list of products - springer978-1-4899-6621-6/1.pdf · postoperative care, 367 preoperative...
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List of products
Allis' clamps, Codman, Massachusetts, USA
Babcock's forceps, Codman, Massachusetts, USA
Dacron, Du Pont, Wilmington, USA Dexon, Davis & Geck, Gosport, UK/Davis & Geck International, c/o
Cyanamid International, Wayne, New Jersey, USA
EEA stapler, Auto Suture Co. UK, Ascot, UK/US Surgical Corporation, Connecticut, USA
Endo-Babcock, Auto Suture Co. UK, Ascot, UK/US Surgical Corporation, Connecticut, USA
Endo·Retract, Auto Suture Co. UK, Ascot, UK/US Surgical Corporation, Connecticut, USA
Ethibond, Ethicon, Edinburgh, UK!Ethicon Inc, Somerville, New Jersey, USA
Gastrografin, Schering Health Care, UK GIA stapler, Auto Suture Co. UK, Ascot, UK/US Surgical Corporation,
Connecticut, USA
U.S stapler, Ethicon Endosurgery, Edinburgh, UK!Ethicon Endosurgery, Cincinatti, Ohio, USA
Ligaclip, Ethicon Endosurgery, Edinburgh, UK!Ethicon Endosurgery, Cincinatti, Ohio, USA
Marlex, C P Bard, Massachusetts, USA Maxon, Davis & Geck, Gosport, UK!Davis & Geck International, c/o
Cyanamid International, Wayne, New Jersey, USA Mousseau-Barbin tube, Porges Catheter Corporation, New York, USA
Prolene, Ethicon, Edinburgh, UK!Ethicon Inc, Somerville, New Jersey, USA
Rigiflex dilator, Rigiflex Inc, Belmont, Massachusetts, USA
Satinsky clamp, Codman, Massachusetts, USA SGIA 50 stapler, Auto Suture Co. UK, Ascot, UK/US Surgical
Corporation, Connecticut, USA Shaw scissors, Hemostatic Surgery Corporation, San Francisco, USA
TA 55 stapler, Auto Suture Co. UK, Ascot, UK/US Surgical Corporation, Connecticut, USA
TA 90 stapler, Auto Suture Co. UK, Ascot, UK/US Surgical Corporation, Connecticut, USA
Thoracoports, Auto Suture Co. UK, Ascot, UK/US Surgical Corporation, Connecticut, USA
Vicryl, Ethicon, Edinburgh, UK!Ethicon Inc, Somerville, New Jersey, USA
607
Index
Abdominal fundoplication, 294-300 Abdominal incisions, 70-8
choice of, 71-2 exposure, 74-5 haemostasis, 72 method, 72 midline incision, 7 3 paramedian incision, 73 preoperative preparation; 72 principles and justification, 70 subcostal incision, 74 wound closure, 75-8
knots, 75-7 single-layer or mass closures, 77 suture materials, 77 two-layer closures, 78
wound protection/infection, 72 Abdominal vagotomy, see Vagotomy Achalasia
abdominal myotomy, 267-75 anaesthesia, 268 assessment, 268 history, 267 indications, 268 operation, 269-75
anterior partial fundoplication, 274-5 approximation ·of crura, 273 exposure of gastro-oesophageal
junction, 270 incision, 269 mobilization ofleft lobe ofliver, 269 mobilization of oesophagus, 270 myotomy, 271-3 wound closure, 275
outcome, 275 patient preparation, 268 postoperative care, 275 preoperative preparation, 268 principles and justification, 268
thoracic myotomy, 262-6 anaesthesia, 263 complications, 266 diagnosis, 263 history, 262 operation, 263-5 outcome, 266 postoperative care, 266 preoperative preparation, 263 principles and justification, 262
videoendoscopic surgery, 593-600 anaesthesia, 595 complications, 600 operations, 595-9
laparoscopic Heller myotomy, 598-9 thoracoscopic Heller myotomy, 596- 8
postoperative care, 599 preoperative preparation, 594-5
clinical, 594 endoscopy, 594 manometry, 595 radiology, 594
principles and justification, 59 3
Afferent limb syndrome, 412 Alcoholism, 513 Alkaline reflux gastritis, 391,413 Anaesthesia
achalasia abdominal myotomy, 268 thoracic myotomy, 263 videoendoscopic surgery, 595
extrarnucosal enucleation of oesophageal leiomyoma, 2 3 7
gastric restriction surgery, 550 intrathoracic fundoplication, 322 left posterolateral thoracotomy, 56 oesophageal perforation, 249 oesophageal replacement, stomach, 143 oesophageal strictures, resection of, 345 oesophageal varices, stapling procedures,
516 oesophagectomy
abdominal-right thoracic approach, 52 left thoracoabdominal approach, 62 transhiatal, 198
oesophagogastrectomy, 282 pyloroplasty, 395 rigid oesophagoscopy, 22 ulcer surgery, 482, 532
Anastomosis cervical
gastro-oesophageal, 207-9 left thoracic subtotal oesophagectomy,
194 duodenojejunal, 546 gastric
hand-sewn technique, 88-107,459-60 stapled, 108-19
gastroduodenal, 99-101,489-90 see also Billroth I gastrectomy
gastrojejunal, 103-7 Billroth II, 101-2
stapled, 116-17 Roux-en-Y, 101
gastric reconstruction, 163,433 transmesocolic, 339
stapled, 430-2 anastomotic reconstruction, 431 closure of mesocolon, 432 closure of stapler defect, 432 stapler application, 431
sutured, 429-30 anterior portion of anastomosis, 429 completion of anastomosis, 430 posterior inner suture, 429
gastro-oesophageal, 112-15 hand-sewn, gastric, 88-107 jejunogastric, 348 jejunojejunal, 411
end-to-side, 90-2 gastric reconstruction, 158-9 Roux-en-Y, 110-11 stapled, 159 terrninolateral, 3 39
laparoscopic gastroenterostomy, 578-82
Anastomosis- continued ·oesophageal
leakage, 41 stapled, 84-7 sutured, 79-83
oesophageal replacement small intestine, 12 3-5 stomach, 150-2
oesophagojejunal, 108-11 gastric reconstruction, 160-2 oesophageal stricture resection, 348 stapled, 108-11, 162
portacaval end-to-side, 508-9 side-to-side, 506-8
stapled gastric, 108-19 gastrojejunal, 101-2, 116-17 Heineke-Mikulicz pyloroplasty, 118 oesophageal, 84-7 oesophagojejunal, 108-11, 162
sutured, oesophageal, 84-7 see also Shunts, portasystemic
Anatomical repair for uncomplicated gastrooesophageal reflux, 311
Anatomy oesophagus, 256-61
anatomical relations, 256-7 blood supply, 258 cervical, 170-2 mobilization of distal oesophagus,
259-60 musculature, 258 nerve supply, 259 oesophageal hiatus, 260-1 phreno-oesophagealligarnent, 259
stomach fundus, 256-61 as oesophageal replacement, 143
vagus nerves, 354-9 abdominal, 356 angle of His, 359 anterior divisions, 3 57 central vagus complex, 355 cervical, 355 coeliac branches, 358 'criminal' nerve of Grassi, 359 distal oesophageal plexus, 358 gastric branches
anterior, 357 posterior, 358
gastroepiploic vagal innervation, 359 hepatic branches, 357 nerves of Latarjet
