General and Visceral Surgery Review (ISBN 9783131543110) © 2012 Georg Thieme Verlag KG VI Preface

List of Contributors V

List of Contributors

Hinrich Brunn, MD Nicolas T. Schwarz, MD Friedrich Ebert Hospital Associate Professor Surgical Clinic Friedrich Ebert Hospital Department of Vascular Surgery Surgical Clinic Neumünster Neumünster Germany Germany

Ronald J. Elfeldt, MD Alexander Selch, MD Associate Professor Friedrich Ebert Hospital Friedrich Ebert Hospital Surgical Clinic Surgical Clinic Department of Vascular Surgery Department of Thoracic Surgery Neumünster Neumünster Germany Germany Burkhard Thiel, MD Michael Fuchs, MD Friedrich Ebert Hospital Associate Professor Surgical Clinic Friedrich Ebert Hospital Neumünster Trauma and Orthopedic Clinic, Sports Trauma Clinic Germany Neumünster Germany Michael Voelz, MD Friedrich Ebert Hospital Jan M. Mayer, MD Surgical Clinic Friedrich Ebert Hospital Neumünster Surgical Clinic Germany Neumünster Germany

Ingo L. Schmalbach, MD Friedrich Ebert Hospital Surgical Clinic Neumünster Germany

Preface

General and Visceral Surgery Review was originally The purpose of this textbook is higher training published in German in 1996 as a revision aid for and examination preparation in general and visceral surgery in general. Since then, as the individual sur- surgery. We have made every effort to include up-to- gical subspecialties continue to develop, and today’s date information and to present this information in a medical training is built around the “Common concise and succinct format, thus enabling col- Trunk” (as it is called in Germany), with subsequent leagues to acquire the necessary theoretical knowl- specialist training, it has been necessary to continu- edge in the shortest possible time. ally update and adapt the higher-training content This book is designed to place emphasis on core according to the various surgical specialties. General statements, and includes suggestions for further and Visceral Surgery Review was published in its reading to help consolidate what has been learned. sixth German-language edition in 2009. Contributions were provided by surgeons actively Karl-Heinz Reutter, MD, created General and Vis- working in this field. By calling on their own practi- ceral Surgery Review and continued it through five cal experiences they have produced an ideal learning successful editions in the German language. I am not tool suited to the current requirements of higher only happy to take over the task of editor from him training and examination preparation. for further German language editions, I am also highly delighted to be able to present the first Eng- Nicolas T. Schwarz Neumünster, Germany lish-language edition.

Acknowledgements

I thank my colleague K.-H. Reutter, MD, for giving me this new edition to their enthusiasm for general and the opportunity to take over the editorship of this visceral surgery and to their constant thirst for book. My special thanks also go to my medical col- knowledge, coupled with the desire to pass on this leagues in the Departments of Surgery and Trauma interest and their love of the specialty to their many Surgery in Neumünster. We owe the production of colleagues.

Contents

1 Perioperative Medicine N.T. Schwarz 1

Preoperative Phase ...... 1 Postoperative Period ...... 6 Intraoperative Phase ...... 5 Fast-Track Surgery ...... 7

2 Thyroid B. Thiel 9

Anatomy ...... 9 Diseases of the Thyroid ...... 26 Euthyroid Goiter ...... 26 Physiology ...... 12 Hyperthyroidism ...... 28 General Epidemiology ...... 12 Graves Disease, Immunogenic Hyperthyroidism 30 Thyrotoxic Crisis ...... 33 General Diagnostic Approach ...... 12 Thyroiditis ...... 34 General Treatment Approach ...... 17 Thyroid Carcinoma ...... 37

3 Parathyroid B. Thiel 44

Anatomy ...... 44 Tertiary Hyperparathyroidism ...... 54 Physiology ...... 45 Parathyroid Carcinoma ...... 54

Primary Hyperparathyroidism ...... 45 Hypoparathyroidism ...... 55 Secondary Hyperparathyroidism ...... 51

4 Thorax (Pleura, Lung) R.J. Elfeldt 57

Anatomy ...... 57 Fracture of the Sternum ...... 65 Lung Contusion ...... 66 Pleural Effusion ...... 57 Chest Trauma: Penetrating Chest Injuries ...... 67 Pleural Empyema ...... 61 Traumatic Pneumothorax ...... 67 Chest Trauma: Blunt Chest Injuries ...... 62 Hemothorax ...... 69 Chest Contusion ...... 63 Chylothorax ...... 70 Chest Compression ...... 63 Tracheal and Bronchial Injuries ...... 70 Rib Fractures ...... 64

5 Mediastinum R.J. Elfeldt 72

Anatomy ...... 72 Mediastinal Emphysema ...... 74

Mediastinoscopy ...... 73 Mediastinitis ...... 75 Subcutaneous Emphysema ...... 74

6 Diaphragm I.L. Schmalbach 77

Anatomy ...... 77 Rare Disorders of the Diaphragm ...... 81

Diaphragmatic Hernias ...... 78

7 Hernias J.M. Mayer 83

Inguinal Hernias ...... 85 Umbilical Hernia ...... 103

Femoral Hernias ...... 95 Epigastric Hernia ...... 104 Incisional Hernias ...... 96 Internal Hernias ...... 104

8 Esophagus M. Voelz 106

Anatomy ...... 106 Epiphrenic Pulsion Diverticulum ...... 111 Traction Diverticulum ...... 111 Histology ...... 108 Gastroesophageal Reflux Disease (GERD) ...... 111 Physiology ...... 108 Esophageal Carcinoma ...... 115 Functional Disorders ...... 108 Achalasia ...... 108 Injuries of the Esophagus ...... 123 Other Functional Disorders ...... 109 Corrosive Injuries ...... 123 Traumatic Perforation of the Esophagus ...... 124 Esophageal Diverticulum ...... 110 Spontaneous Esophageal Rupture (Boerhaave Cervical Pulsion Diverticulum (Zenker Syndrome) ...... 124 Diverticulum) ...... 110

9 Stomach and Duodenum N.T. Schwarz 126

Anatomy ...... 126 Gastric Carcinoma ...... 155 Ulcer ...... 128 MALT Lymphoma ...... 173

Bleeding from the Stomach and Duodenum ...... 150

10 Small Intestine I.L. Schmalbach 176

Anatomy ...... 176 Meckel Diverticulum ...... 184 Crohn Disease ...... 176 Jejunal Diverticulum ...... 184

11 Vermiform Appendix I.L. Schmalbach 185

Anatomy ...... 185 Diverticulitis of the Appendix ...... 193 Appendix Carcinoid ...... 193 Acute Appendicitis ...... 185 Mucinous Cystadenoma / Pseudomyxoma Rare Diseases of the Appendix ...... 193 Peritonei ...... 194 Endometriosis of the Appendix ...... 193 Appendix Carcinoma ...... 194 Crohn Disease ...... 193

12 Colon J.M. Mayer 196

Anatomy ...... 196 Ulcerative Colitis ...... 205

Anastomosis Techniques ...... 197 Polyps of the Colon ...... 212 Minimally Invasive Colon Surgery ...... 199 Colon Cancer ...... 214

Diverticulosis and Diverticulitis ...... 200

13 Rectum J.M. Mayer 230

Anatomy ...... 230 Pelvic Floor Insufficiency ...... 240 Rectal Cancer ...... 233

14 Anus J.M. Mayer 245

Anatomy ...... 245 Abscesses and Anal Fistulas ...... 251 Hemorrhoids ...... 245 Fecal Incontinence ...... 255

Perianal Vein Thrombosis ...... 250 Anal Carcinoma ...... 258 Anal Fissure ...... 250

15 Intestinal Obstruction H. Brunn 263

16 Spleen H. Brunn 277

Anatomy ...... 277 Hypersplenism Syndrome ...... 277

Physiology ...... 277

17 Liver M. Voelz 281

Anatomy ...... 281 Malignant Liver Tumors ...... 284 Primary Hepatic Carcinoma ...... 284 Benign Liver Tumors ...... 282 Liver Metastases ...... 286 Focal Nodular Hyperplasia (FNH) ...... 282 Hepatocellular Adenoma ...... 283 Hydatid Disease of the Liver (Echinococcosis) ...297 Hepatic Hemangioma ...... 283 Portal Hypertension ...... 299 Hepatic Cysts ...... 284 Liver Trauma ...... 302

18 Gallbladder and Biliary Tract M. Voelz 304

Anatomy ...... 304 Gallbladder Carcinoma ...... 316 Cholecystolithiasis ...... 306 Extrahepatic Bile Duct Carcinoma ...... 319 Acute Cholecystitis ...... 315

19 Pancreas N.T. Schwarz 321

Anatomy ...... 321 Pancreatic Pseudocysts ...... 331

Physiology ...... 323 Carcinoma of the Pancreas ...... 332 Acute Pancreatitis ...... 323 Endocrine Pancreatic Tumors ...... 336

Chronic Pancreatitis ...... 327 Pancreatic Trauma ...... 337

20 Transplantation N.T. Schwarz 339

21 Peritonitis B. Thiel 346

22 Neuroendocrine Tumors and Gastrointestinal Stromal Tumors J.M. Mayer 360

Neuroendocrine Tumors ...... 360 Vermiform Appendix ...... 370 Stomach ...... 364 Colon ...... 371 Duodenum and Pancreas—Insulinoma ...... 364 Rectum...... 372 Duodenum and Pancreas—Gastrinoma ...... 366 Gastrointestinal Stromal Tumors ...... 372 Ileum ...... 369

23 Soft-Tissue Tumors H. Brunn 377

24 Vascular Surgery A. Selch 381

Arteries ...... 381 Subclavian Steal Syndrome ...... 390 Vascular Injuries ...... 382 Veins ...... 391 Aneurysms ...... 383 Varicose Veins ...... 391 Acute Limb Artery Occlusion ...... 385 Phlebothrombosis ...... 392 Acute Mesenteric Artery Occlusion ...... 387 Chronic Arterial Disease of the Limbs ...... 388

25 Emergency and Trauma Surgery M. Fuchs 395

Polytrauma ...... 395 Soft-Tissue Injuries ...... 405 Head Injury ...... 397 Bone Infection ...... 407

Fractures ...... 399 Nerve Injury ...... 409 Dislocations ...... 403 Tendon Rupture ...... 410

lllustration Credits 413

Index 415

Indication Indications for Surgery ● Ulcerative esophagitis, strictures, Barrett esophagus ● Interdisciplinary indication ● Failure or intolerance of drug therapy for surgery ● Patient’s wish as an alternative to long-term drug therapy ● Volume reflux with chronic bronchitis ● Volume reflux with treatment-resistant regurgitation of food ● An interdisciplinary decision with gastroenterologists should be made.

Conservative Treatment ● Weight reduction ● Weight reduction, sleeping ● Sleep with upper body elevated with upper body elevated, ● Proton pump inhibitors, in ca. 80% freedom from symptoms, healing of the proton pump inhibitors reflux esophagitis almost without exception; often requires lifelong treatment

Surgical Treatment ● Laparoscopic Nissen–Rosetti fundoplication ● Standard treatment: lapa- ● Alternatively, hemifundoplication roscopic fundoplication ● Hiatoplasty: posterior narrowing of the esophageal hiatus that has been and hiatoplasty stretched by the sliding hernia; additionally counteracts reflux by increasing the angle at which the esophagus opens into the stomach ● Additional fundophrenicopexy indicated only for upside-down stomach ● With very large sliding hiatal hernias or paraesophageal herniation, use of a plastic mesh to close the hernia may be necessary. ● Numerous other procedures are not established for use outside of clinical studies. These include, for instance, heating by radiofrequency therapy, intra- luminal mucosal plication, and injection of plastic polymers.

