Surgical Anatomy and Technique (eBook)

Preface to the Third Edition 6
Acknowledgments 8
Contents 9
Contributors 11
Skin, Scalp, and Nail 14
Anatomy 14
SKIN AND SUBCUTANEOUS TISSUE (Fig. 1.1) 14
SCALP 15
NAIL 19
Technique 20
BENIGN SKIN LESIONS (Figs. 1.7–1.9) 20
MALIGNANT SKIN LESIONS (Figs. 1.10 and 1.11) 21
SENTINEL LYMPH NODE BIOPSY 23
SKIN GRAFTS 23
SCALP SURGERY 24
INGROWN TOENAIL 27
Neck 30
Anatomy 30
ANTERIOR CERVICAL TRIANGLE (Fig. 2.1) 30
POSTERIOR CERVICAL TRIANGLE (Fig. 2.7) 36
FASCIAE OF THE NECK 38
SPACES OF THE NECK 41
LYMPHATICS OF THE NECK/RIGHT AND LEFT THORACIC DUCTS 41
ANATOMY OF THE THYROID GLAND 45
ANATOMY OF THE PARATHYROID GLANDS 54
ANATOMY OF THE TRACHEA 55
PAROTID GLAND (FIG. 2.21) 56
IDENTIFICATION OF THE FACIAL NERVE 59
BRANCHIAL CLEFT SINUSES AND CYSTS 60
Technique 65
MASSES OF THE NECK 65
PAROTIDECTOMY 65
RESECTION OF SUBMAXILLARY GLAND ( Figs. 2.1 Ò 2.6 ) 70
EXCISION OF STONE FROM WHARTONÌS DUCT 73
THYROIDECTOMY AND PARATHYROIDECTOMY 73
THYROID REOPERATION 83
PARATHYROID REOPERATION 84
THYROGLOSSAL DUCT CYSTECTOMY (Fig. 2.53) 85
EXCISION OF BRANCHIAL CLEFT CYST OR FISTULA 89
RADICAL NECK DISSECTION 91
TRACHEOSTOMY 101
Breast 105
Anatomy 105
GENERAL DESCRIPTION OF THE BREAST 105
DEEP FASCIA 105
AXILLA 107
MUSCLES AND NERVES 107
MORPHOLOGY OF THE BREAST 107
VASCULAR SYSTEM OF THE BREAST 108
SURGICAL ANATOMY OF MASTECTOMY 114
Technique 116
BREAST BIOPSY 116
MODIFIED RADICAL MASTECTOMY 117
LUMPECTOMY WITH SENTINEL LYMPH NODE BIOPSY AND AXILLARY DISSECTION 123
Abdominal Wall and Hernias 125
Anatomy 125
GENERAL DESCRIPTION OF THE ANTERIOR ABDOMINAL WALL 125
UMBILICAL REGION 127
LAYERS OF THE LOWER ANTERIOR BODY WALL 129
FOSSAE OF THE LOWER ANTERIOR ABDOMINAL WALL ( Fig. 4.5 ) 129
ANATOMICAL ENTITIES OF THE GROIN 130
BLOOD SUPPLY OF THE ANTERIOR ABDOMINAL WALL 143
NERVE SUPPLY OF THE ANTERIOR ABDOMINAL WALL 144
PANORAMA OF LAPAROSCOPIC CADAVERIC ANATOMY OF THE INGUINAL AREA ( Figs. 4.21 – 4.36 ) 147
GENERAL DESCRIPTION OF THE POSTERIOR ( LUMBAR) BODY WALL 157
Technique 160
INCISIONS OF THE ANTERIOR ABDOMINAL WALL 160
INCISIONAL HERNIAS 167
EPIGASTRIC HERNIA (HERNIA THROUGH THE LINEA ALBA) 172
UMBILICAL HERNIA 174
SPIGELIAN (LATERAL VENTRAL) HERNIA 175
Groin Hernias 180
Non-Mesh Groin Hernia Repairs 180
INDIRECT INGUINAL HERNIA 180
SLIDING INDIRECT INGUINAL HERNIA 184
DIRECT INGUINAL HERNIA 186
CONDON PROCEDURE (ANTERIOR ILIOPUBIC TRACT REPAIR) 187
SHOULDICE TECHNIQUE 188
RELAXING INCISION (FIG. 4.71) 190
EXTERNAL SUPRAVESICAL HERNIA 191
FEMORAL HERNIA 191
Mesh Groin Hernia Repairs: Posterior Approach 198
NYHUS PROCEDURE (PREPERITONEAL APPROACH) 198
RECURRENT HERNIAS: INGUINAL AND FEMORAL 201
KUGEL HERNIA REPAIR (PREPERITONEAL PATCH) 201
STOPPA PROCEDURE 205
LAPAROSCOPIC INGUINAL HERNIA REPAIR 206
