The surgeon who desires an atlas of techniques covering operations on the colon and rectum almost surely prefers a concise volume rather than an encyclopedic compilation of the innumerable procedures that have been described in the literature. This book includes the operations that have proved to be useful and have survived the test of time. They now are in general use in the Massachusetts General Hospital. Space limitations have necessitated exclusion of detailed illustrations of a number of infrequently performed procedures, such as pelvic exenter ation for cancer of the rectum. In such instances bibliographic references have been provided for ready reference. The bibliography emphasizes recent contributions because they are easily available to the reader. Critical comments by the authors concerning certain technical pro cedures may be due to personal bias and certainly do not imply that the alternative methods are undesirable. Furthermore, the brevity of discus sion of anatomy, physiology, and pathology and the neglect of details of medical therapy of numerous colorectal diseases must be attributed to the fact that this volume is directed primarily toward the practicing surgeon. Thanks are due to the artists Mrs. Edith Tagrin and Mr. Robert Galla, and to Miss Evelyn Hall for help in the preparation of the manuscript. Claude E. Welch, M.D. Leslie W. Ottinger, M.D. John P. Welch, M.D. .

This book provides essential didactic content for the SAGES University Masters Program Colorectal Surgery Curriculum. Surgeons seeking to complete the competency, proficiency, or mastery curriculum of the MASTERS Colorectal Pathway for a particular anchoring colorectal procedure will find relevant educational content in this SAGES Manual. Written by experts in the field, each chapter provides detailed guidance on preoperative and peri-procedural considerations for right and left elective and emergency colorectal resections, for both benign and malignant pathologies. Technical pearls and strategies to manage pitfalls and complications are also extensively reviewed along with detailed guidance for both laparoscopic and robotic procedures. The SAGES Manual of Colorectal Surgery provides a wealth of practical guidance to surgeons along their journey to progress from competency to mastery in various minimally invasive approaches to colorectal surgery.

This is a carefully illustrated volume of surgical procedures. Well-known standard as well as alternative procedures in surgery of the stomach and the proximal duodenum are depicted with anatomical exactness. Possible complications, errors, and dangers and how to avoid them are discussed in detail. Each operative step is illustrated superbly and accompanied by a short, precise text. Both illustrations and text stem from the practical experience in the operating theater of the many renowned surgeons who have contributed to this volume. The book serves as an indispensable reference for surgeons; likewise, gastroenterologists, radiologists, pathologists, and anatomists will find this volume of immeasurable value in their daily work.

The Manual of Upper Gastrointestinal Surgery was compiled as an aid to surgeons, residents, and students who want to acquire a broader knowl edge of the surgical techniques used in the upper gastrointestinal area. Of necessity, a considerable amount of the work of a general surgeon will be confined to this region. The techniques described herein are those preferred by the authors and most, but not all, of their colleagues at the Mayo Clinic. No attempt has been made to include all of the available possibilities and technical varia tions. Likewise, no attempt has been made to include many of the stapling techniques. Although they are good and quite useful, their inclusion would require a complete and separate volume. The omission of an accepted procedure is not meant as a criticism; our aim was to emphasize only the techniques that are most commonly used in day-to-day practice. Gains in knowledge about the anatomy and physiology of the esopha gus, stomach, and duodenum have been highly instrumental in the devel opment of surgical procedures in these areas, particularly the techniques for benign diseases (for example, ulcer, gastritis, and esophagitis).