Laparoscopic Fundoplication 8 Operative Technique

● Position the patient with legs on stirrups and with the buttocks supported. ● Create a pneumoperitoneum and carry out diagnostic laparoscopy (Fig. 8.2). ● Then place the patient in semi-seated position with feet lowered and turned slightly to the right side. The surgeon stands between the patient’s legs. ● The left lobe of the liver is retracted with a triangle over the trocar from the right costal arch (T5). ● Exposure of the gastroesophageal junction is by incision of the lesser omen- tum proximal to the accessory left hepatic artery, which is often present. ● Incision of the peritoneal fold over the esophagus ● Dissection of the fundus along the greater curvature of the stomach from adhesions to the spleen (caution: short gastric arteries) and in a retroperitoneal direction. Dissection with ultrasonic scissors has proven useful. ● Dissect the esophagus free at the junction with the gastric fundus, protecting the vagal trunks. ● If appropriate, perform dissection of a hiatal hernia in the lower mediastinum. ● Tighten the hiatus, usually by two or three sutures posteriorly using nonabsorbable suture material (hiatus repair; Fig. 8.3). ● If appropriate, additional implantation of a plastic mesh after reduction of a large hiatal hernia, paraesophageal hernia or upside-down stomach

Fig. 8.2 Access routes for laparoscopic fundoplication. T1: optic trocar T2: working trocar, surgeon T3: working trocar, assistant T4: working trocar, surgeon T5: working trocar, assistant, for holding the left lobe of the liver (triangle)

T1 T2 T3 T5

● Create a loose fundal cuff around the distal esophagus, drawing the mobilized fundus behind the esophagus. ● Introduction of a large gastric tube to prevent narrowing of the lumen by the fundoplication (this is done only at this time as it would interfere with dis- 8 section beforehand) ● Fixation of the cuff by picking up the esophagus with the first suture to prevent the stomach from sliding proximally. Two further sutures are used to form a loose cuff (floppy Nissen; Fig. 8.4); all sutures are nonabsorbable. ● Remove the gastric tube and check that the cuff is loose. ● Check for hemostasis, particularly on the spleen and liver.

Postoperative Management ● Removal of the gastric tube while still in the operating room ● Light diet the following day, ensuring that it is well masticated ● Check blood count on postoperative days 1 and 3. ● Discharge on postoperative day 3. Reflux symptoms should be eliminated on the day of surgery.

Complications ● Dysphagia ● Dysphagia and gas bloat syndrome (result of an excessively tight cuff) ● Gas bloat syndrome ● Telescope phenomenon if cuff is not fixed to the esophagus ● Stenosis ● Denervation syndrome as a result of injury to vagal branches or vagus trunk ● Recurrence ● Reflux recurrence if the cuff loosens ● Cicatricial stenosis at the esophageal hiatus with symptoms of narrowing

Fig. 8.3 Hiatal repair

Fig. 8.4 Nissen fundoplication

Stomach

Esophagus 8

Esophageal Carcinoma

Epidemiology ● Incidence about 10 per 100 000 population/year ● Predominantly squamous epithelial carcinomas, followed by adenocarcinomas; incidence of adenocarcinomas of the distal esophagus and gastroesophageal junction has been increasing in recent years. ● Ratio of men to women is 5 : 1.

Etiology ● Rapid metastasis to the local lymph nodes and extensive intramural growth ● Intramural growth (mucosal margin of the tumor often does not correspond to the tumor mar- ● Early lymphatogenous gin in the esophageal wall) metastasis ● Lung and liver metastases ● Peritoneal carcinomatosis

● Distant metastases from proximal tumors especially to the lung and from distal tumors to the liver; skeletal metastases only occur later; with locally advanced distal tumors there is often peritoneal carcinomatosis ● Tumor localization is very important because of the different treatment approaches

Risk Factors ● Smoking ● Alcohol ● Thermal injury (hot foods) ● Cicatricial strictures, for example after acid or alkali corrosive injury, radiation ● Barrett esophagus: precancerous condition for adenocarcinoma of the esophagus

Classification ● Assessment of lymph ● Squamous epithelial carcinoma: distinction between cervical, supra- and nodes crucial for staging, infrabifurcation prognosis and treatment ● Adenocarcinoma of the distal esophagus is classified with proximal gastric carcinoma as adenocarcinoma of the esophagogastric junction (AEG): ► Type I: distal esophagus (Barrett carcinoma) ► Type II: cardia carcinoma, at the gastroesophageal junction ► Type III: subcardiac gastric carcinoma, infiltrating the cardia from below ● AEG type I tumors are classified as esophageal carcinomas in the TNM classification, and AEG type II and III tumors are classified as gastric carcinomas (Tables 8.2 and 8.3).

Table 8.2 TNM classification Tx Primary tumor not assessable 8 T0 No evidence of primary tumor Tis Carcinoma in situ T1 Infiltration of the lamina propria, muscularis mucosae, or submucosa T2 Infiltration of the muscularis propria T3 Infiltration of the adventitia T4 Infiltration of neighboring structures Nx Regional lymph nodes not assessable N0 No regional lymph node metastases N1 Regional lymph node metastases M0 No distant metastases M1 Distant metastases and nonregional lymph node metastases Tumor in the upper thoracic esophagus M1a Metastases in cervical lymph nodes M1b Nonregional lymph nodes and/or other distant metastases Tumor in the middle thoracic esophagus M1a not possible M1b Nonregional lymph nodes and/or other distant metastases Tumor in the lower thoracic esophagus M1a Celiac lymph nodes M1b Nonregional lymph nodes and/or other distant metastases

13 Rectum

J.M. Mayer

Anatomy

● Between the dentate line ● The rectum extends from the upper border of the anal canal (dentate line) to and 16 cm from the anus, 16 cm from the anus, measured with a rigid proctoscope. measured with a rigid ● It is divided into three levels: proctoscope ► Upper third: 12–16 cm from the anus (intraperitoneal) ► Middle third: 6–12 cm from the anus (extraperitoneal) ► Lower third: < 6 cm from the anus (extraperitoneal) ● Rectal ampulla: lies against the concavity of the sacrum ● Anal canal: at the level of the pelvic diaphragm, passes in a posterior direction

Fasciae in the Lesser Pelvis ● Anterior and posterior in- ● Posterior: The parietal pelvic fascia lines the pelvis posteriorly. It extends vesting fascia from the pelvic ring almost to the tip of the sacrum, meets the pelvic floor, ● Lateral: paraproctium and covers the mesorectum posteriorly as visceral pelvic fascia (investing forming ligamentous con- fascia). Between them is the avascular Waldeyer space. nection with the pelvis ● Lateral: The paraproctium forms a ligamentous connection with the pelvis. ● The Denonvillier fascia is anterior. In men, it clothes the posterior wall of the bladder, the seminal vesicles and the posterior wall of the prostate. It is reflected at the urogenital diaphragm and covers the rectum anteriorly as the visceral pelvic fascia (investing fascia).

Arteries (Fig. 13.1) ● Main blood supply: superi- ● Superior rectal artery (unpaired) from the inferior mesenteric artery pro- or rectal artery; no mar- vides the blood supply to the major part of the rectum. It divides into three ginal artery terminal branches on the posterior wall of the rectum, which empty into the ● Middle and inferior rectal hemorrhoidal plexus at 3, 7, and 11 o’clock positions. arteries: inconstant, supply ● Middle rectal arteries (paired, inconstant) from the internal iliac artery run the distal anterior wall above the levators into the paraproctium and supply a small section of the ● After resection, usually ad- distal anterior rectal wall together with the inferior rectal arteries (paired, equate blood supply from inconstant) from the pudendal arteries, which are branches of the internal distally iliac artery, running below the levators. ● Blood supply after low anterior rectal resection: ► With ligature close to the trunk of the inferior mesenteric artery, the proximal colon stump is supplied only through the anastomosis of the Riolan and Drummond arcade. It is therefore important to spare the marginal arcade. ► The rectal stump can be supplied only by the inferior rectal arteries and possibly the middle rectal arteries. The longer the rectal stump, the more endangered is its blood supply. Intramural vascular anastomoses usually ensure an adequate blood supply from distally.

Fig. 13.1 Blood supply of 1 the rectum. 1: Aorta 9 2 2: Inferior mesenteric artery 10 3: Levator ani with pubo- 11 rectalis sling 4: Anal canal 5. Inferior rectal artery 6: Levator ani 7: Middle rectal artery 8: Internal iliac artery 8 9: Superior rectal artery 10: Middle sacral artery 11: Common iliac artery 7 6 3

Veins ● The main venous drainage is to the liver through the unpaired superior rectal ● Main drainage is to the vein and portal vein system. liver through the superior ● In the lower quarter of the rectum, there may be venous drainage to the rectal vein. lungs via the middle and inferior rectal veins and inferior vena cava (incon- ● Middle and inferior rectal stant). veins usually absent.

Lymphatic Drainage ● The main lymphatic drainage follows the branching of the superior rectal ● Main drainage along the artery to the locoregional lymph nodes in the mesorectum, and from there superior rectal artery along the main trunk of the superior rectal artery to the para-aortic lymph ● Only slight spread along nodes. the bowel because of the ● Because of the absence of a vascular arcade close to the bowel wall, there are absence of a marginal ar- no lymphatic pathways running proximally and distally along the bowel. tery Malignant cells are usually not found more than 4 cm from the primary ● Drainage to iliac and in- tumor. Thus, smaller safety margins are sufficient in rectal surgery. guinal lymph nodes usually ● The inferior quarter of the rectum has no lymph nodes because of the ab- absent sence of mesorectum. Lymphatic drainage is intramural in the cranial direction. ● Lymphatic channels along the middle and inferior rectal arteries are present only rarely. Iliac lymph node metastases (lateral pelvic wall) therefore occur rarely, even with supraanal rectal cancer. ● The anal canal also drains to the inguinal lymph nodes.

Innervation ● The distal quarter of the rectum has particularly pronounced innervation. ● This is the site of the procontinence reaction for maintaining the anorectal reflex. ● The epicritic sensibility for distinguishing solid matter, liquid, and gas is located in the anoderm. 13

Index

Note: ‘vs’ indicates differential acute lung injury or acute respi- alveolar echinococcosis 298 diagnosis. ratory distress syndrome, ven- American College of Chest Physi- tilation 358 cians/Society of Critical Care adenocarcinoma Medicine (ACPP/SCCM) Consen- A anal 258, 261 sus Conference, diagnostic cri- esophagus 117, 119 teria for sepsis and septic shock abdomen (abdominal cavity) distal 115, 116 359 acute see acute abdomen esophagogastric junction American Joint Committee on approach to pelvic floor insuf- (AEG) 116, 155, 166 Cancer (AJCC) staging ficiency surgery via 244 adenoma esophageal carcinoma 117 cleansing 353, 354–357 colonic 213, 214 gallbladder and bile duct carci- sepsis see sepsis progression to carcinoma 215 noma 317, 319 wall hepatocellular 283 American Society of Anesthesiol- anatomy 96 parathyroid 45, 46, 47, 48, 49 ogists’ risk group classification distension with obstructed removal 48 1, 2 bowel 265, 269 ultrasonography 15 amine precursor uptake and de- hernia see hernia thyroid 15, 16, 28, 29 carboxylation (APUD) system abdominal guarding in peritonitis adenomatous polyposis, familial 360 349 (FAP) 213, 214 aminosalicylates abdominoperineal approach adhesions, bowel 266, 275 Crohn disease 180 anal carcinoma 260 adhesive plastic drapes for tem- diverticulitis 203 rectal cancer porary abdominal closure 356 ulcerative colitis 207, 208 amputation of rectum 239 adjunctive treatment in peritoni- amputation, soft-tissue tumors intersphincteric resection of tis 358 380 rectum 238 adjuvant (postoperative) therapy anal canal see anus abdominothoracic esophageal colon carcinoma 218 anal sphincters, internal and resection 119–120 gastric carcinoma 159–160 external 232 abscesses gastric MALToma 175 dysfunction causing fecal bowel pancreatic carcinoma 334 incontinence 255 anus 251–254 rectal cancer 234 artificial sphincter implanta- colorectal carcinoma surgery soft-tissue tumors 379 tion 258 and risk of 228 adventitia reconstructive surgery 257 Crohn disease 178, 181, 183 arterial 381 incision (sphincterotomy) hepatic 307 esophageal 108 251 pleural (empyema) 61–62 afferent loop syndrome 147 see also intersphincteric resec- pyogenic see empyema aftercare see postoperative care tion accessory spleen 277 airway injury 70–71 anaplastic (undifferentiated) thy- achalasia 108–109 Aitken classification of epiphyseal roid carcinoma 38, 41, 43 ACPP/SCCM Consensus Confer- fractures 401 anastomosis (surgical) ence, diagnostic criteria for AJCC see American Joint Commit- colorectal 197–199, 238 sepsis and septic shock tee on Cancer low anterior proctectomy 359 alimentary tract see gastrointes- 237 acute abdomen 349 tinal tract proctocolectomy 210, 211, mesenteric artery occlusion vs Altemeier operation in pelvic 212 other causes of 387 floor insufficiency 244 hepatic resections 292