Mesh Groin Hernia Repairs: Anterior Approach 213
LICHTENSTEIN TENSION-FREE HERNIORRHAPHY 213
GILBERT SUTURELESS MESH-PLUG REPAIR 214
BARD PLUG AND PATCH REPAIR 216
Other Repairs 220
HYDROCELE 220
LUMBAR HERNIA REPAIR (DOWD-PONKA) 221
Diaphragm 224
ANATOMY 224
CRURA 224
OPENINGS OF THE DIAPHRAGM 225
DIAPHRAGMATIC-MEDIASTINAL RELATIONS 230
VASCULAR SYSTEM OF THE DIAPHRAGM 231
NERVE SUPPLY OF THE DIAPHRAGM 235
STRUCTURES AT OR NEAR THE ESOPHAGEAL HIATUS ( FIG. 5.15 ) 236
Technique 238
DIAPHRAGMATIC HERNIA 238
LAPAROSCOPIC NISSEN FUNDOPLICATION 249
Esophagus 256
Anatomy 256
GENERAL DESCRIPTION OF THE ESOPHAGUS 256
TOPOGRAPHY AND RELATIONS OF THE ESOPHAGUS 257
GASTROPHRENIC LIGAMENT (SEE CHAPTER 7, STOMACH) 266
Technique 271
PHARYNGOESOPHAGEAL DIVERTICULUM 271
ACHALASIA OR CARDIOSPASM 274
TRANSHIATAL ESOPHAGECTOMY 274
IVOR LEWIS APPROACH 288
OTHER APPROACHES (SUMMARIZED) 293
COLON INTERPOSITION 293
Stomach 296
Anatomy 296
TWO GASTRIC UNITS 296
GASTRIC WALL 299
LIGAMENTS 299
VASCULAR SYSTEM OF THE STOMACH (FIG. 7.3) 300
PARASYMPATHETIC NERVES (VAGUS NERVES) 301
SYMPATHETIC NERVES 305
Technique 306
GASTROSTOMY 306
GASTROJEJUNOSTOMY 307
PERFORATED ULCERS 311
PYLORIC STENOSIS (FIG. 7.19) 314
PYLOROPLASTY 314
GASTRECTOMIES 316
VAGOTOMIES 338
Duodenum 344
Anatomy 344
GENERAL DESCRIPTION OF THE DUODENUM 344
VASCULAR SYSTEM OF THE DUODENUM 347
NERVE SUPPLY OF THE DUODENUM 349
Technique 351
SURGICAL APPLICATIONS 351
EXPOSURE AND MOBILIZATION OF THE DUODENUM ( FIGS. 8.9 – 8.11) 352
REPAIR OF VASCULAR COMPRESSION 355
OF DUODENUM (FIGS. 8.2 AND 8.12–8.16) 355
Pancreas 358
Anatomy 358
GENERAL DESCRIPTION OF THE PANCREAS 358
PARTS OF THE PANCREAS 359
PANCREATIC DUCTS 363
VASCULAR SYSTEM OF THE PANCREAS 366
NERVE SUPPLY OF THE PANCREAS 368
ECTOPIC AND ACCESSORY PANCREAS 369
Technique 370
EVALUATION OF RESECTABILITY OF THE PANCREAS 370
EXPLORATION OF THE PANCREAS 370
PUESTOW PROCEDURE 371
PANCREATECTOMIES 376
TRANSDUODENAL PANCREATIC BIOPSY 389
DRAINAGE OF PANCREATIC PSEUDOCYST 390
PANCREATIC TRAUMA 397
Small Intestine 399
Anatomy 399
GENERAL DESCRIPTION OF THE SMALL INTESTINE 399
VASCULAR SYSTEM OF THE SMALL INTESTINE 401
ABNORMAL DEVELOPMENT OF THE SMALL INTESTINE 403
SURGICAL ANATOMY OF INTUSSUSCEPTION 404
ANATOMIC GUIDELINES FOR SURGERY 405
Technique 406
RESECTION OF SMALL BOWEL FOR TUMOR 406
MECKEL’S DIVERTICULUM ( ORIENTATION FIG. 10.5 ) 408
INTUSSUSCEPTION (ORIENTATION FIG. 10.7) 409
WITZEL JEJUNOSTOMY 409
FEEDING JEJUNOSTOMY 412
Appendix 413
Anatomy 413
RELATIONS AND POSITIONS OF THE APPENDIX 413
MESENTERY 413
VASCULAR SYSTEM OF THE APPENDIX 413
Technique 416
APPENDECTOMY 416
LAPAROSCOPIC APPENDECTOMY 422
Colon and Anorectum 424
Anatomy 424
GENERAL DESCRIPTION OF COLON AND ANORECTUM 424
