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Carotid Endarterectomy

Introduction Carotid endarterectomy (CEA) is one of the most commonly performed vascular operations, with the majority of these procedures being performed for carotid bifurcation atherosclerotic disease ( Fig. 41.1A ). Two landmark multicenter randomized trials, North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial, have demonstrated the reduction of stroke risk with CEA in patients with ipsilateral symptomatic carotid stenosis. Reduction of…

Open Retromuscular Hernia Repair

Video 40.1 Open Transversus Abdominis Release (TAR) Introduction Approximately 300,000 to 400,000 ventral hernias are fixed yearly in the United States, encompassing primary defects as well as the 20% to 25% of incisional hernias that occur after midline laparotomy and 24% to 43% of recurrences even after mesh repair. Even for the smallest primary defects, long-term follow-up of randomized controlled data has found that mesh reinforcement…

Open Flank and Lumbar Hernia Repair

Introduction Lumbar and flank hernias are caused by defects originating in the lateral abdominal wall. Such defects can be congenital or acquired as a consequence of surgery, trauma, or progressive weakening of native tissues. There are some specific challenges associated with these hernias that require surgeons who repair them to have a profound knowledge of the abdominal wall and anatomy. First, their anatomic location is bordered…

Surgical Approach to Chronic Groin Pain Following Inguinal Hernia Repairs

Introduction Chronic postoperative inguinal pain (CPIP) has become an increasingly appreciated complication of one of the most common operations performed in surgery, the inguinal hernia repair. The rate of CPIP after inguinal hernia repair is greater than the risk of developing an inguinal hernia recurrence. Chronic groin pain is defined as having pain that persists for more than 3 months after an inguinal hernia repair; 15%…

Laparoscopic Inguinal Hernia Repair

Introduction Since the first laparoscopic cholecystectomy was successfully performed in 1987, there has been a remarkable adoption of minimally invasive techniques, which has dramatically changed the field of general surgery. The surgical management of inguinal hernias, traditionally one of the most commonly performed procedures by the general surgeon, has paralleled the natural evolution of such surgical innovation. Compared with the open tension-free technique, laparoscopic inguinal hernia…

Sphincter Repair and Sacral Neuromodulation

Introduction Fecal incontinence is a devastating problem. The incidence has been cited between 1% and 18% based on several studies. However, even at this rate, this symptom seems to be under-reported, with true incontinence (that excludes incontinence of flatus) thought to be around 7% to 8%. The initial treatment of fecal incontinence is usually by conservative means involving diet and bowel management. This is done by…

Ileal Pouch Anal Anastomosis

Videos 35.1 Single Incision Total Abdominal Colectomy (First Stage Restorative Proctectomy/Ileal Pouch Anal Anastomosis) 35.2 Completion Proctectomy/J-Pouch Construction You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Suture Rectopexy and Ventral Mesh Rectopexy

Introduction Full-thickness external rectal prolapse is herniation of the rectum through the anal orifice. More commonly seen in older women, rectal prolapse can occur in both genders and even at a young age. The underlying mechanism of rectal prolapse is poorly understood. However, a mid-to-low rectal intussusception is thought to be the initiating step. Chronic straining is also thought to be a precipitating factor. The goals…

Perianal Abscess and Fistula in Ano

Introduction Perianal sepsis is a common problem that can be handled simply and successfully if treatment is based on an understanding of its anatomy and pathophysiology. The anatomy of the anus and the surrounding areas of the pelvis and perineum is complex, and sepsis in the area can be complex also. The aim of this chapter is to explain perianal sepsis in the context of anatomy…

Hemorrhoids and Hemorrhoidectomy

Introduction “Doctor, I have hemorrhoids” is a common complaint. The majority of these complaints are not truly hemorrhoids but other benign conditions; some may hide a more threatening diagnosis, such as anal cancer. Evaluating each patient based on his or her symptoms is important to avoid missing a condition that may require further management. Management of symptomatic hemorrhoids requires an in-depth understanding of the anorectal anatomy…

