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 TEXTBOOK OF
SURGICAL GASTROENTEROLOGY
 TEXTBOOK OF
SURGICAL GASTROENTEROLOGY
2 VOLUMES

Editor
PK Mishra
MS PhD
Professor
Govind Ballabh Pant Institute of
Postgraduate Medical Education and
Research
New Delhi, India

Foreword
Samiran Nundy

The Health Sciences Publisher

New Delhi | London | Philadelphia | Panama
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Textbook of Surgical Gastroenterology (2 Volumes)

First Edition: 2016
ISBN: 978-93-5152-998-9
Printed at
Dedicated to
My Parents
 Contributors
Abhijit Chandra MS MCh Anshuman Ray MD (Anatomy) Ashwin Rammohan MS FRCS MCh
Professor and Head Associate Professor Surgical Gastroenterolgy
Department of Surgical Gastroenterology Department of Anatomy Surgical Fellow in Liver Transplantation
King George’s Medical University RG Kar Medical College and Hospital Institute of Liver Surgery and Transplantation
Lucknow, Uttar Pradesh, India Kolkata, West Bengal, India National Foundation for Liver Research
Global Hospital, Chennai, Tamil Nadu, India
Adarsh Chaudhary MS Anubhav Vindal MS
Chairman Professor Asit Arora MS MCh
Department of Gastrointestinal Surgery Department of Surgery Assistent Professor
Gastrointestinal Oncology and Lok Nayak Jai Prakash Narayan Hospital and Institute of Liver and Biliary Sciences (ILBS)
Bariatric Surgery Maulana Azad Medical College
New Delhi, India
Medanta Institute of Digestive and New Delhi, India
Hepatobiliary Sciences Atul K Sharma (AVSM) MS DNB
Medanta—The Medicity Anuj Sharma (VSM)
MS DNB MNAMS DNB (GI Surg) FAIS FICS
Senior Consultant (Gastrointestinal)
Gurgaon, Haryana, India
Liver and Pancreas Transplant Fellowship Laparoscopic and Bariatric Surgery
Ahmad Jan MRCS( Ed) ChM (Ed) (UCLA) Chairman
Asian Bariatrics R and R Hospital Institute of Gastrointestinal Sciences
Ahmedabad, Gujarat, India Armed Forces, New Delhi, India Alchemist Hospitals
Ajit Sewkani MS DNB Panchkula, Chandigarh Tricity, India
Anurag Mishra MS DNB MNAMS
Associate Professor Asistant Professor Atul Sharma MD DM FRCPC
Department of Surgical Gastroenterology Lok Nayak Jai Prakash Narayan Hospital and Department of Internal Medicine
and Clinical Nutrition Maulana Azad Medical College Section of Hematology/Oncology
Bhopal Memorial Hospital and Research Centre New Delhi, India
Bhopal, Madhya Pradesh, India University of Manitoba and Professor of
Archana Thakur MD Medical Oncology
AK Sarada MS FACS FICS FAIS Director Professor Dr BR Ambedkar, Institute—Rotary Cancer
Director Professor (Surgery) Department of Microbiology Hospital (Dr BRA-IRCH)
Lok Nayak Jai Prakash Narayan Hospital and Govind Ballabh Pant Institute of Postgraduate All India Institute of Medical Sciences (AIIMS)
Maulana Azad Medical College Medical Education and Research New Delhi, India
New Delhi, India New Delhi, India
AK Singh MS DNB Avinash Supe MS FICS DNBE FCPS DHA PGDME
Arun Kumar Rathi MDRT MHPE (UIC) FIAGES FMAS FAIS Dean
Senior Advisor Director Professor
Gastrointestinal Surgery Professor (GI Surgery)
Department of Radiotherapy and Oncology
Army Hospital (R and R) GS Medical College
Lok Nayak Jai Prakash Narayan Hospital and
New Delhi, India KEM Hospital
Maulana Azad Medical College
New Delhi, India Mumbai, Maharashtra, India
Amar Mukund
Associate Professor Baljit Singh MD FICA
Arvind Kumar MS
Interventional Radiology Director Professor
Director
Institute of Liver and Biliary Sciences (ILBS) Department of Anesthesiology and
Institute of Robotic Surgery
New Delhi, India
Sir Ganga Ram Hospital Intensive Care
Ankur Arora MD DNB FRCR EDiR New Delhi, India Govind Ballabh Pant Institute of Postgraduate
Associate Professor (Radiology) Medical Education and Research
AS Soin MS FRCS(Glos) FRCS (Edin)
Institute of Liver and Biliary Sciences New Delhi, India
Chief
New Delhi, India
Medanta Institute of Liver Transplant and Belal Bin Asaf MS
Ankur Garg MS MCh HPB Regenerative Medicine Consultant
Surgery and Liver Transplantation Medanta—The Medicity
Institute of Robotic Surgery
Institute of Liver and Biliary Sciences Gurgaon, Haryana, India
Sir Ganga Ram Hospital
New Delhi, India
Ashok Kumar MS MCh FRCS FACS FAMS New Delhi, India
Ankur Goyal MD Professor
Assistant Professor Departments of Surgical Gastroenterology Benjamin Perakath MS FRCS (G)
Department of Radiology Sanjay Gandhi Postgraduate Institute of Consultant
All India Institute of Medical Sciences (AIIMS) Medical Sciences (SGPGIMS) Dr Grays’s Hospital
New Delhi, India Lucknow, Uttar Pradesh, India Elgin, Scotland, UK
viii Textbook of Surgical Gastroenterology

