Current Surgical Therapy 14E Jan 23 2023 - 0323796834 - Elsevier 14Th Edition John L Cameron Full Chapter

Current Surgical Therapy, 14e (Jan 23,
2023)_(0323796834)_(Elsevier).pdf 14th
Edition John L. Cameron
Visit to download the full and correct content document:
https://ebookmass.com/product/current-surgical-therapy-14e-jan-23-2023_032379683
4_elsevier-pdf-14th-edition-john-l-cameron/
tSURGICAL
THERAPY
FOURTEENTH EDITION
u
Any screen.
Any time.
Anywhere.
Activate the eBook version
of this title at no additional charge.
Elsevier eBooks+ gives you the power to browse, search, and customize your content,
make notes and highlights, and have content read aloud.
Unlock your eBook today.

1. Visit http://ebooks.health.elsevier.com/
2. Log in or Sign up
3. Scratch box below to reveal your code
4. Type your access code into the “Redeem
Access Code” box
5. Click “Redeem”
It’s that easy! Place Peel Off

Sticker Here
For technical assistance:

email textbookscom.support@elsevier.com
call 1-800-545-2522 (inside the US)
call +44 1 865 844 640 (outside the US)
Use of the current edition of the electronic version of this book (eBook) is subject to the terms of the nontransferable, limited license granted on
http://ebooks.health.elsevier.com/. Access to the eBook is limited to the first individual who redeems the PIN, located on the inside cover of this book,
at http://ebooks.health.elsevier.com/ and may not be transferred to another party by resale, lending, or other means.
2022v1.0
current
surgical
therapy
current
surgical
therapy
14
edition
th
John L. Cameron
MD, FACS, FRCS(Eng)(Hon), FRCS(Ed)(Hon), FRCSI (Hon)
The Alfred Blalock Distinguished Service Professor
Department of Surgery
Johns Hopkins University School of Medicine
Baltimore, Maryland
Andrew M. Cameron
MD, PhD, FACS
Professor
Director, Department of Surgery
Chief, Division of Transplantation
Baltimore, Maryland
ELSEVIER
1600 John F. Kennedy Blvd.
Ste. 1600
Philadelphia, PA 19103-2899
CURRENT SURGICAL THERAPY, FOURTEENTH EDITION ISBN: 978-0-323-79683-5

Copyright © 2023 by Elsevier Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher's permissions policies, and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary. Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein. In using such
information or methods they should be mindful of their own safety and the safety of others, including parties
for whom they have a professional responsibility. With respect to any drug or pharmaceutical products
identified, readers are advised to check the most current information provided (i) on procedures featured or
(ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the
method and duration of administration, and contraindications. It is the responsibility of practitioners, relying
on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the
best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent
of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury
and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any
use or operation of any methods, products, instructions, or ideas contained in the material herein.
Previous editions copyrighted 2020, 2017 by Elsevier Inc.; 2014, 2011, 2008, 2004, 2001, 1998, 1995, 1992, 1989,
1986, 1984 by Saunders Inc, an affiliate of Elsevier Inc.
Content Strategist: Jessica McCool

Senior Content Development Manager: Kathryn DeFrancesco
Publishing Services Manager: Catherine Jackson
Senior Project Manager: John Casey
Design Direction: Brian Salisbury
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1

Contributors
Ariane M. Abcarian, MD David B. Adams, MD Nita Ahuja, MD, MBA, FACS

Attending Surgeon Distinguished University Professor Emeritus Professor and Chair
Division of Colon and Rectal Surgery Department of Surgery Department of Surgery
Cook County Health Medical University of South Carolina Yale School of Medicine
Assistant Professor Charleston, South Carolina Professor
Department of Surgery Pancreas Divisum and Other Variants of Department of Pathology
Rush University Medical Center Dominant Dorsal Duct Anatomy Yale–New Haven Hospital
Chicago, Illinois New Haven, Connecticut
Management of Hemorrhoids Laura M. Adams, MD Management of Adrenal Cortical Tumors
Associate Physician and Surgeon
Herand Abcarian, MD, FACS Department of Surgery Venkata S. Akshintala, MD
Professor of Surgery UC San Diego Assistant Professor
University of Illinois Hospital and Health La Jolla, California Division of Gastroenterology
Sciences System Endocrine Changes with Critical Illness Johns Hopkins University School of
John H. Stroger Jr. Hospital of Cook Medicine
County Reid B. Adams, MD Baltimore, Maryland
Chicago, Illinois S. Hurt Watts Chair and Professor Management of Hepatic Encephalopathy
Management of Hemorrhoids Department of Surgery
University of Virginia Mohammad Al Efishat, MD, FSSO
Mohamad A. Abdulhai, MD Charlottesville, Virginia Complex Surgical Oncology, HPB Fellow
Colon and Rectal Surgeon Management of Liver Hemangioma Department of Surgery
Department of Surgical Oncology Johns Hopkins Hospital
Banner MD Anderson Cancer Center Adeseye Adekeye, MD, PhD Baltimore, Maryland
Phoenix, Arizona Assistant Professor Management of Intrahepatic, Perihilar, and
Surgical Management of Colon Cancer Department of Surgery Distal Extrahepatic Cholangiocarcinoma
Thomas Jefferson University
Philadelphia, Pennsylvania Hasan B. Alam, MD
Christopher J. Abularrage, MD
Advances in Neoadjuvant and Adjuvant Therapy Loyal and Edith Davis Professor and
Associate Professor
for Early-Stage Breast Cancer Chair
Division of Vascular Surgery and
Endovascular Therapy Department of Surgery
Johns Hopkins Hospital Gina L. Adrales, MD, MPH, FACS Northwestern University Feinberg School of
Baltimore, Maryland Associate Professor Medicine
Diabetic Foot Department of Surgery Surgeon-in-Chief
Johns Hopkins School of Medicine Northwestern Memorial Hospital
Baltimore, Maryland Chicago, Illinois
Ali F. AbuRahma, MD, FRCS, FACS,
Management of Inguinal Hernia Initial Assessment and Resuscitation of the
RVT, RPVI
Professor and Chief Trauma Patient
Vascular and Endovascular Surgery Gillian M. Ahrendt, MD
Director, Vascular Fellowship and Residency Resident Vance L. Albaugh, MD, PhD
Programs Department of Orthopaedic Surgery Assistant Professor of Metabolic Surgery
Department of Surgery University of Pittsburgh School of Metamor Institute
Robert C. Byrd Health Sciences Center Medicine Pennington Biomedical Research Center
West Virginia University Pittsburgh, Pennsylvania Staff Surgeon
Medical Director, Vascular Laboratory Management of Primary Sclerosing Cholangitis Metabolic and Bariatric Surgery
Charleston Area Medical Center Franciscan Missionaries of Our Lady
Charleston, West Virginia Steven A. Ahrendt, MD Baton Rouge, Louisiana
Femoropopliteal Occlusive Disease Professor Cardiovascular Disease Risk Reduction After
Department of Surgery Bariatric Surgery
Zachary T. AbuRahma, DO Division of Surgical Oncology
Assistant Professor of Vascular Surgery University of Colorado
Charleston Area Medical Center Denver, Colorado
West Virginia University Management of Primary Sclerosing Cholangitis
Charleston, West Virginia
Femoropopliteal Occlusive Disease
v
vi CONTRIBUTORS
Katherine Albutt, MD, MPH Lauren Antognoli, MD Adrian Barbul, MD

Assistant Professor Surgical Resident Professor
Division of Trauma, Emergency Luminis Health Anne Arundel Medical Department of Surgery
Surgery, and Surgical Critical Care Center Vanderbilt University Medical Center
Massachusetts General Hospital Annapolis, Maryland Professor
Boston, Massachusetts Management of Primary Chest Wall Tumors Department of Surgery
Current Management of Rectal Injury Nashville Veterans Affairs Hospital
Pathik Aravind, MD Nashville, Tennessee
Yewande Alimi, MD, MHS Resident Physician Is Nasogastric Intubation
Assistant Professor Yale University School of Medicine Necessary After Alimentary Tract Surgery?
Department of Surgery New Haven, Connecticut
Georgetown University School of Medicine Treatment Trends in Locally Recurrent and Philip S. Barie, MD, MBA, MCCM,
Washington, DC Metastatic Breast Cancer FSIS, FIDSA, FACS, MAMSE
Loss of Domain in Abdominal Wall Professor Emeritus of Surgery
Reconstruction Margaret W. Arnold, MD Division of Trauma, Burns, Critical and
Program Director Acute Care
Wilson M. Alobuia, MD, MS General Surgery Weill Cornell Medical College
General Surgery Resident MedStar Baltimore New York, New York
Stanford University Baltimore, Maryland; Burn Wound Management
Stanford, California Associate Professor
Management of Pheochromocytoma Department of Surgery Emilie C. Barnes, MD
Georgetown School of Medicine Department of Surgery
Ranim Alsaad, MD Washington, DC University of North Carolina
General Surgery Resident Treatment of Claudication Chapel Hill, North Carolina
Johns Hopkins Hospital Management of Tumors of the Anal Region
Baltimore, Maryland Chady Atallah, MD
Ischemic Colitis Assistant Professor Stephen L. Barnes, MD, FACS
Pregnancy and Breast Cancer Management Department of Surgery Chair, Hugh E Stephenson Department of
Johns Hopkins Medical Institutions Surgery
Emanuela Silva Alvarenga, MD Baltimore, Maryland University of Missouri
Clinical Associate Staff Management of Radiation-Induced Injury to the Columbia, Missouri
Colon and Rectal Surgery Small and Large Bowel Abdomen That Will Not Close
Cleveland Clinic Florida Management of Pruritus Ani
Weston, Florida
Erica Barnett, BA
Rectovaginal Fistula Andrea L. Axtell, MD, MPH
MD Candidate
Surgical Fellow
John C. Alverdy, MD, FACS, FSIS Division of Thoracic Surgery
Harvard Medical School
Sara and Harold Lincoln Thompson Massachusetts General Hospital
Boston, Massachusetts
Professor of Surgery Boston, Massachusetts
Management of Acute Cholangitis
Executive Vice Chair Management of Tracheal Stenosis
Reva Basho, MD
The University of Chicago Pritzker School Nilofer Azad, MD
Assistant Professor
of Medicine Associate Professor
Medical Oncology
Chicago, Illinois Department of Gastrointestinal Oncology
Cedars-Sinai Medical Center
Management of Acute Necrotizing Pancreatitis Johns Hopkins Medical Institutions
Director, Women’s Cancer Research
Baltimore, Maryland
Ellison Institute for Transformative
Avani Amin, MD Neoadjuvant and Adjuvant Therapy for
Medicine
Instructor of Medicine Colorectal Cancer
Los Angeles, California
Division of Hospital Medicine Molecular Targets in Breast Cancer
Section of Palliative Medicine Omaira Azizad, MD
Johns Hopkins University School of Assistant Professor
Gary A. Bass, MD, MSc, MBA, PhD,
Medicine Anesthesiology and Pain Management
FEBS (EmSurg)
Baltimore, Maryland University of Texas Southwestern Medical
Assistant Professor
Surgical Palliative Care Center
Division of Traumatology, Surgical Critical
Dallas, Texas
Care, and Emergency Surgery
Ciro Andolfi, MD, FACS ERAS Protocols for General Surgery
University of Pennsylvania
Pediatric Surgeon Philadelphia, Pennsylvania
Department of Surgery Alison M. Bales, MD Acute Kidney Injury in the Injured
The University of Chicago Pritzker School Fellow and Critically Ill
of Medicine Department of Surgery
Chicago, Illinois, Indiana University
Richard J. Battafarano, MD, PhD
Pediatric Surgeon Indianapolis, Indiana
Associate Professor and Chief
Department of Surgery Management of Pulmonary Parenchymal Injury
Division of Thoracic Surgery
Les Hôpitaux Civils de Colmar
Johns Hopkins Medical Institutions
Colmar, France
Baltimore, Maryland
Management of Cysts, Tumors, and Abscesses of
Management of Paraesophageal Hernia Repair
the Spleen
C ontributors vii
Solange Bayard, MD Shivanand Bomman, MD Stephen R. Broderick, MD, MPHS

General Surgery Gastroenterology Research Fellow Assistant Professor
NewYork-Presbyterian/Weill Cornell Center for Digestive Health Department of Surgery
Medicine Virginia Mason Franciscan Health Johns Hopkins Medical Institutions
New York, New York Seattle, Washington Baltimore, Maryland
Surgical Management of the Axilla Pancreatic Ductal Disruptions Leading to Management of Barrett’s Esophagus
Pancreatic Fistula, Pancreatic Ascites, or
Marshall S. Bedine, MD Pancreatic Pleural Effusion Lawrence B. Brown, MD, MPH, MHS
Assistant Professor General Surgery Resident
Department of Medicine Morgan Bonds, MD Johns Hopkins University
Division of Gastroenterology and Assistant Professor Baltimore, Maryland
Hepatology Department of Surgery Gastrointestinal Tubes for Feeding and
Johns Hopkins Medical Institutions University of Oklahoma Health Sciences Decompression
Baltimore, Maryland Center
Management of Acute Colonic Pseudo-Obstruction Oklahoma City, Oklahoma Jill C. Buckley, MD
(Ogilvie’s Syndrome) Management of Gallstone Ileus Professor
Department of Urology
Kevin E. Behrns, MD Marylise Boutros, MD, FRCSC, FACS UC San Diego Health System
Chief Medical Officer and Professor Associate Professor San Diego, California
Department of Surgery Department of Surgery Renal and Ureteral Traumatic Injuries
University of Florida McGill University
Leesburg, Florida Attending Surgeon Corinne Bunn, MD
Genetic Testing and High-Risk Pancreatic Colorectal Surgery Resident
Cancer Screening Jewish General Hospital Loyola University Medical Center
Montreal, Quebec Chicago, Illinois
Lauren Beliveau, MD Management of Clostridioides Difficile Colitis Buerger’s Disease (Thromboangiitis Obliterans)
Vascular Fellow
Baylor Heart and Vascular Hospital Justin Brilliant, MD Mark S. Burke, MD, FACS
Dallas, Texas Resident Physician Attending Surgeon
Brachiocephalic Reconstruction Johns Hopkins Hospital Plastic and Reconstructive Surgery
Baltimore, Maryland Erie County Medical Center
Elizabeth R. Benjamin, MD, PhD Management of Refractory Ascites Buffalo, New York
Associate Clinical Professor Breast Reconstruction Following Mastectomy:
Department of Surgery L.D. Britt, MD, MPH, DSc (Hon), Considerations, Techniques, and Outcomes,
Emory University FACS, FCCM Part 2
Trauma Medical Director Henry Ford Professor and Edward J.
Grady Memorial Hospital Brickhouse Chairman Richard A. Burkhart, MD
Atlanta, Georgia Department of Surgery Associate Professor
Management of Traumatic Liver Injury Eastern Virginia Medical School Departments of Surgery and Oncology
Norfolk, Virginia Johns Hopkins Hospital and Johns Hopkins
David Berger, MD Blunt Abdominal Trauma University
Associate Professor Baltimore, Maryland
General and Gastrointestinal Surgery Sacha P. Broccard, MD Intraductal Papillary Mucinous Neoplasms of
Harvard Medical School Resident the Pancreas
Massachusetts General Hospital Mayo Clinic
Boston, Massachusetts Jacksonville, Florida
Michael S. Burnim, MD
Management of Acute Cholangitis Surgical Management of the Polyposis
Fellow
Syndromes
Division of Pulmonary and Critical Care
James H. Black III, MD, FACS Medicine
David Goldfarb MD Professor of Surgery Malcolm V. Brock, MD Johns Hopkins University School of
Vascular Surgery and Endovascular Therapy Professor Medicine
Johns Hopkins School of Medicine Division of Thoracic Surgery Baltimore, Maryland
Chief, Vascular Surgery and Endovascular Johns Hopkins Medical Institutions COVID-19 and Health Care Delivery in a
Therapy Baltimore, Maryland Pandemic
Johns Hopkins Hospital Esophageal Function Tests
Baltimore, Maryland Mediastinal Masses
William Reece Burns, MD
Management of Thoracic and Thoracoabdominal Assistant Professor
Aortic Aneurysms Ryan C. Broderick, MD Department of Surgery
Assistant Professor Johns Hopkins School of Medicine
Alex B. Blair, MD Department of Surgery Baltimore, Maryland
Surgical Resident Division of Minimally Invasive Surgery Management of Intrahepatic, Perihilar, and
Johns Hopkins Hospital UC San Diego Distal Extrahepatic Cholangiocarcinoma
Baltimore, Maryland La Jolla, California
Management of Gastric Adenocarcinoma Management of Acute Cholecystitis
viii CONTRIBUTORS
Errol L. Bush, MD, FACS Melissa S. Camp, MD, MPH Timothy D. Chilton, DO
Surgical Director Assistant Professor Resident Physician
Advanced Lung Disease and Transplant Department of Surgery Vascular and Endovascular Surgery
Program Johns Hopkins Hospital St. Louis University
Associate Professor Baltimore, Maryland St. Louis, Missouri
Division of Thoracic Surgery Breast Implant-Associated Anaplastic Large Cell Management of Infected Grafts
Johns Hopkins University Lymphoma
Baltimore, Maryland Walter Cholewczynski, MD
Extracorporeal Membrane Oxygenation for Yilin (Linda) Cao, MD Associate Chairman of Surgery
Respiratory Failure Resident Physician Director of Surgical Critical Care
Department of Radiation Oncology and Department of Surgery
Ronald W. Busuttil, MD, PhD Molecular Radiation Sciences Bridgeport Hospital
Distinguished Professor Emeritus and Johns Hopkins University School of Bridgeport, Connecticut;
Executive Chair Medicine Clinical Assistant Professor
Department of Surgery Baltimore, Maryland Department of Surgery
Founding Chief Neoadjuvant and Adjuvant Therapy for Yale School of Medicine
Division of Liver and Pancreas Colorectal Cancer New Haven, Connecticut
Transplantation Antibiotics in Surgical Critical Care
David Geffen School of Medicine at Ned Z. Carp, MD
University of California Los Angeles Michael A. Choti, MD, MBA
Barbara Brodsky Chief of Surgery and Chair
Los Angeles, California Chief, Department of Surgery
Management of Budd-Chiari Syndrome Banner MD Anderson Medical Center
Lankenau Medical Center
Phoenix, Arizona
Wynnewood, Pennsylvania
Surgical Management of Colon Cancer
Jo Buyske, MD Management of Male Breast Cancer
CEO and President Joani Christensen, MD
American Board of Surgery Fabio Casciani, MD Assistant Professor
Adjunct Professor Department of Surgery Department of Surgery
Department of Surgery University of Pennsylvania Perelman School Washington University in St. Louis School
University of Pennsylvania Perelman School of Medicine of Medicine
of Medicine Philadelphia, Pennsylvania St. Louis, Missouri
Philadelphia, Pennsylvania Management of Complications After the Lymphedema
The American Board of Surgery Certifying (Oral) Whipple Procedure
Examination Adrienne N. Christopher, MD
Elliot L. Chaikof, MD, PhD Resident Physician
Kristine E. Calhoun, MD Johnson and Johnson Professor of Thomas Jefferson University Hospital
Professor Surgery Clinical Research Fellow
Director of Medical Student Surgical Department of Surgery Division of Plastic Surgery
Education Harvard Medical School University of Pennsylvania Hospital
University of Washington School of Chair, Roberta and Stephen R. Weiner Philadelphia, Pennsylvania
Medicine Department of Surgery Use of Various Meshes in Hernia Repair
Seattle, Washington Beth Israel Deaconess Medical Center
Ductal and Lobular Carcinoma in situ of the Boston, Massachusetts Anna Chudnovets, MD
Breast Popliteal and Femoral Artery Aneurysm General Surgery Specialist
Nicholas A. Calotta, MD Ahmed Chatila, MD Johns Hopkins Medical Institutions
Resident Physician Fellow Baltimore, Maryland
Plastic and Reconstructive Surgery Department of Gastroenterology and Preoperative Bowel Preparation: Is It Necessary?
Johns Hopkins School of Medicine Hepatology
Baltimore, Maryland University of Maryland Jose R. Cintron, MD
Nonmelanoma Skin Cancers Baltimore, Maryland Chairman, Division of Colon and Rectal
Management of Cutaneous Melanoma Pneumatosis Intestinalis and the Importance Surgery (Retired)
for the Surgeon John H. Stroger Hospital of Cook County
Richard P. Cambria, MD Associate Professor (Retired)
Robert R. Linton Professor of Vascular and University of Illinois College of Medicine at
Sophia Y. Chen, MD, MPH
End-Vascular Surgery Chicago
Resident Physician
Harvard Medical School Chicago, Illinois
Johns Hopkins University School of
Division of Vascular and Endovascular Surgical Management of Constipation
Medicine
Surgery Baltimore, Maryland
St. Elizabeth Medical Center Management of Radiation-Induced Injury Bryan M. Clary, MD, MBA
Boston, Massachusetts to the Small and Large Bowel Professor and Chair
Open Repair of Abdominal Aortic Aneurysms Department of Surgery
Endovascular Treatment of Abdominal Aortic UC San Diego
Albert Chi, MSE, MD
Aneurysms San Diego, California
Associate Professor
Management of Acute Cholecystitis
Division of Trauma, Critical Care, and Acute
Care Surgery
Oregon Health & Science University
Portland, Oregon
Fluid and Electrolyte Therapy
C ontributors ix
Jordan M. Cloyd, MD Chris Cribari, MD, FACS Whitney A. Davidson, MD

