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Minimal access technology has experienced an accelerated growth since its introduction into the field of diagnostic and therapeutic surgery over two decades ago. The progressive amalgamation of science and technology has lead to its ever-increasing applications in general surgery for increasingly complex procedures. Although sufficient educational material is available on minimal access surgery as textbooks and graphic atlases, here a ready reference guide in the form of surgical updates comes in handy to stay abreast with what’s new. This edition of minimal access surgery in gastrointestinal diseases is a conscientious effort by its dedicated contributors, some of the most capable persons in the field of minimal access gastrointestinal surgery. The contents of this ECAB series include topics which involve a degree of controversy and therefore are likely to be of immense help to surgical residents and practicing surgeons facing such dilemmas. The collective wisdom of these specialists is intended to yield safe and improved outcomes in the concerned patient.
All surgeons are convinced that they provide the best possible care to their patients and fortunately most patients are happy with their surgeons. Where safety and quality were once considered to be self-evident, these issues need to be made more explicit in modern surgery. Doctors and the general public alike are nowadays more aware of the variations in quality that exist among surgeons and institutions and of the unwarranted harmful effects surgery can have. Super- or sub-specialization seems one way to improve both its quality and safety. Surgical Gastroenterology or Gastrointestinal Surgery is one of these new superspecialties. The path towards this specialization is not easy and turf battles between General Surgery and Surgical Gastroenterology are still being fought. Professor Kaushik recounts the history and development of this superspecialty in India. He recounts that although the history of Surgical Gastroenterology in this country is short, its future is bright but, as has happened in other countries, its further division into organ-based superspecialties can be expected. ‘Practice makes one perfect’ is the motto that is probably true for the high-risk surgery which is still being performed in small institutions or by surgeons with only little expertise. The inverse correlation between volume and outcome expressed as mortality and morbidity has been shown all over the world. Wouters et al systematically analyze the literature covering this topic. They also show that concentration and regionalization do not automatically lead to an improved quality of surgery, since other issues for quality assurance are of equal importance, such as adherence to evidence-based guidelines, feedback, and monitoring. Despite all the inputs in training and instruction by experts, a uniformly high quality of surgery is hard to achieve in day-to-day gastrointestinal surgery. Sudhir Joseph and his colleagues show that a dedicated checklist can save lives and reduce postoperative morbidity in many countries with different systems and levels of healthcare. A similar beneficial effect was found in The Netherlands using a more comprehensive checklist that covers the whole period of the hospital stay. The new type of surgeon is aware of the principles of evidence-based medicine and he/she will challenge the dogmas of the ‘old’ surgery. Over the years our surgical masters have told us about the importance of good pre-operative and postoperative care for our patients. The bowel should be put at rest before operation and oral feeding restored only slowly after surgery starting with nothing by mouth to sips of clear water. Bed rest was essential for recovery. He introduced the ERAS (Enhanced Recovery after Surgery) strategy also named Fast Track Surgery. Mitchell et al provide ample evidence that all surgeons should adopt the ERAS strategy. Implementation of this will lead to better and more cost-effective operations.
ECAB Gastrointestinal Hemorrhage - E-Book
Newer Technologies in Hepatopancreatobiliary Surgery - ECAB
ECAB Adjuvant and Neoadjuvant Therapy in Gastrointestinal Cancer - E-Book
ECAB Surgery of the Bile Ducts - E-Book
Carcinoma of the gallbladder is the most common cancers in North India which is very difficult to treat as well as manage as it is associated with many important issues. The current volume covers the topic right from its etiopathology to its palliation and gives an overview on the current knowledge of the disease. The international authorship of this book reflects the multidisciplinary nature of the book and of the field of gallbladder cancer care. The book promises to stimulate studies to provide specific answers to some unanswered questions. Above all it will destroy the myth that gallbladder carcinoma is incurable and will thus benefit a large number of patients. This edition focuses mainly on Etiopathogenesis of gallbladder cancer Management of gallbladder carcinoma Diagnosis and treatment outcomes Aggressive surgical management Molecular biology and pathogenesis of gallbladder cancer
Pancreas - ECAB - E-Book
The appendix has historically been considered to be a vestigial organ without any known function. However, it often becomes inflamed, and appendicitis is a common cause of acute and chronic abdominal pain with appendectomy being one of the commonest operations performed by general surgeons. Like the tonsils, uterus, and gall bladder, it also carries the distinction of being an organ which is often removed for dubious indications. This tendency has been exacerbated by the widespread practice and popularity of laparoscopic surgery. The majority of this book naturally focuses on the problem of appendicitis and the various issues in its management. Many of the authors have also brought in their substantial personal experience which, though not necessarily based on scientific studies, is valuable in a given clinical situation. The two chapters on appendicular tumors come from experts who are considered leaders in this field and their message is that these tumors can be treated effectively if diagnosed early and managed appropriately. This issue has contributions from a wide variety of specialists including gastro surgeons, colorectal surgeons, surgical oncologists, laparoscopic surgeons, pediatric surgeons, and pathologists. The collection not only highlights what is a relatively ignored topic but also sounds a cautionary note against trivialization of appendicular disease and appendectomy.
Of all the malignant lesions of the gastrointestinal tract, cancer of the esophagus is among the most difficult to manage. Although it has fairly typical presenting clinical features in the form of an elderly patient with dysphagia; the subsequent investigations have to be fine-tuned to select which patient should undergo esophageal resection (a formidable procedure which carries a high mortality risk and is associated with serious complications), who should undergo neoadjuvant therapy and who should only be palliated with stents or chemoradiotherapy. In recent years this fine-tuning has become much more precise with many patients being saved from harmful explorations of the chest and abdomen only to encounter widespread disease and at the same time many who have large, locally invasive tumors which were thought to be unresectable being given neoadjuvant chemotherapy and subsequently being able, sometimes, to undergo curative esophagectomy. Possibly because of these improvements in diagnosis and multimodality treatment, the 5-year survival of patients with esophageal cancer that has been resected has improved from a dismal 5%, 15 years ago to a more respectable 25% now. In this book, authors, two thirds of whom are from the Memorial Sloan-Kettering Cancer Center (MSKCC) in New York, have evaluated the published evidence on different aspects of the management of patients with esophageal cancer as well as made recommendations from their own experience with the disease. Thus, we have chapters on diagnostic and therapeutic endoscopy, staging, perioperative therapy, operative treatment (transhiatal, radical, Ivor Lewis and the minimally invasive approaches) and postoperative complications. Finally there is a chapter discussing the epidemiology and difficulties in the management of patients with esophageal cancer in India where the disease is common and mainly affects poor people who cannot afford expensive treatment. The author mainly discusses the experience of the Tata Memorial Hospital in Mumbai where every year 1200 patients are seen with the disease and 180 undergo surgery. This is amongst the largest experience of the treatment of patients with esophageal cancer worldwide. All the subjects and authors have been brought together for this volume by the Editor, Manjit Singh Bains, who is a Professor of Clinical Cardiothoracic Surgery at the Cornell Weill Medical College in New York as well as an Attending Thoracic Surgeon at the MSKCC.