Bhawna Sirohi Debasis Mishra MBBS MD DM Harpal S Dhaliwal MD DM

Consultant Medical Oncologist-GI and Breast Department of Gatroenterology Department of Gastroenterology
Cancers IMS and SUM Hospital Postgraduate Institute of Medical Education
Head of Medical Oncology Bhubaneswar, Odisha, India and Research
Mazumdar Shaw Cancer Centre Chandigarh, India
Narayana Health Deborshi Sharma MS MRCS Edin
Bengaluru, Karnataka, India Department of Surgery Harsh Shah MS MCh
Lady Hardinge Medical College and Consultant Gastrointestinal Surgery and Liver
Biju Pottakat MS MCh Associated Transplant
Professor of Surgical Gastroenterology Ram Manohar Lohia Hospital Gangaram Institute of Postgraduate Medical
Jawaharlal Institute of Postgraduate New Delhi, India Education and Research (GRIPMER)
Medical Education and Research (JIPMER) New Delhi, India
Puducherry, India Deepak Govil MS PhD
Senior Consultant (GI Surgery and Oncology)
Himanshu Yadav
BK Jain MS FICS MNAMS Indraprastha Appollo Hospital
Department of Surgical Gastronterology
Professor of Surgery and Medical New Delhi, India
Sanjay Gandhi Postgraduate Institute of
Superintendent
DK Sharma MS MCh Medical Sciences (SGPGIMS)
Guru Teg Bahadur (GTB) Hospital
Head Lucknow, Uttar Pradesh, India
New Delhi, India
Department of Surgery
Brundavan Nahak MS Mch Udaipur, Rajasthan, India Hirdaya H Nag MS
Consultant Surgical Gastroenterologist Professor of Surgical Gastroenterology
Kalinga Hospital Dronacharya Routh Govind Ballabh Pant Institute of
Bhubaneshwar, Odisha, India Consultant GI Surgeon Postgraduate Medical Education and
Command Hospital Research
C Palanivelu West Bengal, India New Delhi, India
MS MCh DNB DSc PhD FACS FRCS (Hon) Ed
Director Durgatosh Pandey MS MCh Ho-Seong Han MD
Gem Institute of Gastroenterology and Consultant Department of Surgery
Laparoscopy Thoracic and Surgical Oncology Seoul National University
Chairman Max Superspecialty Hospital Bundang Hospital
Gem Hospital and Research Centre New Delhi, India
Seongnam, Korea
Coimbatore, Tamil Nadu, India George Karimunadackal MCh MRCS
Professor Indira Malik MD
Chintamani Godbole Assistant Professor
Senior Resident Tata Memorial Hospital
Mumbai, Maharashtra, India Department of Anesthesiology and
Department of Surgical Gastroenterology Intensive Care
Jaslok Hospital and Research Centre Girish K Pande Govind Ballabh Pant Institute of
Mumbai, Maharashtra, India MBBS MS PhD FRCS Eng FRCS Edin FRACS Postgraduate Medical Education and
Chirag Shah Specialist HPB and Upper GI Surgery Research
Department of Gastroenterology Launceston General Hospital New Delhi, India
Seth GS Medical College and King Edward Charles Street, Launceston, Tasmania 7250,
Australia Jagdish Chander MS FICLS FICS
Memorial (KEM) Hospital
Director
Mumbai, Maharashtra, India Gomathy Narasimhan MS ASTS Fellowship Institute of Minimal Access Surgery
CS Naidu Senior Consultant Jaypee Hospital
Professor and Head Transplant Surgeon Institute of Liver Disease Noida, Uttar Pradesh, India
Department of Surgery and Transplantation
AFMC, Pune, Maharashtra, India Global Hospital and Health City Jayanth Reddy MCh MRCS
India and National Foundation for Liver Associate Consultant of Surgical
CS Pramesh MS FRCS Research, India Gastroenterology
Chief, Division of Thoracic Surgery Minimal Access and Bariatric Surgery (BGS)
Gourdas Choudhuri
Tata Memorial Hospital Global Hospital
MD DM FAMS FICP FACG FRCPI
Mumbai, Maharashtra, India Bengaluru, Karnataka, India
Director and Head
Cyriac Abby Philips MD DM Fellow Department of Gastroenterology and
JK Banerjee MBBS MS DNB
Hepatology Hepatobiliary Sciences
Post Doctoral Training in GI Surgery
Institute of Liver and Biliary Sciences (ILBS) Fortis Memorial Research Institute
Command Hospital
New Delhi, India Gurgaon, Haryana, India
Pune, Maharashtra, India
D Nageshwar Reddy Govind K Makharia
MD DM DSc FAMS FRCP FASGE FACG MWGO MD DM DNB (Gastroenterology) John Joseph MD DM
Chairman Additional Professor Center for Liver and Biliary Sciences
Asian Institute of Gastroenterology All India Institute of Medical Sciences (AIIMS) Indraprastha Apollo Hospital
Hyderabad, Telangana, India New Delhi, India New Delhi, India
 Contributors ix

Joseph George MS Mch Mahendra Narwaria MS FICS FIAGES FALS Mohammed A Nayeem MS MCH
Rajagiri Hospital Director Consultant Liver Transplant Surgeon
Kerala, India Asian Bariatrics Indraprastha Apollo Hospital
Ahmedabad, Gujarat, India New Delhi, India
Kamal Kataria
Assistant Professor Mahesh Goel MS Mohan N MS DNB
Department of Surgery Associate Professor Consultant Surgeon
Guru Teg Bahadur Hospital (GTB) and Gastrointestinal and Hepato-Pancreato- Department of Surgical Gastroenterology
University College of Medical Sciences (UCMS) Biliary Service Meenakshi Mission Hospital and
New Delhi, India Department of Surgical Oncology Research Centre
Tata Memorial Centre Madurai, Tamil Nadu, India
Kamal Yadav MS FMAS Mumbai, Maharashtra, India
Lady Hardinge Medical College and
Associated Manav Wadhawan MD DM Mohd Qaleem Fellow DNB
Ram Manohar Lohia Hospital Center for Liver and Biliary Sciences Department of GI Surgery
New Delhi, India Indraprastha Apollo Hospital Indraprastha Apollo Hospital
New Delhi, India New Delhi, India
Kamlesh Kumar MS
Senior Resident Manish Suresh Bhandare Monika Gupta MS MCh
Department of Surgery MCh (Surgical Oncology) Consultant
All India Institute of Medical Sciences (AIIMS) Fellow in Gastrointestinal and Hepato- Surgical Gastroenterology and Minimally
New Delhi, India Pancreato-Biliary Oncology Invasive Surgery
Tata Memorial Hospital Soni Hospital
Kapileshwar Vijay MS DNB GI Surgery Mumbai, Maharashtra, India Jaipur, Rajasthan, India
Santokba Durlabhji Memorial Hospital
Jaipur, Rajasthan, India Manoj Gupta MS MS Ansari MS Mch DNB
Associate Consultant Additional Professor
Kaushal Madan MD DM Jaypee Hospital
Consultant, Director Department of Urology
Noida, Uttar Pradesh, India Sanjay Gandhi Postgraduate Institute of
Gastroenterology Services
Artemis Hospital Manoj Kumar Sharma MD DM Medical Sciences (SGPGIMS)
Gurgaon, Haryana, India Associate Professor Lucknow, Uttar Pradesh, India
Department of Hepatology
Kishore GS Bharathy Institute of Liver and Biliary Sciences N Ananthakrishnan MS FRCS (Eng.) FRCS (Ed.)
Additional Professor New Delhi, India FRCS (Glasg.) MNAMS FIMSA FAMS FICS FACS FACG
Surgical Gastroenterolgy Professor of Surgery
Institute of Liver and Biliary Sciences (ILBS) Masao Tanaka MD PhD FACS Mahatma Gandhi Medical College and
New Delhi, India Chief Director Research Institute
Shimonoseki City Hospital Puducherry, India
Kishore Singh MDRT MNAMS President Emeritus, Japan Pancreas Society
Director Professor President, Asian-Oceanic Pancreatic Namrata Singh
Department of Radiotherapy and Oncology Association Chief Dietician
Lok Nayak Jai Prakash Narayan Hospital and Professor Emeritus Department of Gastroenterology and
Maulana Azad Medical College Kyushu University Nutrition
New Delhi, India Fukuoka 812-8582, Japan All India Institute of Medical Sciences (AIIMS)
KJ Singh New Delhi, India
Mihir K Mohapatra
Professor and Head Professor Naoki Nakashima MD PhD
Department of Gastrointestinal Surgery Department of Surgical Gastroenterology Telemedicine Development Center of Asia
Command Hospital SCB Medical College and Medical Information Center
Lucknow, Uttar Pradesh, India Cuttack, Odisha, India Kyushu University Hospital, Fukuoka, Japan
Kunal Parasar MS MCh Mohamed Rela MS FRCS
Senior Resident Director Naresh Jangir MS
Department of Surgical Gastroenterology Institute of Liver Disease and Transplantation Senior Resident
Govind Ballabh Pant Institute of Global Hospital and Health City Department of GI Surgery
Postgraduate Medical Education and National Foundation for Liver Research, India Fortis Hospital
Research (GIPMER) New Delhi, India
New Delhi, India Mohammad Ibrarullah MCh FACS
Senior Consultant Neeraj Bhateja MS DNB GI Surg
Kuriko Kudo PhD Surgical Gastroenterology Department of GI Surgery
Telemedicine Development Center of Asia Apollo Hospitals Fortis Hospital
Kyushu Hospital, Fukoka, Japan Bhubaneswar, Odisha, India Jaipur, Rajasthan, India
x Textbook of Surgical Gastroenterology

