidectomy
Page 334: Stapled Hemorrhoidopexy
Page 334: Doppler-Guided Hemorrhoid Artery Ligation and Mucopexy
Page 334: Open Transanal Hemorrhoidopexy
Page 336: Postoperative Considerations
Page 336: SPECIAL SITUATIONS AND COMPOUNDING CONDITIONS
Page 336: Pregnancy
Page 336: Portal Hypertension
Page 336: Immunocompromised Patients
Page 336: Crohn’s Disease
Page 336: SUMMARY
Page 337: Subchapter 54 Management of Fissure-In-Ano
Page 337: INTRODUCTION
Page 337: NONOPERATIVE MANAGEMENT
Page 337: Dietary and Lifestyle Modifications
Page 338: Topical Sphincter Relaxants
Page 338: Chemical Denervation
Page 338: OPERATIVE MANAGEMENT
Page 338: Lateral Internal Sphincterotomy
Page 339: Advancement Flaps
Page 340: SPECIAL CONSIDERATIONS
Page 340: Subchapter 55 Management of Anorectal Abscess and Fistula
Page 341: ANORECTAL ABSCESS
Page 341: Etiology and Classification
Page 341: Presentation and Diagnosis
Page 342: Operative Evaluation and Drainage
Page 342: Primary Fistulotomy
Page 343: Antibiotics and the Immunocompromised Patient
Page 343: Necrotizing Perianal Skin Infection
Page 344: FISTULA-IN-ANO
Page 344: Etiology and Classification
Page 344: Presentation and Diagnosis
Page 345: Surgical Treatment
Page 345: Define Fistula Anatomy
Page 346: Ensure the Resolution of Sepsis
Page 346: Assess and Preserve Anal Sphincter Function
Page 347: Minimize Recurrence Risk
Page 347: Fistulotomy
Page 347: Seton
Page 347: LIFT
Page 348: Endorectal Advancement Flap
Page 349: Other Continence Preserving Procedures
Page 349: Subchapter 56 Anal Stenosis
Page 349: BACKGROUND
Page 349: DIAGNOSIS
Page 350: MANAGEMENT
Page 350: Nonoperative Management
Page 350: Operative Management
Page 350: Stricturoplasty
Page 350: Mucosal Advancement Flaps
Page 350: Y-V Advancement Flap
Page 351: V-Y Advancement Flap
Page 351: House Flap
Page 351: Diamond-Shaped and U-Shaped Flap
Page 352: Rotational S Flap
Page 352: POSTOPERATIVE CARE AND COMPLICATIONS
Page 352: SELECTION OF SURGICAL TECHNIQUE
Page 353: Subchapter 57 Management of Pruritus Ani
Page 353: DEFINITION
Page 353: ETIOLOGY
Page 353: Primary/Idiopathic Pruritus Ani
Page 353: Secondary Pruritus Ani
Page 353: Infectious
Page 354: Dermatologic
Page 354: Anorectal Diseases
Page 354: Miscellaneous
Page 354: EVALUATION AND DIAGNOSIS
Page 354: History
Page 354: Physical
Page 355: MANAGEMENT
Page 355: Education and Lifestyle Modifications
Page 355: Medical
Page 355: Subchapter 58 Surgical Management of Fecal Incontinence
Page 355: INTRODUCTION
Page 356: DIAGNOSTIC EVALUATION
Page 357: NONOPERATIVE MANAGEMENT
Page 357: Medical Management
Page 357: Biofeedback
Page 357: SURGICAL MANAGEMENT
Page 358: Sacral Nerve Stimulation
Page 359: Overlapping Anterior Sphincteroplasty
Page 359: Fecal Diversion
Page 359: Additional Surgical Interventions
Page 361: CONCLUSIONS
Page 361: Subchapter 59 Rectovaginal Fistula
Page 361: ETIOLOGY AND CLASSIFICATION
Page 361: EVALUATION
Page 362: ABDOMINAL APPROACHES
Page 362: PERINEAL APPROACHES
Page 362: Transanal Fistulotomy
Page 363: Endorectal Advancement Flap
Page 364: Fibrin Glue
Page 364: Fistula Plug
Page 364: TRANSVAGINAL REPAIRS
Page 364: Transvaginal Approach Vaginal Advancement Flap
Page 365: Transperineal Repairs
Page 365: Transperineal Ligation with a LIFT Procedure
Page 366: Overlapping Anterior Sphincteroplasty
Page 366: Episioproctotomy
Page 366: Transperineal Stapled Repair
Page 366: Interposition Flaps
Page 366: Gracilis Muscle Transposition
Page 369: Bulbocavernosus (Martius) Flap
Page 369: Subchapter 60 Anal Condyloma
Page 369: OVERVIEW
Page 369: INCIDENCE
Page 369: RISK FACTORS
Page 369: PATHOGENESIS, PRESENTATION, AND DETECTION
Page 370: MANAGEMENT OF ANAL CONDYLOMA
Page 371: GIANT CONDYLOMA ACUMINATA
Page 371: ANAL SQUAMOUS INTRAEPITHELIAL LESION
Page 373: HUMAN PAPILLOMAVIRUS VACCINE
Page 373: Subchapter 61 Management of Pilonidal Disease
Page 373: INTRODUCTION
Page 373: TREATMENT
Page 374: Nonoperative Treatment
Page 374: Operative Management
Page 374: Principles of Treatment
Page 374: Control Sepsis
Page 374: Do the Least Amount of Work Possible
Page 374: Avoid Too Much Excision
Page 374: Unroof All Disease, Debride Granulation Tissue, and Remove Hair
Page 374: Use Off-Midline Excision and Closure
Page 374: Minimize Tension if the Wound Is Closed
Page 374: Change the Anatomy/Flatten the Natal Cleft
Page 374: Never Underestimate the Impact of Postoperative Care
Page 374: Basic/Simple Procedures
Page 374: Abscess Drainage
Page 374: Non-Excisional Procedures
Page 375: Pit-Picking/Simple Bascom Procedure
Page 375: Excision With or Without Primary Wound Closure
Page 375: Intermediate Procedures
Page 376: Karydakis Flap
Page 376: Cleft Lift Procedure
Page 376: Complex Procedures
Page 376: Rhomboid Flap
Page 377: Special Situations
Page 379: Endoscopic Procedures
Page 379: Subchapter 62 Pneumatosis Intestinalis and the Importance for the Surgeon
Page 379: INTRODUCTION
Page 379: BENIGN CAUSES OF PNEUMATOSIS INTESTINALIS
Page 379: PNEUMATOSIS INTESTINALIS RESULTING FROM AN INTRAABDOMINAL EMERGENCY
Page 379: IMAGING FINDINGS
Page 379: X-ray
Page 379: Computed Tomography
Page 380: Ultrasound
Page 380: Magnetic Resonance Imaging
Page 380: Laboratory Findings
Page 380: Endoscopic Findings
Page 380: Distinguishing Benign from Pathologic Pneumatosis Intestinalis
Page 381: Medical Management of Benign Pneumatosis Intestinalis
Page 381: SURGICAL MANAGEMENT OF PATHOLOGIC PNEUMATOSIS INTESTINALIS
Page 381: Constant Communication with the Anesthesiologist
Page 381: Resuscitation to Euvolemia
Page 381: How Much to Resect
Page 381: Avoiding or Delaying an Anastomosis
Page 382: Subchapter 63 Management of Rectal Cancer
Page 382: BACKGROUND
Page 382: CLINICAL EVALUATION AND CLINICAL STAGING
Page 383: NEOADJUVANT THERAPY
Page 383: MANAGEMENT OF TUMOR-RELATED COMPLICATIONS
Page 384: RADICAL RESECTION
Page 386: LOCAL EXCISION
Page 387: NONOPERATIVE MANAGEMENT
Page 387: MANAGEMENT OF METASTATIC DISEASE
Page 387: POSTOPERATIVE MANAGEMENT/SURVEILLANCE
Page 388: Subchapter 64 Management of Tumors of the Anal Region
Page 388: OVERVIEW AND ANATOMY
Page 389: SQUAMOUS NEOPLASMS
Page 389: Human Papilloma Virus and Anal Squamous Neoplasia
Page 389: Condyloma Acuminatum (Anal Warts)
Page 389: Buschke-Lowenstein Tumor (Verrucous Carcinoma)
Page 389: Anal Intraepithelial Neoplasia
Page 390: Diagnosis
Page 390: Management
Page 390: Squamous Cell Carcinoma
Page 390: Diagnosis
Page 391: Staging
Page 391: Treatment
Page 391: Posttreatment Surveillance
Page 391: Treatment of Recurrent or Persistent Disease
Page 391: Metastatic Disease
Page 391: COLUMNAR NEOPLASMS
Page 391: Adenocarcinoma
Page 391: Paget’s Disease
Page 392: MELANOMA
Page 392: NEUROENDOCRINE AND MESENCHYMAL TUMORS
Page 392: MALIGNANT LYMPHOMA
Page 336: Suggested Readings
Page 340: Suggested Readings
Page 349: Suggested Readings
Page 353: Suggested Readings
Page 355: Suggested Readings
Page 361: Suggested Readings
Page 369: Suggested Readings
Page 373: Suggested Readings
Page 379: Suggested Readings
Page 382: Suggested Readings
Page 388: Suggested Readings
Page 392: Suggested Readings
Page 393: Section 7 – Liver
Page 393: 65 Cystic Disease of the Liver
Page 393: Lucas W. Thornblade, MD, MPH, and Yuman Fong, MD
INTRODUCTION
Page 393: Imaging Characteristics
Page 393: Types of Cystic Liver Lesions
Page 393: Mucinous Cystic Neoplasm and Mucinous Cystadenocarcinoma
Page 394: Intraductal Papillary Mucinous Neoplasm of the Bile Duct
Page 394: Ciliated Hepatic Foregut Cyst
Page 395: Cystic Malignancy
Page 395: Hepatic Pseudocysts and Traumatic Cysts
Page 395: Polycystic Liver Disease
Page 395: Special Considerations
Page 395: Biliary Cysts
Page 396: Extrahepatic Cysts
Page 396: Cystic Lesions Associated With Infection or Parasites
Page 396: Treatment Considerations
Page 397: CONCLUSION
Page 397: 66 Management of Echinococcal Cyst Disease of the Liver
Page 397: PATHOLOGY AND CLASSIFICATION
Page 399: PRESENTATION AND DIAGNOSIS
Page 399: Laboratory Tests
Page 399: Imaging
Page 399: TREATMENT
Page 400: Medical Management
Page 401: Percutaneous Therapy
Page 401: Operative Therapy
Page 401: Scolecoidal Agents
Page 401: Open Cyst Evacuation
Page 402: Minimally Invasive Cyst Evacuation
Page 402: Pericystectomy
Page 403: Liver Resection/Transplantation
Page 403: SUMMARY
Page 403: Uncomplicated Disease
Page 404: Complicated Disease
Page 404: RESULTS
Page 404: Morbidity and Mortality
Page 405: Long-Term Outcomes
Page 405: 67 Management of Liver Hemangioma
Page 405: Victor M. Zaydfudim, MD, MPH, and Reid B. Adams, MD
OVERVIEW
Page 405: Pathogenesis and Clinical Presentation
Page 406: Diagnosis
Page 407: Treatment
Page 409: RUPTURED HEMANGIOMATA, KASABACH-MERRITT SYNDROME, AND BUDD-CHIARI SYNDROME
Page 410: MASQUERADING LESIONS
Page 410: 68 Management of Benign Liver Tumors
Page 410: RADIOGRAPHIC EVALUATION OF LIVER LESIONS
Page 410: BENIGN LIVER CYSTS
Page 410: Pathogenesis
Page 411: Presentation
Page 411: Imaging
Page 412: Management
Page 412: MUCINOUS CYSTIC NEOPLASM
Page 412: Pathogenesis
Page 412: Presentation
Page 412: Imaging
Page 413: Management
Page 413: HEPATIC HEMANGIOMA
Page 413: Pathogenesis
Page 413: Presentation
Page 413: Imaging
Page 413: Management
Page 413: HEPATIC ADENOMA
Page 413: Pathogenesis
Page 414: Presentation
Page 414: Imaging
Page 415: Management
Page 415: FOCAL NODULAR HYPERPLASIA
Page 415: Pathogenesis
Page 415: Presentation
Page 415: Imaging
Page 416: Management
Page 416: SUMMARY
Page 417: 69 Management of Malignant Liver Tumors
Page 417: PRIMARY LIVER TUMORS
Page 417: Hepatocellular Carcinoma
Page 418: Intrahepatic Cholangiocarcinoma
Page 418: METASTATIC LIVER TUMORS
Page 418: Colorectal Liver Metastasis
Page 419: PREOPERATIVE EVALUATION
Page 419: TECHNICAL CONSIDERATIONS
Page 419: Positioning, Incision, and Exposure
Page 419: Inflow and Outflow and Outflow Control
Page 420: Parenchymal Transection
Page 421: HEPATECTOMY
Page 421: Right Hepatic Lobectomy
Page 421: Right Trisectionectomy
Page 422: Left Hepatic Lobectomy
Page 422: Left Trisectionectomy
Page 422: 70 Hepatic Malignancy: Resection Versus Transplantation
Page 422: Sharon R. Weeks, MD, and Shane E. Ottmann, MD
INTRODUCTION
Page 422: PATIENT EVALUATION
Page 423: ASSESSMENT OF LIVER FUNCTION
Page 423: RESECTION FOR HEPATOCELLULAR CARCINOMA
Page 425: LIVER TRANSPLANTATION IN HEPATOCELLULAR CARCINOMA
Page 425: FUTURE DIRECTIONS
Page 425: SUMMARY
Page 426: 71 Management of Colorectal Liver Metastases
Page 426: Jordan M. Cloyd, MD, and Timothy M. Pawlik, MD, MPH, PhD
INTRODUCTION
Page 426: EVALUATION
Page 426: ROLE OF CHEMOTHERAPY
Page 428: SURGICAL RESECTION
Page 428: Surgical Technique
Page 428: Margin Status
Page 429: Parenchymal-Sparing Techniques
Page 429: Minimally Invasive Approaches
Page 429: LOCOREGIONAL THERAPIES
Page 429: Ablation
Page 429: Hepatic Artery Infusion Therapy
Page 430: SPECIFIC CLINICAL SCENARIOS
Page 430: Initially Unresectable Disease
Page 431: Bilateral Metastatic Disease
Page 431: Synchronous Colorectal Metastases
Page 432: CONCLUSION
Page 433: 72 Ablation of Colorectal Carcinoma Liver Metastases
Page 433: Naomi M. Sell, MD, MHS, Zhi Ven Fong, MD, PhD, and Kenneth K. Tanabe, MD
INTRODUCTION
Page 433: ABLATION MODALITIES
Page 433: Cryotherapy
Page 433: Radiofrequency Ablation
Page 434: Microwave Ablation
Page 434: Irreversible Electroporation
Page 435: Laser Thermal Ablation
Page 436: PATIENT SELECTION
Page 436: Tumor Characteristics
Page 436: Use of Systemic Therapies
Page 436: PATIENT EVALUATION
Page 436: Baseline Hepatic Function
Page 436: Extrahepatic Metastases
Page 436: CHOOSING A TREATMENT MODALITY
Page 436: Tumor-Specific Considerations
Page 436: Treatment Approach
Page 437: Technical Considerations
Page 437: Clinical Follow-up of Ablated Tumors
Page 437: SUMMARY
Page 438: 73 Management of Hepatic Abscess
Page 439: PYOGENIC LIVER ABSCESS
Page 439: Pathophysiology
Page 439: Diagnosis
Page 439: Treatment
Page 439: Antibiotics
Page 440: Percutaneous Drainage
Page 441: Surgical Drainage or Resection
Page 441: Outcomes
Page 441: AMEBIC LIVER ABSCESS
Page 441: Pathophysiology
Page 442: Diagnosis
Page 442: Treatment
Page 442: Antibiotics
Page 442: Drainage
Page 442: FUNGAL HEPATIC ABSCESS
Page 442: Treatment
Page 443: 74 Transarterial Therapies for Primary and Metastatic Liver Tumors
Page 443: Nariman Nezami, MD, and Clifford R. Weiss, MD
INTRODUCTION
Page 443: TRANSARTERIAL THERAPIES
Page 444: Bland Embolization
Page 444: Conventional Transarterial Chemoembolization
Page 445: Drug-Eluting Beads Transarterial Chemoembolization
Page 445: Selective Internal Radiation Therapy
Page 448: Hepatic Artery Infusion
Page 448: Indications and Patient Selection
Page 448: Contraindications to Transarterial Chemoembolization
Page 448: Major Contraindications
Page 448: Relative Contraindications
Page 448: Contraindications to SIRT Application (FDA Recommendation):
Page 448: Patient Preparation
Page 448: Techniques: Angiogram and Embolization Technique
Page 450: POSTPROCEDURE FOLLOW-UP
Page 450: TOXICITIES AND COMPLICATIONS
Page 451: OUTCOMES
Page 451: Lesion-Based Response
Page 451: Imaging Response Criteria
Page 451: Overall Survival, Progression-Free Survival, and Hepatic Progression-Free Survival
Page 452: CANCER-SPECIFIC OUTCOMES
Page 452: Intrahepatic Cholangiocarcinoma
Page 452: Metastatic Colorectal Cancer
Page 452: Metastatic Neuroendocrine Tumors
Page 452: Metastatic Renal Cell Carcinoma
Page 452: Metastatic Breast Cancer
Page 452: Metastatic Melanoma
Page 453: Metastatic Sarcomas
Page 453: NEW DEVELOPMENTS AND FUTURE DIRECTIONS
Page 453: Radiopaque Beads
Page 453: Various Drug-Loaded Beads
Page 453: Immunoembolization
Page 453: Nanoparticles
Page 453: Combination with Systemic Therapies
Page 453: Combination with Percutaneous Therapies
Page 453: Preoperative TACE
Page 453: SUMMARY
Page 397: Suggested Readings
Page 405: Suggested Readings
Page 410: Suggested Readings
Page 417: Suggested Readings
Page 422: Suggested Readings
Page 426: Suggested Readings
Page 432: Suggested Readings
Page 438: Suggested Readings
Page 442: Suggested Readings
Page 453: Suggested Readings
Page 455: Section 8 – Portal Hypertension
Page 455: Subchapter 75 Portal Hypertension: Role of Shunting Procedures
Page 455: INTRODUCTION
Page 455: COMPLICATIONS OF PORTAL HYPERTENSION
Page 456: TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT
Page 456: SURGICAL SHUNTS
Page 457: Total Nonselective Shunts
Page 457: Partial Nonselective Shunts
Page 457: Selective Shunts
Page 458: Other Surgical Shunts and Devascularization Procedures
Page 459: CONCLUSION
Page 459: Subchapter 76 Liver Transplantation
Page 459: HISTORY
Page 459: IMMUNOSUPPRESSION
Page 459: Indications for Liver Transplantation
Page 459: Acute Liver Failure
Page 460: Chronic Liver Disease
Page 461: MELD
Page 462: Waiting List Additions, Removals, and Transplantation
Page 462: LIVER TRANSPLANTATION
Page 462: Techniques
Page 463: Bicaval anastomosis
Page 464: Piggyback Technique
Page 464: Modified Piggyback Technique
Page 465: Vascular Reconstruction
Page 465: PV Reconstruction in the Presence of Native PV Thrombosis
Page 465: Arterial Reconstruction
Page 465: Biliary Anastomosis
Page 466: OUTCOMES
Page 466: VASCULAR COMPLICATIONS
Page 466: Arterial
Page 466: Venous
Page 466: Portal Vein
Page 466: PVT
Page 466: PVS
Page 467: Biliary Complications
Page 467: Bile Leak
Page 467: Bile Duct Strictures
Page 467: LIVING DONOR LIVER TRANSPLANTATION
Page 469: Subchapter 77 Endoscopic Therapy for Esophageal Variceal Hemorrhage
Page 469: PORTAL HYPERTENSION AND VARICES
Page 470: ENDOSCOPIC SCREENING FOR ESOPHAGEAL VARICES
Page 470: PRIMARY PREVENTION
Page 472: MANAGEMENT OF ACUTE GASTROESOPHAGEAL VARICEAL HEMORRHAGE
Page 472: Resuscitation
Page 472: Intravenous Antibiotics
Page 472: Vasoactive Agents
Page 472: Prokinetics
Page 472: Balloon Tamponade
Page 473: Endoscopic Variceal Ligation
Page 474: Endoscopic Sclerotherapy
Page 474: Other Endoscopic Techniques
Page 474: MANAGEMENT OF ENDOSCOPIC TREATMENT FAILURES
Page 474: Transjugular Intrahepatic Portosystemic Shunt Placement
Page 474: Esophageal Stent for Refractory Bleeding
Page 474: Gastric Varices
Page 474: Classification
Page 475: Endoscopic Treatment of Gastric Varices
Page 475: Radiologic Intervention for Gastric Varices
Page 476: SUMMARY
Page 476: Subchapter 78 Transjugular Intrahepatic Portosystemic Shunt
Page 476: INTRODUCTION
Page 476: INDICATIONS
Page 476: Acute Variceal Bleeding and Secondary Prophylaxis
Page 477: Ascites
Page 477: Hepatic Hydrothorax
Page 478: Hepatorenal Syndrome
Page 478: Hepatopulmonary Syndrome
Page 478: Budd-Chiari Syndrome
Page 478: Portal Hypertensive Gastropathy
Page 478: TECHNIQUE
Page 478: Patient Preparation
Page 478: Diagnostic Assessment
Page 480: Shunt Evaluation
Page 480: SPECIAL CASES
Page 480: Direct Intrahepatic Portosystemic Shunt
Page 481: Parallel Transjugular Intrahepatic Portosystemic Shunt
Page 481: Transumbilical, Transplenic, or Direct Portal Access
Page 482: Reversal or Revision of Transjugular Intrahepatic Portosystemic Shunt
Page 483: TIPS in Transplanted Livers
Page 483: TIPS in the Setting of Portal Vein Thrombus
Page 483: CLINICAL OUTCOMES
Page 483: Clinical Response to TIPS
Page 483: Complications and Management
Page 484: Follow-Up
Page 484: SUMMARY
Page 484: Subchapter 79 Management of Refractory Ascites
Page 484: INTRODUCTION
Page 485: Urinary Electrolyte Measurement in Refractory Ascites
Page 485: SPONTANEOUS BACTERIAL PERITONITIS
Page 485: Diagnosis
Page 485: Empiric Treatment
Page 485: Choice of Antibiotics
Page 485: Intravenous Albumin Infusion
Page 485: β-Blockers
Page 485: Follow-Up Paracentesis
Page 486: MEDICAL TREATMENT CONSIDERATIONS IN REFRACTORY ASCITES
Page 486: β-Blockers
Page 486: Vasoconstrictors and Albumin
Page 486: INTERVENTIONAL METHODS IN THE TREATMENT OF REFRACTORY ASCITES
Page 486: Liver Transplantation
Page 486: Large Volume Paracentesis with Albumin Replacement
Page 487: Transjugular Intrahepatic Portosystemic Shunt
Page 488: Peritoneovenous Shunts
Page 488: Peritoneal Catheters
Page 488: EXPERIMENTAL OPTIONS
Page 488: Clonidine and Midodrine
Page 488: Sodium-Glucose Cotransporter 2 Inhibitors
Page 488: Low-Flow Ascites Pump (ALFApump)
Page 489: Subchapter 80 Management of Hepatic Encephalopathy
Page 489: PATHOPHYSIOLOGY
Page 489: DIAGNOSIS AND GRADING
Page 490: Differential Diagnosis
Page 490: PRECIPITATING FACTORS
Page 491: TREATMENT FOR HE IN CHRONIC LIVER DISEASE
Page 491: Nonabsorbable Disaccharides
Page 491: Oral Nonabsorbable Antibiotics
Page 492: OTHER THERAPIES REQUIRING FURTHER RESEARCH
Page 492: OTHER CONSIDERATIONS
Page 492: Nutrition
Page 492: Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt
Page 492: Portosystemic Shunts
Page 492: Liver Transplantation