This book is the structured, comprehensive work of experienced surgeons and constitutes the condensed and succinct epitome of knowledge and guidance for those interested in Laparoscopic Colon Surgery (LCS), focusing only on colon laparoscopy. The milestones in LCS are presented offering valuable background information about the evolution of LCS throughout the years and presenting how it still has a limited application, no matter the need for minimal invasive, fast-track, surgical procedures that can offer better quality to patients and less cost for any healthcare system. The book aims to highlight the preferred diagnostic procedures, the right methods for the efficient and rational selection of patients, the choice of the best surgical techniques and treatments, and the best management of post-operative complications for an early discharge. It provides adequate information to the surgeons or the surgical residents interested in LCS about how to select, what to avoid, what instruments to use, what techniques to follow, how the evaluation of patient’s anatomy can lead to better surgical planning, and the add-on of robotic colon surgery in the quality of patients’ life. Moreover, the book provides information about the most efficient anaesthesia adequate for LCS; information that most books of its kind do not include. Finally, the book provides excellent information about the best education and practices to be followed in LCS; something of special importance after considering the level of difficulty associated with LCS and the high conversion rate compared to other laparoscopic procedures. Although the primary focus of this book are surgeons (LCS, GI, General) and surgical residents, the content still can offer valuable information to these healthcare leaders who are interested in understanding the milestones and benefits of the right model of education, and the best practices related to LCS.

Since RUTHERFORD MORISON left us with the concept of the Omentum being the 'abdominal policeman', clinicians have tacitly assumed that they know sufficient about the structure and function of this organ. However interest in the omentum and its relationship to clinical surgery has recently been develop ing. This book examines all aspects with special reference to surgery and should provide a welcome impetus in research and clinical practice. The editors and contributors have produced a book which is comprehensive and well illustrated and contains detailed refer ences to the important original sources - so essential in a work of this nature. It is written for those who wish to share the delight of acquiring knowledge - even about a comparatively humble organ - as well as for practical surgeons. Both will find ample information to arouse their interest and expand their surgical horizons in exciting ways of which they will almost certainly not have dreamt. I welcome a book of this calibre on a subject which deserves our increasing interest. I delight in the fact that it is dedicated to my friend and colleague MARTIN ALLGOWER.

I have particular pleasure in introducing this publication by Gian Pietro Marzoli and Sergio Vesentini. Years ago they enthusiastically accepted my suggestion that they should take specific interest in the clinical and surgical problem of portal hypertension, and assess the proposals of surgical ex perience with regard to this debated physiopathological picture. These thanks are all the more real because in this way the school's attention remained fixed on a subject that had already attracted it profoundly from the start - with Giovanni Castiglioni and Vittorio Pettinari as heads of the school - and then threatened to die away into general con formism. In Italy "precariousness" is easily extended to the concept of school continuity. In Warren's proposal (1967) of "distal splenorenal anas tomosis with disconnection of the spleno-oesophageal from the mesenteric district", I felt there was an intelligent at tempt to solve all the basic problems, albeit in different ways. An attempt, that is to say, at alleviating the gastro oesophageal circulation, thus avoiding· haemorrhage, and at ensuring that the liver would maintain the circulatory ef ficiency with which it was still endowed. The spleen was re tained, but there was reason to think that, by reducing blood stasis within its ambit, it would be possible to manage or alleviate any hypersplenism: not an absurd hypothesis if the Americans had sometimes noted in their material function al and even anatomical reversion of the splenopathy after a simple portacaval shunt.