Neeraj Goel MS MCh Palanippan Ramanathan MS MCh Pradeep Jain MS MCh

Consultant Surgical Oncology Director
Max Hospital All India Institute of Medical Sciences (AIIMS) Gastrointestinal Surgery,
New Delhi, India New Delhi, India Laparoscopy and Oncology
Sri Balaji Action Hospital
Neerav Goyal Pankaj Agarwal MBBS DNB
New Delhi, India
DNB (Gen Surgery) DNB (GI Surgery) MNAMS Consultant
Senior Consultant Max Hospital, New Delhi, India
Prakash Jain MS
Centre for Liver and Biliary Sciences Pankaj Kumar Garg MS Consultant Surgeon
Indraprastha Apollo Hospital Department of Surgery Mercy Hospital
New Delhi, India University College of Medical Sciences Kolkata, West Bengal, India
Nikhil Aggarwal MS MCh (UCMS) and Guru Teg Bahadur (GTB) Hospital
Assistant Professor New Delhi, India Pramod Kumar Garg MD DM
Institute of Liver and Biliary Sciences (ILBS) Professor
Pankaj Sharma MS
New Delhi, India Department of Gastroenterology
Senior Consultant
All India Institute of Medical Sciences (AIIMS)
Laparoscopic, Bariatric and GI Surgery
Nikhil Gupta MS MCh New Delhi, India
Sri Balaji Action Hospital
Consultant
New Delhi, India Praneeth Moka MD DM
Rajiv Gandhi Cancer Institute
New Delhi, India Pankaj Tyagi MD DM Department of Gastroenterology
Consultant All India Institute of Medical Sciences (AIIMS)
Nilesh Doctor MS DNB FRCS Jaypee Hospital New Delhi, India
Consultant Surgeon Noida, Uttar Pradesh, India
Department of Surgical Gastroenterology Prasad Thotton Veedu MD
Jaslok Hospital and Research Centre Patta Radhakrishna MS MCh Department of Radiology
Mumbai, Maharashtra, India Chief Surgical Gastroenterologist All India Institute of Medical Sciences (AIIMS)
SRM Institute for Medical Sciences (SIMS) New Delhi, India
Nilesh Patil MS MCh Chennai, Tamil Nadu, India
Fellow, HPB Surgery
Pavan Addala MS Priya Ranjan
Department of HPB Surgery and
Senior Registrar Classified Specialist
Liver Transplant
Department of Surgical GE GI Surgery
Indraprastha Apollo Hospital
Apollo Hospitals Command Hospital
New Delhi, India
Chennai, Tamil Nadu, India Kolkata, West Bengal, India
Nitesh Patidar MS MCh
Pawan Rawal MD DM Puneet Puri MS Mch
Senior Resident
Senior Consultant Department of Surgical Gastroenterology
Department of Urology
Fortis hospital Sanjay Gandhi Postgraduate Institute of
Sanjay Gandhi Postgraduate Institute of
Gurgaon, Haryana, India Medical Sciences (SGPGIMS)
Medical Sciences (SGPGIMS)
Lucknow, Uttar Pradesh, India Peush Sahni MS Phd Lucknow, Uttar Pradesh, India
Professor and Head
Noushif M MCh Department of Surgical Gastroenterology Punit Singla MS DNB (GI Surgery)
Department of Surgical Gastroenterology All India Institute of Medical Sciences (AIIMS) Liver Transplant Surgeon
King George’s Medical University New Delhi, India Fortis Hospital
Lucknow, Uttar Pradesh, India Gurgaon, Haryana, India
PK Garg
NS Balaji Department of Surgery Purak Mishra MS
Consultant Surgeon Guru Teg Bahadur (GTB) Hospital and Department of GI Surgery
Esophagogastric and Bariatric Surgery University College of Medical Sciences Indraprastha Apollo Hospital
University Hospitals North Midlands (UCMS), New Delhi, India New Delhi, India
Stoke on Trent, UK
PK Mishra MS PhD
P Senthilnathan MS DNB MRCS (Ed) DNB R Kalayarasan MS DNB MCh
Professor
Assistant Professor
(GI Surgery) FMAS FACS Govind Ballabh Pant Institute of
Consultant Surgical Gastroenterologist Department of Surgical Gastroenterology
Postgraduate Medical Education and
Division of Minimally invasive and Jawaharlal Institute of Postgraduate
Research
HPB Surgery Medical Education and Research (JIPMER)
New Delhi, India
Gem Hospital and Research Centre Puducherry, India
Poonam Narang MD
Coimbatore, Tamil Nadu, India
Director Professor R Surendran MS MCh DSc
Paari Vijayraghavan MS DNB MCh Department of Radiology Director
Consultant GB Pant Institute of Medical Education HPB Surgery and Transplant
Miot International Hospital and Research Miot International Hospital
Chennai, Tamil Nadu, India New Delhi, India Chennai, Tamil Nadu, India
 Contributors xi

RA Sastry MS FRCS (Glasg) Rakesh Kumar Singh MS Mch Sabita Jiwnani MS MRCS
Professor of Surgical Gastroenterology Department of Surgical Gastroenterology Tata Memorial Hospital
Krishna Institute of Medical Sciences Sanjay Gandhi Postgraduate Institute of Mumbai, Maharashtra, India
Hyderabad, Telangana, India Medical Sciences (SGPGIMS) Saket Kumar MS
Lucknow, Uttar Pradesh, India Department of Surgical Gastroenterology
Raghavendra Raja
Kokilaben Dhirubhai Ambani Hospital Rakesh Kumar MD PhD King George’s Medical University
Mumbai, Maharashtra, India Professor Lucknow, Uttar Pradesh, India
Department of Nuclear Medicine Sanjay Govil MS FRCS
Rajan Chaudhry AVSM VSM PHS
All India Institute of Medical Sciences (AIIMS) Senior Consultant
Air Marshal, Director General
New Delhi, India HPB Surgery and Liver Transplantation
Medical Service (Air)
Institute of Liver Surgery and Transplantation
Rajan Saxena Rakesh Rai MS FRCS (UK) MD (Newcastle) CCST National Foundation for Liver Research
(UK) ASTS Fellow
Professor and Head Global Hospital, Chennai, Tamil Nadu, India
Department of Surgical Gastroenterology Senior Consultant Transplant Surgeon
Fortis Hospital Sanjay Gupta MS
and Liver Transplant Head
Sanjay Gandhi Postgraduate Institute of Mumbai, Maharashtra, India
Department of Surgery
Medical Sciences (SGPGIMS) Rakhi Maiwall MD DM University College of Medical Sciences
Lucknow, Uttar Pradesh, India Associate Professor New Delhi, India
Rajesh Bhojwani MS MCh Institute of Liver and Biliary Science (ILBS)
Sanjay Nagral MS
Consultant New Delhi, India
Consultant Hepatobiliary Surgeon
Surgical Gastroenterolgist, Laparoscopic and Rambha Pandey MD Department of Surgical Gastroenterology
Bariatric Surgeon Assistant Professor Jaslok Fortis and Shushrusha Hospital
Santokba Durlabhji Memorial Hospital Dr BR Ambedkar Institute—Rotary Cancer Mumbai Honorary Surgeon
Jaipur, Rajasthan, India Hospital (Dr BRA-IRCH) KB Bhabha Municipal General Hospital
Rajesh Panwar MS Mch All India Institute of Medical Sciences (AIIMS) Sanjay Singh Negi MS MCh FEBS
Assistant Professor New Delhi, India Director
Department of GI Surgery HPB Surgery and Liver Transplantation
Ramesh Ardhnari MS MCh FRCS
All India Institute of Medical Sciences (AIIMS) BLK Superspecialty Hospital
Senior Consultant
New Delhi, India New Delhi, India
Meenakshi Mission Hospital and Research
Rajesh Rajalingam MS MCh Centre Sanjoy Mandal MS DNB MRCS MCh
Transplant Fellowship, HPB and Transplant Madurai, Tamil Nadu, India Director and Senior Consultant
Surgeon Global Hospital Department of GI Surgery
Chennai, Tamil Nadu, India Ramkrishna Prabhu MS Medica Superspecialty Hospital
Department of Surgical Gastroenterology Kolkata, West Bengal, India
Rajinder Parshad Seth GS Medical College
Professor Mumbai, Maharashtra, India Saroj K Sinha MD DM
Department of Surgical Disciplines Department of Gastroenterology
All India Institute of Medical Sciences (AIIMS) RK Saran MD Postgraduate Institute of Medical Education
New Delhi, India Department of Pathology and Research (PGIMER)
Govind Ballabh Pant Institute of Chandigarh, India
Rajneesh Kumar Singh MS MCh Postgraduate Medical Education and Satish B Dharap
Additional Professor Research (GIPMER), New Delhi, India Professor
Department of Surgical Gastroenterology
Rohin Mittal MS LTM Medical College and LTM General
Sanjay Gandhi Postgraduate Institute of
Consultant Hospital
Medical Sciences (SGPGIMS)
Surgical Gastroenterology Mumbai, Maharashtra, India
Lucknow, Uttar Pradesh, India
Christian Medical College Satya Prasad Samantaray
Raju Sharma MD Vellore, Tamil Nadu, India Assistant Professor
Professor Department of Surgical Gastroenterology
Department of Radiology S Rajesh MD PDCC SCB Medical College
All India Institute of Medical Sciences (AIIMS) Assistant Professor Cuttack, Odisha, India
New Delhi, India Department of Radiology
Institute of Liver and Biliary Sciences (ILBS) Satyajit Godhi MS MCh
Rakesh Kochhar MD DM New Delhi, India Senior Resident
Professor Surgical Gastroenterology
Department of Gastroenterology S Sudhindran MS FRCS Govind Ballabh Pant Institute of
Postgraduate Institute of Medical Education Consultant Surgeon Postgraduate Medical Education and
and Research HPB and Transplant Research
Chandigarh, India Amrita Institute, Kochi, Kerala, India New Delhi, India
xii Textbook of Surgical Gastroenterology