anterior, 357 crow's foot, 359 posterior, 358
posterior divisions, 358 thoracic, 356
Angelchikcollar, 311-12 Angle of His, 359 Antecolic gastrojejunostomy, 407-8
609
610 Index
Anterior gastropexy, 279 Antibiotic cover
left thoracoabdominal oesophagectomy, 62 oesophageal perforation, 248 oesophageal strictures, 30
Antiperistaltic jejunal interposition loop, 392 Antireflux surgery, 292-3
complicated gastro-oesophageal reflux, 350-3
antral patch, 351-2 fundic patch, 350-1 Schatzki's ring, 352-3
paraoesophageal hiatus hernia, 276 rationale for
contrast studies, 293 endoscopy, 292-3 histology, 293 objective assessment, 292-3 oesophageal manometry, 293 pH monitoring, 293 symptoms, 292
reoperative, 316-19 incision, 317-18 outcome, 319 principles and justification, 316
Roux-en-Y diversion and fundoplication, 335-44
anastomosis jejunojejunal terminolateral, 339 Roux-en-Y gastrojejunal
transmesocolic, 339 antireflux procedure, 338 antrectomy, 339 complications, 368 duodenal diversion
after partial gastrectomy, 341 after previous partial gastro
oesophagectomy, 342 after total gastrectomy, 343 after total gastro-oesophagectomy and
colonic interposition replacement, 343
history, 335 indications, 335 normal technique, 336-9 outcome, 368 postoperative care, 367 preoperative preparation, 335 vagotomy, 336-7
problems of, 340-1 hiatal opening difficult or dangerous
to reach, 340-1 hiatal opening easily reached but
vagotomy difficult, 340 thoracic approach, 301-6
Belsey Mark IV procedure, 302-6 history, 30 1 outcome, 306 postoperative care, 306
uncomplicated gastro-oesophageal reflux, 307-15
anatomical repair, 311 circumferential prosthesis ( Angelchik ),
311-12 ligamentum teres fixation, 312 oesophageal extension, 308
and fundoplication, 309-10 posterior gastropexy, 314-15 postoperative care, 315 principles and justification, 307 supplemental proximal gastric
vagotomy, 313
Antral patch, 351-2 Antrectomy, 339
ulcers duodenal, 4 79-80 recurrent, 391
Balloon dilators, 29-30, 38 Balloon tube tamponade, 19 Belsey Mark IV procedure, 302-6 Billroth I gastrectomy, 414-19
history, 414 incision, 415-19 indications, 414 postoperative care, 419 wound closure, 419
Billroth II gastrectomy, 101-2 Roux-en-Y gastrojejunostomy after,
411-12 stapled anastomosis, 116-17
Biopsy endoscopic, 9 laparoscopic, 570 liver, 509
Bleeding, 388-9 Dieulafoy's lesion, 526 Mallory-Weiss tear, 525-6 ulcers, see Ulcers videoendoscopic surgery for achalasia, 600 watermelon stomach, 526
Carcinoma distal oesophagus, cardia and proximal
stomach, en bloc oesophagectomy for, see Oesophagectomy,
en bloc oesophagogastrectomy for, see
Oesophagogastrectomy Cardio-oesophageal junction, mobilization of,
68 Cardiovascular fitness, preoperative, 39-40 Celestin dilator, 27, 28, 29, 37 Chest drains, oesophageal surgery, 40 Circumferential prosthesis, 311-12 Collis gastroplasty, 331 Collis-Nissen combined operation, 327-34
complications, 334 postoperative care, 334 preoperative preparation, 327 principles and justification, 327 surgery, 328-33
dissection of oesophageal hiatus, 329 division of short gastric vessels, 330 exposure, 328 incision, 328 Nissen fundoplication, 332 placement of crural sutures, 330 reduction of wrap and closure of hiatus,
333 removal of gas teo-oesophageal fat pad,
331 uncut Collis gastroplasty, 331
Colonic interposition oesophageal replacement, 128-41
choice of colonic segment, 130 complications, 140-1 contraindications, 129 duodenal diversion, 343 history, 128 indications, 129 operation, 131-9
Colonic interposition oesophageal- continued outcome, 141 postoperative care, 140 preoperative preparation, 131 principles and justification, 129
Contrast studies, gastro-oesophageal reflux, 293,321
Cricopharyngeal myotomy, 173-7 incision, 173-7 patient position, 1 73 postoperative care, 177
'Criminal' nerve of Grassi, 359
Delirium tremens, 511-12 Diaphragm, division of, 66 Diarrhoea, postvagotomy, 368, 393 Dieulafoy's lesion, 526 Dilators, 26-30
balloon, 29-30, 38 mercury-filled, 27, 31-3
self-bougienage, 32-3 wire-guided, 27-9, 33-7 see also individual types
Distal oesophageal plexus, 358 Diverticula
duodenal, 537-47 operation, 539-46
diverticulectomy, 540-4 with reimplantation of ampulla of
Vater, 543-4 simple extraduodenal, 540-1 transduodenal, 541-2
duodenojejunostomy, 546 exposure, 539 extended sphincteroplasty, 545
postoperative care, 547 preoperative preparation, 538 principles and justification, 53 7
long oesophageal myotomy, 230-6 assessment, 230 indications, 230 operation, 231-6 patient preparation, 230 postoperative care, 236 principles and justification, 230
pharyngo-oesophageal, excision of, 173-7 incision, 173-7 patient position, 173 postoperative care, 177
Diverticulectomy, 540-4 with reimplantation of ampulla of Vater,
543-4 simple extraduodenal, 540-1 transduodenal, 541-2
Drainage chest, oesophageal surgery, 40 gastric interposition oesophageal
replacement, 152 total abdominal vagotomy, 364
Dumping syndrome, 368, 392, 491 Duodenal diversion
after partial gastrectomy, 341 after previous partial gastro
oesophagectomy, 342 after total gastrectomy, 343 after total gastro-oesophagectomy and
colonic interposition replacement, 343
Duodenal diverticula, see Diverticula Duodenal obstruction/trauma,
gastroenterostomy in, 404
Duodenal stump blow-out, 387 Duodenal ulcers, 479-80
aims of surgery, 476 background, 476 choice of procedure, 480 giant duodenal ulcer, 480 oversewing with duodenotomy and
parietal cell vagotomy, 480 oversewing truncal vagotomy and
pyloroplasty, 479 oversewing with vagotomy and
antrectomy, 479-80 oversewing with vagotomy and
pyloroplasty anterior vagal trunk, 486 duodenotomy, 480, 483 incision and exposure, 483 oesophageal exposure, 485 posterior vagal trunk, 486 pyloroplasty, 485 suture ligation, 484
perforated, 531 definitive procedure, 534-5 with haemorrhage, 534 with obstruction, 534 simple closure, 532-4
predictors of continued bleeding! rebleeding, 476
Duodenojejunostomy, 546 Duodenotomy, duodenal ulcers, 480, 483