Page 492: Acute Liver Failure
Page 493: Extracorporeal Liver Support Devices
Page 493: Subchapter 81 Management of Budd-Chiari Syndrome
Page 493: INTRODUCTION
Page 493: PATHOGENESIS
Page 493: PRESENTATION
Page 494: DIAGNOSIS
Page 494: MEDICAL MANAGEMENT
Page 495: SURGICAL MANAGEMENT
Page 495: Surgical Shunts
Page 496: Liver Transplantation
Page 497: CONCLUSION
Page 459: SUGGESTED READINGS
Page 468: SUGGESTED READINGS
Page 476: SUGGESTED READINGS
Page 484: SUGGESTED READINGS
Page 488: SUGGESTED READINGS
Page 493: SUGGESTED READINGS
Page 497: SUGGESTED READINGS
Page 499: Section 9 – Gallbladder and Biliary Tree
Page 499: Subchapter 82 Management of Asymptomatic (Silent) Gallstones
Page 499: NATURAL HISTORY OF CHOLELITHIASIS
Page 499: RISK OF PROGRESSION TO SYMPTOMATIC CHOLELITHIASIS
Page 499: MORBIDITY ASSOCIATED WITH LAPAROSCOPIC CHOLECYSTECTOMY VERSUS EXPECTANT MANAGEMENT
Page 500: SPECIFIC PATIENT POPULATIONS
Page 500: Cancer Risk Reduction
Page 501: Weight Loss Surgery
Page 501: Gastrectomy
Page 501: Diabetes
Page 502: Hemolytic Anemias
Page 502: Intestinal Insufficiency (Short Gut Syndrome)
Page 502: Asymptomatic Choledocholithiasis
Page 502: Spinal Cord Injury
Page 502: SUMMARY
Page 502: Subchapter 83 Management of Biliary Dyskinesia
Page 502: EPIDEMIOLOGY
Page 502: CLINICAL PRESENTATION, EVALUATION, AND DIAGNOSIS
Page 504: Subchapter 84 Management of Acute Cholecystitis
Page 504: INTRODUCTION
Page 504: CLINICAL PRESENTATION, EVALUATION, AND DIAGNOSIS
Page 505: SURGICAL MANAGEMENT
Page 505: Laparoscopic Cholecystectomy
Page 506: Indocyanine Green Use in Cholecystectomy
Page 507: Open Cholecystectomy
Page 507: Bailout Options
Page 508: Complications and Postoperative Care
Page 508: MEDICAL MANAGEMENT
Page 508: PERCUTANEOUS DRAINAGE
Page 508: ENDOSCOPIC THERAPY
Page 508: SPECIAL CONSIDERATIONS
Page 508: Acalculous Cholecystitis
Page 508: Cholecystitis in Pregnancy
Page 509: Subchapter 85 Proper Use of Cholecystotomy Tubes
Page 509: INTRODUCTION
Page 509: INDICATIONS FOR CHOLECYSTOSTOMY TUBE PLACEMENT
Page 509: GALLBLADDER PATHOLOGY FACTORS
Page 509: Calculous or Acalculous Cholecystitis
Page 510: Severity of Inflammation and Duration of Symptoms
Page 510: Sepsis and/or Hemodynamic Instability
Page 510: Underlying Intraabdominal Malignancy Precluding Definitive Surgical Intervention
Page 510: PATIENT-RELATED FACTORS
Page 511: ROLE OF CHOLECYSTOSTOMY TUBE PLACEMENT IN COVID-19 PATIENTS
Page 513: APPROACHES TO CHOLECYSTOSTOMY TUBE PLACEMENT
Page 513: Percutaneous Approach
Page 515: Operative Approach
Page 515: COMPLICATIONS OF CHOLECYSTOSTOMY TUBE PLACEMENT
Page 515: Immediate Complications
Page 516: Later Complications
Page 516: Ineffective Placement
Page 516: LONG-TERM MANAGEMENT OF CHOLECYSTOSTOMY TUBES
Page 517: DEFINITIVE TREATMENT WITH CHOLECYSTECTOMY
Page 517: PROPOSED ALGORITHM FOR CHOLECYSTOSTOMY TUBE PLACEMENT AND MANAGEMENT
Page 518: Subchapter 86 Management of Common Bile Duct Stones
Page 518: EPIDEMIOLOGY
Page 518: PATHOPHYSIOLOGY AND PRESENTATION
Page 518: DIAGNOSIS
Page 518: Liver Panel Changes in Patients with CBDS
Page 518: Useful Diagnostic Imaging Modalities
Page 520: MANAGEMENT
Page 520: General Considerations
Page 520: Endoscopic CBD Clearance
Page 520: ERCP in Patients with Altered Anatomy
Page 520: Laparoendoscopic Rendezvous Approach
Page 520: Surgical CBD Clearance
Page 521: Intraoperative Imaging
Page 521: Minimally Invasive Surgery CBDE
Page 521: Transcystic Approach
Page 522: Transcholedochal Approach
Page 522: Open CBDE
Page 523: Subchapter 87 Management of Acute Cholangitis
Page 523: INTRODUCTION
Page 523: EPIDEMIOLOGY
Page 523: PATHOPHYSIOLOGY
Page 523: DIAGNOSTIC WORKUP
Page 523: History and Physical Examination
Page 524: Laboratory Workup
Page 524: Imaging Studies
Page 524: Diagnostic Criteria
Page 524: MANAGEMENT
Page 525: Management Based on Severity
Page 525: Resuscitation and Antibiotic Choice
Page 525: Biliary Drainage
Page 527: Definitive Management
Page 527: AREAS OF RECENT INVESTIGATION
Page 527: Early Cholecystectomy
Page 527: Antibiotic Duration
Page 527: CONCLUSION
Page 528: Subchapter 88 Management of Benign Biliary Strictures
Page 528: IATROGENIC BILE DUCT INJURY AND STRICTURE
Page 528: Overview and Incidence
Page 528: Mechanisms of Bile Duct Injury
Page 528: Preventing Iatrogenic Bile Duct Injuries
Page 528: The “Critical View of Safety”
Page 528: Intraoperative Cholangiography
Page 529: Classification of Biliary Injuries
Page 530: Recognition of Bile Duct Injuries
Page 530: Intraoperative Recognition
Page 530: Delayed Presentation
Page 530: Operative Repair of Bile Duct Injuries and Strictures
Page 530: Segmental or Accessory Duct Injuries
Page 530: Partial Injury to the Bile Duct
Page 530: Transection of the Common Bile Duct
Page 531: General Approach to Repair of Bile Duct Injuries Recognized in the Postoperative Period
Page 532: Definitive Management of Established Bile Duct Strictures
Page 532: Outcomes after Surgical Reconstruction
Page 532: Morbidity and Mortality
Page 532: Quality of Life
Page 532: NONIATROGENIC BILIARY STRICTURES
Page 532: Chronic Pancreatitis
Page 533: Strictures from Gallstone Disease
Page 533: Noniatrogenic Bile Duct Injuries
Page 533: Primary Sclerosing Cholangitis
Page 533: Subchapter 89 Management of Cystic Disorders of the Bile Ducts
Page 533: EPIDEMIOLOGY
Page 533: ETIOLOGY
Page 533: CLASSIFICATION
Page 534: CLINICAL PRESENTATION
Page 534: DIAGNOSIS
Page 534: WHEN IS A DILATED COMMON BILE DUCT A CHOLEDOCHAL CYST?
Page 536: MANAGEMENT
Page 536: Type I: Extrahepatic Bile Duct Cyst
Page 536: Type II: Extrahepatic Biliary Diverticulum
Page 536: Type III: Choledochocele
Page 536: Type IV: Intrahepatic and Extrahepatic Bile Duct Cyst
Page 537: Type V: Caroli’s Disease
Page 537: Morbidity of Surgical Therapy
Page 538: PROGNOSIS
Page 539: Subchapter 90 Management of Primary Sclerosing Cholangitis
Page 539: CLINICAL PRESENTATION
Page 539: NATURAL HISTORY
Page 539: ASSOCIATED DISEASES AND COMPLICATIONS
Page 539: DIAGNOSIS
Page 540: THERAPY
Page 540: Medical Therapy
Page 540: Nonoperative Interventional Therapy
Page 541: Operative Therapy
Page 541: Surgical Resection
Page 541: Liver Transplant
Page 543: SUMMARY
Page 543: Subchapter 91 Management of Intrahepatic, Perihilar, and Distal Extrahepatic Cholangiocarcinoma
Page 543: INTRODUCTION
Page 544: INTRAHEPATIC CHOLANGIOCARCINOMA
Page 544: Presentation and Preoperative Evaluation
Page 544: Staging
Page 544: Management
Page 544: Surgical Resection
Page 546: Other Treatments
Page 546: HILAR CHOLANGIOCARCINOMA
Page 546: Presentation and Preoperative Evaluation
Page 547: Staging
Page 547: Management
Page 547: Surgical Resection
Page 549: Additional Treatments
Page 549: DISTAL CHOLANGIOCARCINOMA
Page 549: Presentation and Preoperative Evaluation
Page 549: Staging
Page 549: Management
Page 549: Surgical Resection
Page 550: Other Treatments
Page 551: SUMMARY
Page 551: Subchapter 92 Biomarker Guided Surgical Management of Hepatobiliary and Pancreatic Tumors
Page 551: INTRODUCTION
Page 551: LIQUID COMPONENT OF A SOLID TUMOR: DEFINING ANATOMIC AND BIOLOGIC RESECTABILITY
Page 553: INTEGRATING ANATOMIC AND BIOLOGIC RESECTABILITY IN HEPATOBILIARY AND PANCREATIC SURGERY
Page 553: DEFINING A BIOMARKER
Page 554: TUMOR BIOMARKER PORTRAIT IN HEPATOBILIARY AND PANCREATIC SURGERY
Page 554: CURRENT BIOMARKERS TO GUIDE SURGICAL MANAGEMENT OF HEPATOBILIARY AND PANCREATIC TUMORS
Page 554: Pancreas
Page 554: Pancreatic Ductal Adenocarcinoma
Page 555: Cystic Disease of the Pancreas
Page 556: Pancreatic Neuroendocrine Tumors
Page 556: Autoimmune Pancreatitis
Page 556: Periampullary Cancer
Page 556: Liver
Page 556: Hepatocellular Carcinoma
Page 556: Colorectal Liver Metastases
Page 557: Gallbladder and the Biliary Tree
Page 557: Cholangiocarcinoma
Page 557: Gallbladder Carcinoma
Page 557: Primary Sclerosing Cholangitis
Page 557: THE FUTURE OF BIOMARKERS: PRECISION HEPATOBILIARY AND PANCREATIC SURGERY
Page 558: Subchapter 93 Surgical Management of Gallbladder Cancer
Page 558: OVERVIEW
Page 558: EPIDEMIOLOGY
Page 558: RISK FACTORS
Page 558: STAGING
Page 559: BRIEF ANATOMY AND PHYSIOLOGY OF THE GALLBLADDER
Page 560: PRESENTATION, WORKUP, AND MANAGEMENT
Page 560: Incidental GBC
Page 560: Intraoperative Suspicion of GBC
Page 561: Preoperatively Diagnosed GBC
Page 562: SURVIVAL
Page 562: ADJUVANT THERAPY
Page 562: SUMMARY
Page 563: Subchapter 94 Management of Gallstone Ileus
Page 563: PATHOGENESIS
Page 563: PRESENTATION
Page 563: DIAGNOSIS
Page 563: PREOPERATIVE MANAGEMENT
Page 564: SURGICAL MANAGEMENT
Page 565: Subchapter 95 Transhepatic Interventions for Obstructive Jaundice
Page 565: INTRODUCTION
Page 566: PERCUTANEOUS CHOLANGIOGRAM TECHNIQUE SUMMARY
Page 566: COMPLICATIONS OF TRANSHEPATIC PERCUTANEOUS BILIARY INTERVENTIONS
Page 567: MANAGEMENT OF BENIGN CAUSES OF BILIARY OBSTRUCTION
Page 570: Benign Biliary Strictures
Page 570: Choledocholithiasis
Page 571: Malignant Causes of Biliary Obstruction
Page 572: SUMMARY
Page 574: Subchapter 96 Obstructive Jaundice: The Role of Endoscopic Intervention
Page 574: CLINICAL PRESENTATION
Page 574: EVALUATION OF OBSTRUCTIVE JAUNDICE
Page 575: OVERVIEW OF ENDOSCOPIC APPROACHES TO THERAPY AND MAJOR ADVERSE EFFECTS
Page 575: Endoscopic Retrograde Cholangiopancreatography
Page 575: Endoscopic Ultrasound with Biliary Drainage
Page 575: Adverse Events
Page 576: APPROACHES IN COMMON CAUSES OF OBSTRUCTIVE JAUNDICE
Page 576: Choledocholithiasis and Cholangitis
Page 577: Benign Biliary Strictures
Page 578: Malignant Biliary Strictures
Page 502: Suggested Readings
Page 504: Suggested Readings
Page 509: Suggested Readings
Page 517: Suggested Readings
Page 522: Suggested Readings
Page 527: Suggested Readings
Page 533: Suggested Readings
Page 538: Suggested Readings
Page 543: Suggested Readings
Page 551: Suggested Readings
Page 557: Suggested Readings
Page 562: Suggested Readings
Page 565: Suggested Readings
Page 574: Suggested Readings
Page 579: Suggested Readings
Page 581: Section 10 – Pancreas
Page 581: Subchapter 97 Management of Acute Necrotizing Pancreatitis
Page 581: DIAGNOSIS AND EVALUATION
Page 581: INITIAL MANAGEMENT
Page 581: Fluid Resuscitation
Page 582: Nutrition
Page 582: Antibiotics
Page 582: Biliary Tract Management
Page 582: INTERVENTIONAL MANAGEMENT
Page 582: Pancreatic Fluid Collections
Page 583: Indications for Intervention in Sterile Collections
Page 583: Management of Infected Pancreatic Necrosis
Page 584: Endoscopic Step-Up Approach
Page 584: Percutaneous Drainage
Page 585: Video-Assisted Retroperitoneal Debridement
Page 585: Sinus Tract Endoscopic Debridement
Page 586: Dual-Modality Drainage
Page 587: Surgical Transgastric Necrosectomy
Page 587: Open Transperitoneal Necrosectomy
Page 587: Postprocedural Irrigation
Page 587: KEY PANCREATITIS-RELATED COMPLICATIONS
Page 587: Chronic Pancreatitis and Pancreatic Insufficiency
Page 587: Splanchnic Vein Thrombosis
Page 587: Disconnected Pancreatic Duct Syndrome
Page 587: Pseudoaneurysm
Page 588: RECURRENCE PREVENTION
Page 588: Subchapter 98 Gallstone Pancreatitis
Page 588: EPIDEMIOLOGY
Page 588: PATHOPHYSIOLOGY
Page 589: CLINICAL PRESENTATION
Page 589: DIAGNOSIS
Page 589: SEVERITY
Page 589: MANAGEMENT: INITIAL TREATMENT
Page 590: MANAGEMENT: TIMING OF CHOLECYSTECTOMY
Page 590: MANAGEMENT: IDIOPATHIC ACUTE PANCREATITIS
Page 590: SYSTEMIC COMPLICATIONS OF GALLSTONE PANCREATITIS
Page 590: SUMMARY
Page 591: Subchapter 99 Pancreas Divisum and Other Variants of Dominant Dorsal Duct Anatomy
Page 592: DIAGNOSIS
Page 593: ENDOSCOPIC TREATMENT
Page 593: Identifying the Minor Papilla and Positioning the Endoscope
Page 593: Cannulation
Page 594: Minor Endoscopic Sphincterotomy
Page 595: Pancreatitis Prevention
Page 595: Postprocedure Management
Page 595: SURGICAL TREATMENT
Page 595: Minor Duct Sphincteroplasty
Page 595: Technique
Page 596: Postoperative Management
Page 596: LATERAL PANCREATICOJEJUNOSTOMY
Page 597: WHIPPLE PROCEDURE
Page 597: HYBRID PROCEDURES
Page 597: TOTAL PANCREATECTOMY WITH ISLET AUTOTRANSPLANTATION
Page 597: CONCLUSION
Page 598: Subchapter 100 Diagnosis and Management of Autoimmune Pancreatitis
Page 598: INTRODUCTION
Page 598: DIAGNOSIS AND EVALUATION
Page 599: Cross-Sectional and Ductal Imaging of the Pancreas
Page 599: Serum IgG4 Levels
Page 599: Histopathology
Page 600: Other Organ Involvement
Page 600: Response to Corticosteroid Therapy
Page 601: INTERNATIONAL CONSENSUS DIAGNOSTIC CRITERIA
Page 601: FINDINGS NOT TYPICAL OF AIP
Page 601: TREATMENT
Page 601: Medical Treatment
Page 601: Surgical Treatment
Page 602: FOLLOW-UP AND SURVEILLANCE
Page 603: SUMMARY
Page 603: Subchapter 101 Management of Pancreatic Necrosis
Page 603: DEFINITIONS AND DIAGNOSIS
Page 603: Severity Classification of Acute Pancreatitis
Page 603: Local Complications of Acute Pancreatitis
Page 605: Imaging Modalities
Page 605: INITIAL MANAGEMENT
Page 605: Monitored Care
Page 606: Fluid Resuscitation
Page 606: Prevention of Infection
Page 606: Nutrition
Page 606: INDICATIONS AND TIMING OF INTERVENTIONS
Page 606: THE STEP-UP APPROACH
Page 606: Percutaneous Drainage
Page 607: Endoscopic Drainage and Necrosectomy
Page 608: Surgical Management
Page 608: Minimally Invasive Necrosectomy
Page 609: Open Necrosectomy
Page 609: Postoperative Management and Complications
Page 609: CONCLUSION
Page 610: Subchapter 102 Management of Pancreatic Pseudocyst
Page 610: INTRODUCTION
Page 610: DEFINITION AND CLASSIFICATION
Page 611: PATHOPHYSIOLOGY
Page 611: PRESENTATION AND EVALUATION
Page 613: MANAGEMENT
Page 613: Percutaneous Drainage
Page 614: Endoscopic Procedures
Page 615: Surgical Management
Page 615: POSTOPERATIVE CONCERNS
Page 615: CONCLUSION
Page 616: Subchapter 103 Pancreatic Ductal Disruptions Leading to Pancreatic Fistula, Pancreatic Ascites, or Pancreatic Pleural Effusion
Page 616: DEFINITIONS
Page 616: CLINICAL PRESENTATION AND DIAGNOSIS
Page 616: Identification of Pancreatic Ductal Disruption
Page 617: Diagnostic Approach
Page 619: INDICATIONS AND RATIONALE FOR TREATMENT
Page 619: Percutaneous Catheter Drainage
Page 620: Percutaneous Transgastric Catheter Drainage
Page 620: Endoscopic Treatment
Page 621: Surgical Management
Page 622: Multidisciplinary Team Approach
Page 622: SUMMARY
Page 624: Subchapter 104 Management of Chronic Pancreatitis
Page 624: DEFINITION
Page 624: ETIOLOGY
Page 624: DIAGNOSIS
Page 626: MANAGEMENT
Page 626: Pharmacologic
Page 626: Nonpharmacologic
Page 626: Endoscopic
Page 626: Surgical
Page 626: Drainage Procedures
Page 626: Longitudinal Pancreatojejunostomy
Page 626: Combined Resection and Drainage Procedures
Page 626: Frey Procedure
Page 627: Beger Procedure
Page 627: Resection Procedures
Page 627: Pancreatoduodenectomy
Page 627: Distal Pancreatectomy
Page 628: Total Pancreatectomy with Islet Cell Autotransplantation
Page 629: Subchapter 105 Genetic Testing and High-Risk Pancreatic Cancer Screening
Page 629: CASE PRESENTATION
Page 629: CLINICAL QUESTIONS TO BE ADDRESSED
Page 629: BACKGROUND
Page 629: HIGH-RISK INDIVIDUALS
Page 629: EFFECTIVENESS OF SCREENING
Page 630: SCREENING GUIDELINES
Page 630: MANAGEMENT OF CYSTIC LESIONS IN HIGH-RISK INDIVIDUALS
Page 631: PARADIGM SHIFT OF CRITICAL ASSESSMENT
Page 631: CASE PRESENTATION REVISITED
Page 631: CONCLUSION
Page 631: Subchapter 106 Management of Periampullary Cancers
Page 631: INTRODUCTION
Page 631: CLINICAL PRESENTATION AND DIAGNOSTIC WORKUP
Page 631: Clinical Presentation
Page 632: Imaging Studies
Page 633: Clinical Staging
Page 635: Endoscopic Procedures
Page 635: Laboratory Studies
Page 636: MULTIDISCIPLINARY MANAGEMENT
Page 636: Rationale for Neoadjuvant Therapy
Page 636: SURGICAL MANAGEMENT
Page 636: Preoperative Preparation
Page 637: Pancreaticoduodenectomy
Page 639: Vascular Resection
Page 639: Reconstruction
Page 640: Minimally Invasive Approaches
Page 640: POSTOPERATIVE CARE
Page 640: Postoperative Complications
Page 640: Pancreatic Fistula
Page 641: Delayed Gastric Emptying
Page 641: Postpancreatectomy Hemorrhage
Page 641: SUMMARY
Page 641: Subchapter 107 Management of Complications after the Whipple Procedure
Page 642: CLINICALLY RELEVANT POSTOPERATIVE PANCREATIC FISTULA
Page 644: POST-PANCREATECTOMY ACUTE PANCREATITIS (PPAP)
Page 645: POSTPANCREATECTOMY HEMORRHAGE
Page 646: DELAYED GASTRIC EMPTYING
Page 647: CHYLE LEAK
Page 648: Subchapter 108 Vascular Reconstruction During the Whipple Operation
Page 648: PATIENT SELECTION FOR ELECTIVE VASCULAR PANCREATIC SURGERY
Page 648: VENOUS RECONSTRUCTION
Page 649: ARTERIAL RECONSTRUCTION
Page 649: PERIADVENTITIAL DISSECTION OF ARTERIES
Page 650: ROBOTIC VASCULAR PANCREATIC SURGERY
Page 650: POSTOPERATIVE MANAGEMENT AND COMPLICATIONS
Page 651: SUMMARY
Page 651: Acknowledgment
Page 651: Subchapter 109 Palliative Interventions for Patients with Operable and Advanced Pancreatic and Periampullary Cancer
Page 652: INITIAL EVALUATION OF THE PATIENT WITH PANCREATIC/PERIAMPULLARY CANCER
Page 652: BILE DUCT OBSTRUCTION
Page 653: Our Guiding Principles for the Management of Bile Duct Obstruction
Page 653: GASTRIC OUTLET (DUODENAL) OBSTRUCTION
Page 654: Our Guiding Principles for the Management of Duodenal Obstruction with and without Bile Duct Obstruction
Page 654: OPEN PROPHYLACTIC BILIARY AND GASTRIC BYPASS
Page 655: Our Guiding Principles for the Management of Biliary and Duodenal Obstruction at the Time of Open Laparotomy
Page 655: PALLIATIVE PANCREATICODUODENECTOMY
Page 655: MALIGNANT BOWEL OBSTRUCTION
Page 655: MALIGNANT ASCITES
Page 655: VASCULAR THROMBOSIS
Page 655: TUMOR-ASSOCIATED PAIN MANAGEMENT
Page 656: DEPRESSION
Page 656: CONCLUSION
Page 657: Subchapter 110 Neoadjuvant and Adjuvant Therapy for Pancreatic Cancer
Page 657: DEFINING THE CLINICAL STAGE OF DISEASE
Page 657: RESECTABLE PANCREATIC CANCER
Page 659: BORDERLINE RESECTABLE PANCREATIC CANCER
Page 659: LOCALLY ADVANCED PANCREATIC CANCER
Page 660: CONCLUSION AND FUTURE DIRECTIONS
Page 662: Subchapter 111 Rare and Unusual Pancreatic Tumors
Page 662: INTRODUCTION
Page 662: BENIGN PANCREATIC CYSTS
Page 662: Serous Cystadenoma
Page 662: Lymphoepithelial Cyst
Page 664: NEOPLASTIC PANCREATIC CYSTS
Page 664: Mucinous Cystic Neoplasm
Page 664: Solid Pseudopapillary Neoplasm
Page 665: EPITHELIAL CELL TUMORS
Page 665: Acinar Cell Carcinoma
Page 665: Pancreatoblastoma
Page 666: MESENCHYMAL PANCREATIC TUMORS
Page 666: PEComa
Page 666: Solitary Fibrous Tumor
Page 666: Schwannoma and Paraganglioma
Page 668: INFLAMMATORY MASSES AND SECONDARY MALIGNANCIES
Page 668: Groove (Paraduodenal) and Autoimmune Pancreatitis
Page 669: ADDITIONAL MALIGNANCIES
Page 669: Primary Pancreatic Lymphoma
Page 669: Pancreatic Metastases
Page 669: CONCLUSION
Page 669: Subchapter 112 Intraductal Papillary Mucinous Neoplasms of the Pancreas
Page 670: CLINICAL CLASSIFICATION OF MALIGNANT POTENTIAL
Page 670: Pathogenesis
