Single-access laparoscopic surgery (SALS), performed using a single transumbilical access, has recently proved to bring advantages over other forms of laparoscopic surgery due to the reduction in the number of incisions and the consequent decrease in morbidity, less blood loss and postoperative pain. Furthermore, cosmesis may be improved because incision within the umbilicus renders surgery virtually scarless. Nevertheless, as with all new surgical concepts, questions may be raised regarding safety, usefulness and appropriateness. This book analyzes the use of SALS for different indications and abdominal surgical procedures based on a careful literature review of the experience of the most important surgical teams employing this approach and also the authors' personal observations. The coverage is broad, encompassing, for example, the role of SALS in appendectomy, repair of abdominal wall defects, cholecystectomy, gastric surgery, nephrectomy, splenectomy, hemicolectomy and pancreatic, liver and gynecological surgery.

This book describes current examination techniques and advanced clinical applications of state-of-the-art multidetector computed tomography (MDCT) scanners. There are contributions from several distinguished radiologists and clinicians. Each chapter is written from a practical perspective, so that radiologists, residents, medical physicists, and radiology technologists can obtain relevant information about MDCT applications.

Cancer of the rectum continues to be a significant health problem in industrialized co- tries around the world. Relative 5-year survival rates in the USA for cancer of the rectum from 1995 to 2001 improved to 65%, a 15% improvement over 20 years (American Cancer Society, 2007). The reasons for this dramatic improvement include more accurate pr- perative staging, aggressive neoadjuvant therapy and improved surgical technique as well as specialty-trained surgeons. Despite advances in nonoperative techniques of radiation therapy, chemotherapy and immunotherapy, surgical extirpation continues to be the cornerstone of curative treatment of this potentially lethal disease. Radical cancer excision with total mesorectal excision has become the preferred surgical procedure for even early-stage cancers of the rectum. Over the past decade the enthusiasm for local excision (and other local treatments) has given way to persuasive (predominantly retrospective) evidence that the incidence of locoregional recurrence due to unsuspected lymphatic metastases and positive lateral margins is un- ceptably high even for stage T tumors. Vigorous attempts to find characteristics of the 1 tumor that would allow successful local treatments are ongoing.

Reconstructive Colorectal and Anal Surgery presents a didactic discussion of complex colonic, rectal, anal, and perineal problems which require reoperative surgery. The book provides a very practical description of the management towards these problems including preoperative investigation, postoperative follow-up and detailed operative approach. The text is aimed at being relatively didactic with an algorithm approach to these complicated cases using operative photographs and composite explanatory line drawings which are complemented by 'how-to' guides in all cases describing the operative technical tips and pitfalls from experienced world-renowned commentators. Given the rapid change in techniques over the last 10 years newer procedures will be incorporated. This book will be essential reading for all colorectal surgeons and trainees, general surgeons and trainees, gynecologists as well as specialist nurses in the OR room.

Since the success in chemical induction of cancer in rabbit's ear skin by K. Yamagiwa in 1915, oncologists of the world have come to believe that they can only solve their problems by means of animal experimen tation. The importance of environmental factors became moreevident in 1935 when T. Yoshida and T. Sasaki introduced azodye hepatocarcino genesis in rats. In the domain of the gastrointestinal tract, T. Sugimura has more recently accumulated enough evidence to indicate that locally active chemical mutagens are carcinogenic. In contrast, principal approaches to colorectal tumors have been quite different: emphasis has been placed on gene identification. Long before cancer of the large bowel was recognized, importance of the roles of adenomatosis coli and its familial occurrence attracted the attention of epidemiologists and geneticists. Morphological characteri zation and analysis of hereditary trends of human material have already bad a long history, and recently detailed analysis of genetic material has become feasible in the wake of rapid development in our knowledge of the oncoviruses, oncogenes, suppressor genes, chromosomal and DNA mapping, molecular mutation and so on. lt is true that in colorectal pathology, and in no other field, these areas of research have been explored more extensively and decisively. The identification of previ ously ill-defined lesions such as precancers and benign neoplasms have been improved because sequential changes can be observed in multiple samples spread over a wide area and followed up in due course.