Eder-Puestow dilator, 27, 29,37 En bloc oesophagectomy, see
Oesophagectomy, en bloc Endoscope
injection sclerotherapy, 11 insertion
blind, 2 visual, 3
see also Endoscopy Endoscopic cautery, 478 Endoscopic heater probe, 4 78 Endoscopy
balloon dilators, 38 flexible, 1-9
examination of oesophagus, 4 examination of stomach, 5-8 introduction of endoscope, 2-3
blind insertion, 2 visual insertion, 3
passage into stomach, 5 patient preparation, 1 principles and justification, 1 recovery from, 9 taking tissue specimens, 9
gastro-oesophageal reflux, 292-3, 321-2 injection sclerotherapy
bleeding ulcers, 478 elective, 13-14 emergency, 17
oesophageal achalasia, 594 oesophageal perforation, 248 oesophagectomy, 601-6
history, 601 operation, 602-4 postoperative care, 606 preoperative preparation, 601 tumour dissection, 604-6
Enteroenterostomy, 434 Enterotomy, 581
Eversion extraction oesophagectomy, see Oesophagectomy, eversion extraction
Extended sphincteroplasty, 545
Finney pyloroplasty, 398-9 Fundic patch, 350-1 Fundoplication
abdominal, 294-300 complications, 300 history, 294 indications, 294 operation, 295-300
buttressing fundoplication, 300 crural plication, 298 distal oesophagus
final mobilization, 298 initial mobilization, 296
encircling oesophagus, 297 fixing fundoplication, 299 fundus
adequacy of mobilization, 299 further mobilization, 296 initial mobilization, 296
general exposure, 295 identification and preservation of
anterior/posterior vagal trunks, 297
incision, 295 local exposure, 295 wound closure, 300
postoperative care, 300 preoperative preparation, 295 principles and justification, 294
anterior partial, 274-5 gastro-oesophageal reflux, 339-44 intrathoracic (Nissen), 320-6, 332
anaesthesia, 322 complications, 326 history, 320 indications, 321 laparoscopic, 571-4
contraindications, 571 indications, 5 71 operation, 571-4 outcome, 574 postoperative care, 574
operation, 322-4 outcome, 325 patient preparation, 322 postoperative care, 325 preoperative assessment, 321-2
barium swallow, 321 oesophageal manometry, 322 upper gastrointestinal endoscopy,
321-2 with oesophageal extension, for
uncomplicated gastro-oesophageal reflux, 309-10
paraoesphageal hiatus hernia, 278
Gallstones, postvagotomy, 368 Gastrectomy
Billroth I, 414-19 history, 414 incision, 415-19 indications, 414 postoperative care, 419 wound closure, 419
Index 611
Gastrectomy- continued Billroth II, Roux-en-Y gastrojejunostomy
after, 411-12 distal, for gastric ulcers, 481, 487-90 limited total, 443-8 with oesophagojejunogastric
reconstruction, 465-71 operation, 466-70 outcome, 470-1 postoperative care, 470 preoperative preparation, 466 principles and justification, 466
partial, 420-35 anatomy, 421 complications, 434-5 duodenal diversion, 341 history, 420 operation
closure of duodenum, 427 closure of mesocolon, 432 division of duodenum, 426 division of gastrohepatic ligament, 422 division of left gastroepiploic vessels,
423 gastrojejunostomy
stapled, 430-2 sutured, 429-30
incision, 421 incision in transverse mesocolon, 428 lesser curvature neurovascular arcade,
425 ligation of right gastric vessels, 424 ligation of right gastroepiploic vessels,
424 mobilization of greater curvature, 422 position of gastrojejunostomy, 428 preoperative preparation, 420 preparation of greater curvature, 423 preparation of lesser curvature, 425 proximal division of stomach, 427 retractors, 4 21
postoperative care, 434 reconstruction, 96-102
enteroenterostomy, 434 gastroduodenal anastomosis, 99-101 gastrojejunal anastomosis, 433
Billroth II, 101-2 Roux-en-Y, 101
jejunal interposition, 102 'lesser curve', 97-9 Roux-en-Y, 101,433
with preservation of innervation, 474-5 incision and exposure, 474 isolation of jejunal segment, 474-5 postoperative care, 475 preservation of antral vagal innervation,
474 principles and justification, 474 proximal gastrectomy, 474
segmental resections, 472-3 exposure of stomach, 473 exposure of upper abdomen, 473 incision, 472 postoperative care, 473 preoperative preparation, 472 principles and justification, 472 problems of, 473
total, 92-5 duodenal diversion, 343 with lymph node dissection, 450-64
combined resection of spleen and distal pancreas, 463
612 Index
Gastrectomy- continued dissection around duodenum, 453-4 dissection around spleen and
oesophagus, 457-8 hand-sewn anastomosis (end-to-side),
459-60 incision, 452 lymph node dissection, 455-6 omentectomy, 452-3 postoperative care, 464 principles and justification, 450-1 reconstruction of gastrointestinal
continuity, 461-3 without lymph node dissection, 436-49
history, 436 postoperative care, 449 preoperative preparation, 436 reconstruction, 446-8
Gastric acid hypersecretion, 512 Gastric anastomosis
hand-sewn technique, 88-107 gastrojejunostomy, 103-7 partial gastrectomy, 96-102
gastroduodenal anastomosis, 99-101 gastrojejunal anastomosis
Billroth II, 101-2 Rouxloop,lOl
jejunal interposition, 102 'lesser curve' reconstruction, 97-9
Roux-en-Y loop, 89-92 end-to-side jejunojejunostomy, 90-2
single-layer serosubmucosal appositional, 88
total gastrectomy, 92-5 stapled, 108-19
gastrojejunostomy, 116-17, 119 closure of stab wound, 117 duodenal closure, 116 resection of stomach, 116 stapling technique, 117
gastro-oesophageal, 112-15 closure of gastrotomy, 114 construction, 112-13 GIA technique, 114-15 narrow oesophagus, 114
Heineke-Mikulicz pyloroplasty, 118 oesophagojejunal, 108-11
checking integrity of anastomosis, 110 construction ofRoux-en-Y
jejunojejunostomy, 110-11 firing EEA device, 110 insertion ofEEA device, 109 passage of anvil into oesophagus, 109 preparation of oesophagus, 108
Gastric bypass, gastroenterostomy in, 404 Gastric outlet obstruction, 367, 389 Gastric reconstruction, 154-64,446-8
operations, 156-63 jejunal preparation, 15 7 jejunojejunostomy, 158-9
anterior wall, 159 posterior wall, 158-9 stapled, 159
jejunoplication, 162-3 pouch with orthograde duodenal
transit, 163 Roux-en-Y anastomosis, 163
oesophagojejunostomy, 160-2 anterior wall, 161 posterior wall, 160-1 stapled, 162
