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ISTUDY
Ellis andCalne’s
Lecture Notes inGeneral Surgery
Ellis and Calne’s
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Lecture Notes in General Surgery
Edited by
Christopher Watson, MD BChir FRCS
Cambridge University Hospitals NHS Foundation Trust
Cambridge, UK
Justin Davies, MA MChir FRCS (Gen Surg) FEBS (Coloproctology)
Consultant Colorectal Surgeon
Cambridge University Hospitals NHS Foundation Trust
Affiliated Assistant Professor
University of Cambridge
Fellow in Clinical Medicine
Downing College, Cambridge, UK
Fourteenth Edition
This fourteenth edition first published 2023
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© 2023John Wiley & Sons Ltd
Edition History
1965, 1968, 1970, 1972, 1977, 1983, 1987, 1993, 1998, 2002, 2006, 2011, 2016 by Harold Ellis, Sir Roy Y. Calne and Christopher J. E. Watson
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Christopher Watson, and Justin Davies to be identified as the authors of the editorial material in this work has been asserted in accordance with law.
Registered Office
John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
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Limit of Liability/Disclaimer of Warranty
The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging-
Paperback ISBN: 9781119862482
Cover Design: Wiley Cover Image: © Morsa Images/Getty Images
Set in 8.5/11 pt Utopia by Straive, Pondicherry, India
in- Publication Applied for
Contents
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Author afliations, vi
Preface, viii
Acknowledgements, ix
Abbreviations, x
About the companion website, xiv
1 Surgical strategy (Justin Davies), 1
2 Human factors insurgery (Peter A. Brennan), 5
Fluid andnutrition management (Lynsey Spillman), 12
3
4 Preoperative assessment
(Hemantha Alawattegama), 20
5 Postoperative complications
(Elizabeth Tweedle), 27
6 Acute infections (Christopher Watson), 49
7 Tumours (Christopher Watson), 55
8 Shock (Vijay Sujendran), 63
9 Trauma surgery (Jonathan Morton), 70
10 Burns (Ian Grant), 79
11 The skin andits adnexae (Amer J. Durrani), 86
12 Arterial disease (Patrick Coughlin), 101
13 The heart and thoracicaorta (David P. Jenkins), 119
14 The chest andlungs (Aman Singh Coonar), 129
Venous disorders ofthe lower limb (Manj Gohel), 140
15
16 The brain andmeninges (Stephen Price), 147
17 Head injury (Stephen Price), 157
18 The spine (Rodney J. C. Laing), 170
19 Peripheral nerve injuries (Ian Grant), 182
20 The oral cavity (Kanwalraj Moar), 189
21 The salivary glands (Brian Fish), 203
22 The oesophagus (Peter Safranek), 208
23 The stomach andduodenum (Stavros Gourgiotis), 218
24 The surgery ofobesity, (Christopher Pring), 240
The small intestine (Justin Davies), 245
25
26
The appendix (Ioanna G. Panagiotopoulou), 251
The colon (Justin Davies), 259
27
28
The rectum andanal canal (Justin Davies), 274
The acute abdomen (Constantinos Simillis), 289
29
30 Intestinal obstruction andparalytic ileus
(Christopher Watson), 299
31 Hernia (Christopher Watson), 311
32 The liver (Raaj Kumar Praseedom), 323
33 The gallbladder and bileducts
(Anita Balakrishnan), 340
34 The pancreas (Raaj Kumar Praseedom), 351
35 The spleen (Christopher Watson), 364
36 The lymph nodes andlymphatics
(Christopher Watson), 367
37 The breast (Eleftheria Kleidi), 371
38 The neck (Ekpemi Irune), 389
39 The thyroid (Brian Fish), 393
The parathyroids (Ekpemi Irune), 406
40
41 The thymus (Christopher Watson), 412
42 The adrenal glands (Vasilis Kosmoliaptsis), 414
43 The kidney andureter (Alexandra J. Colquhoun), 425
44 The bladder (Alexandra J. Colquhoun), 444
45 The prostate (Arthur McPhee), 450
46 The male urethra (Arthur McPhee), 459
47 The penis (Arthur McPhee), 462
48 The testis andscrotum (Alexandra J. Colquhoun), 466
49 Transplantation surgery (Christopher Watson), 476
Index, 484
Author affiliations
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Hemantha Alawattegama
Consultant Anaesthetist Cambridge University Hospitals NHS Foundation Trust
Anita Balakrishnan
Consultant HPB Surgeon Cambridge University Hospitals NHS Foundation Trust
Peter A. Brennan
Consultant Maxillofacial Surgeon and Honorary Professor of Surgery Portsmouth Hospitals University Trust Portsmouth
Alexandra J. Colquhoun
Consultant Urologist Cambridge University Hospitals NHS Foundation Trust
Aman Singh Coonar
Consultant Thoracic Surgeon Royal Papworth Hospital Cambridge
Patrick Coughlin
Leeds Vascular Institute Leeds
Justin Davies
Consultant Colorectal Surgeon Cambridge University Hospitals NHS Foundation Trust
Affiliated Assistant Professor University of Cambridge
Fellow in Clinical Medicine Downing College, Cambridge
Manj Gohel
Consultant Vascular & Endovascular Surgeon Cambridge University Hospitals NHS Foundation Trust