Gastrointestinal bleeding is an age-old problem. The original description of g- trointestinalbleedingmayhavebeenfromGalenandhisworkconnectingdyspepsia andmelanoticstool. Thechangesinourmanagementofgastrointestinalbleeding overthecenturieshavebeendrivenbynaturalalterationsinthespectrumofdiseases, expanding our understanding of these diseases and the never ending advances in technologyandpharmacologythathaveoccurredrelativetoGIdiseases. Academic interestingastrointestinalbleedingpeakedinthelasthalfofthetwentiethcentury withtheexpandingroleofsurgery,thediscoveryofacid-basedpepticulcerthe- pies,andtheriseof?exibleendoscopyandculminatedinthedescriptionofh. pylori as a causative agent for ulcer disease. More recently there has been a decrease incidenceinbleedingdiseasesofthegutandthereforeadecreasinginterestinthe scholarlywritingaboutthesediseases. Therehasnotbeenamajortextbookwritten aboutgutbleedinginover10yearsandthereforetheintentionofthistextbookisto ?llthatvoidbyprovidingareviewofacomprehensiveapproachtouppergut,mid, andlowergutbleeding. CliniciansatDukeUniversitywhohaveacommoninterestinthegastrointes- naltracthavecollaboratedintheconstructionofthistext. Thisefforthasbrought together surgeons, gastroenterologists, and radiologists, to carefully chronicle the presentation, diagnosis, and management of modern day causes of gastrointes- nal bleeding. These co-authors concentrate on some of the latest innovations in the endoluminal and minimally invasive techniques that characterize the current approaches to these diseases. Emphasis has been placed on capsule endoscopy, double-balloon endoscopy, laparoscopic peptic ulcer surgery, and angiographic diagnosis and management techniques. The text has been written in such a way thatthereadercanquicklyreviewaspeci?ccauseofGIbleedingpriortomanaging ofsuchapatient. Weexpectthistextwillbeusedwiththesameimmediacyasthe diseasespresent. Wehopethatthistextprovidesafoundationforlearningformedicalstudents, interns,residents,andpractitionerswhoencounterthesecriticallyillanddif?cultto managepatients. Durham,NC,USA AuroraD. Pryor Durham,NC,USA TheodoreN. Pappas Durham,NC,USA MalcolmStanleyBranch v Acknowledgment TheeditorswouldliketothankMs. VirginiaCashforherhelpinthepreparation andcoordinationofthetext. vii Contents Part I Upper GI Bleeding Stabilization of Patients Presenting with Upper Gastrointestinal Bleeding. ..3 ErrolL. BushandMarkL. Shapiro Urgent Workup for Upper Gastrointestinal Bleeding...13 LorettaErhunmwunseeandSandhyaA. Lagoo-Deenadayalan Management of Esophageal Variceal Bleeding ...23 KekiBalsaraandLisaPickett Management of Dieulafoy's Lesions ...31 SerainaK. Faes,BrianR. Untch,ClaireEdwards,JohnTurner, MartinPoleski,andDouglasS. Tyler Management of Bleeding Peptic Ulcer Disease ...39 JamesC. PadussisandTheodoreN. Pappas Management of Unusual Sources of Upper GI Bleeding...65 ElisabethTracyandJanetTuttle-Newhall Mallory-Weiss Syndrome...79 JacobN. SchroderandMalcolmS. Branch Management of Bleeding Small Bowel Tumors...85 KeriE. LunsfordandAuroraD. Pryor Management of Bleeding from the Bile Duct ...103 CarlosE. MarroquinandBridgetM. Marroquin Management of Bleeding from the Pancreas...

The series of volumes Progress in Surgical Pathology was conceived in an attempt to honor the 70th birthday of Dr. Raffaele Lattes. The original vol umes were the result of an initial call for papers dedicated to progress in the field of surgical pathology with contributors from all over the world. The pa pers published in these volumes have represented examples of classical clin ical pathologic correlations within the discipline of surgical pathology; other papers reflect the work being done at the interface between classical diagnos tic surgical pathology and research in the realm of immunology, molecular biology, cell biology, etc. These papers illustrate what is possible utilizing all of the advances made in basic biology, while remembering that the patholo gist remains an essential, crucial figure in the analysis of tissues, both with respect to their diagnosis as weil as the analysis of the dynamic interactions between cells. There have also been papers that may be characterized as philosophical or historical, which Iook at aspects of surgical pathology in a unique way. Five volumes have been published since 1980. The last of these was pub lished in 1983. For those of you who have been our loyal readers, you may wonder why there has been a gap in the publication of these volumes. This has been due to reorganization both among ourselves as weil as with the pub lisher."