transposition of jejunum, 15 7
Gastric reconstruction- continued outcome, 164 principles and justification, 156 types of, 155
Gastric restriction surgery, 548-60 anaesthesia, 550 history, 548 indications, 549 operation, 550-9
gastric stapling, 554-6 hand position, 551 incision, 5 51 patient position, 550 placement of Marlex mesh, 558 pouch measurement, 557 preparation of stomach for stapling,
552-3 wound closure, 559
outcome, 559 postoperative care, 559 preoperative preparation, 549-50 principles and justification, 548-9
Gastric ulcers, 480-2 background, 477 choice of procedure, 482 distal gastrectomy with
gastroduodenostomy, 481,487-90 division of duodenum, 489 division of stomach, 488 duodenal mobilization, 488 gastric mobilization, 487 gastroduodenal anastomosis, 489-90 preparation of gastric remnant, 489 ulcer exposure, 487
giant gastric ulcer, 481 high-lying gastric ulcer, 481-2 and non-steroidal anti-inflammatory drugs,
477,481 oversewing alone, 481 oversewing or excision with vagotomy and
pyloroplasty, 481 perforated, 531, 535 types of, 477
Gastric vagotomy, see Vagotomy Gastric varices, stapling procedures, see
Stapling procedures, oesophageal varices Gastroduodenal anastomosis, 99-101, 489-
90 see also Billroth I gastrectomy
Gastroenterostomy, 403-13 complications, 412-13
afferent limb syndrome, 412 alkaline reflux gastritis, 413 early, 412 jejunogastric intussusception, 412 'Roux syndrome', 413 twisted gastrojejunostomy, 413
incision, 404 indications, 403-4
duodenal obstruction/trauma, 404 gastric bypass surgery, 404 gastric malignancy, 404 peptic ulcer surgery, 403
laparoscopic, 575-83 history, 575 indications, 576 instrumentation, 575-6
bowel occlusion, 576 grasping forceps, 575-6 needle holders and sutures, 576
jamming loop knot, 577 outcome, 583
Gastroenterostomy- continued patient positioning and port placement,
577 postoperative care, 583 preoperative preparation, 576 stapled and sutured anastomosis, 581-2
application of stapler, 581 external anchoring suture and
enterotomy, 581 suture of residual anastomotic defect,
582 sutured anastomosis, 578-80
anterior layer, 580 opening bowel, 580 posterior layer, 578-9
loop antecolic gastrojejunostomy, 406-7 retrocolic in peptic ulcer surgery, 404-6
postoperative care, 412 Roux-en-Y, 408-12
indications, 408 preoperative preparation, 408 technique, 409-12
closure of mesocolonic defect, 410 division of jejunum, 410 gastrojejunostomy after Billroth II
gastrectomy, 411-12 jejunojejunal anastomosis, 411 selection of jejunal segment, 410 take-down of previous anastomosis,
409 Gastroepiploic vagal innervation, 359 Gastrojejunostomy, 101-2, 103-7, 116-17
antecolic, 407-8 Billroth II, 101-2,411-12
stapled, 116-17 closure of stab wound, 117 duodenal closure, 116 position of, 428 resection of stomach, 116 Roux-en-Y, 101,408-12
gastric reconstruction, 163,433 indications, 408 preoperative preparation, 408 technique, 409-12
closure of mesocolic defect, 410 division of jejunum, 410 jejunojejunal anastomosis, 411 selection of jejunal segment, 410 take-down of previous anastomosis,
409 transmesocolic, 339
stapled, 430-2 anastomotic reconstruction, 431 closure of mesocolon, 432 closure of stapler defect, 432 stapler application, 4 31
sutured, 429-30 anterior portion of anastomosis, 429 completion of anastomosis, 430 posterior inner suture, 429
twisted, 413 Gastro-oesophageal anastomosis, 112-15
closure of gastrotomy, 114 construction, 112-13 GIA technique, 114-15 narrow oesophagus, 114
Gastro-oesophageal fat pad, 331 Gastro-oesophageal reflux
videoendoscopic surgery for achalasia, 600
see also Antireflux surgery
Gastro-oesophagectomy partial, and duodenal diversion, 342 total, and duodenal diversion, 343
Gastropexy anterior, 279 posterior, 314-15
Gastrostomy, high with peritoneal cuff, 527-9
incision, 528-9 indications, 527 outcome, 529 wound closure, 529
Grasping forceps, 5 75-6
Haemostasis, 72 Heineke-Mikulicz pyloroplasty, 347, 396-7
incision, 396-7 patient position, 396
Heller myotomy laparoscopic, 598-9 thoracoscopic, 596-7
Hepatic failure, 512 Hernia, see Paraoesophageal hiatus hernia Hiatus
anatomy, 260-1 closure of, 333
crural sutures, 330 dissection of, 329 hernia, see paraoesophageal hiatus hernia
Hurst dilator, 27 Hyperdynamic circulation, 511 Hypokalaemia, 496
Infection, 512 Injection sclerotherapy, see oesophageal
varices, injection sclerotherapy of Injectors, injection sclerotherapy, 11 Intercostal muscles, division of, 64 Intravariceal injection sclerotherapy, 10, 17
Jaboulay gastroduodenostomy, 400 Jaundice, postoperative, 367 Jejunogastric intussusception, 412 Jejunojejunal anastomosis, 411
end-to-side, 90-2 gastric reconstruction, 158-9 Roux-en-Y, 110-11 stapled, 159 terminolateral, 339
Jejunoplication, 162
Knots abdominal closure, 75-7 jamming loop, 577
Kocherprocedure,339,502
Laparoscopes, 566 Laparoscopy, 561-70
abdominal procedures, 564-5 completion of procedure, 5 70 dissection, 568 equipment, 562-3
instruments, 563 video cameras, 562
Laparoscopy- continued gastroenterostomy, 575-83
history, 575 indications, 576 instrumentation, 575-6
bowel occlusion, 576 grasping forceps, 575-6 needle holders and sutures, 576
jamming loop knot, 577 outcome, 583 patient positioning and port placement,
577 postoperative care, 583 preoperative preparation, 576 stapled and sutured anastomosis, 581-2
application of stapler, 581 external anchoring suture and
enterotomy, 581 suture of residual anastomotic defect, 582
sutured anastomosis, 578-80 anterior layer, 580 opening bowel, 580 posterior layer, 578-9
Heller myotomy, 598-9 laparoscopes, 566 Nissen fundoplication, 5 71-4
contraindications, 571 indications, 571 operation, 571-4 outcome, 574 postoperative care, 574
placement of additional ports, 567 postoperative care, 570 retrieval of specimens, 570 suturing and stapling, 569 vagotomy, 584-92
complications, 592 highly selective, 587-8 history, 584-5 outcome, 592 patient position, 586 postoperative care, 592 preoperative preparation, 585 truncal, 590