Abdominoperineal Resection

Introduction Abdominoperineal resection (APR) is most often employed for lower-third rectal cancers, rare low pelvic tumors, and other low pelvic cancers requiring pelvic exenteration with involvement of the sphincters. Tumors above the levator muscles and inflammatory bowel diseases (IBD) can typically be treated with sphincter-sparing restorative and nonrestorative intersphincteric proctectomy. Patients with anal squamous cell carcinoma with persistent or recurrent disease despite, or who have contraindication…

Low Anterior Resection With Total Mesorectal Excision and Anastomosis

Video 30.1 Low Anterior Resection With Total Mesorectal Excision and Anastomosis Introduction Colorectal cancer is the second most common tumor in men and women in the Western world. Tumors occur most frequently in the rectum and sigmoid colon and are usually treated by resection and primary anastomosis. Surgery is the mainstay of therapy, and patients with positive nodal disease also require adjuvant chemotherapy. Some additional patients…

Transverse Colectomy

Introduction Transverse colectomy, in isolation, is an uncommon procedure. Potential indications for transverse colectomy include transverse colon cancer, segmental inflammatory bowel disease, and segmental transverse colon ischemia. In contrast, mobilization and resection of the transverse colon—in total or segmental—is commonly performed as a component of a right, left, subtotal, or total colectomy. Familiarity with the potential anatomic variability of this part of the colon, along with…

Left and Sigmoid Colectomy

Video 28.1 Left and Sigmoid Colectomy Introduction Left colectomy or hemi-colectomy is a resection of the colon within the territory supplied by the left branch of the middle colic artery and the inferior mesenteric artery within the embryologic partitioning of the hindgut. Common indications include neoplasia of the distal transverse colon descending or sigmoid colon; segmental ischemia; or occasionally diffuse diverticulitis. Sigmoid colectomy involves resection of…

Right Colectomy

Video 27.1 Right Colectomy Introduction A right colectomy is performed to treat a variety of pathologies. Common indications include an unresectable polyp, colon cancer, and Crohn’s disease of the terminal ileum. Ischemia, volvulus, and malignant lesions of the appendix or terminal ileum may also be indications. Resection of the terminal ileum and cecum is common to all these procedures. The distal extent of the right hemicolectomy…

Abdominal Wall Marking and Stoma Site Selection

Introduction Intestinal stomas serve as the end of the gastrointestinal tract, protect distal anastomoses, and relieve obstruction. Small intestinal stomas frequently are used in the management of inflammatory bowel disease, familial adenomatous polyposis, motility disorders, and colorectal cancer. Colostomies are used in the treatment of colorectal cancer, diverticulitis, rectal atresia, Hirschsprung disease, and trauma. You’re Reading a Preview Become a Clinical Tree membership for Full access…

Appendectomy

Video 25.1 Appendectomy Introduction The first recorded appendectomy was performed by Claudius Amyand in December 1735. Since that time, it has become the standard of care for the treatment of acute appendicitis because of its efficacy and low morbidity. The term appendectomy was first coined by pathological anatomist Reginald Fitz in 1886, in which he described the clinical features of acute appendicitis and advocated for early…

Deceased Donor Organ Recovery

Introduction Organ transplantation is the only viable lifesaving option for many patients with end-stage organ failure. The progress in transplant procedures and post-transplant care has resulted in decreased morbidity and mortality after transplantation. More patients with end-stage organ failure are now being placed on the waiting list, resulting in more need for lifesaving organs. The sources of organs are either from living donors, which are discussed…

Laparoscopic Donor Nephrectomy

Video 23.1 Left Laparoscopic Donor Nephrectomy Introduction A donor nephrectomy is an operation that allows for safe removal of a patient’s kidney in such a way that permits and optimizes transplantation into an appropriately matched recipient. The surgical procedure must be done in an efficient and reliable manner to minimize, or completely eliminate, any problematic complications that may arise in the donor and recipient pair. A…

Pancreas and Kidney Transplantation

Video 22.1 Simultaneous Pancreas and Kidney Transplantation Preoperative Planning and Consideration Pancreas transplantation is currently a therapeutic option for patients with type 1 diabetes mellitus and, in selected circumstances, those with type 2 diabetes mellitus. The primary goal of the procedure is to replace insulin that is otherwise absent as a result of islet cell loss from the native pancreas. There are three possible scenarios for…