in pancreatic carcinoma pallia- see also colo-anal pouch anas- atherogenesis, steps in 388–389 tion 336 tomosis; ileo-anal pouch; atherosclerosis, risk factors 388 peptic ulcer surgery transanal procedures Atlanta classification of acute leakage 147 AO classification pancreatitis 324 stenosis 147 fractures 399 auscultation techniques 134–136 soft-tissue injury 405 obstructed bowel 269 in portal hypertension surgery aortic hiatus 77 peritonitis 350 301 aortoiliac occlusion 389 autoimmune thyroid disease small bowel in Crohn disease APACHE-II score in peritonitis 350 30–32 182 appendectomy diagnosis 14 transplantation, kidney–pan- appendicitis autonomic adenoma 15, 16, 28, creas 343 conventional 192 29 anastomosis of Riolan 197 laparoscopic 190–191 autotransplantation (grafts of au- anesthesia 6 carcinoid 194 tologous tissue) liver resection 289 appendicitis, acute 183–193 interposition graft in post-gas- aneurysms 383–385 treatment 189–192 trectomy reconstruction 165, angiographic embolization in appendix (vermiform) 185–195 166, 167–168 upper GI bleeding 153, 154 rare conditions 186, 193–194 parathyroid tissue 53 angiography neuroendocrine tumors skin graft with incisional hernia acute limb artery occlusion 386 193–194, 370–371 103 acute mesenteric artery occlu- APUD (amine precursor uptake for vessel replacement 381 sion 387 and decarboxylation) system aneurysms 384 bowel obstruction 271 360 see also bypass grafts rib fractures 65 arteries 381–391 axonotmesis 409 subclavian steal syndrome 390 structure/anatomy 381 azathioprine see also computed tomography supply to tissues/organs Crohn disease 181 angiography colon 196–197 ulcerative colitis 208 anoderm 232 diaphragm 77 extent of loss in hemorrhoidec- esophagus 106–107 tomy 247–249 gallbladder/biliary tract 305 B antecolic Billroth II gastrectomy liver 281–282 140 pancreas 321 B cell lymphoma, gastric 174 antibiotics peritoneum 346 bacteria in peritonitis pathogene- cholecystitis (acute) 316 rectum 230 sis 347–348 diverticulitis 203 spleen 277 bands, adhesive (bowel) 266, 275 H. pylori eradication 132 stomach/duodenum 126 barium swallow peritonitis 352–353 thyroid 9, 10 achalasia 109 antibodies in autoimmune thy- surgery 381–391 esophageal diverticulum 110 roid disease 14, 30, 31 arteriosclerosis 388 Barrett esophagus 111, 112, 113, anticoagulation 3–5 arthroplasty prosthesis, infected 116 after deep vein thrombosis 409 Bassini herniotomy 88 treatment 393 ASA’s risk group classification 1, 2 Beger operation 329, 330 lifelong 394 ascending colon 196 Best Crohn Disease Activity Index antithyroid drugs 29, 32 aspiration, pleural 58 (CDAI) 177 anus (and anal canal) 245–262 aspiration biopsy/cytology (incl. bile, inspection for leaks with abscesses 251–254 fine needle) liver resection 292 anatomy 232 pancreatic carcinoma 333 bile ducts carcinoma 258–262 thyroid 16–17 anatomy 304 fissure 250 carcinoma 39–41 carcinoma (cholangiocarci- fistulas in or in region of de Quervain’s thyroiditis 34 noma) 284, 285, 318–320 251–254 goiter 27 common 304 Crohn disease 182 hyperthyroidism 28 exploration 309, 314 hemorrhoids 245–249 aspirin-related peptic ulcers 130 stone impacted in 307

aus: Schwarz u. a., General and Visceral Surgery Review (ISBN 9783131543110) © 2012 Georg Thieme Verlag KG Index 417 biliary (gallstone) ileus 267, 275, bronchoscopy, esophageal carci- definition 360 307 noma 118 carcinoma biliary-enteric anastomosis (pro- Brook terminal ileostomy, ulcera- anal 258–262 cedure) tive colitis 209 bile duct (cholangiocarcinoma) hepatic metastases 292 Budd–Chiari syndrome 299 284, 285, 319–320 pancreatic carcinoma 336 budesonide, Crohn disease 180 colorectal see colorectal cancer; biliary-enteric fistula (pathologi- Buess transanal endoscopic mi- rectum cal) 307 crosurgery 235 esophageal 115–123 biliary tract 304–320 bypass grafts 381 gallbladder 316–318 anatomy 304–305 peripheral arterial occlusive gallstones predisposing to Billroth I gastrectomy 133, disease 390 306 138–140 subclavian steal syndrome 391 gastric 134, 155–173 ulcer recurrence after 150 lymph node metastases 127, Billroth II gastrectomy 133 156, 157, 163 afferent loop syndrome follow- C in stump following gastrec- ing 147 tomy 149 ulcer recurrence after 150 C-cell carcinomas 38, 42 hepatocellular 284, 285, 341 biopsy CA-19-9 and pancreatic carcino- neuroendocrine 360, 361 aspiration see aspiration biopsy ma 333 pancreatic 332–336 esophageal 112 calcitonin 12, 45 parathyroid 54–55 liver, in portal hypertension measurement 14 thyroid 36, 37–46 300 see also procalcitonin carcinomatosis, peritoneal see soft-tissue tumors 378 calcium levels peritoneal cavity for radical removal 378, 379 abnormal see hypercalcemia; cardia, achalasia of 108–109 bisegmental liver resection hypocalcemia cardiac contusions 65, 66 294–295 regulation 46 cardiopulmonary symptoms, dia- Bismuth–Corlette classification of Calot triangle 305 phragmatic hernia 79 Klatskin tumors 319 cancer (malignant tumors) caval filter 393 bleeding see hemorrhage appendiceal 193–194 cecum 196 blood vessels see entries under bile duct (cholangiocarcinoma) reservoir construction from vascular and specific types of 284, 285, 319–320 238 vessels colorectal see colorectal cancer; celiac trunk 126 Blumberg sign 187 rectum central liver resection 294 blunt chest trauma 62–67 esophageal 115–123 central soft-tissue tumors 378 Bochdalek hernia 77, 79 gallbladder 316–320 cervical esophageal, resection Boerhaave syndrome 124–125 gallstones predisposing to 121–122 bone 306, 316 cervical exploration, bilateral, in fractures see fractures gastric 134, 155–175 hyperparathyroidism 48 in hyperparathyroidism 46 lymph node metastases 127, cervical lymph nodes see neck infection 407–409 156, 157, 163 lymph nodes bone scintigraphy, esophageal in stump following gastrec- cervical pulsion diverticulum 110, carcinoma 118 tomy 149 110–111 Borrmann classification, ad- hepatic see liver chemical injury, esophagus vanced gastric carcinoma 157 pancreatic 332–336 123–124 bowel see intestine parathyroid 54–55 chemoradiotherapy brachytherapy pleural effusions in 58, 59 anal carcinoma 260, 261 anal carcinoma 261 soft-tissue, classification 377 prognosis 262 esophageal carcinoma 119 thyroid 36, 37–46 esophageal carcinoma 118, 119 Braun anastomosis 140, 141, 171 see also metastases; precancer- gastric carcinoma 160 breast, video-endoscopic goiter ous conditions rectal cancer 234 resection approach via 24 carcinoid syndrome 362, 369, 370 chemotherapy bridging mesh 101 carcinoid tumor anal carcinoma 260, 261 bronchial injury 70–71 appendiceal 193–194 bile duct carcinoma 320

colon carcinoma 218 magnetic resonance see mag- laparoscopic and laparoscopi- gallbladder carcinoma 318 netic resonance cholangio cally-assisted 199–200 gastric carcinoma 158 (pancreato)graphy transverse see transverse colon adjuvant 159–160, 160 cholangitis, purulent, with stones see also hemicolectomy; proc- palliative 171 307 tocolectomy; subtotal resec- gastric MALToma 175 cholecystectomy tion hepatic metastases 286, 287, cholecystitis (acute) 316 colitis, ulcerative see ulcerative 288 choledocholithiasis 309, colitis neuroendocrine tumors 363 309–315 collagen metabolism and inci- gastrinoma 368 aftercare 313–314 sional hernia pathogenesis 97 pancreatic carcinoma 334 complications 314–315 collar mediastinoscopy 73 pancreatic endocrine tumors laparoscopic see laparoscopy, colo-anal pouch anastomosis 238 337 interventional colo-colostomy 198 rectal cancer open see open cholecystec- colon 196–229 adjuvant and neoadjuvant tomy cancer see colorectal cancer 234 liver metastases 290 fast-track surgery 7–8 palliative 240 cholecystitis 315–316 minimally invasive surgery soft-tissue tumors 379 acute 315–316 199–200 thyroid carcinoma 43 with choledocholithiasis 306, neuroendocrine tumors 371 chest (thorax) 57–71 307 pseudo-obstruction 267 anatomy 57 chronic, with choledocholithia- stenosis in Crohn disease 182 drainage see drains sis 307 colonoscopy trauma see trauma choledocholithiasis 306, 309 colorectal carcinoma, prophy- chest X-ray/radiograph choledochoscopy 313 lactic/screening 229 achalasia 109 choledochotomy 313 in ulcerative colitis 208 diaphragmatic hernia 80 choleliths see gallstones diverticulitis 202 mediastinitis 76 cholestasis, laboratory tests 308 esophageal carcinoma 118 peritonitis 351 cholinesterase levels and liver color-coded Doppler, thyroid 14 Perthes syndrome (traumatic surgery 285 colorectal cancer (predominantly asphyxia) 64 CHOP regimen, gastric MALToma carcinoma) 214–229, pleural effusions 58 175 274–275 in pleurodesis 59 chromogranin A and neuroendo- classification 216 sternal fractures 66 crine tumors 362 definition 214 thyroid carcinoma 39 chylothorax 70 diagnostic approach 216–217 trauma 63 ciclosporin, ulcerative colitis 208 epidemiology 214 lung contusions 67 cirrhosis, liver etiology 214–215 rib fractures 65 cancer risk 284 follow-up care 228 Child classification of liver Child classification 285, 286 hepatic metastases 218, 234, cirrhosis 285, 286 portal hypertension in 299 286 children closed dislocation 404 lymph node metastases 197, fracture classification 401 closed fractures, soft-tissue 215 inguinal hernia 85, 93 damage with, classification 400 obstruction in 218–219, intussusception 267 closed pneumothorax 67–68 274–275 large bowel obstruction 264 closed postoperative peritoneal pathogenesis 215 cholangiocarcinoma 284, 285 lavage 355 postoperative care 227 cholangiography coagulation therapy with liver screening 229 intravenous 308 metastases 291 in ulcerative colitis 208 percutaneous transhepatic 308 cold thyroid nodule, scintigraphy surgery 218–227, 235–239 cholangiopancreatography 15 minimally invasive 199 endoscopic retrograde see en- colectomy (colon resection) symptoms 216 doscopic retrograde cholan- 219–227, 274 treatment 217–229, 231–240, giopancreatography carcinoma 219–227 274–275 diverticulitis 204, 205 conservative 218, 234

