Benign Breast Disease Halley Vora, MD Tawakalitu O. Oseni, MD GENERAL CONSIDERATIONS Most women will experience a benign breast concern in their lifetime. These patients are often referred to general surgeons for evaluation and management. Evaluation of any breast complaint begins with a focused history and physical examination. The history should include an assessment of the patient’s presenting problem including onset, symptoms, quality, duration, presence of aggravating/alleviating factors,…

Management of Inguinal Hernia James E. Wiseman, MD, MBA Gina L. Adrales, MD, MPH More than 20 million inguinal hernia repairs are performed every year around the globe, placing this operation among the most common general surgical procedures ( ). Although the use of mesh in inguinal hernia repair parallels a dramatic reduction in recurrence rates, chronic post-herniorrhaphy pain syndrome has simultaneously emerged as an important cause of…

Splenectomy for Hematologic Disorders Adam S. Weltz,, MD Adrian E. Park,, MD INTRODUCTION Splenectomy may be indicated in a wide variety of hematologic diseases that lead to hypersplenism. It may also be performed more generally to relieve the mass effect and symptoms of splenomegaly, to control infection or traumatic hemorrhage, and, finally, a surgeon may decide to remove the spleen to diagnose splenic pathology. Despite a broad range…

Management of Acute Necrotizing Pancreatitis Ryan B. Morgan, MD John C. Alverdy, MD Acute pancreatitis is the leading cause of gastrointestinal-related hospitalization in the United States, with an estimated incidence of 15 to 45 per 100,000 per year. The severity of acute pancreatitis varies widely among patients, ranging from self-limited episodes to prolonged hospitalization and death from infected necrotizing pancreatitis. The most common causes of pancreatitis include excess…

Management of Asymptomatic (Silent) Gallstones Theodore N. Pappas, MD Christopher R. Reed, MD NATURAL HISTORY OF CHOLELITHIASIS The first description of incidental gallstones probably dates back to the 14th century, a relatively recent observation in the grand scheme of pathologic observations. This has been attributed to the relative rarity of gallstone formation before modern diets. These postmortem findings preceded the first descriptions of symptomatic gallstones by about 200…

Portal Hypertension: Role of Shunting Procedures Eliza J. Lee, MD Russel N. Wesson, MBChB INTRODUCTION Defined as a portal venous pressure gradient greater than 5 to 7 mm Hg, portal hypertension develops when resistance to portal blood flow increases. Although the etiology of portal hypertension is broad, it is classified as prehepatic, intrahepatic, or posthepatic ( Table 1 ). In instances of prehepatic and posthepatic portal hypertension, mechanical…

Cystic Disease of the Liver INTRODUCTION Cysts of the liver are a common phenomenon and occur in approximately 5% to 20% of adults. They are sporadic and largely not associated with familial syndromes. Most cysts of the liver are simple and benign, however a minority of liver cysts and cystic lesions harbor either active malignancy or malignant potential ( Table 1 ). The challenge presented to…

Management of Hemorrhoids Ariane M. Abcarian, MD Herand Abcarian, MD INTRODUCTION Hemorrhoids are specialized vascular cushions in the anal canal or at the anal verge. These cushions are composed of blood vessels, connective tissue, and smooth muscle fibers. Hemorrhoids are a normal part of human anatomy and are responsible for 15% to 20% of anal resting pressure. Hemorrhoids are typically paired and located in the right posterior, right…

Preoperative Bowel Preparation: Is It Necessary? Anna Chudnovets, MD, Sandy Hwang Fang, MD Patients who undergo colorectal surgery for cancer and inflammatory bowel disease often have associated risk factors that impair wound healing, such as chemoradiation therapy, steroid therapy, and malnutrition. Additional complicating factors include case complexity, perineal wounds, and combined multispecialty cases. Due to the nature of the colon and rectum yielding high bacterial inoculum and these…

Management of Small Bowel Obstruction Charudutt Paranjape, MD George Velmahos,, MD INTRODUCTION Small bowel obstruction (SBO) accounts for 2% to 4% of emergency department (ED) visits for abdominal pain and accounts for as many as 16% of surgical admissions and more than 300,000 operations annually in the United States. The associated cost is over $2 billion in inpatient costs annually. Although some obstructions occur in the large intestine,…

Benign Gastric Ulcer Daniel T. Dempsey, MD Benign gastric ulcer is a discrete macroscopic wound in the luminal surface of the stomach, extending into the submucosa or muscularis propria and rarely to the serosa of the organ. It is generally believed to start as a mucosal defect that remains unrepaired and deepens because of an imbalance between gastric mucosal defenses and aggressive luminal forces, primarily acid and…

Esophageal Function Tests Wasay Nizam, MBBS Hamza Khan, MD Malcolm V. Brock, MD The esophagus is a muscular, tubelike structure located in the posterior mediastinum. It spans from the posterior oropharynx to the cardia of the stomach with three functional regions: the upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES). With the aid of peristalsis and coordinated relaxation/contraction of sphincters, the esophagus allows the transport of…