Page 671: Clinical Presentation
Page 671: Workup and Management
Page 672: Operative Management
Page 673: Postoperative Care
Page 673: Postoperative Surveillance
Page 674: CLINICAL EVALUATION FOR EXTRAPANCREATIC MALIGNANCIES
Page 674: Prognosis
Page 674: CONCLUSION
Page 674: Subchapter 113 Pancreatic Neuroendocrine Tumors of the Pancreas Excluding Gastrinoma
Page 674: INTRODUCTION
Page 675: CLASSIFICATION
Page 675: PRESENTATION
Page 675: DIAGNOSTIC EVALUATION
Page 675: Cross-Sectional Imaging
Page 677: Functional Imaging
Page 678: Biochemical Markers
Page 678: EUS/FNA
Page 679: MANAGEMENT OF PNETs
Page 679: Functional PNETs
Page 679: Nonfunctional PNETs
Page 679: Metastatic Disease
Page 679: SURGICAL APPROACHES
Page 679: Minimally Invasive Approaches
Page 679: Enucleation
Page 680: MANAGEMENT OF UNRESECTABLE PNETs
Page 680: CONCLUSION
Page 680: Subchapter 114 Intraoperative Radiation for Pancreatic Cancer
Page 680: INTRODUCTION
Page 680: REVIEW OF EXISTING LITERATURE
Page 681: IORT for Unresectable Disease
Page 681: IORT for Resected Disease
Page 681: PATIENT SELECTION
Page 681: EQUIPMENT
Page 682: TECHNIQUE
Page 682: TARGET VOLUME DELINEATION
Page 682: DOSING
Page 683: NORMAL TISSUE TOXICITY
Page 683: CONCLUSION
Page 683: Subchapter 115 Transplantation of the Pancreas
Page 683: INTRODUCTION
Page 684: WHOLE-ORGAN PANCREAS TRANSPLANTATION
Page 684: History and Early Results
Page 684: Indications and Patient Selection
Page 684: The Donor Operation
Page 684: Backbench Preparation of the Pancreas
Page 685: The Recipient Operation
Page 685: COMPLICATIONS
Page 685: RESULTS
Page 687: RISK-TO-BENEFIT CONSIDERATIONS
Page 687: FUTURE DIRECTIONS
Page 688: Subchapter 116 Total Pancreatectomy and Islet Autotransplantation for Chronic Pancreatitis
Page 688: INTRODUCTION
Page 688: PATIENT SELECTION
Page 688: EVIDENCE
Page 688: Pain Control
Page 688: Endocrine Function
Page 689: Overall Quality of Life
Page 689: Factors Predictive of Outcome
Page 689: PREOPERATIVE EVALUATION
Page 689: Investigations
Page 689: SURGICAL PLANNING
Page 689: Timing of Surgical Intervention
Page 689: COUNSELING AND DECISION MAKING
Page 689: OPERATIVE TECHNIQUE
Page 690: Preparation
Page 690: Total Pancreatectomy
Page 690: Islet Processing and Infusion
Page 691: INTRAOPERATIVE CARE
Page 691: POSTOPERATIVE CARE
Page 691: OTHER CONSIDERATIONS
Page 588: Suggested Readings
Page 590: Suggested Readings
Page 597: Suggested Readings
Page 603: Suggested Readings
Page 610: Suggested Readings
Page 615: Suggested Readings
Page 623: Suggested Readings
Page 628: Suggested Readings
Page 631: SUGGESTED READINGS
Page 641: Suggested Readings
Page 647: Suggested Readings
Page 651: Suggested Readings
Page 656: Suggested Readings
Page 662: Suggested Readings
Page 669: Suggested Readings
Page 674: Suggested Readings
Page 680: Suggested Readings
Page 683: Suggested Readings
Page 687: Suggested Readings
Page 691: Suggested Readings
Page 693: Section 11 – Spleen
Page 693: 117 Splenectomy for Hematologic Disorders
Page 693: INTRODUCTION
Page 693: BENIGN CONDITIONS
Page 693: Red Cell Disorders
Page 693: Glucose-6-Phosphate Dehydrogenase Deficiency
Page 693: Hereditary Spherocytosis
Page 693: Pyruvate Kinase Deficiency
Page 693: Warm-Antibody Autoimmune Hemolytic Anemia
Page 694: Hemoglobinopathies
Page 694: Sickle Cell Disease
Page 694: Thalassemia
Page 694: PLATELET DISORDERS
Page 694: Idiopathic Thrombocytopenic Purpura
Page 694: Thrombotic Thrombocytopenic Purpura
Page 695: MALIGNANT CONDITIONS
Page 695: White Cell Disorders
Page 695: Chronic Lymphocytic Leukemia
Page 695: Hairy Cell Leukemia
Page 695: Hodgkin’s Lymphoma
Page 695: Non-Hodgkin’s Lymphoma
Page 695: MYELOPROLIFERATIVE DISORDERS
Page 695: Acute Myeloid Leukemia
Page 695: Chronic Myelogenous Leukemia
Page 695: Chronic Myelomonocytic Leukemia
Page 695: Essential Thrombocythemia
Page 695: Myelofibrosis (Agnongenic Myeloid Metaplasia)
Page 695: Polycythemia Vera
Page 696: PRIMARY TUMORS OF THE SPLEEN AND METASTASIS
Page 696: MISCELLANEOUS CONDITIONS
Page 696: Amyloidosis
Page 696: Gaucher’s Disease
Page 696: Niemann-Pick Disease
Page 696: Sarcoidosis
Page 696: PERIOPERATIVE CONSIDERATIONS
Page 696: Vaccination
Page 696: Deep Vein Thrombosis Prophylaxis
Page 696: SPLENECTOMY TECHNIQUES
Page 696: Open
Page 697: Laparoscopic
Page 697: Robotic
Page 697: CONCLUSIONS
Page 698: 118 Management of Cysts, Tumors, and Abscesses of the Spleen
Page 698: SURGICAL ANATOMY OF THE SPLEEN
Page 698: SPLENIC CYSTS
Page 699: SPLENIC PELIOSIS
Page 699: SPLENIC TUMORS
Page 699: Benign Tumors
Page 699: Hemangioma
Page 699: Lymphangioma
Page 699: Hamartoma
Page 699: Littoral Cell Angioma
Page 700: Malignant Tumors
Page 700: Lymphoma
Page 700: Angiosarcoma
Page 700: Other Nonvascular, Nonhematopoietic Splenic Tumors
Page 700: Metastatic Tumors
Page 701: SPLENIC ABSCESS
Page 701: SURGERY
Page 701: Preoperative Considerations
Page 701: Laparoscopic Splenectomy
Page 701: Laparoscopic Access and Initial Port Placement
Page 701: Positioning of the Patient
Page 702: Port Placement
Page 702: Mobilization of Splenic Ligaments
Page 702: Management of Splenic Hilum
Page 702: Extraction of the Spleen
Page 702: Posterior Approach
Page 702: Postoperative Care
Page 702: Robotic Splenectomy
Page 703: Outcome and Complications
Page 697: Suggested Readings
Page 703: Suggested Readings
Page 705: Section 12 – Hernia
Page 705: Subchapter 119 Management of Inguinal Hernia
Page 705: INDICATIONS AND TIMING OF REPAIR
Page 705: CONSIDERATIONS IN SELECTING THE OPERATIVE APPROACH
Page 705: OPEN INGUINAL HERNIA REPAIR
Page 705: Tissue Repair
Page 706: Lichtenstein Repair
Page 706: Local Anesthesia Block
Page 706: MINIMALLY INVASIVE INGUINAL HERNIA REPAIR
Page 706: Transabdominal Preperitoneal Repair
Page 708: Total Extraperitoneal Repair
Page 709: TAPP VERSUS TEP?
Page 709: Risk Factors for Inguinal Hernia Development and Recurrence
Page 709: CHRONIC PAIN AFTER INGUINAL HERNIA REPAIR
Page 709: CONCLUSION
Page 710: Subchapter 120 Management of Recurrent Inguinal Hernia
Page 710: INTRODUCTION
Page 710: RISK FACTORS FOR RECURRENCE
Page 710: Patient Factors
Page 710: Technical Factors
Page 710: Mesh Factors
Page 710: PREOPERATIVE EVALUATION
Page 711: Defining Recurrent Inguinal Hernia
Page 711: Patient History and Physical Examination
Page 711: Role of Imaging
Page 711: Management of Patient Expectations
Page 711: Management of Asymptomatic Recurrent Inguinal Hernia
Page 711: TECHNIQUES FOR REPAIR OF RECURRENCE
Page 711: Minimally Invasive Approaches
Page 712: Open (Anterior) Approaches
Page 712: The Complex Recurrent Inguinal Hernia Patient
Page 712: Mesh Considerations
Page 713: CONCLUSION
Page 713: Subchapter 121 Incisional, Epigastric, and Umbilical Hernias
Page 713: PATIENT SELECTION
Page 714: SURGICAL CONSIDERATIONS
Page 714: OPEN SURGICAL REPAIR OF INCISIONAL HERNIAS
Page 715: LAPAROSCOPIC/ROBOTIC APPROACH
Page 718: EPIGASTRIC AND UMBILICAL HERNIAS
Page 718: PERIOPERATIVE AND POSTOPERATIVE CARE
Page 718: COMMON COMPLICATIONS
Page 719: CONCLUSION
Page 720: Acknowledgment
Page 720: Subchapter 123 Management of Spigelian, Obturator, and Lumbar Hernias
Page 720: SPIGELIAN HERNIA
Page 720: Clinical Presentation
Page 720: Anatomy
Page 721: Operative Approaches
Page 721: Minimally Invasive Surgical Approaches
Page 721: Transabdominal Preperitoneal Approach
Page 722: Totally Extraperitoneal Approach
Page 722: Intraperitoneal Onlay Mesh Approach
Page 722: Open Approach
Page 722: OBTURATOR HERNIA
Page 722: Clinical Presentation
Page 723: Anatomy
Page 723: Operative Approaches
Page 723: Minimally Invasive Surgical Approaches
Page 723: Open Approach
Page 724: LUMBAR HERNIA
Page 724: Clinical Presentation and Anatomy
Page 724: Patient Positioning
Page 725: Laparoscopic Approach
Page 725: Open Approach
Page 728: Subchapter 124 Athletic Pubalgia
Page 728: APPROACH TO GROIN PAIN
Page 728: Definitions
Page 728: Broad Categorization
Page 728: Start With the Activity
Page 729: GROIN PAIN CONSIDERATIONS
Page 729: Hip Pathologies
Page 730: WORKUP/IMAGING
Page 730: MANAGEMENT
Page 731: SURGERY AND CLINICAL ENTITIES
Page 731: Unilateral or Bilateral Rectus Abdominis/Adductor Aponeurosis Injury (U or B RA/AAI)
Page 731: Midline Rectus Abdominis/Adductor Aponeurotic Plate Injury (M RA/AAPI)
Page 731: Osteitis Pubis
Page 731: Adductor Injury
Page 731: Rectus Abdominis Strain
Page 731: Inguinal Hernia
Page 733: OTHER SOURCES of GROIN PAIN
Page 733: Hip Disorders
Page 733: Surgical Approach
Page 735: OUTCOME MEASURES
Page 735: SUMMARY
Page 735: Subchapter 125 Abdominal Wall Reconstruction
Page 735: INTRODUCTION
Page 736: ANATOMY
Page 736: Muscle Groups
Page 736: Tendinous Structures
Page 736: Vascular Supply
Page 736: Nerve Supply
Page 736: PATIENT SELECTION AND PREPARATION FOR AWR
Page 736: SURGICAL TECHNIQUES
Page 736: Anterior Component Separation
Page 736: Open ACS
Page 736: Patient Positioning and Entry
Page 736: Creation of Subcutaneous Flaps
Page 736: External Oblique Release
Page 737: Posterior Rectus Sheath Release
Page 737: Restoration of the Linea Alba, Onlay Mesh Placement, and Closure
Page 737: Open ACS with Perforator Preservation
Page 737: EO Aponeurosis Identification and Release
Page 738: Mesh Placement and Midline Closure
Page 738: Robotic ACS
Page 738: Patient Positioning and Trocar Placement
Page 738: Creation of Subcutaneous Flaps
Page 738: Contralateral Port Placement
Page 738: Fascia Closure and Mesh Placement
Page 738: Endoscopic ACS
Page 738: Patient Positioning and Trocar Placement
Page 738: External Oblique Fascial Division
Page 739: Posterior Component Separation
Page 739: Open TAR
Page 739: Retrorectus Dissection
Page 739: Transversus Abdominis Muscle Division
Page 740: Posterior Sheath Closure
Page 741: Mesh Placement, Restoration of Linea Alba, and Soft Tissue Closure
Page 742: MIS TAR
Page 742: Patient Positioning and Trocar Placement
Page 742: Trocar Placement
Page 742: POSTOPERATIVE CARE AND OUTCOMES
Page 742: PROCEDURE SELECTION STRATEGIES
Page 744: Subchapter 126 Loss of Domain in Abdominal Wall Reconstruction
Page 744: DEFINITION
Page 745: ETIOLOGY
Page 745: OPERATIVE PLANNING
Page 745: Patient Preparation
Page 746: Surgical Approach
Page 747: STRATEGIES TO MIND THE GAP
Page 747: Anterior Component Separation
Page 747: Posterior Component Separation
Page 747: Tissue Expanders
Page 749: Botulinum Toxin A
Page 749: Perioperative Management
Page 749: SUMMARY
Page 750: Subchapter 127 Use of Various Meshes in Hernia Repair
Page 750: INTRODUCTION
Page 750: MESH PROPERTIES
Page 750: Biocompatibility
Page 751: Porosity
Page 751: Weight
Page 751: Tensile Strength
Page 751: Elasticity
Page 751: Constitution
Page 751: MESH CLASSES
Page 751: Synthetic Meshes
Page 752: Biologic Meshes
Page 752: Composite/Hybrid Meshes
Page 753: MESH LOCATION
Page 754: SUBLAY
Page 754: Retrorectus
Page 755: Technique
Page 755: Preperitoneal
Page 755: Technique
Page 756: Intraperitoneal
Page 756: Technique
Page 756: ONLAY
Page 756: Technique
Page 756: INLAY
Page 756: Technique
Page 757: IMPORTANT TENETS OF SKIN AND SOFT TISSUE MANAGEMENT
Page 757: Preservation of Blood Supply to the Abdominal Wall
Page 757: Skin and Soft Tissue Excess
Page 757: Dead Space
Page 758: CONCLUSION
Page 709: Suggested Readings
Page 713: Suggested Readings
Page 720: Suggested Readings
Page 727: Suggested Readings
Page 735: Suggested Readings
Page 744: Suggested Readings
Page 750: Suggested Readings
Page 758: Suggested Readings
Page 759: Section 13 – Breast
Page 759: Subchapter 128 Benign Breast Disease
Page 759: GENERAL CONSIDERATIONS
Page 759: COMMON BREAST COMPLAINTS
Page 759: Breast Pain
Page 759: Nipple Discharge
Page 760: Mastitis/Abscess
Page 760: MANAGEMENT OF BENIGN BREAST MASSES AND LESIONS
Page 760: Fibroadenoma
Page 760: Benign Phyllodes Tumor
Page 760: Cysts
Page 760: Granulomatous Mastitis
Page 760: Fat Necrosis
Page 761: Lipoma
Page 761: Proliferative Lesions without Atypia
Page 761: Proliferative Lesions with Atypia
Page 761: SPECIAL POPULATIONS
Page 761: Pregnancy and Lactation
Page 761: Abscess
Page 761: Galactocele
Page 761: Lactating Adenoma
Page 761: Male Gynecomastia
Page 761: COVID-19 Vaccination–Associated Lymphadenopathy
Page 762: Subchapter 129 Screening for Breast Cancer
Page 762: INTRODUCTION
Page 762: SCREENING MODALITIES
Page 762: Breast Self-Examination
Page 762: Clinical Breast Examination
Page 762: Mammography
Page 763: Digital Mammography
Page 763: Tomosynthesis
Page 764: Whole-Breast Ultrasound
Page 764: Magnetic Resonance Imaging
Page 764: Newer Methods
Page 764: SCREENING RECOMMENDATIONS
Page 764: Screening in Average-Risk Individuals
Page 766: Screening in High-Risk Individuals
Page 766: SUMMARY
Page 766: Subchapter 130 Role of Stereotactic Biopsy in Management of Breast Disease
Page 767: TECHNIQUES
Page 767: INDICATIONS
Page 768: CONTRAINDICATIONS
Page 768: EQUIPMENT
Page 768: PROCEDURE
Page 769: COMPLICATIONS
Page 769: CONCORDANCE
Page 769: FOLLOW-UP
Page 770: Subchapter 131 Molecular Targets in Breast Cancer
Page 770: INTRODUCTION
Page 770: BREAST CANCER SUBTYPES
Page 770: HORMONE RECEPTOR–POSITIVE BREAST CANCER
Page 770: Endocrine Therapy
Page 771: Cyclin-Dependent Kinase Inhibitors
Page 772: Phosphoinositide 3-Kinase Inhibitors
Page 772: Poly(Adenosine Diphosphate-Ribose) Polymerase Inhibitors
Page 772: HER2-POSITIVE BREAST CANCER
Page 772: HER2 Monoclonal Antibodies
Page 773: HER2 Antibody-Drug Conjugates
Page 773: HER2 Tyrosine Kinase Inhibitors
Page 774: TRIPLE-NEGATIVE BREAST CANCER
Page 774: Immune Checkpoint Inhibitors
Page 774: Antibody-Drug Conjugates
Page 774: HER2-LOW BREAST CANCER
Page 775: CONCLUSION
Page 775: Subchapter 132 Breast Cancer: Surgical Therapy
Page 775: SCREENING FOR BREAST CANCER
Page 775: DIAGNOSIS OF BREAST CANCER
Page 776: DISCUSSION OF SURGICAL OPTIONS
Page 776: LUMPECTOMY
Page 777: MASTECTOMY
Page 779: MANAGEMENT OF THE AXILLA
Page 779: INFLAMMATORY BREAST CANCER
Page 779: LOCALLY ADVANCED BREAST CANCER
Page 780: BREAST CANCER STAGING: AMERICAN JOINT COMMITTEE ON CANCER
Page 781: ADJUVANT THERAPY
Page 781: SURGERY FOR STAGE IV BREAST CANCER
Page 781: CONCLUSION
Page 782: Subchapter 133 Pregnancy and Breast Cancer Management
Page 782: EPIDEMIOLOGY OF BREAST CANCER IN PREGNANCY
Page 782: PREGNANCY CHANGES TO THE BREAST
Page 782: PRESENTATION AND DIAGNOSTIC WORKUP
Page 784: Biopsy
Page 785: Staging
Page 785: HISTOLOGY OF BREAST CANCER IN PREGNANCY
Page 785: TREATMENT: BREAST CANCER IN PREGNANCY
Page 785: SURGICAL CONSIDERATIONS
Page 785: Mastectomy versus Breast Conservation
Page 786: Axillary Staging/Sentinel Lymph Node Biopsy
Page 787: Immediate Reconstruction
Page 787: CHEMOTHERAPY IN PREGNANCY
Page 787: PEDIATRIC OUTCOMES AFTER MATERNAL CANCER DIAGNOSIS
Page 787: Breastfeeding
Page 787: KEY POINTS
Page 788: Subchapter 134 Ablative Techniques in the Treatment of Benign and Malignant Breast Disease
Page 788: RADIOFREQUENCY ABLATION
Page 789: MICROWAVE ABLATION
Page 789: CRYOABLATION
Page 790: HIGH-INTENSITY FOCUSED ULTRASOUND
Page 790: INTERSTITIAL LASER
Page 790: IRREVERSIBLE ELECTROPORATION
Page 790: SUMMARY
Page 791: Subchapter 135 Lymphatic Mapping and Sentinel Lymphadenectomy
Page 791: INTRODUCTION
Page 791: INDICATIONS FOR SENTINEL LYMPH NODE BIOPSY
Page 792: SLNB: TECHNIQUE
Page 794: TROUBLESHOOTING SLNB
Page 794: RESULTS OF SLNB AND LYMPHATIC MAPPING
Page 794: SLNB in Node-Negative Patients
Page 795: Positive SLNs in Clinically Node-Negative Patients
Page 796: SLNB and TAD in Node-Positive Patients after Neoadjuvant Treatment
Page 797: Axillary Reverse Mapping
Page 798: CONCLUSION
Page 798: Subchapter 136 Surgical Management of the Axilla
Page 798: OVERVIEW
Page 799: SURGICAL APPROACHES TO AXILLARY LYMPH NODE DISSECTION
Page 799: SENTINEL LYMPH NODE BIOPSY: HISTORY
Page 800: AVOIDING AXILLARY LYMPH NODE DISSECTION IN PATIENTS WITH SENTINEL NODE METASTASES
Page 800: MANAGEMENT OF THE AXILLA IN PATIENTS RECEIVING NEOADJUVANT CHEMOTHERAPY
Page 802: Lymphatic Mapping and SLNB in Special Situations
Page 802: Pregnancy
Page 802: Ductal Carcinoma in Situ
Page 802: Reoperative Axillary Surgery
Page 802: Situations in Which Axillary Staging Can Be Omitted
Page 802: Older Patients with T1/HR-Positive/HER2-Negative Breast Cancer
Page 802: DCIS Patients Undergoing Breast-Conserving Surgery
Page 802: THE NEXT FRONTIER IN DEESCALATION OF AXILLARY MANAGEMENT: ONGOING TRIALS OF AXILLARY MANAGEMENT AFTER NEOADJUVANT THERAPY
Page 803: SUMMARY
Page 804: Subchapter 137 Inflammatory Breast Cancer
Page 804: INTRODUCTION
Page 804: WORKUP
Page 806: TREATMENT FOR NONMETASTATIC IBC
Page 806: SURGICAL APPROACH TO IBC
Page 806: MODIFIED RADICAL MASTECTOMY
Page 806: Total Mastectomy
Page 806: Axillary Lymph Node Dissection
Page 808: POSTOPERATIVE MANAGEMENT
Page 809: SPECIAL CONSIDERATIONS FOR SURGERY
Page 809: POTENTIAL SURGICAL COMPLICATIONS AND MANAGEMENT STRATEGIES
Page 809: OTHER CONSIDERATIONS
Page 810: Subchapter 138 Ductal and Lobular Carcinoma in situ of the Breast
Page 810: DUCTAL CARCINOMA IN SITU
Page 810: Diagnosis
Page 810: Treatment
Page 811: Surveillance
Page 811: LOBULAR CARCINOMA IN SITU
Page 811: Classifications
Page 811: Diagnosis
Page 811: Treatment/Management
Page 812: Subchapter 139 Advances in Neoadjuvant and Adjuvant Therapy for Early-Stage Breast Cancer
Page 812: ROLE OF RECEPTOR STATUS IN DETERMINING TIMING OF CHEMOTHERAPY (NEOADJUVANT VS. ADJUVANT)
Page 812: HR+/HER2- BREAST CANCER
Page 814: TRIPLE NEGATIVE BREAST CANCER
Page 814: HER2+ BREAST CANCER SUBTYPE
Page 814: IMMUNOTHERAPY IN BREAST CANCER
Page 815: SUMMARY
Page 815: Subchapter 140 Treatment Trends in Locally Recurrent and Metastatic Breast Cancer
Page 815: BACKGROUND AND EPIDEMIOLOGY
Page 816: DEFINING A BREAST CANCER RECURRENCE
Page 816: GENOMIC ASSAYS USED TO STRATIFY RECURRENCE RISK
Page 816: EVALUATION AND MANAGEMENT OF RECURRENT DISEASE IN BREAST CANCER
Page 817: AXILLARY LYMPH NODE DISSECTION IN RECURRENT DISEASE
Page 817: ROLE OF LOCOREGIONAL THERAPY IN METASTATIC DISEASE
Page 818: FUTURE QUESTIONS TO ANSWER
Page 819: RECONSTRUCTION IN ADVANCED AND RECURRENT DISEASE
Page 821: Subchapter 141 Management of Male Breast Cancer
Page 821: INTRODUCTION
Page 821: DIAGNOSIS
Page 822: TREATMENT
Page 822: Preoperative Considerations
Page 822: Operative Management
Page 822: Mastectomy
Page 822: Breast Conservation
Page 822: Axillary Management
Page 823: Analgesia
Page 824: Postoperative Considerations
Page 824: Subchapter 142 A Surgeon’s Practical Guide to Breast Imaging
Page 824: THE ABNORMAL SCREENING MAMMOGRAM
Page 824: PALPABLE MASS
Page 825: NIPPLE DISCHARGE
Page 827: THE AUGMENTED BREAST
Page 827: LOCALIZATION
Page 828: Subchapter 143 Genetic Counseling and Testing
Page 828: IMPLICATIONS OF GENETIC TESTING
Page 828: GENETIC COUNSELING
Page 828: WHO SHOULD GET TESTED?