thoracoscopic, 591 Laser therapy, bleeding ulcers, 478-9 Left thoracolaparotomy, 190 Leiomyoma, oesophageal, 237-43
anaesthesia, 237 complications, 243 operation, 238-42
exposure and mobilization of oesophagus, 239
extramucosal enucleation, 239-40 incision, 2 38 repair of mucosal defects, 241 repair of muscle coat defect, 242 underwater inflation test for mucosal
leakage, 241 wound closure, 242
outcome, 243 postoperative care, 243 preoperative preparation, 237 principles and justification, 23 7
ligamentum teres fixation, 312 Long oesophageal myotomy, 230-6 Lymph node dissection, 145,455-6
Mallory-Weiss tear, 525-6 Maloney dilator, 27
self-bougienage, 32-3
Manometry, oesophageal achalasia, 595
Index 613
gastro-oesophageal reflux, 293, 322 Mercury-filled bougies, 27, 31-3
self-bougienage, 32-3 Metabolic alkalosis, 496 Midline abdominal incision, 73 Musculature, hiatus and abdominal
oesophagus, 258 Myotomy
for achalasia abdominal approach, 267-75
anaesthesia, 268 assessment, 268 history, 267 indications, 268 operation, 269-75
anterior partial fundoplication, 274-5
approximation of crura, 273 exposure of gastro-oesophageal
junction, 270 incision, 269 mobilization ofleft lobe of liver, 269 mobilization of oesophagus, 270 myotomy, 271-3 wound closure, 275
outcome, 275 patient preparation, 268 postoperative care, 275 preoperative preparation, 268 principles and justification, 268
thoracic approach, 262-6 anaesthesia, 263 complications, 266 diagnosis, 263 history, 262 operation, 263-5 outcome, 266 postoperative care, 266 preoperative preparation, 263 principles and justification, 262
cricopharyngeal, 173-7 incision, 173-7 patient position, 173 postoperative care, 177
long oesophageal, 230-6 assessment, 230 indications, 230 operation, 231-6 patient preparation, 230 postoperative care, 236 principles and justification, 230
pyloromyotomy, 193
Needle holders, 576 Nerves of Latarjet
anterior, 358 crow's foot, 359 posterior, 358
Nerve supply, hiatus and abdominal oesophagus, 259
Nissen fundoplication, 320-6, 332 anaesthesia, 322 complications, 326 history, 320 indications, 321 laparoscopic, 571-4
contraindications, 5 71 indications, 5 71 operation, 571-4
614 Index
Nissen fundoplication- continued outcome, 574 postoperative care, 57 4
operation, 322-4 outcome, 325 patient preparation, 322 postoperative care, 325 preoperative preparation, 321-2
barium swallow, 321 oesophageal manometry, 322 upper gastrointestinal endoscopy,
321-2 see also Collis-Nissen combined operation
Non-steroidal anti-inflammatory drugs and duodenal ulcers, 477 and gastric ulcers, 481
Nutrition postoperative, in liver disease, 513 preoperative, 40
Obesity surgery, see Gastric restriction surgery
Oesophageal anastomosis leakage, 41 stapled, 84-7
principles and justification, 84 technique, 85-7
sutured, 79-83 operation, 80-3 outcome,83 postoperative care, 83 principles and justification, 79
Oesophageal extension for uncomplicated gastro-oesophageal reflux, 308
with fundoplication, 309-10 Oesophageal leiomyoma, see Leiomyoma,
oesophageal Oesophageal perforation, 244-61
aggressive resuscitation, 248 anaesthesia, 249 antibiotic therapy, 248 assessment of injury, 248 diagnosis
clinical, 245 endoscopic, 248 radiological, 245-7
indications for surgical intervention, 248-9
contained perforations, 248 free perforations, 248 location/extent of perforation, 249 patient's general health, 249 presence of underlying oesophageal
disease, 249 time elapsed since injury, 248-9
initial management, 248 late diagnosed, 254, 388
postoperative care, 255 operation
alternative approach, 254 late diagnosed perforation, 254 obstructed oesophagus, 251-3
perforation above fibrotic, benign or malignant stricture, 252-3
perforation from pneumatic dilatation, 251
unobstructed oesophagus, 250-1 postoperative care, 255 preoperative preparation, 245-9 principles and justification, 244
Oesophageal replacement, 134 colon, 128-41
choice of colonic segment, 130 complications, 140-1 contraindications, 129 history, 128 indications, 129 operation, 131-9 outcome, 141 postoperative care, 140 preoperative preparation, 131 principles and justification, 129
extra-anatomical, 165-9 anterior mediastinum, 166-8
patient position, 166 postoperative care, 169 prehilar route, 169 preoperative preparation, 165 prethoracic tubing, 169 principles and justification, 165 subcutaneous route, 169
small intestine, 120-7 free jejunal graft, 126-7 jejunal loop, 121 postoperative care, 127 principles and justification, 120 Roux-en-Y, 122-5
formation of anastomosis, 123-5 selection of small intestinal segment,
122 stomach, 142-53
anaesthesia, 143 anatomical points, 143 completion of abdominal operation,
152 complications, 153 drainage, 152 duodenal mobilization, 149 elevation of stomach and cervical
anastomosis, 150-2 elevation of stomach and intrathoracic
anastomosis, 152 formation of gastric tube, 146-8 history, 142 incision, 144 interposition of whole stomach, 149 lymph node dissection, 145 outcome, 153 patient position, 144 postoperative care, 153 preoperative preparation, 142-3 preparation of stomach, 144-5 preparation of tunnel for interposition,
149-50 principles and justification, 142
Oesophageal strictures dilatation, 26-38
balloon dilators, 29-30, 38 indications, 26 mercury-filled bougies, 27, 31 postoperative care, 38 preoperative preparation, 30 prophylactic antibiotics, 30 self-bougienage, 32-3 types of dilator, 26-30 wire-guided dilators, 27-9, 33-7
Celestin, 29, 37 Eder-Puestow, 29,37 Savary-Gilliard, 28, 3 7
resection, 345-9 anaesthesia, 345 history, 345
Oesophageal strictures- continued operation, 346-8
jejunogastric anastomosis, 348 oesophagojejunostomy, 348 passage of jejunal segment through
oesophageal hiatus, 347 preparation of jejunal segment, 346 resection of gastro-oesophageal
junction, pyloroplasty and gastrostomy tube, 347
selection of jejunal segment, 346 thoracotomy and oesophagectomy,