Saurabh Kedia MD DM Shivendra Singh MS MCh Sreenivas

All India Institute of Medical Sciences (AIIMS) Head (Gastrointestinal Oncology) Additional Professor of Biostatistics
New Delhi, India Rajiv Gandhi Cancer Institute All India Institute of Medical Sciences (AIIMS)
New Delhi, India New Delhi, India
Saurabh Singhal Director Professor
Junior Resident Department of Radiology Subhash Gupta MS FRCS
Department of Surgical Disciplines Govind Ballabh Pant Institute of Chief Liver Transplant and HPB Surgery
All India Institute of Medical Sciences (AIIMS) Postgraduate Medical Education and Research Director Centre for Liver and Biliary Sciences
New Delhi, India New Delhi, India Indraprastha Apollo Hospital
Savio George Barreto Shivendra Singh MS MCh New Delhi, India
Consultant Head (Gastrointestinal Oncology)
Rajiv Gandhi Cancer Institute Subhash Mishra DNB
Department of Gastrointestinal Surgery
New Delhi, India Indraprastha Appollo Hospital
Gastrointestinal Oncology and Bariatric Surgery
New Delhi, India
Medanta Institute of Digestive and Shivraj Bahadur Singh DM
Hepatobiliary Sciences HPB and Transplant Fellow Subodh Varshney MS DNB MNAMS FRCS
Medanta—The Medicity Department of Surgical Gastroenterology Professor and Head
Gurgaon, Haryana, India and Liver Transplantation Department of Surgical Gastroenterology
Sellam Karunanithi MD Sir Ganga Ram Hospital and Clinical Nutrition
Department of Nuclear Medicine New Delhi, India Bhopal Memorial Hospital and Research Centre
All India Institute of Medical Sciences (AIIMS) Shobna J Bhatia Bhopal, Madhya Pradesh, India
New Delhi, India Head
Department of Gastroenterology Sudeep R Shah MS DNB FRCS (Edin)
Shagun Misra MD Seth GS Medical College and King Edward Consultant GI HPB and Liver Transplant Surgeon
Lecturer Memorial (KEM) Hospital PD Hinduja Hospital
Department of Radiation Oncology Mumbai, Maharashtra, India Mumbai, Maharashtra, India
Tata Memorial Hospital
Parel, Mumbai, Maharashtra, India Shuzi Shimizu MD PhD S Sudhindran MS FRCS
Department Endoscopic Diagnostics and Consultant Surgeon (HPB and Transplant)
Shailesh V Shrikhande MS MD FRCS Therapeutics and Telemedicine Development
Amrita Institute
Chief Gastrointestinal and Hepato-Pancreato- Center of Asia
Kochi, Kerala, India
Biliary Service Kyushu University Hospital, 3-1-1 Maidashi,
Department of Surgical Oncology Higashi-ku, Suhar Kumar MS DNB
Tata Memorial Centre Fukuoka 812-8582, Japan Resident
Mumbai, Maharashtra, India Shyamkumar N Keshava Rajiv Gandhi Cancer Institute
Shaleen Agarwal MS Mch Department of Radiology New Delhi, India
Senior Consultant Christian Medical College
Vellore, Tamil Nadu, India Sujoy Pal MS DNB MCh
Centre for Liver and Biliary Sciences
Siddharth Srivastava MD DM Professor
Indraprastha Apollo Hospital
Professor Department of GI Surgery and Liver
New Delhi, India
Department of Gastroenterology Transplantation
Shaleen Kumar MD Govind Ballabh Pant Institute of All India Institute of Medical Sciences (AIIMS)
Professor Postgraduate Medical Education and New Delhi, India
Department of Radiotherapy Research
Sanjay Gandhi Postgraduate Institute of New Delhi, India Sukanta Ray MS MCh
Medical Sciences (SGPGIMS) Professor of Surgical Gastroenterology
Lucknow, Uttar Pradesh, India SK Acharya MD DM School of Digestive and Liver Disease
Head Institute of Postgraduate Medical Education
Shalimar MD DM Department of Gastroenterology and Research
Associate Professor (Gastroenterology) All India Institute of Medical Sciences (AIIMS) Kolkata, West Bengal, India
All India Institute of Medical Sciences (AIIMS) New Delhi, India
New Delhi, India SK Sarin MD DM Sundeep Jain MS MCh
Senior Professor and Head Senior Consultant
Shivanand Gamanagatti MD
Department of Hepatology Gastrointestinal, HPB, Laparoscopic and
Additional Professor of Radiology
Director Bariatric Surgery
All India Institute of Medical Sciences (AIIMS)
Institute of Liver and Biliary Science (ILBS) Fortis-Escorts Hospital
New Delhi, India
Adjunct Professor Jaipur, Rajasthan, India
Shivaram Prasad Singh MD DM Molecular Medicine
(Past President), ISG Jawahar Lal Nehru University, New Delhi Sundeep Singh Saluja MS MCh
Secretary General SAASL Honorary Professor Professor of Surgical Gastroenterology
Head, Department of Gastroenterology Jawaharlal Nehru Center for Advanced Govind Ballabh Pant Institute of Postgraduate
SCB Medical College Scientific Research Medical Education and Research
Cuttack, Odisha, India New Delhi, India New Delhi, India
 Contributors xiii

Sunil Kumar Gupta MD DM V Baskaran MS PhD FACS Vikram Chaudhary MS

Oncology Senior Consultant and
Chief of Head and Neck Medical Services
Rajiv Gandhi Cancer Institute and Research
Centre
New Delhi, India
Department of Surgical Gastroenterology Gastrointestinal and Hepato-Pancreato-
Minimal Access and Bariatric Surgery Biliary Service
Madras Institute of Orthopedics and Department of Surgical Oncology
Traumatology (MIOT) International Hospital Tata Memorial Centre
Chennai, Tamil Nadu, India Mumbai, Maharashtra, India