Page 828: WHO ARE WE MISSING?
Page 828: WHICH GENES ARE TESTED FOR?
Page 828: WHAT TO DO WITH A POSITIVE RESULT
Page 829: WHO IS OFFERED RISK-REDUCING MASTECTOMY?
Page 829: WHAT ARE THE SURGICAL OPTIONS?
Page 829: Subchapter 144 Contralateral Prophylactic Mastectomy
Page 829: INDICATIONS FOR CONTRALATERAL PROPHYLACTIC MASTECTOMY
Page 829: Pathogenic Variants in Breast Cancer Susceptibility Genes
Page 830: Variant of Unknown Significance
Page 830: History of Chest Wall Radiation
Page 830: Family History
Page 830: Age
Page 830: Average Risk Women with Sporadic Breast Cancer
Page 830: Male Breast Cancer
Page 830: OUTCOMES OF CONTRALATERAL PROPHYLACTIC MASTECTOMY
Page 830: Risk Reduction for Contralateral Cancer
Page 830: Survival
Page 831: Local and Distant Recurrence of the Index Cancer
Page 831: SURGICAL RISKS ASSOCIATED WITH CONTRALATERAL PROPHYLACTIC MASTECTOMY
Page 831: IMPACT ON QUALITY OF LIFE AND PATIENT SATISFACTION
Page 831: ALTERNATIVES TO CPM
Page 831: COST-EFFECTIVENESS OF CONTRALATERAL MASTECTOMY
Page 831: SURGICAL OPTIONS FOR CONTRALATERAL PROPHYLACTIC MASTECTOMY
Page 831: Types of Mastectomies
Page 831: Axilla
Page 832: Breast Reconstruction
Page 832: SHARED DECISION MAKING AND PATIENT EDUCATION
Page 832: CONTRAINDICATIONS TO CONTRALATERAL PROPHYLACTIC MASTECTOMY
Page 833: CONCLUSION
Page 833: Subchapter 145 Margins: How to and How Big?
Page 834: PREOPERATIVE PLANNING
Page 834: Imaging
Page 834: Patient Selection
Page 834: Preoperative Localization
Page 834: OPERATIVE TECHNIQUE
Page 834: Breast Conserving Surgery
Page 835: Mastectomy
Page 835: Borderline Lesions
Page 836: SPECIMEN HANDLING AND PROCESSING
Page 836: REEXCISION OF MARGINS BASED ON FINAL PATHOLOGY
Page 836: Breast Conserving Surgery for Invasive Cancer
Page 836: Breast Conserving Surgery for Ductal Carcinoma In Situ
Page 836: Breast Conserving Surgery After Neoadjuvant Chemotherapy
Page 836: Mastectomy
Page 837: CONCLUSION
Page 837: Subchapter 146 Breast Reconstruction Following Mastectomy: Considerations, Techniques, and Outcomes, Part 1
Page 837: PREOPERATIVE CONSIDERATIONS
Page 837: Mitigating Preoperative Risks
Page 838: AESTHETIC CONSIDERATIONS
Page 838: Unilateral versus Bilateral Reconstruction
Page 838: Nipple-Sparing versus Simple Mastectomy
Page 838: RADIATION THERAPY
Page 838: TIMING OF RECONSTRUCTION
Page 838: Immediate Reconstruction
Page 838: Delayed Reconstruction
Page 838: Delayed-Immediate Reconstruction
Page 838: RECONSTRUCTIVE TECHNIQUES (FIG. 1)
Page 838: Oncologic Reconstruction
Page 838: Implant Based Reconstruction
Page 838: Two-Stage Reconstruction
Page 839: Single-Stage Reconstruction
Page 839: Acellular Dermal Matrices
Page 839: COMPLICATIONS
Page 839: Capsular Contracture
Page 839: Infection
Page 839: Implant Rupture
Page 839: Breast Implant-Associated Anaplastic Large Cell Lymphoma
Page 840: AUTOLOGOUS RECONSTRUCTION
Page 840: Abdominal Free Flaps
Page 841: Other Perforator Flaps
Page 841: Pedicled Latissimus Dorsi Flap
Page 842: REVISION SURGERIES
Page 842: Fat Grafting/Lipofilling
Page 842: Nipple Reconstruction
Page 842: BREAST CANCER SURVEILLANCE AFTER BREAST RECONSTRUCTION
Page 842: Subchapter 147 Breast Reconstruction Following Mastectomy: Considerations, Techniques, and Outcomes, Part 2
Page 842: INTRODUCTION
Page 842: RECONSTRUCTIVE METHODS
Page 842: Alloplastic Reconstruction
Page 843: Breast Implant-Associated Anaplastic Large Cell Lymphoma
Page 843: Autologous
Page 844: Abdomen
Page 844: Lower Extremity
Page 844: Hybrid
Page 844: TIMING OF RECONSTRUCTION
Page 844: Immediate
Page 845: Delayed
Page 845: Delayed-Immediate
Page 845: RISK MANAGEMENT CONSIDERATIONS
Page 845: Smoking
Page 845: Obesity
Page 846: Patient Age
Page 846: Radiation
Page 846: SUMMARY
Page 847: Subchapter 148 Breast Implant-Associated Anaplastic Large Cell Lymphoma
Page 847: INTRODUCTION
Page 847: SCOPE
Page 847: EPIDEMIOLOGY
Page 847: PRESENTATION
Page 847: DIAGNOSIS AND WORKUP
Page 847: TREATMENT
Page 848: STAGING
Page 848: FDA WARNINGS ON IMPLANTS
Page 849: DECISION MAKING REGARDING PROPHYLACTIC MANAGEMENT
Page 849: SOFT TISSUE MANAGEMENT FOR PROPHYLAXIS
Page 849: SUBSEQUENT RECONSTRUCTION
Page 850: CONCLUSION
Page 762: Suggested Readings
Page 766: Suggested Readings
Page 769: Suggested Readings
Page 775: Suggested Readings
Page 781: Suggested Readings
Page 788: Suggested Readings
Page 791: Suggested Readings
Page 798: Suggested Readings
Page 803: Suggested Readings
Page 809: Suggested Readings
Page 811: Suggested Readings
Page 815: Suggested Readings
Page 820: Suggested Readings
Page 824: Suggested Readings
Page 827: Suggested Readings
Page 829: Suggested Readings
Page 833: Suggested Readings
Page 837: Suggested Readings
Page 842: Suggested Readings
Page 846: Suggested Readings
Page 850: Suggested Readings
Page 851: Section 14 – Endocrine Glands
Page 851: Subchapter 149 Adrenal Incidentaloma
Page 851: INITIAL EVALUATION
Page 851: Radiographic Assessment
Page 851: Size
Page 851: Computed Tomography Features
Page 852: Magnetic Resonance Imaging Features
Page 852: Molecular Imaging
Page 854: Fine-Needle Aspiration
Page 854: Assessment of Biochemical Functionality
Page 854: Screening for Hypercortisolism
Page 854: Screening for Pheochromocytoma
Page 854: Screening for Hyperaldosteronism
Page 854: Screening for Secretion of Sex Hormones
Page 855: Management
Page 855: Surgery
Page 855: Perioperative Management
Page 856: Special Cases
Page 856: Follow-up
Page 856: Postoperative Surveillance
Page 856: Nonoperative Management
Page 857: Subchapter 150 Management of Adrenal Cortical Tumors
Page 857: INTRODUCTION
Page 857: PREOPERATIVE EVALUATION FOR THE SURGEON
Page 858: INDICATIONS FOR SURGICAL INTERVENTION
Page 858: Functional Cortical Tumors
Page 858: Nonfunctional Cortical Adenomas
Page 858: Adrenocortical Carcinoma
Page 858: Isolated Adrenal Metastases
Page 859: IMMEDIATE PERIOPERATIVE MANAGEMENT AND CONSIDERATIONS
Page 859: SURGICAL APPROACH
Page 859: Choosing Minimally Invasive versus Open Adrenalectomy
Page 860: Open Right Adrenalectomy
Page 860: Open Left Adrenalectomy
Page 862: Open Posterior Adrenalectomy
Page 862: Open Thoracoabdominal Adrenalectomy
Page 862: Laparoscopic Transabdominal versus Retroperitoneoscopic Adrenalectomy
Page 862: Laparoscopic Right Transabdominal Adrenalectomy
Page 864: Laparoscopic Left Transabdominal Adrenalectomy
Page 864: Posterior Right Retroperitoneoscopic Adrenalectomy
Page 864: Posterior Left Retroperitoneoscopic Adrenalectomy
Page 864: Newer Techniques
Page 864: Single-Port Adrenalectomy
Page 865: Robotic Adrenalectomy
Page 865: SPECIAL CONSIDERATIONS
Page 865: Genetics
Page 865: POSTOPERATIVE CONSIDERATIONS
Page 865: Adjuvant Treatment for Adrenocortical Carcinoma
Page 866: Subchapter 151 Management of Pheochromocytoma
Page 866: BACKGROUND
Page 867: CLINICAL PRESENTATION
Page 868: DIAGNOSIS
Page 868: Biochemical Testing
Page 869: Imaging
Page 870: PREOPERATIVE MANAGEMENT
Page 872: INTRAOPERATIVE CONSIDERATIONS
Page 872: OPERATIVE TECHNIQUE
Page 872: Transabdominal Laparoscopic Adrenalectomy and Paraganglioma Resection
Page 873: Posterior Retroperitoneal Adrenalectomy
Page 874: Laparoscopic Cortex-Sparing Adrenalectomy
Page 874: Open Adrenalectomy
Page 875: POSTOPERATIVE MANAGEMENT
Page 875: MALIGNANT PHEOCHROMOCYTOMA AND PARAGANGLIOMA
Page 875: SUMMARY
Page 876: Subchapter 152 Management of Thyroid Nodules
Page 876: INTRODUCTION
Page 876: ULTRASONOGRAPHY
Page 876: NONULTRASOUND THYROID INCIDENTALOMAS
Page 876: OTHER TESTS IN EVALUATION OF THYROID NODULES
Page 876: SIZE OF THYROID NODULE
Page 876: BIOPSY
Page 877: Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFT-P)
Page 877: INDETERMINATE NODULES
Page 877: MOLECULAR TESTING
Page 877: MUTATIONAL ANALYSIS
Page 877: ThyroSeq v3
Page 879: Afirma Genomic Sequencing Classifier (GSC)
Page 879: SURGICAL MANAGEMENT
Page 879: MANAGEMENT OF BENIGN NODULES WITH RADIOFREQUENCY ABLATION
Page 879: CONCLUSION
Page 879: Subchapter 153 Nontoxic Goiter
Page 879: OVERVIEW
Page 879: PATHOGENESIS
Page 880: CLINICAL FEATURES
Page 880: EVALUATION
Page 881: INDICATIONS FOR TREATMENT
Page 881: TREATMENT MODALITIES
Page 882: POSTOPERATIVE CARE
Page 883: Subchapter 154 Management of Thyroiditis
Page 883: INTRODUCTION
Page 884: HASHIMOTO THYROIDITIS
Page 885: PAINLESS THYROIDITIS
Page 886: DRUG-INDUCED THYROIDITIS
Page 887: SUBACUTE (DE QUERVAIN) THYROIDITIS
Page 887: REIDEL THYROIDITIS
Page 888: ACUTE SUPPURATIVE THYROIDITIS
Page 888: RADIOIODINE–INDUCED THYROIDITIS
Page 888: SARS-CoV-2–INDUCED THYROIDITIS
Page 888: Subchapter 155 Management of Hyperthyroidism
Page 888: INITIAL EVALUATION
Page 889: MEDICAL MANAGEMENT OF HYPERTHYROIDISM
Page 889: Antithyroid Medications
Page 890: Adjunctive Therapies
Page 890: Radioactive Iodine Therapy
Page 892: SURGICAL MANAGEMENT OF HYPERTHYROIDISM
Page 892: Surgery as First-Line Treatment for Graves’ Disease
Page 893: Preoperative Management
Page 893: Extent of Surgery
Page 893: Technical Considerations of Thyroidectomy
Page 894: Postoperative Management
Page 894: Complications of Thyroidectomy
Page 894: SPECIAL CONSIDERATIONS
Page 894: Thyroid Storm
Page 894: Graves’ Disease in Children
Page 895: Graves’ Disease in Pregnancy
Page 895: Amiodarone-Induced Thyrotoxicosis
Page 895: ACKNOWLEDGMENTS
Page 895: Subchapter 156 Surgical Management of Thyroid Cancer
Page 895: BACKGROUND
Page 896: DIAGNOSIS AND STAGING
Page 896: OVERVIEW OF SURGICAL MANAGEMENT
Page 897: TOTAL THYROIDECTOMY
Page 897: Anatomy
Page 898: Technique Overview
Page 898: Exposure
Page 898: Retraction and Mobilization
Page 899: Preservation of Parathyroid Glands
Page 899: Preservation of the Recurrent Laryngeal Nerve
Page 900: Intraoperative Neuromonitoring
Page 900: Closure
Page 900: SELECTIVE CERVICAL LYMPH NODE DISSECTION
Page 900: Anatomy
Page 900: Technique Overview
Page 900: Exposure
Page 901: Lateral Mobilization
Page 902: Inferior Mobilization
Page 902: Medial Mobilization
Page 902: Closure
Page 902: Subchapter 157 Primary Hyperparathyroidism
Page 902: BACKGROUND
Page 902: DIAGNOSIS
Page 902: Indications for Surgery
Page 903: Preoperative Considerations
Page 904: Preoperative Imaging
Page 904: Neck Ultrasound
Page 904: Nuclear Scintigraphy/Sestamibi Scanning
Page 904: Four-Dimensional Computed Tomography
Page 905: Other Imaging Modalities
Page 905: PARATHYROIDECTOMY
Page 905: Surgical Approach
Page 907: Intraoperative Adjuncts and Alternative Surgical Approaches
Page 907: Recurrent Laryngeal Nerve Monitoring
Page 907: Gamma Probe–Facilitated Intraoperative Parathyroid Disease Localization
Page 907: Parathyroid Autofluorescence Detection
Page 908: Alternative Surgical Approaches to the Parathyroid Glands
Page 908: OPERATIVE COMPLICATIONS
Page 908: POSTOPERATIVE CONSIDERATIONS
Page 909: Subchapter 158 Persistent and Recurrent Hyperparathyroidism
Page 909: ETIOLOGY
Page 909: DIAGNOSIS AND INDICATIONS FOR REOPERATIVE PARATHYROIDECTOMY
Page 909: EVALUATION
Page 910: LOCALIZATION STUDIES
Page 911: PLANNING AND RISK ASSESSMENT
Page 912: OPERATIVE TECHNIQUE
Page 915: POSTOPERATIVE MANAGEMENT
Page 915: CONCLUSION
Page 915: Subchapter 159 Surgical Management of Secondary and Tertiary Hyperparathyroidism
Page 915: INTRODUCTION
Page 915: PATHOPHYSIOLOGY
Page 916: CLINICAL PRESENTATION
Page 916: DIAGNOSIS
Page 916: MEDICAL MANAGEMENT
Page 917: PARATHYROIDECTOMY
Page 917: ANATOMY
Page 917: INDICATIONS FOR SURGERY
Page 917: Secondary HPT
Page 918: PREOPERATIVE MANAGEMENT
Page 919: EXTENT OF SURGERY
Page 919: Intraoperative PTH Monitoring
Page 920: Creating a Parathyroid Remnant
Page 920: Creating an Autograft
Page 920: Cryopreservation
Page 920: POSTOPERATIVE MANAGEMENT AND COMPLICATIONS
Page 920: SUMMARY
Page 921: Subchapter 160 Metabolic Changes Following Bariatric Surgery
Page 921: METABOLIC CONSEQUENCES OF OBESITY
Page 922: METABOLIC IMPROVEMENTS AFTER WEIGHT LOSS SURGERY
Page 922: Weight Loss
Page 923: Nonalcoholic Fatty Liver Disease
Page 923: Lipid Profiles
Page 923: Hypertension
Page 923: Cardiovascular Risk and Mortality
Page 923: Polycystic Ovary Syndrome
Page 923: Fertility
Page 924: Type 2 Diabetes
Page 924: METABOLIC SURGERY AND FUTURE DIRECTIONS
Page 924: Low BMI Metabolic Surgery
Page 925: Adolescent Bariatric and Metabolic Surgery
Page 925: Alternative Surgical Procedures
Page 925: Endosurgical Options and Devices
Page 926: Cardiovascular Disease Risk Reduction After Bariatric Surgery
Page 926: CARDIOVASCULAR DISEASE RISK FACTORS
Page 926: Overview
Page 926: Metabolic Syndrome
Page 927: Diabetes Mellitus
Page 927: Obesity
Page 928: Effect of Weight Loss on Risk for Cardiovascular Disease
Page 928: Lifestyle-Induced Weight Loss
Page 928: Drug-Induced Weight Loss
Page 928: Metabolic and Bariatric Surgery: Overview of Common Procedures
Page 929: Effect of Bariatric Surgery on Cardiovascular Disease Risk Factors
Page 929: Glycemic Control
Page 931: Lipid Metabolism
Page 932: Inflammatory State
Page 932: Effect of Bariatric Surgery on Cardiovascular Disease and Mortality
Page 935: CONCLUSION
Page 856: Suggested Readings
Page 866: Suggested Readings
Page 876: Suggested Readings
Page 879: Suggested Readings
Page 883: Suggested Readings
Page 888: Suggested Readings
Page 895: Suggested Readings
Page 902: Suggested Readings
Page 908: Suggested Readings
Page 915: Suggested Readings
Page 921: Suggested Readings
Page 926: Suggested Readings
Page 935: Suggested Readings
Page 937: Section 15 – Skin and Soft Tissue
Page 937: Subchapter 162 Nonmelanoma Skin Cancers
Page 937: BACKGROUND
Page 937: RISK FACTORS AND PRECURSOR LESIONS
Page 938: INITIAL EVALUATION OF SUSPECTED CUTANEOUS MALIGNANCY
Page 938: Clinical Evaluation
Page 938: BASAL CELL CARCINOMA
Page 939: Basal Cell Nevus Syndrome
Page 939: SQUAMOUS CELL CARCINOMA
Page 940: Keratoacanthoma Squamous Cell Variant
Page 940: Squamous Cell Carcinoma in Situ
Page 941: Bowen’s Disease
Page 941: SURGICAL EVALUATION AND TREATMENT
Page 941: Biopsy
Page 941: RISK PROGNOSTICATION
Page 941: SURGICAL MANAGEMENT OF NONMELANOMA SKIN CANCER
Page 941: Markings and Margin Considerations
Page 941: Evaluation of Margins and Confirmation of Negative Margins
Page 942: Considerations for Enlarged Lymph Nodes
Page 942: NONSURGICAL MANAGEMENT OF NONMELANOMA SKIN CANCER
Page 943: Radiation as Primary or Adjunctive Treatment
Page 943: CONSIDERATIONS FOR METASTATIC DISEASE
Page 943: Long-Term Follow-up of Basal Cell and Squamous Cell Skin Cancers
Page 943: OTHER MALIGNANT CUTANEOUS ENTITIES
Page 943: Merkle Cell Carcinoma
Page 944: Dermatofibrosarcoma Protuberans
Page 944: Treatment
Page 944: Cutaneous T-Cell Lymphoma
Page 944: Angiosarcoma
Page 944: Adnexal Tumors of the Skin
Page 944: Acknowledgment
Page 945: Subchapter 163 Management of Cutaneous Melanoma
Page 945: EPIDEMIOLOGY AND RISK FACTORS
Page 945: Risk Factors
Page 945: Precursor Lesions
Page 946: MELANOMA, CLINICALLY AND PATHOLOGICALLY, DOES NOT HAVE SOLID DIAGNOSTIC CRITERIA
Page 946: MELANOMA CLASSIFICATION
Page 946: Superficial Spreading Melanoma
Page 947: Nodular Melanoma
Page 947: Lentigo Maligna Melanoma
Page 947: Acral Lentiginous Melanoma
Page 947: Amelanotic Melanoma
Page 948: Desmoplastic Melanoma
Page 949: Clear Cell Sarcoma
Page 949: Mucosal Melanoma
Page 949: STAGING AND PROGNOSIS
Page 949: INITIAL WORKUP
Page 949: Lesion History and Characteristics
Page 949: Total Body Skin Examination
Page 949: Examination of Regional Nodes
Page 950: Laboratory Examinations
Page 950: BIOPSY
Page 951: Relevant Information Provided by Biopsy
Page 951: SURGICAL MANAGEMENT OF PRIMARY CUTANEOUS MELANOMA
Page 951: Tumor Extirpation
Page 951: Optimal Deep Margins
Page 951: Management of Regional Lymph Nodes
Page 952: MANAGEMENT OF PATIENTS WITHOUT CLINICALLY SUSPICIOUS OR CLINICALLY POSITIVE NODES
Page 953: NONSURGICAL MANAGEMENT OF LOW-VOLUME INVOLVEMENT IN SENTINEL LYMPH NODES
Page 953: MANAGEMENT OF PATIENTS WITH CLINICALLY SUSPICIOUS OR POSITIVE NODES
Page 953: MANAGEMENT OF RECURRENT MELANOMA
Page 953: IMMUNOTHERAPY AND TARGETED THERAPY
Page 954: Subchapter 164 Management of Soft Tissue Sarcomas
Page 954: INTRODUCTION
Page 954: ETIOLOGY
Page 954: Radiation
Page 954: Other Causative Factors
Page 956: Predisposing Genetic Conditions
Page 956: DIAGNOSTIC EVALUATION
Page 956: Pain
Page 957: Size
Page 958: Depth
Page 958: Mobility
Page 959: Growth
Page 960: Imaging Characteristics
Page 962: Biopsy
Page 962: Staging
Page 962: TREATMENT
Page 963: Surgical Management
Page 963: Considerations Specific to Retroperitoneal Sarcomas
Page 964: Radiation Therapy
Page 964: Chemotherapy
Page 964: HISTOLOGY-SPECIFIC CONSIDERATIONS
Page 964: Well-Differentiated Liposarcoma/Atypical Lipomatous Tumors
Page 965: Myxoid Liposarcoma
Page 965: Leiomyosarcoma
Page 965: Synovial Sarcoma
Page 965: Epithelioid Sarcoma
Page 965: Malignant Peripheral Nerve Sheath Tumors
Page 965: Myxofibrosarcoma
Page 965: Dermatofibrosarcoma Protuberans
Page 965: SUMMARY
Page 966: Subchapter 165 Management of Solitary Neck Mass
Page 966: GENERAL PRINCIPLES
Page 966: ANATOMIC CONSIDERATIONS
Page 967: DIFFERENTIAL DIAGNOSIS
Page 967: DIAGNOSTIC EVALUATION
Page 967: History
Page 967: Physical Examination
Page 970: Office-Based Endoscopy
Page 970: Laboratory Testing
Page 970: Imaging
Page 970: Pathology
Page 971: MANAGEMENT
Page 973: Subchapter 166 Surgical Infections of The Hand
Page 973: BACKGROUND
Page 973: GENERAL PRINCIPLES
Page 973: EXAMINATION
Page 973: TESTS AND IMAGING
Page 973: TREATMENT
Page 973: MINOR INFECTIONS
Page 973: Cellulitis
Page 973: Symptoms
Page 973: Treatment
Page 974: Paronychia
Page 974: Symptoms
Page 974: Treatment
Page 974: Felon
Page 975: Symptoms
Page 975: Treatment
Page 975: MAJOR INFECTIONS
Page 975: Pyogenic Flexor Tenosynovitis
Page 975: Symptoms
Page 975: Treatment
Page 976: Infections of the Deep Spaces of the Hand
Page 976: Thenar Space
Page 976: Symptoms
Page 976: Treatment
Page 977: Midpalmar Space
Page 977: Symptoms
Page 977: Treatment
Page 977: Hypothenar Space
Page 977: Symptoms
Page 977: Treatment
Page 977: Interdigital Webspace
Page 977: Symptoms
Page 977: Treatment
Page 978: Dorsal Subaponeurotic Space
Page 978: Symptoms
Page 978: Treatment