indications/contraindications rupture 125 cricomyotomy 111 217, 234 gallbladder carcinoma 318 criminal nerves 127 palliative 217, 219, 227, hypersplenism 277 Crohn disease 176–184 239–240 liver appendix 193 surgical see subheading above focal nodular hyperplasia 282 Crohn Disease Activity Index see also rectum hydatid cyst 298 (CDAI) 177 colostomy liver cancer 285 crural arterial occlusion 389 emergency, colorectal carcino- operative planning 289 cryoablation, hepatic metastases ma 219 neuroendocrine tumors 362 288 terminal descending 239 pancreatitis (acute) 325 cutaneo-enteric fistulas, Crohn compartment resection, soft- parathyroid 47 disease 183 tissue tumors 379–380 peritonitis 351 CVI regimen, gastric MALToma complications of procedures incl. Perthes syndrome (traumatic 175 surgery, perioperative (incl. asphyxia) 64 cyst(s) iatrogenic damage) and their pleural effusions 58 diaphragmatic 82 risks portal hypertension 300 hepatic 284 for appendicitis 192–193 thyroid 16 hydatid 297, 298, 299 for bowel obstruction 276 computed tomography angiogra- cystadenoma of appendix, muci- cholecystectomy 314–315 phy (angio-CT) 382, 383 nous 194 for colon cancer 227–228 acute limb artery occlusion 386 cystic artery 305, 306 left hemicolectomy 224 acute mesenteric artery occlu- in laparoscopic cholecystec- right hemicolectomy 222 sion 387 tomy 311 sigmoid colectomy 227 pancreatic trauma 337 cystic duct 304, 305 for esophageal carcinoma 123 congenital hypoparathyroidism in laparoscopic cholecystec- gastric resection 146–149 55 tomy 311 for gastroesophageal reflux consent, informed 3 Czerny method, inguinal hernia disease 114 continence-preserving proctoco- 93 ileostomy 210 lectomy 210–212 ileus as 264, 267–268, contrast-enhanced CT 272–273 pancreatic carcinoma 333 D inguinal hernia repair 93 pancreatitis for liver metastases 297 acute 325 Dacron grafts for vessel replace- for liver trauma 303 chronic 327 ment 381 parathyroid surgery 51 contrast-enhanced radiography de Quervain’s (subacute) thyroi- peritonitis as 349 bowel obstruction 271 ditis 34 proctocolectomy 212 Crohn disease 178 death see mortality for rectal cancer 240 diaphragmatic hernia 80 decompression surgery splenectomy 280 mediastinitis 76 bowel 273 thyroid surgery 24–26 peritonitis 351 endocrine orbitopathy 32–33 vascular investigations 382 ulcerative colitis 207 mediastinitis 76 for Zenker diverticulum 111 see also barium swallow pneumothorax 68, 69 compound fractures, classification contrast-enhanced ultrasound of deep venous thrombosis 400 liver in focal nodular hyperpla- 392–394 compression, chest 63–64 sia 282 defecation 232 computed tomography (CT) contusions deglutition (swallowing) 108 appendicitis 188 cardiac 65, 66 delayed primary surgery, poly- bile duct carcinoma 319 chest 63 trauma 397 bowel obstruction 271 lung 66–67 Delorme operation in pelvic floor cholecystolithiasis 308 corpus cavernosum of rectum insufficiency 244 diaphragmatic hernia 80 232 Denonvillier fascia 230 diverticulitis 202 corrosive injuries, esophagus descending colon 196 esophagus 123–124 devascularization operations in carcinoma 118 corticosteroids see steroids portal hypertension 301

development, thyroid 9 drapes (adhesive plastic) for tem- E see also embryogenesis porary abdominal closure 356 diabetes, pancreatic transplanta- dressings for temporary abdomi- ECF regimen, gastric carcinoma tion 342 nal closure 356–357 171 diaphragm 77–82 drug administration (pharma- ECG, peritonitis 352 hernia 77, 78–81, 113 ceuticals) echinococcosis 297–299 rare disorders 81–82 choledocholithiasis 309 echocardiography, cardiac contu- Dieulafoy ulcer 130, 153 Crohn disease 180–182 sions 66 differentiated thyroid carcinoma gastroesophageal reflux disease edema (fluid collection), pan- 37, 42, 43 113 creatic necrosis 324, 325 digestive tract see gastrointestinal hyperparathyroidism (secon- efferent loop syndrome 147 tract dary) 52 effusions, pleural 57–60 dilation procedures, gastric 143 hyperthyroidism 29 elastic arteries 381 dislocations 403–404 immunogenic 32 electrocardiography (ECG), peri- dissecting aneurysms 383 peptic ulcer 132–133 tonitis 352 diverticular disease, definition peritonitis 358 electrolyte administration, acute 200 premedication 3 pancreatitis 326 diverticulitis 200–205 ulcerative colitis 207–208 embolism, arterial appendiceal 193 drug-induced conditions limbs 385 diverticulum paralytic ileus 265 removal 386 colon 200, 201 peptic ulcer 129, 130 mesenteric 387 esophageal 110–112 thyroiditis 36 removal 387 small bowel 184 drug monitoring with immuno- embolization in upper GI bleed- dobutamine, peritonitis 358 suppressive agents 345 ing, angiographic 153, 154 dome sign 202 ductal adenocarcinoma of pan- embryogenesis, neuroendocrine Doppler ultrasound creas 332 tumor classification according peripheral arterial disease 386 Dukes staging, colorectal cancer to 361 thyroid 14 216 see also development see also duplex ultrasound dumping (gastric) emergency surgery 395–412 Dormia basket 313 early 148–149 diverticulitis 202 double-barrelled ileostomy late 149 malignant bowel occlusion 274 incisional hernia 101 Dunhill operation 21–22 portal hypertension 300, 301 ulcerative colitis 209–210 duodenopancreatectomy proctocolectomy 212 double contrast enema, ulcerative partial 320, 329, 333, 334–335 thyroidectomy 34 colitis 207 total 329 trauma 395–412 drain(s) 6 duodenum 126–175 ulcerative colitis 207 anal fistulas and abscesses 254 anatomy 126–128 emesis see vomiting chest 59 bleeding from 150–153 emphysema hemothorax 69 Kocher mobilization see Kocher mediastinal 74–75 mediastinitis 76 mobilization subcutaneous 74 pleural empyema 61, 62 neuroendocrine tumors 364– empyema pneumothorax 68–69 369 gallbladder 307 polytrauma 396 post-gastrectomy restoration of pleural 61–62 in hepatic resection 292 passage to 166 endocrine pancreatic tumors tube, wound dressings made of stenosis in Crohn disease 182 336–337, 364–365 357 ulcer see ulcer see also neuroendocrine tumors drainage operations/procedures duplex ultrasound Endo-GIA stapler, liver metasta- gastric 143–146 subclavian steal syndrome 390 ses 291 resection procedures com- thyroid 14 endometriosis, appendiceal 193 bined with 330 duplications, diaphragmatic 81– endoscopic investigation pancreatic 327 82 Crohn disease 178 pseudocyst 331 dynamic gracilis repair 257 vs ulcerative colitis 180 peritonitis 353 dystopic parathyroid glands 49

gastrointestinal stromal tumors enterogenital fistulas, Crohn F 374 disease 183 large bowel obstruction 271 enterovesical fistulas, Crohn false aneurysm 383 neuroendocrine tumors 363 disease 183 familial adenomatous polyposis peritonitis 352 enzymes, pancreatic 323 (FAP) 213, 214 ulcerative colitis 207 epigastric hernia 104 familial hyperparathyroidism 49 see also bronchoscopy; chole- epiphrenic diverticulum 110, 111 familial medullary thyroid carci- dochoscopy; colonoscopy; epiphyseal (growth plate) frac- noma 38, 41, 42 esophagoscopy; gastroscopy; tures in children Fansler–Arnold operation 246, laparoscopy; laryngoscopy; classification 401 248 mediastinoscopy; thoraco- reduction and internal fixation fascia scopy 402 duplication with incisional her- endoscopic retrograde cholangio- erythrocyte concentrate, perito- nia 103 pancreatography (ERCP) nitis 358 pelvic 230 bile duct carcinoma 319 esophageal hiatus 77 in rectal resection 236, 237 gallbladder carcinoma 318 hernia 78–79, 113 fast-track review 7–8 gallstones 308, 309 esophageal sphincter, lower 108 fasting 2–3 pancreatic carcinoma 333 esophagitis, reflux 111, 112, 113 fatty streaks 388 pancreatic trauma 337 esophagogastric junction, adeno- feces pancreatitis carcinoma (AEG) 116, 155, 166 discharge/expulsion 232 acute 325 esophagogastrostomy in gastric fistula producing, risk with chronic 327 carcinoma palliation 171 colorectal cancer surgery 228 endoscopic sonography, esopha- esophagojejunostomy 168–169 incontinence 255–258 geal carcinoma 118 cancer 165, 166, 168–169 occult blood test 229 endoscopic treatment/surgery peptic ulcer 143 females see women gastrointestinal esophagoscopy femoral hernias 95–96 gastric carcinoma 159, 161 achalasia 109 femoral thrombosis 393 rectal cancer 235 carcinoma 118 femoropopliteal occlusion 389 rectal polyps 239 diverticulum 110 fibrinopurulent phase of pleural upper GI bleeding 152, reflux esophagitis 112 empyema 61, 62 153–154 esophagus 106–125 fibrosing phase of pleural em- parathyroid 49 anatomy 106–107 pyema 61, 62 thyroid 22–23 carcinoma 115–123 fibrous thyroiditis 36 see also laparoscopy, interven- diverticulum 110–112 fine needle biopsy see aspiration tional/operative; minimally function (physiology) 108 biopsy/cytology invasive surgery disorders 108–109 finger fracture method with liver endothelial damage in athero- histology 108 metastases 291 genesis 388 injuries 123–125 Finney gastroduodenostomy 145 endotoxin (lipopolysaccharide)- varices 150, 299, 300, 301 first aid at accident site 406 binding protein levels in peri- eventration, diaphragmatic 82 fissure, anal 250–251 tonitis 351 excision biopsy, soft-tissue fistula repair 254 endovascular transluminal stent tumors 378, 379 fistulas, gastrointestinal graft 385 external fixation, bone infection with biliary tract 307 enteral nutrition, peritonitis 358 following 409 Crohn disease 183 entero-biliary anastomoses and extracorporeal shock wave litho- fecal, risk with colorectal can- fistulas see biliary-enteric anas- tripsy 309 cer surgery 228 tomosis; biliary–enteric fistula exudative pleural effusions 57 fixation enterocele 242 with empyema 61, 62 bone infection following 409 enterocutaneous fistulas, Crohn eye opening in Glasgow Coma growth plate fractures 401 disease 183 Scale 398 FLP regimen, gastric carcinoma entero-enteric fistulas, Crohn 171 disease 183 fluid administration/volume replacement