Honorary Senior Lecturer Imperial College London
Stavros Gourgiotis
Consultant Surgeon Cambridge Oesophago­Cambridge University Hospitals NHS Foundation Trust
Ian Grant
Consultant Plastic Surgeon Cambridge University Hospitals NHS Foundation Trust
Ekpemi Irune
Consultant Laryngology, Head & Neck Surgeon Cambridge University Hospitals NHS Foundation Trust
David P. Jenkins
Consultant Cardiothoracic Surgeon Royal Papworth Hospital Cambridge
Eleftheria Kleidi
Consultant Oncoplastic Breast Surgeon Cambridge University Hospitals NHS Foundation Trust
Vasilis Kosmoliaptsis
Honorary Consultant Abdominal Transplant, HPB and Endocrine Surgeon
Associate Professor, Department of Surgery University of Cambridge
Gastric Centre
Amer J. Durrani
Consultant Plastic & Reconstructive Surgeon Cambridge University Hospitals NHS Foundation Trust
Brian Fish
Consultant ENT/Head and Neck Surgeon Cambridge University Hospitals NHS Foundation Trust
Rodney J. C. Laing
Consultant Neurosurgeon Cambridge University Hospitals NHS Foundation Trust
Arthur McPhee
Consultant Urologist Cambridge University Hospitals NHS Foundation Trust
Author affiliations vii
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Kanwalraj Moar
Consultant Cleft and Maxillofacial Surgeon Cambridge University Hospitals NHS Foundation Trust
Jonathan Morton
Consultant Colorectal Surgeon Cambridge University Hospitals NHS Foundation Trust
Ioanna G. Panagiotopoulou
Consultant Colorectal Surgeon Cambridge University Hospitals NHS Foundation Trust
Raaj Kumar Praseedom
Consultant HPB & Transplant Surgeon Cambridge University Hospitals NHS Foundation Trust
Stephen Price
Honorary Consultant Neurosurgeon Cambridge University Hospitals NHS Foundation Trust
Christopher Pring
Consultant Bariatric Surgeon St Richard’s Hospital Chichester
Visiting Professor University of Surrey
Peter Safranek
Consultant Surgeon Cambridge Oesophago­Cambridge University Hospitals NHS Foundation Trust
Constantinos Simillis
Consultant Colorectal Surgeon Cambridge University Hospitals NHS Foundation Trust
Lynsey Spillman
Hepatology and Liver Transplant Dietitian Cambridge University Hospitals NHS Foundation Trust
Vijay Sujendran
Consultant Surgeon Cambridge Oesophago- Gastric Centre Cambridge University Hospitals NHS Foundation Trust
Elizabeth Tweedle
Consultant Colorectal Surgeon Cambridge University Hospitals NHS Foundation Trust
Christopher Watson
Professor of Transplantation and Honorary Consultant Surgeon Cambridge University Hospitals NHS Foundation Trust
Gastric Centre
Preface
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Many medical students will have effectively written their own textbook at the end of their clinical course– a digest of the lectures and tutorials assiduously attended and of the textbooks meticulously read. Unfortunately, students may approach the qualifying examinations burdened by the thought of many pages of excellent and exhaustive textbooks wherein lies the wisdom required of them by the examiners. Although the Internet is increasingly used as a source of infor­mation, we believe that there is still a serious need for a book that briefly sets out the important facts in General Surgery that are classified, analysed and, as far as possible, rationalized for the revision student. These lecture notes represent such a text; they are in no way a substitute for the standard textbooks, but they do draw together, in a logical way, the fundamen­tals of General Surgery and its subspecialties. As such we hope it will also be of use to the junior surgeon.
We wish to point the reader to the electronic resource accompanying the text, including case stud­ies, radiographs and histology slides illustrating common conditions mentioned in the text, as well as a quiz to test the reader’s knowledge.
The first edition of Lecture Notes in General Surgery was written by Harold Ellis and Sir Roy Calne and published in 1965. This is the first edition without their involvement, and we acknowledge their huge contribution to surgery and its teaching. Surgery has changed enormously since the days of that first edi­tion, and each subsequent edition has tried to keep pace with surgical practice. Never has the pace of change been so great as it is today. The biggest changes have been seen in the development of specialist services, at the expense of the generalist, and the development of multidisciplinary teams to optimize management. Recognizing this, previous editions have relied heavily on colleagues from other specialties to keep chapters updated and relevant. For this edition we have taken this further, and each chap­ter now has a nominated expert author – who, for some chapters, has updated previous content; and, for others, has written completely new content– to ensure relevance for today’s student.
Christopher Watson
Justin Davies