Sunil Kumar Puri MD FICRI Vaageesh BG MS MCh Vikram Kate MS FRCS (Eng.) FRCS (Ed.) FRCS
Director-Professor and Head (Radiology) (Glasg.) PhD (SGE) MAMS FIMSA FACS FACG MFST (Ed.)
Senior Resident
Govind Ballabh Pant Institute of Professor
Govind Ballabh Pant Institute of
Postgraduate Medical Education and Department of General Surgery and Surgical
Postgraduate Medical Education and
Research Gastroenterology
Research
New Delhi, India Jawaharlal Institute of Postgraduate Medical
New Delhi, India
Education and Research
Sunil T MS Mch Puducherry, India
Vaibhav Varshney MS MCh
Assistant Professor Senior Resident Eppa Vimlakar Reddy
Department of Surgical Gastroenterology Department of Surgical Gastroenterology Consultant Surgeon
Sanjay Gandhi Postgraduate Institute of Govind Ballabh Pant Institute of Department of Surgical Gastroenterology
Medical Sciences (SGPGIMS) Postgraduate Medical Education and Meenakshi Mission Hospital and Research
Lucknow, Uttar Pradesh, India Research Centre
New Delhi, India Madurai, Tamil Nadu, India
Supriyo Ghatak MS MCh
Consultant HPB and GI Surgeon Vedavyas Mohapatra MS Vinay Gaikwad MS
Calcutta Medical Research Institute Senior Resident Consultant
Kolkata, West Bengal, India Department of Surgery GI and HPB Surgical Oncologist
SCB Medical College Artemis Health Institute
Sushmita Nitin Bhatnagar MS MCh Cuttack, Odisha, India Gurgaon, Haryana, India
Professor, Unit Head
Department of Pediatric Surgery Venkatramani Sitaram MS DNB FRCS Vinay Kapoor FRCS FACS
Baijerbai Hospital for Children Professor and Head Professor of Surgical Gastroenterology
Mumbai, Maharashtra, India Department of HPB Surgery Sanjay Gandhi Postgraduate Institute of
Christian Medical College Medical Sciences (SGPGIMS)
Swarupa Mitra MD Vellore, Tamil Nadu, India Lucknow, Uttar Pradesh, India
Senior Consultant, Radiation Oncologist
Rajiv Gandhi Cancer Institute Vinay Kumaran MS Mch
Venu Madhav Thumma Consultant and Head
New Delhi, India
MS MRCSEd DNB (Surg Gastro)
Liver Transplant and HPB Surgery
Reader Kokilaben Dhirubhai Ambani Hospital
TK Chattopadhyay ??? Department of Surgical Gastroenterology
Senior Professor and Head Mumbai, Maharashtra, India
Nizams Institute of Medical Sciences
Department of Surgical Gastroenterolgy Hyderabad, Telangana, India Vineet Ahuja MD DM
Institute of Liver and Biliary Sciences (ILBS)
Addditional Professor
New Delhi, India
Vibha Verma Department of Gastroenterology
MS DNB (General Surgry) DNB (GI surgery) MRCS (Edn) All India Institute of Medical Sciences (AIIMS)
TP Elamurugan D Ortho MS DNB MNAMS
Consultant Liver Transplant and HPB Surgery New Delhi, India
Assistant Professor
Kokilaben Dhirubhai Ambani Hospital
Jawaharlal Institute of Postgraduate Vineeta Goel MBBS DNB
Mumbai, Maharashtra, India
Medical Education and Research (JIPMER) Consultant Radiation Oncologist
Puducherry, India Max Superspecialty Hospital
Vijay Vohra MD
Chairman New Delhi, India
Uday Somashekar MS DNB
Assistant Professor Liver Transplant Gastrointestinal Anaesthesia
Vinu Moses
Jabalpur Medical College and Critical Care
Department of Radiology
Jabalpur, Madhya Pradesh, India Medanta—The Medicity
Christian Medical College
Gurgaon, Haryana, India
Vellore, Tamil Nadu, India
Umesh Kapil
Professor Vikas Gupta MS MCh Vishal Gupta MS MCh
Public Health Nutrition Department of Surgery Associate Professor
Human Nutrition Unit Postgraduate Institute of Medical Education Department of Surgical Gastroenterology
All India Institute of Medical Sciences (AIIMS) and Research King George’s Medical University
New Delhi, India Chandigarh, India Lucknow, Uttar Pradesh, India
xiv Textbook of Surgical Gastroenterology

Vivek Goel MS Yasuaki Antoku PhD Yoshiko Houkabe MD PhD

Consultant Telemedicine Development Center of Asia Kyushu University
Department of Laparoscopy and GI Surgery and Medical Information Center Fukuoka, Japan
Sri Balaji Action Hospital Kyushu University Hospital
New Delhi, India Fukuoka, Japan Zaheer MD DNB Gastroenterology
Yogesh Kumar Sarin MS MCh Consultant Gastroenterologist
Vivek Mangla MS MCh Asian Institute of Gastroenterology
Director Professor and Medical
Consultant Hyderabad, Telangana, India
Superintendent
Gastroenterology and Liver Transplantation Lok Nayak Jai Prakash Narayan Hospital and
Sir Ganga Ram Hospital Maulana Azad Medical College
New Delhi, India New Delhi, India
 Editorial Board
Mohammed Nayeem MS MCH DNB Sundeep Singh Saluja MS MCh
Consultant Liver Transplant Surgeon Professor of Surgical Gastroenterology
Indraprastha Apollo Hospital Govind Ballabh Pant Institute of
New Delhi, India Postgraduate Medical Education and
Research
Rajneesh Kumar Singh MS MCh New Delhi, India
Additional Professor
Department of Surgical Gastroenterology Uday Somashekar MS DNB
Sanjay Gandhi Postgraduate Institute of Assistant Professor
Medical Sciences (SGPGIMS) Jabalpur Medical College
Lucknow, Uttar Pradesh, India Jabalpur, Madhya Pradesh, India
Shivendra Singh MS MCh
Head (Gastrointestinal Oncology) V Baskaran MS PhD FACS
Rajiv Gandhi Cancer Institute Department of Surgical Gastroenterology
New Delhi, India Minimal Access and Bariatric Surgery
Madras Institute of Orthopedics and Traumatology (MIOT)
Sujoy Pal MS (General Surgery) DNB MCh (GI Surgery) International Hospital
Professor Chennai, Tamil Nadu, India
Department of Gastrointestinal Surgery and
Liver Transplantation
All India Institute of Medical Sciences (AIIMS)
New Delhi, India
 Foreword
Thirty years ago, general surgeons did almost all abdominal operations including those for hernia, hydrocele, as well as for diseases
of the stomach and intestines. At this time, medical gastroenterology was making rapid strides by using diagnostic and therapeutic
techniques driven by the advent of fiberoptic endoscopy and advances in imaging modalities. This opened up whole new challenges
such as the management of massive variceal bleeding and obstructive jaundice, but there was no complementary specialty of surgical
gastroenterology. This meant that the more complex procedures like portosystemic shunts and liver and pancreatic resections received
little attention because they were done infrequently, demanded a lot of extra time and effort and, unfortunately, were consequently
accompanied by high morbidity and mortality rates. In the late 1980s, after a rather hesitant and uncertain beginning, a few stalwarts
set up separate departments of surgical gastroenterology in Trivandrum, Chennai, Lucknow and Delhi, which confined themselves to
dealing with complex gastrointestinal problems, which were neglected by general surgeons, and these have since spawned over thirty
others all over the country. With the advent of liver transplantation, this specialty has now acquired a certain glamour as well as extensive
coverage in the media. Consequently, in 2015, surgical gastroenterology has now become the most sought after subspecialty for doctors
who have just completed their Master of Surgery qualification and is, fortunately, attracting the brightest and best.
Unfortunately, there are very few textbooks which can guide the neophyte trainees in this field. Professor PK Mishra, who is a
member of one of the elite and pioneering departments in the specialty, and who, incidentally, did a good PhD at All India Institute of
Medical Sciences (AIIMS) under my guidance, has gathered together nearly all of India’s luminaries in this comparatively new specialty
and succeeded in producing a reference book which will be a sine qua non for all who venture into this exciting field.
There are introductory chapters on the approach to patients, imaging and chemoradiotherapy, followed by detailed descriptions
of the management of disorders of different organs from the esophagus to the anal canal, and a section on liver transplantation. I
particularly enjoyed the last ‘Miscellaneous’ section which deals with upper GI bleeding, robotics, tumor markers and finally ethics in
surgery.
The choice of topics has been imaginative and the writing simple, informative and helpful.
I have little doubt that the book will be a success and go into many subsequent editions.