Page 978: Space of Parona
Page 978: Symptoms
Page 978: Treatment
Page 978: OTHER INFECTIONS
Page 978: Animal and Human Bites
Page 979: Septic Arthritis
Page 979: Symptoms
Page 979: Treatment
Page 979: NECROTIZING INFECTIONS
Page 979: SUMMARY
Page 979: Subchapter 167 Nerve Injury and Repair
Page 979: BASIC ANATOMY
Page 980: FASCICULAR TOPOGRAPHY
Page 980: PATHOPHYSIOLOGY
Page 981: TIMING
Page 982: TREATMENT FOR NERVE INJURY
Page 982: GENERAL PRINCIPLES
Page 982: Preoperative Assessment
Page 982: Key Operative Principles
Page 983: TECHNIQUES FOR NERVE SURGERY
Page 983: Neurolysis
Page 983: Direct Repair
Page 983: Nerve Graft
Page 984: Nerve Allografts
Page 986: Nerve Transfers
Page 986: Muscle and Tendon Transfer and Bone and Joint Procedures
Page 986: EXPECTED OUTCOMES FROM REPAIR AND RECONSTRUCTION
Page 986: WHO SHOULD OPERATE
Page 987: SUMMARY
Page 988: Subchapter 168 Necrotizing Skin and Soft Tissue Infections
Page 988: INTRODUCTION
Page 988: PATHOPHYSIOLOGY
Page 988: DIAGNOSIS
Page 988: TREATMENT
Page 990: CONCLUSION
Page 944: Suggested Readings
Page 954: Suggested Readings
Page 965: Suggested Readings
Page 972: Suggested Readings
Page 979: Suggested Readings
Page 987: Suggested Readings
Page 991: Suggested Readings
Page 993: Section 16 – Chest Wall, Mediastinum, and Trachea
Page 993: Management of Spontaneous and Secondary Pneumothorax
Page 993: PNEUMOTHORAX
Page 993: Primary Spontaneous Pneumothorax
Page 993: Secondary Pneumothorax
Page 993: CLINICAL PRESENTATION
Page 993: IMAGING
Page 994: Computed Tomography
Page 995: MANAGEMENT OF PNEUMOTHORAX
Page 995: Observation
Page 995: Aspiration
Page 995: Tube Drainage
Page 996: Chemical Pleurodesis
Page 997: Video-Assisted Thoracic Surgery
Page 997: Management of Primary Chest Wall Tumors
Page 997: OVERVIEW
Page 997: DIAGNOSIS
Page 998: CHEST WALL NEOPLASMS
Page 998: Benign Bony and Cartilaginous Tumors
Page 998: Fibrous Dysplasia
Page 998: Osteochondroma
Page 998: Chondroma
Page 998: Malignant Bony and Cartilaginous Tumors
Page 998: Chondrosarcomas
Page 999: Osteosarcomas
Page 999: Ewing Sarcomas and Askin Tumors
Page 999: Solitary Plasmacytomas
Page 999: Benign Soft Tissue Tumors
Page 999: Lipomas
Page 999: Fibromas (Desmoid Tumors) and Fibromatosis
Page 999: Hemangiomas
Page 999: Benign Peripheral Nerve Sheath Tumors
Page 999: Malignant Soft Tissue Tumors
Page 999: Malignant Fibrous Histiocytomas
Page 1000: Synovial Sarcomas
Page 1000: Rhabdomyosarcomas
Page 1000: SURGICAL TREATMENT OF CHEST WALL TUMORS
Page 1000: Chest Wall Resection
Page 1000: Chest Wall Reconstruction
Page 1000: General Principles of Chest Wall Reconstruction
Page 1001: Options for Chest Wall Reconstruction
Page 1002: Surgical Technique for Chest Wall Reconstruction
Page 1002: SUMMARY
Page 1003: Mediastinal Masses
Page 1003: APPROACH TO A PATIENT WITH A MEDIASTINAL MASS
Page 1003: ANTERIOR MEDIASTINAL MASSES
Page 1003: Thymic Tumors
Page 1003: Thyroid and Parathyroid
Page 1004: Lymphoma
Page 1006: Germ Cell Tumors
Page 1006: Teratoma
Page 1006: Seminoma
Page 1006: Nonseminoma
Page 1009: MIDDLE MEDIASTINAL MASSES
Page 1009: Castleman’s Disease
Page 1009: Mediastinal Cysts
Page 1009: Mediastinal Lymphadenopathy
Page 1010: POSTERIOR MEDIASTINAL MASSES
Page 1010: Schwannomas and Neurofibromas
Page 1010: Ganglion and Paraganglion Cell Tumors
Page 1011: SURGICAL APPROACHES
Page 1011: Biopsy vs. Surgery
Page 1011: Anterior Mediastinotomy
Page 1011: Median Sternotomy
Page 1011: Transcervical Approach
Page 1011: Thoracotomy
Page 1011: Minimally Invasive Approaches
Page 1013: Primary Tumors of the Thymus
Page 1013: INTRODUCTION
Page 1013: CLINICAL PRESENTATION
Page 1013: IMAGING
Page 1014: TISSUE DIAGNOSIS
Page 1014: HISTOLOGIC CLASSIFICATION
Page 1015: STAGING
Page 1015: PRINCIPLES OF SURGERY
Page 1016: TRANS-STERNAL THYMECTOMY
Page 1016: MINIMALLY INVASIVE RESECTION
Page 1016: SYSTEMIC THERAPY
Page 1017: RADIATION THERAPY
Page 1017: SURVEILLANCE AND RECURRENCE
Page 1017: Management of Tracheal Stenosis
Page 1017: INTRODUCTION
Page 1017: INDICATIONS FOR TRACHEAL RESECTION
Page 1017: PREOPERATIVE ASSESSMENT
Page 1018: ANESTHESIA AND AIRWAY MANAGEMENT
Page 1019: SURGICAL TECHNIQHE FOR TRACHEAL RESECTION
Page 1021: COMPLICATIONS OF TRACHEAL SURGERY
Page 1022: RESULTS
Page 1024: Management of Acquired Esophageal Respiratory Tract Fistula
Page 1024: OVERVIEW
Page 1024: PATHOGENESIS
Page 1024: Iatrogenic
Page 1024: Infectious
Page 1024: Traumatic
Page 1025: CLINICAL FEATURES
Page 1025: DIAGNOSIS
Page 1025: TREATMENT
Page 1025: Preop Care
Page 1025: Operative Management
Page 1027: Extensive TEF
Page 1027: Postop Management
Page 1027: Malignant TEF Management
Page 1028: OUTCOMES
Page 1028: SUMMARY
Page 1029: Repair of Pectus Excavatum
Page 1029: INTRODUCTION
Page 1029: EVALUATION OF PECTUS EXCAVATUM
Page 1029: Disease Severity
Page 1029: Cardiopulmonary Evaluation
Page 1029: Indications for Surgery and Operative Timing
Page 1030: Other Preoperative Considerations
Page 1030: OPERATIVE REPAIR
Page 1030: Minimally Invasive Repair
Page 1031: Open Repair
Page 1031: POSTOPERATIVE MANAGEMENT
Page 1031: Pain Management
Page 1032: Physical Therapy Guidelines
Page 1032: EARLY COMPLICATIONS
Page 1032: LATE COMPLICATIONS
Page 1032: OUTCOMES
Page 1032: Reversal
Page 1033: Recurrence
Page 997: Suggested Readings
Page 1002: Suggested Readings
Page 1013: Suggested Readings
Page 1017: Suggested Readings
Page 1024: Suggested Readings
Page 1028: Suggested Readings
Page 1033: Suggested Readings
Page 1035: Section 17 – Vascular Surgery
Page 1035: Subchapter 176 Open Repair of Abdominal Aortic Aneurysms
Page 1035: PREOPERATIVE EVALUATION AND PLANNING FOR OPEN REPAIR
Page 1036: GENERAL PRINCIPLES OF OPEN REPAIR AND OPERATIVE PLANNING
Page 1037: TECHNICAL DETAILS OF OPERATION
Page 1037: Midline Transperitoneal Approach and Its Variations
Page 1038: Left Flank Approach
Page 1039: SPECIAL CONSIDERATIONS IN OPEN REPAIR OF RUPTURED AAA
Page 1040: TREATMENT OUTCOMES WITH OPEN AAA REPAIR
Page 1040: Subchapter 177 Endovascular Treatment of Abdominal Aortic Aneurysms
Page 1041: PREOPERATIVE PLANNING
Page 1041: ASSESSING ACCESS VESSELS
Page 1041: PROXIMAL AORTIC SEAL
Page 1041: DISTAL ILIAC AND JUNCTIONAL SEAL
Page 1041: PATIENT SELECTION
Page 1041: PROCEDURAL STEPS
Page 1041: Arterial Access
Page 1041: Open Femoral Access
Page 1041: Percutaneous Femoral Access
Page 1042: Device Deployment
Page 1044: Follow-up
Page 1044: COMPLICATIONS
Page 1044: Endoleak
Page 1044: Type I Endoleak
Page 1044: Type II Endoleak
Page 1044: Type III Endoleak
Page 1045: Type IV Endoleak
Page 1045: Type V Endoleak
Page 1045: Graft Limb Occlusion
Page 1045: Ischemic Complications
Page 1046: Renal Artery Occlusion
Page 1046: Subchapter 178 Management of Ruptured Abdominal Aortic Aneurysms
Page 1046: INTRODUCTION
Page 1046: PRESENTATION, DIAGNOSIS, AND INITIAL MANAGEMENT
Page 1047: ENDOVASCULAR VERSUS OPEN REPAIR
Page 1047: TECHNIQUE
Page 1047: Operating Room Preparation and Retrograde Balloon Occlusion of the Aorta
Page 1047: Endovascular Repair
Page 1048: Open Repair
Page 1050: COMPLICATIONS
Page 1051: FOLLOW-UP
Page 1051: CONCLUSION
Page 1051: Subchapter 179 Management of Abdominal Aortic Aneurysm with Concomitant Nonvascular Abdominal Pathology
Page 1051: GENERAL CONSIDERATIONS
Page 1052: ELECTIVE AORTIC ANEURYSM WITH ASYMPTOMATIC ABDOMINAL DISEASE
Page 1052: CHOLELITHIASIS
Page 1052: GASTROINTESTINAL MALIGNANCIES
Page 1052: Renal Cancer
Page 1052: Bladder Cancer
Page 1052: Prostate Cancer
Page 1053: Solid Organ Tumors
Page 1053: Appendix and Meckel’s Diverticulum
Page 1053: EMERGENT AAA REPAIR AND CONCOMITANT DISEASE
Page 1053: Emergent Laparotomy for Abdominal Pathology with Incidental AAA
Page 1053: Elective Laparotomy for Abdominal Pathology with an Incidental Asymptomatic AAA
Page 1053: SUMMARY
Page 1054: Subchapter 180 Management of Thoracic and Thoracoabdominal Aortic Aneurysms
Page 1054: INTRODUCTION
Page 1054: INDICATIONS FOR SURGERY
Page 1055: PATIENT SELECTION AND PREOPERATIVE RISK ASSESSMENT
Page 1055: STRATEGIES FOR THORACIC AND THORACOABDOMINAL AORTIC RECONSTRUCTION
Page 1055: Organ Protection Adjuncts
Page 1056: Operative Technique
Page 1057: Outcomes
Page 1058: ENDOVASCULAR MANAGEMENT OF DTAA and TAAA
Page 1058: Preoperative Planning
Page 1058: Operative Technique
Page 1059: Outcomes
Page 1061: Subchapter 181 Management of Acute Aortic Dissections
Page 1061: PRESENTATION AND DIAGNOSIS
Page 1062: CLASSIFICATION
Page 1063: MANAGEMENT
Page 1063: Initial Management
Page 1063: Management of Acute Type A Dissections
Page 1064: Surgical Results with Acute Type A Dissections
Page 1064: Management of Acute Type B Dissections
Page 1067: Subchapter 182 Carotid Endarterectomy
Page 1067: CLINICAL PRESENTATION
Page 1068: Imaging Studies
Page 1068: INDICATIONS FOR CEA
Page 1069: CEA: OPERATIVE TECHNIQUE
Page 1069: Anesthesia
Page 1069: Patient Positioning
Page 1069: Skin Incision
Page 1069: Operative Exposure
Page 1070: Conventional Endarterectomy
Page 1071: Eversion Endarterectomy
Page 1071: Cerebral Protection and Monitoring
Page 1071: Completion Studies
Page 1072: EXPOSURE FOR HIGH LESIONS
Page 1072: PERIOPERATIVE MEDICAL MANAGEMENT
Page 1072: RESULTS
Page 1072: Recurrent Carotid Stenosis
Page 1073: Reoperative CEA
Page 1073: Subchapter 183 Management of Recurrent Carotid Artery Stenosis
Page 1073: INTRODUCTION
Page 1073: INCIDENCE AND PRESENTATION OF RECURRENT CAROTID STENOSIS
Page 1074: RISK FACTORS FOR RECURRENT CAROTID STENOSIS
Page 1074: PATHOGENESIS OF RECURRENT CAROTID STENOSIS
Page 1075: SURVEILLANCE FOR RECURRENT CAROTID STENOSIS
Page 1075: After Carotid Endarterectomy
Page 1075: After Carotid Artery Stenting
Page 1075: MANAGEMENT OF RECURRENT STENOSIS AFTER CAROTID ENDARTERECTOMY
Page 1077: MANAGEMENT OF RECURRENT STENOSIS AFTER CAROTID ARTERY STENTING
Page 1079: SUMMARY
Page 1079: Subchapter 184 Balloon Angioplasty and Stents in Carotid Artery Occlusive Disease
Page 1079: BACKGROUND
Page 1080: PREPROCEDURAL CONSIDERATIONS
Page 1080: TRANSFEMORAL APPROACH FOR CAROTID ANGIOPLASTY
Page 1082: TRANSCAROTID APPROACH FOR CAROTID ANGIOPLASTY
Page 1084: PERIPROCEDURAL MANAGEMENT
Page 1085: FOLLOW-UP
Page 1085: SUMMARY AND PERSPECTIVE
Page 1086: Subchapter 185 Management of Aneurysms of the Extracranial Carotid and Vertebral Arteries
Page 1086: EXTRACRANIAL CAROTID ARTERY ANEURYSMS
Page 1086: Etiology
Page 1086: Presentation and Diagnosis
Page 1087: Indications for Treatment
Page 1087: Preoperative Considerations
Page 1087: Open Surgical Repair
Page 1089: Endovascular Repair
Page 1090: Results of Treatment
Page 1090: EXTRACRANIAL VERTEBRAL ARTERY ANEURYSMS
Page 1091: Subchapter 186 Brachiocephalic Reconstruction
Page 1091: INTRODUCTION
Page 1091: CLINICAL PRESENTATION
Page 1092: DIAGNOSTIC EVALUATION
Page 1093: TREATMENT
Page 1093: Indication for Treatment
Page 1093: Treatment Options
Page 1094: ANATOMIC (DIRECT) REVASCULARIZATION
Page 1094: Endarterectomy
Page 1095: Bypass Graft
Page 1095: EXTRAANATOMIC (INDIRECT) REVASCULARIZATION
Page 1096: ARTERIAL TRANSPOSITION
Page 1096: ENDOVASCULAR TREATMENT
Page 1097: INNOMINATE ARTERY INTERVENTIONS
Page 1097: Left Common Carotid Artery
Page 1097: Left Subclavian Artery
Page 1098: MANAGEMENT OF THE LEFT SUBCLAVIAN ARTERY FOR THORACIC AORTIC ENDOVASCULAR REPAIR
Page 1098: SUMMARY
Page 1099: Subchapter 187 Upper Extremity Arterial Occlusive Disease
Page 1099: ETIOLOGY
Page 1099: Systemic Disease
Page 1099: Embolism
Page 1099: Trauma
Page 1100: EVALUATION
Page 1100: History and Physical Examination
Page 1101: Noninvasive Vascular Evaluation
Page 1101: Advanced Imaging
Page 1102: MANAGEMENT
Page 1102: Medical Therapy
Page 1102: Endovascular Therapy
Page 1103: Surgical Therapy
Page 1103: Operative Exposure of the Subclavian Artery
Page 1104: Surgical Reconstruction for Proximal Subclavian Artery Lesions
Page 1104: Subclavian Artery Transposition
Page 1105: Carotid-Subclavian Bypass
Page 1105: Axillary Artery
Page 1105: Brachial Artery
Page 1105: Radial and Ulnar Arteries
Page 1105: RESULTS OF TREATMENT
Page 1106: SUMMARY
Page 1106: Subchapter 188 Aortoiliac Occlusive Disease
Page 1106: INTRODUCTION
Page 1106: DIAGNOSTIC EVALUATION
Page 1106: History and Physical Examination
Page 1107: Physiologic Testing
Page 1107: Imaging
Page 1107: MEDICAL TREATMENT
Page 1107: Decision Making for Intervention
Page 1107: ENDOVASCULAR TREATMENT
Page 1109: Establishing Arterial Access
Page 1109: Diagnostic Arteriogram and Identification of the Culprit Lesion(s)
Page 1109: Crossing the Lesion(s)
Page 1109: Balloon Angioplasty with Stenting
Page 1110: Closure of the Arterial Access Site(s)
Page 1110: Results
Page 1110: Covered Endovascular Reconstruction of the Aortic Bifurcation
Page 1110: Technique
Page 1111: Results
Page 1111: SURGICAL TREATMENT
Page 1111: Aortofemoral Bypass
Page 1112: Technique
Page 1114: Results
Page 1114: Aortoiliac Endarterectomy
Page 1114: Technique
Page 1114: Results
Page 1114: Unilateral Iliofemoral Bypass
Page 1115: Technique
Page 1115: Results
Page 1115: Axillofemoral Bypass
Page 1115: Technique
Page 1115: Results
Page 1115: Femorofemoral Bypass
Page 1116: Technique
Page 1116: Results
Page 1116: Thoracofemoral Bypass
Page 1116: Technique
Page 1116: Results
Page 1116: Hybrid Revascularization Procedures
Page 1116: Follow-up
Page 1116: SUMMARY
Page 1117: Subchapter 189 Femoropopliteal Occlusive Disease
Page 1117: INTRODUCTION
Page 1118: OUR CLINICAL EVALUATION/IMAGING
Page 1118: TREATMENT
Page 1118: Conservative/Medical Therapy
Page 1118: Open Surgical versus Endovascular Therapy
Page 1119: Open Surgical Therapy
Page 1119: Exposure of Above- and Below-Knee Popliteal Artery
Page 1119: The Conduit of Choice
Page 1119: Vein Harvest/Bypass Technique
Page 1120: Perioperative Management
Page 1120: Postoperative Graft Surveillance
Page 1120: Femoropopliteal Bypass Using Prosthetic Conduit
Page 1121: Result of Open Surgical Bypass
Page 1121: ENDOVASCULAR THERAPY FOR FEMOROPOPLITEAL DISEASE
Page 1122: Angioplasty/Stenting
Page 1122: Technical Consideration
Page 1122: Challenges in Stenting SFA/Popliteal Lesions
Page 1123: Cutting Balloon Angioplasty
Page 1123: Atherectomy
Page 1123: Covered Stents
Page 1123: Drug Eluting Balloons and Stents
Page 1123: Limitations of DCB
Page 1124: Drug-Coated Stents (DCS)
Page 1124: DCB versus DES for SFA Interventions
Page 1124: Primary Amputation
Page 1124: CONCLUSION
Page 1125: Subchapter 190 Tibioperoneal Arterial Occlusive Disease
Page 1125: PATIENT ASSESSMENT
Page 1126: SELECTION OF INTERVENTION
Page 1128: SURGICAL BYPASS
Page 1128: Anesthesia and Positioning
Page 1128: Operative Exposures
Page 1128: Inflow Vessels
Page 1128: Outflow Vessels
Page 1128: Proximal Posterior Tibial and Peroneal Arteries
Page 1129: Anterior Tibial Artery and Dorsalis Pedis Artery
Page 1129: Conduit
Page 1129: Inflow Anastomosis
Page 1130: Tunnels for Bypass Grafts
Page 1131: Outflow Anastomosis
Page 1131: ENDOVASCULAR REVASCULARIZATION
Page 1131: Indications for Intervention
Page 1132: Vascular Access and Imaging
Page 1132: Balloon Angioplasty and Stent Placement
Page 1132: OTHER TECHNOLOGIES
Page 1132: POSTINTERVENTION MANAGEMENT AND SURVEILLANCE
Page 1133: COMPLICATIONS
Page 1134: FUTURE TREATMENT: CELL-BASED THERAPIES
Page 1134: Subchapter 191 Popliteal and Femoral Artery Aneurysm
Page 1134: FEMORAL ANEURYSM
Page 1134: Degenerative Femoral Artery Aneurysm
Page 1134: Indication for Repair
Page 1134: Approach
Page 1135: Iatrogenic Femoral Artery Pseudoaneurysm
Page 1135: Indication for Intervention
Page 1135: Approach
Page 1136: Paraanastomotic Femoral Artery Aneurysm
Page 1136: Indication for Repair
Page 1136: Approach
Page 1136: Noninfected Anastomotic Pseudoaneurysm
Page 1136: Infected Femoral Anastomotic Pseudoaneurysm
Page 1136: Primary Infected Femoral Artery Aneurysm
Page 1137: POPLITEAL ANEURYSM
Page 1137: Indication for Repair
Page 1137: Open Surgical or Endovascular Repair
Page 1137: Approach: Repair in the Absence of Acute Thrombosis
Page 1139: Approach: Repair in the Presence of Acute Thrombosis
Page 1139: Subchapter 192 Treatment of Claudication
Page 1139: ASSESSMENT
Page 1139: Screening
Page 1139: Clinical Presentation and Evaluation
Page 1141: TREATMENT
Page 1141: Medical Management
Page 1141: Smoking Cessation
Page 1142: Diabetes Mellitus
Page 1142: Hypertension
Page 1142: Hyperlipidemia
Page 1143: Antiplatelet and Antithrombotic Therapy
Page 1143: Homocysteine-Lowering Therapy
Page 1143: Cilostazol and Pentoxifylline
Page 1143: Exercise Therapy
Page 1143: Revascularization
Page 1144: Subchapter 193 Pseudoaneurysms and Arteriovenous Fistulas
Page 1144: RISK FACTORS
Page 1144: Diagnosis
Page 1146: Treatment
Page 1146: Observation
Page 1146: USGC
Page 1147: UGTI
Page 1147: Endovascular Repair
Page 1148: Open Surgical Repair
Page 1148: Noninfected Pseudoaneurysms
Page 1149: Infected Pseudoaneurysms
Page 1149: Alternate Percutaneous Methods
Page 1149: Anastomotic Pseudoaneurysms
Page 1149: ARTERIOVENOUS FISTULA
Page 1149: Diagnosis
Page 1149: Treatment
Page 1149: Open Surgical Repair
Page 1150: Endovascular Repair
Page 1150: Subchapter 194 Management of Peripheral Arterial Thromboembolism
Page 1150: BACKGROUND/OVERVIEW
Page 1150: CLASSIFICATION, SITE, AND SOURCE OF EMBOLISM
Page 1151: CLINICAL PRESENTATION
Page 1151: DIAGNOSTIC EXAMINATION
Page 1152: MANAGEMENT
Page 1152: Initial Medical Management
Page 1152: Selection of Approach
Page 1153: Open Surgical Technique
Page 1154: Aortic and Lower Extremity Embolectomy
Page 1154: Brachial Embolectomy
Page 1154: Percutaneous Endovascular Techniques
Page 1154: Catheter Directed Thrombolysis
Page 1154: Pharmacomechanical Thrombectomy
Page 1154: Aspiration Mechanical Thrombectomy
Page 1154: Compartment Syndrome
Page 1155: Postoperative Management
Page 1157: CONCLUSION
Page 1157: Subchapter 195 Acute Peripheral Arterial and Bypass Graft Occlusion: Thrombolysis and Thrombectomy
Page 1157: BACKGROUND
Page 1157: INDICATIONS
Page 1157: Clinical Assessment
Page 1157: IMAGING ASSESSMENT
Page 1158: SELECTION OF THERAPY
Page 1158: Recommended Interventions for Disease in Native Arteries