Surgical Oncologist Associate Clinical Professor Faculty, Department of Surgery
Department of Surgery Department of Surgery Mercy NWA
Ohio State University University of Colorado Rogers, Arkansas
Columbus, Ohio Medical Director Management of Primary Chest Wall Tumors
Management of Colorectal Liver Metastases Acute Care Surgery
UC Health Medical Group Katherine deAngeli, MD
Christine S. Cocanour, MD, FACS, Loveland, Colorado Fellow
FCCM Septic Response and Management Mount Sinai Hospital
Professor New York, New York
Department of Surgery Patricia A. Cronin, MD, BAO, BCh, Genetic Counseling and Testing
Division of Trauma BMedSci, FRCS, FACS
UC Davis Assistant Professor Sarah E. Deery, MD, MPH
Sacramento, California Division of Surgical Oncology and Vascular Surgeon
Catheter Sepsis in the Intensive Care Unit Endocrine Surgery Division of Vascular and Endovascular
Mayo Clinic Arizona Therapy
Raul Coimbra, MD, PhD Phoenix, Arizona Maine Medical Center
Surgeon-in-Chief Margins: How to and How Big? Portland, Maine;
Division of Trauma, Surgical Critical Care, Clinical Assistant Professor
and Burns Patrick Crosby, MD Tufts University School of Medicine
Riverside University Health System Medical General Surgery Resident Boston, Massachusetts
Center Johns Hopkins Hospital Management of Recurrent Carotid Artery
Riverside, California; Baltimore, Maryland Stenosis
Professor Metabolic Changes Following Bariatric Surgery
Department of Surgery Daniel J. Delitto, MD, PhD
Loma Linda University Alisa Cross, MD Assistant Professor
Loma Linda, California Associate Professor Department of Surgery
Chest Wall Trauma, Hemothorax, and Department of Surgery Stanford University
Pneumothorax University of Oklahoma Stanford, California
Oklahoma City, Oklahoma Genetic Testing and High-Risk Pancreatic
Surgeon’s Use of Ultrasound in the Trauma and Cancer Screening
Salih Colakoglu, MD
Critical Care Settings
Assistant Professor
Plastic and Reconstructive Surgery Steven C. Cunningham, MD, FACS Tom R. DeMeester, MD
Johns Hopkins Hospital Director of Pancreatic and Hepatobiliary Professor and Chairman Emeritus
Baltimore, Maryland Surgery Department of Surgery
Breast Reconstruction Following Mastectomy: Department of Surgery University of Southern California,
Indications, Techniques, and Results, Part 1 Ascension Saint Agnes Hospital and Cancer Los Angeles
Institute Los Angeles, California
Julie A. Conyers, MD, MBA, FACS Baltimore, Maryland New Approaches to Gastroesophageal Reflux
Surgeon, Trauma Acute Care Surgery Management of Common Bile Duct Stones Disease (LINX)
UC Health
Colorado Springs, Colorado; Hasan Dani, MD Daniel T. Dempsey, MD, MBA
Chief Medical Officer Brady Urological Institute Professor Emeritus
Pikes Peak Regional Hospital Department of Urology Department of Surgery
Woodland Park, Colorado Johns Hopkins Hospital University of Pennsylvania
Endoscopic Therapy for Esophageal Variceal Baltimore, Maryland Pennsylvania, Philadelphia
Hemorrhage Urologic Complications of Pelvic Fracture Benign Gastric Ulcer
Management of Duodenal Ulcers
Edward E. Cornwell III, MD, FACS, Alan Dardik, MD, PhD
FCCM, FWACS (Hon.) Professor Isabel S. Dennahy, MD
The LaSalle D. Leffall Jr. Professor Surgery and Cellular and Molecular General Surgery Resident
Department of Surgery Physiology Johns Hopkins Hospital
Howard University Hospital Vice Chair, Faculty Affairs Baltimore, Maryland
Washington, DC Yale School of Medicine Total Pancreatectomy and Islet
Injured Spleen New Haven, Connecticut; Autotransplantation for Chronic Pancreatitis
Attending, Vascular Surgery
Gregory A. Coté, MD, MS Department of Surgery Daniel L. Dent, MD
Professor VA Connecticut Healthcare Systems Vice Chair for Education
Department of Medicine West Haven, Connecticut Department of Surgery
Division of Gastroenterology and Raynaud’s Phenomenon Chair, Department of Medical Education
Hepatology UT Health San Antonio Long School of
Oregon Health & Science University Halley Darrach, MD Medicine
Portland, Oregon Medical Student San Antonio, Texas
Pancreas Divisum and Other Variants Plastic and Reconstructive Surgery The American Board of Surgery Certifying (Oral)
of Dominant Dorsal Duct Anatomy Johns Hopkins School of Medicine Examination
Baltimore, Maryland
Lymphedema
x CONTRIBUTORS
Danielle K. DePeralta, MD Joy Zhou Done, MD, MHS Anne P. Ehlers, MD, MPH
Assistant Professor Resident Senior Fellow
Surgical Oncology Johns Hopkins University of Washington
Northwell Health Baltimore, Maryland Seattle, Washington
New York, New York PET Scanning in the Management of Colorectal Endoscopic Treatment of Barrett’s Esophagus
Management of Malignant Liver Tumors Cancer
Treatment Trends in Locally Recurrent and Daniel L. Eisenson, MD
Niraj M. Desai, MD Metastatic Breast Cancer Resident
Assistant Professor Johns Hopkins University School of
Department of Surgery Jay J. Doucet, MD, MSc, FACS, Medicine
Johns Hopkins University School of FRCSC Baltimore, Maryland
Medicine Professor Management of Hepatic Abscess
Baltimore, Maryland Department of Surgery
Transplantation of the Pancreas UC San Diego S. James El Haddi, MD, MS
San Diego, California General Surgery Resident
Melissa Louise DeSouza, MD Endocrine Changes with Critical Illness
Surgeon Oregon Health & Science University
Foregut and Bariatric Surgery Portland, Oregon
Quan-Yang Duh, MD Fluid and Electrolyte Therapy
The Oregon Clinic
Professor and Chief
Portland, Oregon
Section of Endocrine Surgery
Management of Disorders of Esophageal Mohamad El Moheb, MD
UC San Francisco
Motility General Surgery Resident
Attending Surgeon
University of Virginia
VA Medical Center
Lauren M. DeStefano, MD Charlottesville, Virginia;
San Francisco, California
Breast Surgical Oncologist Postdoctoral Research Fellow
Management of Thyroid Nodules
Department of Surgery Massachusetts General Hospital
Cedars-Sinai Medical Center Boston, Massachusetts
Mark D. Duncan, MD, FACS Use of Opioids in the Postoperative Period
Associate Professor
Ductal and Lobular Carcinoma in situ of the
Division of Surgical Oncology
Breast Ramy El-Diwany, MD, PhD
Resident
Associate Professor
Laurence P. Diggs, MD Johns Hopkins University School of
Department of Oncology
Chief Resident Medicine
Miller Coulson Academy of Clinical
Rutgers Robert Wood Johnson University Baltimore, Maryland
Excellence
School of Medicine Management of Small Bowel Tumors
Baltimore, Maryland
New Brunswick, New Jersey Management of Gastric Adenocarcinoma
Management of Gastrointestinal Stromal James K. Elsey, MD, FACS
Tumors Professor
Mark A. Eckardt, MD
Surgical Resident
Conor Dillon, DO Medical University of South Carolina
Yale School of Medicine
Instructor, General Surgery Charleston, South Carolina
New Haven, Connecticut
Homer Stryker School of Medicine Management of Abdominal Aortic Aneurysm
Management of Adrenal Cortical Tumors
Western Michigan University with Concomitant Nonvascular Abdominal
Kalamazoo, Michigan Pathology
Barish H. Edil, MD
Surgical Site Infections
Professor and Chair
Joel Elterman, MD, FACS
Associate Clinical Professor
Joseph DiNorcia, MD University of Oklahoma
Associate Professor Oklahoma City, Oklahoma
University of Colorado School of Medicine
Recanati/Miller Transplantation Institute Management of Gallstone Ileus
Anschutz Medical Campus
Icahn School of Medicine at Mt. Sinai
Fort Collins, Colorado;
New York, New York David T. Efron, MD Trauma and Acute Care Surgery
Management of Budd-Chiari Syndrome Professor Medical Center of the Rockies
Department of Surgery Loveland, Colorado
Gerard M. Doherty, MD University of Maryland Shock Trauma Septic Response and Management
Moseley Professor and Chair of Surgery Center
Harvard Medical School Medical Director and Chief of Trauma
Zachary Obinna Enumah, MD, MA
Surgeon-in-Chief and Crowley Family RA Cowley Shock Trauma Center
General Surgeon
Chair University of Maryland School of Medicine
Johns Hopkins Hospital
Brigham and Women’s Hospital Baltimore, Maryland
Baltimore, Maryland
Boston, Massachusetts Emergency Department Resuscitative
Tenets of Damage Control
Nontoxic Goiter Thoracotomy
Acid-Base Disorders
James M. Donahue, MD Jonathan E. Efron, MD
David M. Euhus, MD
Associate Professor Professor of Surgery and Urology
Professor
Department of Surgery Johns Hopkins University
University of Alabama at Birmingham Baltimore, Maryland
Johns Hopkins University
Birmingham, Alabama Management of Toxic Megacolon
Baltimore, Maryland
Management of Esophageal Perforation
Pregnancy and Breast Cancer Management
C ontributors xi
Douglas B. Evans, MD David V. Feliciano, MD, FACS, MAMSE James W. Fleshman Jr., MD, FACS,
Donald C Ausman Family Foundation Clinical Professor FASCRS
Professor and Chair Department of Surgery Chairman, Department of Surgery
Department of Surgery University of Maryland School of Baylor University Medical Center
Medical College of Wisconsin Medicine Clinical Professor
Milwaukee, Wisconsin Attending Surgeon Emeritus Texas A&M College of Medicine
Palliative Interventions for Patients with Shock Trauma Center Dallas, Texas
Operable and Advanced Pancreatic and University of Maryland Medical Center Surgical Management of Crohn’s Colitis
Periampullary Cancer Baltimore, Maryland
Penetrating Abdominal Trauma Katherine L. Florecki, MD
Mikael A. Fadoul, MD Assistant Professor
Resident Physician David J. Feller-Kopman, MD, FACP Department of Surgery
Department of Vascular and Endovascular Professor Division of Acute Care Surgery
Surgery Department of Medicine Johns Hopkins University School of
Cooper University Hospital Geisel School of Medicine at Dartmouth Medicine
Camden, New Jersey Hanover, New Hampshire; Baltimore, Maryland
Endovascular Management of Vascular Injuries Chief, Pulmonary and Critical Care Ventilator-Associated Pneumonia
Medicine Post–Intensive Care Syndrome
Peter J. Fagenholz, MD Dartmouth-Hitchcock Medical Center
Associate Professor Lebanon, New Hampshire
Division of Trauma, Emergency Surgery, Yuman Fong, MD
Tracheostomy The Sangiacomo Family Chair in Surgical
and Critical Care
Massachusetts General Hospital Oncology
Associate Professor
Kirkpatrick Beekman Fergus, MD, MAS City of Hope National Medical Center
Resident Physician Duarte, California
UC San Francisco Cystic Disease of The Liver
San Francisco, California
Current Management of Rectal Injury
Management of Chronic Ulcerative Colitis Zhi Ven Fong, MD, MPH
Marissa Famularo, DO Complex General Surgical Oncology Fellow
Integrated Vascular Resident Carlos Fernandez-del Castillo, MD Department of Surgery
Vascular Surgery Professor Massachusetts General Hospital
Cooper University Hospital Department of Surgery Boston, Massachusetts
Camden, New Jersey Massachusetts General Hospital Ablation of Colorectal Carcinoma Liver
Endovascular Management of Vascular Injuries Boston, Massachusetts Metastases
Rare and Unusual Pancreatic Tumors Diagnosis and Management of Autoimmune
Sandy Hwang Fang, MD
Pancreatitis
Associate Professor
Department of Surgery Alessandro Fichera, MD, FACS,
Oregon Health & Sciences University FASCRS Ryan B. Fransman, MD
Portland, Oregon Surgery Safety and Quality Officer Trauma Surgery
Preoperative Bowel Preparation: Is It Necessary? Division Chief, Colorectal Surgery University of Maryland Shock Trauma Center
PET Scanning in the Management of Colorectal Baylor University Medical Center Baltimore, Maryland
Cancer Dallas, Texas Emergency Department Resuscitative
Surgical Management of Crohn’s Colitis Thoracotomy
Alik Farber, MD, MBA Surgical Management of Fecal Incontinence
Chief Julie A. Freischlag, MD, FACS,
Division of Vascular and Endovascular John P. Fischer, MD, MPH FRCSEd(Hon), DFSVS
Surgery Assistant Professor Professor, Vascular and Endovascular
Associate Chair for Clinical Operations Division of Plastic Surgery Surgery
Department of Surgery University of Pennsylvania Wake Forest University School of Medicine
Boston Medical Center Pennsylvania, Philadelphia Chief Executive Officer
Professor of Surgery and Radiology Use of Various Meshes in Hernia Repair Atrium Health Wake Forest Baptist
Boston University School of Medicine Dean, Wake Forest University School of
Boston, Massachusetts Adam Fish, MD Medicine
Management of Peripheral Arterial Resident Physician Winston-Salem, North Carolina;
Thromboembolism Department of Interventional Radiology Chief Academic Officer
Yale School of Medicine Atrium Health Enterprise
Genevieve Fasano, MD, MS
New Haven, Connecticut Charlotte, North Carolina
Resident
Vena Cava Filters Thoracic Outlet Syndrome
NewYork-Presbyterian/Weill Cornell
Medicine P. Marco Fisichella, MD, MBA, FACS
New York, New York Christopher Frost, MD
Associate Professor Resident Physician
Surgical Management of the Axilla Department of Surgery Plastic and Reconstructive Surgery
Harvard Medical School Johns Hopkins Hospital
Associate Chief of Surgery Baltimore, Maryland
Department of Surgery Nerve Injury and Repair
West Roxbury VA
Management of Cysts, Tumors, and Abscesses of
the Spleen
xii CONTRIBUTORS
Alodia Gabre-Kidan, MD, MPH Danon E. Garrido, MD Armando E. Giuliano, MD, FACS,
Assistant Professor Assistant Professor FRCSEd
Department of Surgery Vascular and Endovascular Surgery Chief, Surgical Oncology
Johns Hopkins School of Medicine University of Mississippi Medical Center Department of Surgery
Baltimore, Maryland Jackson, Mississippi Cedars-Sinai Medical Center
Management of Rectal Prolapse Balloon Angioplasty and Stents in Carotid Artery Clinical Professor
Occlusive Disease Department of Surgery
Vivian Gahtan, MD UCLA School of Medicine
Chair, Department of Surgery Susan L. Gearhart, MD, MEHP Los Angeles, California
Stritch School of Medicine Associate Professor of Colorectal Surgery Molecular Targets in Breast Cancer
Loyola University Director, Colorectal Surgery Fellowship Ablative Techniques in the Treatment of Benign
Staff Physician Program and Malignant Breast Disease
Department of Surgery Johns Hopkins University School of
Edward Hines Jr. VA Hospital Medicine Natalia O. Glebova, MD, PhD
Maywood, Illinois Baltimore, Maryland Vascular Surgeon
Buerger’s Disease (Thromboangiitis Obliterans) Gastrointestinal Tubes for Feeding and Mid-Atlantic Permanente Medical Group
Decompression Rockville, Maryland
Susan Galandiuk, MD Tibioperoneal Arterial Occlusive Disease
Price Endowed Professor of Surgery Mary L. Gemignani, MD, MPH
Director, Price Institute of Surgical Attending Surgeon Ana Gleisner, MD, PhD
Research Program Director, Breast Surgery Fellowship Associate Professor
Director, Division of Colon and Rectal Breast Service Department of Surgery
Surgery Department of Surgery University of Colorado
Program Director, Division of Colon and Memorial Sloan Kettering Cancer Center Aurora, Colorado
Rectal Surgery New York, New York Management of Benign Liver Tumors
Hiram C. Polk Jr, MD, Department of Breast Cancer: Surgical Therapy
Surgery Lee A. Goeddel, MD, MPH
University of Louisville Christos Georgiades, MD, PhD Assistant Professor
Louisville, Kentucky Professor Department of Anesthesiology and Critical
Management of Diverticular Disease of the Radiology and Radiological Sciences Care Medicine
Colon Director, Interventional Oncology Johns Hopkins University School of
Johns Hopkins University Medicine
Samuel M. Galvagno Jr., DO, PhD, MS, Baltimore, Maryland Assistant Professor
FCCM Transjugular Intrahepatic Portosystemic Shunt Biomedical Engineering
Professor of Anesthesiology Transhepatic Interventions for Obstructive Johns Hopkins Whiting School of
R. Adams Cowley Shock Trauma Center Jaundice Engineering
Executive Vice Chair, Anesthesiology Baltimore, Maryland
University of Maryland School of Zachary German, MD Perioperative Optimization
Medicine Medical Student
Baltimore, Maryland; Wake Forest School of Medicine Eric M. Goldberg, MD
Colonel, Air Force Reserve Winston-Salem, North Carolina Associate Professor
USAF Pentagon Thoracic Outlet Syndrome Department of Medicine and
Arlington, Virginia Gastroenterology
Management of Diverticular Disease of the University of Maryland School of Medicine
Colon Bruce L. Gewertz, MD
Chair and Surgeon in Chief Baltimore, Maryland
Airway Management in the Trauma Patient Pneumatosis Intestinalis and the Importance
Cedars-Sinai Medical Center for the Surgeon
Raisa Gao, DO Los Angeles, California
Instructor, General Surgery Takayasu’s Arteritis Reyna Gonzalez, MD, MS
Homer Stryker MD School of Medicine Emergency General Surgery Medical
Western Michigan University Director
Kalamazoo, Michigan Omar M. Ghanem, MD, FACS
Assistant Professor Riverside University Health Systems
Surgical Site Infections Moreno Valley, California
Mayo Clinic Glucose Control in the Postoperative Period
Brian T. Garibaldi, MD Rochester, Minnesota
Associate Professor Diagnosis and Management of Motility Amy V. Gore, MD
Pulmonary and Critical Care Medicine Disorders of the Stomach and Small Bowel in Assistant Professor
Johns Hopkins University School of the Current Era Department of Surgery
Medicine Rutgers New Jersey Medical School
Baltimore, Maryland Newark, New Jersey
COVID-19 and Health Care Delivery in a Joseph S. Giglia, MD
Professor Management of Intraabdominal Infections
Pandemic
Interim Chief of Vascular Surgery
University of Cincinnati College of Medicine
Cincinnati, Ohio
Atherosclerotic Renal Artery Stenosis
C ontributors xiii
Jeremy Goverman, MD Traci M. Grucz, PharmD, BCCCP Jafar Haghshenas, DO

Assistant Professor Clinical Pharmacy Specialist Clinical Assistant Professor
Department of Surgery Department of Pharmacy Department of Surgery
Harvard Medical School Johns Hopkins Hospital University of Illinois
MGH Trustee’s Fellow in Burns Baltimore, Maryland Chicago, Illinois;
Division of Burns Ventilator-Associated Pneumonia Attending Surgeon
Massachusetts General Hospital Department of Trauma Surgery and Surgical
Medical Staff Matthew D. Grunwald, MD Critical Care
Shriners Hospital for Children Physician Fellow Advocate Christ Medical Center
Boston, Massachusetts Department of Gastroenterology Oak Lawn, Illinois
Medical Management of the Burn Patient Maimonides Medical Center Venous Thromboembolism: Prevention, Diagnosis,
New York, New York and Treatment
Miral Sadaria Grandhi, MD Use of Esophageal Stents
Associate Professor Pegge M. Halandras, MD
Director of Hepatobiliary Surgery Jose G. Guillem, MD, MPH, MBA Associate Professor
Department of Surgery, Division of Surgical Chief, Division of GI Surgery Division of Vascular Surgery and
Oncology Department of Surgery Endovascular Therapy
Program Director of the Complex General University of North Carolina Loyola University Chicago
Surgical Oncology Fellowship Program Chapel Hill, North Carolina Stritch School of Medicine
Rutgers Cancer Institute of New Jersey Management of Colonic Volvulus Maywood, Illinois
Rutgers Robert Wood Johnson Medical Management of Tumors of the Anal Region Buerger’s Disease (Thromboangiitis Obliterans)
School
New Brunswick, New Jersey Rebecca L. Gunter, MD, MS James P. Hamilton, MD
Management of Gastrointestinal Stromal Associate Staff Associate Professor
Tumors Colorectal Surgery Director of Hepatology
Management of Echinococcal Cyst Cleveland Clinic Foundation Division of Gastroenterology and
Disease of the Liver Cleveland, Ohio Hepatology
Management of Pilonidal Disease Department of Medicine
Michael D. Grant, MD Johns Hopkins University School of
Breast Surgeon NavYash Gupta, MD, FACS Medicine
Department of Surgery Associate Professor Baltimore, Maryland
Baylor University Medical Center Department of Surgery Management of Refractory Ascites
Dallas, Texas Director, Venous Program
A Surgeon’s Practical Guide to Breast Imaging Vascular Surgery Muhammad Hammami, MD
Cedars-Sinai Medical Center Fellow
Richard J. Gray, MD Los Angeles, California Gastroenterology and Hepatology
Professor Takayasu’s Arteritis University of Maryland School of Medicine
Division of Surgical Oncology and Baltimore, Maryland
Endocrine Surgery Joseph R. Habib, MD Pneumatosis Intestinalis and the Importance for
Mayo Clinic Department of Surgery the Surgeon
Scottsdale, Arizona University of Maryland Medical Center
Margins: How to and How Big? Baltimore, Maryland Britta Jean Han, MD, MS
Biomarker Guided Surgical Management of Resident Physician
Jonathan B. Greer, MD Hepatobiliary and Pancreatic Tumors Washington University School of Medicine
Assistant Professor St. Louis, Missouri
Department of Surgery Mehran Habibi, MD, MBA Management of Recurrent Inguinal Hernia
Johns Hopkins University School of Assistant Professor
Medicine Department of Surgery Misop Han, MD, MS
Baltimore, Maryland Johns Hopkins University Professor
Small Bowel Diverticulosis Baltimore, Maryland Departments of Urology and Oncology
Management of Hepatic Abscess Treatment Trends in Locally Recurrent and Johns Hopkins Medicine
Metastatic Breast Cancer Baltimore, Maryland
Mahip Grewal, BA Urologic Complications of Pelvic Fracture
Medical Student Edward R. Hagen, MD
NYU Grossman School of Medicine General/Colon and Rectal Surgery Guy Handley, MD
NYU Langone Health Traverse General Surgery and Trauma Care Assistant Professor
New York, New York Traverse City, Michigan Division of Infectious Disease and
Biomarker Guided Surgical Management of Anal Condyloma International Medicine
Hepatobiliary and Pancreatic Tumors Morsani College of Medicine
Tampa, Florida
Chassidy Grimes, MD Antifungal Therapy in the Surgical Patient
Resident
Rush University Medical Center John W. Harmon, MD
Chicago, Illinois Professor
Anal Stenosis General Surgery
Baltimore, Maryland
Management of Small Bowel Tumors
xiv CONTRIBUTORS
Andrew Harris, MD Joseph M. Herman, MD, MSc, MSHCM Michael G. House, MD

Resident Physician Director of Clinical Research Professor
Department of Orthopaedic Surgery Radiation Oncology Department of Surgery
Johns Hopkins University Northwell Health Cancer Institute Chief, Division of Surgical Oncology
Baltimore, Maryland Lake Success, New York Indiana University School of Medicine
Spine and Spinal Cord Injuries Intraoperative Radiation for Pancreatic Cancer Indianapolis, Indiana
Management of Mallory-Weiss Syndrome
James E. Harris Jr. MD Sean Hickey, MD
Chair, Department of Surgery Instructor David B. Hoyt, MD
Johns Hopkins Hospital Department of Surgery Professor Emeritus and Chair
Howard County General Massachusetts General Hospital Department of Surgery
Columbia, Maryland Boston, Massachusetts University of California, Irvine
Acid-Base Disorders Cold-Induced Injuries and Hypothermia Irvine, California;
Immediate Past Executive Director
Jon M. Harrison, MD Caitlin W. Hicks, MD, MS American College of Surgeons
Surgical Resident Associate Professor Chicago, Illinois
GI and General Surgery Division of Vascular Surgery and Chest Wall Trauma, Hemothorax, and
Massachusetts General Hospital Endovascular Therapy Pneumothorax
Boston, Massachusetts Johns Hopkins University School of
Rare and Unusual Pancreatic Tumors Medicine Yinin Hu, MD
Baltimore, Maryland Assistant Professor
Christine Haugen, MD, PhD Diabetic Foot Department of Surgery
Resident Management of Ruptured Abdominal Aortic University of Maryland
Johns Hopkins Hospital Aneurysms Baltimore, Maryland
Baltimore, Maryland Surgical Management of Thyroid Cancer
Hemodialysis Access Surgery David Hindin, MD, MS
Fellow Nadia Ijaz, MBBS, MS
Elliott R. Haut, MD, PhD Division of General Surgery Geriatric Medicine Fellow
Associate Professor Stanford University Division of Internal Medicine
Anesthesiology/Critical Care Medicine and Stanford, California University of Maryland
Emergency Medicine Loss of Domain in Abdominal Wall Baltimore, Maryland
Division of Acute Care Surgery Reconstruction Coagulation Issues and the Trauma Patient
Medicine O. Joe Hines, MD
Baltimore, Maryland Kenji Inaba, MD
Professor and Interim Chair Professor of Surgery, Anesthesia, and
Venous Thromboembolism: Prevention, Diagnosis, Department of Surgery
and Treatment Emergency Medicine
David Geffen School of Medicine at the Department of Surgery
Pancreatic and Duodenal Injuries University of California, Los Angeles University of Southern California
Los Angeles, California Los Angeles, California
Dana Hayden, MD, MPH, FACS, Management of Pancreatic Necrosis
FASCRS Management of Diaphragmatic Injuries
Associate Professor Jessie Ho, MD
Department of General Surgery General Surgery Resident
Gabriel D. Ivey, MD
Rush University Medical Center Assistant Professor
Northwestern University
Chicago, Illinois Department of Surgery
Chicago, Illinois
Anal Stenosis Division of Surgical Oncology
Initial Assessment and Resuscitation of the
Trauma Patient
Jin He, MD, PhD Medicine
Associate Professor Baltimore, Maryland
Department of Surgery Richard A. Hodin, MD Intraductal Papillary Mucinous Neoplasms of
Johns Hopkins University School of Professor the Pancreas
Medicine Department of Surgery
Baltimore, Maryland Harvard Medical School
Lisa K. Jacobs, MD, MSPH
Vascular Reconstruction During the Whipple Boston, Massachusetts
Associate Professor
Operation Management of Enterocutaneous Fistulas
Departments of Surgery and Oncology
Fernando A.M. Herbella, MD Abraham P. Houng, MD, FACS Baltimore, Maryland
Associate Professor Assistant Professor Role of Stereotactic Biopsy in Management of
Department of Surgery Department of Surgery Breast Disease
Federal University of Sao Paulo Weill Cornell Medical College
Sao Paulo, Brazil New York, New York
Claire Janssen, MD
Management of Zenker’s Diverticulum Burn Wound Management
Fellow
Vascular Surgery
UC San Diego
San Diego, California
Aortoiliac Occlusive Disease
C ontributors xv
Ammar A. Javed, MD Anthony N. Kalloo, MD Qingwen Kawaji, MD, ScM

Assistant Professor of Surgery Chairman Surgical Resident
NYU Langone Health Department of Medicine Medstar Health
New York, New York Maimonides Medical Center Baltimore, Maryland
Biomarker Guided Surgical Management of New York, New York Treatment of Claudication
Hepatobiliary and Pancreatic Tumors Use of Esophageal Stents
Management of Pancreatic Pseudocyst Khaled M. Kebaish, MD, FRCS
Lewis J. Kaplan, MD, FACS, FCCM, Professor of Orthopaedic Surgery
Amballur David John, MD FCCP Johns Hopkins University
Assistant Professor Professor Baltimore, Maryland
Anesthesia and Critical Care Department of Surgery Spine and Spinal Cord Injuries
Johns Hopkins University Division of Trauma, Critical Care,
Baltimore, Maryland and Emergency Surgery Electron Kebebew, MD
Management of Postoperative Delirium University of Pennsylvania Perelman School Professor and Chief
of Medicine Department of Surgery
Eric K. Johnson, MD, FACS, FASCRS Section Chief, Surgical Critical Care Stanford University
Professor Department of Surgery Stanford, California
Colorectal Surgery Corporal Michael J Crescenz VA Medical Management of Pheochromocytoma
Cleveland Clinic Foundation Center
Cleveland, Ohio Philadelphia, Pennsylvania Scott R. Kelley, MD, FACS, FASCRS
Management of Pilonidal Disease Acute Kidney Injury in the Injured and Critically Ill Consultant, Colon and Rectal Surgery
Mayo Clinic
Shkala Karzai, MD Rochester, Minnesota
Wali Rashad Johnson, MD, MPH Surgical Management of the Polyposis
General Surgery Resident Breast and Endocrine Surgeon
Department of Surgery Syndromes
Vanderbilt University Medical Center
Nashville, Tennessee WestMed Medical Group
Rye, New York Kaitlyn Kennard, MD
Is Nasogastric Intubation Necessary After
Adrenal Incidentaloma Breast Surgical Oncology Fellow
Alimentary Tract Surgery?
Primary Hyperparathyroidism Siteman Cancer Center
Washington University in St. Louis
Fabian M. Johnston, MD, MHS St. Louis, Missouri
Associate Professor of Surgery Vikram S. Kashyap, MD, FACS
Frederik Meijer Chair Management of Male Breast Cancer
Baltimore, Maryland Meijer Heart and Vascular Institute
Vice President, Cardiovascular Health Alistair J. Kent, MD, MPH
Familial Gastric Cancer
Spectrum Health Assistant Professor
Management of Peritoneal Surface Malignancies
Grand Rapids, Michigan Trauma, Critical Care, and Emergency
Upper Extremity Arterial Occlusive Disease General Surgery
Ronald C. Jones, MD Johns Hopkins School of Medicine
Chief Emeritus of Surgery Baltimore, Maryland
Baylor Scott & White Health Mark Katlic, MD, FACS
Chair, Department of Surgery Abdominal Compartment Syndrome and
Dallas, Texas Management of the Open Abdomen
A Surgeon’s Practical Guide to Breast Imaging Sinai Hospital of Baltimore
Baltimore, Maryland
Achalasia of the Esophagus Rachel G. Khadaroo, MD, PhD, FRCSC
Bellal Joseph, MD, FACS Professor of Surgery
Professor and Chief of Surgery University of Alberta
University of Arizona Michael G. Kattah, MD, PhD
Assistant Professor Edmonton, Alberta
Tucson, Arizona A Practical Approach to Surgery in the Frail
Use of Resuscitative Endovascular Balloon Occlusion Department of Medicine
Division of Gastroenterology Elderly
of the Aorta in Resuscitation of the Trauma Patient
UC San Francisco
San Francisco, California Ali H. Khalifeh, MD
Girish P. Joshi, MBBS, MD, FFARCSI Management of Chronic Ulcerative Colitis Vascular Surgeon
Professor Cleveland Clinic
Anesthesiology and Pain Management Cleveland, Ohio
UT Southwestern Medical Center Krista L. Kaups, MD, MSc
Professor of Clinical Surgery Management of Vascular Injuries
Dallas, Texas
ERAS Protocols for General Surgery Department of Surgery
UCSF Fresno Maria Abou Khalil, MD, MSc, FRCSC
Fresno, California Colorectal Surgery Fellow
Haytham Kaafarani, MD, MPH Glucose Control in the Postoperative Period McGill University
Associate Professor of Surgery Montreal, Quebec
Massachusetts General Hospital Management of Clostridioides difficile Colitis
Yasaman Kavousi, MD
Clinical Vascular Fellow
Division of Vascular Surgery and
Use of Opioids in the Postoperative Period
Endovascular Therapy
Baltimore, Maryland
Management of Thoracic and Thoracoabdominal
Aortic Aneurysms
Diabetic Foot
xvi CONTRIBUTORS
Hamza Khan, MD Karen M. Kim, MD, MS Richard Kozarek, MD