intraoperative 6 ulcer 133–146 goiter 26–27 pancreatitis (acute) 326 gastric ... see stomach euthyroid 26–27 peritonitis 358 gastrin measurement 133 video-endoscopic resection fluid collection (edema), pan- gastrinoma 132, 149, 336, via axillo-bilateral breast creatic necrosis 324, 325 366–369 approach 24 focal nodular hyperplasia (liver) post-gastrectomy 150 Goodsall rule, anal fistulas 251, 282–283 gastrocolic ligament division 221, 254 Fogarty catheter, embolectomy 222 Gottstein–Heller myotomy 109 386 gastroduodenal artery ligation gracilis muscle transposition in follicles, thyroid 9–10 154, 155 fecal incontinence 257 follicular thyroid carcinoma 37, gastroduodenostomy 145 grafts see autotransplantation; 39, 41, 43 gastroenterostomy, palliative stent graft Fontaine classification of periph- gastric carcinoma 171 Graves disease 30–32 eral arterial occlusive disease pancreatic carcinoma 336 Grob method, inguinal hernia 93 389 gastroepiploic artery ligation, growth plate fractures see epi- Forrest classification of upper GI right 154, 155 physeal fractures bleeding 151, 152 gastroesophageal reflux disease guarding in peritonitis 349 fractures 399–403 (GERD) 111–114 Gütgemann post-gastrectomy rib 64–65 gastrointestinal (gastroenterolog- reconstruction 167 sternal 65–66 ical/alimentary/digestive) tract gynecological disorders vs French triple therapy, H. pylori or system appendicitis 189 eradication 132 appendicitis vs other conditions Frey operation 330 of 189 Frykmann and Goldberg opera- diaphragmatic hernia effects 79 H tion in pelvic floor insufficiency hyperparathyroidism effects 46 244 neuroendocrine tumors Haemoccult test 229 fundophrenicopexy 113 364–372 hamartomas, colonic 213 fundoplication 113–114 WHO classification 361 hanging maneuver, hemihepatec- stromal tumors 372–376 tomy 292 see also specific regions Hansen–Stock classification, G gastrointestinal series (contrast diverticulitis and diverticulosis study), Crohn disease 178 201 gallbladder 304–320 gastrojejunostomy in Billroth II Häring tube 171, 172 anatomy 304 gastrectomy 141 Hartmann operation/discontinu- cancer see cancer gastroscopy ity resection removal see cholecystectomy choledocholithiasis 308 cancer 274 stones 306–315 esophageal/gastric varices 300 colon 219 gallstones (biliary stones; chole- peptic ulcer 131 rectum 239 liths) 306–315 genetic factors/predisposition diverticulitis 202 carcinoma predisposition 306, colon cancer 215 Hashimoto disease 35 316 screening 229 hazards see complications in common bile duct (chole- immunogenic hyperthyroidism head injury 397–399 cystolithasis) 306 30 heart contusions 65, 66 in gallbladder 306–315 medullary thyroid carcinoma in see also cardiopulmonary ileus with 267, 275, 307 MEN II syndrome 39, 41, 42 symptoms gastrectomy (gastric resection) genetic testing or analysis Heidelberg–Allenberg classifica- 133–146 MEN I 361 tion of aneurysms 385 carcinoma 158–159, 161–162 RET mutations 41 Heinecke–Mikulicz pyloroplasty complications 146–149 genitoenteric fistulas, Crohn 144 distal see subtotal resection disease 183 Helicobacter pylori MALToma 175 Glasgow Coma Scale 398 eradication postoperative care see post- Glisson triads 282 with MALToma 174 operative care glucagonoma 367 with ulcer 132

in etiology hepatic duct, common 304 hormone-secreting tumors see gastric carcinoma 155 stone in 307 endocrine pancreatic tumors; ulcer 129, 130 hepatic veins 282 neuroendocrine tumors hemangioma, hepatic 283–284 obstruction 299 hormones hemicolectomy 220–224 hepatobiliary sequence scintigra- parathyroid see parathyroid left 274 phy 308 hormone colorectal carcinoma hepatocellular adenoma 283 thyroid 12 223–224 hepatocellular carcinoma 284, laboratory test 13, 14 right 274 285, 341 postoperative preventive re- appendiceal carcinoid 194 hereditary factors and disorders placement therapy 25, 26 appendiceal carcinoma 194 see genetic factors hot thyroid nodule, scintigraphy colorectal carcinoma 219, Herfarth operation 170 15 220–222 hernia 78–81, 83–105 Hunt (Hunt–Lawrence–Rodino) hemifundoplication 113 abdominal 83–105 pouch 166, 170 hemihepatectomy 292, 292–294 classification 83–84 hydatid disease 297–299 exposure and ligation of large definition 83–84 hydrocortisone, peritonitis 358 vessels before 290 epidemiology 83 5-hydroxyindole acetic acid and hanging maneuver 292 etiology 83 neuroendocrine tumors 362 left 293 external 83, 85–104 hypercalcemia in hyperpara- extended 294 incarcerated see incarcerated thyroidism 46, 47 right 292 hernia effects 46 extended 293, 318 internal 84, 104 in secondary hyperpara- hemithyroidectomy 17, 21 palpation 269 thyroidism 52 carcinoma 41 diaphragmatic 77, 78–81, 113 hyperparathyroidism 40, 45–54 goiter 27 herniotomy familial 49 preventive replacement ther- femoral hernia 95–96 primary 45–51 apy after 26 inguinal hernia 88–90 secondary 46, 51–54 with subtotal resection of con- children and infants 93 tertiary 46, 54 tralateral side 21–22 heterotopic autotransplantation hyperplasia, hepatic 281 immunogenic hyperthyroid- of parathyroid tissue 53 focal nodular 282–283 ism 32 Heyrowsky method, gastric carci- hyperplastic polyps 213 hemorrhage/bleeding noma palliation 171, 172 hypersplenism 277–280 diverticular 202, 205 hiatus, diaphragmatic 77 hypertension, portal 299–301 esophageal varices 300, 301 hernia 77, 78–79, 80, 81, 113 hyperthyroidism 28–29 gastroduodenal 150–153 sliding 78, 133 immunogenic 30–32 into pleural cavity 69 hiccup, postoperative 82 see also thyrotoxic crisis postoperative histology hypertrophy, hepatic 281 gastric resection 146–147 esophageal 108 hypocalcemia thyroid surgery 24–25 peritoneal 346 after parathyroid surgery 51 hemorrhoids 245–249 thyroid 9–10 after thyroid surgery 25 hemostasis histopathology hypoparathyroidism 55–56 liver anal carcinoma 258 after thyroid surgery 25 in resection 292 appendicitis, in classification traumatic 302 186 spleen without resection 279 colorectal carcinoma, in grad- I hemothorax 69 ing 216 heparin 5 gastric carcinoma iatrogenic damage see complica- hepatectomy (hepatic resection) in classification 156 tions 285, 287, 288–297 in grading 156 ileo-anal pouch (ileal pouch-anal general technique 289–292 gastric MALToma 173 anastomosis) 212 hepatic arteries 281–282, 305 in classification 164 ileocolostomy 197, 198 right, mistaken for cystic artery history-taking in peritonitis 350 ileostomy, ulcerative colitis 311 homeostasis 1 209–210

ileum thorax 58 obstructed bowel 269 neuroendocrine tumors mediastinitis 76 peritonitis 350 369–370 Perthes syndrome (traumatic insulin therapy in peritonitis reservoir construction from asphyxia) 64 358 210–211 rib fractures 65 insulinoma 336, 364–366, 367 terminal, Crohn disease involv- sternal fractures 66 intensive unit/intensive therapy ing 176 thyroid 14–15 head trauma 398 endoscopy 178 ulcerative colitis 207 polytrauma 396–397 ileus see also specific modalities interdisciplinary care see multi- advanced 264–265 imatinib, gastrointestinal stromal disciplinary care colorectal carcinoma 218–219 tumors 374, 375 interleukin-6 levels in peritonitis definition 263 immunogenic hyperthyroidism 351 gallstone 267, 275 30–32 internal fixation paralytic see paralytic ileus immunosuppressive agents for bone infection following 409 postoperative 264, 267–268, transplantation 345 growth plate fractures 401 272–273 immunosuppressive drugs, ulcer- International Union Against Can- imaging (diagnostic) ative colitis 208 cer (UICC) classification appendicitis 188 immunotherapy colorectal cancer 216 arterial disease 382 Crohn disease 182 follow-up care and 228 bile duct carcinoma 319–320 hepatic cancer 286 survival and 229 bone infection 408 incarcerated hernia 84, 266, 275 esophageal carcinoma 117 bowel obstruction 270 inguinal 87, 88 gastric carcinoma 157, 173 cholecystitis (acute) 315 incidentaloma, thyroid 13 interposition graft in post-gas- cholecystolithiasis 308 incision biopsy, soft-tissue tumors trectomy reconstruction 165, colorectal cancer 217 378 166, 167–168 Crohn disease 178 incisional hernia 96–103 intersphincteric resection of rec- deep venous thrombosis 393 incontinence, fecal 255–258 tum 238 diaphragmatic hernia 80 infants intestine (bowel) 176–276 diverticulitis 202 inguinal hernia 85, 93 large see large intestine esophagus intussusception 267 neuroendocrine tumors see achalasia 109 see also neonates neuroendocrine tumors carcinoma 118 infection obstruction 263–276 fractures 401–402 bone 407–409 definition 263 gallbladder carcinoma 318 pancreatic necrotic areas 325, malignant 218–219, gastrointestinal stromal tumors 326 274–275 374 in peritonitis, eradication of mechanical 263–264 hypersplenism 277 source of 354 special forms 266–268 incisional hernia 98 post-splenectomy 280 see also stenosis (subheading inguinal hernia 87 see also sepsis below) liver inflammatory bowel disease see preparation 3 cancer 285 Crohn disease; ulcerative colitis small see small intestine focal nodular hyperplasia 282 inflammatory polyps 213 stenosis in Crohn disease 182, hepatic hemangioma 283 infliximab, Crohn disease 182 183 neuroendocrine tumors 362 informed consent 3 intima see neointima; tunica inti- pancreatic carcinoma 333 infrahyoid neck muscles in thy- ma pancreatitis roid surgery 18 intraoperative phase 5–6 acute 325 inguinal canal anatomy 85 fast-track colon surgery 7 chronic 327 inguinal hernia 83 neuromonitoring see neuromo- parathyroid 15, 47 inherited factors see genetic fac- nitoring peptic ulcer 131 tors intraperitoneal onlay mesh peritonitis 351–352 injury see trauma (IPOM), incisional hernia 100 portal hypertension 300 innervation see nerve supply intravenous cholangiography 308 soft-tissue tumors 378 inspection (observation) intussusception 267, 275

aus: Schwarz u. a., General and Visceral Surgery Review (ISBN 9783131543110) © 2012 Georg Thieme Verlag KG Index 425 iodine L liver deficiency 12, 13 cysts 384 radioactive see radioiodine laboratory tests focal nodular hyperplasia therapy bile duct carcinoma 320 282, 283 irreducible hernia 84 bowel disorders metastases 296 islets of Langherhans 323 appendicitis 187 rectosigmoid resection 243 carcinoma 332 Crohn disease 178 splenectomy 279 endocrine tumors 336 diverticulitis 202 see also endoscopic treatment/ endocrine tumors arising from obstructive 270 surgery; minimally invasive 336–337 ulcerative colitis 206–207 surgery Italian triple therapy, H. pylori cholecystitis (acute) 315 laparoscopy, non-interventional/ eradication 132 cholecystolithiasis 308 diagnostic diaphragmatic hernia 80 esophageal carcinoma 118 esophageal carcinoma 117 gallbladder carcinoma 318 J gastric MALToma 174 gastric carcinoma staging 158 hydatid disease 298 peritonitis 352 J pouch 238 hypersplenism 277 portal hypertension 300 continence-preserving procto- liver cancer 285 laparotomy vs minimally invasive colectomy 210, 211 neuroendocrine tumors 362 surgery 5 Jaboulay gastroduodenostomy pancreatitis (acute) 324 see also relaparotomy 145 parathyroid large intestine/bowel 196–262 jejunum hypoparathyroidism 56 anatomy 196–197 diverticulum 184 primary hyperparathyroid- cancer see colorectal cancer in post-gastrectomy recon- ism 46 obstruction 263, 264, 268, struction 165, 166, 167–168 secondary hyperparathyroid- 274–275 see also esophagojejunostomy ism 52 causes 264 Johnson classification, gastric peptic ulcer 131 diagnosis 270, 271 ulcer 130 peritonitis 351 malignant 218–219, 274–275 joint portal hypertension 300 treatment 272 dislocations 403–404 thyroid 13–14 Larrey hernia 77, 79 replacement (arthroplasty) acute purulent thyroiditis laryngeal nerve prosthesis, infected 409 35 internal branch 11 cancer 39 recurrent 11 chronic lymphocytic thyroi- exposure 19 K ditis 35 injury 25 de Quervain’s thyroiditis 34 superior 10 kidney goiter 27 laryngoscopy in thyroid cancer hyperparathyroidism (primary) hyperthyroidism 28, 31 39 affecting the 46 Lanz point tenderness 187 laser ablation, hepatic metastases hyperparathyroidism (secon- laparoscopy, interventional/oper- 288 dary), caused by 51 ative Lauren classification, gastric car- transplantation 340 appendicitis 190–191 cinoma 156 with kidney 343 cholecystectomy 309–312 leg, lower, deep vein thrombosis c-KIT and gastrointestinal stromal aftercare 313–314 393 tumors 373, 374, 375 in cholecystitis (acute) 316 see also limbs Klatskin tumors, in choledocholithiasis Lichtenstein herniotomy 89 Bismuth–Corlette classification 309–312 LigaSure, hepatic resection 291 319 complications 314–315 limbs Kocher mobilization of duode- colon carcinoma 199 amputation with soft-tissue num 136, 137, 321 diverticulitis 204 tumors 380 pancreatic trauma 338 fundoplication 113–114 arterial occlusions Kremer operation 170–171 gastric carcinoma 159, 161 acute 385–386 hiatal hernia 81 chronic 388–390