Page 1158: Recommended Interventions for Disease in Bypass Grafts
Page 1159: Techniques
Page 1159: Catheter-Directed Thrombolysis
Page 1159: Preoperative Planning
Page 1159: Technique
Page 1160: Monitoring
Page 1160: MECHANICAL THROMBECTOMY
Page 1160: Preoperative Planning
Page 1160: Technique
Page 1161: Follow-up
Page 1161: Subchapter 196 Management of Infected Grafts
Page 1161: INTRODUCTION
Page 1161: DIAGNOSIS
Page 1161: Imaging
Page 1162: TREATMENT
Page 1162: Graft Excision with Revascularization
Page 1162: Extra-Anatomic Bypass
Page 1164: In Situ Antibiotic Impregnated Graft Replacement
Page 1165: In Situ Cryopreserved Allograft Replacement
Page 1165: In Situ Venous Autograft
Page 1166: Graft Excision without Revascularization
Page 1166: Graft Preservation
Page 1166: INFECTED STENT GRAFTS
Page 1167: INFECTED DIALYSIS ACCESS GRAFTS
Page 1168: CONCLUSION
Page 1168: Subchapter 197 Atherosclerotic Renal Artery Stenosis
Page 1168: INCIDENCE
Page 1168: NATURAL HISTORY
Page 1168: EVALUATION
Page 1168: TREATMENT
Page 1169: MEDICAL THERAPY
Page 1169: RENAL ARTERY STENOSIS SURVEILLANCE AND FOLLOW-UP
Page 1169: REVASCULARIZATION
Page 1169: ENDOVASCULAR THERAPY
Page 1171: COMPLICATIONS
Page 1171: OUTCOMES
Page 1171: SURVEILLANCE AND FOLLOW-UP
Page 1171: ENDOVASCULAR MANAGEMENT OF RESTENOSIS
Page 1172: OPEN SURGICAL REPAIRS
Page 1172: AORTORENAL ARTERY BYPASS
Page 1173: AORTORENAL ENDARTERECTOMY
Page 1173: EXTRAANATOMIC RECONSTRUCTION
Page 1174: COMPLICATIONS
Page 1174: RESULTS
Page 1174: SURVEILLANCE AND FOLLOW-UP
Page 1174: SUMMARY
Page 1175: Subchapter 198 Raynaud’s Phenomenon
Page 1175: PRIMARY RAYNAUD’S PHENOMENON
Page 1175: SECONDARY RAYNAUD’S
PHENOMENON
Page 1177: PATHOGENESIS
Page 1177: DIAGNOSIS
Page 1177: MANAGEMENT
Page 1177: Nonpharmacologic
Page 1177: Pharmacologic
Page 1178: Surgical Treatment
Page 1178: SUMMARY
Page 1179: Subchapter 199 Thoracic Outlet Syndrome
Page 1179: INTRODUCTION
Page 1179: DIAGNOSIS AND TREATMENT
Page 1179: Neurogenic Thoracic Outlet Syndrome
Page 1180: Venous Thoracic Outlet Syndrome
Page 1181: Arterial Thoracic Outlet Syndrome
Page 1181: SURGICAL MANAGEMENT
Page 1181: Transaxillary Approach
Page 1183: Supraclavicular Approach
Page 1184: Infraclavicular Approach
Page 1184: Robot-Assisted Approach
Page 1184: SURGICAL OUTCOMES
Page 1184: CONCLUSION
Page 1185: Subchapter 200 Diabetic Foot
Page 1185: INTRODUCTION
Page 1185: CLASSIFICATION OF THE DIABETIC FOOT AND THREATENED LIMB
Page 1185: EVALUATION OF THE DIABETIC FOOT
Page 1185: Wound
Page 1186: Ischemia
Page 1187: Infection
Page 1187: Glycemic Control
Page 1187: TREATMENT OF THE DIABETIC FOOT
Page 1187: Wound
Page 1187: Ischemia
Page 1188: Infection
Page 1189: Glycemic Control
Page 1190: MULTIDISCIPLINARY MANAGEMENT, RESULTS OF TREATMENT, AND LONG-TERM PREVENTION
Page 1190: Subchapter 201 Gangrene of the Foot
Page 1190: INTRODUCTION
Page 1190: EPIDEMIOLOGY
Page 1190: CLINICAL EVALUATION
Page 1192: DIAGNOSTICS
Page 1192: Noninvasive Tests
Page 1192: Ankle-Brachial Index
Page 1192: Toe-Brachial Index
Page 1193: Segmental Limb Pressures
Page 1193: Fluorescence Angiography
Page 1193: Transcutaneous Oxygen Measurement
Page 1193: Imaging
Page 1193: Duplex Ultrasonography
Page 1193: Multidetector Computed Tomographic Angiography
Page 1193: Magnetic Resonance Angiography
Page 1193: Digital Subtraction Angiography
Page 1193: MANAGEMENT
Page 1193: Antibiotic and Medical Management
Page 1193: Debridement
Page 1194: Revascularization
Page 1194: Amputations
Page 1194: Toe Amputation
Page 1195: Transmetatarsal Amputation
Page 1195: Transtibial Amputation
Page 1195: Transfemoral Amputation
Page 1195: Cryoamputation
Page 1195: Other Amputations
Page 1196: SUMMARY
Page 1197: Subchapter 202 Buerger’s Disease (Thromboangiitis Obliterans)
Page 1197: INTRODUCTION/EPIDEMIOLOGY
Page 1197: PRESENTATION
Page 1197: DIAGNOSIS
Page 1198: TREATMENT
Page 1198: Tobacco Use Cessation
Page 1198: Medical/Adjunct Therapy
Page 1198: Surgical Therapy
Page 1199: PROGNOSIS
Page 1199: SUMMARY
Page 1200: Subchapter 203 Takayasu’s Arteritis
Page 1200: CLINICAL PRESENTATION
Page 1200: PATHOLOGY
Page 1201: THERAPY
Page 1201: SUMMARY
Page 1202: Subchapter 204 Acute Mesenteric Ischemia
Page 1202: ANATOMY
Page 1202: TREATMENT
Page 1202: OPEN INTERVENTIONS
Page 1202: OPEN EMBOLECTOMY
Page 1202: OPEN BYPASS
Page 1202: ANTEGRADE BYPASS
Page 1205: RETROGRADE BYPASS
Page 1205: RETROGRADE OPEN MESENTERIC STENTING
Page 1206: OPEN ENDARTERECTOMY
Page 1208: ENDOVASCULAR APPROACHES
Page 1208: POSTOPERATIVE CARE
Page 1209: LONG-TERM FOLLOW-UP
Page 1209: Subchapter 205 Chronic Mesenteric Ischemia
Page 1209: ETIOLOGY
Page 1209: DIAGNOSIS AND EVALUATION
Page 1210: REVASCULARIZATION OPTIONS
Page 1211: Endovascular Techniques
Page 1213: Hybrid Technique
Page 1213: Open Surgical Techniques
Page 1213: Endarterectomy
Page 1214: Bypass
Page 1214: Antegrade Bypass
Page 1215: Retrograde Bypass
Page 1216: OUTCOMES
Page 1217: Subchapter 206 Hemodialysis Access Surgery
Page 1217: HISTORICAL NOTES
Page 1218: NATIONAL PRACTICES AND GUIDELINES
Page 1219: PREOPERATIVE EVALUATION
Page 1219: OPERATIVE TECHNIQUES
Page 1219: Autogenous Arm Fistulas
Page 1219: Radiocephalic Fistula
Page 1220: Upper Arm Fistula
Page 1221: Prosthetic Arteriovenous Grafts
Page 1221: OPTIONS FOR NONCONVENTIONAL ACCESSES
Page 1221: The Hemodialysis Reliable Outflow Graft
Page 1221: Low-Volume Flow Access
Page 1221: Leg Access
Page 1222: CAUSES OF ACCESS FAILURE
Page 1222: Stenosis or Occlusion
Page 1222: Infection
Page 1222: Arteriovenous Access Steal
Page 1223: CONCLUSION
Page 1224: Subchapter 207 Venous Thromboembolism: Prevention, Diagnosis, and Treatment
Page 1224: INTRODUCTION/IMPACT
Page 1224: RISK FACTORS
Page 1224: PREVENTION AND PROPHYLAXIS
Page 1225: DIAGNOSIS
Page 1226: DEEP VENOUS THROMBOSIS TREATMENT
Page 1226: PULMONARY EMBOLISM TREATMENT
Page 1226: INFERIOR VENA CAVA FILTERS
Page 1227: CONCLUSION
Page 1227: Subchapter 208 Vena Cava Filters
Page 1227: INTRODUCTION
Page 1227: INDICATIONS FOR INFERIOR VENA CAVA FILTER PLACEMENT
Page 1230: FILTER SELECTION
Page 1230: Special Considerations: Suprarenal Inferior Vena Cava Filter
Page 1230: Contraindications for Placement of an Inferior Vena Cava Filter
Page 1231: TECHNIQUE
Page 1231: Preoperative Planning
Page 1231: Venography
Page 1232: Deployment
Page 1232: FILTER RETRIEVAL
Page 1233: FILTER COMPLICATIONS
Page 1233: Periprocedural Complications
Page 1233: Delayed Complications
Page 1234: DISCUSSION
Page 1234: Subchapter 209 Treatment of Varicose Veins
Page 1234: INTRODUCTION
Page 1234: CLASSIFICATION AND ETIOLOGY
Page 1235: DIAGNOSIS
Page 1235: Examination and Testing
Page 1235: Management of Deep Venous Reflux
Page 1235: MANAGEMENT OF SUPERFICIAL VENOUS REFLUX
Page 1235: Techniques
Page 1235: Thermal Endovenous Techniques
Page 1236: Radiofrequency Ablation of Truncal Veins
Page 1237: Endovenous Laser Ablation of Truncal Veins
Page 1238: Nonthermal Endovenous Techniques
Page 1238: Mechanochemical Ablation of Truncal Veins
Page 1238: Endovenous Closure with Cyanoacrylate Glue
Page 1239: Polidocanol Endovenous Microfoam
Page 1239: Perforator Vein Treatment Techniques
Page 1240: Considerations and Potential Complications of Endovenous Procedures
Page 1241: Open Surgical Techniques
Page 1241: Great Saphenous Vein High Ligation and Stripping
Page 1242: Small Saphenous Vein Ligation and Stripping
Page 1242: Ambulatory Phlebectomy
Page 1243: Sclerotherapy
Page 1243: Tips for Sclerotherapy
Page 1243: Treatment Planning and Conundrums
Page 1243: Unilateral Symptoms with Bilateral Pathology
Page 1245: Bilateral Symptoms with Unilateral Pathology
Page 1245: Isolated Segmental Disease
Page 1245: Restless Legs Syndrome
Page 1245: Tobacco Use, Coronary Artery Disease, and Peripheral Artery Disease
Page 1245: Simultaneous Versus Staged Procedures
Page 1245: Follow-up and Compression Recommendations
Page 1245: Postprocedure Thrombophlebitis
Page 1245: Future Technologies
Page 1246: CONCLUSION
Page 1246: Subchapter 210 Lymphedema
Page 1246: ETIOLOGY
Page 1247: DIAGNOSIS
Page 1247: CONSERVATIVE MANAGEMENT
Page 1248: SURGICAL TREATMENT
Page 1248: Physiologic Procedures
Page 1248: LVB
Page 1248: VLNT
Page 1249: Debulking Procedures
Page 1250: Combination of Procedures
Page 1251: SUMMARY
Page 1251: Subchapter 211 Lower Extremity Amputation
Page 1251: INDICATIONS
Page 1252: AMPUTATION TYPES
Page 1252: Minor Amputations
Page 1252: Major Amputations
Page 1252: SELECTION OF AMPUTATION
Page 1253: POSTOPERATIVE MANAGEMENT AND COMPLICATIONS
Page 1255: OUTCOMES
Page 1255: Postoperative Ambulation
Page 1255: Contralateral Amputation
Page 1255: Prosthesis
Page 1255: CONCLUSION
Page 1040: Suggested Readings
Page 1046: Suggested Readings
Page 1051: Suggested Readings
Page 1053: Suggested Readings
Page 1061: Suggested Readings
Page 1067: Suggested Readings
Page 1073: Suggested Readings
Page 1079: Suggested Readings
Page 1085: Suggested Readings
Page 1091: Suggested Readings
Page 1099: Suggested Readings
Page 1106: Suggested Readings
Page 1116: Suggested Readings
Page 1124: Suggested Readings
Page 1134: Suggested Readings
Page 1139: Suggested Readings
Page 1144: Suggested Readings
Page 1150: Suggested Readings
Page 1157: Suggested Readings
Page 1161: Suggested Readings
Page 1168: Suggested Readings
Page 1174: Suggested Readings
Page 1178: Suggested Readings
Page 1185: Suggested Readings
Page 1190: Suggested Readings
Page 1196: Suggested Readings
Page 1199: Suggested Readings
Page 1201: Suggested Readings
Page 1209: Suggested Readings
Page 1217: Suggested Readings
Page 1223: Suggested Readings
Page 1227: Suggested Readings
Page 1234: Suggested Readings
Page 1246: Suggested Readings
Page 1251: Suggested Readings
Page 1255: Suggested Reading
Page 1257: Section 18 – Trauma and Emergency Care
Page 1257: Subchapter 212 Initial Assessment and Resuscitation of the Trauma Patient
Page 1257: INTRODUCTION
Page 1258: PRIMARY SURVEY
Page 1258: Airway
Page 1258: Breathing
Page 1258: Circulation
Page 1259: Resuscitation
Page 1261: Definitive Hemorrhage Control
Page 1262: Disability
Page 1262: Exposure and Environment
Page 1262: SECONDARY ASSESSMENT
Page 1262: Imaging Adjuncts
Page 1262: Plain Radiography
Page 1262: Ultrasound
Page 1264: Computed Tomography
Page 1264: SUMMARY
Page 1265: Subchapter 213 Prehospital Management of the Trauma Patient
Page 1265: LEVELS OF PREHOSPITAL CARE DELIVERY
Page 1265: Basic Life Support—Spontaneous Responders
Page 1265: Basic Life Support—Emergency Medical Responders and Technicians
Page 1265: Advanced Life Support Personnel
Page 1265: Medical Direction
Page 1265: INITIAL PREHOSPITAL MANAGEMENT OF THE CRITICALLY INJURED PATIENT
Page 1266: Scene Assessment and Safety
Page 1266: Massive Hemorrhage Control
Page 1266: Airway Management
Page 1266: Respiratory Support
Page 1267: Circulation
Page 1267: Circulation: Use of Blood Products
Page 1267: Circulation: Tranexamic Acid and Calcium
Page 1268: Head Injury and Neurologic Concerns
Page 1268: Hypothermia
Page 1268: PREHOSPITAL PAIN MANAGEMENT
Page 1268: PREHOSPITAL TRIAGE
Page 1271: MODE OF TRANSPORTATION
Page 1272: EMS PATIENT HANDOFF
Page 1272: PREHOSPITAL TRAUMATIC ARREST
Page 1272: FUTURE DIRECTIONS
Page 1273: Subchapter 214 Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in Resuscitation of the Trauma Patient
Page 1273: INTRODUCTION
Page 1273: INDICATIONS
Page 1274: CONTRAINDICATIONS
Page 1275: RISKS
Page 1275: TECHNICAL POINTS
Page 1277: PITFALLS
Page 1278: COMPLICATIONS
Page 1278: CONCLUSION
Page 1278: Subchapter 215 Airway Management in the Trauma Patient
Page 1279: RAPID CLINICAL AIRWAY ASSESSMENT: INDICATIONS FOR MANAGEMENT
Page 1279: OXYGEN THERAPY AND AIRWAY ADJUNCTS
Page 1280: RAPID-SEQUENCE INDUCTION AND INTUBATION
Page 1281: ENDOTRACHEAL INTUBATION
Page 1282: SUPRAGLOTTIC AIRWAY DEVICES
Page 1282: AWAKE FIBER-OPTIC INTUBATION
Page 1283: AIRWAY MANAGEMENT DECISION MAKING
Page 1284: SURGICAL AIRWAY
Page 1285: Subchapter 216 Surgeon’s Use of Ultrasound in the Trauma and Critical Care Settings
Page 1285: INTRODUCTION
Page 1285: THE USE OF ULTRASOUND IN TRAUMA
Page 1285: FAST
Page 1285: Technique
Page 1286: Accuracy
Page 1288: Traumatic Hemothorax
Page 1288: Technique
Page 1288: Accuracy
Page 1288: Pneumothorax
Page 1288: Technique
Page 1288: Accuracy
Page 1289: Sternal Fracture
Page 1289: Technique
Page 1289: Special Situations
Page 1289: USE OF ULTRASOUND IN SURGICAL CRITICAL CARE
Page 1289: Pleural Effusion
Page 1290: Technique
Page 1290: Venous Interrogation for Deep Vein Thrombosis
Page 1290: Technique
Page 1290: Placement and Confirmation of Central Venous Lines
Page 1290: Technique
Page 1291: THE USE OF ULTRASOUND IN THE ASSESSMENT OF INTRAVASCULAR VOLUME AND CARDIAC FUNCTION
Page 1291: Assessment of Intravascular Volume Status Technique
Page 1291: FREE Technique
Page 1291: SUMMARY
Page 1294: Subchapter 217 Emergency Department Resuscitative Thoracotomy
Page 1294: OVERVIEW
Page 1295: ANTEROLATERAL THORACOTOMY
Page 1296: PERICARDIOTOMY AND CARDIORRHAPHY
Page 1297: NONCARDIAC-RELATED THORACIC HEMORRHAGE
Page 1297: AORTIC CROSS-CLAMPING
Page 1298: APPROACH TO OPEN CARDIAC MASSAGE
Page 1298: RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION OF THE AORTA
Page 1299: Subchapter 218 Management of Traumatic Brain Injury
Page 1299: INITIAL EVALUATION AND IMMEDIATE MANAGEMENT
Page 1301: MEDICAL MANAGEMENT
Page 1304: SURGICAL MANAGEMENT
Page 1305: OUTCOMES
Page 1306: Subchapter 219 Chest Wall Trauma, Hemothorax, and Pneumothorax
Page 1306: INITIAL EVALUATION
Page 1306: SPECIFIC INJURIES
Page 1306: Rib Fractures
Page 1307: Flail Chest
Page 1308: Surgical Stabilization of Rib Fractures
Page 1309: Sternal Fractures
Page 1309: Pneumothorax
Page 1309: Tension Pneumothorax
Page 1310: Open Pneumothorax
Page 1310: Occult Pneumothorax
Page 1310: Hemothorax
Page 1311: Retained Hemothorax
Page 1311: SPECIAL CONSIDERATIONS IN PEDIATRIC CHEST TRAUMA
Page 1312: Subchapter 220 Management of Pulmonary Parenchymal Injury
Page 1312: INITIAL EVALUATION
Page 1312: ANATOMY
Page 1312: SPECIFIC INJURIES
Page 1312: Pulmonary Contusion
Page 1313: Pulmonary Laceration
Page 1313: Traumatic Pneumatoceles
Page 1313: Pneumothorax
Page 1314: Hemothorax
Page 1314: TREATMENT
Page 1314: Nonoperative Treatment
Page 1314: Needle Decompression
Page 1314: Percutaneous Tube Thoracostomy
Page 1314: Open Tube Thoracostomy
Page 1315: Emergency Department Thoracotomy
Page 1315: Video-Assisted Thoracoscopic Surgery
Page 1316: Urgent/Delayed Thoracotomy
Page 1316: Thoracotomy: Specific Operative Strategies
Page 1317: CONCLUSION
Page 1317: Subchapter 221 Blunt Abdominal Trauma
Page 1317: DIAGNOSTIC AND IMAGING ADJUNCTS
Page 1317: Diagnostic Peritoneal Lavage
Page 1317: Focused Abdominal Sonography for Trauma
Page 1318: Computed Tomography
Page 1319: SPECIFIC CONSIDERATION FOR BLUNT TRAUMA
Page 1319: The Bowel
Page 1320: Radiographic Findings of Blunt Bowel Injury
Page 1320: Operative Management
Page 1321: The Spleen
Page 1321: Nonoperative Management
Page 1321: Splenectomy
Page 1322: Splenorrhaphy
Page 1322: Overwhelming Post-Splenectomy Infection
Page 1323: Hepatobiliary System
Page 1323: Approach to the Injured Liver
Page 1324: Intraoperative Decisions: General Principles
Page 1326: Juxtahepatic Venous Injuries
Page 1327: Porta Hepatis
Page 1327: Portal Vein
Page 1327: Hepatic Artery
Page 1327: Extrahepatic Biliary Ducts
Page 1327: ADVANCEMENTS AND ONGOING CONTROVERSY IN BLUNT ABDOMINAL TRAUMA MANAGEMENT
Page 1327: Resuscitative Endovascular Balloon Occlusion of the Aorta
Page 1329: Laparoscopy in Blunt Abdominal Trauma
Page 1330: CONCLUSION
Page 1330: Subchapter 222 Penetrating Abdominal Trauma
Page 1330: TRANSPORT
Page 1330: MANAGEMENT IN THE EMERGENCY DEPARTMENT
Page 1331: TIMING OF LAPAROTOMY IN BUSY TRAUMA CENTERS
Page 1331: PATIENTS WITHOUT CLEAR-CUT INDICATIONS FOR LAPAROTOMY
Page 1331: SELECTIVE MANAGEMENT OF PATIENTS WITH PENETRATING ABDOMINAL TRAUMA
Page 1331: Possible Penetrating Abdominal Trauma/Multiple Truncal and Extremity Wounds (Hemodynamically Unstable)
Page 1332: Possible Penetrating Thoracoabdominal Trauma (Hemodynamically Stable)
Page 1332: Penetrating Anterior Abdominal Stab Wound (Hemodynamically Stable)
Page 1333: Penetrating Anterior Stab Wound Away from Left Hemidiaphragm/Omental Evisceration (Hemodynamically Stable)
Page 1333: Penetrating Stab or Gunshot Wound to the Flank or Back (Hemodynamically Stable)
Page 1334: Gunshot Wound from Flank-to-Anterior/Anterior-to-Flank Abdominal Wall or Possibly Through-and-Through Anterior Abdominal …
Page 1334: Selective Nonoperative Management of Gunshot Wounds in Proximity to the Abdomen/Unknown if Penetrating (Hemodynamically Stable)
Page 1334: GENERAL PRINCIPLES OF TRAUMA LAPAROTOMY
Page 1335: SUMMARY
Page 1335: Subchapter 223 Management of Diaphragmatic Injuries
Page 1335: INTRODUCTION
Page 1335: EPIDEMIOLOGY
Page 1336: ANATOMY
Page 1337: DIAGNOSTIC WORKUP: BLUNT TRAUMA
Page 1337: DIAGNOSTIC WORKUP: PENETRATING TRAUMA
Page 1338: SURGICAL MANAGEMENT
Page 1340: PROGNOSIS
Page 1341: SUMMARY
Page 1341: Subchapter 224 Management of Traumatic Liver Injury
Page 1341: INTRODUCTION
Page 1341: INITIAL EVALUATION
Page 1342: NONOPERATIVE MANAGEMENT
Page 1343: OPERATIVE MANAGEMENT
Page 1346: MANAGEMENT AND COMPLICATIONS
Page 1346: CONCLUSION
Page 1347: Subchapter 225 Pancreatic and Duodenal Injuries
Page 1347: DUODENAL INJURIES
Page 1347: Management of Duodenal Injury
Page 1347: Grade I
Page 1347: Grade II
Page 1348: Grade III
Page 1348: Grade IV
Page 1348: Grade V
Page 1349: Operative Techniques for Repair of Duodenal Injury
Page 1349: Description of Cattell-Braasch Maneuver
Page 1350: Surgical Techniques for Duodenal Repair
Page 1350: Pyloric Exclusion or Antrectomy with Gastrojejunostomy
Page 1350: Roux-en-Y Duodenojejunostomy
Page 1350: Abdominal Drains and Intraluminal Drain Placement
Page 1351: Jejunostomy Tube or Gastrojejunostomy Tube
Page 1351: Techniques for Identification of Ampulla
Page 1351: Pancreatic Injury
Page 1351: Diagnosis
Page 1351: Management
Page 1351: Grade I and II Injuries
Page 1352: Grade III Injuries
Page 1352: Grade IV and V Injuries