Post-Doctoral Research Fellow Assistant Professor Director Emeritus, Digestive Disease Institute
Department of Surgery Department of Cardiac Surgery Division of Gastroenterology
Johns Hopkins University University of Michigan Virginia Mason Franciscan Health
Baltimore, Maryland Ann Arbor, Michigan Clinical Professor
Esophageal Function Tests Management of Acute Aortic Dissections Department of Medicine
Familial Gastric Cancer University of Washington
Mediastinal Masses Elizabeth Gherardi King, MD Seattle, Washington
Assistant Professor Pancreatic Ductal Disruptions Leading to
Maryam Ali Khan, MD Division of Vascular and Endovascular Pancreatic Fistula, Pancreatic Ascites, or
Research Fellow Surgery Pancreatic Pleural Effusion
Division of Vascular Surgery Boston University
UC San Diego Boston, Massachusetts Ashley Krepline, MD
San Diego, California Management of Peripheral Arterial General Surgery Resident
Aortoiliac Occlusive Disease Thromboembolism Medical College of Wisconsin
Milwaukee, Wisconsin
Sameer Khan, MD Benedict Kinny-Köster, MD Palliative Interventions for Patients with
Clinical Fellow Postdoctoral Research Fellow Operable and Advanced Pancreatic and
Gastroenterology and Hepatology Department of Surgery Periampullary Cancer
Johns Hopkins Hospital Johns Hopkins University School of
Laurel, Maryland Medicine Swati A. Kulkarni, MD
Obstructive Jaundice: The Role of Endoscopic Baltimore, Maryland; Professor
Intervention Surgical Resident Department of Surgery
Department of General, Visceral, and Northwestern University Feinberg School of
Mouen A. Khashab, MD Transplantation Surgery Medicine
Associate Professor of Medicine Heidelberg University Hospital Chicago, Illinois
Director of Therapeutic Endoscopy Heidelberg, Baden-Württemberg, Germany Contralateral Prophylactic Mastectomy
Department of Gastroenterology and Vascular Reconstruction During the Whipple
Hepatology Operation Vivek Kumbhari, MD
Assistant Professor of Medicine
Baltimore, Maryland V. Suzanne Klimberg, MD, PhD, Director of Endoscopy
Enteral Stents in the Treatment of Colonic MSHCT, MAMSE, FACS Department of Medicine
Obstruction Professor and Courtney M Townsend Jr Bayview Medical Center
MD Distinguished Chair in General Director of Bariatric Endoscopy
Dmitriy O. Khodorskiy, MD Surgery Department of Medicine
Assistant Director of Advanced Therapeutic University of Texas Medical Branch in Johns Hopkins Medical Institutions
Endoscopy Galveston Baltimore, Maryland
Maimonides Medical Center Galveston, Texas; Management of Morbid Obesity
Clinical Assistant Professor Adjunct Professor
Department of Medicine MD Anderson Cancer Center
State University of New York Downstate Shaun M. Kunisaki, MD, MSc
Houston, Texas Associate Professor
Medical Center Lymphatic Mapping and Sentinel
New York, New York Department of Surgery
Lymphadenectomy Johns Hopkins Children’s Center
Use of Esophageal Stents
Baltimore, Maryland
Deepika Koganti, MD Common Pediatric Surgical Emergencies
Mohammad R. Khreiss, MD Assistant Professor
Associate Professor Department of Surgery
Department of Surgery Gifty Kwakye, MD, MPH, FACS,
Emory University School of Medicine FASCRS
University of Arizona Associate Fellowship Program Director
Tucson, Arizona Associate Professor
Atlanta, Georgia Division of Colorectal Surgery
Pancreatic Neuroendocrine Tumors of the Management of Traumatic Liver Injury
Pancreas Excluding Gastrinoma University of Michigan
Ann Arbor, Michigan
George Kokosis, MD Management of Colorectal Polyps
Jina Kim, MD
Assistant Professor of Surgery
Endocrine Surgeon
Rush Medical College Mitchell R. Ladd, MD, PhD
Inova Health System
Rush University Medical Center Pediatric Surgery Fellow
Falls Church, Virginia
Chicago, Illinois Division of Pediatric Surgery
Management of Hyperthyroidism
Lymphedema Johns Hopkins Children’s Center
Joseph Kim, MD Baltimore, Maryland
Andrew R. Kolarich, MD Common Pediatric Surgical Emergencies
Internal Medicine
Diagnostic and Interventional Radiology
University of Maryland
Resident Kelly J. Lafaro, MD, MPH
Baltimore, Maryland
Johns Hopkins Hospital Assistant Professor
Pneumatosis Intestinalis and the Importance for
the Surgeon
Transjugular Intrahepatic Portosystemic Shunt Johns Hopkins University
Transhepatic Interventions for Obstructive Baltimore, Maryland
Jaundice Management of Pancreatic Pseudocyst
C ontributors xvii
Daniel A. Laheru, MD Adam S. Levin, MD Laurie Anne Loiacono, MD

Ian T. MacMillan Professorship in Clinical Associate Professor Associate, Critical Care Medicine
Pancreatic Research Orthopaedic Surgery and Oncology Geisinger Clinics
Medical Oncology Johns Hopkins University Wilkes-Barre, Pennsylvania
Johns Hopkins University School of Baltimore, Maryland Electrical and Lightning Injury
Medicine Management of Soft Tissue Sarcomas
Baltimore, Maryland Joseph V. Lombardi, MD
Neoadjuvant and Adjuvant Therapy Robert P. Liddell, MD Professor and Chief
for Pancreatic Cancer Assistant Professor Vascular Surgery
Radiology and Radiological Sciences Cooper University Hospital
William P. Lancaster, MD Johns Hopkins School of Medicine Camden, New Jersey
Assistant Professor Baltimore, Maryland Endovascular Management of Vascular Injuries
Department of Surgery Acute Peripheral Arterial and Bypass Graft
Medical University of South Carolina Occlusion: Thrombolysis and Thrombectomy Gregory K. Low, MD
Charleston, South Carolina Assistant Professor
Gallstone Pancreatitis Heather A. Lillemoe, MD Department of Surgery
Fellow, Complex General Surgical Oncology University of Tennessee Medical Center
Julie R. Lange, MD, ScM Department of Surgical Oncology Knoxville, Tennessee
Associate Professor University of Texas MD Anderson Management of Rectal Cancer
Department of Surgery Cancer Center
Johns Hopkins University School of Houston, Texas Lea Lowenfeld, MD
Medicine Management of Benign Biliary Strictures Assistant Professor
Screening for Breast Cancer Keith D. Lillemoe, MD
NewYork-Presbyterian Hospital/Weill
Chief, Department of Surgery
Cornell Medical Center
Massachusetts General Hospital
Anna M. Ledgerwood, MD New York, New York
W. Gerald Austen Professor
Professor Use of Strictureplasty in Crohn’s Disease
Michael and Marian Ilitch Department of
Surgery Charles E. Lucas, MD
Wayne State University Professor
Management of Benign Biliary Strictures
Trauma Medical Director The Michael and Marian Ilitch Department
Trauma Services of Surgery
Detroit Receiving Hospital Pamela A. Lipsett, MD, MHPE
Wayne State University
Detroit, Michigan Warfield M. Firor Endowed Professorship
Surgeon
Penetrating Neck Trauma Department of Surgery
Detroit Receiving Hospital
Blunt Cardiac Injury Assistant Dean of Assessment and
Detroit, Michigan
Extremity Compartment Syndrome Evaluation
Penetrating Neck Trauma
Blunt Cardiac Injury
Medicine
Christina Lee, MD Extremity Compartment Syndrome
Program Director, General Surgery and
Burn Surgeon
Surgical Critical Care Ying Wei Lum, MD, MPH
Co-Director, Surgical Intensive Care Units Associate Professor
Cooperman Barnabas Medical Center
Baltimore, Maryland Division of Vascular Surgery and
Livingston, New Jersey
Ischemic Colitis Endovascular Therapy
Burn Wound Management
Post-Intensive Care Syndrome Johns Hopkins Hospital
Eliza J. Lee, MD Baltimore, Maryland
Anna Liveris, MD Management of Recurrent Carotid Artery
Transplant Surgery Fellow
Assistant Professor Stenosis
Division of Trauma and Critical
Baltimore, Maryland
Care Services Juliet Siena Lumati, MD, MPH
Portal Hypertension: Role of Shunting
Jacobi Medical Center Complex Surgical Oncology Fellow
Procedures
Albert Einstein College of Medicine Division of Surgical Oncology
New York, New York Johns Hopkins University School of
Grace C. Lee, MD Management of Lower Gastrointestinal Medicine
General Surgery Resident Bleeding Baltimore, Maryland
Massachusetts General Hospital Familial Gastric Cancer
Boston, Massachusetts Management of Peritoneal Surface Malignancies
David H. Livingston, MD
Management of Enterocutaneous Fistulas
Wesley J. Howe Professor
Chief of Trauma and Surgical Critical Care Gray R. Lyons, MD, PhD
Hanjoo Lee, MD
Department of Surgery Assistant Professor
Colorectal Surgeon
Rutgers New Jersey Medical School Interventional Radiology
Harbor-UCLA Medical Center
Newark, New Jersey Johns Hopkins School of Medicine
Torrance, California
Management of Intraabdominal Infections Baltimore, Maryland
Surgical Management of Crohn’s Colitis
Acute Peripheral Arterial and Bypass Graft
Occlusion: Thrombolysis and Thrombectomy
xviii CONTRIBUTORS
Thomas E. MacGillivray, MD Michele Ann Manahan, MD, MBA, Matthew J. Martin, MD

Chief of Cardiac Surgery and Thoracic FACS Director of Trauma Research
Transplant Surgery Professor of Clinical Plastic and Division of Trauma and Acute Care Surgery
Jimmy Howell Endowed Chair of Cardiac Reconstructive Surgery Los Angeles County, USC Medical Center
Surgery Department of Plastic and Reconstructive Los Angeles, California;
Department of Cardiovascular Surgery Surgery Professor
Houston Methodist Johns Hopkins Hospital Department of Surgery
Houston, Texas Baltimore, Maryland Uniformed Services University of the Health
Management of Acute Aortic Dissections Breast Implant-Associated Anaplastic Large Cell Sciences
Lymphoma Bethesda, Maryland
Thomas H. Magnuson, MD Management of Traumatic Brain Injury
Associate Professor Paul N. Manson, MD
Department of Surgery Distinguished Service Professor Niels D. Martin, MD
Johns Hopkins University School of Plastic Surgery Section Chief of Surgical Critical Care
Medicine Johns Hopkins University Department of Surgery
Chair, Surgeon in Chief Baltimore, Maryland University of Pennsylvania
Johns Hopkins Bayview Medical Center Nonmelanoma Skin Cancers Philadelphia, Pennsylvania
Baltimore, Maryland Management of Cutaneous Melanoma Acute Kidney Injury in the Injured
Metabolic Changes Following Bariatric Surgery and Critically Ill
M. Ashraf Mansour, MD, MBA
Elaa Mahdi, MD, MPH Professor and Chief
General Surgery Resident Cardiovascular Medicine Michael Martyak, MD, MS
Pediatric Surgery Michigan State University College of Human Assistant Professor
University of Rochester Medicine Department of Surgery
Rochester, New York Chief of Vascular Surgery Eastern Virginia Medical School
Appendicitis: Diagnosis and Management Cardiovascular Health Norfolk, Virginia
Spectrum Health Medical Group Blunt Abdominal Trauma
Martin A. Makary, MD, MPH Grand Rapids, Michigan
Professor of Surgery and Health Policy and Gangrene of the Foot Regina Matar, MD
Management Research Fellow
Chief, Johns Hopkins Islet Transplantation Nathalie Mantilla, MD Breast Service, Department of Surgery
Center Colon and Rectal Surgeon Memorial Sloan Kettering Cancer Center
Director, Minimally Invasive Pancreas Division of Colon and Rectal Surgery New York, New York
Surgery John H. Stroger Jr. Hospital of Cook County Breast Cancer: Surgical Therapy
Johns Hopkins Hospital Assistant Professor
Baltimore, Maryland Department of Surgery Douglas J. Mathisen, MD
Management of Chronic Pancreatitis Rush University Thoracic Surgeon
Total Pancreatectomy and Islet Chicago, Illinois Department of Surgery
Autotransplantation for Chronic Pancreatitis Surgical Management of Constipation Massachusetts General Hospital
Mahmoud B. Malas, MD, MHS, RPVI, Mariuxi C. Manukyan, MD, FACS Management of Tracheal Stenosis
FACS Assistant Professor
Professor and Chief Department of Trauma Aarti Mathur, MD, PhD, FACS
Division of Vascular and Endovascular Acute Care Surgery and Surgical Critical Associate Professor
Surgery Care Departments of Surgery and Oncology
Vice Chair of Surgery for Research Johns Hopkins Hospital Section of Endocrine Surgery
UC San Diego Baltimore, Maryland Johns Hopkins University School of
La Jolla, California; Ventilator-Associated Pneumonia Medicine
Professor of Epidemiology Baltimore, Maryland
Johns Hopkins Bloomberg School of Public Adrenal Incidentaloma
James F. Markmann, MD, PhD
Health
Chief, Division of Transplant Surgery
Baltimore, Maryland Kazuhide Matsushima, MD, FACS
Aortoiliac Occlusive Disease Assistant Professor
Massachusetts General Hospital
William C. Mallon, MD Claude E. Welch Professor of Surgery Department of Surgery
Assistant Professor Harvard Medical School University of Southern California
Department of Radiology Boston, Massachusetts Los Angeles, California
University of Southern California Transplantation of the Pancreas Management of Diaphragmatic Injuries
Role of Stereotactic Biopsy in Management of Christopher A. Maroun, MD J. Greg Mawn, MD
Breast Disease Resident Physician Orthopedic Surgeon
Department of Otolaryngology Johns Hopkins Medical Institutions
Johns Hopkins Hospital Baltimore, Maryland
Baltimore, Maryland Early Management of Pelvic Ring Disruption
Management of Solitary Neck Mass
C ontributors xix
Mary C. McCarthy, MD Raman Menon, MD Peter Muscarella II, MD

Professor Colon and Rectal Surgery Gastrointestinal Surgery
Department of Surgery Swedish Medical Center Niagara Falls Memorial Medical Center
Wright State University School of Medicine Seattle, Washington Niagara Falls, New York
Dayton, Ohio Anal Condyloma Management of Lower Gastrointestinal Bleeding
Management of Pulmonary Parenchymal Injury
Thomas S. Metkus Jr., MD, PhD Matthew Mutch, MD
Patrick M. McCarthy, MD Assistant Professor Chief, Section of Colon and Rectal
General Surgery Resident Departments of Surgery and Medicine Surgery
Brooke Army Medical Center Johns Hopkins University Associate Professor
San Antonio, Texas Baltimore, Maryland Department of Surgery
Management of Traumatic Brain Injury Cardiovascular Pharmacology Washington University in St. Louis
St. Louis, Missouri
Katherine McDermott, MD Fabrizio Michelassi, MD Management of Rectal Cancer
General Surgery Resident Lewis Atterbury Stimson Professor and
Johns Hopkins School of Medicine Chairman Juan A. Muñoz-Largacha, MD
Baltimore, Maryland Department of Surgery Cardiothoracic Surgery Fellow
Incisional, Epigastric, and Umbilical Hernias Weill Cornell Medical College Division of Cardiothoracic Surgery
Surgeon-in-Chief University of Alabama at Birmingham
David W. McFadden, MD, MBA NewYork-Presbyterian Hospital/Weill Birmingham, Alabama
Murray-Heilig Chairman and Professor Cornell Medical Center Management of Esophageal Perforation
Department of Surgery New York, New York
University of Connecticut Use of Strictureplasty in Crohn’s Disease Arthur J. Nam, MD, MS
Farmington, Connecticut Associate Professor
Shruti Mony, MBBS
Management of Zollinger-Ellison Syndrome Plastic and Reconstructive Surgery
Department of Gastroenterology and
R Adams Cowley Shock Trauma Center
Hepatology
Sean P. McGuire, MD Baltimore, Maryland
General Surgery Resident Necrotizing Skin and Soft Tissue Infections
Baltimore, Maryland
Indiana University Enteral Stents in the Treatment of Colonic
Indianapolis, Indiana Obstruction Amol Kumar Narang, MD
Management of Cystic Disorders of the Bile Assistant Professor
Ducts Katherine A. Morgan, MD, FACS Department of Radiation Oncology and
Professor and Chief Molecular Sciences
Christopher R. McHenry, MD, FACS Division of Gastrointestinal and Johns Hopkins University School of Medicine
Vice Chair, Department of Surgery Laparoscopic Surgery Baltimore, Maryland
Metro Health Medical Center Medical University of South Carolina Intraoperative Radiation for Pancreatic Cancer
Professor Charleston, South Carolina
Department of Surgery Gallstone Pancreatitis Isam W. Nasr, MD
Case Western Reserve University School of Assistant Professor
Medicine Ryan B. Morgan, MD Department of Surgery
Cleveland, Ohio Department of Surgery Johns Hopkins University
Management of Thyroiditis University of Chicago Baltimore, Maryland
Chicago, Illinois Repair of Pectus Excavatum
Management of Acute Necrotizing Pancreatitis
Erin E. McIntosh, MD
Resident Physician Carol D. Morris, MD, MS James T. Nawalaniec, MD
Department of Surgery Division Chief, Orthopaedic Oncology General Surgery Resident
St. Elizabeth’s Medical Center Vice Chair, Clinical Operations Massachusetts General Hospital
Boston, Massachusetts Department of Orthopaedic Surgery Boston, Massachusetts
Open Repair of Abdominal Aortic Aneurysms Johns Hopkins Medicine Management of Acquired Esophageal
Baltimore, Maryland Respiratory Tract Fistula
Genevieve B. Melton-Meaux, Management of Soft Tissue Sarcomas
MD, PhD Matthew A. Nehs, MD
Professor Christopher R. Morse, MD Assistant Professor
Department of Surgery Assistant Professor Department of Surgery
University of Minnesota Thoracic Surgery Brigham and Women’s Hospital
Minneapolis, Minnesota Massachusetts General Hospital Harvard Medical School
Management of Colorectal Polyps Harvard University Boston, Massachusetts
Boston, Massachusetts Nontoxic Goiter
Avedis Meneshian, MD Management of Acquired Esophageal
Assistant Professor Respiratory Tract Fistula Adam Nelson, MD
Department of Surgery Assistant Professor
Johns Hopkins University School of Medicine Ashok Muniappan, MD Department of Surgery
Baltimore, Maryland, Thoracic Surgeon University of Arizona
Thoracic Surgeon Department of Surgery Tucson, Arizona
Anne Arundel Medical Center Massachusetts General Hospital Use of Resuscitative Endovascular Balloon
Annapolis, Maryland Boston, Massachusetts Occlusion of the Aorta in Resuscitation of
Management of Primary Chest Wall Tumors Management of Tracheal Stenosis the Trauma Patient
xx CONTRIBUTORS
Brenda S. Nettles, DNP, MS, Wasay Nizam, MBBS Tawakalitu O. Oseni, MD, MPH
ACNP-BC, CNE Research Associate Assistant Professor
Assistant Professor Department of Surgery Department of Surgery
School of Nursing Johns Hopkins Medical Institutions Massachusetts General Hospital
Acute Care Nurse Practitioner Baltimore, Maryland Boston, Massachusetts
Division of Surgical Oncology Esophageal Function Tests Benign Breast Disease
Johns Hopkins Hospital Mediastinal Masses
Baltimore, Maryland Greg M. Osgood, MD
Surgical Palliative Care Yuri W. Novitsky, MD
Associate Professor
Director, Columbia Comprehensive Hernia
Chief, Orthopedic Trauma
Lisa Ann Newman, MD, MPH Center
Department of Orthopedic Surgery
Professor, Department of Surgery Columbia University Medical Center
NewYork-Presbyterian Hospital/Weill Professor, Department of Surgery
Medicine
Cornell Medical Center Columbia College of Physicians and
Baltimore, Maryland
Chief, Division of Breast Surgery Surgeons
Early Management of Pelvic Ring Disruption
Director, NewYork-Presbyterian Hospital Chief, Division of Abdominal Wall Surgery
Network Interdisciplinary Breast Columbia University School of Medicine
Program New York, New York Luis Ostrosky-Zeichner, MD, FACP,
Medical Director and Founder Abdominal Wall Reconstruction FIDSA, FSHEA, FECMM
International Center for the Study of Breast Professor and Division Chief
Cancer Subtypes Brant K. Oelschlager, MD Division of Infectious Diseases
Weill Cornell Medicine Professor, Byers Endowed Chair in University of Texas Health Science Center at
New York, New York Esophageal Research Houston
Surgical Management of the Axilla Department of Surgery Medical Director for Epidemiology
University of Washington Memorial Hermann Texas Medical Center
Division of General Surgery Houston, Texas
Nariman Nezami, MD
University of Washington Medical Center Antifungal Therapy in the Surgical Patient
Associate Professor
Seattle, Washington
Division of Vascular and Interventional
Surgical Management of Gastroesophageal Shane Ottmann, MD
Radiology
Reflux Disease Transplant Surgeon
Department of Diagnostic Radiology and
Endoscopic Treatment of Barrett’s Esophagus Department of Surgery
Nuclear Medicine
University of Maryland School of Medicine Johns Hopkins Hospital
Jennifer B. Ogilvie, MD Baltimore, Maryland
Associate Professor Section Chief, Endocrine Surgery
Experimental Therapeutics Program Hepatic Malignancy: Resection Versus
Yale School of Medicine Transplantation
University of Maryland Marlene and Stewart New Haven, Connecticut
Greenebaum Comprehensive Cancer Management of Adrenal Cortical Tumors
Center Theodore N. Pappas, MD
Baltimore, Maryland Professor
John A. Olson Jr., MD, PhD
Transarterial Therapies for Primary and Department of Surgery
William K. Bixby Professor and Chair
Metastatic Liver Tumors Duke University
Durham, North Carolina
Washington University School of Medicine
Dennis C. Nguyen, MD Management of Asymptomatic (Silent)
Surgeon-in-Chief
Assistant Professor Gallstones
Barnes-Jewish Hospital
Plastic and Reconstructive Surgery St. Louis, Missouri
Washington University School of Medicine Surgical Management of Thyroid Cancer Charudutt Paranjape, MD, FACS
St. Louis, Missouri Assistant Professor
Evaluation and Management of the Patient Kristofor A. Olson, MD, PhD Department of Surgery
with Craniomaxillofacial Trauma Administrative Chief Resident Harvard Medical School
Surgery and Perioperative Care Trauma Emergency and Critical Care
Hien T. Nguyen, MD, MBA The University of Texas at Austin Surgeon
Director of the Comprehensive Hernia Dell Medical School Massachusetts General Hospital
Center Austin, Texas Boston, Massachusetts;
Associate Professor Acute Mesenteric Ischemia Chief, General Surgery and Acute Care
Department of Surgery Surgery
Johns Hopkins Medical Institutions Charles S. O’Mara, MD, MBA Mass General Brigham Newton-Wellesley
Baltimore, Maryland Professor Emeritus Hospital
Incisional, Epigastric, and Umbilical Hernias Department of Surgery Newton, Massachusetts
University of Mississippi Medical Center Management of Small Bowel Obstruction
Jake A. Nicholson, DO Jackson, Mississippi
Resident Physician Balloon Angioplasty and Stents in Carotid Artery
Vascular Surgery Occlusive Disease
Spectrum Health
Michigan State University
Grand Rapids, Michigan
Gangrene of the Foot
C ontributors xxi
Adrian E. Park, MD, FRCSC Walter Pegoli Jr., MD Elisa Port, MD, FACS
Chair and Surgeon in Chief Professor of Surgery and Pediatrics Chief, Breast Surgery
Department of Surgery University of Rochester Mount Sinai Health System
Luninis Health Rochester, New York Professor
Annapolis, Maryland; Appendicitis: Diagnosis and Management Icahn School of Medicine at Mount Sinai
Professor New York, New York
Department of Surgery Bruce A. Perler, MD, MBA Genetic Counseling and Testing
Johns Hopkins University School of Medicine Julius H. Jacobson II Professor
Baltimore, Maryland Vice Chair for Clinical Operations Carolyn R. Postol, DO
Splenectomy for Hematologic Disorders Chief Emeritus, Division of Vascular Resident Physician
Surgery and Endovascular Therapy Vascular Surgery
Pauline K. Park, MD Johns Hopkins University School of Spectrum Health
Professor Medicine Michigan State University
Division of Acute Care Surgery Baltimore, Maryland; Grand Rapids, Michigan
University of Michigan Vice President Lower Extremity Amputation
Ann Arbor, Michigan American Board of Surgery
Postoperative Respiratory Failure Philadelphia, Pennsylvania Ajita S. Prabhu, MD
Carotid Endarterectomy Associate Professor
Jessica M. Pastoriza, MD Department of Surgery
Breast Surgical Oncology Fellow Nancy D. Perrier, MD, FACS Cleveland Clinic
Department of Surgery Walter and Ruth Sterling Endowed Professor Cleveland, Ohio
Johns Hopkins Hospital of Surgery Management of Spigelian, Obturator, and
Baltimore, Maryland Surgical Oncology Lumbar Hernias
Role of Stereotactic Biopsy in Management of MD Anderson Cancer Center
Breast Disease Houston, Texas Joshua E. Preiss, MD
Pregnancy and Breast Cancer Management Persistent and Recurrent Hyperparathyroidism Fellow
Cardiothoracic Surgery
Purvi P. Patel, MD Benjamin Philosophe, MD, PhD University of Washington
Assistant Professor Surgical Director Seattle, Washington
Department of Surgery Comprehensive Transplant Center Primary Tumors of the Thymus
Loyola University Medical Center Johns Hopkins Medical Institutions
Chicago, Illinois Baltimore, Maryland Jason D. Prescott, MD, PhD
Management of Traumatic Brain Injury Liver Transplantation Associate Professor
Shirali T. Patel, MD, FACS Henry A. Pitt, MD NYU Grossman School of Medicine
Chief of General Surgery Distinguished Professor New York, New York
St. Agnes Department of Surgery Primary Hyperparathyroidism
Baltimore, Maryland Rutgers Robert Wood Johnson Medical
Management of Common Bile Duct Stones School Leigh Ann Price, MD
Chief of Oncologic Quality Director, Department of Surgery
Marco G. Patti, MD Rutgers Cancer Institute of New Jersey National Burn Reconstruction Center
Professor New Brunswick, New Jersey Assistant Professor
Department of Surgery Management of Echinococcal Cyst Disease of Plastic and Reconstructive Surgery
University of Virginia the Liver Johns Hopkins University School of
Charlottesville, Virginia Medicine
Management of Zenker’s Diverticulum Jennifer K. Plichta, MD, MS Baltimore, Maryland
Associate Professor Electrical and Lightning Injury
Timothy M. Pawlik, MD, PhD, MPH, Department of Surgery
MTS, MBA, FACS Duke University Medical Center Matthew D. Price, MD
Professor and Chair Durham, North Carolina General Surgery Fellow
Department of Surgery Inflammatory Breast Cancer Johns Hopkins University School of
Ohio State University Medical Center Medicine
Urban Meyer III and Shelley Meyer Chair Dina Podolsky, MD Baltimore, Maryland
for Cancer Research Assistant Professor Management of Pruritus Ani
Wexner Medical Center at Ohio State University Department of Surgery Management of Chronic Pancreatitis
Columbus, Ohio Columbia University Medical Center
Management of Colorectal Liver Metastases New York, New York Scott G. Prushik, MD
Abdominal Wall Reconstruction Vascular Surgeon
Gregory J. Pearl, MD, FACS Division of Vascular and Endovascular
Chair, Department of Vascular Surgery Amani D. Politano, MD, MS Surgery
Baylor Scott & White Heart and Vascular Assistant Professor St. Elizabeth’s Medical Center
Hospital Vascular Surgery Brighton, Massachusetts
Chief, Division of Vascular Surgery Oregon Health & Science University Endovascular Treatment of Abdominal Aortic
Baylor University Medical Center Portland, Oregon Aneurysm
Clinical Professor Pseudoaneurysms and Arteriovenous Fistulas
Texas A&M Health Sciences Center
Dallas, Texas
Brachiocephalic Reconstruction
xxii CONTRIBUTORS
Carla M. Pugh, MD, PhD Christina Maria Yesenia Rojas-Khalil, MD, FACS
Thomas Krummel Professor Regelsberger-Alvarez, DO Assistant Professor
Department of Surgery Clinical Assistant Professor Department of Surgery
Stanford University School of Medicine Trauma and Surgical Critical Care Baylor College of Medicine
Stanford, California Brody School of Medicine Houston, Texas
Loss of Domain in Abdominal Wall Reconstruction East Carolina University Management of Large Bowel Obstruction
Greenville, North Carolina
T. Robert Qaqish, MD Postoperative Respiratory Failure Rae S. Rokosh, MD
Clinical Assistant Professor General Surgery Resident
Thoracic Surgery Thomas Reifsnyder, MD NYU Langone Health
University at Buffalo Johns Hopkins Bayview Medical Center New York, New York
Buffalo, New York Department of Surgery Popliteal and Femoral Artery Aneurysm
Achalasia of the Esophagus Johns Hopkins University
Baltimore, Maryland Riccardo Rosati, MD, FACS
Zaffer Qasim, MBBS, FRCEM, EDIC Hemodialysis Access Surgery Professor
Assistant Professor of Emergency Medicine Gastrointestinal Surgery
and Critical Care Linda M. Reilly, MD San Raffaele Hospital
University of Pennsylvania Perelman School Professor Milan, Italy
of Medicine Vascular Surgery Management of Zenker’s Diverticulum
Philadelphia, Pennsylvania UC San Francisco
Prehospital Management of the Trauma Patient San Francisco, California J. Bart Rose, MD, MAS, FACS
Chronic Mesenteric Ischemia Assistant Professor
Jacob A. Quick, MD Department of Surgery
Associate Professor Taylor S. Riall, MD, PhD University of Alabama Birmingham
Department of Surgery Professor Birmingham, Alabama
University of Missouri Department of Surgery Management of Biliary Dyskinesia
Columbia, Missouri Associate Director, Oncology Services
University of Arizona Cancer Center Laura H. Rosenberger, MD, MS
Abdomen That Will Not Close
University of Arizona Associate Professor
Tucson, Arizona Department of Surgery
Amanda Radisic, MD Duke University
General Surgery Resident Pancreatic Neuroendocrine Tumors of the
Pancreas Excluding Gastrinoma Durham, North Carolina
Robert Wood Johnson University Inflammatory Breast Cancer
Hospital
New Brunswick, New Jersey John Peter Ricci, MD, FACS Robert C. Ross, MD
Injuries to Small and Large Bowel Assistant Professor Fellow in Surgical Metabolism and
Department of Surgery Metabolic Surgery
Shannon N. Radomski, MD Zucker School of Medicine at Hofstra/ Department of Metabolic Surgery
Resident Northwell Pennington Biomedical Research Center
Department of Surgery Hempstead, New York; Baton Rouge, Louisiana
Johns Hopkins School of Medicine Chief, Colon and Rectal Surgery Cardiovascular Disease Risk Reduction After
Baltimore, Maryland Long Island Jewish Medical Center Bariatric Surgery
Management of Rectal Prolapse New Hyde Park, New York
Management of Crohn’s Disease of the Small Gedge D. Rosson, MD
Bowel Associate Professor
Todd E. Rasmussen, MD Department of Plastic and Reconstructive
Professor and Vice-Chair for Education Anamaria J. Robles, MD Surgery
Department of Surgery Assistant Professor Johns Hopkins University School of
Vascular Surgeon Department of Surgery Medicine
Mayo Clinic UC Davis Baltimore, Maryland
Rochester, Minnesota Sacramento, California Nerve Injury and Repair
Management of Vascular Injuries Catheter Sepsis in the Intensive Care Unit Breast Reconstruction Following Mastectomy:
Considerations, Techniques, and Outcomes,
Abhinav V. Reddy, MD Douglas Rodgers, MD Part I
Resident Physician Resident
Radiation Oncology Rishi A. Roy, MD
Vascular Surgery Partner and Founder
Johns Hopkins University School of University of Cincinnati Medical Center
Medicine Advanced Vascular and Vein Associates
Cincinnati, Ohio Jackson, Mississippi
Baltimore, Maryland Atherosclerotic Renal Artery Stenosis
Intraoperative Radiation for Pancreatic Cancer Balloon Angioplasty and Stents in Carotid Artery
Occlusive Disease
Alexandra B. Roginsky, MD, FACS
Christopher R. Reed, MD Assistant Professor
Resident Physician Grace S. Rozycki, MD, MBA
Department of Surgery Professor
Department of Surgery Johns Hopkins University School of
Duke University Medical Center Department of Surgery
Medicine Johns Hopkins School of Medicine
Durham, North Carolina Baltimore, Maryland
Management of Asymptomatic Baltimore, Maryland
Multiple Organ Dysfunction and Failure Surgeon’s Use of Ultrasound in the Trauma and
(Silent) Gallstones
Critical Care Settings
C ontributors xxiii
Colleen M. Ryan, MD Michael G. Sarr, MD Todd R. Schlachter, MD