LAYERS OF WALL OF LARGE INTESTINE 429
PERITONEAL REFLECTIONS 433
FASCIAL RELATIONS AND TISSUE SPACES 434
PELVIC DIAPHRAGM AND CONTINENCE 434
VASCULAR SYSTEM OF THE COLON AND RECTUM 436
NERVE SUPPLY OF THE RECTUM AND ANUS 445
Technique 447
DECALOGUE OF GOOD COLON SURGERY 447
CECOPEXY 447
CECOSTOMY 447
COLON RESECTION 456
GENERAL PRINCIPLES OF LAPAROSCOPIC HAND- ASSISTED COLECTOMY 474
LAPAROSCOPIC COLECTOMIES 475
PROCEDURES OF THE SURGICAL ANAL CANAL AND PERIANAL REGIONS 484
Liver 505
Anatomy 505
TOPOGRAPHIC ANATOMY OF THE LIVER 505
PERITONEAL REFLECTIONS AND LIGAMENTS OF THE LIVER 506
MORPHOLOGY OF THE LIVER 508
ANOMALIES 512
VASCULAR SYSTEM OF THE LIVER 513
PERIHEPATIC SPACES 519
Technique 525
NEEDLE BIOPSY 525
EXCISIONAL BIOPSY 525
HEPATIC RESECTIONS 527
Extrahepatic Biliary Tract 540
Anatomy 540
RIGHT, LEFT, AND COMMON HEPATIC DUCTS 540
ANOMALOUS HEPATIC DUCTS: SURGICALLY SIGNIFICANT SOURCES OF BILE LEAKAGE ( FIG. 14.3) 540
CYSTIC DUCT 542
GALLBLADDER 542
COMMON BILE DUCT 543
HEPATOCYSTIC TRIANGLE AND TRIANGLE OF CALOT 545
VASCULAR SYSTEM OF THE EXTRAHEPATIC BILIARY TRACT 548
Technique 552
CHOLECYSTECTOMY 552
OPERATING ROOM CHOLANGIOGRAM 556
COMMON BILE DUCT EXPLORATION 558
SPHINCTEROPLASTY 567
CHOLEDOCHODUODENOSTOMY 567
CHOLEDOCHAL CYSTECTOMY 572
LAPAROSCOPIC CHOLECYSTECTOMY 573
Spleen 580
Anatomy 580
GENERAL DESCRIPTION OF THE SPLEEN 580
CHIEF SPLENIC LIGAMENTS 580
MINOR SPLENIC LIGAMENTS 581
VASCULAR SYSTEM OF THE SPLEEN 585
SEGMENTAL ANATOMY 586
ACCESSORY SPLEENS 586
Technique 590
SPLENECTOMY 590
OCCLUSION OF THE SPLENIC ARTERY 598
LAPAROSCOPIC SPLENECTOMY 600
Adrenal Glands 609
Anatomy 609
GENERAL DESCRIPTION OF THE ADRENAL GLANDS 609
RELATIONS OF THE ADRENAL GLANDS 609
VASCULAR SYSTEM OF THE ADRENAL GLANDS 611
Technique 613
ADRENALECTOMIES 613
LAPAROSCOPIC ADRENALECTOMY 625
Vascular System 637
Anatomy 637
ANATOMY FOR CAROTID ENDARTERECTOMY 637
ANATOMY FOR ABDOMINAL AORTIC ANEURYSM REPAIR 637
ANATOMY FOR LOWER EXTREMITY BYPASS 638
Technique 641
CAROTID ENDARTERECTOMY 641
ELECTIVE INFRARENAL ABDOMINAL AORTIC ANEURYSM REPAIR 647
FEMOROPOPLITEAL BYPASS, BELOW KNEE, WITH SAPHENOUS VEIN 651
Uterus, Tubes, and Ovaries 658
Anatomy 658
RELATIONS AND POSITIONS OF THE UTERUS, TUBES, AND OVARIES 658
VASCULAR SYSTEM OF THE UTERUS, TUBES, AND OVARIES 659
Technique 660
ABDOMINAL HYSTERECTOMY AND BILATERAL SALPINGO- OOPHORECTOMY 660
Carpal Tunnel 669
Anatomy 669
Technique 677
SURGICAL TREATMENT OF CARPAL TUNNEL SYNDROME 677
Microsurgical Procedures 681
Anatomy 681
INTRODUCTION 681
MICROSURGICAL INSTRUMENTATION 681
METHODS OF MAGNIFICATION 682
PSYCHOMOTOR SKILLS TRAINING 682
SURGICAL SETUP 683
SUTURE MATERIALS 683
PROCEDURE FOR VASCULAR REPAIR 683
PROCEDURE FOR NERVE REPAIR 686
PROCEDURE FOR NEUROENTUBULATION 687
SUMMARY 688
Index 689