Page 1352: SURGICAL EXPOSURE OF THE PANCREAS
Page 1352: Anterior Exposure
Page 1353: Posterior Exposure
Page 1353: Identification of the Pancreatic Duct
Page 1354: Distal Pancreatectomy
Page 1354: Combined Duodenal and Pancreatic Injuries
Page 1354: Whipple Procedure
Page 1355: OUTCOMES AND COMPLICATIONS
Page 1355: Duodenal Leak
Page 1355: Biliary Leak
Page 1355: Pancreatic Fistula
Page 1355: Delayed Gastric Emptying
Page 1355: Hemorrhagic Complications
Page 1355: CONCLUSION
Page 1356: Subchapter 226 Injuries to the Small and Large Bowel
Page 1356: INTRODUCTION
Page 1356: DIAGNOSTIC WORKUP
Page 1356: Blunt Injury
Page 1357: Penetrating Bowel Injuries
Page 1357: MANAGEMENT
Page 1358: SURGICAL TECHNIQUE
Page 1358: Small Bowel and Mesenteric Injuries
Page 1359: Large Bowel Injuries
Page 1359: Laparoscopic Evaluation
Page 1360: CONCLUSION
Page 1360: Subchapter 227 Current Management of Rectal Injury
Page 1360: INTRODUCTION
Page 1360: ANATOMIC CONSIDERATIONS
Page 1361: DIAGNOSIS
Page 1361: MANAGEMENT
Page 1361: Intraperitoneal Injury
Page 1361: Extraperitoneal Injury
Page 1362: Anorectal Injuries
Page 1362: COMPLICATIONS
Page 1362: Subchapter 228 Injured Spleen
Page 1363: NONOPERATIVE MANAGEMENT
Page 1363: Criteria of Patient Inclusion
Page 1363: Particulars of Nonoperative Management
Page 1364: Angioembolization of the Splenic Artery
Page 1365: Progression of Care
Page 1365: The Success of Nonoperative Management
Page 1365: SPLENORRHAPHY AND SPLENIC PRESERVATION
Page 1366: Argon Beam Coagulator
Page 1366: Absorbable Mesh Wrap
Page 1367: Fibrin Glue
Page 1367: Laparoscopy
Page 1367: POSTSPLENECTOMY VACCINATION
Page 1367: RECOMMENDATIONS
Page 1368: Subchapter 229 Renal and Ureteral Traumatic Injuries
Page 1368: RETROPERITONEAL EVALUATION
Page 1369: RENAL
Page 1369: Indications for Nonoperative Management
Page 1370: Indications for Interventional Radiologic Management
Page 1370: Surgical Indication
Page 1371: The Trauma Ex Lap—Renal Injury
Page 1371: Technique
Page 1371: Nephrectomy versus Renal Salvage
Page 1371: Technique
Page 1372: Complications
Page 1372: Outcomes
Page 1372: URETER
Page 1372: Indications
Page 1372: Indications for Ureteral Stent or Nephrostomy Tube Management
Page 1372: Surgical Indication
Page 1372: The Trauma Exploratory Laparotomy—Ureteral Injury
Page 1372: Open Technique
Page 1372: Proximal Ureter (Cephalad to Iliac Crest)
Page 1373: Midureter (Caudal to Iliac Crest, Cephalad to Sacroiliac)
Page 1373: Distal Ureter (Caudal to Sacroiliac)
Page 1373: The Delayed Ureteral Repair
Page 1373: Technique
Page 1375: Ureteral Injury (>10 cm)
Page 1376: Complications
Page 1376: Outcomes
Page 1377: Subchapter 230 Tenets of Damage Control
Page 1377: INTRODUCTION
Page 1377: PHASE I: PREOPERATIVE DAMAGE CONTROL
Page 1378: PHASE II: INTRAOPERATIVE DAMAGE CONTROL
Page 1378: Damage Control Laparotomy
Page 1378: Liver
Page 1378: Spleen
Page 1378: Kidneys
Page 1379: Pancreas
Page 1379: Viscera
Page 1379: DAMAGE CONTROL THORACIC SURGERY
Page 1380: DAMAGE CONTROL VASCULAR SURGERY
Page 1380: PHASE III: POSTOPERATIVE CARE AND ONGOING RESUSCITATION
Page 1380: Coagulopathy
Page 1380: Acidosis
Page 1380: DEFINITIVE REPAIR
Page 1381: CLOSING REMARKS
Page 1381: Subchapter 231 Early Management of Pelvic Ring Disruption
Page 1381: EARLY MANAGEMENT OF PELVIc FRACTURES
Page 1381: Mechanism of Injury in Pelvic Fractures
Page 1382: Relevant Patient History at the Time of Pelvic Trauma
Page 1382: IMMEDIATE ACTION SAVES LIVES: PRIMARY INTERVENTIONS
Page 1384: Physical Examination vs. Radiographs
Page 1385: Treatment of Open Pelvic Fracture Wounds
Page 1385: Traction Pins and Closed Reduction
Page 1386: Binder Removal
Page 1386: Role of Pelvic Angiography
Page 1386: Role of Pelvic Packing in Emergency Control of Pelvic Hemorrhage
Page 1386: Systematic Radiographic Evaluation
Page 1388: Classification of Pelvic Fractures
Page 1388: Role of External Fixation
Page 1389: Need for Definitive Surgical Stabilization of Pelvic Fractures
Page 1389: Hospital Admission in Pelvic Fracture
Page 1389: Definitive Nonoperative Pelvis Fracture Care
Page 1390: CONCLUSION
Page 1390: Subchapter 232 Urologic Complications of Pelvic Fracture
Page 1390: INITIAL EVALUATION
Page 1391: IMAGING
Page 1391: BLADDER INJURY
Page 1392: URETHRAL INJURY
Page 1392: CONCLUSION
Page 1393: Subchapter 233 Spine and Spinal Cord Injuries
Page 1393: INTRODUCTION AND EPIDEMIOLOGY
Page 1393: INITIAL EVALUATION AND MANAGEMENT
Page 1394: IMAGING
Page 1395: SELECTION OF SURGICAL CANDIDATES AND TIMING OF SURGERY
Page 1395: Cervical Spine
Page 1396: Thoracolumbar Spine
Page 1397: MEDICAL MANAGEMENT
Page 1397: Hemodynamic Support
Page 1397: Corticosteroids
Page 1398: Alternative Neuroprotective and Neuroregenerative Agents
Page 1398: COMPLICATIONS AND REHABILITATION
Page 1398: Rehabilitation After Acute Spinal Cord Injury
Page 1398: PROGNOSIS
Page 1399: Subchapter 234 Evaluation and Management of the Patient with Craniomaxillofacial Trauma
Page 1399: GENERAL CONCEPTS
Page 1400: EMERGENT MANAGEMENT OF CRANIOMAXILLOFACIAL TRAUMA
Page 1400: Airway
Page 1400: Hemorrhage
Page 1400: UPPER FACIAL INJURIES
Page 1401: TREATMENT OF UPPER FACIAL INJURIES
Page 1402: MIDFACIAL INJURIES
Page 1404: TREATMENT OF MIDFACE FRACTURES
Page 1404: Naso-Orbital-Ethmoid Fractures
Page 1405: Zygoma Fractures
Page 1405: Maxillary Fractures (Le Fort Patterns)
Page 1405: LOWER FACIAL INJURIES
Page 1405: TREATMENT OF MANDIBLE FRACTURES
Page 1406: SOFT TISSUE INJURIES
Page 1406: CERVICAL SPINE AND INTRACRANIAL INJURIES
Page 1406: CONCLUSION
Page 1407: Subchapter 235 Penetrating Neck Trauma
Page 1407: EMERGENCY AIRWAY CHALLENGES
Page 1408: HEMOSTASIS OF EXTERNAL BLEEDING
Page 1408: URGENT OPERATION IN NONBLEEDING PATIENTS
Page 1408: URGENT DIAGNOSTIC EVALUATION
Page 1408: NECK EXPLORATION VERSUS OBSERVATION
Page 1408: OPERATIVE EXPOSURE
Page 1409: REPAIR OF SPECIFIC INJURIES
Page 1409: Venous Injuries
Page 1409: Arterial Injuries
Page 1411: Esophageal Injury
Page 1411: Pharyngeal Injury
Page 1411: Tracheal and Cartilaginous Injuries
Page 1411: Thyroid Injuries
Page 1411: Miscellaneous Injuries
Page 1412: Subchapter 236 Blunt Cardiac Injury
Page 1412: INCIDENCE
Page 1412: MECHANISM OF INJURY AND PATHOPHYSIOLOGY
Page 1412: CLINICAL DIAGNOSIS OF BCI
Page 1412: BCI INJURY SEVERITY
Page 1412: TREATMENT OF BCI
Page 1412: Grade 1 Injury
Page 1412: Grade 2 Injury
Page 1412: Grade 3 Injury
Page 1414: Grade 4 Injury
Page 1414: Grade 5 BCI
Page 1416: COMMOTIO CORDIS
Page 1416: LONG-TERM FUNCTION AFTER BCI
Page 1416: ALGORITHM FOR DIAGNOSIS AND MANAGEMENT OF BCI
Page 1416: Subchapter 237 Abdominal Compartment Syndrome and Management of the Open Abdomen
Page 1417: INTRODUCTION AND PATHOPHYSIOLOGY
Page 1417: PREVENTION
Page 1417: DIAGNOSIS
Page 1417: Clinical Findings
Page 1417: Grading Severity and Measurement of Abdominal Pressure
Page 1419: SURGICAL INTERVENTION AND TECHNIQUE
Page 1419: Decompression of the Abdomen
Page 1419: Temporary Abdominal Closure
Page 1419: Skin-Only Closure
Page 1419: Silo and Vacuum Type Temporary Closure Methods
Page 1420: Abdominal Closure
Page 1420: Approach and Strategy
Page 1421: Primary Abdominal Closure
Page 1422: Retention Sutures
Page 1422: Progressive Closure Techniques
Page 1423: Tissue Rearrangement and Mesh: Hernia Repair Techniques to Achieve Closure
Page 1424: MANAGEMENT OF THE OPEN ABDOMEN IN THE INTENSIVE CARE UNIT
Page 1424: Nutritional Support
Page 1425: Fluid Management
Page 1425: Sedation and Analgesia
Page 1425: COMPLICATIONS
Page 1425: Risk Factors and Management Strategy
Page 1426: Enteroatmospheric Fistula
Page 1426: Early Management and Sepsis Control
Page 1427: Wound Care Techniques
Page 1427: Characterization of Fistula
Page 1427: CONCLUSION
Page 1429: Subchapter 240 Abdomen That Will Not Close
Page 1429: INDICATIONS FOR THE OPEN ABDOMEN
Page 1429: Abdominal Compartment Syndrome
Page 1429: Damage Control Surgery
Page 1429: Second-Look Laparotomy
Page 1429: Loss of Domain
Page 1429: Failure to Achieve Source Control
Page 1429: TEMPORARY CLOSURE TECHNIQUES
Page 1429: Short Term
Page 1431: Long Term
Page 1433: PERIOPERATIVE STRATEGIES FOR SUCCESS
Page 1434: SPECIAL CONSIDERATIONS
Page 1434: DEFINITIVE CLOSURE
Page 1434: CONCLUSION
Page 1435: Subchapter 241 Management of Vascular Injuries
Page 1435: INTRODUCTION
Page 1435: INITIAL EVALUATION AND PREPARATION
Page 1435: Evaluation and Stabilization
Page 1435: Diagnosis
Page 1436: Preparing the Operating Room
Page 1437: MANAGEMENT PRINCIPLES
Page 1437: Damage Control
Page 1437: Vessel Ligation
Page 1437: Temporary Vascular Shunts
Page 1437: Balloon Occlusion
Page 1438: Definitive Repair
Page 1439: Lower Extremity
Page 1439: Upper Extremity
Page 1439: Cervical Region
Page 1441: Torso
Page 1442: Abdomen and Pelvis
Page 1444: OTHER CONSIDERATIONS FOR VASCULAR INJURY MANAGEMENT
Page 1444: Vascular Conduits
Page 1446: Anticoagulation and Antiplatelet Use
Page 1446: Soft Tissue Coverage
Page 1446: Extremity Fasciotomy
Page 1447: Subchapter 242 Endovascular Management of Vascular Injuries
Page 1447: PREPAREDNESS
Page 1448: MANAGEMENT OF BLUNT THORACIC AORTIC INJURIES
Page 1449: PENETRATING AXILLOSUBCLAVIAN INJURIES
Page 1449: ENDOVASCULAR REPAIR OF TRACHEOINNOMINATE ARTERY FISTULA
Page 1449: RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION OF THE AORTA
Page 1451: ENDOVASCULAR MANAGEMENT OF INADVERTENT ARTERIAL PLACEMENT OF VENOUS CATHETERS
Page 1453: Subchapter 243 Extremity Compartment Syndrome
Page 1453: CAUSES OF COMPARTMENT SYNDROME
Page 1454: DIAGNOSIS
Page 1456: ARM COMPARTMENT DECOMPRESSION
Page 1456: FOREARM COMPARTMENT SYNDROME
Page 1456: THIGH COMPARTMENT SYNDROME
Page 1456: LEG COMPARTMENT DECOMPRESSION
Page 1457: SELECTIVE COMPARTMENT DECOMPRESSION
Page 1457: ANTERIOR COMPARTMENT SYNDROME
Page 1457: CHRONIC EXERTIONAL COMPARTMENT SYNDROME
Page 1457: HAND AND FOOT COMPARTMENT DECOMPRESSION
Page 1459: POSTOPERATIVE MANAGEMENT
Page 1460: Subchapter 244 Burn Wound Management
Page 1461: EVALUATION
Page 1461: Assessing the Patient and the Burn
Page 1462: Assessing the Need for Decompression
Page 1462: Electrical Injury
Page 1462: Child Abuse
Page 1463: OPERATIVE CARE OF THE BURN WOUND
Page 1463: Preparing the Wound Bed
Page 1463: Special Considerations
Page 1463: Placing the Skin Graft
Page 1463: Donor Sites
Page 1464: Scalp as a Donor Site
Page 1464: Dressings
Page 1464: SUMMARY
Page 1464: Subchapter 245 Medical Management of the Burn Patient
Page 1464: INTRODUCTION
Page 1464: Burn Care System
Page 1464: Burn Center Referral
Page 1465: PHYSIOLOGIC CHANGES
Page 1465: Early Physiology
Page 1465: Late Physiology
Page 1465: INITIAL EVALUATION
Page 1465: Evaluation of the Patient
Page 1465: Evaluation of the Wound
Page 1465: INITIAL WOUND CARE
Page 1465: Decompression
Page 1465: Topical Care
Page 1465: BURN EXCISION
Page 1465: Excision Philosophy and Basic Strategy
Page 1465: Excision Basic Technique
Page 1467: RESUSCITATION
Page 1467: General Strategy
Page 1467: Fluid Choice
Page 1467: End points and Monitoring
Page 1467: Management of Anasarca (ACS, Escharotomy Monitoring)
Page 1467: CRITICAL CARE
Page 1467: Practice of Burn Critical Care
Page 1468: LONG-TERM FOLLOW-UP
Page 1468: Reconstruction Philosophy
Page 1468: Laser Therapy
Page 1470: Subchapter 246 Cold-Induced Injuries and Hypothermia
Page 1470: INTRODUCTION
Page 1470: SYSTEMIC HYPOTHERMIA: NONLOCALIZED COLD-INDUCED INJURY
Page 1470: Signs and Symptoms
Page 1470: Physiologic Responses to Generate Heat and Conserve Core Body Temperature
Page 1471: Diagnosis and Treatment
Page 1471: Outcomes After Hypothermia
Page 1472: LOCALIZED NONFREEZING AND FREEZING COLD-INDUCED INJURY
Page 1472: Chilblains
Page 1472: Immersion Foot and Hand and Trench Foot
Page 1472: FROSTBITE
Page 1472: First-Degree Frostbite
Page 1473: Second-Degree Frostbite
Page 1473: Third- and Fourth-Degree Frostbite
Page 1473: Epidemiology
Page 1473: Pathophysiology
Page 1474: Diagnosis and Adjunct Imaging Studies
Page 1474: Medical Management of Frostbite
Page 1474: Surgical Management of Frostbite
Page 1474: OUTCOMES IN FROSTBITE
Page 1475: Subchapter 247 Electrical and Lightning Injury
Page 1475: EPIDEMIOLOGY
Page 1475: PHYSICS (AND PATHOPHYSIOLOGY) OF ELECTRICAL INJURY
Page 1475: Direct Injury (Electrical and Lightning)
Page 1476: ELECTRICITY BASICS
Page 1476: Current
Page 1476: Alternating Current
Page 1476: Direct Current
Page 1476: Voltage and Resistance
Page 1476: Voltage
Page 1476: Resistance
Page 1476: Joule’s Law
Page 1476: PHYSICS AND PATHOPHYSIOLOGY OF ELECTRICAL INJURY
Page 1478: Importance of Current Pathways
Page 1479: Indirect Injury
Page 1479: MANAGEMENT
Page 1480: PREHOSPITAL MANAGEMENT/SPECIAL CONSIDERATIONS
Page 1480: Critical Care Management
Page 1480: Multidisciplinary, System-Based Critical Care Management of the Electrical Injury Patient
Page 1480: Neurologic
Page 1480: Complications
Page 1480: Cardiac
Page 1480: Monitoring
Page 1480: Complications
Page 1480: Respiratory
Page 1482: Gastrointestinal
Page 1482: Renal
Page 1482: Complications
Page 1482: Infectious Disease
Page 1482: Musculoskeletal
Page 1482: Complications
Page 1482: Skin Complications
Page 1482: SURGICAL MANAGEMENT
Page 1482: Low-Voltage Injury Management
Page 1482: High-Voltage Injury Management
Page 1483: Scalp and Cranial Defects
Page 1483: Commissure Injuries (Pediatric)
Page 1484: Late Complications
Page 1264: Suggested Readings
Page 1272: Suggested Readings
Page 1278: Suggested Readings
Page 1284: Suggested Readings
Page 1294: Suggested Readings
Page 1299: Suggested Readings
Page 1305: Suggested Readings
Page 1311: Suggested Readings
Page 1317: Suggested Readings
Page 1330: Suggested Readings
Page 1335: Suggested Readings
Page 1341: Suggested Readings
Page 1346: Suggested Readings
Page 1355: Suggested Readings
Page 1360: Suggested Readings
Page 1362: Suggested Readings
Page 1368: Suggested Readings
Page 1377: Suggested Readings
Page 1381: Suggested Readings
Page 1390: Suggested Readings
Page 1393: Suggested Readings
Page 1398: Suggested Readings
Page 1406: Suggested Readings
Page 1411: Suggested Readings
Page 1416: Suggested Readings
Page 1428: Suggested Readings
Page 1435: Suggested Readings
Page 1447: Suggested Readings
Page 1452: Suggested Readings
Page 1459: Suggested Readings
Page 1464: Suggested Readings
Page 1469: Suggested Readings
Page 1475: Suggested Readings
Page 1484: Suggested Readings
Page 1485: Section 19 – Preoperative and Postoperative Care
Page 1485: Eras Protocols for General Surgery
Page 1485: INTRODUCTION
Page 1485: ERAS PATHWAY COMPONENTS
Page 1485: PREOPERATIVE CONSIDERATIONS
Page 1485: Preoperative Optimization of Comorbid Conditions
Page 1485: Prehabilitation
Page 1486: Patient and Family Education and Counseling
Page 1486: Avoidance of Prolonged Preoperative Fasting
Page 1486: Carbohydrate Loading
Page 1486: Bowel Preparation
Page 1486: Shortening the Duration of Ileus
Page 1486: Patient Selection for Ambulatory Surgery
Page 1487: INTRAOPERATIVE CONSIDERATIONS
Page 1487: Fast-Track Anesthetic Technique
Page 1487: Mechanical Ventilation
Page 1487: Goal-Directed Fluid Therapy and Hemodynamic Management
Page 1487: Nausea and Vomiting Prophylaxis
Page 1488: Procedure-Specific Pain Management
Page 1489: Venous Thromboembolism Prophylaxis
Page 1489: POSTOPERATIVE CONSIDERATIONS
Page 1489: Early Oral Nutrition and Avoidance of Fluid Overload
Page 1489: Early Mobilization
Page 1489: Nursing/Ancillary Support Considerations
Page 1489: POSTDISCHARGE CONSIDERATIONS
Page 1489: SUMMARY
Page 1491: Fluid and Electrolyte Therapy
Page 1491: FLUID COMPARTMENTS, DYNAMICS, AND OSMOLALITY
Page 1492: FLUID STATUS AND THE MANAGEMENT OF VOLUME THERAPY
Page 1492: Assessment of Fluid Status
Page 1493: Classes of IV Fluid Therapy
Page 1493: Maintenance Fluids and Daily Electrolyte Requirements
Page 1494: Resuscitative Fluids
Page 1494: Enhanced Recovery After Surgery (ERAS) Protocols and Fluid Management
Page 1494: DIAGNOSIS AND TREATMENT OF ELECTROLYTE DISORDERS
Page 1494: Sodium
Page 1494: Homeostasis and Clinical Significance
Page 1494: Hypernatremia
Page 1495: Hyponatremia
Page 1496: Potassium
Page 1496: Homeostasis and Clinical Significance
Page 1496: Hyperkalemia
Page 1496: Hypokalemia
Page 1496: Calcium
Page 1496: Homeostasis and Clinical Significance
Page 1496: Hypercalcemia
Page 1497: Hypocalcemia
Page 1497: Magnesium
Page 1497: Homeostasis and Clinical Significance
Page 1497: Hypermagnesemia
Page 1497: Hypomagnesemia
Page 1497: Phosphorus
Page 1497: Homeostasis and Clinical Significance
Page 1497: Hyperphosphatemia
Page 1497: Hypophosphatemia
Page 1498: SUMMARY
Page 1499: Common Pediatric Surgical Emergencies
Page 1499: INTRODUCTION
Page 1499: PHYSIOLOGY AND ANESTHESIA IN CHILDREN
Page 1499: Appendicitis
Page 1500: Pediatric Trauma
Page 1500: Pediatric Inguinal Hernias
Page 1501: Bilious Emesis and Malrotation
Page 1502: Necrotizing Enterocolitis
Page 1503: Pyloric Stenosis
Page 1503: Ileocolic Intussusception
Page 1504: SUMMARY
Page 1505: A Practical Approach to Surgery in the Frail Elderly
Page 1505: PREOPERATIVE ASSESSMENT
Page 1505: Frailty Assessment
Page 1505: The Edmonton Frail Scale
Page 1506: Clinical Frail Scale
Page 1506: The FRAIL Questionnaire
Page 1506: Prehabilitation
Page 1506: Goals of Care Discussion
Page 1507: OPERATIVE MODIFICATIONS FOR THE OLDER PATIENT
Page 1507: POSTOPERATIVE CARE
Page 1507: Team-Based/Interdisciplinary Care
Page 1508: Delirium Prevention, Detection, and Treatment
Page 1508: Maintaining Function and Preventing Deconditioning
Page 1509: PREPARING FOR DISCHARGE AND RETURNING HOME
Page 1510: SUMMARY
Page 1510: Perioperative Optimization
Page 1510: TYPE 2 DIABETES MANAGEMENT: THE GOAL OF PERIOPERATIVE EUGLYCEMIA
Page 1511: Recommendations
Page 1511: CARDIOVASCULAR DISEASE
Page 1512: Recommendations
Page 1512: FRAILTY, MOBILITY, AND PREHABILITATION
Page 1512: Recommendations
Page 1512: NUTRITIONAL STATUS
Page 1513: Recommendations
Page 1513: SARS-COV-2 AND PERIOPERATIVE OPTIMIZATION
Page 1513: Recommendations
Page 1514: CONCLUSION
Page 1514: Is Nasogastric Intubation Necessary After Alimentary Tract Surgery?