Professor of Surgery James C. Masson Emeritus Professor of Assistant Professor
Massachusetts General Hospital Surgery Department of Radiology and Biomedical
Harvard Medical School Department of Surgery Imaging
Staff Surgeon Mayo Clinic Yale School of Medicine
Shriners Hospitals for Children-Boston Rochester, Minnesota New Haven, Connecticut
Boston, Massachusetts Diagnosis and Management of Motility Vena Cava Filters
Cold-Induced Injuries and Hypothermia Disorders of the Stomach and Small Bowel in
the Current Era Sally Schonefeld, MD
Uma M. Sachdeva, MD, PhD Vascular Fellow
Assistant in Surgery Robert G. Sawyer, MD Department of Surgery
Division of Thoracic Surgery Professor and Chair of Surgery Cedars-Sinai Medical Center
Massachusetts General Hospital Homer Stryker MD School of Medicine Los Angeles, California
Assistant Professor Adjunct Professor of Engineering and Takayasu’s Arteritis
Harvard Medical School Applied Sciences
Boston, Massachusetts Western Michigan University Andrew Schulick, MD, MBA, FACS
Multimodality Therapy in Esophageal Cancer Kalamazoo, Michigan; Division of Vascular Surgery and
Adjunct Professor Endovascular Therapy
Bethany C. Sacks, MD, MEd Department of Surgery Department of Surgery
Associate Professor of Surgery University of Virginia Johns Hopkins School of Medicine
Surgery Clerkship and Curriculum Director Charlottesville, Virginia Baltimore, Maryland;
Associate Program Director Surgical Site Infections Chief of Vascular Surgery
Department of Surgery Suburban Hospital
Washington University School of Medicine Samer Sbayi, MD, MBA, FACS Bethesda, Maryland
St. Louis, Missouri Assistant Professor Treatment of Varicose Veins
Management of Recurrent Inguinal Hernia Department of Surgery
Stony Brook University Richard D. Schulick, MD, MBA, FACS
Justin M. Sacks, MD, MBA, FACS Stony Brook, New York Professor and Chair
Chief, Division of Plastic and Reconstructive Athletic Pubalgia Department of Surgery
Surgery University of Colorado School of Medicine
Washington University School of Medicine Thomas M. Scalea, MD, FACS Director, University of Colorado Cancer
St. Louis, Missouri Francis X. Kelly Professor of Trauma Center
Lymphedema Surgery University of Colorado School of Medicine
Evaluation and Management of the Patient Director of Program in Trauma Aurora, Colorado
with Craniomaxillofacial Trauma Physician-in-Chief Management of Benign Liver Tumors
University of Maryland School of Medicine
Zeyad T. Sahli, MD R Adams Cowley Shock Trauma Center Michael A. Schweitzer, MD
General Surgery Resident Baltimore, Maryland Associate Professor
University of Virginia Airway Management in the Trauma Patient Department of Surgery
Charlottesville, Virginia Johns Hopkins University
Surgical Management of Secondary and Tertiary Philip R. Schauer, MD Baltimore, Maryland
Hyperparathyroidism Professor Management of Morbid Obesity
Bariatric and Metabolic Institute Metabolic Changes Following Bariatric Surgery
Joseph V. Sakran, MD, MPH, MPA Cleveland Clinic
Associate Professor of Surgery and Nursing Cleveland, Ohio Naomi M. Sell, MD, MHS
Vice Chair of Clinical Operations Cardiovascular Disease Risk Reduction After Chief Resident Physician
Department of Surgery Bariatric Surgery Department of Surgery
Johns Hopkins Hospital Massachusetts General Hospital
Baltimore, Maryland; Katharina M. Scheurlen, MD, PhD Boston, Massachusetts
Senior Fellow Price Institute of Surgical Research Fellow Ablation of Colorectal Carcinoma Liver
Satcher Health Leadership Institute Department of Surgery Metastases
Morehouse School of Medicine University of Louisville
Atlanta, Georgia Louisville, Kentucky Anthony J. Senagore, MD, MS, MBA
Injuries to Small and Large Bowel Management of Diverticular Disease of the Chief Medical Officer
Colon PolyPid Inc.
David Sanders, MD, FRCPC Summit, New Jersey
Gastroenterology Dennis K. Schimpf, MD, MBA, FACS Management of Large Bowel Obstruction
Kelowna General Hospital Owner
Kelowna, British Columbia, Canada Sweetgrass Plastic Surgery Aamir S. Shah, MD
Pancreatic Ductal Disruptions Leading to Charleston, South Carolina Associate Professor
Pancreatic Fistula, Pancreatic Ascites, or Breast Reconstruction Following Mastectomy: Cardiothoracic and Vascular Surgery
Pancreatic Pleural Effusion Considerations, Techniques, and Outcomes, Cedars-Sinai Medical Center
Part 2 Los Angeles, California
Takayasu’s Arteritis
xxiv CONTRIBUTORS
Adil A. Shah, MD Jason K. Sicklick, MD, FACS Thomas J. Smith, MD, FACP
Fellow Professor Director of Palliative Medicine
Department of General and Thoracic Surgery Departments of Surgery and Pharmacology Johns Hopkins University Medical Institutions
Children’s National Medical Center Division of Surgical Oncology Professor of Oncology and Palliative
Washington, DC University of California San Diego Moores Medicine
Injured Spleen Cancer Center Sidney Kimmel Comprehensive Cancer
University of California San Diego Health Center
Brian D. Shames, MD San Diego, California Johns Hopkins
Chief, Division of General Surgery Proper Use of Cholecystostomy Tubes Baltimore, Maryland
General Surgery Residency Program Surgical Palliative Care
Director Frederick Sieber, MD
University of Connecticut Health Center Professor Thomas W. Smith Jr., MD, MS
Program Director Anesthesiology and Critical Care Medicine Professor
General Surgery Residency Johns Hopkins Medical Institutions Department of Pathology
University of Connecticut School of Medicine Baltimore, Maryland UMass Chan Medical School
Farmington, Connecticut Management of Postoperative Delirium Worcester, Massachusetts
Management of Zollinger-Ellison Syndrome Contralateral Prophylactic Mastectomy
Justin M. Simmons, DO, RPVI Anthony Sorrentino, MD
Ashwyn K. Sharma, MD Vascular Surgeon General Surgery Resident
Resident Physician Division of Vascular Surgery NYU Langone
Department of Surgery Spectrum Health Medical Group New York, New York
UC San Diego Clinical Instructor Surgical Management of Gallbladder Cancer
San Diego, California Department of Surgery
Proper Use of Cholecystostomy Tubes Michigan State University Julie Ann Sosa, MD, MA
College of Human Medicine Leon Goldman MD Distinguished Professor
Robert Sheridan, MD Grand Rapids, Michigan and Chair
Medical Director, Burn Service Lower Extremity Amputation Department of Surgery
Shriners Hospital for Children Affiliated Faculty
Professor, Department of Surgery Sarah S. Sims, MD Philip R. Lee Institute for Health Policy
Harvard Medical School Endocrine Surgeon Studies
Boston, Massachusetts Department of Surgery UC San Francisco
Medical Management of the Burn Patient Caremount Medical San Francisco, California
Poughkeepsie, New York Management of Hyperthyroidism
Aditya S. Shirali, MD Management of Thyroid Nodules
Surgical Endocrinology Fellow Konstantinos Spaniolas, MD, FACS,
University of Texas MD Anderson Cancer Vikesh K. Singh, MD, MSc FASMBS
Center Professor of Medicine Professor
Houston, Texas Division of Gastroenterology Department of Surgery
Persistent and Recurrent Hyperparathyroidism Director of Pancreatology Stony Brook University
Johns Hopkins University School of Stony Brook, New York
Artem Shmelev, MD Medicine Athletic Pubalgia
Clinical Fellow Director of Endoscopy
Department of Surgery Johns Hopkins Hospital Jason Sperry, MD, MPH
Columbia University Medical Center Baltimore, Maryland Andrew B. Peitzman Professor of Surgery
New York, New York Management of Hepatic Encephalopathy Section Chief, Trauma and General Surgery
Management of Common Bile Duct Stones Obstructive Jaundice: The Role of Endoscopic University of Pittsburgh
Intervention Pittsburgh, Pennsylvania
Shmuel Shoham, MD Nutrition Therapy in the Critically Ill Surgical
Matthew R. Smeds, MD
Professor Patient
Professor
Department of Medicine
Johns Hopkins University School of Scott R. Steele, MD, MBA
Division of Vascular and Endovascular
Medicine Chairman, Department of Colorectal Surgery
Surgery
Baltimore, Maryland Cleveland Clinic
Saint Louis University
Epidemiology, Prevention, and Management Professor
St. Louis, Missouri
of Occupational Exposure to Bloodborne Cleveland Clinic Lerner College of Medicine
Management of Infected Grafts
Infections of Case Western Reserve University
John Nikolhaus Smith, MD Cleveland, Ohio
Jaimie T. Shores, MD Chief Fellow Management of Pilonidal Disease
Clinical Director of Hand and Upper Department of Cardiology
Extremity Transplantation Johns Hopkins Hospital Jonathan M. Stem, MD
Assistant Professor Baltimore, Maryland Assistant Professor
Plastic and Reconstructive Surgery Cardiovascular Pharmacology Department of Surgery
Johns Hopkins University School of University of North Carolina School of
Medicine Medicine
Baltimore, Maryland Chapel Hill, North Carolina
Surgical Infections of The Hand Management of Colonic Volvulus
C ontributors xxv
Jane Stevens, MD, MSN Visakha Suresh, MD Kenneth K.Tanabe, MD

House Officer Resident Physician Professor
General Surgery Department of Plastic and Reconstructive Department of Surgery
Oregon Health & Science University Surgery Harvard Medical School
Portland, Oregon Johns Hopkins School of Medicine Co-Chief, Division of Gastrointestinal and
Fluid and Electrolyte Therapy Baltimore, Maryland Oncologic Surgery
Surgical Infections of The Hand Department of Surgery
Kent Allen Stevens, MD, MPH Massachusetts General Hospital
Associate Professor Srinivas M. Susarla, DMD, MD, MPH, Boston, Massachusetts
Department of Surgery FACS, FAAP Ablation of Colorectal Carcinoma Liver
Chief, Division of Acute Care Surgery Associate Professor Metastases
Trauma Medical Director Oral and Maxillofacial Surgery
Director, Johns Hopkins Global Surgery University of Washington School of Rebecca Tang, MD
Initiative Dentistry General Surgery Resident
Johns Hopkins Medical Institutions Associate Professor Massachusetts General Hospital
Baltimore, Maryland Surgery (Plastic) Boston, Massachusetts
Tenets of Damage Control University of Washington School of Management of Acute Cholangitis
Medicine
Seattle, Washington Julia Tchou, MD, PhD, FACS
David P. Stonko, MD, MS Evaluation and Management of the Patient Director, Breast Surgery Research,
Resident Physician in Surgery with Craniomaxillofacial Trauma Director, Breast Surgery Fellowship
Professor of Clinical Surgery
Baltimore, Maryland
Whitney Sutton, MD University of Pennsylvania
Management of Ruptured Abdominal Aortic
General Surgery Resident Philadelphia, Pennsylvania
Aneurysms
MedStar Georgetown University Hospital Advances in Neoadjuvant and Adjuvant Therapy
Washington, DC for Early-Stage Breast Cancer
Michael B. Streiff, MD Adrenal Incidentaloma
Professor of Medicine
Pedro G.Teixeira, MD
Department of Medicine (Hematology)
Lee L. Swanstrom, MD Associate Professor
Professor Division Chief, Vascular Surgery
Baltimore, Maryland
Institute for Image Guided Surgery Surgery and Perioperative Care
Coagulation Issues and the Trauma Patient
IHU Strasbourg University of Texas at Austin
Strasbourg, Alsace, France; Austin, Texas
Sarah Stringfield, MD Professor Acute Mesenteric Ischemia
Assistant Professor Department of Surgery
Department of Surgery Oregon Health & Science University Jeffrey Thiboutot, MD
Texas A&M School of Medicine Portland, Oregon Assistant Professor
Colorectal Surgeon Management of Disorders of Esophageal Pulmonary and Critical Care Medicine
Department of Surgery Motility Johns Hopkins University
Baylor University Medical Center Baltimore, Maryland
Dallas, Texas Mark A.Talamini, MD Tracheostomy
Surgical Management of Fecal Incontinence Chair, Department of Surgery
Chief, Surgical Services Jon S.Thompson, MD
David S. Strosberg, MD Stony Brook Medicine Professor
Assistant Professor Stony Brook, New York Department of Surgery
Department of Surgery (Vascular) Management of Crohn’s Disease of the Small University of Nebraska Medical Center
Yale University Bowel Omaha, Nebraska
New Haven, Connecticut Management of Short Bowel Syndrome
Raynaud’s Phenomenon Vernissia Tam, MD, MS
General Surgery Resident Lucas W.Thornblade, MD, MPH
Amanda Su, MD University of Pittsburgh Assistant Professor of Clinical Surgery
Clinical Fellow Pittsburgh, Pennsylvania Division of Surgical Oncology
Gastroenterology and Hepatology Management of Fissure-In-Ano UC San Francisco–East Bay
Johns Hopkins Hospital Highland Hospital
Baltimore, Maryland Nicola Tamburini, MD Oakland, California
Management of Hepatic Encephalopathy Department of Surgery Cystic Disease of The Liver
Sant’Anna University Hospital
Madhu Subramanian, MD Ferrara, Italy Amy J.Thorsen, MD
Assistant Professor Management of Cysts, Tumors, and Abscesses of Clinical Associate Professor
Johns Hopkins University School of the Spleen Department of Surgery
Medicine University of Minnesota
Baltimore, Maryland Li Ting Tan, MBBS Minneapolis, Minnesota
Pancreatic and Duodenal Injuries General Surgery Resident Management of Anorectal Abscess and Fistula
Baltimore, Maryland
Ventilator-Associated Pneumonia
xxvi CONTRIBUTORS
Crisanto M.Torres, MD Brooks V. Udelsman, MD, MHS Andrew L. Warshaw, MD, FACS,
Assistant Professor of Surgery Cardiothoracic Fellow FRCSEd (Hon), MAMSE
BU School of Medicine Department of Surgery Emeritus Surgeon-in-Chief
Trauma and Acute Care Surgeon Intensivist Yale–New Haven Hospital Massachusetts General Hospital
Boston Medical Center New Haven, Connecticut W. Gerald Austen Distinguished Professor
Boston, Massachusetts Multimodality Therapy in Esophageal Cancer of Surgery
Injuries to Small and Large Bowel Harvard Medical School
Abdominal Compartment Syndrome and Marissa Vane, MD, MSc Physician Director
Management of the Open Abdomen Department of Surgery Network Development and Integration
Maastricht UMC+ Mass General Brigham
Susan Tsai, MD, MHS Maastricht, Limburg, Netherlands Boston, Massachusetts
Professor of Surgical Oncology Ablative Techniques in the Treatment of Benign Diagnosis and Management of Autoimmune
Department of Surgery and Malignant Breast Disease Pancreatitis
Medical College of Wisconsin
Milwaukee, Wisconsin George Velmahos, MD, PhD Philip J. Wasicek, MD
Management of Periampullary Cancers John F. Burke Professor of Surgery Resident
Palliative Interventions for Patients with Harvard Medical School Department of Plastic Surgery
Operable and Advanced Pancreatic and Division Chief of Trauma, Emergency University of Pittsburgh
Periampullary Cancer Surgery, and Surgical Critical Care Pittsburgh, Pennsylvania
Massachusetts General Hospital Necrotizing Skin and Soft Tissue Infections
Yvonne Tsitsiou, MBBS, BSc (Hon) Boston, Massachusetts
Department of Radiology Management of Small Bowel Obstruction Sharon R. Weeks, MD
Division of Vascular and Interventional Abdominal Transplant Surgeon
Radiology Jack P. Vernamonti, MD Department of Surgery
Johns Hopkins University School of Medicine Surgical Research Fellow Johns Hopkins School of Medicine
Baltimore, Maryland Pediatric Surgery Baltimore, Maryland
Charing Cross Hospital University of Michigan Hepatic Malignancy: Resection Versus
Imperial NHS Healthcare Trust Ann Arbor, Michigan Transplantation
Imperial College London Postoperative Respiratory Failure
London, United Kingdom Roi Weiser, MD
Transjugular Intrahepatic Portosystemic Shunt Charles M.Vollmer Jr., MD Breast Surgical Oncology Fellow
Transhepatic Interventions for Obstructive Professor, Chief of Gastrointestinal Surgery Department of Surgery
Jaundice Department of Surgery University of Texas Medical Branch
University of Pennsylvania Galveston, Texas
Eric Tsung, MD Philadelphia, Pennsylvania International Surgical Oncology Fellow
Acute Care Surgeon Management of Complications after the Department of Surgical Oncology
Trauma, Critical Care Whipple Procedure University of Texas MD Anderson Cancer
Acute Care Surgery, Burns Center
Yale–New Haven Health Houston, Texas
Bridgeport Hospital Halley Vora, MD Lymphatic Mapping and Sentinel
Bridgeport, Connecticut Department of Surgical Oncology Lymphadenectomy
Antibiotics in Surgical Critical Care Loma Linda University
Loma Linda, California
Clifford R. Weiss, MD
Benign Breast Disease
Anthony Tufaro, MD, DDS, FACS Professor of Radiology
Professor and Interim Chief Radiologic Science and Biomedical
Department of Surgery Peter S.Vosler, MD, PhD, FACS Engineering
Division of Plastic Surgery and Surgical Assistant Professor Department of Radiology/Division of
Oncology Department of Otolaryngology-Head and Interventional Radiology
Case Western Reserve University Neck Surgery Johns Hopkins University School of
Cleveland, Ohio Johns Hopkins University Medicine
Nonmelanoma Skin Cancers Baltimore, Maryland Medical Director of Johns Hopkins Center
Management of Cutaneous Melanoma Management of Solitary Neck Mass for Bioengineering Innovation and Design
Department of Biomedical Engineering
Kiara A.Tulla, MD Christi M. Walsh, MSN, CRNP Johns Hopkins University School of
Abdominal Transplant Fellow Department of Surgery Medicine and the Whiting School of
Department of Surgery Johns Hopkins Hospital Medicine
Johns Hopkins Medicine Management of Chronic Pancreatitis Baltimore, Maryland
Baltimore, Maryland Total Pancreatectomy and Islet Transarterial Therapies for Primary and
Liver Transplantation Autotransplantation for Chronic Pancreatitis Metastatic Liver Tumors
Kelly H.Tunder, DO Eric G. Weiss, MD