Samiran Nundy
Dean
Ganga Ram Institute for
Postgraduate Education and Research
New Delhi, India
 Preface
I feel so relieved to be writing this preface, now that this massive project is near completion. Serendipity is sometimes more important
than the noble motivation later ascribed to an act. The origin of the book had a bit of both. When I was approached by M/s Jaypee
Brothers Medical Publishers (P) Ltd, for this book, I was in a frame of mind to strive to return to the profession a bit of what I gained from
it. Fortunately or otherwise, I had no idea as to what it actually involved.
Surgical gastroenterology is relatively a new superspecialization which has established itself in the last three decades. Most of the
work in surgical gastroenterology was done by general surgeons with various other responsibilities. Evolution in gastroenterology pushed
the requirement of specialized care for this group of patients. Resection of liver, surgery for portal hypertension, surgery of pancreas and
esophagus, for example, required specialized training and dedicated care. The challenge was taken up by a few stalwarts like Professors
Samiran Nundy, Aranya, Kaushik, Wig and Chatterjee in the North and Professors Rangabashyam, Khanduri and Anantkrishnan in the
South. Thanks to their efforts, surgical gastroenterology has not only become an established specialty but also, it is the most wanted
one for the residents completing their MS (General Surgery). I was fortunate to train under Professor Nundy, All India Institute of Medical
Sciences (AIIMS), and have been at Govind Ballabh Pant Postgraduate Institute of Medical Education and Research for last many years.
GB Pant is an established pioneering superspecialty academic institute for training MCh and DM residents.
In the last many years, enormous experience has been gathered in various institutes working in this field in India. However, we are
still dependent mainly on textbooks from the West. The available textbooks in surgical gastroenterology are not comprehensive, do not
adequately discuss some of the diseases which are specifically relevant in the Asian context and do not have Indian protocols for therapy
and follow-up even for diseases which are commonly seen by us. I, therefore, worked to compile a book, which could serve as a textbook
for the students of surgical gastroenterology and could also be of help to the practicing surgeons and the gastroenterologists.
With this in mind, I got together a team of editors. We chose the authors and chapters to be covered with lots of deliberation. Most
authors of the chapters are surgeons with vast experience and are well known in their field of expertise. Eminent gastroenterologists have
also written some chapters, as required. All the chapters have been reviewed to add some balance in the coverage. We have also included
several chapters with clinical approach which are not usually covered in other textbooks. A chapter on statistics was especially included
as this knowledge is now essential for interpreting or publishing research articles. We also incorporated some chapters on robotics and
telemedicine to acquaint our readers with critical knowledge in these important areas. An entire section on liver transplantation was
envisaged which has now become an important and established specialization by itself. Knowledge about radiology and antibiotics
relevant to our practice has been included. The last chapter in the book had to be on ethics. While teaching ethics may not by itself be a
remedy for all ills, it certainly promotes responsibility, integrity and accountability in medical practice. I wish that the students undertake
medical learning and research guided by ethical principles. Ethics is the essence of being human and I believe that every human effort is
wasted, if it is ethically incorrect.
The idea of the book was to be a comprehensive textbook of surgical gastroenterology. When we had started, I wished to bring
together a complete volume that had all the essential knowledge for a person being initiated into surgical gastroenterology. I did not
realize initially that it was such a colossal project. With the full load of clinical and teaching duties, editing such a volume was really a
tough task. Time delays took such a toll that at times I felt like shelving the project. We had to reject or redo many chapters. Many other
chapters had to be left out. It was the effort of the editorial team, residents, and colleagues and of several authors of the book that kept
me on course. I sincerely trust that the book would be a single point reference book, to the residents, gastroenterologists and surgeons.
No textbook in the present day can have all the information a person seeks. In the fast-changing medical world, readers should treat
this compilation as a starter pack. Authors have worked hard on these chapters and the chapters have also been reviewed by peers. Still,
there may be many shortcomings and there may be many aspects that are not up to the desirable level of discussion. I fully realize that
some of the pronouncements in the ensuing chapters may already be getting modified or even outdated. A textbook takes almost two
years to come to the print. I offer this to you with no apologies. I request all the readers to mail me their opinions so that the shortcomings
may be corrected in the subsequent editions. It is my sincere hope that with your help the work will raise its level even further in the
subsequent editions. Thank you readers for choosing the book.

PK Mishra
surgeonmishra@yahoo.com
 Acknowledgments

It is a privilege to thank all those who helped me complete this work. First of all, I thank my publishers M/s Jaypee Brothers Medical
Publishers (P) Ltd, New Delhi, India, for choosing me to do this work. On behalf of Jaypee, Shri Jitendar P Vij (Group Chairman),
Mr Ankit Vij (Group President), Mr Tarun Duneja (Director-Publishing), Mr KK Raman (Production Manager), Mr Subrata Adhikary
(Commissioning Editor) and Mr Mohit Bhargava (Production Coordinator) kept goading me to get this textbook into shape. They were
liaising with designers, language editors, designers, artists, management and all other people who worked hard to put the book in
your hand. I thank all the members of the Jaypee team for their effort. I wish that we continue to collaborate in the same spirit in future
as well.
I wish to thank all the members of the editorial board Dr Baskaran, Dr Sujoy, Dr Rajnish, Dr Shivendra, Dr Uday Somashekhar,
Dr Sundeep Singh Saluja and Dr Nayeem for reviewing and editing various chapters and sections of the book. The book was impossible
without their efforts and constant support. Being at Govind Ballabh Pant and always available, Dr Saluja was a sounding board for all my
decisions. He deserves my special thank.
I wish to thank all the authors who have contributed their chapters in this book. This book is shaped by the immense experience
put forth in these chapters by the authors. The book actually belongs to them. On their behalf, as well as mine, I wish to also thank all
our patients who gave us this experience. I wish to thank all my teachers under whom I learned to treat these patients. I was privileged
to have Dr Samiran Nundy, a pioneer surgeon in the field of surgical gastroenterology, as my teacher and guide at All India Institute of
Medical Sciences (AIIMS). He is one of the most admired doctors in the country today and a guiding star for all of us in this field. I profusely
thank him for all he has done for me and also for writing the foreword of the book.
Being in an MCh, teaching institutes gave me the opportunity to interact with some of the sharpest minds in the profession. Our
residents come through a grueling selection process and are extremely hard-working. Some of our fellows have become consultants in
prestigious hospitals and have also contributed in the chapters of the book. They have helped me in several ways from the intellectual
inputs to proofreading. I wish to immensely thank our present and past residents for all their help. I need to especially mention, Drs Vaibhav,
Kunal and Vaageesh amongst the present ones, and Drs Rajesh, Kalay, Asit, Nilesh, John, Neeraj, Dinesh, Satyajit and Harsh amongst the
earlier ones.
Over the last two years, I have had extra-long hours and my contribution at home in my absence was borne by my family. I wish to
thank my wife Yuthika and daughters Pragya and Bhavya for their constant support and encouragement. Above all, they make this effort
worthwhile.
In the end, the book represents desire of my parents for my learning and higher education. My late mother with her simplicity and
affection nurtured me. My father has always strived for excellence and discipline. His generosity and deep love for all of us is exceeded
only by his desire for us to be useful to the society. My gratitude for them is more than I can ever express. I dedicate this book to them
and seek their blessing for me, my patients and for all my future endeavors.
 Contents
VOLUME 1 17. Benign Tumors of the Esophagus
Vivek Mangla, Manoj Gupta
207