Whereas during the past decade endoscopy has become established as the leading means of diagnosis and management of diseases affecting the esophagus, starnach and large bowel, radiology has retained its pre-eminence for the clinical study and evaluation of the small bowel. This book provides unique coverage of all current radiological techniques used to study the small bowel, including not only barium studies and angiography but also cross-sectional methods such as uhrasound and computer tomography as well as nuclear medicine. Ernerging techniques such as magnetic resonance imaging are given close consideration, and interventional procedures are dealt with fully. Following an introduction on anatomy, physiology, and pathology pertinent to radiol ogy, the book describes in great detail common and less common congenital and development anomalies, trauma, infectious and infl.ammatory conditions, and tumors. The radiological accounts are illustrated by unique color photographs of pathological specimens. It is important for all professionals involved in the management of patients with small-bowel disease tobe critically informed about the specific advantages as well as the limitations of the various modern imaging techniques now employed for the in vivo morphological evaluation of the small bowel. This comprehensive book provides a timely update of our knowledge in this field and is a welcome addition to our series "Medical Radiology;' which aims to provide exhaustive coverage of modern diagnostic radiology. It will be of great interest for general and abdominal radiologists, gastroen terologists, and abdominal surgeons.

Patient Preparation for Bariatric Surgery provides a comprehensive and state of the art review of all aspects of the patient preparation process, The text reviews current literature and controversies involving sources of referrals and the difficulties encountered by primary care physicians in managing patients with extreme obesity. Strategies for addressing this problem and integrating primary care physicians in comprehensive obesity programs are presented. The text also reviews current indications for surgery and the current patient access limitations that have resulted in the need for revised surgical indications based more on medical need than mere extent of obesity. Written by an authority in the field, Patient Preparation for Bariatric Surgery is a valuable resource for bariatric surgeons, bariatric physicians and all allied health personnel who manage patients with extreme obesity and will assist in the advancement of this area of surgery as well as stimulate new discovery.

Much progress has been made in recent years and new techniques have been developed in the field of plastic surgery of the breast. Breast Surgery presents plastic surgeons with a comprehensive summary of current practice and the techniques available.
Clearly written in language accessible to both specialists and non-specialists, Breast Surgery presents a variety and range of techniques with which excellent results in both plastic and reconstructive breast surgery can be achieved. Over 600 drawings and photographs, both in black and white and in colour, accompany the text, providing the plastic surgeon with clearly-illustrated guidelines to follow.
Dr. Nathalie Bricout is a leading figure in the field of plastic surgery of the breast in France.

The current medical literature contains ample text addressing the topics of trauma and critical care. However, there are few texts existing that specifically address the common surgical problems encountered by practicing acute care surgeons. Common Problems in Acute Care Surgery provides a comprehensive, evidence-based review of the most common clinical problems encountered by acute care surgeons. Focusing on the clinical care of the patient, this volume explores the general principles of acute care surgery and the specific disease states that are commonly encountered by acute care surgeons. The work also touches upon the ethical issues and systems development behind acute care surgery, including practical considerations for establishing an acute care surgery program, ethical considerations in acute care surgery, and the role of palliative care. Authored by respected experts in the field and illustrated throughout with detailed photographs, Common Problems in Acute Care Surgery is of great value to resident surgeons in training, fellows, and practicing surgeons in acute care surgery.

Perioperative Management is reviewed extensively in this important Surgical Clinics of North America issue. Articles include: Cardiac risk stratification and protection; Prevention of pulmonary complications; Perioperative nutrition; Prophylactic antibiotics and prevention of post-operative infections; DVT and VTE prophylaxis; Post-operative pain control and sedation; End points of resuscitation; Optimal glucose management in the perioperative period; Essentials of sepsis management; Transfusion and management of surgical patients with hematologic disorders; Perioperative management of the obese patient; Perioperative management of the elderly patient; Perioperative management in the patient with substance abuse; Management of the pregnant patient undergoing general surgical procedures; Advanced directives, living wills and futility; and more!