Xuanji Wang, MD, MS
Complex Abdominal Wall Surgeon Chief Academic Officer
General Surgery Resident
Department of Surgery Education Center, Chairman
Loyola University Medical Center
St. Luke’s Medical Center Regional Education Institute
Maywood, Illinois
Advocate Aurora, Milwaukee, Wisconsin Cleveland Clinic Florida
Inflammatory Breast Cancer
Abdominal Wall Reconstruction Weston, Florida
Rectovaginal Fistula
C ontributors xxvii
Matthew J. Weiss, MD, MBA David R. Whittaker, MD, FACS, RPVI Daniel J. Wong, MD, MHS
Deputy Physician-in-Chief Associate Professor General Surgery Resident
Director of Surgical Oncology Vascular and Endovascular Surgery Beth Israel Deaconess Medical Center
Northwell Health Cancer Institute Johns Hopkins University School of Boston, Massachusetts
Lake Success, New York Medicine Popliteal and Femoral Artery Aneurysm
Management of Malignant Liver Tumors Bethesda, Maryland
Treatment of Varicose Veins Virginia L. Wong, MD, FACS
Ethel D. Weld, MD, PhD Associate Professor
Assistant Professor of Medicine Elizabeth C. Wick, MD Vascular Surgery
Infectious Diseases Professor University Hospitals Cleveland Medical Center
Clinical Pharmacology Division of General Surgery Case Western Reserve University
Johns Hopkins University School of Medicine UC San Francisco Cleveland, Ohio
Baltimore, Maryland San Francisco, California Management of Aneurysms of the Extracranial
Epidemiology, Prevention, and Management Management of Chronic Ulcerative Colitis Carotid and Vertebral Arteries
of Occupational Exposure to Bloodborne Upper Extremity Arterial Occlusive Disease
Infections Fatima G. Wilder, MD, MS
Cardiothoracic Surgery Fellow Douglas E. Wood, MD, FACS, FRCSEd
Jennine H. Weller, MD, PhD General Surgeon The Henry N. Harkins Professor and Chair
General Surgery Resident Johns Hopkins University School of Department of Surgery
Johns Hopkins Hospital Medicine University of Washington
Baltimore, Maryland Baltimore, Maryland Seattle, Washington
Repair of Pectus Excavatum Management of Esophageal Cancer Primary Tumors of the Thymus
Extracorporeal Membrane Oxygenation for
Respiratory Failure Cameron D. Wright, MD
Adam S. Weltz, MD, FACS
Attending Surgeon Professor
Associate Professor Austin D. Williams, MD, MSEd Department of Surgery
Department of Surgery Assistant Professor Massachusetts General Hospital
Anne Arundel Medical Center Department of Surgical Oncology Harvard Medical School
Annapolis, Maryland Fox Chase Cancer Center Boston, Massachusetts
Splenectomy for Hematologic Disorders Philadelphia, Pennsylvania Management of Spontaneous and Secondary
Management of Male Breast Cancer Pneumothorax
Russel N. Wesson, MBChB
Assistant Professor Timothy K. Williams, MD Clement Wu, MBBS, MRCP, MMed,
Division of Transplantation Associate Professor MCI
Johns Hopkins Hospital Vascular and Endovascular Surgery Consultant Gastroenterologist
Baltimore, Maryland Wake Forest Baptist Health Department of Gastroenterology and
Portal Hypertension: Role of Shunting Procedures Winston-Salem, North Carolina Hepatology
Thoracic Outlet Syndrome Singapore General Hospital
Singapore
Steven D. Wexner, MD, PhD (Hon),
James E. Wiseman, MD, MBA Enteral Stents in the Treatment of Colonic
FACS, FRCS(Eng), FRCS(Ed),
Department of Surgery Obstruction
FRCSI(Hon), Hon FRCS(Glasg)
Director, Digestive Disease Center University of Arizona College of Medicine
Chair, Department of Colorectal Surgery Tucson, Arizona Lawrence W. Wu, MD
Cleveland Clinic Florida Management of Inguinal Hernia Resident
Weston, Florida; Department of Medicine
Clinical Affiliate Professor Michael W. Witthaus, MD Johns Hopkins Hospital
Division of Surgery Reconstructive Urology Fellow Baltimore, Maryland
Charles E. Schmidt College of Medicine UC San Diego Neoadjuvant and Adjuvant Therapy for
Florida Atlantic University San Diego, California Pancreatic Cancer
Boca Raton, Florida; Renal and Ureteral Traumatic Injuries
Clinical Professor Stephen C.Yang, MD
Herbert Wertheim College of Medicine Aric Wogsland, MD Professor of Surgery and Oncology
Florida International University Fellow The Arthur B. and Patricia B. Modell
Miami, Florida Vascular Surgery and Endovascular Therapy Endowed Chair in Thoracic Surgery
Management of Clostridioides Difficile Colitis University Hospitals Cleveland Medical Department of Surgery
Center Division of Thoracic Surgery
Glenn J.R. Whitman, MD Case Wester Reserve University Johns Hopkins Medical Institutions
Professor Cleveland, Ohio Baltimore, Maryland
Division of Cardiac Surgery Upper Extremity Arterial Occlusive Disease Management of Esophageal Cancer
Johns Hopkins School of Medicine
Co-Director, CVSICU Christopher L. Wolfgang, MD, PhD Linda Ye, MD
Johns Hopkins Hospital Chief, Hepatobiliary and Pancreatic Surgery Resident Physician
Director, Cardiac Surgery Quality and Safety NYU Grossman School of Medicine Department of Surgery
Johns Hopkins Health System NYU Langone Health System David Geffen School of Medicine at
Baltimore, Maryland New York, New York University of California Los Angeles
Cardiovascular Pharmacology Surgical Management of Gallbladder Cancer Los Angeles, California
Management of Pancreatic Necrosis
xxviii CONTRIBUTORS
Heather L.Yeo, MD, MHS Martha A. Zeiger, MD Maaz K. Zuberi, MD

Assistant Professor Professor and Chair Chief Resident
Department of Surgery Department of Surgery Department of General Surgery
NewYork-Presbyterian/Weill Cornell University of Virginia School of Medicine Howard University College of Medicine
Medical Center Charlottesville, Virginia Washington DC
Associate Professor of Population Health Surgical Management of Secondary and Injured Spleen
Sciences Tertiary Hyperparathyroidism
Healthcare Policy and Research Nicholas J. Zyromski, MD
Weill Cornell Medical Center Michael E. Zenilman, MD Professor
New York, New York Professor Department of Surgery
Management of Fissure-In-Ano Department of Surgery Indiana University School of Medicine
Weill Cornell Medicine Indianapolis, Indiana
Stephanie Young, MD, MPH
Chief, Department of Surgery Management of Cystic Disorders of the Bile
Complex General Surgical Oncology Fellow
New York Methodist Hospital Ducts
Department of Surgical Oncology
New York, New York
John Wayne Cancer Institute
A Practical Approach to Surgery in the Frail
Santa Monica, California
Elderly
Management of Periampullary Cancers
Jay Zhu, MD
Victor M. Zaydfudim, MD, MPH
Assistant Professor of Surgery
Associate Professor
University of New Mexico School of
Section of Hepatobiliary and Pancreatic
Medicine
Surgery
Albuquerque, New Mexico
Division of Surgical Oncology
Surgical Management of Gastroesophageal
University of Virginia
Reflux Disease
Charlottesville, Virginia
Management of Liver Hemangioma
Preface
The first edition of Current Surgical Therapy was published in 1984. boards or recertifying. Medical students have also given us feedback
The textbook has thus been in existence for almost 40 years, and that they believe the text is of value to them. However, Current
this is the fourteenth edition. In each edition, we have updated the Surgical Therapy is not written principally for medical students. We
material to reflect the continuing evolution of the field of general believe a more classic surgical textbook with substantial sections on
surgery. The textbook continues to be perhaps the most popular disease presentation, diagnosis, and pathophysiology is more appro-
surgical book in the field, and as long as it fulfills a need, we plan to priate for medical students.
continue the publication every 3 years. It has been a special privilege We remain grateful to the many surgeons throughout the
and honor for the two editors to be able to review contributions from country, as well as to the international surgeons, who participated
surgeons around the country and, indeed, from around the world, in creating this textbook. Most of the potential authors whom we
on what they believe is the current surgical therapy for essentially solicit respond enthusiastically to the opportunity to present their
all common general surgical topics. It is an enjoyable task and keeps expert views. Their efforts obviously are what make this textbook
two surgeons who care for surgical patients current on all general a success. In addition, we could not have compiled this textbook
surgical topics. without the herculean efforts of Ms. Irma Silkworth, who has been
As with prior editions, nearly every chapter has been written by a involved with virtually all of these editions. Ms. Katie DeFrancesco
new author. All authors have contributed their specific and personal at Elsevier has also has been a terrific help and stands out in the
thoughts on the current surgical therapy of the disease about which publishing industry.
they are experts. Therefore, to obtain a broad view of the topic, the Both editors continue to enjoy and thrive in our chosen profes-
reader may want to review the contributions of the other experts in sion of general surgery. In recruiting medical students into our spe-
the past two or three editions of Current Surgical Therapy. cialty over the past 40 years, we have used the statement, “If you pick
As with the past editions, disease presentation, pathophysiology, a profession you love, you never have to work the rest of your life.” In
and diagnosis are discussed only briefly, with the emphasis on cur- our view, that profession is surgery.
rent surgical therapy. When an operative procedure is discussed, an Finally, we would like to dedicate this edition, as with the others,
effort has been made to include brief and concise descriptions with to the surgical house staff and fellows at Johns Hopkins Hospital,
figures and diagrams when possible. Current Surgical Therapy is who are “the best of best.”
written for surgical residents, fellows, and fully trained surgeons in
private practice or in an academic setting. Many have told us that it Andrew M. Cameron, MD
is an excellent textbook to review before taking the general surgical John L. Cameron, MD
xxix
Contents
The American Board of Surgery

Certifying (Oral) Examination Stomach
The American Board of Surgery Certifying (Oral) Benign Gastric Ulcer 81
Examination 1 Daniel T. Dempsey, MD, MBA
Jo Buyske, MD, and Daniel L. Dent, MD
Management of Duodenal Ulcers 86
Daniel T. Dempsey, MD
Esophagus Management of Zollinger-Ellison Syndrome 92

David W. McFadden, MD, MBA, and Brian D. Shames, MD
Esophageal Function Tests 3
Wasay Nizam, MBBS, Hamza Khan, MD, and Malcolm V. Brock, MD Management of Mallory-Weiss Syndrome 98
Michael G. House, MD
Surgical Management of Gastroesophageal Reflux
Disease 7 Management of Gastric Adenocarcinoma 100
Jay Zhu, MD, and Brant K. Oelschlager, MD Alex B. Blair, MD, and Mark D. Duncan, MD
New Approaches to Gastroesophageal Reflux Disease Familial Gastric Cancer 107

(LINX) 14 Hamza Khan, MD, Juliet Siena Lumati, MD, and Fabian M. Johnston, MD
Tom R. DeMeester, MD
Management of Gastrointestinal Stromal Tumors 111
Management of Barrett’s Esophagus 19 Laurence P. Diggs, MD, and Miral Sadaria Grandhi, MD
Stephen R. Broderick, MD, MPHS
Gastrointestinal Tubes for Feeding
Endoscopic Treatment of Barrett’s Esophagus 24 and Decompression 119
Anne P. Ehlers, MD, MPH, and Brant K. Oelschlager, MD Lawrence B. Brown, MD, MPH, MHS, and Susan L. Gearhart, MD
Management of Paraesophageal Hernia Repair 29 Management of Morbid Obesity 123

Richard J. Battafarano, MD, PhD Michael A. Schweitzer, MD, and Vivek Kumbhari, MD
Management of Zenker’s Diverticulum 34

Fernando A.M. Herbella, MD, Riccardo Rosati, MD,
and Marco G. Patti, MD
Small Bowel
Achalasia of the Esophagus 39 Management of Small Bowel Obstruction 129
T. Robert Qaqish, MD, and Mark Katlic, MD Charudutt Paranjape, MD, and George Velmahos, MD
Management of Disorders of Esophageal Motility 45 Management of Crohn’s Disease of the Small Bowel 134
Melissa Louise DeSouza, MD, and Lee L. Swanstrom, MD John Peter Ricci, MD, and Mark A. Talamini, MD
Management of Esophageal Cancer 54 Use of Strictureplasty in Crohn’s Disease 138

Fatima G. Wilder, MD, and Stephen C. Yang, MD Lea Lowenfeld, MD, and Fabrizio Michelassi, MD
Multimodality Therapy in Esophageal Cancer 59 Management of Small Bowel Tumors 144

Brooks V. Udelsman, MD, MHS, and Uma M. Sachdeva, MD, PhD Ramy El-Diwany, MD, PhD, and John W. Harmon, MD
Use of Esophageal Stents 65 Small Bowel Diverticulosis 149

Matthew D. Grunwald, MD, Anthony N. Kalloo, MD, Jonathan B. Greer, MD
and Dmitriy O. Khodorskiy, MD Diagnosis and Management of Motility Disorders of the
Management of Esophageal Perforation 74 Stomach and Small Bowel in the Current Era 152
Juan A. Muñoz-Largacha, MD, and James M. Donahue, MD Omar M. Ghanem, MD, and Michael G. Sarr, MD
xxxi
xxxii CONTENTS
Management of Short Bowel Syndrome 161 Neoadjuvant and Adjuvant Therapy for Colorectal Cancer 259
Jon S. Thompson, MD Yilin (Linda) Cao, MD, and Nilofer Azad, MD
Management of Enterocutaneous Fistulas 166 Management of Colorectal Polyps 263

Grace C. Lee, MD, and Richard A. Hodin, MD Gifty Kwakye, MD, MPH, and Genevieve B. Melton, MD, PhD
Management of Radiation-Induced Injury to the Small Management of Peritoneal Surface Malignancies 267
and Large Bowel 171 Fabian M. Johnston, MD, and Juliet Siena Lumati, MD
Sophia Y. Chen, MD, MPH, and Chady Atallah, MD
Management of Lower Gastrointestinal Bleeding 274
Anna Liveris, MD, and Peter Muscarella II, MD
Large Bowel Appendicitis: Diagnosis and Management 281

Elaa Mahdi, MD, MPH, and Walter Pegoli Jr., MD
Preoperative Bowel Preparation: Is It Necessary? 177
Anna Chudnovets, MD, and Sandy Hwang Fang, MD
Management of Diverticular Disease of the Colon 181 Anorectal

Katharina M. Scheurlen, MD, and Susan Galandiuk, MD
Management of Hemorrhoids 287
Management of Chronic Ulcerative Colitis 186 Ariane M. Abcarian, MD, and Herand Abcarian, MD
Kirkpatrick Beekman Fergus, MD, Michael G. Kattah, MD, PhD,
Management of Fissure-In-Ano 295
and Elizabeth C. Wick, MD
Vernissia Tam, MD, MS, and Heather L. Yeo, MD, MHS
Management of Toxic Megacolon 190
Management of Anorectal Abscess and Fistula 298
Jonathan E. Efron, MD
Amy J. Thorsen, MD
Surgical Management of Crohn’s Colitis 194
Anal Stenosis 307
Hanjoo Lee, MD, Alessandro Fichera, MD, and
Chassidy Grimes, MD, and Dana Hayden, MD
James W. Fleshman Jr., MD
Management of Pruritus Ani 311
Ischemic Colitis 200
Matthew D. Price, MD, and Chady Atallah, MD
Ranim Alsaad, MD, and Pamela A. Lipsett, MD, MHPE
Surgical Management of Fecal Incontinence 313
Management of Clostridioides Difficile Colitis 204
Sarah Stringfield, MD, and Alessandro Fichera, MD
Marylise Boutros, MD, Maria Abou Khalil, MD, and Steven D. Wexner,
MD, PhD (Hon) Rectovaginal Fistula 319
Eric G. Weiss, MD, and Emanuela Silva Alvarenga, MD
Management of Large Bowel Obstruction 209
Anthony J. Senagore, MD, MS, MBA, and Yesenia Rojas-Khalil, MD Anal Condyloma 327
Edward P. Hagen, DO, and Raman Menon, MD
Enteral Stents in the Treatment of Colonic
Obstruction 215 Management of Pilonidal Disease 331
Shruti Mony, MBBS, Clement Wu, MBBS, and Mouen Khashab, MD Rebecca L. Gunter, MD, MS, Eric K. Johnson, MD,
and Scott R. Steele, MD
Management of Acute Colonic Pseudo-Obstruction
(Ogilvie’s Syndrome) 226 Pneumatosis Intestinalis and the Importance for the
Marshall S. Bedine, MD Surgeon 337
Joseph Kim, MD, Ahmed Chatila, MD, Muhammad Hammami, MD,
Management of Colonic Volvulus 229
and Eric Goldberg, MD
Jose G. Guillem, MD, and Jonathan M. Stem, MD
Management of Rectal Cancer 340
Management of Rectal Prolapse 232
Gregory K. Low, MD, and Matthew Mutch, MD
Shannon N. Radomski, MD, and Alodia Gabre-Kidan, MD, MPH
Management of Tumors of the Anal Region 346
Surgical Management of Constipation 236
Emilie C. Barnes, MD, and Jose G. Guillem, MD
Nathalie Mantilla, MD, and Jose R. Cintron, MD
Surgical Management of the Polyposis Syndromes 244

Scott R. Kelley, MD, and Sacha P. Broccard, MD Liver
Surgical Management of Colon Cancer 251 Cystic Disease of the Liver 351
Mohamad A. Abdulhai, MD, and Michael A. Choti, MD Lucas W. Thornblade, MD, MPH, and Yuman Fong, MD
PET Scanning in the Management of Colorectal Cancer 255 Management of Echinococcal Cyst Disease of the Liver 355
Joy Zhou Done, MD, and Sandy H. Fang, MD Miral Sadaria Grandhi, MD, and Henry A. Pitt, MD
CONTENTS xxxiii
Management of Liver Hemangioma 363 Management of Common Bile Duct Stones 476
Victor M. Zaydfudim, MD, MPH, and Reid B. Adams, MD Artem Shmelev, MD, Shirali T. Patel, MD, and Steven C. Cunningham, MD
Management of Benign Liver Tumors 368 Management of Acute Cholangitis 481

Richard D. Schulick, MD, MBA, and Ana Gleisner, MD, PhD Rebecca Tang, MD, Erica Barnett, BA, and David Berger, MD
Management of Malignant Liver Tumors 375 Management of Benign Biliary Strictures 486
Danielle K. DePeralta, MD, and Matthew J. Weiss, MD, MBA Heather A. Lillemoe, MD, and Keith D. Lillemoe, MD
Hepatic Malignancy: Resection Versus Transplantation 380 Management of Cystic Disorders of the Bile Ducts 491
Sharon R. Weeks, MD, and Shane E. Ottmann, MD Sean P. McGuire, MD, and Nicholas J. Zyromski, MD
Management of Colorectal Liver Metastases 384 Management of Primary Sclerosing Cholangitis 497
Jordan M. Cloyd, MD, and Timothy M. Pawlik, MD, MPH, PhD Gillian M. Ahrendt, MD, and Steven A. Ahrendt, MD
Ablation of Colorectal Carcinoma Liver Metastases 391 Management of Intrahepatic, Perihilar, and Distal
Naomi M. Sell, MD, MHS, Zhi Ven Fong, MD, PhD, Extrahepatic Cholangiocarcinoma 501
and Kenneth K. Tanabe, MD Mohammad Al Efishat, MD, and William Reece Burns, MD
Management of Hepatic Abscess 396 Biomarker Guided Surgical Management of Hepatobiliary

Daniel L. Eisenson, MD, and Jonathan B. Greer, MD and Pancreatic Tumors 509
Mahip Grewal, BA, Joseph R. Habib, MD, and Ammar A. Javed, MD
Transarterial Therapies for Primary and Metastatic Liver
Tumors 401 Surgical Management of Gallbladder Cancer 516
Nariman Nezami, MD, and Clifford R. Weiss, MD Anthony Sorrentino, MD, and Christopher L. Wolfgang, MD, PhD
Management of Gallstone Ileus 521

Morgan Bonds, MD, and Barish H. Edil, MD
Portal Hypertension
Transhepatic Interventions for Obstructive Jaundice 523
Portal Hypertension: Role of Shunting Procedures 413 Andrew R. Kolarich, MD, Yvonne Tsitsiou, MBBS, and Christos
Eliza J. Lee, MD, and Russel N. Wesson, MBChB Georgiades, MD, PhD
Liver Transplantation 417 Obstructive Jaundice: The Role of Endoscopic
Benjamin Philosophe, MD, PhD, and Kiara A. Tulla, MD Intervention 532
Endoscopic Therapy for Esophageal Variceal Hemorrhage 427 Sameer Khan, MD, and Vikesh K. Singh, MD, MSc
Julie A. Conyers, MD
Transjugular Intrahepatic Portosystemic Shunt 434 Pancreas

Andrew R. Kolarich, MD, Yvonne Tsitsiou, MBBS,
and Christos Georgiades, MD, PhD Management of Acute Necrotizing Pancreatitis 539
Ryan B. Morgan, MD, and John C. Alverdy, MD
Management of Refractory Ascites 442
Justin Brilliant, MD, and James P. Hamilton, MD Gallstone Pancreatitis 546
Katherine A. Morgan, MD, and William P. Lancaster, MD
Management of Hepatic Encephalopathy 447
Amanda Su, MD, Venkata S. Akshintala, MD, and Vikesh K. Singh, MD, MSc Pancreas Divisum and Other Variants of Dominant Dorsal
Duct Anatomy 549
Management of Budd-Chiari Syndrome 451
David B. Adams, MD, and Gregory A. Coté, MD, MS
Joseph DiNorcia, MD, and Ronald W. Busuttil, MD, PhD
Diagnosis and Management of Autoimmune Pancreatitis 556
Zhi Ven Fong, MD, MPH, and Andrew L. Warshaw, MD
Gallbladder and Biliary Tree Management of Pancreatic Necrosis 561
Management of Asymptomatic (Silent) Gallstones 457 Linda Ye, MD, and O. Joe Hines, MD
Theodore N. Pappas, MD, and Christopher R. Reed, MD Management of Pancreatic Pseudocyst 568
Management of Biliary Dyskinesia 460 Ammar A. Javed, MD, and Kelly J. Lafaro, MD, MPH
J. Bart Rose, MD Pancreatic Ductal Disruptions Leading to Pancreatic Fistula,
Management of Acute Cholecystitis 462 Pancreatic Ascites, or Pancreatic Pleural Effusion 574
Ryan C. Broderick, MD, and Bryan M. Clary, MD David Sanders, MD, Shivanand Bomman, MD, and Richard Kozarek, MD
Proper Use of Cholecystotomy Tubes 467 Management of Chronic Pancreatitis 582

Ashwyn K. Sharma, MD, and Jason K. Sicklick, MD Matthew D. Price, MD, Christi M. Walsh, MSN, CRNP, and
Martin A. Makary, MD, MPH
xxxiv CONTENTS
Genetic Testing and High-Risk Pancreatic Cancer Incisional, Epigastric, and Umbilical Hernias 671
Screening 587 Hien T. Nguyen, MD, MBA, and Katherine McDermott, MD
Daniel J. Delitto, MD, PhD, and Kevin E. Behrns, MD
Management of Spigelian, Obturator, and Lumbar Hernias 678
Management of Periampullary Cancers 589 Ajita S. Prabhu, MD
Stephanie Young, MD, MPH, and Susan Tsai, MD, MHS
Athletic Pubalgia 686
Management of Complications after the Whipple Samer Sbayi, MD, MBA, and Konstantinos Spaniolas, MD
Procedure 599
Abdominal Wall Reconstruction 693
Fabio Casciani, MD, and Charles M. Vollmer Jr., MD
Dina Podolsky, MD, Kelly H. Tunder, DO, and Yuri W. Novitsky, MD
Vascular Reconstruction During the Whipple
Loss of Domain in Abdominal Wall Reconstruction 702
Operation 606
Yewande Alimi, MD, David Hindin, MD, and Carla M. Pugh, MD, PhD
Benedict Kinny-Köster, MD, and Jin He, MD, PhD
Use of Various Meshes in Hernia Repair 708
Palliative Interventions for Patients with Operable and
Adrienne N. Christopher, MD, and John P. Fischer, MD, MPH
Advanced Pancreatic and Periampullary Cancer 609
Ashley Krepline, MD, Susan Tsai, MD, MHS, and Douglas B. Evans, MD
Neoadjuvant and Adjuvant Therapy for Pancreatic Breast

Cancer 615
Lawrence W. Wu, MD, and Daniel A. Laheru, MD Benign Breast Disease 717
Halley Vora, MD, and Tawakalitu O. Oseni, MD
Rare and Unusual Pancreatic Tumors 620
Jon M. Harrison, MD, and Carlos Fernandez-del Castillo, MD Screening for Breast Cancer 720
Julie R. Lange, MD, ScM
Intraductal Papillary Mucinous Neoplasms of the
Pancreas 627 Role of Stereotactic Biopsy in Management of Breast
Gabriel D. Ivey, MD, and Richard A. Burkhart, MD Disease 724
Jessica M. Pastoriza, MD, William C. Mallon, MD,
Pancreatic Neuroendocrine Tumors of the Pancreas and Lisa K. Jacobs, MD, MSPH
Excluding Gastrinoma 632
Mohammad R. Khreiss, MD, and Taylor S. Riall, MD, PhD Molecular Targets in Breast Cancer 728
Reva K. Basho, MD, and Armando E. Giuliano, MD
Intraoperative Radiation for Pancreatic Cancer 638
Amol Kumar Narang, MD, Joseph M. Herman, MD, MSc, MSHCM, and Breast Cancer: Surgical Therapy 733
Abhinav V. Reddy, MD Regina Matar, MD, and Mary L. Gemignani, MD, MPH
Transplantation of the Pancreas 641 Pregnancy and Breast Cancer Management 740
Niraj M. Desai, MD, and James F. Markmann, MD, PhD Jessica M. Pastoriza, MD, Ranim Alsaad, MD, and David M. Euhus, MD
Total Pancreatectomy and Islet Autotransplantation for Ablative Techniques in the Treatment of Benign and
Chronic Pancreatitis 646 Malignant Breast Disease 746
Isabel S. Dennahy, MD, Christi Walsh, MSN, CRNP, Marissa Vane, MD, MSc, and Armando E. Giuliano, MD, FACS, FRCSEd
and Martin A. Makary, MD, MPH Lymphatic Mapping and Sentinel Lymphadenectomy 749
Roi Weiser, MD, and V. Suzanne Klimberg, MD, PhD, MSHCT
Spleen Surgical Management of the Axilla 756