18. Carcinoma Esophagus 216

SECTION 1­  General Kishore GS Bharathy, TK Chattopadhyay
19. Esophageal Cancer: Operative Strategies
1. Approach to a Patient of Digestive Disease 3
PK Mishra and Lymphadenectomy 229
C S Pramesh, George Karimundackal, Sabita Jiwnani
2. Gastrointestinal Imaging 7
Raju Sharma, Ankur Goyal 20. Multimodality Treatment in Carcinoma
of the Esophagus 237
3. Infections and Antibiotics in Shaleen Kumar, Shagun Misra, Rajneesh Kumar Singh
Gastrointestinal Surgery 18
Archana Thakur 21. Minimal Invasive Esophagectomy 247
Rajesh Bhojwani, Kapileshwar Vijay
4. Nuclear Medicine Imaging in
22. Esophageal Replacement Procedures 257
Gastrointestinal Diseases 37 Sundeep Jain, Neeraj Bhateja
Rakesh Kumar, Sellam Karunanithi
5. Radiation Therapy 52 SECTION 3 Stomach, Duodenum, Small
Kishore Singh, Arun Kumar Rathi
Intestine and Retroperitoneum
6. Chemotherapy Principles and
Techniques for GI Cancers 61 23. Stomach and Duodenum 269
Atul Sharma Neeraj Goel, PK Mishra
7. Nutritional Support to Hospitalized Patients 69 24. Surgery for Peptic Ulcer Disease 283
Umesh Kapil, Namrata Singh Vikram Kate, R Kalayarasan, TP Elamurugan,
N Ananthakrishnan
8. Statistics for Surgeons 86
Sreenivas 25. Carcinoma Stomach 300
Durgatosh Pandey, Palaniappan Ramanathan,
9. Interventional Radiology of the Pankaj Kumar Garg, Rambha Pandey
Gastrointestinal Tract and Hepatobiliary
26. Duodenal and Small Intestinal Tumors 313
System 104 Monika Gupta
Amar Mukund, S Rajesh
27. Gastric Bezoar and Gastric Volvulus 320
KJ Singh
SECTION 2­  Esophagus 28. Intestinal Obstruction 327
Sanjoy Mandal
10. Anatomy and Physiology of the Esophagus 133
Nikhil Aggarwal 29. Abdominal Tuberculosis 337
Nilesh Patil, RK Saran, Uday Somashekar
11. Diagnostic Tests in Esophageal Diseases 140
Shobna J Bhatia, Chirag Shah 30. Gastrointestinal Lymphomas 348
Anurag Mishra, AK Sarda
12. Approach to a Patient with Dysphagia 151
Vishal Gupta
31. Visceral Artery Aneurysms 355
RA Sastry, Venu Madhav Thumma
13. Gastroesophageal Reflux Disease 158 32. Mesenteric Ischemia 365
V Baskaran
D K Sharma
14. Motility Disorders of the Esophagus 176 33. Radiation Enteritis: Pathophysiology,
NS Balaji Prevention and Management 381
15. Esophageal Perforation: Diagnosis and Vineeta Goel, Pankaj Agarwal
Management 184 34. Gastrointestinal Stromal Tumor 387
Rajneesh Kumar Singh, Puneet Puri Subodh Varshney, Ajit Sewkani
16. Corrosive Injury of Esophagus and Stomach 194 35. Retroperitoneal Tumors 399
N Ananthakrishnan, R Kalayarasan, Vikram Kate Sanjay Gupta
xxiv Textbook of Surgical Gastroenterology

SECTION 4­  Pancreas 55. Biliary Atresia 639

Yogesh Kumar Sarin, Sushmita Nitin Bhatnagar
36. Pancreas: Embryology, Anatomy and 56. Choledochal Cysts 650
Physiology 409 Sundeep Singh Saluja, Mohammed Nayeem
Harsh Shah, Sundeep Singh Saluja Vaibhav Varshneya
37. Acute Pancreatitis 417 57. Bile Duct Injury, Biliary Fistula and Benign Biliary
Pramod Kumar Garg
Stricture 662
38. Surgery in Acute Pancreatitis 429 Sundeep Singh Saluja, Nilesh Patil, Neeraj Goel
Mohammad Ibrarullah, Jayanth Reddy, V K Kapoor
58. Primary Sclerosing Cholangitis 688
39. Pseudocyst and other Complications of Siddharth Srivastava
Pancreatitis 437 59. Recurrent Pyogenic Cholangitis 696
Chintamani Godbole, Nilesh Doctor Sukanta Ray
40. Medical Management of Chronic Pancreatitis 449 60. Gallbladder Polyps 701
Harpal S Dhaliwal, Saroj K Sinha, Rakesh Kochhar Biju Pottakkat
41. Surgery for Chronic Pancreatitis 465 61. Carcinoma Gallbladder 706
Vikas Gupta Asit Arora, PK Mishra
42. Pancreatic and Periampullary Cancer 485 62. Cholangiocarcinoma 726
Savio George Barreto, Adarsh Chaudhary Rajan Saxena, Himanshu Yadav
43. Pancreatic Surgery 494
Rajesh Rajalingam, PK Mishra
44. Cystic Neoplasms of the Pancreas 518 VOLUME 2
Masao Tanaka
45. Neuroendocrine Tumors of the Pancreas 535 SECTION 6­  Liver
Vinay Gaikwad, Mahesh Goel,
Bhawna Sirohi, Shailesh V Shrikhande
63. Surgical Anatomy of the Liver 743
Supriyo Ghatak, Anshuman Ray
46. Minimally Invasive Approach to
64. Liver Function Tests 749
Pancreatic Lesions 548 Kaushal Madan, Pankaj Tyagi
C Palanivelu, P Senthilnathan
65. Approach to a Patient with Jaundice 757
47. Pancreaticoduodenal Injuries 558 R Surendran, Paari Vijayraghavan
Satish B Dharap
66. Liver Abscess 762
48. Pancreas and Islet Transplantation 565 Mihir K Mohapatra, Satya Prasad Samantaray
Rakesh Rai Vedavyas Mohapatra
67. Hydatid Disease of Liver 766
SECTION 5­  Gallbladder and Bile Ducts Eppa Vimalakar Reddy, Mohan N, Ramesh Ardhnari
49. Gallbladder and Bile Ducts: Anatomy and 68. Imaging and Intervention in Hemobilia 784
Physiology 577 Shivanand Gamanagatti, Prasad Thotton Veedu
Satyajit Godhi, PK Mishra 69. Hepatic Trauma 789
50. Imaging of Liver and Biliary Tract 586 Rajan Chaudhry, Anuj Sharma
Ankur Arora, Sunil Kumar Puri 70. Approach to Space-occupying Lesion of Liver 796
51. Endoscopic Retrograde Cholangiopancreatogra- Nilesh Patil, PK Mishra
phy in Biliary and Pancreatic Diseases 609 71. Benign Liver Tumors 814
Zaheer, D Nageshwar Reddy Sudeep R Shah
52. Gallstone Disease 618 72. Malignant Neoplasms of Liver 821
Avinash Supe, Ramkrishna Prabhu S Sudhindran
53. Current Management of Common 73. Liver Metastases 830
Bile Duct Stones 627 Sanjay Govil, Ashwin Rammohan
Jagdish Chander, Anubhav Vindal 74. Perioperative Management in Patients
54. Cholangitis 635 with Biliary Tract and Liver Disease 842
Gourdas Choudhuri, Pawan Rawal Ankur Garg, Sanjay Singh Negi
 Contents xxv