In conventional partial resection of parenchymatous organs significant bleeding is one of the main problems, especially in neonates and infants. The patients rapidly lose considerable amounts of their small blood volume. Laser light leads to photo thermal effects in tissue and causes coagulation, drying up, carbonization and evaporization, depending on the temperature. The neodymium Y AG laser emits nonvisible light in the near infrared with a wavelength of l. 0611m. This wavelength implies a relatively deep penetration into the tissue. This laser system, properly a coagulation laser, achieves its cutting effect by its high power density [9]. Because of thermal radiation in all directions, both sides of the section plane are coagulated as a positive side effect. Thus, in parenchymatous organs a combination of resection and sealing of the cut vessels and ducts, up to a limited diameter, is obtained. Laser Instruments We use a neodymium-YAG laser mediLas 2 (MBB-Medizintechnik, D-8012 Ottobrunn, Federal Republic of Germany), wavelength l. 0611m, maximal power output around 110 W (Fig. 1). Normally we prefer to work without tissue contact, Fig. l. The Nd-YAG laser system mediLas 2 with maximal power output around 100 W The Neodymium Y AG Laser in Surgery of Parenchymatous Organs 25 Fig. 2. The focusing handpiece with focal distance of 50 mm 1cm Fig. 3.

This pocket manual is a quick-reference handbook for general thoracic surgery. It is organized into 9 chapters providing a concise, yet inclusive list of the most common pathologies seen in thoracic surgery: pre-operative evaluation, peri-operative care, lungs and airways (divided into 3 separate sections to cover the vast number of topics), pleural disorders, mediastinal disorders, chest wall disorders, thoracic trauma, and benign and malignant esophageal disorders. The content of each chapter was specifically structured to make the handbook a high-yield reference that includes numerous management algorithms, flow diagrams, tables and images. Unlike a comprehensive textbook, paragraphs are kept at a minimum and the written material is presented using lists and bullet points to facilitate learning and retention. More importantly, the content is evidence-based and highlights the various controversies in the field. The Pocket Manual of General Thoracic Surgery is an irreplaceable educational tool amongst trainees and practicing physicians.

Steven A. Rosenberg, MD In the past two decades significant progress has quality of life. The use of local radiation therapy has occurred, in the management of patients with mus- had a profound impact on the ability to achieve local loskeletal cancers, that has improved both the survival control. Cooperation between surgeons and radiation and the quality of life of afflicted patients. Changes in therapists often results in the tailoring of surgical p- the management of these patients have mirrored cedures to maximize the combined application of these trends in the entire field of oncology. two effective treatment modalities. Although impact on The most significant change has been improvement overall survival has not been demonstrated due to the in the surgical techniques for the resection of musculo- addition of radiation therapy, important advances in skeletal cancers based on a detailed understanding of improving the quality of life of patients receiving this the anatomic features of each particular tumor site, as combined-modality treatment have been evident. well as an appreciation of the natural biology that affects A third change impacting on the survival of patients the local spread of these tumors. The current volume of with musculoskeletal cancers has been the aggressive Musculoskeletal Cancer Surgery: Treatment of Sarcomas and resection of metastatic deposits.

Laparoscopy is a new frontier of the surgical technique, which recently gained more and more popularity and credit upon the surgical teams, also in Urology. The reason stays in the reduced invasivity and in the advances on the techniques of "video-assisted surgery." More recently the retroperitoneal access to laparoscopy surgery ("retroperitoneoscopy" or "retroperitoneal laparoscopy") opened a new surgical approach to several diagnostic and operative procedures for a large number of urogenital tract diseases. The applications in pediatric and in adult age and the technical challenges are widely debated at the moment. The volume gathers contributions by internationally renowned authors and is a complete overview of the technique. The book addresses urologists, general and abdominal surgeons, pediatric urologists and pediatric surgeons who are interested in minimally invasive procedures and particularly in retroperitoneal laparoscopy.