deep vein thrombosis in lower lymph node dissection (lymph- thyroid 16 leg 393 adenectomy) male rectum, mobilization (for injury including soft-tissue appendiceal carcinoid 194 anterior resection) 236–237 damage 406 appendiceal carcinoma 194 malignant tumors see cancer lipopolysaccharide-binding pro- colorectal cancer 199, 219, 220 MALT lymphoma 173–175 tein levels in peritonitis 351 gastric carcinoma 158–159, Mannheim Peritonitis Index 350 lithotripsy 309 160–161, 163 manometry (and pressure assess- liver 281–303 ileal neuroendocrine tumor 370 ment) abscesses 307 thyroid carcinoma 41, 42, 43 anal, in fecal incontinence acute failure indicating trans- lymph node metastases 256 plantation 341 biliary carcinoma esophageal, achalasia 109 advanced disease indicating bile duct 319 Mason classification, rectal cancer transplantation 340 gallbladder 317 233 anatomy 281–282 colon cancer 197, 215 Mayo–Dick fascial duplication benign tumors 282–284 esophageal cancer 115 103 malignant tumors 284–297, gastric carcinoma 127, 156, MCF regimen, gastric carcinoma 340 157, 163 171 primary 284–286, 341 hepatic cancer 284, 285, 290 mechanical obstruction of bowel secondary see metastases pancreatic carcinoma 332 263–264 transplantation with 284, rectal cancer 233 Meckel diverticulum 184 341 thyroid area 37, 38 media, arterial 381 liver transplantation 340–342 lymphatic drainage mediastinitis 75–76 with hepatocellular carcinoma colon 197 mediastinoscopy 73–74 284, 340 esophagus 107 esophageal carcinoma 118 living-donor for liver transplant liver 282 mediastinum 72–76 342 pancreas 322–323 anatomy 72, 73 lobes of liver 281 peritoneum 346 lymph nodes, thyroid surgery excision (lobectomy), left-sided rectum 231 and 11 294–295 stomach/duodenum 127 see also transmediastinal lobules, hepatic 282 lymphocytic thyroiditis, chronic esophageal resection Loewe and Rehn skin graft, inci- 35 medullary thyroid carcinoma 40 sional hernia 103 lymphoma, gastric 173–175 diagnosis 39, 40, 41 Longmire post-gastrectomy re- Lynch syndrome 215 familial 38, 41, 42 construction 165, 166, 167 sporadic 42 Longo operation 246, 249 megacolon, toxic 212 Lotheissen herniotomy 96 M megadiaphragm 82 lower leg, deep vein thrombosis men, mobilization of rectum 393 McBurney point tenderness 186 (for anterior resection) lungs McVay herniotomy 96 236–237 acute injury, ventilation 358 magnetic resonance cholangio 6-mercaptopurine, Crohn disease anatomy 57 (pancreato)graphy (MRCP) 181 contusions 66–67 bile duct carcinoma 320 Merendino operation 166 metastases from liver 284 cholecystolithiasis 308 mesalazine, Crohn disease 180 see also cardiopulmonary gallbladder carcinoma 318 mesenteric arteries 197 symptoms magnetic resonance imaging acute occlusion 387–388 luxations (dislocations) 403–404 (MRI) mesentericocaval anastomosis lymph node(s) diaphragmatic hernia 80 301 gastric area 126, 127 liver mesentery, division liver hilum 288 focal nodular hyperplasia left hemicolectomy 224 pancreas 322–323 282 right hemicolectomy 222 rectal area 231 hepatic hemangioma 283 transverse colectomy 225 thyroid area 11 neuroendocrine tumors 362 see also mesocolon; mesorectal ultrasound assessment 15 parathyroid 47 excision

aus: Schwarz u. a., General and Visceral Surgery Review (ISBN 9783131543110) © 2012 Georg Thieme Verlag KG Index 427 mesh repair parathyroid 49 transposition (gracilis) in fecal abdominal hernia thyroid 22–24 incontinence 257 epigastric hernia 104 see also endoscopic treatment muscular arteries 381 incisional hernia 98, 99, 100, Mirrizi syndrome 307 muscularis, esophageal 108 101, 103 monoclonal antibody therapy, Musshoff staging of MALToma inguinal hernia 87, 90, 91, 92 Crohn disease 182 175 umbilical hernia 104 Moore classification of hepatic myotomy hiatal hernia 81, 113 trauma 302 anterior, in achalasia 109 mesocolon, division Morgagni hernia 77, 79 cricopharyngeus 111 in low anterior rectal resection mortality (death) 236 gastric ulcer perforation 129 in sigmoid colectomy 226 upper GI bleeding 151 N mesorectal excision, total and motility, bowel, recovery after partial 235 abdominal surgery 267 nasogastric tubes 6 metabolic causes of paralytic ileus after bowel surgery 274 nausea and vomiting, postopera- 265 motor response in Glasgow Coma tive 1 metastases (distant) Scale 398 neck lymph nodes (incl. cervical to liver 286–297 MRI see magnetic resonance LN) from colorectal cancer 218, imaging metastases in thyroid carcino- 234, 286 mucinous cystadenoma of ap- ma 38 from neuroendocrine tumors pendix 194 dissection (lymphadenec- 361, 363, 364, 369, 370, mucosa tomy) 41, 42, 43 371 esophageal 108 in thyroid surgery 11 to lung from liver 284 gastroduodenal assessment 15 source protective agents 133 necrotizing pancreatitis 324, 325, bile duct carcinoma 319 resection of gastric mucosa 326 colon cancer 215, 216, 217, with carcinoma 159 needle aspiration biopsy see aspi- 218, 227, 228, 229 see also proctomucosectomy ration biopsy esophageal carcinoma 116 mucosa-associated lymphoid tis- neoadjuvant (preoperative) ther- gallbladder carcinoma 317 sue (MALT) lymphoma apy gastric carcinoma 156, 158, 173–175 esophageal carcinoma 118, 119 159, 160, 171 multidisciplinary (interdiscipli- gastric carcinoma 158, 160 hepatic carcinoma 284, 285 nary) care hepatic metastases 287 neuroendocrine tumors 361, fast-track surgery and 7 rectal cancer 234 362, 363, 364, 365, 368, postoperative period 6 neointima formation 389 370, 371, 372, 373 multiple endocrine neoplasia 38, neonates, large bowel obstruction pancreatic carcinoma 332 360–361 264 rectal cancer 233, 234, 240 type I (MEN I) 46, 360–361, neoplasms see tumors soft-tissue tumors 378 368, 369 nerve thyroid carcinoma 37 type II (MEN II) 39, 41, 42, 46 injury 405, 409–410 see also TNM classification medullary thyroid carcinoma removal for pain after inguinal metastases (lymph node) see 38 hernia surgery 93 lymph node metastases; TNM multiple trauma 395–397 nerve supply classification multivisceral resection diaphragm 77 methotrexate, Crohn disease 181 colorectal carcinoma 217, 219 peritoneal 346 Milligan–Morgan operation 246, gastric carcinoma 163–165 rectum 231–232 257–258 multivisceral transplantation 344 stomach/duodenum 127–128 minilaparotomy in laparoscopic Murphy sign 308 thyroid 10–11 cholecystectomy 311 muscle injury 25 minimally invasive surgery compartment resection, soft- neurapraxia 409 colon 199–200 tissue tumors 379–380 neurectomy for pain after ingui- laparotomy vs 5 injury 405 nal hernia surgery 93 pancreatic pseudocyst 332

neuroendocrine tumors 360–372 O pancreatic carcinoma 336 general aspects palpation definition 360 observation see inspection obstructed bowel 269–270 diagnosis 362–363 onlay technique, incisional hernia peritonitis 350 epidemiology 360 100 rectal cancer 269 etiology 360 open cholecystectomy 312–313 pancreas 321–338 prognosis 364 aftercare 313–314 anatomy 321–323 symptoms 361–362 in cholecystitis (acute) 316 peptic ulcer penetrating into treatment 363–364 in choledocholithiasis 131, 142–143 specific sites 364–372 312–313 pseudocysts 324, 331–332 appendix 193–194, 370–371 complications 314–315 transplantation 341–342 colon 371 open dislocation 404 trauma 337–338 duodenum 364–369 open minimally invasive para- tumors 332–337 pancreas 336–337, 364–369 thyroidectomy (OMIP) 49 neuroendocrine 336–337, stomach 364, 365 open pneumothorax 68 364–369 neurological examination in fecal open postoperative peritoneal pancreatectomy 329 incontinence 256 lavage 355 combined with drainage oper- neuromonitoring (intraoperative) open splenectomy 279 ation 334 parathyroid surgery 50 orbitopathy, endocrine 31, 32 distal see subtotal resection thyroid surgery 20, 22 organ transplantation see trans- total 333 neuromuscular effects of hyper- plantation see also duodenopancreatec- parathyroidism 46 orthotopic autotransplantation of tomy neuron-specific enolase and neu- parathyroid tissue 53 pancreatic duct roendocrine tumors 362 osteitis and osteomyelitis 407, anatomy 305, 321 neuropathic pain, inguinal hernia 408 drainage procedure 329 surgery 93 outpatient review of fast-track obstruction 327 neurotmesis 409 colon surgery, post-hospital 8 see also ductal adenocarcinoma newborns (neonates), large bowel pancreaticoduodenal arteries 321 obstruction 264 ligation 154, 155 Nissen fundoplication 113, 115 P pancreatitis 323–330 nodule, thyroid acute 323–326 diagnosis 14, 15, 16, 17, 28 pain chologenic 307 enucleation 20, 26 acute abdominal see acute ab- chronic 327–330 incidentally discovered 13 domen pancreaticojejunostomy, Parting- malignant 39, 40, 41 appendicitis, diagnostic exami- ton–Rochelle side-to-side 329 non-Hodgkin lymphoma, gastric nation for 186–187 resection procedure combined 173–175 motor response in Glasgow with 330 non-steroidal anti-inflammatory Coma Scale 398 pancreatoduodenectomy see drug-related peptic ulcers 129, peritonitis 349 duodenopancreatectomy 130 postoperative, inguinal hernia papilla (duodenal/of Vater) norepinephrine, peritonitis 358 surgery 93 incision (papillotomy) 308, 309 Notaras lateral submucous thyroiditis 34–35 local excision 333 sphincterotomy 251 venous thrombosis 393 papillary thyroid carcinoma 36, nutrition palisade dressings for temporary 37, 41, 42, 43 acute pancreatitis 326 abdominal closure 357 paraesophageal hernia 77, 79, 80, peritonitis 358 palliative therapy 113 preoperative 2–3 anal carcinoma 260 parafollicular C-cell carcinomas Nyhus classification, inguinal bile duct carcinoma 320 38, 42 hernias 86 colorectal carcinoma 217, 219, paralytic ileus 263, 264 227, 239–240 after gastric resection 147 esophageal carcinoma 119, 123 causes 265, 387 gallbladder carcinoma 318 treatment 272 gastric carcinoma 159, 171 paraproctium 230