Genevieve Fasano, MD, Solange Bayard, MD, and
Splenectomy for Hematologic Disorders 651 Lisa Ann Newman, MD, MPH
Adam S. Weltz, MD, and Adrian E. Park, MD
Inflammatory Breast Cancer 762
Management of Cysts, Tumors, and Abscesses of the Jennifer K. Plichta, MD, MS, Xuanji Wang, MD, MS,
Spleen 656 and Laura H. Rosenberger, MD, MS
P. Marco Fisichella, MD, Nicola Tamburini, MD, and Ciro Andolfi, MD
Ductal and Lobular Carcinoma in situ of the Breast 768
Lauren M. DeStefano, MD, and Kristine E. Calhoun, MD
Hernia Advances in Neoadjuvant and Adjuvant Therapy for Early-

Stage Breast Cancer 770
Management of Inguinal Hernia 663 Julia Tchou, MD, PhD, and Seye Adekeye, MD, PhD
James E. Wiseman, MD, MBA, and Gina L. Adrales, MD, MPH
Treatment Trends in Locally Recurrent and Metastatic Breast
Management of Recurrent Inguinal Hernia 668 Cancer 773
Britta Jean Han, MD, MS, and Bethany C. Sacks, MD, MEd Joy Zhou Done, MD, Pathik Aravind, MD, and Mehran Habibi, MD
CONTENTS xxxv
Management of Male Breast Cancer 779 Cardiovascular Disease Risk Reduction After Bariatric
Austin D. Williams, MD, MSEd, Kaitlyn Kennard, MD, Surgery 884
and Ned Z. Carp, MD Robert C. Ross, MD, Vance L. Albaugh, MD, PhD, and Philip R. Schauer, MD
A Surgeon’s Practical Guide to Breast Imaging 782

Michael D. Grant, MD, and Ronald C. Jones, MD
Skin and Soft Tissue
Genetic Counseling and Testing 786
Katherine deAngeli, MD, and Elisa Port, MD Nonmelanoma Skin Cancers 895
Nicholas Calotta, MD, Paul N. Manson, MD, and Anthony Tufaro, MD, DDS
Contralateral Prophylactic Mastectomy 787
Thomas W. Smith Jr., MD, MS, and Swati A. Kulkarni, MD Management of Cutaneous Melanoma 903
Nicholas Calotta, MD, Paul N. Manson, MD,
Margins: How to and How Big? 791 and Anthony Tufaro, MD, DDS
Patricia A. Cronin, MD, and Richard J. Gray, MD
Management of Soft Tissue Sarcomas 912
Breast Reconstruction Following Mastectomy: Adam S. Levin, MD, and Carol D. Morris, MD, MS
Considerations, Techniques, and Outcomes, Part 1 795
Salih Colakoglu, MD, and Gedge Rosson, MD Management of Solitary Neck Mass 924
Christopher A. Maroun, MD, and Peter S. Vosler, MD, PhD
Breast Reconstruction Following Mastectomy:
Considerations, Techniques, and Outcomes, Part 2 800 Surgical Infections of the Hand 931
Mark S. Burke, MD, and Dennis K. Schimpf, MD Visakha Suresh, MD, and Jaimie T. Shores, MD
Breast Implant-Associated Anaplastic Large Cell Lymphoma 805 Nerve Injury and Repair 937
Melissa S. Camp, MD, and Michele Ann Manahan, MD, MBA Christopher Frost, MD, and Gedge D. Rosson, MD
Necrotizing Skin and Soft Tissue Infections 946

Philip J. Wasicek, MD, and Arthur J. Nam, MD, MS
Endocrine Glands
Adrenal Incidentaloma 809
Whitney Sutton, MD, MHS, Shkala Karzai, MD, and Aarti Mathur, MD, PhD
Chest Wall, Mediastinum, and Trachea
Management of Adrenal Cortical Tumors 815 Management of Spontaneous and Secondary
Mark A. Eckardt, MD, Jennifer B. Ogilvie, MD, and Nita Ahuja, MD, MBA Pneumothorax 951
Cameron D. Wright, MD
Management of Pheochromocytoma 824
Wilson M. Alobuia, MD, MS, and Electron Kebebew, MD Management of Primary Chest Wall Tumors 955
Whitney A. Davidson, MD, Lauren Antognoli, MD,
Management of Thyroid Nodules 834 and Avedis Meneshian, MD
Quan-Yang Duh, MD, and Sarah S. Sims, MD
Mediastinal Masses 961
Nontoxic Goiter 837 Hamza Khan, MD, Wasay Nizam, MBBS, and Malcolm V. Brock, MD
Matthew A. Nehs, MD, and Gerard M. Doherty, MD
Primary Tumors of the Thymus 971
Management of Thyroiditis 841 Joshua E. Preiss, MD, and Douglas E. Wood, MD, FRCSEd
Christopher R. McHenry, MD
Management of Tracheal Stenosis 975
Management of Hyperthyroidism 846 Andrea L. Axtell, MD, MPH, Douglas J. Mathisen, MD,
Jina Kim, MD, and Julie Ann Sosa, MD, MA and Ashok Muniappan, MD
Surgical Management of Thyroid Cancer 853 Management of Acquired Esophageal Respiratory
Yinin Hu, MD, and John A. Olson Jr., MD, PhD Tract Fistula 982
Primary Hyperparathyroidism 860 James T. Nawalaniec, MD, and Christopher R. Morse, MD
Shkala Karzai, MD, and Jason D. Prescott, MD, PhD Repair of Pectus Excavatum 987
Persistent and Recurrent Hyperparathyroidism 867 Jennine H. Weller, MD, PhD, and Isam W. Nasr, MD
Aditya S. Shirali, MD, and Nancy D. Perrier, MD
Surgical Management of Secondary and Tertiary Vascular Surgery

Hyperparathyroidism 873
Zeyad T. Sahli, MD, and Martha A. Zeiger, MD Open Repair of Abdominal Aortic Aneurysms 993
Erin E. McIntosh, MD, and Richard P. Cambria, MD
Metabolic Changes Following Bariatric Surgery 879
Patrick Crosby, MD, Thomas H. Magnuson, MD, Endovascular Treatment of Abdominal Aortic Aneurysms 998
and Michael A. Schweitzer, MD Richard P. Cambria, MD, and Scott G. Prushik, MD
xxxvi CONTENTS
Management of Ruptured Abdominal Aortic Atherosclerotic Renal Artery Stenosis 1126

Aneurysms 1004 Douglas Rodgers, MD, and Joseph S. Giglia, MD
David P. Stonko, MD, MS, and Caitlin W. Hicks, MD, MS
Raynaud’s Phenomenon 1133
Management of Abdominal Aortic Aneurysm with David S. Strosberg, MD, and Alan Dardik, MD, PhD
Concomitant Nonvascular Abdominal Pathology 1009
Thoracic Outlet Syndrome 1137
James K. Elsey, MD
Timothy K.Williams, MD, Zachary German, BSPH, and Julie A. Freischlag, MD
Management of Thoracic and Thoracoabdominal Aortic
Diabetic Foot 1143
Aneurysms 1012
Yasaman Kavousi, MD, Caitlin W. Hicks, MD, MS,
Yasaman Kavousi, MD, and James H. Black III, MD
and Christopher J. Abularrage, MD
Management of Acute Aortic Dissections 1019
Gangrene of the Foot 1148
Karen M. Kim, MD, MS, and Thomas E. MacGillivray, MD
Jake A. Nicholson, DO, and M. Ashraf Mansour, MD
Carotid Endarterectomy 1025
Buerger’s Disease (Thromboangiitis Obliterans) 1155
Bruce A. Perler, MD, MBA
Corinne Bunn, MD, MS, Pegge M. Halandras, MD, and Vivian Gahtan, MD
Management of Recurrent Carotid Artery Stenosis 1031
Takayasu’s Arteritis 1158
Sarah E. Deery, MD, MPH, and Ying Wei Lum, MD
Sally Schonefeld, MD, NavYash Gupta, MD, Aamir Shah, MD,
Balloon Angioplasty and Stents in Carotid Artery Occlusive and Bruce L. Gewertz, MD
Disease 1037
Acute Mesenteric Ischemia 1160
Danon E. Garrido, MD, Rishi A. Roy, MD, and
Kristofor A. Olson, MD, PhD, and Pedro G. Teixeira, MD
Charles S. O’Mara, MD, MBA
Chronic Mesenteric Ischemia 1167
Management of Aneurysms of the Extracranial Carotid and
Linda M. Reilly, MD
Vertebral Arteries 1044
Virginia L. Wong, MD Hemodialysis Access Surgery 1175
Christine Haugen, MD, PhD, and Thomas Reifsnyder, MD
Brachiocephalic Reconstruction 1049
Gregory J. Pearl, MD, and Lauren Beliveau, MD Venous Thromboembolism: Prevention, Diagnosis, and
Treatment 1182
Upper Extremity Arterial Occlusive Disease 1057
Jafar Haghshenas, DO, and Elliott R. Haut, MD, PhD
Aric Wogsland, MD, Virginia L. Wong, MD, and Vikram S. Kashyap, MD
Vena Cava Filters 1185
Aortoiliac Occlusive Disease 1064
Todd R. Schlachter, MD, and Adam Fish, MD
Maryam Ali Khan, MD, Claire Janssen, MD, and
Mahmoud B. Malas, MD, MHS Treatment of Varicose Veins 1192
Andrew Schulick, MD, and David R. Whittaker, MD
Femoropopliteal Occlusive Disease 1075
Zachary T. AbuRahma, DO, and Ali F. AbuRahma, MD Lymphedema 1204
Joani Christensen, MD, George Kokosis, MD, Halley Darrach, MD, and
Tibioperoneal Arterial Occlusive Disease 1083
Justin M. Sacks, MD, MBA
Natalia O. Glebova, MD, PhD
Lower Extremity Amputation 1209
Popliteal and Femoral Artery Aneurysm 1092
Justin M. Simmons, DO, and Carolyn R. Postol, DO
Rae S. Rokosh, MD, Daniel J. Wong, MD, MHS,
and Elliot L. Chaikof, MD, PhD
Treatment of Claudication 1097 Trauma and Emergency Care

Qingwen Kawaji, MD, and Margaret W. Arnold, MD
Initial Assessment and Resuscitation of the Trauma
Pseudoaneurysms and Arteriovenous Fistulas 1102 Patient 1215
Amani D. Politano, MD, MS Jessie Ho, MD, and Hasan B. Alam, MD
Management of Peripheral Arterial Prehospital Management of the Trauma Patient 1223
Thromboembolism 1108 Zaffer Qasim, MBBS
Alik Farber, MD, and Elizabeth Gherardi King, MD
Use of Resuscitative Endovascular Balloon Occlusion of the
Acute Peripheral Arterial and Bypass Graft Occlusion: Aorta in Resuscitation of the Trauma Patient 1231
Thrombolysis and Thrombectomy 1115 Adam Nelson, MD, and Bellal Joseph, MD
Gray R. Lyons, MD, and Robert P. Liddell, MD
Airway Management in the Trauma Patient 1236
Management of Infected Grafts 1119 Samuel M. Galvagno Jr., DO, PhD, and Thomas M. Scalea, MD
Timothy D. Chilton, DO, and Matthew R. Smeds, MD
CONTENTS xxxvii
Surgeon’s Use of Ultrasound in the Trauma and Critical Care Abdominal Compartment Syndrome and Management
Settings 1243 of the Open Abdomen 1374
Alisa Cross, MD, and Grace F. Rozycki, MD, MBA Crisanto M. Torres, MD, and Alistair J. Kent, MD, MPH
Emergency Department Resuscitative Thoracotomy 1252 Abdomen That Will Not Close 1387
Ryan B. Fransman, MD, and David T. Efron, MD Stephen L. Barnes, MD, and Jacob A. Quick, MD
Management of Traumatic Brain Injury 1257 Management of Vascular Injuries 1393

Purvi P. Patel, MD, Patrick M. McCarthy, MD, and Matthew J. Martin, MD Ali H. Khalifeh, MD, and Todd E. Rasmussen, MD
Chest Wall Trauma, Hemothorax, and Pneumothorax 1264 Endovascular Management of Vascular Injuries 1405
Raul Coimbra, MD, PhD, and David B. Hoyt, MD Joseph V. Lombardi, MD, Mikael A. Fadoul, MD,
and Marissa Famularo, DO
Management of Pulmonary Parenchymal Injury 1270
Alison M. Bales, MD, and Mary C. McCarthy, MD Extremity Compartment Syndrome 1411
Charles E. Lucas, MD, and Anna M. Ledgerwood, MD
Blunt Abdominal Trauma 1275
L.D. Britt, MD, MPH, and Michael Martyak, MD Burn Wound Management 1418
Christina Lee, MD, Philip S. Barie, MD, MBA,
Penetrating Abdominal Trauma 1288
and Abraham P. Houng, MD, MSE
David V. Feliciano
Medical Management of the Burn Patient 1422
Management of Diaphragmatic Injuries 1293
Robert Sheridan, MD, and Jeremy Goverman, MD
Kazuhide Matsushima, MD, and Kenji Inaba, MD
Cold-Induced Injuries and Hypothermia 1428
Management of Traumatic Liver Injury 1299
Sean Hickey, MD, and Colleen M. Ryan, MD
Elizabeth R. Benjamin, MD, PhD, and Deepika Koganti, MD
Electrical and Lightning Injury 1433
Pancreatic and Duodenal Injuries 1305
Leigh Ann Price, MD, and Laurie Anne Loiacono, MD
Madhu Subramanian, MD, and Elliott R. Haut, MD, PhD
Injuries to the Small and Large Bowel 1314

Crisanto M. Torres, MD, Amanda Radisic, MD, Preoperative and Postoperative Care
and Joseph V. Sakran, MD, MPH, MPA
ERAS Protocols for General Surgery 1443
Current Management of Rectal Injury 1318 Omaira Azizad, MD, and Girish P. Joshi, MBBS, MD
Katherine Albutt, MD, MPH, and Peter J. Fagenholz, MD
Fluid and Electrolyte Therapy 1449
Injured Spleen 1320 S. James El Haddi, MD, MS, Jane Stevens, MSN, MD, and Albert Chi, MD
Adil A. Shah, MD, Maaz K. Zuberi, MD, and Edward E. Cornwell III, MD
Common Pediatric Surgical Emergencies 1457
Renal and Ureteral Traumatic Injuries 1326 Mitchell R. Ladd, MD, PhD, and Shaun M. Kunisaki, MD, MSc
Michael W. Witthaus, MD, and Jill C. Buckley, MD
A Practical Approach to Surgery in the Frail
Tenets of Damage Control 1335 Elderly 1463
Zachary Obinna Enumah, MD, PhD, MA, and Kent Allen Stevens, MD, MPH Rachel G. Khadaroo, MD, PhD, FRCSC, and Michael E. Zenilman, MD
Early Management of Pelvic Ring Disruption 1339 Perioperative Optimization 1468
J. Greg Mawn, MD, and Greg M. Osgood, MD Lee A. Goeddel, MD, MPH
Urologic Complications of Pelvic Fracture 1348 Is Nasogastric Intubation Necessary After Alimentary
Hasan Dani, MD, and Misop Han, MD, MS Tract Surgery? 1472
Spine and Spinal Cord Injuries 1351 Wali Rashad Johnson, MD, MPH, and Adrian Barbul, MD, FACS
Khaled M. Kebaish, MD, FRCS, and Andrew Harris, MD Surgical Site Infections 1474
Evaluation and Management of the Patient with Raisa Gao, DO, Conor Dillon, DO, and Robert G. Sawyer, MD
Craniomaxillofacial Trauma 1357 Management of Intraabdominal Infections 1480
Dennis C. Nguyen, MD, Srinivas M. Susarla, DMD, MD, MPH, Amy V. Gore, MD, and David H. Livingston, MD
and Justin M. Sacks, MD
Epidemiology, Prevention, and Management of Occupational
Penetrating Neck Trauma 1365 Exposure to Bloodborne Infections 1486
Anna M. Ledgerwood, MD, and Charles E. Lucas, MD Ethel D. Weld, MD, PhD, and Shmuel Shoham, MD
Blunt Cardiac Injury 1370 Antifungal Therapy in the Surgical Patient 1491
Anna M. Ledgerwood, MD, and Charles E. Lucas, MD Guy Handley MD, and Luis Ostrosky-Zeichner, MD
xxxviii CONTENTS
Use of Opioids in the Postoperative Period 1501 Tracheostomy 1548

Mohamad El Moheb, MD, and Haytham Kaafarani, MD, MPH Jeffrey Thiboutot, MD, and David J. Feller-Kopman, MD
Management of Postoperative Delirium 1507 Acute Kidney Injury in the Injured and Critically Ill 1554
Amballur David John, MD, and Frederick Sieber, MD Gary A. Bass, MD, MSc, MBA, PhD, Niels D. Martin, MD,
and Lewis J. Kaplan, MD
Acid-Base Disorders 1564
Surgical Critical Care Zachary Obinna Enumah, MD, PhD, MA, and James E. Harris Jr., MD
COVID-19 and Health Care Delivery Catheter Sepsis in the Intensive Care Unit 1568
in a Pandemic 1513 Anamaria J. Robles, MD, and Christine S. Cocanour, MD
Michael S. Burnim, MD, and Brian T. Garibaldi, MD
Septic Response and Management 1572
Surgical Palliative Care 1517 Chris Cribari, MD, and Joel Elterman, MD
Avani Amin, MD, Brenda S. Nettles, DNP, ACNP-BC,
Multiple Organ Dysfunction and Failure 1576
and Thomas J. Smith, MD
Alexandra B. Roginsky, MD
Cardiovascular Pharmacology 1522
Antibiotics in Surgical Critical Care 1582
John Nikolhaus Smith, MD, Thomas S. Metkus Jr., MD, PhD,
Walter Cholewczynski, MD, and Eric Tsung, MD
and Glenn J.R. Whitman, MD
Endocrine Changes with Critical Illness 1592
Glucose Control in the Postoperative Period 1528
Laura M. Adams, MD, and Jay J. Doucet, MD, MSc, FRCSC
Reyna Gonzalez, MD, and Krista L. Kaups, MD
Nutrition Therapy in the Critically Ill Surgical
Postoperative Respiratory Failure 1531
Patient 1597
Christina Maria Regelsberger-Alvarez, DO, Jack P. Vernamonti, MD,
Jason Sperry, MD
and Pauline K. Park, MD
Coagulation Issues and the Trauma Patient 1604
Ventilator-Associated Pneumonia 1537
Nadia Ijaz, MD, and Michael B. Streiff, MD
Katherine L. Florecki, MD, MPH, Li Ting Tan, MBBS, Traci M. Grucz,
PharmD, BCCP, and Mariuxi C. Manukyan, MD Post–Intensive Care Syndrome 1615
Pamela A. Lipsett, MD, MHPE, and Katherine L. Florecki, MD
Extracorporeal Membrane Oxygenation for Respiratory
Failure 1541 Index 1621
Fatima G. Wilder, MD, MS, and Errol L. Bush, MD
Video Contents
Enteral Stents in the Treatment of Colonic Obstruction Management of Spontaneous and Secondary Pneumothorax
Uncovered self-expandable metal stent (USEMS) in malignant colonic Normal lung sliding
stricture process Absence of lung sliding with no shimmering appearance of bright
pleural line
Management of Spigelian, Obturator, and Lumbar Hernias
Laparoscopic obturator repair Acute Mesenteric Ischemia
Laparoscopic lumbar hernia repair Acute embolic mesenteric ischemia in the setting of chronic SMA
Reverse transversus abdominis release (reverse TAR) atherosclerosis and IMA occlusion following open exploration,
Mesh fixation utilizing bone anchors resection, and SMA endarterectomy
xxxix
The American Board of Surgery
Certifying (Oral) Examination
The American Board CONTENT
of Surgery Certifying The content of the Certifying Examination is generally aligned with
the ABS SCORE Curriculum Outline. The majority of the exam will
(Oral) Examination focus on topics that are listed among the core content of the curric-
ulum. The remainder of the exam will be on complications of these
basic scenarios or may be taken from the advanced portion of the
Jo Buyske, MD, and Daniel L. Dent, MD curriculum.4 While each exam roster contains 12 cases, the content
for the exam comes from 13 question-writing committees. There
PRINCIPLE is some overlap of the content between committees. For example,
a case of septic shock secondary to a colonic perforation from an
The American Board of Surgery (ABS) was founded in 1937, with a incarcerated hernia could have been put forward as content from
mission to protect the public and enhance the profession. At the time, the colorectal, hernia, or critical care committees. Each roster of
the standards for becoming a surgeon were vague and inconsistent. cases is reviewed for breadth of content and consistency of difficulty
Some people did a Halstedian residency. Some apprenticed them- relative to historical performance of the individual questions so exam
selves to surgeons. Others did internships and then were self-taught, difficulty is consistent across all rosters. Because the candidate will
or they skipped formal training altogether. The public had no way to also be tested as to baseline surgical knowledge on the qualifying
distinguish the training or skill of these practitioners. The ABS and the (written) exam, it is not generally expected that the candidate will
certification process was a way to set standards for the profession and be asked to regurgitate basic surgical facts. With that said, the candi-
to provide a testimonial to patients that their surgeon was qualified. date can expect that some questions may include a list of questions
Certification by the ABS is the culmination of surgical training. It asking how the candidate’s management plan might change in the
is a testimonial to quality, knowledge, and judgment based on several face of variations of patient presentation or pathologic findings, or
distinct components. First, training in an Accreditation Council for in the setting of intraoperative or postoperative complications. This
Graduate Medical Education (ACGME)-accredited training pro- should not necessarily be interpreted as meaning that the candidate
gram is a prerequisite for certification in nearly all cases. Second, is off track, but rather is a way of probing the candidate’s skill and
candidates must meet the standards of training as set by the ABS, judgment in managing a variety of situations.
including things like passing knowledge and skills tests in laparos-
copy (FLS), endoscopy (FES), trauma (ATLS), and cardiovascular PROCESS
events (ACLS). Candidates must meet case minimums both in the
early years of training to “prepare the soil” and also during the chief The Certifying Examination consists of three exam sessions that
year to demonstrate maturation. There are time requirements, and each last 30 minutes. In each session, the candidate will be presented
required observations of both clinical and operative skills. Third is with four case scenarios. Two examiners are used in each session
a knowledge exam, the Qualifying Examination. The Qualifying or to help ensure the validity of the exam. All examiners are in active
written examination is a 300-plus question, computer-based multiple practice, currently certified by the ABS, and participating in the
choice exam designed to test foundational knowledge.1 Finally, after ABS Continuous Certification Program. All of the examiners have
all of these other qualifications have been met, the Certifying, or oral taken the certifying exam themselves, some of them more than once.
examination, is a test of judgment and applied knowledge. The two Examiners are all volunteers, and they do not receive any financial
tests measure different assets, and candidates’ performance is not compensation for their service.5–7
predictable across the two exams. That is to say, doing well on one The examiners will typically alternate in presenting the case
exam does not predict doing well on the other exam. They measure information to the candidate. In presenting the case scenarios, the
different attributes, and each one is important to fulfill the ABS mis- goal of the examiners is to provide a clear description of each case.
sion of serving the public and the profession.2 It is the intent of the examiners to provide sufficient information at
The Certifying Examination consists of a series of carefully cre- each step in the case so the candidate may make pertinent decisions
ated scenarios. The scenarios are the tool that supports the examiners on how to progress in the workup and treatment of the patient.
in their charge, which is to “evaluate a candidate’s clinical skills in The COVID-19 pandemic presented a new challenge for the
organizing the diagnostic evaluation of common surgical problems administration of the Certifying Examination. The inability to
and determining appropriate therapy. Emphasis is placed on candi- administer the exam in person created a need to administer the exam
dates’ ability to use their knowledge and training to “safely, effectively in a virtual format. In the 2020–2021 academic year, the exam was
and promptly manage a broad range of clinical problems.” Addition- administered with all candidates and examiners participating virtu-
ally, “Technical details of operations may also be evaluated, as well ally. This necessitated some modifications to the timing of the exam,
as issues related to a candidate’s ethical and humanistic qualities.”3 specifically that each room was given an extra 5 minutes in case of
1
2 The American Board of Surgery Certifying (Oral) Examination
technical difficulties. The time allotted to answering questions did information to give a passing grade, such as when the candidate
not change; if the extra time was not needed, then there was simply spends more time asking questions than answering them, or
a short break between sessions. The candidates found the experience when the candidate makes multiple noncritical errors while also
to be fair and the vast majority support keeping the exam in a virtual making a number of correct management choices. The examiners
format going forward.8 are charged with assessing the following characteristics of the
candidate’s performance:
PREPARATION
■ Demonstrates an organized approach and solid rationale for
The ideal preparation for the Certifying Examination is to have suc- planned actions.
cessfully provided evidence-based care for each condition that will be ■ Rapidly determines and interprets key findings in a clinical
covered during the exam. Surgical residency, as currently structured presentation.
by the parameters of the ACGME, Residency Review Committee ■ Effectively and efficiently uses clinical knowledge to solve clinical
(RRC), and ABS, provides strong foundation for the exam. Given the problems; effectively addresses key management points.
breadth of general surgery, however, it is likely that candidates will ■ Avoids errors and critical fails (omission and commission) asso-
encounter scenarios they have not seen in training. Before taking the ciated with the case.
exam, candidates are encouraged to practice taking oral exams with ■ Recognizes personal limitations in knowledge and expertise
colleagues who have successfully completed the examination process when diagnosing and treating clinical problems.
as the concise oral presentation of decision making benefits from ■ Reacts in a prompt but flexible manner to alterations in the
repetition and practice. In doing so, the candidate should practice patient’s course (e.g., disease or treatment complications).
case scenarios over a wide range of pathologic conditions. Specific ■ Overall, demonstrates appropriate surgical judgment, clinical
recommendations for preparing for the exam include the following: reasoning skills, and problem-solving ability.2,3
■ Practice clarity of communication with regard to explaining the In answering the examiners’ questions, candidates should be able
decision-making process. to not only state what they would do, but also concisely explain how
■ Practice anatomic descriptions of common procedures (e.g., and why they would provide the stated care.5
inguinal herniorrhaphy) as verbalizing operative anatomy can be
challenging in a high-stakes setting. SUMMARY
■ Recognize that the goal of the exam is to convey how one would
actually safely manage a patient, not to try to guess what the The ABS Certifying Examination is an assessment of a surgeon’s
examiners want to hear. thought processes in managing surgical conditions. Board certifica-
■ Plan for management of complications and consequences of treat- tion is the culmination of targeted training in accredited programs,
ment decisions. For example, in appropriately selected patients meeting specific training requirements in order to be eligible for the
with colon pathology, it may be appropriate to perform primary exam process, and then passing a written foundational knowledge
anastomosis. However, the candidate should also know how to exam and an oral exam of judgment delivered by trained surgical
handle the potential consequence of an anastomotic leak. Con- examiners. The process serves as a testimonial that board-certified
versely, if the candidate initially chooses to manage the patient surgeons have met the standards established by the profession.
with a colostomy, it is reasonable to expect that the candidate can
also manage ostomy ischemia and parastomal hernia.
■ Recognize that the exam is not a multiple-choice exam and that Suggested Readings
each case discussion is an ongoing conversation. As the case
1. The American Board of Surgery. Training and Certification. General
evolves, the optimal management evolves with it. For example, Surgery Qualifying Examination (QE) https://www.absurgery.org/default.
it may be appropriate to initially manage a patient nonopera- jsp?certgsqe.
tively but then convert to operative management if the patient’s 2. Kopp J, Ibanez B, Jones A, et al. Association between American Board
condition changes. of Surgery General Surgery Initial Certification and risk of receiv-
ing severe disciplinary actions against medical licenses. JAMA Surg.
2020;155(5):e200093.
ASSESSMENT 3. The American Board of Surgery. Training and Certification. General
Examiners receive standardized training before giving an exam. This Surgery Qualifying Examination (QE). https://www.absurgery.org/
includes practice scoring, implicit bias training, and team review default.jsp?certcehome.
4. The American Board of Surgery. Training and Certification. SCORE
of the scenarios. In addition, examiners routinely get formative Curriculum Outline for General Surgery. https://www.absurgery.org/
feedback from observers and their co-examiners. Finally, examiner default.jsp?scre_booklet.
scoring patterns are evaluated from a psychometric perspective, 5. The American Board of Surgery. Training and Certification. Taking
looking at patterns of consistency and severity as well as any evidence the CE—What to Expect. https://www.absurgery.org/default.jsp?certce_
of bias.9 whattoexpect.
6. The American Board of Surgery. Training and Certification, CE Candidate
■ Each examiner records a score for each case to maximize the Video. https://www.absurgery.org/default.jsp?certce_video.
number of independent observations that contribute to the can- 7. The American Board of Surgery. Training and Certification. FAQs.
didate’s total score. A total score that reflects the ability to safely htttp://www.absurgery.org/default.jsp?faq_gsce.
8. Chen H, Tseng JF, Chaer R, et al. Outcomes of the First Virtual General
care for the broad array of cases that are presented over the course Surgery Certifying Exam of the American Board of Surgery. Ann Surg.
of the exam is considered a passing grade. There is no preset pass 2021;274(3):467–472.
or fail rate for the exam. On each scenario, candidates may be 9. Ong TQ, Kopp JP, Jones AT, Malangoni MA. Is there gender bias on the
given a passing grade, a failing grade, or an equivocal grade. The American Board of Surgery General Surgery Certifying Examination?
equivocal grade is given when the examiners do not have enough J Surg Res. 2019;237:131–135.
Esophagus
Esophageal Function tip in the stomach. Characteristics of the pressure waveform after a
swallowing event allow for the recognition of the UES, the esoph-
Tests ageal body, the LES, and the gastric cardia (Fig. 1). However, con-
ventional manometry has several limitations including: (1) widely
spaced sensors that preclude information on motor activity less than
Wasay Nizam, MBBS, Hamza Khan, MD, and 5 cm apart, (2) unidirectional sensors unable to record pressures
Malcolm V. Brock, MD accurately in an asymmetrical lumen, and (3) false pressure readings
during swallowing because of the tendency of the sphincters to move
cephalad, dislodging the catheter.
T he esophagus is a muscular, tubelike structure located in the