Cardiothoracic Surgery in the Elderly: Evidence Based Practice is an important and timely book that reflects the thoughtful work of pioneers in geriatric surgery. It encompasses their knowledge related to geriatric surgery, and their reflections and guidance on the rapidly accumulating knowledge related to improving the health and surgical care of seniors. This book provides a scholarly review of the constantly expanding knowledge base about cardiovascular and thoracic surgery in seniors. The book follows a logical sequence covering general aspects of care, cardiac surgery and thoracic surgery. Chapters are focused on common, devastating and often missed complications of surgical care in the seniors. These include delirium, depression, pressure sores, functional losses, incontinence, volume depletion and asymptomatic or atypical complications -myocardial infarction, post-operative diarrhea, urinary track infections and pneumonia. Each is expertly reviewed. Strategies to help the surgeons and the surgical team anticipate, recognize and effectively prevent or manage such problems are discussed and the evidence basis for such strategies is provided. Cardiothoracic Surgery in the Elderly: Evidence Based Practice is particularly timely and the first to review the substantial body of knowledge that has been developed in recent years related to geriatric cardiothoracic surgical problems. It catalogs well the expanding knowledge basis for achieving successful surgical outcomes in the very old. It provides a most useful resources for cardiovascular thoracic surgeons in training and those already in practice.

Fetal and perinatal medicine is a rapidly expanding field, and noninvasive imaging by means of ultrasonography and MRI is playing a major role in refining diagnosis and therapy. Recent technological advances in these imaging modalities now allow unprecedented morphological depiction of the fetus and excellent insight into complex pathologic conditions, as well as yielding superior guidance for therapeutic fetal inter ventions. I am very pleased that Professor F. Avni , a leading international pediatric radiologist, was prepared to take on the challenging task of preparing and editing this comprehen sive and up-to-date overview of our knowledge in the area of fetal and perinatal imaging. He has been successful in engaging well-known experts with outstanding qualifications in fetal imaging to join him in this venture. I would like to congratulate Professor Avni and all contributing authors most sincerely for their excellent work. I am confident that this outstanding volume will meet with great interest not only from general as well as specialized pediatric radiologists but also from neonatologists and pediatricians. I trust it will enjoy the same success as many previous volumes in this series. ALBERT L. BAERT Leuven Preface Fetal and perinatal medicine would not have developed without the extensive use of obstetric ultrasound (US). In order to be efficient, the examination has to be performed very carefully and by sonologists fully conversant with the normal and abnormal development of the fetus.

Uterine fibroids are the commonest benign tumors of the uterus and pelvis, and are the single most common cause of surgery in women apart from childbirth. Originally published in 2003, this pioneering book compares and contrasts conventional surgical treatments with the rapid emergence of uterine artery embolization as an alternative and less invasive procedure, and is of major importance in relation to the treatment of the condition. A host of international experts from gynecology and interventional radiology have contributed chapters, including one by Dr Jacques Ravina, the pioneer of uterine artery embolization. Although the main focus is on embolization, the book does also give a very comprehensive account of the epidemiology, pathology, diagnosis and management of uterine fibroids, and of conventional treatments such as hysterectomy and myomectomy. This all-inclusive approach makes the book suitable for gynecologists, radiologists, and for all trainees and residents looking after patients with uterine fibroids.

It is estimated that the functionally significant body of knowledge for a given medical specialty changes radically every 8 years. New specialties and "sub-specialization" are occurring at approximately an equal rate. Historically, established journals have not been able either to absorb this increase in publishable material or to extend their readership to the new specialists. International and national meetings, symposia and seminars, workshops and newsletters, successfully bring to the attention of physi cians within developing specialties what is occurring, but generally only in demonstration form without providing historical perspective, patho anatomical correlates, or extensive discussion. Page and time limitations oblige the authors to present only the essence of their material. Pediatric neurosurgery is an example of a specialty that has developed during the past 15 years and over this period, neurosurgeons have ob tained special training in pediatric neurosurgery and then dedicated them selves primarily to its practice. Centers, Chairs, and educational pro grams have been established as groups of neurosurgeons in different countries throughout the world organized themselves respectively into national and international societies for pediatric neurosurgery. These events were both preceded and followed by specialized courses, national and international journals, and ever-increasing clinical and investigative studies into all aspects of surgically treatable diseases of the child's ner vous system."