aus: Schwarz u. a., General and Visceral Surgery Review (ISBN 9783131543110) © 2012 Georg Thieme Verlag KG Index 429 parathyroid glands 44–56 percutaneous transjugular intra- pharmaceuticals see drug admin- anatomy 44–45 hepatic portosystemic shunt istration carcinoma 54–55 301 pheochromocytoma 40 dystopic 49 perforation phlebothrombosis see veins imaging 15, 47 bowel in Crohn disease 184 phlegmasia cerulea dolens 393 physiology 45 esophagus, traumatic 124 phosphate in thyroid surgery gastric ulcer 131, 132 levels in hyperparathyroidism dissection 19 periampullary carcinoma 332 46 postoperative insufficiency perianal, venous thrombosis 250 regulation 45 25 perianal fistulas see anus plastic bag (sterile) for temporary parathyroid hormone (PTH; pericystectomy 299 abdominal closure 357 parathormone) 45 perineal descent 242 plastic drapes for temporary ab- abnormal levels see hyperpara- see also abdominoperineal dominal closure 356 thyroidism; hypopara- approach plastic zippers or slide fasteners thyroidism perioperative medicine 1–8 for temporary abdominal clo- parathyroidectomy 53 peripheral arterial disease see sure 356 carcinoma 55 limbs platelets, elevated levels (throm- minimally invasive 49 peripheral nerves see nerve bocytosis) after splenectomy subtotal 53 peripheral soft-tissue tumors 280 with simultaneous autotrans- 378 pleural cavity plantation 53 peristalsis air in 67–69 without autotransplantation 53 examination 269 anatomy 57 parenchyma, hepatic in peritonitis, disturbed 349 chyle in 70 dissection with metastases 291 peritoneal cavity effusions 57–60 injuries 302 carcinomatosis empyema 61–62 parenteral nutrition in acute esophageal cancer 116, 118, hemorrhage into 69 pancreatitis 326 119 pleurodesis 59 parietal pelvic fascia 230 obstruction due to 266, 275 pleuroperitoneal hernia 77, 79 parietal peritoneum 346 lavage 354, 355 pneumoperitoneum for laparo- pain in peritonitis relating to pseudomyxoma (pseudomyxo- scopic cholecystectomy 311 349 ma peritonei) 194 pneumothorax, traumatic 67–69 Parks operation/procedure see also pneumoperitoneum poliglecapron + polypropylene hemorrhoidectomy 246, 248 peritoneum, anatomy 346 mesh 99 transanal local excision in rec- peritonitis 346–359 polyethylene terephthalate mesh tal cancer 235, 238 classification 347–348 99 Partington–Rochelle side-to-side definition 346 polyglactin + polypropylene mesh pancreaticojejunostomy see diagnosis 349–352, 359 99 pancreaticojejunostomy diffuse 349, 353 polyp(s) pediatrics see children epidemiology 347 colonic 212–214 pelvic fascia see fascia etiology 347 screening following removal pelvic floor insufficiency/dysfunc- acute mesenteric artery 229 tion 240 occlusion 387 rectal, endoscopic removal 239 fecal incontinence due to 255 primary 347–348, 352 polypropylene mesh 99 surgery 257 risk in colorectal carcinoma polytetrafluorethylene pelvic vein thrombosis 393 surgery 227–228 (PTFE/ePTFE) penetrating chest injury 67–71 secondary 348, 352–353 grafts for vessel replacement penetrating peptic ulcer 128, 131 symptoms 349 381, 381–382 treatment 133 tertiary 348 mesh for hernia repair 99 peptic ulcer see ulcer treatment 348, 352–358 polytrauma 395–397 peptide hormones and neuro- Perthes syndrome (traumatic poorly differentiated thyroid car- endocrine tumors 362 asphyxia) 63 cinoma 37, 42 percutaneous transhepatic chol- PET see positron emission tomog- portal hypertension 299–301 angiography 308 raphy portal veins 282

branch ligature, with liver pouch proctopexy (rectopexy) 243 metastases 287 post-gastrectomy reconstruc- programmed relaparotomy in pressure measurement 299 tion 165, 166, 169, 170–171 peritonitis/abdominal sepsis thrombosis 299 post-proctectomy reconstruc- 355–357 portocaval end-to-side anasto- tion 238 prolapse, rectal 242 mosis 301 post-proctocolectomy recon- protein C, recombinant activated, portosystemic shunt, transjugular struction 210, 211, 212 administration in peritonitis intrahepatic 301 pouch of Douglas tenderness 187 358 positron emission tomography precancerous/premalignant con- proton pump inhibitors (PET) ditions gastroesophageal reflux disease cancer 285 colon 213 113 gastrointestinal stromal tumors esophagus 112, 116, 118, 124 peptic ulcer 132 374 stomach 155 pseudoaneurysm (false aneu- neuroendocrine tumors 362 prednisolone rysm) 383 positron emission tomography- Crohn disease 181 pseudoarthrosis 403 CT (PET-CT), esophageal carci- ulcerative colitis 207, 208 pseudocysts, pancreatic 324, noma 118 pregnancy 331–332 post-hospital outpatient review of appendicitis diagnosis in 187 pseudodiverticulum see pulsion fast-track colon surgery 8 Graves disease during/after 30 diverticulum postoperative care (aftercare) 6 prehospital care pseudohypoparathyroidism 55 appendiceal carcinoid 194 first aid at accident site 406 pseudomyxoma peritonei 194 appendicitis 192 head trauma 398 pseudo-obstruction of colon 267 bile duct carcinoma 320 polytrauma 396 psoas sign 187 bowel obstruction 276 premalignant conditions see pre- PTFE see polytetrafluorethylene cholecystectomy 313–314 cancerous conditions puerperal (postpartum) thyroid colorectal carcinoma 227 premedication 3 disease 30, 36 deep vein thrombosis 393 preoperative phase 1–5 pulmonary problems see cardio- fast-track colon surgery 7–8 colorectal carcinoma 218 pulmonary symptoms; lungs fractures 403 fast-track surgery 7 pulsion diverticulum (pseudo- gallbladder carcinoma 318 parathyroid surgery for hyper- diverticulum) gastric resection parathyroidism 48 colon 200, 201 for cancer 173 splenectomy 278 esophagus 110, 110–111 for ulcer 146 preperitoneal mesh repair of in- purse-string suture, bleeding gastroesophageal reflux disease guinal hernia, transabdominal duodenal ulcer 154 114 (TAPP) 91 purulent/pyogenic disorders nausea and vomiting 1 Pringle maneuver 291, 302 cholangitis with stones 307 parathyroid surgery procalcitonin levels in peritonitis thyroiditis (acute) 35 primary hyperparathyroid- 351 pyloromyectomy, extramucosal ism 50 proctectomy (rectal resection) 144 secondary hyperparathyroid- 235–237 pyloroplasty, Heinecke–Mikulicz ism 53 abdominoperineal intersphinc- 144 peritoneal lavage in 355 teric 238 pyogenic lesions see empyema; proctocolectomy 212 low anterior 235–237 purulent/pyogenic disorders splenectomy 280 blood supply after 230 tendon injury 411 ulcerative colitis 208, 210–212 thromboprophylaxis 3–5 proctocele (rectocele) 242, 244 Q thyroid surgery 24 proctocolectomy, ulcerative colitis postoperative complications see 208, 210–212 quinodeoxycholic acid 309 complications proctodeal glands 232 postpartum thyroid disease 30, proctomucosectomy, transanal 36 210

R amputation 239 rib fractures 64–65 with anal carcinoma 261 Riedel disease 36 radiation thyroiditis 35 anatomy 230 Riolan’s anastomosis 197 radiofrequency thermoablation, cancer of (and not colon) Ripstein operation in pelvic floor liver metastases 287, 288, 296 233–240 insufficiency 244 radiography (x-ray) cancer of colon and see risk assessment 1–2 appendicitis 188 colorectal cancer risk factors bowel obstruction 270 examination in peritonitis 350 operation 2 chest see chest X-ray neuroendocrine tumors 372 patient 2 contrast see contrast-enhanced prolapse 242 thrombosis 3–5 radiography stenosis in Crohn disease 182 Roux-en-Y reconstruction/eso- Crohn disease 178, 180 ulcerative colitis involving 206 phagojejunostomy 169 pancreatitis (chronic) 327 see also entries under procto- with cancer 165, 166, 169 peptic ulcer 131 red cell (erythrocyte) concentrate, with ulcer 143 peritonitis 351 peritonitis 358 Rovsing sign 187 ulcerative colitis 180 reducible hernia 84 rubber band ligature, hemor- radioiodine therapy inguinal, reduction 88 rhoids 247 Graves disease 31–32, 32 reduction of fractures 401 thyroid carcinoma 41, 43 reflex causes of paralytic ileus radiology see imaging and specific 265 S modalities reflux radionuclide scans see scintigra- duodenogastric, after Billroth II sacral nerve stimulation 257 phy procedure 133 Salter–Harris classification of epi- radiotherapy gastroesophageal 111–114 physeal fractures 401 anal carcinoma 261 regional chemotherapy, hepatic Santorini duct 305, 321 esophageal carcinoma, pallia- metastases 288 sarcoma, soft-tissue 377, 378, tive 119, 123 relaparotomy in peritonitis/ab- 379, 380 gastric MALToma 175 dominal sepsis 355–357 scarring phase of pleural empye- neuroendocrine tumors 363 relaxation, diaphragmatic 82 ma 61, 62 pancreatic carcinoma 334 renal organ see kidney Schlatter operation 166 rectal cancer 234 reoperation, parathyroid Schreiber post-gastrectomy re- thyroid carcinoma 41 in primary hyperparathyroid- construction 167 see also chemoradiotherapy ism 50 Schumpelick classification, ingui- Ramirez component separation in secondary hyperpara- nal hernias 86 102 thyroidism 53 scintigraphy (radionuclide scans) RAP regimen, H. pylori eradica- reservoir hepatobiliary sequence 308 tion 132 cecal 238 neuroendocrine tumors 362 reconstructive surgery dysfunction, fecal incontinence parathyroid 47 fecal incontinence 257 due to 255 skeletal, esophageal carcinoma post-esophagectomy 121 ileal 210–211 118 post-gastrectomy 138–143 residual tumor (R) in gastric car- thyroid 15, 16 in gastric carcinoma 162, cinoma, classification of 156 carcinoma 39, 43 165–169 respiratory distress syndrome, chronic lymphocytic thyroi- post-partial duodenopan- acute, ventilation 358 ditis 35 createctomy 335 resuscitation room, polytrauma goiter 27 rectal arteries 230 396 hyperthyroidism 28, 31 rectocele 242, 244 RET mutations 39, 40, 41, 42 sclerotherapy, hemorrhoids 247 rectopexy 243 retrocolic Billroth I gastrectomy screening for colorectal cancer see rectosigmoid resection, laparo- 140 colorectal cancer scopic 243 retromuscular mesh implantation segment(s), hepatic (vascular rectouterine (Douglas) pouch for incisional hernia 101 divisions) 281 tenderness 187 retroperitoneal fistulas, Crohn rectum 230–244 disease 183