Page 1514: HISTORICAL PERSPECTIVE
Page 1515: FOREGUT AND PANCREATIC SURGERY
Page 1515: COLORECTAL SURGERY AND ERAS
Page 1515: EMERGENCY SURGERY AND NASOGASTRIC TUBES
Page 1515: COMPLICATIONS OF NASOGASTRIC TUBES
Page 1515: WHY ARE SURGEONS STILL ROUTINELY USING NASOGASTRIC TUBES?
Page 1516: CONCLUSION
Page 1516: Surgical Site
Infections
Page 1516: INTRODUCTION
Page 1516: EPIDEMIOLOGY
Page 1516: DEFINITION
Page 1516: RISK FACTORS
Page 1516: CLASSIFICATION
Page 1516: PREVENTION
Page 1521: TREATMENT
Page 1522: REMOTE MONITORING
Page 1522: SUMMARY
Page 1522: Management of Intraabdominal Infections
Page 1522: CLASSIFICATION
Page 1523: DIAGNOSIS
Page 1523: Presentation
Page 1523: Diagnostic Workup
Page 1524: MANAGEMENT
Page 1524: Resuscitation
Page 1524: Antimicrobial Therapy
Page 1525: Source Control
Page 1528: CONCLUSION
Page 1528: Epidemiology, Prevention, and Management of Occupational Exposure to Bloodborne Infections
Page 1528: INTRODUCTION
Page 1529: EPIDEMIOLOGY
Page 1530: PREVENTION
Page 1530: Management of Any Exposure to Bloodborne Infection
Page 1530: Postexposure Immediate Care
Page 1530: Cleansing the Affected Area
Page 1530: Management of an HIV Exposure
Page 1530: Testing the Source Patient
Page 1530: Postexposure Prophylaxis
Page 1530: Failures of Multidrug PEP Reported to the CDC through 2005
Page 1530: What about exposed pregnant/breastfeeding women?
Page 1530: Monitoring and Follow-up Care
Page 1531: Management of HBV Exposure
Page 1531: Prevention: HBV Vaccination (Figs. 1 and 2)
Page 1531: Immediate Management of Occupational Exposure to HBV
Page 1531: Management of HCV Exposure
Page 1533: Antifungal Therapy in the Surgical Patient
Page 1534: SPECIFIC FUNGI
Page 1534: Candida, Yeastlike Organisms, and Dimorphic Fungi
Page 1534: Candida
Page 1536: Other Yeastlike Organisms
Page 1537: Dimorphic Fungi
Page 1537: Aspergillus, Mucormycosis, and Molds
Page 1537: Aspergillus
Page 1537: Mucormycosis
Page 1537: Other Molds
Page 1537: ANTIFUNGAL AGENTS
Page 1537: Polyenes
Page 1538: Flucytosine
Page 1538: Echinocandins
Page 1538: Azoles
Page 1538: Fluconazole
Page 1538: Itraconazole
Page 1538: Voriconazole
Page 1538: Posaconazole
Page 1539: Isavuconazole
Page 1539: INVESTIGATIONAL AGENTS
Page 1539: COMMON FUNGAL INFECTIONS
Page 1539: Mucocutaneous Candidal Infections
Page 1539: Cutaneous Candidiasis
Page 1539: Oropharyngeal and Esophageal Candidiasis
Page 1539: Candidal Vulvovaginitis
Page 1540: Candiduria and Cystitis
Page 1540: INVASIVE FUNGAL INFECTIONS
Page 1540: Candidemia
Page 1540: Candidal Intraabdominal Fungal Infection
Page 1541: Surgical Site Infections
Page 1541: FUNGAL INFECTIONS COMPLICATING BURN PATIENTS
Page 1541: FUNGAL RHINOCEREBRAL AND PULMONARY INFECTIONS
Page 1541: Yeasts and Yeastlike Organisms
Page 1541: Molds
Page 1541: Aspergillosis
Page 1542: Mucormycosis
Page 1543: Use of Opioids in the Postoperative Period
Page 1543: THE OPIOID EPIDEMIC
Page 1543: OPIOID-RELATED ADVERSE EVENTS
Page 1543: NONOPIOID PAIN MANAGEMENT STRATEGIES
Page 1544: PREOPERATIVE EDUCATION AND ASSESSMENT OF PATIENT NEEDS
Page 1546: APPROPRIATE OPIOID PRESCRIBING
Page 1546: CHRONIC OPIOID USE AFTER SURGERY
Page 1546: DISPOSAL OF EXCESS OPIOID PILLS
Page 1548: METHODS TO DECREASE OPIOID PRESCRIBING
Page 1548: CONCLUSION
Page 1549: Management of Postoperative Delirium
Page 1549: INTRODUCTION
Page 1549: DEFINITION
Page 1549: DIAGNOSIS
Page 1550: RISK FACTORS
Page 1551: PRINCIPLES OF DELIRIUM PREVENTION
Page 1552: PRINCIPLES OF DELIRIUM MANAGEMENT
Page 1553: CONCLUSION
Page 1491: Suggested Readings
Page 1498: Suggested Readings
Page 1505: Suggested Readings
Page 1510: Suggested Readings
Page 1514: Suggested Readings
Page 1516: Suggested Readings
Page 1522: Suggested Readings
Page 1528: Suggested Readings
Page 1533: Suggested Readings
Page 1542: Suggested Readings
Page 1549: SUGGESTED READINGS
Page 1553: Suggested Readings
Page 1555: Section 20 – Surgical Critical Care
Page 1555: Subchapter 260 COVID-19 and Health Care Delivery in a Pandemic
Page 1555: BACKGROUND
Page 1555: PATHOPHYSIOLOGY AND CLINICAL MANIFESTATIONS
Page 1555: DIAGNOSIS
Page 1556: MANAGEMENT
Page 1558: POSTDISCHARGE, PERIOPERATIVE, AND HEALTH SYSTEMS CONSIDERATIONS
Page 1559: SUMMARY
Page 1559: Subchapter 261 Surgical Palliative Care
Page 1559: INTRODUCTION: WHAT AND WHY SURGEONS SHOULD KNOW ABOUT PALLIATIVE CARE
Page 1559: DEFINITION OF PALLIATIVE CARE
Page 1560: WHEN TO CALL A PALLIATIVE CARE CONSULT—THE “SURPRISE QUESTION”
Page 1561: DIFFERENCES BETWEEN PALLIATIVE CARE AND HOSPICE
Page 1563: SPECIFIC SPECIALIST PALLIATIVE CARE MEASURES THAT CAN HELP THE SURGICAL ONCOLOGIST
Page 1564: PALLIATIVE PROCEDURES PERFORMED NEAR THE END OF LIFE
Page 1564: Subchapter 262 Cardiovascular Pharmacology
Page 1564: INTRODUCTION
Page 1564: ANTIPLATELET AGENTS
Page 1564: Aspirin (ASA)
Page 1564: Clopidogrel
Page 1565: Prasugrel
Page 1565: Ticagrelor
Page 1565: Cangrelor
Page 1565: LIPID-LOWERING THERAPY
Page 1565: ANTICOAGULANTS
Page 1565: Heparin
Page 1566: Warfarin
Page 1566: Bivalirudin
Page 1566: Direct, Nonvitamin K, Oral Antagonists
Page 1566: MEDICATIONS THAT IMPACT CARDIAC RHYTHM
Page 1566: β-Adrenergic Receptor Antagonists
Page 1567: Amiodarone
Page 1567: Diltiazem
Page 1567: Digoxin
Page 1567: INHALED DRUGS THAT CAUSE PULMONARY VASODILATION
Page 1567: Nitric Oxide and Inhaled Prostacyclins
Page 1567: VASOACTIVE DRUGS
Page 1567: Epinephrine
Page 1568: Dopamine
Page 1568: Isoproterenol
Page 1568: Dobutamine
Page 1568: Milrinone
Page 1568: Norepinephrine
Page 1569: Vasopressin
Page 1569: Neo-Synephrine
Page 1569: Midodrine
Page 1569: Vasodilators
Page 1569: CONCLUSION
Page 1570: Subchapter 263 Glucose Control in the Postoperative Period
Page 1570: INDICATIONS
Page 1570: Stress-Induced Hyperglycemia
Page 1570: THE THREE DOMAINS OF GLYCEMIC CONTROL: HYPOGLYCEMIA, HYPERGLYCEMIA, AND GLYCEMIC VARIABILITY
Page 1571: Hyperglycemia
Page 1571: Hypoglycemia
Page 1571: Glycemic Variability
Page 1571: MANAGEMENT
Page 1571: Preoperatively
Page 1572: Intraoperatively
Page 1572: Postoperatively
Page 1573: CONCLUSION
Page 1573: Subchapter 264 Postoperative Respiratory Failure
Page 1573: INTRODUCTION
Page 1573: TYPES OF POSTOPERATIVE RESPIRATORY FAILURE
Page 1573: PREOPERATIVE RISK ASSESSMENT
Page 1574: PREVENTION OF PULMONARY COMPLICATION
Page 1574: INITIAL EVALUATION AND TREATMENT
Page 1575: Mechanical Ventilation
Page 1575: Delivery of Mechanical Ventilation
Page 1575: Modes of Mechanical Ventilation
Page 1575: Continuous Mandatory Ventilation and Assist Control
Page 1575: Synchronized Intermittent Mandatory Ventilation
Page 1576: Spontaneous Ventilation
Page 1576: Volume and Pressure Breaths
Page 1576: Volume Control Breaths
Page 1576: Pressure Control Breaths
Page 1576: Pressure-Regulated Volume Control Breaths
Page 1576: Pressure Support Ventilation Breaths
Page 1576: Airway Pressure Release Ventilation
Page 1576: ARDS
Page 1577: Lung Protective Ventilation
Page 1577: Permissive Hypercapnia
Page 1577: PEEP Titration
Page 1577: Driving Pressure
Page 1577: Prone Positioning
Page 1577: Neuromuscular Blockade
Page 1577: Conservative Fluid Management
Page 1578: Salvage Strategies in Refractory ARDS
Page 1578: Recruitment Maneuvers
Page 1578: Inhaled Pulmonary Vasodilators
Page 1578: Extracorporeal Membrane Oxygenation
Page 1579: Subchapter 265 Ventilator-Associated Pneumonia
Page 1579: INTRODUCTION
Page 1579: TERMINOLOGY/PATHOGENESIS
Page 1580: RISK FACTORS
Page 1580: PREVENTION
Page 1580: VAP Bundle and Early Extubation
Page 1580: Lung Protective Ventilation
Page 1580: Noninvasive Ventilation
Page 1580: DIAGNOSIS
Page 1580: Chest Radiographs
Page 1581: Sputum
Page 1581: Endotracheal/Tracheal Aspirates
Page 1581: Bronchioalveolar Lavage
Page 1581: TREATMENT
Page 1582: COVID-19
Page 1583: CONCLUSION
Page 1583: Subchapter 266 Extracorporeal Membrane Oxygenation for Respiratory Failure
Page 1583: BACKGROUND
Page 1583: ECMO: INDICATIONS AND CONTRAINDICATIONS
Page 1585: ECMO SYSTEM COMPONENTS
Page 1585: TECHNIQUE
Page 1587: INITIATION OF VENOVENOUS ECMO
Page 1587: MANAGEMENT
Page 1587: Neurologic
Page 1587: Respiratory
Page 1588: Cardiovascular
Page 1588: Gastrointestinal
Page 1588: Renal
Page 1588: Hematology
Page 1588: Infectious Disease
Page 1589: TROUBLESHOOTING
Page 1589: ECMO Flow Limitation (Chatter or Chugging)
Page 1589: Suck-Down Event with Flows Dropping <1.0 LPM (Extreme Form of Chatter)
Page 1589: Persistent Hypoxemia (PaO2 <55, SaO2 <85%)
Page 1589: Recirculation
Page 1589: VENOVENOUS ECMO WEANING
Page 1590: TERMINAL DECANNULATION
Page 1590: CONCLUSION
Page 1590: Subchapter 267 Tracheostomy
Page 1590: INTRODUCTION AND HISTORY
Page 1590: TRACHEAL ANATOMY
Page 1591: INDICATIONS, CONTRAINDICATIONS, AND TIMING
Page 1591: SURGICAL TRACHEOSTOMY
Page 1592: PERCUTANEOUS DILATATIONAL TRACHEOSTOMY
Page 1593: COMPLICATIONS
Page 1595: COMPARISON BETWEEN SURGICAL AND PERCUTANEOUS DILATATIONAL TRACHEOSTOMY
Page 1595: SUMMARY
Page 1596: Subchapter 268 Acute Kidney Injury in the Injured and Critically Ill
Page 1596: INTRODUCTION
Page 1596: EPIDEMIOLOGY
Page 1596: CLASSIFICATION AND STAGING OF AKI
Page 1597: ADQI and RIFLE
Page 1597: AKIN and KDIGO
Page 1598: AKI TRIGGERS
Page 1598: COVID-19
Page 1598: PATHOPHYSIOLOGY
Page 1598: AKI-Relevant Cellular Events
Page 1600: Biomarkers
Page 1601: PREVENTION OF AKI
Page 1601: Radiocontrast
Page 1601: Unplanned Care
Page 1603: Prophylaxis
Page 1603: MANAGEMENT STRATEGIES
Page 1603: Stage-Based Therapeutics
Page 1603: Bedside Imaging
Page 1603: Renally Relevant Laboratory Profiling
Page 1604: Therapeutic Agent Adjustment
Page 1604: Phenotypes and Therapeutic Agent Selection
Page 1604: Furosemide Stress Test and Prognostication
Page 1604: Renal Replacement Therapy (Renal Support Therapy)
Page 1606: Indications
Page 1606: RECOVERY AND OUTCOMES AFTER AKI
Page 1606: CONCLUSION
Page 1606: Subchapter 269 Acid-Base Disorders
Page 1607: HOMEOSTASIS AND BUFFERING SYSTEMS
Page 1607: Respiratory System
Page 1607: Renal System
Page 1607: ACID-BASE DISORDERS
Page 1607: APPROACH TO BLOOD GAS INTERPRETATION
Page 1607: STEPS TO ARTERIAL BLOOD GAS INTERPRETATION
Page 1608: METABOLIC ACIDOSIS
Page 1608: Anion Gap Metabolic Acidosis
Page 1608: Base Deficit
Page 1609: Nonanion Gap Metabolic Acidosis
Page 1609: METABOLIC ALKALOSIS
Page 1609: RESPIRATORY ACIDOSIS
Page 1609: RESPIRATORY ALKALOSIS
Page 1609: MIXED ACID-BASE DISORDERS
Page 1610: Subchapter 270 Catheter Sepsis in the Intensive Care Unit
Page 1610: INTRODUCTION
Page 1610: SURVEILLANCE DEFINITIONS
Page 1610: CRBSI and CLABSI
Page 1610: Incidence and Monitoring
Page 1610: INFECTION
Page 1610: Pathogenesis
Page 1610: Diagnosis
Page 1611: MANAGEMENT
Page 1611: Antibiotic Selection
Page 1611: Catheter Salvage versus Removal
Page 1612: INFECTION PREVENTION
Page 1612: Catheter Care Bundles
Page 1612: Selection of Catheter Site
Page 1613: Catheter Selection
Page 1613: Insertion
Page 1613: Maintenance
Page 1613: SUMMARY
Page 1614: Subchapter 271 Septic Response and Management
Page 1614: DEFINITION
Page 1615: DIAGNOSIS
Page 1615: TREATMENT
Page 1616: SUPPORTIVE TREATMENT ADJUNCTS
Page 1616: Ventilator Management
Page 1617: Blood Products
Page 1617: Corticosteroids
Page 1617: Glycemic Control
Page 1617: Renal Replacement Therapy
Page 1617: Nutrition
Page 1617: Chemical Prophylaxis
Page 1617: GOALS OF CARE
Page 1618: Subchapter 272 Multiple Organ Dysfunction and Failure
Page 1619: DYSFUNCTION AND FAILURE BY ORGAN SYSTEM
Page 1619: Neurologic
Page 1619: Cardiovascular
Page 1620: Pulmonary
Page 1621: Renal
Page 1622: Gastrointestinal and Hepatic
Page 1622: Endocrine and Metabolic
Page 1623: Hematologic, Including Disseminated Intravascular Coagulation
Page 1624: SPECIAL POPULATIONS
Page 1624: PALLIATIVE CARE AND ETHICS
Page 1624: SUMMARY
Page 1624: Subchapter 273 Antibiotics in Surgical Critical Care
Page 1625: HOSPITAL-ACQUIRED AND VENTILATOR-ASSOCIATED PNEUMONIA
Page 1627: COMMUNITY-ACQUIRED PNEUMONIA
Page 1628: ABDOMINAL SEPSIS
Page 1628: Gastrointestinal Tract
Page 1628: Treatment
Page 1629: Biliary
Page 1629: Treatment
Page 1629: Clostridioides difficile Colitis
Page 1630: Treatment
Page 1630: SURGICAL SITE INFECTIONS
Page 1630: Background
Page 1630: Treatment
Page 1630: NECROTIZING SOFT TISSUE INFECTIONS
Page 1631: VASCULAR ACCESS DEVICE–RELATED INFECTIONS
Page 1631: Background
Page 1631: Treatment
Page 1632: CATHETER-ASSOCIATED URINARY TRACT INFECTIONS
Page 1632: ANTIBIOTIC RESISTANCE
Page 1633: COVID-19
Page 1633: FUNGAL INFECTIONS
Page 1633: Background
Page 1633: Treatment
Page 1634: Subchapter 274 Endocrine Changes with Critical Illness
Page 1634: ADRENAL INSUFFICIENCY
Page 1635: HYPERGLYCEMIA
Page 1637: THYROIDAL DYSFUNCTION
Page 1639: Subchapter 275 Nutrition Therapy in the Critically Ill Surgical Patient
Page 1639: INTRODUCTION
Page 1640: CHANGES IN METABOLISM IN THE ACUTEly ILL OR SURGICAL PATIENT
Page 1640: MALNUTRITION
Page 1640: Biochemical Markers of Nutrition
Page 1640: Scoring Systems of Malnutrition
Page 1642: Barriers to Nutrition
Page 1642: DETERMINATION OF NUTRITIVE NEEDS
Page 1642: Protein
Page 1642: Lipids
Page 1644: Carbohydrates
Page 1644: ROUTES OF NUTRITION
Page 1644: Frequency and Formula of Tube Feeds
Page 1644: Total Parenteral Nutrition
Page 1645: SPECIAL CONSIDERATIONS
Page 1645: Refeeding Syndrome
Page 1645: Pancreatitis
Page 1645: Trauma/Burns
Page 1645: Open Abdomen
Page 1645: GI Surgery
Page 1645: Chyle Leaks
Page 1645: Enterocutaneous Fistula
Page 1646: Morbidly Obese
Page 1646: CONCLUSION
Page 1646: Subchapter 276 Coagulation Issues and the Trauma Patient
Page 1646: INTRODUCTION
Page 1646: OVERVIEW OF NORMAL HEMOSTASIS
Page 1646: TRAUMA-INDUCED COAGULOPATHY
Page 1648: CLINICAL ASSESSMENT OF TIC
Page 1650: MANAGEMENT OF TRAUMA-INDUCED COAGULOPATHY
Page 1650: Permissive Hypotension
Page 1650: Hypothermia, Acidosis, and Hypocalcemia
Page 1650: BLOOD PRODUCT MANAGEMENT
Page 1652: Fresh Whole Blood
Page 1652: Packed Red Blood Cells
Page 1653: Plasma
Page 1653: Fibrinogen Replacement
Page 1654: Platelets
Page 1654: Antiplatelet Medications
Page 1654: Anticoagulant Medications
Page 1654: Recombinant-Activated Factor VII
Page 1654: Tranexamic Acid
Page 1655: Desmopressin
Page 1655: Local Hemostatic Agents and Dressings
Page 1656: RECOMMENDED APPROACH TO TRAUMA-ASSOCIATED BLEEDING
Page 1656: TRAUMA-INDUCED COAGULOPATHY IN CHILDREN
Page 1657: Subchapter 277 Post–Intensive Care Syndrome
Page 1657: INTRODUCTION
Page 1657: PHYSICAL IMPAIRMENT
Page 1657: COGNITIVE IMPAIRMENT
Page 1658: PSYCHOLOGICAL IMPAIRMENT
Page 1658: PREVENTION OF PICS
Page 1658: Both Spontaneous Awakening Trials and Spontaneous Breathing Trials
Page 1658: Choice of Analgesia and Sedation
Page 1659: Daily Delirium Monitoring
Page 1659: Early Mobility and Exercise
Page 1659: Family Engagement and Empowerment
Page 1660: CAREGIVER BURDEN
Page 1660: POST-ICU CLINICS
Page 1660: ONGOING CLINICAL TRIALS
Page 1660: CONCLUSION
Page 1559: Suggested Readings
Page 1564: Suggested Readings
Page 1569: Suggested Readings
Page 1573: Suggested Readings
Page 1579: Suggested Readings
Page 1583: Suggested Readings
Page 1590: Suggested Readings
Page 1595: Suggested Readings
Page 1606: Suggested Readings
Page 1609: Suggested Readings
Page 1614: Suggested Readings
Page 1618: Suggested Readings
Page 1624: Suggested Readings
Page 1634: Suggested Readings
Page 1638: Suggested Readings
Page 1646: Suggested Readings
Page 1656: Suggested Readings
Page 1660: Suggested Readings
Page 1663: Index
Page 1699: IBC

Current Surgical Therapy – Andrew Cameron

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