posterior mediastinum. It spans from the posterior oropharynx
to the cardia of the stomach with three functional regions: the upper
To overcome these challenges, manometry systems have evolved
to utilize more sensors (20–36) placed 1 cm apart that also record cir-
cumferentially. As a result, data on various pressure points are gathered
esophageal sphincter (UES), esophageal body, and lower esophageal and plotted using computer software as a smooth contour plot giving a
sphincter (LES). With the aid of peristalsis and coordinated relax- high-resolution manometry (HRM) image. Readings are presented in
ation/contraction of sphincters, the esophagus allows the transport color-coded spatiotemporal pressure graphs called esophageal pressure
of food boluses to the stomach and prevents the reflux of corrosive topography (EPT) or Clouse plots, named after Ray Clouse, who estab-
stomach contents. Assessment of esophageal motility requires eval- lished the technique. These topographical plots represent time on the
uating its structural integrity, peristalsis, and synchronized pressure x-axis, location of the pressure wave on the y-axis, and color denoting
changes of the sphincters. The diagnostic tools assessing these func- pressure (Fig. 2). With the advent of HRM, a smooth continuous pres-
tions are termed esophageal function tests. Utilizing pressure sensors, sure wave along the esophagus in real-time is now available. This led
these tests provide a dynamic demonstration of esophageal motility to advances in our understanding of many esophageal motor diseases
and an assessment of alternating pressures within the LES. that were previously puzzling, such as achalasia.
Patients presenting with dysphagia, reflux, or non-cardiac chest A standard protocol for esophageal manometry conduction
pain should undergo endoscopic or radiologic examination first to has been outlined in version 4.0 of the Chicago Classification. The
rule out structural lesions such as malignancy. Once these are ruled original classification scheme, proposed in 2009 by the Interna-
out, functional disorders secondary to esophageal dysmotility are tional HRM Working Group, was in response to rapid advances in
considered (Box 1). This chapter will review commonly used tests, HRM technology. But the scheme became so clinically useful that
such as manometry and esophageal pH monitoring. Esophageal
integrity may be evaluated both directly and indirectly by endos-
copy or radiologic tools, respectively. These modalities will also be
discussed in depth in subsequent chapters along with details on BOX 1 Indications and Contraindications for
management of esophageal dysmotility disorders such as achalasia. Esophageal Function Tests
Indications
ESOPHAGEAL MANOMETRY
• Noncardiac chest pain or heartburn with no improvement from
Esophageal manometry remains the gold standard for assessing acid suppression and no explanation on radiologic or endo-
esophageal motility. This test permits evaluation of the contractil- scopic examination
ity and coordination of esophageal muscles. It measures a series of • Nonobstructive dysphagia or odynophagia that is unexplained
pressure events along the esophageal length and presents them as • Evaluating esophageal peristalsis before foregut surgery
curves of amplitude over time. Originally developed in the 1950s, • Localizing LES to place impendence probe in preparation of
esophageal manometry underwent numerous modifications before pH monitoring study
becoming the state-of-the-art diagnostic tool it is today. Briefly, all • Evaluating dysphagia after foregut surgery
versions of the manometer contain a series of sensors placed on a • Workup of scleroderma
thin catheter that transduce intraluminal esophageal pressure into
electrical signals that are then displayed as pressure waves. The orig- Contraindications
inal version was based on a pneumo-hydraulic system that has since • Esophageal mass causing obstruction
been replaced by a solid-state catheter that provides a faster response • Abnormal nasal-oropharyngeal anatomy precluding catheter
and requires less technical expertise. placement
Conventional manometry utilizes information from sensors • Nonresponsive patients unable to follow commands
placed at fixed locations (∼5 cm) along the length of the catheter. • Patients on anticoagulation with high risk of bleeding
This catheter is placed transnasally into the esophagus with its distal
3
4 Esophageal Function Tests
Water-perfused catheter with

5 channels placed 5 cm apart Pressure, mm Hg
80
60
% cm
Cricopharyngeal sphincter 40
10 1 20
30 6
Esophageal body
50 11
Length
Fifth channel 70 16
with 4 sensors
at the same
level
90 21
Resp.
FIG. 1 Esophageal manometry 100
showing a transnasally placed cathe- Lower esophageal sphincter
18
ter that records a normal waveform Time
progression. Newer solid-state cathe-
ters have sensors placed 1 cm apart.
FIG. 2 Clouse plot showing a peristaltic wave after swallowing in a healthy individual. (From Baldwin D, Puckett Y. Esophageal manometry. Updated Sep 28,
2021. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2021. https://www.ncbi.nlm.nih.gov/books/NBK559237/.)
it helped accelerate esophageal HRM’s current position as the state- the supine position for 10 wet (5-mL) swallows spaced 30 seconds
of-the-art diagnostic tool that has thoroughly replaced conventional apart. This is followed by a single multiple rapid swallow sequence
line tracing. Before the procedure, patients are obliged to fast for a (five 2-mL swallows, 2–3 seconds apart) that can be repeated up to
minimum of 4 hours, and then the procedure begins with patients in three times. Following this, the patient is placed upright and given
E so p h ag us 5
five additional wet swallows and one rapid drink challenge (200 mL anesthesia is used. It is an outpatient procedure requiring no seda-
of water ingested as fast as possible). More provocative testing may tion, and patients can drive home afterward. It is important, however,
include the utilization of a solid swallow test, a solid test meal, or that patients stop H2-blockers, proton pump inhibitors, opioids,
even pharmacologic provocation. Pressure sensors within the body nitrates, and calcium channel blockers before the study to avoid any
of the catheter then record intraluminal pressure that is transmitted interference with testing. Furthermore, it must be remembered that
to an external recording device. Clouse plots generated from HRM patients with a history of esophageal surgery, peptic stricture, or
are interpreted with consideration of the following five metrics: those with a current hiatal hernia are prone to false readings.
1. Integrated relaxation pressure (IRP): the average deglutitive relax- ESOPHAGEAL pH MONITORING
ation pressure in a 4-second window beginning at UES relaxation
2. Distal contractile integral: the product of amplitude, duration, Acid reflux into the esophagus may be assessed with intraluminal pH
and length of the distal esophageal contraction monitoring. This can be performed with catheter-based devices or a
3. Distal latency: the interval between UES relaxation and the con- wireless device (Bravo probe, Medtronic, Minneapolis, MN). Cathe-
tractile deceleration point ter-based devices are inserted transnasally, with the distal pH probe
4. Peristaltic breaks located approximately 5 cm above the LES. This device is then left in
5. Pressurization patterns situ for 24 hours with patients instructed to record meals, symptoms,
and periods of sleep by pressing buttons on a recorder. A wireless
Information from these indices may be applied toward the diag- device is placed endoscopically in the distal esophagus and attached to
noses of esophageal motility disorders. The Chicago Classification the esophageal mucosa with a clip. This device then transmits informa-
broadly divides these disorders into disorders of esophagogastric tion to a recorder. As there is no external component to this method,
junction (EGJ) outflow or of peristalsis. A useful algorithm presented patient activities, dietary patterns, and comfort levels are more natural.
in the classification then allows for the delineation of specific disor- Furthermore, because this is a single device, pH levels are only assessed
ders, based on manometry findings (Fig. 3). at a single level, rather than across the length of the esophagus.
HRM is the preferred diagnostic tool when evaluating esophageal pH monitoring is used to determine whether or not acid expo-
motor function, especially when radiologic or endoscopic studies are sure to the esophagus is physiologic. Data gathered from the probe
unable to explain the patient’s symptoms. It is safe, with a low-risk are correlated with symptoms, patient positioning, and relation to
profile of complications that is similar to those of nasogastric tube meals. The information from the device is then used to calculate a
placement, namely, gagging, oropharyngeal discomfort, epistaxis, composite pH or DeMeester score. Scores of 14.72 (95th percentile
and rarely aspiration or perforation. Diet can be resumed immedi- of normal) or greater are considered abnormal. The components of
ately following removal of the catheter because only topical nasal the DeMeester score include the following:
FIG. 3 Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0 Hierarchical Classification Scheme. EGJOO,
Esophagogastric junction outflow obstruction; FLIP, functional lumen imaging probe; IBP, intrabolus pressurization; IRP, integrated relaxation pressure; LES,
lower esophageal sphincter; MRS, multiple rapid swallows; PEP, pan-esophageal pressurization; RDC, rapid drink challenge; TBE, timed barium esophagram.
(From Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0. Neurogastroenterol Motil.
2021;33:e14058.)
6 Esophageal Function Tests
Bolus movement Bolus movement

Swallow upward
downward
Bolus entry
FIG. 4 Impedance testing showing (A) normal

downward movement of the bolus after swallowing
and (B) reflux of the swallowed bolus. A B
1. Percent total time pH <4 probe, and within the balloon, electrodes are present, enabling the
2. Percent upright time pH <4 detection of impedance. The balloon may be inflated with saline in
3. Percent supine time pH <4 10-mL increments up to 70 mL. The data from the sensors are then
4. Number of reflux episodes converted in real time to allow for assessment of the various metrics
5. Number of reflux episodes ≥5 minutes such as wall stiffness, pressure changes, diameter, volume, and EGJ
6. Longest reflux episode (in minutes) dynamics. FLIP panometry may be used as a complementary tool in
diagnosing esophageal motility disorders as well as intraoperatively
IMPEDANCE TESTING during antireflux procedures to assess the adequacy of esophageal
wraps.
Impedance testing utilizes the principles of current resistance. A
long flexible catheter with 6 to 8 sensors is placed transnasally for CONCLUSION
24 hours, with patients instructed to proceed with normal activity.
The tube is connected to a small receiver for data recording. A small Esophageal function testing can provide valuable information regard-
voltage is applied between two electrodes. In principle, at resting ing the biomechanics of esophageal motility. The practicing surgeon
state, an electrical charge within the esophageal mucosa carries must be well aware of the utility of these tests and be able to interpret
current between the catheter sensors. Because liquids permit faster them in light of the patient’s symptoms. Optimal outcomes require
ion conductivity, a liquid bolus will be sensed as a rapid decrease in close collaboration between the radiologist, gastroenterologist, and
impedance (resistance) between the sensors. In contrast, air is a poor surgeon within the clinical realm to treat these complex patients.
conductor, and swallowed air boluses will be detected as increased As technology evolves, newer testing techniques may improve our
impedance. Based on the direction of change, this can assess both understanding of complicated esophageal disease and assist with
antegrade and retrograde movement (normal peristalsis or gastro- intervention.
esophageal reflux). Data on change in impedance gathered from
multiple electrodes along the catheter is then used to determine the
position of a bolus after swallowing and whether there is reflux back Suggested Readings
into the esophagus after it has entered the stomach (Fig. 4). Special
impedance catheters are also available that combine impedance Gyawali CP, Bredenoord AJ, Conklin JL, et al. Evaluation of esophageal motor
testing with assessment of esophageal pH sensors and manometry function in clinical practice. Neurogastroenterol Motil. 2013;25(2):99–133.
testing (high-resolution impedance manometry [HRIM]), allowing Hamer PW, Holloway RH, Crosthwaite G, et al. Update in achalasia: what the
surgeon needs to know. ANZ J Surg. 2016;86(7-8):555–559.
for improved diagnosis. Pandolfino JE, Kahrilas PJ; American Gastroenterological Association.
AGA technical review on the clinical use of esophageal manometry.
FUNCTIONAL LUMINAL IMAGING PROBE Gastroenterology. 2005;128(1):209–224.
PANOMETRY van Hoeij FB, Bredenoord AJ. Clinical application of esophageal high-res-
olution manometry in the diagnosis of esophageal motility disorders. J
Functional luminal imaging probe (FLIP) panometry is an emerg- Neurogastroenterol Motil. 2016;22(1):6–13.
ing technology in esophageal function testing used in concert Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders
with endoscopy. It is performed with a catheter possessing a distal on high-resolution manometry: Chicago classification version 4.0©.
overlying balloon. The tip of the catheter functions as an imaging Neurogastroenterol Motil. 2021;33(1):e14058.
Another random document with
no related content on Scribd:
science, has not been able to distract me from it? Let not your
Excellency think it self-praise in me, if I am bold to present to you my
defence.
When I was studying in the School of the Redeemer, I was
surrounded on all sides with powerful obstacles that made against
science, and in those years the influence of these tendencies was
almost insurmountable. On the one hand, my father, who had never
had any other children but me, said that in leaving him I, being his
only son, had left all his possessions (such as they were in those
parts), which he had acquired for me in the sweat of his brow, and
which strangers would carry away after his death. On the other hand,
I was confronted with unspeakable poverty: as I received but three
kopeks a day, all I dared spend a day for food was half a kopek for
bread and half a kopek for kvas, while the rest went for paper, shoes
and other necessities. In this way I passed five years, and did not
abandon study. On the one hand, they wrote to me that, knowing the
well-being of my father, well-to-do people of my village would give
me their daughters in marriage, and in fact they proposed them to
me, when I was there; on the other hand, the small schoolboys
pointed their fingers at me, and cried: “Look at the clodhopper who
has come to study Latin at the age of twenty!” Soon after that I was
taken to St. Petersburg, and was sent abroad, receiving an
allowance forty times as large as before. But that did not divert my
attention from study, but proportionately increased my eagerness,
though there is a limit to my strength. I most humbly beg your
Excellency to feel sure that I will do all in my power to cause all
those who ask me to be wary in my zeal to have no anxiety about
me, and that those who judge me with malicious envy should be put
to shame in their unjust opinion, and should learn that they must not
measure others with their yardstick, and should also remember that
the Muses love whom they list.
If there is anyone who persists in the opinion that a learned man
must be poor, I shall quote on his side Diogenes, who lived in a
barrel with dogs, and left his countrymen a few witticisms for the
increase of their pride; on the other side I shall mention Newton, the
rich Lord Boyle, who had acquired all his glory in the sciences
through the use of a large sum of money; Wolff, who with his lectures
and presents had accumulated more than five hundred thousand,
and had earned, besides, a baronetcy; Sloane, in England, who had
left such a library that no private individual was able to purchase it,
and for which Parliament gave twenty thousand pounds. I shall not
fail to carry out your commands, and remain with deep respect your
Excellency’s most humble servant, Mikháylo Lomonósov. St.
Petersburg, May 10, 1753.
II
Dear Sir, Iván Ivánovich:—I received yesterday your Excellency’s

letter of May 24th, in which I see an unchangeable token of your
distinguished favour to me, and which has greatly pleased me,
especially because you have deigned to express your assurance
that I would never abandon the sciences. I do not at all wonder at the
judgment of the others, for they really have had the example in
certain people who, having barely opened for themselves the road to
fortune, have at once set out on other paths and have sought out
other means for their farther advancement than the sciences, which
they have entirely abandoned; their patrons ask little or nothing of
them, and are satisfied with their mere names, not like your
Excellency who ask for my works in order to judge me. In these
above-mentioned men, who in their fortune have abandoned
science, all can easily perceive that all they know is what they have
acquired in their infancy under the rod, and that they have added no
new knowledge since they have had control of themselves. But it has
been quite different with me (permit me, dear sir, to proclaim the
truth not for the sake of vainglory, but in order to justify myself): my
father was a good-hearted man, but he was brought up in extreme
ignorance; my step-mother was an evil and envious woman, and she
tried with all her might and main to rouse my father’s anger by
representing to him that I eternally wasted my time with books; so I
was frequently compelled to read and study anything that fell into my
hands, in lonely and deserted places, and to suffer cold and hunger,
until I went to the School of the Redeemer.
Now that I have, through your fatherly intercession, a complete
sufficiency from her august Imperial Highness, and your approbation
of my labours, and that of other experts and lovers of the sciences,
and almost their universal delight in them, and finally no longer a
childish reasoning of an imperfect age,—how could I in my manhood
disgrace my early life? But I shall stop troubling your patience with
these considerations, knowing your just opinion of me. So I shall
report to your Excellency that which your praiseworthy zeal wishes to
know of the sciences.
First, as to electricity: There have lately been made here two
important experiments, one by Mr. Richmann by means of the
apparatus, the other by me in the clouds. By the first it was proved
that Musschenbroek’s experiment with a strong discharge can be
transferred from place to place, separating it from the apparatus for a
considerable distance, even as much as half a mile. The second
experiment was made on my lightning apparatus, when, without any
perceptible thunder or lightning, on the 25th of April, the thread was
repelled from the iron rod and followed my hand; and on the 28th of
the same month, during the passage of a rain-cloud without any
perceptible thunder or lightning, there were loud discharges from the
lightning apparatus, with bright sparks and a crackling that could be
heard from a great distance. This has never been noticed before,
and it agrees completely with my former theory of heat and my
present one of the electric power, and this will serve me well at the
next public lecture. This lecture I shall deliver in conjunction with
Professor Richmann: he will present his experiments, and I shall
illustrate the theory and usefulness arising from them; I am now
preparing for this lecture.
As to the second part of the text-book on eloquence, it is well on
its way, and I hope to have it printed by the end of October. I shall
use all my endeavour to have it out soon; I do not send your
Excellency any manuscript of it, as you have asked for printed
sheets. As I have promised, I am also using all my endeavour in
regard to the first volume of the Russian History, so as to have it
ready in manuscript by the new year. From him who delivers lectures
in his subject, who makes new experiments, delivers public lectures
and dissertations, and besides composes all kinds of verses and
projects for solemn expressions of joy; who writes out the rules of
eloquence for his native language and a history of his country, which,
at that, he has to furnish for a certain date,—I cannot demand
anything more, and I am ready to be patient with him, provided
something sensible will result in the end.
Having again and again convinced myself that your Excellency
likes to converse about science, I eagerly await a pleasant meeting
with you, in order to satisfy you with my latest endeavours, for it is
not possible to communicate them all to you at a distance. I cannot
see when I shall be able to arrange, as I had promised, the optical
apparatus in your Excellency’s house, for there are no floors, nor
ceilings, nor staircases in it yet, and I lately walked around in it with
no small degree of danger to myself. The electric balls I shall send
you, as you wish, without delay, as soon as possible. I must inform
your Excellency that there is here a great scarcity in mechanics, so
that I have not been able to get anywhere, not even at your estate, a
joiner for any money, to build me an electric apparatus, so that up to
the present I have been making use, instead of a terrestrial machine,
of the clouds, to which I have had a pole erected from the roof.
Whatever instruments your Excellency may need, I beg you to permit
me to report in the office of the Academy in your name that the
orders for them should be given to the mechanics, or else the
business will be endlessly prolonged. In fine, I remain, with the
expression of deep respect, your most humble and faithful servant,
Mikháylo Lomonósov. St. Petersburg, May 31, 1753.
ODE IN HONOUR OF THE EMPRESS ANNA, ON THE
OCCASION OF THE CAPTURE OF KHOTÍN FROM THE
TURKS, BY THE RUSSIAN ARMIES, IN 1739
A sudden ecstasy has seized my soul; it transports me to the
summit of a lofty mountain, where the wind has ceased to howl, and
all is hushed in the deep valleys below. Silent are the listening
streams, to which it is natural to murmur, or with loud rush to roll
down the mountains; crowns of laurel are weaving; thither rumour is
seen to hasten; afar off the blue smoke rises in the fields.
Is not Pindus beneath my feet? I hear the sweet music of the pure
sisters. Parnassian fire burns within me. I hasten to the sacred band.
They offer me to taste of the healing stream. “Drink, and forget thy
troubles; bathe thine eyes in Castilian dew; stretch them forth over
the deserts and hills, and fix them on the spot where the bright light
of day is seen rising out of the dark shadows of night.”
As a ship, amidst the angry waves which seek to overwhelm her,
sails on triumphantly, and appears to threaten should they dare to
impede her course; grey froth foams around her, her track is
imprinted in the deep; thus crowds of Tartars rush towards and
surround the Russian forces, but in vain; powerless and breathless
they fall.
The love of their country nerves the souls and arms of Russia’s
sons; eager are all to shed their blood; the raging tumult but inspires
them with fresh courage; as the lion, by the fearful glare of his eyes,
drives before him whole herds of wolves, their sharp teeth vainly
showing; the woods and shores tremble at his roar; with his tail he
lashes the sand and dust; with his strength he beats down every
opposing force.
Hear I not the deafening din of Ætna’s forges? Roars not the brass
within, bubbling with boiling sulphur? Is not Hell striving to burst its
chains, and ope its jaws? The posterity of the rejected deity have
filled the mountain track with fire, and hurl down flame and liquid
metal; but neither foe nor nature can withstand the burning ardour of
our people.
Send away thy hordes, Stamboul, beyond these mountains, where
the fiery elements vomit forth smoke, ashes, flame and death;
beyond the Tigris, whose strong waves drag after them the huge
stones from the shores, but the world holds no impediment to arrest
the eagle in his flight. To him the waters, the woods, the mountains,
the precipices and the silent deserts are but as level paths; wherever
the wind can blow, thither he can wing his way.
Let the earth be all motion like the sea; let myriads oppose; let
thickest smoke darken the universe; let the Moldavian mountains
swim in blood; such cannot harm you, O Russians! whose safety
Fate itself has decreed for the sake of the blessed Anna. Already in
her course your zeal has led you in triumph against the Tartars, and
wide is the prospect before you.
The parting ray of daylight falls gently into the waters, and leaves
the fight to the night fires; Murza has fallen on his long shadow; in
him the light and soul of the infidels pass from them. A wolf issues
from the thick forest and rushes on the pale carcass, even in the
Turkish camp. A dying Tartar, raising his eyes towards the evening
star for the last time, “Hide,” he feebly cries, “thy purple light, and
with it the shame of Mahomet; descend quickly with the sun into the
sea.”
Why is my soul thus oppressed with terror? My veins grow stiff, my
heart aches. Strange tones meet mine ear; a howling noise seems
passing through the desert, the woods and the air. The wild beast
has taken refuge in its cavern; the gates of heaven are opened; a
cloud has spread itself over the army; suddenly a countenance of fire
shines forth: a hero appears chasing his enemies before him, his
sword all red with blood.
Is it not he who, near the rapid waters of the Don, destroyed the
walls raised to check the Russians’ progress? And the Persians in
their arid deserts, was it not by his arms they fell? Thus looked he on
his foes when he approached the Gothic shores; thus lifted he his
powerful arm; thus swiftly his proud horse galloped over those fields
where we see the morning star arise.
Loud thunder rattles around him; the plains and the forests tremble
at the approach of Peter, who by his side so sternly looks towards
the south, girt round with dreadful thunder! Is it not the conqueror of
Kazán? It is he, ye Caspian waters, who humbled the proud Selim,
and strewed the desert with the dead bodies of his enemies.
Thus the heroes addressed each other: “Not in vain we toiled; not
fruitless our united efforts, that the whole world should stand in awe
of Russia. By the aid of our arms, our boundaries have been
widened on the north, on the west, and on the east. Anna now
triumphs in the south; she has crowned her troops with victory.” The
cloud has passed, and the heroes within it: the eye no longer sees,
the ear no longer hears them.
The blood of the Tartar has purpled the river; he dares not again
venture to the fight; he seeks refuge in the desert; and, forgetful alike
of the sword, the camp, his own shame, he pictures to himself his
friends weltering in their blood; the waving of the light leaf startles
him like whizzing balls as they fly through the air.
The shouts of the victors echo through the woods and valleys; but
the wretch who abandons the fight dreads his own shadow. The
moon, a witness to her children’s flight, shares in their shame, and,
deeply reddening, hides her face in darkness. Fame flies through the
gloom of the night; her trumpet proclaims to the universe the terrible
might of Russia.
The Danube rushes into the sea, and, roaring in echo to the
acclamations of the conquerors, dashes its furious waves against the
Turk, who seeks to hide his shame behind its waters. To and fro he
runs like a wild beast wounded, and, despairing, he thinks that for
the last time he moves his steps; the earth disdains to support the
wretch who could not guard her; darkness and fear confuse his path.
Where is now the boasting Stamboul?—thy courage, thy obstinacy
in the fight, thy malice against the nations of the North, thy contempt
of our strength? No sooner hadst thou commanded thy hordes to
advance than thou thoughtest to conquer; cruelly thy janissary
vented his rage; like a tiger he rushed upon the Muscovite troop.
Soon the boaster fell; he weltered in his own blood.
Water with your tears, children of Hagar, the foot which has
trampled you down! Kiss ye that hand whose bloody sword brought
fear before your eyes. Anna’s stern glance is quick to grant relief to
those who seek it; it shines forth, for the storm has passed away.
She sees you prostrate before her; fervent in affection towards her
own subjects, to her enemies she proffers punishment or pardon.
Already has the golden finger of the morning star withdrawn the
starry curtain of night; a horse fleet as the wind, his rider Phœbus in
the full blaze of his glory, issues from the east, his nostrils breathing
sparks of radiant light. Phœbus shakes his fiery head, dwells in
wonder on the glorious work and exclaims: “Few such victories have
I witnessed, long as I have continued to give light to the world, long
as the circle of ages has revolved.”
Like as the serpent rolls itself up, hissing and hiding its sting under
a rock, when the eagle, soaring into those regions where the winds
blow not, above lightnings, snow and tempests, looks down upon the
beasts, the fishes and the reptiles beneath him, thus Khotín trembles
before the eagle of Russia; thus its inhabitants crouch within its
walls.
What led your Tartar race, Kalchák,[135] to bend so promptly
beneath the Russian power? to deliver up the keys of your town in
token of submission, evading thus disgrace more deep? The
clemency of Anna, of her who is ever ready to raise the suppliant.
Where flows the Vistula, and where the glorious Rhine, even there
her olive-trees have flourished; there have the proud hearts of her
defeated foes yielded up their lives.
Joyful are the lands which have thrown off the cruel yoke; the
burden the Turks had laid on them is thrown back upon themselves!
The barbarian hands which held them in restraint now wear their
chains in captivity; and the feet are shackled which trampled down
the field of the stranger, and drove away his flocks.
Not thus alone must thou be humbled; not all thy punishment this,
O Turkey! A far greater hast thou merited, for thou didst refuse to let
us live in peace. Still does the rage of your haughty souls forbid you
to bend before Anna? Where would ye hide yourselves from her?
Damascus, Cairo, Aleppo, shall flame! Crete shall be surrounded
with her fleets; Euphrates shall be dyed with your blood.
A sudden and universal change! A dazzling vision passes before
my eyes, and with heaven’s purest beams outshines the brightness
of the day! The voices of heroes strike upon my ear. Anna’s joyous
band, in glory clad, bear up eternity beyond the starry orbs, and
Truth with her golden pen traces her glorious deeds in that book
which is not reached by corruption.
Russia thrives like a young lily under Anna’s care; within China’s
distant walls she is honoured, and every corner of the earth is filled
with her subjects’ glory. Happy art thou, O my country, under the rule
of thy Empress! Bright the laurels thou hast gained by this triumph.
Fear not the ills of war; they fly from the land where Anna is glorified
by her people. Malicious envy may pour forth her poison, she may
gnaw her tongue in rage. Our joy heeds it not.
The robbers who, from beyond the Dniester, came to plunder the
fields of the Cossacks, are driven back, scattered like dust; no longer
dare they venture on that soil where the fruits of the earth and the
blessings of peace together flourish. In safety the merchant pursues
his traffic, and the mariner sees a boundary to the waves; no
obstacles impede his course. The old and the young are happy; he
who wished for the hour of death now prays for lengthened life; his
heart is gladdened by his country’s triumphs.
The shepherd drives his flocks into the meadow, and enters the
forest without fear; there, with his friend who tends his sheep, he
sings the song of joy, his theme the bravery of the soldier; he
blesses the passing moments of his life, and implores endless peace
on the spot where he sleeps in quiet. Thus, in the simple sincerity of
his heart, he glorifies her who shields him from his enemies.
O thou great Empress! The love of Russia, the dread of thy foes,
the heroine of the northern world, the hope, the joy, the goddess of
the shores of seven wide seas, thou shinest in the cloudless lights of
goodness and beneficence. Forgive thy slave that he has chosen thy
glory for his lay, and that his rugged verse, in token of submission to
thy rule, has thus dared to attempt to magnify thy power.—Given in
F. R. Grahame’s The Progress of Science, Art and Literature in
Russia.
MORNING MEDITATIONS
O’er the wide earth yon torch of heavenly light