segmental resection sliding hernia stapling colon abdominal 84 colon 198–199 in diverticulitis 205 hiatal 78, 133 esophagojejunostomy 168 transverse, in gastric carci- small intestine/bowel 176–184 hemorrhoidectomy (Longo noma 165 anatomy 176 operation) 246, 249 liver, with metastases 291, 295 interposition in post-gastrec- liver resection for metastases spleen 279 tomy reconstruction 165, 166 291 see also bisegmental liver re- obstruction 263, 266, 267, 268 stomach and duodenum section causes 264 134–136 Seo post-gastrectomy reconstruc- imaging 270, 271 stent graft for aneurysms 385 tion 167 treatment 272, 273–274 sterile plastic bag for temporary sepsis transplantation 342–343 abdominal closure 357 abdominal 346, 351 soft-tissue sternal fractures 65–66 eradication of septic foci injury see trauma steroids (corticosteroids) 353–354 tumors 377–380 Crohn disease 180–181 diagnostic criteria 359 see also specific soft tissues refractoriness to 181 pancreatic necrosis complicated somatostatin analogs with neu- peritonitis 358 by 325, 326 roendocrine tumors ulcerative colitis 207, 208 splenectomy complicated by diagnostic use (receptor detec- stomach 126–175 280 tion) 362 anatomy 126–128 see also infection therapeutic use 363 atony, postoperative 147 septic shock, diagnostic criteria yttrium-90-labelled 363 bleeding from 150–153 359 somatostatinoma 367 carcinoma see carcinoma Seton drain 254 sonography see ultrasonography neuroendocrine tumors 364, Sherren triangle tenderness 186 spasm, esophageal, idiopathic 365 Shouldice herniotomy diffuse 109 substitute (post-gastrectomy) femoral hernia 95–96 spermatic cord pain after inguinal 170–171 inguinal hernia 89 hernia surgery 93 functions 165–166 shunt operations in portal hyper- sphincters see anal sphincters; ulcer see ulcer tension 301 esophageal sphincter upside-down 79 Siewert–Peiper Operation 166, spleen 277–280 stools see feces 170 anatomy 277 strangulated obstruction of bowel sigmoid colon 196 hyperfunction 277–280 263 resection physiology 277 stromal tumors, gastrointestinal colorectal carcinoma 219, splenectomy 277–279 372–376 226–227 aftercare and complications subclavian steal syndrome laparoscopic, in diverticulitis 280 390–391 204 distal pancreatectomy with subcutaneous emphysema 74 see also rectosigmoid resec- 159, 333, 335 sublay technique, incisional her- tion gastric carcinoma 159 nia 99–100 volvulus 266 splenic artery 277 submucosa, esophageal 108 sigmoid mesocolon (mesosig- splenic vein 277 subtotal (partial/limited) resec- moid) division in low anterior thrombosis 299 tion rectal resection 236 splenoportography 300 colon 212 skeletal scintigraphy, esophageal spleno-renal anastomosis, distal in malignancy 219, 274–275 carcinoma 118 301 pancreas, distal (distal pan- skeletonization of greater and squamous epithelial carcinoma createctomy) 163–165 lesser curvatures 136 anal 258, 260, 261 chronic pancreatitis 329 skin graft with incisional hernia esophagus 115, 116 gastric carcinoma 159 103 management approach 118 pancreatic carcinoma 333 slide fasteners (plastic) for tem- staging laparoscopy, gastric carci- splenectomy with 159, 333, porary abdominal closure 356 noma 158 335

pancreas, proximal (incl. head) thoracotomy preventive replacement ther- 329, 333, 335–336 epiphrenic pulsion diverticu- apy after 26 parathyroid 53 lum 111 see also hemithyroidectomy stomach (distal) esophageal carcinoma 119, 121 thyroiditis 34–37 carcinoma 158, 162 esophageal rupture 125 autoimmune see autoimmune MALToma 175 pleural empyema 62 thyroid disease ulcer 136 thorax see chest painful 34–35 thyroid 17, 21 thrombocytosis, post-splenec- painless 35–36 on contralateral side, hemi- tomy 280 thyroliberin (TRH; thyroid-re- thyroidectomy with see thromboendarterectomy 390 leasing hormone; thyrotropin- hemithyroidectomy thrombosis releasing hormone) 12 goiter 27 arterial measurement 13 Sudeck operation in pelvic floor limbs, and its removal 385, thyrotoxic crisis 33–34 insufficiency 244 390 thyrotropin (TSH; thyroid-stimu- Sudeck point 197 mesenteric, and it removal lating hormone) 12 supportive therapy, peritonitis 387, 388 measurement 13 357–358 perioperative, and its preven- suppression of stimulation 16, sutures tion 3–5 27 colon 197, 198 venous see veins in thyroid carcinoma, post- esophagojejunostomy 168 thyroglobulin 12 operative use 43 small bowel in Crohn disease measurement 14 thyrotropin-releasing hormone 182 thyroid (gland) 9–43 see thyroliberin stomach and duodenum 134 anatomy 9–11 thyroxine (T 4) 12 Billroth I gastrectomy 139, complications of surgery measurement 13 140, 141 24–26 suppression 16 Billroth II gastrectomy 141, diseases/disorders 26–43 thyroid carcinoma 41 142, 143 diagnostic approach 12–17 TNFα, monoclonal antibody to, bleeding ulcer 154 indications for surgery 17 Crohn disease therapy 182 leakage 147 postoperative care 24 TNM classification/staging swallowing 108 recurrence of benign condi- anal carcinoma 259 symptomatic hernia 78 tions, follow-up and pre- biliary carcinoma synaptophysin and neuroendo- vention 25 bile duct 319 crine tumors 362 treatment (in general) gallbladder 317 synthetic vessel replacement 17–26 colorectal cancer 216 381–382 physiology 12 treatment approach depend- thyroid arteries ing on 217, 234 inferior 10, 106 esophageal carcinoma T superior 10 116–117 thyroid ima artery 10 indicating treatment ap- T-cell lymphoma, gastric 174 thyroid plexus, unpaired 10 proach 118–119 TASC II classification of peripheral thyroid-releasing hormone see gastric carcinoma 156 arterial occlusive disease 389 thyroliberin hepatic cancer 285 temperature in peritonitis 350 thyroid-stimulating hormone see pancreatic carcinoma 332 tendon injury 405, 410–411 thyrotropin thyroid carcinoma 38 tension pneumothorax 68 thyroid veins 10, 107 tomography terminal ileostomy, ulcerative thyroidectomy (thyroid resection) computed see computed to- colitis 209 subtotal see subtotal resection mography thermoablation, liver metastases total/near total 22 conventional, sternal fractures 287, 288, 296 carcinoma 41, 42, 43 66 thoracoscopy, video-assisted emergency 34 total extraperitoneal hernia debridement with pleural em- goiter 27 repair (TEP) 92 pyema 62 immunogenic hyperthyroid- toxic megacolon 212 dystopic parathyroid glands 49 ism 32 tracheal injury 70–71

traction diverticulum 110, 111 suppression 16 ulcerative colitis 205 transabdominal preperitoneal tube drains, wound dressings differential diagnosis 207 (TAPP) hernia repair 91 made of 357 Crohn disease 179, 180 transanal procedures tubular adenoma 213 ultrasonic dissectors/scissors pouch advancement 212 tubulovillous adenoma 213 hepatic resection 291 rectal resection tumor(s) (neoplasms) 360–382 laparoscopic colon surgery 199 in cancer 235, 244 diaphragmatic 82 ultrasonography full-thickness 235, 244 malignant see cancer appendicitis 188 mucosal 210 neuroendocrine see neuro- bowel obstruction 270–271 in prolapse 244 endocrine tumors cholecystitis (acute) 315 transjugular intrahepatic porto- pancreatic see pancreas cholecystolithiasis 308 systemic shunt 301 parathyroid, ultrasonography colorectal cancer 217 transmediastinal esophageal 15 Crohn disease 178 resection 122–123 soft-tissue 377–380 diaphragmatic hernia 80 transplantation 339–345 thyroid 15, 16, 28, 29, 37–46 esophageal carcinoma 118 autologous tissue see auto- tumor markers gallbladder carcinoma 318 transplantation esophageal carcinoma 117 hypersplenism 277 liver see liver transplantation pancreatic carcinoma 333 liver multivisceral 343 tumor necrosis factor-alpha focal nodular hyperplasia 282 pancreatic 341–342 (TNFα), monoclonal antibody hepatic hemangioma 283 renal see kidney to, Crohn disease therapy 182 hydatid cyst 298 transudative pleural effusions 57 tunica adventitia, arterial 381 liver cancer 285 transverse colon tunica intima, arterial 381 pancreatic carcinoma 333 anatomy 196 see also neointima pancreatic trauma 337 resection 225 tunica media, arterial 381 pancreatitis colorectal carcinoma 219, Turnbull procedure for toxic acute 324 225 megacolon 212 chronic 327 segmental 165 tyrosine kinase inhibitors with parathyroid 15, 47 trauma (injury) 395–412 gastrointestinal stromal tumors peritonitis 351 chest 62–71 374, 375 pleural effusions 58 blunt 62–67 portal hypertension 300 diaphragmatic hernia due to rib fractures 65 79, 80, 81 U sternal fractures 66 emphysema due to 74, 75 thyroid 14–15, 16 penetrating 67–71 UICC see International Union acute purulent thyroiditis 35 pleural empyema following Against Cancer carcinoma 39 61–62 ulcer, peptic/gastroduodenal chronic lymphocytic thyroi- esophageal 123–125 128–149 ditis 35 head 397–399 acute 130 de Quervain’s thyroiditis 34 hepatic 302–303 bleeding 150 goiter 27 multiple 395–397 chronic 130 hyperthyroidism 28, 31 pancreatic 337–338 classification 130–131 ulcerative colitis 207 soft-tissue 405–407 definition 128 see also Doppler ultrasound; with closed fractures, classi- diagnostic approach 131–132 duplex ultrasound; endo- fication 400 epidemiology 129 scopic sonography nerve 405, 409–410 etiology 129–130 umbilical hernia 103–104 tendon 405, 410–411 postoperative care 146 undifferentiated thyroid carcino- splenic 279 recurrence 149 ma 38, 41, 43 vascular 382–383, 405 symptoms 131 urease rapid test 131 see also fractures treatment 132–140 urological disorders vs appendi- Treitz hernia 84 conservative 132–133 citis 189 triiodothyronine (T 3) 12 indications 132 ursodeoxycholic acid 309 measurement 13 surgical 133–149

V deep 392–394 W perianal 250 vacuum dressings for temporary portal or splenic 299 Warren shunt 301 abdominal closure 356 varicose see varicose veins water jet dissection of liver 291 vagus nerve 127–128 vena cava (inferior) filter 393 wedge excision/resection division (vagotomy) 134, 146 ventilation in acute lung injury or gastric carcinoma, laparo- varicose veins (varices) 391–392 acute respiratory distress syn- scopic/endoscopic 159, 161 esophageal 150, 299, 300, 301 drome 358 hepatic metastases 295 vascular (blood) supply verbal response in Glasgow Coma Wells operation in pelvic floor colon 196–197 Scale 398 insufficiency 244 diaphragm 77 vermiform appendix see appendix Werner syndrome (MEN I) 46, esophagus 106–107 vesicoenteric fistulas, Crohn dis- 360–361, 368, 369 gallbladder/biliary tract 305 ease 183 Whipple operation (partial duo- injury 382–383, 405 vibration pain in appendicitis 187 denopancreatectomy) 329, 333, liver 281–282 video-assisted surgery 334–335 in hepatectomy, exposure parathyroid 49 Whipple triad 366 and ligation 290 thoracoscopic see thoracoscopy WHO see World Health Organiza- peritoneum 346 thyroid 23, 23–24 tion rectum 230–231 video-endoscopic goiter resection Winslow’s foramen 305 spleen 277 via axillo-bilateral breast ap- Wirsung duct 305, 321 stomach/duodenum 126 proach 24 Witzel fistula 171, 172 thyroid 9, 10 villous adenoma 213 women ligation 19 VIPoma 336, 367 pelvic floor insufficiency, vascular surgery 381–393 Virchow triad 392 pathologies causing 241 vascularization of thyroid, ultra- visceral pelvic fascia 230 rectal mobilization (for anterior sound 14 visceral peritoneum 346 resection) 237 see also devascularization pain in peritonitis relating to World Health Organization operations 349 (WHO) classification vasoactive intestinal polypeptide vitamin B12 replacement after gastric carcinoma 156 (VIP)-secreting tumor 336, 367 gastrectomy 162 goiter 26 vasopressors, peritonitis 358 vitamin D 45 neuroendocrine tumors of veins use in parathyroid insufficiency digestive tract 361 as bypass graft material 381 after thyroid surgery 25 thyroid carcinoma 37–38 draining various tissues/organs vocal cord paralysis due to cancer colon 197 39 diaphragm 77 Vollmar classification of vascular X esophagus 107 injuries 382, 383 gallbladder/biliary tract 305 volume therapy see fluid admin- x-ray see radiography liver 282 istration pancreas 321 volumetry, thyroid 14 peritoneum 346 volvulus 266–267, 275 Z rectum 231 vomiting (emesis) spleen 277 in bowel obstruction 269 Zenker diverticulum 110, stomach/duodenum 126 postoperative nausea and 1 110–111 thyroid 9, 10 violent, causing esophageal zippers (plastic) for temporary structure/anatomy 391 rupture 124–125 abdominal closure 356 thrombosis (phlebothrombosis) Zollinger–Ellison syndrome 131, 392–394 132, 149, 150