348 outcome, 349 postoperative care, 349 preoperative preparation, 345 principles and justification, 345
Oesophageal varices bleeding
shunts, see Shunts, portasystemic stapling procedures, see Stapling
procedures, oesophageal varices injection sclerotherapy of, 10-20
combined technique, 10 emergency sclerotherapy, 17
elective, 12-16 endoscopy, 13-14 injection technique, 14-16 outcome, 20 patient preparation, 12 postoperative care, 20
emergency, 17-19 balloon tube tamponade, 19 combined injection, 18 endoscopy, 1 7 initial measures, 1 7 intravariceal injection, 1 7 outcome, 20 postoperative care, 20
endoscope, 11 injectors, 11 intravariceal technique, 10
emergency sclerotherapy, 17 outcome, 20 paravariceal technique, 10 postoperative care, 20 sclerosants, 11
Oesophagectomy, 348 abdominal-right thoracic approach, 52-5
abdominal operation, 53 anaesthesia, 52 postoperative care, 55 preoperative preparation, 52 principles and justification, 52 subtotal, 178-88
abdominal approach, 179-82 incision, 179-82 wound closure, 182
history, 178 postoperative care, 188 thoracic approach, 183-8
incision, 183-8 patient position, 183
thoracic operation, 54-5 en bloc, 214-29
extent of, 217-18 history, 214 operation, 218-28 outcome, 229 postoperative care, 228 preoperative preparation, 218 principles and justification, 215-18
Oesophagectomy- continued endoscopic, 601-6
history, 60 1 operation, 602-4 postoperative care, 606 preoperative preparation, 601 tumour dissection, 604-6
eversion extraction, 211-13 indications, 211 operation, 212-13 outcome, 213
left thoracic subtotal, 189-95 cervical anastomosis, 194 closure, 19 3 complications, 195 contraindications, 189 division and closure of stomach, 192 division of oesophagus, 192 indications, 189 left neck incision, 194 left thoracolaparotomy, 190 mobilization of stomach, 191 mobilization of thoracic oesophagus,
191 position of stomach in chest, 193 postoperative care, 195 preoperative preparation, 189 pyloromyotomy, 193
left thoracoabdominal, 61-9 abdominal dissection, 67 anaesthesia, 62 antibiotic prophylaxis, 62 division of diaphragm, 66 division of intercostal muscles, 64 exploration of abdomen, 64 incision, 63 indications, 61 laparotomy and left thoracotomy, 68 nasogastric intubation, 62 patient position, 63 postoperative care, 69 preoperative preparation, 62 rib resection, 65 thoracic dissection, 66 thoracic exploration, 66 thoracic incision, 64 wound closure, 68
transhiatal, 196-21 0 abdominal phase, 199 anaesthesia, 198 cervical gastro-oesophageal anastomosis,
207-8 cervical phase, 200-6 history, 196 outcome, 210 postoperative care, 209-10 preoperative assessment and
preparation, 197-8 principles and justification, 196-7
Oesophagogastrectomy, 280-91 anaesthesia, 282 classification of adenocarcinoma, 280 indications, 281 outcome, 290 postoperative care, 290 preoperative preparation, 282 principles and justification, 281 total, 287-90
extragastric extent of resection, 289-90 left pancreatic resection, 289 pancreas-preserving splenectomy,
289
Oesophagogastrectomy- continued retroduodenal and para-aortic lymph
nodes, 289 transmediastinal oesophagectomy,
290 patient position, 287
transmedial with proximal gastrectomy, 282-7
endoscopic dissection of cervical and intramediastinal oesophagus, 286
patient position, 283 preparation of distal oesophagus, 283 preparation of mediastinal oesophagus,
284 preparation of proximal oesophagus,
285-6 transmediastinal pull-through and
extirpation of oesophagus, 286-7 Oesophagogastroduodenoscopy, 495 Oesophagojejunogastric reconstruction,
465-71 operation, 466-70 outcome, 470-1 postoperative care, 470 preoperative preparation, 466 principles and justification, 466
Oesophagojejunostomy, 108-11 gastric reconstruction, 160-2 oesophageal stricture resection, 348 stapled, 108-11, 162
checking integrity of anastomosis, 110
construction ofRoux-en-Y jejunojejunostomy, 110-11
firing EEA device, 110 insertion ofEEA device, 109 passage of anvil into oesophagus, 109 preparation of oesophagus, 108
Oesophagoscopy, rigid, 21-5 anaesthesia, 22 contraindications, 21 equipment, 22 examination, 25 indications, 21 passage of oesophagoscope, 24 patient position, 23 patient preparation, 22 postoperative care, 25 tooth protection, 23
Oesophagus abdominal approach, see Abdominal
incisions achalasia, see Achalasia adenocarcinoma, oesophagogastrectomy,
280-91 anatomy, 256-61
anatomical relations, 256-7 blood supply, 258 mobilization of distal oesophagus,
259-60 musculature, 258 nerve supply, 259 oesophageal hiatus, 260-1 phreno-oesophagealligament, 259
cervical mobilization of, 172 surgical anatomy, 170-2
recurrent laryngeal nerves, 1 72 surgical approach, 45-51
incision, 46-51 patient position, 45
distal, mobilization of, 259
Oesophagus- continued examination of
endoscopic, 4
Index 615
rigid oesophagoscopy, 21-5 injury to, 366 major surgery, 39-42
complications of, 41-2 anastomotic leakage, 41 recurrent laryngeal nerve injury, 42 thoracic duct injury, 41-2
postoperative care, 40-1 chest drains, 40 feeding, 40-1
preoperative preparation, 39-40 cardiovascular fitness, 39-40 diagnosis and operative planning, 39 nutrition, 40 preoperative and perioperative
therapy,40 respiratory fitness, 40
myotomy, see Myotomy, long oesophageal replacement, see Oesophageal replacement resection, see Oesophagectomy strictures, see Oesophageal strictures varices, see Oesophageal varices see also Oesophagectomy;
Oesophagoscopy Omentectomy, 452-3
Pancreas, resection, 463 Pancreatitis, postoperative, 367 Paramedian abdominal incision, 73 Paraoesophageal hiatus hernia, 276-9
associated antireflux procedure, 276 asymptomatic patients, 276 operation, 277-9
anterior gastropexy, 279 closure and completion, 279 closure of hiatus, 278 fundoplication, 278 incision and exposure, 277 reduction and excision of sac, 277
outcome, 279 postoperative care, 279 preoperative preparation, 277 principles and justification, 276 surgical approach, 276
Paravariceal injection sclerotherapy, 10 Parenteral fluid therapy, 510-11 Partial pylorectomy, 401 Peptic ulcers