Introduction Anthony J. Edis, Richard H. Egdahl, Tracy K. Mcintosh, Contents Lester F. Williams xi 1 Surgery of the Parathyroids General Introduction 1 SURGICAL ANATOMY Primary Hyperparathyroidism 7 PATHOLOGY 7 DIAGNOSIS 11 PREOPERATIVE LOCALIZATION STUDIES 22 TREATMENT 27 Secondary Hyperparathyroidism 35 SIGNS, SYMPTOMS, COMPLICATIONS 35 CLINICAL MANAGEMENT 36 Tertiary Hyperparathyroidism 37 Operative Technique 38 CERVICAL EXPLORATION WITH REMOVAL OF A PARATHYROID ADENOMA 46 SUBTOTAL PARATHYROIDECTOMY FOR HYPERPLASIA 59 PARATHYROIDECTOMY FOR CARCINOMA 60 MEDIASTINAL EXPLORATION FOR PARATHYROID TUMOR 61 References 66 2 Surgery of the Thyroid 71 General Introduction 71 SURGICAL ANATOMY 72 Nodular Goiter and Thyroid Carcinoma 79 PATHOLOGY 79 DIAGNOSIS 82 TREATMENT OF THYROID NODULES 94 TREATMENT OF THYROID CANCER RELATED TO PATHOLOGIC TYPE 97 Hyperthyroidism 110 Graves' Disease 111 PATHOLOGY 111 DIAGNOSIS 112 TREATMENT 115 Plummer's Disease 120 PATHOLOGY 120 DIAGNOSIS 120 TREATMENT 122 Complications of Thyroid Surgery 123 PREVENTION AND MANAGEMENT 123 viii CONTENTS 127 Operative Techniques TOTAL THYROID LOBECTOMY 127 REMOVAL OF A SUBSTERNAL GOITER 134 SUBTOTAL THYROID LOBECTOMY 136 MODIFIED NECK DISSECTION FOR PAPILLARY THYROID CARCINOMA 141 References 144 3 Surgery of the Adrenals 151 151 General Introduction SURGICAL ANATOMY 152 Pheochromocytoma 155 PATHOLOGY 155 156 DIAGNOSIS PREOPERATIVE 162 TREATMENT 166 172 Primary Aldosteronism PATHOLOGY 172 DIAGNOSIS 174 178 PREOPERATIVE LOCALIZATION STUDIES TREATMENT 180 Cushing's Syndrome 181 CLASSIFICATION 182 DIAGNOSIS 187 PREOPERATIVE LOCALIZATION STUDIES 192 TREATMENT 194 Adrenal Gland and Metastatic Breast Carcinoma 198 Adrenocortical Carcinoma 200 DIAGNOSIS 201 PREOPERATIVE LOCALIZATION STUDIES AND STAGING 201 TREATMENT 202 PROGNOSIS 203 Nonfunctioning Adrenal Tumors 203

It is appropriate that a surgical teacher. Robert E. Hermann. M.D . . with a large experience in a specialized field should author the beautifully il lustrated Manual of StlrRery of the Gallbladder. Bile Ducts. and Exocrine Pancreas. This manual. which takes its place in the distinguished series sponsored by RiChard H. Egdahl, M.D . . is designed for the working sur geon. resident or practitioner. who wishes to refresh his memory or to bring himself abreast of current thinking and technics. The carefully planned format and the elegant color illustrations of Mr. Robert Reed per mit this with the expenditure of a minimum of time and effort. and sur geons who must operate on the organs and structures it covers will wish to have it available for reference. Stanley O. Hoerr. M.D. former Chairman. Division of Surgery Cleveland Clinic Chairman. Department of Surgery Fairview General Hospital Cleveland. Ohio Preface Operations on the gallbladder and bile ducts are among the surgical proce dures most commonly performed by general surgeons. In most hospitals, cholecystectomy is the most frequently performed operation within the ab domen; approximately 6()(), OOO are performed each year in the United States. In addition, an estimated 120,000 bile duct operations are performed yearly. Pancreatic surgery is less frequent, but because of the close relation between the biliary system and the pancreas, knowledge of pancreatic problems is equally essential to the surgeon.

This volume presents a comprehensive, up to date and practical approach to creating an ERAS program for GI surgery. The first sections review the evidence underlying individual elements of ERAS, including evidence from laparoscopic procedures when available or pointing to evidence gaps where more research is required. These are written by experts in the field, including surgeons, anesthesiologists, nurses, and physiotherapists. The format is in the style of a narrative review, with narrative evidence review, and concluding with a table with “take home messages” and 3-5 key references for readers interested in more depth in each topic. Each chapter also addresses management of common complications and patient selection or exceptions. Subsequent chapters address practical concerns, including creation of a pathway team, project management and engaging administration. Experts contribute real-world examples of their pathways for a variety of procedures, including colorectal surgery, bariatric surgery, upper GI and hepatobiliary surgery, enabling the user to have a starting point for creating their own programs. The SAGES Manual of Enhanced Recovery Programs for Gastrointestinal Surgery will be of great value to fully trained surgeons, anesthesiologists, nurses and administrators interested in initiating an ERAS program.