Its splendour spreads and God’s proud works unveils;
My soul, enraptured at the marvellous sight,
Unwonted peace, and joy, and wonder feels,
And with uplifted thoughts of ecstasy
Exclaims, “How great must their Creator be!”
Or, if a mortal’s power could stretch so high—

If mortal sight could reach that glorious sun,
And look undazzled at its majesty,
’T would seem a fiery ocean burning on
From time’s first birth, whose ever-flaming ray
Could ne’er extinguished be by time’s decay.
There waves of fire ’gainst waves of fire are dashing,

And know no bounds; there hurricanes of flame,
As if in everlasting combat flashing,
Roar with a fury which no time can tame:
There molten mountains boil like ocean-waves,
And rain in burning streams the welkin laves.
But in Thy presence all is but a spark,

A little spark: that wondrous orb was lighted
By Thy own hand, the dreary and the dark
Pathway of man to cheer—of man benighted;
To guide the march of seasons in their way,
And place us in a paradise of day.
Dull Night her sceptre sways o’er plains and hills,

O’er the dark forest and the foaming sea;
Thy wondrous energy all nature fills,
And leads our thoughts, and leads our hopes to Thee.
“How great is God!” a million tongues repeat,
And million tongues re-echo, “God, how great!”
But now again the day star bursts the gloom,
Scattering its sunshine o’er the opening sky;
Thy eye, that pierces even through the tomb,
Has chased the clouds, has bid the vapours fly;
And smiles of light, descending from above,
Bathe all the universe with joy and love.
From Sir John Bowring’s Specimens of the Russian Poets.
EVENING MEDITATIONS
ON SEEING THE AURORA BOREALIS
The day retires, the mists of night are spread

Slowly o’er nature, darkening as they rise;
The gloomy clouds are gathering round our heads,
And twilight’s latest glimmering gently dies:
The stars awake in heaven’s abyss of blue;
Say, who can count them?—Who can sound it?—Who?
Even as a sand in the majestic sea,

A diamond-atom on a hill of snow,
A spark amidst a Hecla’s majesty,
An unseen mote where maddened whirlwinds blow,
And I midst scenes like these—the mighty thought
O’erwhelms me—I am nought, or less than nought.
And science tells me that each twinkling star

That smiles above us is a peopled sphere,
Or central sun, diffusing light afar;
A link of nature’s chain:—and there, even there,
The Godhead shines displayed—in love and light,
Creating wisdom—all-directing might.
Where are thy secret laws, O Nature, where?
In wintry realms thy dazzling torches blaze,
And from thy icebergs streams of glory there
Are poured, while other suns their splendent race
In glory run: from frozen seas what ray
Of brightness?—From yon realms of night what day?
Philosopher, whose penetrating eye

Reads nature’s deepest secrets, open now
This all-inexplicable mystery:
Why do earth’s darkest, coldest regions glow
With lights like these?—Oh, tell us, knowing one,
For thou dost count the stars, and weigh the sun!
Whence are these varied lamps all lighted round?—

Whence all the horizon’s glowing fire?—The heaven
Is splendent as with lightning—but no sound
Of thunder—all as calm as gentlest even;
And winter’s midnight is as bright, as gay,
As the fair noontide of a summer’s day.
What stores of fire are these, what magazine,

Whence God from grossest darkness light supplies?
What wondrous fabric which the mountains screen,
Whose bursting flames above those mountains rise;
Where rattling winds disturb the mighty ocean,
And the proud waves roll with eternal motion?
Vain is the inquiry—all is darkness, doubt:

This earth is one vast mystery to man.
First find the secrets of this planet out,
Then other planets, other systems scan!
Nature is veiled from thee, presuming clod!
And what canst thou conceive of Nature’s God?
—From Sir John Bowring’s Specimens of the Russian Poets.

FOOTNOTES:
[134] To his patron, upon his having expressed his fear that
Lomonósov would lose his zeal for the sciences when he
received the gift of an estate from the Empress.
[135] Kalchák-pasha was the commander of Khotín.
Alexander Petróvich Sumarókov. (1718-1777.)
Sumarókov is the first litterateur of Russia, that is, the first
man to regard literature as a profession, independently of an
official position. After graduating from the military school, in
1740, he served for a while under some military commanders,
but devoted all his leisure time to writing poetry according to
the rules laid down by Tredyakóvski. There was no species of
poetical literature in which he did not try himself and did not
produce prolifically. He has left odes, eulogies, fables, satires
and dramas. In many of these he broke virgin soil in Russia,
and in his unexampled conceit he was not slow to proclaim
his highest deserts: “What Athens has seen and Paris now
sees, after a long period of transition, that you, O Russia,
have perceived at once by my efforts.” In spite of his
mediocrity and acquaintance with only the pseudo-classic
French style (for he disdained all serious study of antiquity),
Sumarókov was highly valued in his day, and his example has
done much to advance Russian literature. In 1756 the
Russian Theatre was created by a decree of the Senate, and
Sumarókov was chosen as its first director. To fill his
repertoire, he was compelled to write plays himself, and he
produced them with astounding facility. His best drama is
probably The False Demetrius, though there is little historical
truth in it. In 1761 he issued the first independent journal, The
Industrious Bee, which, however, was filled mainly with his
own writings. Sumarókov’s influence on Russian letters lasted
up to the time of Púshkin, though Karamzín was the first to
doubt his greatness.
Sumarókov’s The False Demetrius has been translated into
English: Demetrius the Impostor; a tragedy [in five acts and in
prose], translated from the Russian, London, 1806.
Act II., Scene 7, is also given in C. E. Turner’s Studies in
Russian Literature, and, the same, in Fraser’s Magazine,
1877.
THE FALSE DEMETRIUS
ACT II., SCENE 1. GEORGE AND XENIA
Xenia. Blessed in the world is that purple-bearing man who does

not suppress the freedom of our souls, who elevates himself for
society’s good, and with leniency adorns his royal dignity, who gives
his subjects auspicious days, and whom evildoers alone have cause
to fear.
George. O thou sad Kremlin! Thou art this day a witness how that
virtue was cast down from the throne. Languishing Moscow trembles
in despair; happiness flees its walls in sorrow; the bright days seem
darker than dense night; the fair groves about Moscow are clad in
sombreness. When the solemn bell rings in the city, it seems to us
that it repeats the city’s general groan and that it proclaims our
Church’s fall through the machinations of the pope. O Lord, remove
that terror from the Russians! Already the report flies through the
square that Clement has promised reward in heaven to the rebels,
the foes of our country’s city, and that he in advance forgives them
all their sins. Moscow will suffer as suffers the New World! There the
papists have stained with blood the earth, have slaughtered its
inhabitants, have plundered the surviving, have burnt the innocent in
their own land, holding the cross in one hand, in the other—the
bloody sword. What has happened to them in their dire fate will now,
O Russia, be done to you!
Xenia. All powers of evil,—Demetrius, Clement, Hell,—will not
efface you from my heart! O Heaven, remove the fury of the papal
power, and with it Xenia’s unbearable distress, that Russia might
raise its head, and I might be my sweetheart’s wife! Grant us to see
the monarch on the throne, subject to truth, not arbitrary will! All truth
has withered; the tyrant’s law is only what he wants; but on the
happiness of their subjects are based the laws of righteous kings, for
their immortal glory. God’s vicar is to be the Tsar. Strike me, destroy
me, merciless Tsar! Megæra has swept you from Tartarus, the
Caucasus has borne you, Hyrcania has nurtured you. The heretic,
with his crowd of slaves, will, cursing, oust the bodies of saintly men
from their graves. Their names will in Russia for ever perish, and the
houses of God will in Moscow be deserted. Nation, tear the crown
from the creator of dire torments; hasten, wrest the sceptre from the
barbarian’s hands!
SCENE 7
Demetrius (alone). My crown lies not firmly upon my head, and the
end of my greatness is at hand. Each moment I expect a sudden
change. O Kremlin’s walls that frighten me! Meseems each hour you
announce to me: “Villain, you are a foe, a foe to us and the whole
land!” The citizens proclaim: “You have ruined us!” And the temples
weep: “We are stained with blood!” The fair places about Moscow
are deserted, and Hell from its abyss has oped its jaws at me; I see
the sombre steps that lead to the infernal regions, and the tormented
shades of Tartarus: I am already in Gehenna, and burn in the flame; I
cast my glance to heaven, and see the celestial regions: there are
good kings in all the beauty of their natures, and angels besprinkle
them with dew of paradise; but what hope have I to-day in my
despair? I shall be tormented in eternity even as I suffer now. I am
not a crowned potentate in a magnificent city, but an evil malefactor,
in hell tormented. I perish, dragging a multitude of the people to
destruction. Flee, tyrant, flee! From whom?—From myself, for I see
no one else before me. Run! But whither? Your hell is ever with you!
The assassin is here, run! But I am that assassin! I tremble before
myself, and before my shade. I shall avenge myself! On whom?
Myself. Do I hate myself? I love myself! For what? I see it not. All cry
against me: rapine, unfair justice, all terrible things,—they cry
together against me. I live to the misfortune, shall die to the fortune
of my nearest. The fate of men, the lowliest, I envy: even the
mendicant is sometimes happy in his poverty. But I rule here,—and
am always tormented. Endure and perish, having ascended the
throne by deceit! Drive, and be driven! Live and die a tyrant!
INSTRUCTION TO A SON
Perceiving his tearful end near at hand, a father thus instructed his
beloved, only begotten son:
“My son, beloved son! I am old to-day; my mind grows dull, my
fervour is all gone; I am preparing to go before the Judge, and shall
soon pass to eternity, the immeasurable abode of mortals. So I wish
to tell you how you may live, and to show you the road to happiness.
You will travel over a slippery path: though all in the world is vanity,
yet why should one disdain happiness in life? Our whole mind ought
to be bent upon obtaining it, and our endeavour should be to get all
we need.
“Give up that chimera which men call honour; of what good is it
when you have nothing to eat? It is impossible to get along in
commerce without cheating, and in poverty without dishonesty and
theft. By hook and by crook I have scraped together a fortune for
you; now, if you should squander it all, I shall have sold my soul in
vain. Whenever I think of that, my rest is gone.
“Increase your income, keep indolence from your heart, and keep
your money against an evil day. Steal, if you can steal, but do it
secretly,—by all means increase your income every year! The eye is
not satisfied with mere looking on. If you can cheat, cheat artfully, for
’tis a shame to be caught in the act, and it often leads to the gallows.
Make no acquaintances for the mere sake of knowing them, but put
your spoon there where the jam is thickest! Revere the rich, to get
your tribute from them. Never tire praising them with condescension;
but if they be distinguished people, subdue them by creeping!
“Be humble with all men, and simulate! If a mighty person chides
anyone, together with the mighty chide him! Praise those whom the
powerful praise, and belittle those they belittle! Keep your eyes wide
open and watch whom great boyárs are angry with.
“If you walk upon the straight road, you will find no fortune. Swim
there where favourable winds carry you! Against men whom the
people honour speak not a word; and let your soul be ever ready to
thank them, though you receive nothing from them! Endeavour to
speak like them. Whatever the puissant man says are sacred words;
never contradict him, for you are a small man! If he say red of that
which is black, say too: ‘’Tis rather red!’ Before low-born men rave
like a devil; for if you do not, they will forget who you are, and will not
respect you: the common people honour those who are haughty. But
before the high-born leap like a frog, and remember that a farthing is
as nothing in comparison with a rouble. Big souls have they, but we,
my beloved son, have only little souls! Be profuse in thanks, if you
expect some favour from your benefactor; spare your thanks where
you have nothing to gain, for your grateful spirit will be lost.
“Do yourself no injury, and remain honest to yourself, loving
yourself most sincerely! Do no injury to yourself, but for others have
only appearances, and remember how little wisdom there is in the
world, and how many fools. Satisfy them with empty words: honour
yourself with your heart, but others with your lips, for you will have to
pay no toll for fondling them. Let others think that you place yourself
much lower than them, and that you have little regard for yourself;
but do not forget that your shirt is nearer to your body than your
caftan!
“I will allow you to play cards, provided you know how to handle
them. A game without cunning has no interest, and playing you must
not sacrifice yourself to others. Whatever game you play, my son,
remember not to be always honest!—Have contempt for peasants,
seeing them below your feet, but let your lips proclaim the puissant
as gods, and speak no surly word to them. But love none of them, no
matter what their worth, though their deeds be trumpeted through the
subsolar world! Give bribes, and yourself accept them! When there
are no witnesses, steal and cheat as much as you please, but be
wary with your misdoings in presence of witnesses! Change the
good that there is in people into evil, and never say a good word of
another! For what are you to gain from praising them? Indeed, their
virtues put you only in a bad light. Go not out of the way to serve
another, where there is no gain for you.
“Hate the learned, and despise the ignorant, and ever keep your
thoughts fresh for your own advantage! Above all, beware of getting
into the satire of impudent scribblers! Disturb and break the ties of
families, friendship and marriage, for ’tis more convenient to fish in
muddy waters. Know no love, family nor friends, for ever holding
yourself alone in mind! Deceive your friends, and let them suffer
through you sorrow and misfortune, if you are the winner thereby!
Garner your fruits wherever you can! There are some who foolishly
call it dishonest to bring woes to your friends, but they do not see
that duty teaches me only to love myself, and that it is not at all
dishonourable when necessity demands that others perish: it is
contrary to nature not to love yourself best. Let misfortune befall my
country, let it go to the nethermost regions; let everything that is not
mine be ruined,—provided I have peace.
“Forget not my rules! I have left you my fortune and my wisdom.
Live, my son, live as your father has lived!”
He had barely uttered these words, when he was struck by
lightning, and he departed from his child and home; and the soul that
had for so long been disseminating poison flew out of the body and
took its flight to hell.
TO THE CORRUPTERS OF LANGUAGE
In a strange land there lived a dog in a thick forest. He deemed his

citizens to be uncultured, so passed his days in the country of the
wolves and bears. The dog no longer barked, but growled like a
bear, and sang the songs of wolves. When he returned to the dogs,
he out of reason adorned his native tongue. He mixed the growl of
bears and howl of wolves into his bark, and began to speak
unintelligibly to dogs. The dogs said: “We need not your new-fangled
music—you only spoil our language with it”; and they began to bite
him, until they killed him.
I have read the tombstone of that dog: “Never disdain your native
speech, and introduce into it nothing foreign, but adorn yourself with
your own beauty.”
THE HELPFUL GNAT
Six fine horses were pulling an immense carriage. The carriage

would have been a heavy one without any people in it; but this
enormous carriage was filled with people, and was in size a
haystack. It slowly moved along, travelling not over boards, but
carrying the master and his wife through heavy sand, in which it
finally stuck fast. The horses’ strength gave out; the lackeys on the
footboard, to save the horses and wheels, stepped down; but yet the
rick did not move. The driver called to the horses: “Get up, get up!”
and struck them with the whip, as if it was their guilt. He struck them
hard and yelled and yelled, until he grew hoarse, while the horses
were covered with foam, and steam rose from them.
A gnat flew by, perceived the plight of the carriage, and was
anxious to do it a good turn, and help it out. So it began to goad the
horses and the driver, to make the driver on his box more agile, and
that the horses might draw with more vim. Now it stung the driver,
now the horses; it perspired, worked with might and main, but all in
vain; it buzzed and buzzed, but all its songs were useless; there was
not the slightest sign that the carriage would move; so after having
laboured hard, it flew away. In the meanwhile, the horses had rested
themselves, and dragged the huge mass out of the sand. The gnat
saw the carriage from afar, and said: “How foolish it all was of me to
abandon the carriage just as it was to move! ’Tis true I have worked
hard in the sand, but at least I have moved the carriage.”
FOUR ANSWERS
You ask me, my friend, what I would do: (1) if I were a small man
and a small gentleman; (2) if I were a great man and a small
gentleman; (3) if I were a great man and a great gentleman; (4) if I
were a small man and a great gentleman. To the first question I
answer: I should use all my endeavour to become acquainted in the
houses of distinguished people and men of power; I would not allow
a single holiday to pass, without making the round of the city, in
order to give the compliments of the season; I would walk on tiptoes
in the antechambers of the mighty, and would treat their valets to
tobacco; I would learn to play all kinds of games, for when you play
cards you can sit down shoulder to shoulder with the most
distinguished people, and then bend over to them and say in a low

Current Surgical Therapy 14E Jan 23 2023 - 0323796834 - Elsevier 14Th Edition John L Cameron Full Chapter

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Current Surgical Therapy 14E Jan 23 2023 - 0323796834 - Elsevier 14Th Edition John L Cameron Full Chapter

Uploaded by

Copyright:

Available Formats

Current Surgical Therapy, 14e (Jan 23,

Unlock your eBook today.

It’s that easy! Place Peel Off

For technical assistance:

CURRENT SURGICAL THERAPY, FOURTEENTH EDITION ISBN: 978-0-323-79683-5

Content Strategist: Jessica McCool

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Ariane M. Abcarian, MD David B. Adams, MD Nita Ahuja, MD, MBA, FACS

Katherine Albutt, MD, MPH Lauren Antognoli, MD Adrian Barbul, MD

Solange Bayard, MD Shivanand Bomman, MD Stephen R. Broderick, MD, MPHS

Jordan M. Cloyd, MD Chris Cribari, MD, FACS Whitney A. Davidson, MD

Jeremy Goverman, MD Traci M. Grucz, PharmD, BCCCP Jafar Haghshenas, DO

Andrew Harris, MD Joseph M. Herman, MD, MSc, MSHCM Michael G. House, MD

Ammar A. Javed, MD Anthony N. Kalloo, MD Qingwen Kawaji, MD, ScM

Hamza Khan, MD Karen M. Kim, MD, MS Richard Kozarek, MD

Daniel A. Laheru, MD Adam S. Levin, MD Laurie Anne Loiacono, MD

Thomas E. MacGillivray, MD Michele Ann Manahan, MD, MBA, Matthew J. Martin, MD

Mary C. McCarthy, MD Raman Menon, MD Peter Muscarella II, MD

Colleen M. Ryan, MD Michael G. Sarr, MD Todd R. Schlachter, MD

Jane Stevens, MD, MSN Visakha Suresh, MD Kenneth K.Tanabe, MD

Kelly H.Tunder, DO Eric G. Weiss, MD

Heather L.Yeo, MD, MHS Martha A. Zeiger, MD Maaz K. Zuberi, MD

The American Board of Surgery

Esophagus Management of Zollinger-Ellison Syndrome 92

New Approaches to Gastroesophageal Reflux Disease Familial Gastric Cancer 107

Management of Paraesophageal Hernia Repair 29 Management of Morbid Obesity 123

Management of Zenker’s Diverticulum 34

Management of Esophageal Cancer 54 Use of Strictureplasty in Crohn’s Disease 138

Multimodality Therapy in Esophageal Cancer 59 Management of Small Bowel Tumors 144

Use of Esophageal Stents 65 Small Bowel Diverticulosis 149

Management of Enterocutaneous Fistulas 166 Management of Colorectal Polyps 263

Large Bowel Appendicitis: Diagnosis and Management 281

Management of Diverticular Disease of the Colon 181 Anorectal

Surgical Management of the Polyposis Syndromes 244

Management of Benign Liver Tumors 368 Management of Acute Cholangitis 481

Management of Hepatic Abscess 396 Biomarker Guided Surgical Management of Hepatobiliary

Management of Gallstone Ileus 521

Transjugular Intrahepatic Portosystemic Shunt 434 Pancreas

Proper Use of Cholecystotomy Tubes 467 Management of Chronic Pancreatitis 582

Neoadjuvant and Adjuvant Therapy for Pancreatic Breast

Spleen Surgical Management of the Axilla 756

Hernia Advances in Neoadjuvant and Adjuvant Therapy for Early-

A Surgeon’s Practical Guide to Breast Imaging 782

Necrotizing Skin and Soft Tissue Infections 946

Surgical Management of Secondary and Tertiary Vascular Surgery

Management of Ruptured Abdominal Aortic Atherosclerotic Renal Artery Stenosis 1126

Treatment of Claudication 1097 Trauma and Emergency Care

Management of Traumatic Brain Injury 1257 Management of Vascular Injuries 1393

Injuries to the Small and Large Bowel 1314

Use of Opioids in the Postoperative Period 1501 Tracheostomy 1548

The American Board CONTENT

T he esophagus is a muscular, tubelike structure located in the

Water-perfused catheter with

Bolus movement Bolus movement

FIG. 4 Impedance testing showing (A) normal

Dear Sir, Iván Ivánovich:—I received yesterday your Excellency’s

O’er the wide earth yon torch of heavenly light

Or, if a mortal’s power could stretch so high—

There waves of fire ’gainst waves of fire are dashing,

But in Thy presence all is but a spark,

Dull Night her sceptre sways o’er plains and hills,

From Sir John Bowring’s Specimens of the Russian Poets.

The day retires, the mists of night are spread

CURRENT SURGICAL THERAPY, FOURTEENTH EDITION ISBN: 978-0-323-79683-5