gastroenterostomy in, 403, 404-6 perforated, see Ulcers, perforated see also Duodenal ulcers; Gastric ulcers
Perforation of oesophagus, see Oesophageal perforation
Pharyngo-oesophageal diverticulum, excision of, 173-7
incision, 1 73-7 patient position, 173 postoperative care, 1 77
Phreno-oesophagealligament, 259 Portasystemic encephalopathy, 496 Portasystemic shunts, see Shunts,
portasystemic Position of patient
cervical approach to oesophagus, 45 cricopharyngeal myotomy, 1 73 gastric restriction surgery, 550 Heineke-Mikulicz pyloroplasty, 396 injection sclerotherapy, 12
616 Index
Position of patient- continued left posterolateral thoracotomy, 57 oesophageal replacement
extra-anatomical, 166 stomach, 144
oesophageal varices portacaval anastomosis, 500-1 stapling procedures, 517
oesophagectomy abdominal-right thoracic subtotal, 183 left thoracoabdominal, 63
oesophagogastrectomy total, 287 transmedial with proximal gastrectomy,
283 rigid oesophagoscopy, 23 vagotomy
laparoscopic, 586 total abdominal, 361
Posterior gastropexy, 314-15 Postgastrectomy syndrome, 491 Postvagotomy syndrome, 491 Pouches, see Gastric reconstruction Pulmonary complications, 511 Pyloric reconstruction, 368, 392 Pyloromyotomy, 193,402 Pyloroplasty, 118, 394-402
anaesthesia, 395 duodenal ulcers, 479,485 Finney, 398-9 gastric ulcers, 481 Heineke-Mikulicz, 347,396-7 history, 394 Jaboulay gastroduodenostomy, 400 leaking, 367 outcome, 402 partial pylorectomy, 401 postoperative care, 402 preoperative preparation, 395 principles and justification, 395 pyloromyotomy, 402
Radiology oesophageal achalasia, 594 oesophageal perforation, 245-7
Recurrent laryngeal nerves anatomy, 172 injury during oesophageal surgery, 42
Renal failure, 512 Respiratory fitness, preoperative, 40 Retractors, 421 Rib resection, 65 Roux-en-Y loop
construction, 89-92 gastric reconstruction, 163
partial gastrectomy, 96-102, 433 total gastrectomy, 92-5
gastrojejunal anastomosis, 101,433 transmesocolic, 339
gastrojejunostomy, 408-12 Billroth II gastrectomy, 411-12 closure of mesocolic defect, 410 division of jejunum, 410 indications, 408 jejunojejunal anastomosis, 411 preoperative preparation, 408 selection of jejunal segment, 410 take-down of previous anastomosis, 409
gastro-oesophageal reflux, 335-44 complications, 344 history, 335
Roux-en-Y loop- continued indications, 335 operations, 336-43
antireflux procedure, 338 antrectomy, 339 duodenal diversion
after partial gastrectomy, 341 after previous partial gastro
oesophagectomy, 342 after total gastrectomy, 343 after total gastro-oesophagectomy
and colonic interposition replacement, 343
gastrojejunal transmesocolic anastomosis, 339
jejunojejunal terminolateral anastomosis, 339
vagotomy, 336-7 problems of, 340-1
outcome, 344 postoperative care, 343 preoperative preparation, 335
jejunojejunostomy, 110-11 end-to-side, 90-2
oesophageal replacement, 122-5 'Roux syndrome', 413
Savary-Gilliard dilator, 27, 28, 3 7 Savary guidewire, 27, 28 Schatzki's ring, 352-3 Sclerosants, 11 Sclerotherapy
bleeding ulcers, 478 oesophageal varices, see Oesophageal
varices, injection sclerotherapy of Segmental resections, 472-3
exposure of stomach, 473 exposure of upper abdomen, 473 incision, 4 72 postoperative care, 473 preoperative preparation, 472 principles and justification, 4 72 problems of, 473
Self-bougienage, 32-3 Sepsis, 384-8
operative management, 386-8 duodenal stump blow-out, 387 subphrenic abscess, 386-7 suture line dehiscence, 387 unrecognized oesophageal perforation,
388 prevention, 384-6
Shunts, portasystemic, 493-515 choice of, 497-9
end-to-side portacaval, 497 interposition mesocaval H graft, 498 mesocaval, 498 selective distal splenorenal, 499 side-to-side portacaval, 497 splenorenal, 499
direct portacaval anastomosis, 500-10 anaesthesia, 500 assessment of venous pressures, 506 determination of adequacy of
mobilization, 505 end-to-side portacaval anastomosis,
508-9 exposure of inferior vena cava, 502 exposure of operative field, 502 exposure of portal vein, 504 incision, 501
Shunts, portasystemic- continued incision of posterior peritoneum, 502 isolation of inferior vena cava, 503 liver biopsy, 509 mobilization of portal vein, 505 patient position, 500-1 side-to-side portacaval anastomosis,
506-8 wound closure, 510
elective therapeutic, 494 emergency therapeutic, 494 indications, 494 outcome, 513-15 patient preparation, 495-6 postoperative care, 510-13
alcoholism, 513 delirium tremens, 511-12 follow-up, 513 gastric acid hypersecretion, 512 hepatic failure, 512 hyperdynamic circulation, 511 infection, 512 monitoring, 510 nutrition, 513 parenteral fluid therapy, 510-11 pulmonary therapy, 511 renal failure, 512
preoperative preparation, 494-6 blood studies, 495 diagnosis, 494 history and physical examination, 494 nasogastric aspiration and stool
examination, 494-5 oesophagogastroduodenoscopy, 495
prophylactic, 494 Small intestine as oesophageal replacement,
120-7 free jejunal graft, 126-7 jejunal loop, 121 postoperative care, 127 principles and justification, 120 Roux-en-Y, 122-5
formation of anastomosis, 123-5 selection of segment, 122
Spleen injury to, 366-7 resection, 463
Stapling procedures gastric anastomosis, 108-19 gastric restriction, 552-6 gastrojejunal anastomosis, 116-17, 430-2 jejunojejunal anastomosis, 159 laparoscopic gastroenterostomy, 581-2 laparoscopy, 569 oesophageal anastomosis, 84-7 oesophageal varices, 516-24
anaesthesia, 516 circular stapler, 517-21
devascularization of lower oesophagus, 518
division of perforating veins, 519 exposure of left gastric pedicle, 517 insertion of stapling gun, 520 ligation of left gastric pedicle, 517 mobilization of oesophagus, 518 modifications of, 521 placement of encircling ligature, 519 position of patient and incision, 517 transection, 520-1
history, 516 linear stapler, 522-3
cardiofundectomy for gastric varices, 523
Stapling procedures- continued transabdominal subcardiac, 522
outcome, 523 postoperative care, 523 preoperative preparation, 516 principles and justification, 516