Minimally invasive or laparoscopic surgery is becoming increasingly commonplace, as technology has enabled a minimally invasive approach to be offered as a feasible alternative to conventional open surgery for a number of important surgical procedures. This comprehensive, but concise and practically oriented introduction to the subject was first published in 2004 and will be of value to all anaesthetists with an interest in minimally invasive techniques. It begins by covering the key aspects of basic physiology, moves on to patient preparation and positioning, monitoring, the anaesthetic procedures themselves (including possible complications and contraindications and easy-to-follow 'how to' guides for a number of key procedures) and, finally, post-operative pain. Written by a leading expert in the field, from a well-known European centre of excellence, it is essential reading for anaesthetists and intensivists at all levels of expertise.

Liposuction began as a contouring procedure but has evolved into the treatment of obese patients, gynecomastia, ptosis, macromastia, and even patients who have complications from heart disease or diabetes. Other disorders such as axillary sweat hypersecretion, lipomas, and angiomas are also potential disorders that may be treated with liposuction.

Physicians performing liposuction must be adequately trained and experienced in the potential and actual complications before attempting to perform liposuction. Patient safety is the most important aspect of all surgeries, but especially of cosmetic surgery, which is an elective procedure.

New technology helps improve results but experience, care, and skill of the cosmetic surgeon is necessary to obtain optimal results that satisfy the patient.

The contributors to this book have spent time and effort presenting the cosmetic and plastic surgeon as much information as possible on the techniques and uses of liposuction for cosmetic and non-cosmetic surgery purposes.

Abdominal Wall Hernias is the most up-to-date, comprehensive reference available on all aspects of hernia repair. It includes state-of-the-art approaches to conventional open repairs using tissue-to-tissue techniques, the use of prosthetic mesh, minimally invasive approaches, the repair of recurrent and massive hernias, pertinent anatomy, basic science, and emerging biomaterials. The authors present a full spectrum of procedures to enable readers to gain a broad knowledge of the multifaceted repair of hernias. Richly illustrated, this book is a vital resource for all general surgeons and surgeons-in-training.

The second volume of Operative Manual of Endoscopic Surgery covers some of the operative endoscopic procedures which have been introduced into clinical practice since the publication of VoI. 1. In the general section, we have included an updated chapter on instrumentation and new chapters on anaesthetic manage ment of patients undergoing endoscopic surgery and on video image and record ing. Both topics are of importance to the practice of endoscopic surgery and have not been adequately covered in the reported literature. Volume 2 deals with endoscopic procedures)nthechest and abdomen. There have been significant advances in thoracoscopic surgery duririg the past 2 years; particular reference rs made to anatomical pulmonary resections and oesophageal resections. As far as the gastrointestinal trad is concerned, we have included gastric and allied operations but have not covered the colorectal region as we believe that more evaluation is needed before definitive accounts can be written on endoscopic colorectal resections, especially for cancer. For this reason, we have decided to defer this important topic to VoI. 3, which is in preparation. The same applies to laparoscopic repair of abdominal hernias. The same layout has been adopted as in VoI. 1 of the series, with heavy em phasis on illustrative representation of the operative steps and techniques. In the diagrams on sites of trocar/cannulae, we have indicated not only the site and size but also the functional role of each port.

The aim of this Atlas is to present the three-dimensional arrangement of the liver structures, which should be familiar to those who diagnose and treat diseases of the liver, particularly in an era when the methods of diagnostic imaging and surgical treatment are becoming increasingly sophisticated. For this purpose a series of corrosive preparations of the blood vessels and bile ducts of the liver was made and photographed. In addition to the normal situations, many frequent and rare variations are shown. The Atlas also shows some blood vessels that have not been adequately described or are not well-known in the reference literature, but are nevertheless of great importance in performing segmental liver resections.This Atlas takes a fresh approach to the subject. The method used allows the size, three-dimensional arrangement and structure of the blood vessels and bile ducts of the liver to be preserved. The majority of photographs were taken from the direction from which surgeons see the liver during an operation. This, together with the schematic presentations complementing most of the photographs, gives a further instructional value to the work. With colour photographs and explanatory text, the Atlas forms a basic guide to orientation inside the liver parenchyma, to understanding and diagnosing certain pathological processes and to planning surgcial procedures.