Stomach cancer
en bloc oesophagectomy, see Oesophagectomy, en bloc
gastroenterostomy, 404 oesophagogastrectomy, see
Oesophagogastrectomy endoscopic examination of, 5-8 fundal anatomy, 256-61
blood supply, 258 mobilization of distal oesophagus,
259-60 musculature, 258 nerve supply, 259 oesophageal hiatus, 260-1 phreno-oesophageal ligament, 259
lymph nodes, 451 major surgery, 42-4
postoperative care, 43-4 preoperative preparation, 42-3
elective duodenal ulcer surgery, 42 gastric malignancy, 43 urgent/emergency ulcer surgery,
42-3 see also Gastrectomy; Gastric
reconstruction as oesophageal replacement, 142-5 3
anaesthesia, 143 anatomy, 143 completion of abdominal operation,
152 complications, 15 3 drainage, 152 duodenal mobilization, 149 elevation of stomach
and cervical anastomosis, 150-2 and intrathoracic anastomosis, 152
formation of gastric tube, 146-8 history, 1 4 2 incision, 144 interposition of whole stomach, 149 lymph node dissection, 145 outcome, 153 patient position, 144 postoperative care, 15 3 preoperative preparation, 142-3 preparation of stomach, 144-5 preparation of tunnel for interposition,
149-50 principles and justification, 142
passage of endoscope into, 5 see also Gastric anastomosis
Stomal ulcers, perforated, 531, 535 Subcostal abdominal incision, 74 Subphrenic abscess, 386-7 Supplemental proximal gastric vagotomy,
313 Suture line dehiscence, 387 Suturing procedures
abdominal incisions, 77-8 Collis-Nissen combined operation, 330 duodenal ulcer surgery, 484 gastrojejunal anastomosis, 429-30 laparoscopy, 569 oesophageal anastomosis, 79-83 suture line dehiscence, 387
Thoracic duct injury, oesophageal surgery, 41-2
Thoracotomy, left posterolateral, 56-60, 348
anaesthesia, 56 closure of incision, 59 complications, 60 extensions to abdomen, 59 incision, 57 intercostal division, 58 mobilization of oesophagus, 58-9 patient position, 57 postoperative care, 60 preoperative preparation, 56
Tooth protection, rigid oesphagoscopy, 23 Transhiatal oesophagectomy, 196-210
anaesthesia, 198 history, 196 operation, 198-208
abdominal phase, 199 cervical gastro-oesophageal anastomosis,
207-8 cervical phase, 200-6 mediastinal dissection, 200-6
outcome, 290 postoperative care, 209-90 preoperative preparation, 197-8 principles and justification, 196-7
Trocars, placement of, 565
Ulcers bleeding, 476-92
anaesthesia, 482 competing therapies, 477-9
endoscopic cautery, 478 endoscopic heater probe, 478 endoscopic injection/sclerosis, 478 laser, 478-9
complications, 491-2 postvagotomy and postgastrectomy
syndromes, 491 recurrence, 491
indications for surgery, 479-82 outcome, 491 perforated, 5 34 postoperative care, 491 preoperative preparation, 482
duodenal, see Duodenal ulcers gastric, see Gastric ulcers peptic, see Peptic ulcers perforated, 5 30-6
anaesthesia, 532 conservative management, 5 30 future developments, 535 operations, 532-5
duodenal ulcer definitive procedure, 534-5 with haemorrhage, 534 with obstruction, 534 simple closure, 532-4
gastric ulcer, 535 incision, 532 stomal ulcer, 535
postoperative care, 535 preoperative preparation, 532 surgical management, 5 30-1
recurrent, 367-8, 389-91, 491 after proximal gastric vagotomy, 390 after vagotomy and antrectomy, 391 after vagotomy and drainage, 391
Index 617
Ulcers-- continued reoperative surgery, 382-93
early complications, 384-9 bleeding, 388-9 gastric outlet obstruction, 389 sepsis, 384-8
operative management, 385-8 prevention, 384-6
late complications, 389-93 alkaline reflux gastritis, 391 dumping syndrome, 392 postvagotomy diarrhoea, 393 recurrent ulcer, 389-91
principles and justification, 382 techniques, 383
stomal, see Stomal ulcers Underwater inflation test for mucosal leakage,
241
Vagotomy, 336-7 duodenal ulcers, 479-80, 483-6 gastric
proximal, 373-81 indications, 374 operation, 375-80
anterior vagotomy of proximal stomach, 3 77
exposure, 3 75 inspection of completed vagotomy,
379 mobilization of oesophagus and
vagal trunks, 376 oesophageal skeletonization, 3 78 posterior vagotomy of proximal
stomach, 3 78 potential pitfalls, 380
postoperative care, 380 preoperative preparation, 3 7 4 principles and justification, 3 73-4 recurrent ulcers after, 390-1
total, 369-72 anterior selective, 3 70 complications, 3 72 exposure, 3 70 history, 369 incision, 3 70 indications, 369 posterior selective, 3 71 postoperative care, 3 72 pyloroplasty, 3 72 skeletonization of distal oesophagus, 3 72
gastric ulcers, 481 laparoscopic, 584-92
complications, 592 highly selective, 587-8 history, 584-5 outcome, 592 position of patient, 586 postoperative care, 592 preoperative preparation, 585 truncal, 590
thoracoscopic, 591 problems of
hiatal opening difficult or dangerous to reach, 340-1
hiatal opening easily reached but vagotomy difficult, 340
possible previous inadequate surgery, 340
total abdominal, 360-8 closure, 366
618 Index
Vagotomy- continued complications, 366-8
dumping syndrome, 368 gallstone formation, 368 gastric outlet obstruction, 367 leaking pyloroplasty, 367 oesophageal injury, 366 postoperative jaundice, 367 postoperative pancreatitis, 367 postvagotomy diarrhoea, 368 recurrent ulcer, 367-8, 391 splenic injury, 366-7
exploration, 361 exposure, 361 history, 360 incision, 361 indications, 360 modified techniques, 365-6
Vagotomy- continued patient position, 361 postoperative care, 366 truncal technique, 362-4
anterior, 363 modified, 365
drainage procedure, 364 posterior, 363-4
modified, 366 Vagus nerves, anatomy, 354-9
abdominal, 356 angle of His, 359 anterior divisions, 357 central vagus complex, 355 cervical, 355 coeliac branches, 358 'criminal' nerve of Grassi, 359 distal oesophageal plexus, 358
Vagus nerves, anatomy- continued gastric branches
anterior, 357 posterior, 358
gastroepiploic vagal innervation, 359 hepatic branches, 357 nerves ofLatarjet
anterior, 357 crow's foot, 359 posterior, 358
posterior divisions, 358 thoracic, 356
Video cameras, 562
Watermelon stomach, 526 Wire-guided dilators, 27-9, 33-7