75. Liver Resection 852 95. Surgery for Crohn’s Disease 1100
Girish K Pande, Sujoy Pal Benjamin Perakath
76. Non-Cirrhotic Portal Hypertension 878 96. Colonic Polyps and Polyposis Syndromes 1107
Shivraj Bahadur Singh, Vivek Mangla, Sujoy Pal Brundaban Nahak, Debasis Misra
Shivaram Prasad Singh
77. Budd-Chiari and Other Vascular
Diseases of Liver 895 97. Colorectal Cancer: An Overview 1119
Prakash Jain, Shyamkumar N Keshava Ashok Kumar, Puneet Puri
Vinu Moses, Venkatramani Sitaram 98. Colectomy for Colon Cancer 1128
78. Cirrhosis and its Complications 907 Ashok Kumar, Sunil T
Cyriac Abby Philips, SK Sarin 99. Surgery for Carcinoma Rectum 1132
79. Artificial Liver Support in Liver Failure 950 Shivendra Singh, Nikhil Gupta, Suhar Kumar
Rakhi Maiwall, Manoj Kumar Sharma 100. Recurrent Rectal Cancer and
80. Surgery in Acute and Chronic Liver Disease 961 Pelvic Exenteration 1141
Shalimar, SK Acharya Sundeep Jain, Naresh Jangir
101. Minimally Invasive Colorectal Cancer Surgery 1146
SECTION 7 Spleen Subhash Mishra, Mohd Qaleem
Purak Mishra, Deepak Govil
81. Anatomy and Physiology of Spleen 967
AK Singh, Priya Ranjan
102. Chemotherapy for Colorectal Cancer 1154
Sunil Kumar Gupta
82. Splenic Trauma 973
JK Banerjee
103. Radiotherapy for Colorectal and
Anal Carcinoma 1157
83. Splenic Cysts, Tumors and Abscess 979 Swarupa Mitra
Hirdaya H Nag, R Kalayarasan
84. Non-Traumatic Splenectomy 984 SECTION 9 Liver Transplantation
Kamal Yadav, Deborshi Sharma
104. History of Liver Transplantation 1169
Vinay Kumaran
SECTION 8 Colon, Rectum and Anal Canal
105. Liver Transplantation in India 1172
85. History and Examination in Vinay Kumaran
Colorectal Disease 993 106. Indications and Contraindications for
Nikhil Gupta, Shivendra Singh Liver Transplantation 1175
86. Imaging in Colorectal Disease 997 Vibha Verma, Vinay Kumaran
Poonam Narang 107. Organ Preservation in Liver Transplant 1183
87. Anal Fistula 1009 Raghavendra Raja, Vinay Kumaran
BK Jain, PK Garg 108. Anesthetic Management in
88. Rectal Prolapse 1023 Liver Transplantation 1187
Rajinder Parshad, Kamal Kataria, Vijay Vohra
Saurabh Singhal, Kamlesh Kumar
109. Immunology of Liver Transplantation 1197
89. Rectovaginal Fistula 1036 Manav Wadhawan, John Joseph
Ashok Kumar, Rakesh Kumar Singh
110. Pediatric Liver Transplant 1205
90. Rectourethral Fistula 1043 Mohammed A Nayeem
Nitesh Patidar, MS Ansari, Ashok Kumar
111. Liver Transplantation in Acute Liver Failure 1215
91. Fecal Incontinence 1049 Dronacharya Routh, CS Naidu
Abhijit Chandra, Noushif M, Saket Kumar
112. Deceased Donor Liver Transplantation 1226
92. Ulcerative Colitis 1055 Mohamed Rela, Gomathy Narasimhan
Praneeth Moka, Govind K Makharia
113. Living Related Liver Transplantation 1237
93. Surgery for Ulcerative Colitis 1068 Subhash Gupta, Neerav Goyal, Shaleen Agarwal
Rohin Mittal, Benjamin Perakath
114. Complications in Living Donor
94. Crohn’s Disease 1081 Liver Transplantation 1255
Saurabh Kedia, Vineet Ahuja AS Soin, Punit Singla
xxvi Textbook of Surgical Gastroenterology

SECTION 10 Miscellaneous 121. Chylous Ascites 1341

Vageesh BG, PK Mishra
115. Variceal Upper Gastrointestinal Bleeding 1277 122. Acute Postoperative Pain and its
Patta Radhakrishna, Pavan Addala
Management in Major Abdominal
116. Management of Nonvariceal Hemorrhage 1291 Surgeries 1346
Patta Radhakrishna, Pavan Addala Baljit Singh, Indira Malik
117. Approach to the Management of 123. Telemedicine: Principles and the Future 1352
Lower Gastrointestinal Hemorrhage 1298 Shuzi Shimizu, Ho-Seong Han, Kuriko Kudo
Atul Sharma Yoshiko Houkabe, Yasuaki Antoku, Naoki Nakashima
124. Surgery for Portal Hypertension 1357
118. Bariatric and Metabolic Surgery 1311
Joseph George, Rajesh Panwar
Mahendra Narwaria, Ahmad Jan
Sundeep Singh Saluja, Peush Sahni
119. Robotics in Gastrointestinal Surgery 1320 125. Ethics in Surgery 1367
Arvind Kumar, Belal Bin Asaf Sanjay Nagral
120. Tumor Markers in Gastrointestinal
Appendix 1373
Malignancy 1334
Nilesh Patil, Kunal Parasar, Sundeep Singh Saluja Index I-1
SECTION 1
General
Another random document with
no related content on Scribd:
Toda a cousa negra é preta,
Papel é de trapos velhos,
Olhos do. são besbelhos,
Bordão de velho é moleta:
O mascarado é careta,
Tabaco é fumo pizado,
Peixe de moquem é assado,
O pirão duro é taipeiro,
Mareta em mar é carneiro,
Rapadura é mel coalhado.

Quem não tem juizo é tolo,

Quem morre fica sem vida,
Perna delgada é comprida,
Reposto de jogo é bôlo:
Negro ladino é creoulo,
Sebo de vacca é gordura,
Figado e bofes forçura,
Manteiga é nata de leite,
É oleo todo o azeite,
E todo o vigario é cura.

Sem a lingua não se falla,

Quem não come morre á fome,
A empinge toda come,
O surrão de couro é mala:
Palalá é... rala,
O tatú tem casca dura,
O salgado faz secura,
Arroz sem casca é pilado,
As sôpas são pão molhado,
O ferrolho é fechadura.
Os bancos servem de assento,
Leicenço tem carnegão,
Homem de villa é villão,
As pennas voam com vento:
O adro da egreja é bento,
A camisa é roupa branca,
Pau que fecha a porta é tranca,
Tem ventas todo o nariz,
Toda a batata é raiz,
A cara feia é carranca.

A farinha do Brazil
Primeiro foi mandioca,
Milho estalado é pipoca,
O gato todo é subtil:
Tres barris e um barril
Enchem todos uma pipa,
Não se faz casa sem ripa,
Ou vara com seu sipó,
Quem não tem ninguem é só,
Todo o bom cavallo esquipa.

Sempre é boa a espada nova,

Mas a velha é saramago,
Homem que gagueja é gago,
Toda a banana é pacova:
Quem morreu vai para a cova,
Olho do .. é mataco:
Agua de flor do sovaco
Deu sempre vida a um morto,
O que tem um olho é torto,
Guariba não é macaco.
Solimão e rozalgar
Matam, porque são veneno,
Grande doutor foi Galeno,
O fazer curso é purgar:
Fallar por solfa é cantar,
Na botica ha trementina,
Criança femea é menina,
.... ..... ..
Mascarado é papa-angú,
Oleo de pinha é resina.

Tabaco pobre é macaya.

Ave sem penna é morcego,
Toda a agua do Mondego
Desemboca pela praia:
Quem é mulher veste saia,
Os homens vestem calções,
Têm os negros seus bordões,
E cinco palmos a vara,
Tantas arrobas de tara
Tem cada um dos caixões.

Aguardente é geribita,
...dura é .....,
A ...... é pismam
E todo o listão é fita:
A colera logo irrita,
Ganhamú é caranguejo,
Não é sancto São Serejo,
Mas no ceu moram os sanctos;
Todas as casas têm cantos,
Do leite se faz o queijo.
Nos trunfos ha basto e sota,
Dará cartas quem foi mão,
A mulher tem seu pampam,
Pelo pé se calça a bota:
Quem não tem voto não vota,
O que deu cartas é pé,
O escrivão porta por fé,
Obra grosseira é do Porto,
Todo o defuncto está morto,
Vaza e mais enche a maré.

Almorreimas é quentura,
As redes têm seus cadilhos,
Zebedeu foi pae de filhos,
Quem morreu, já não tem cura:
........................
.......................
Jogo de trez é a espadilha,
Ao de dous lhe chamam zanga,
Camisa tem sua manga,
Não ha navio sem quilha.

Faz pasteis o pasteleiro,

Toda a virgem é donzella,
No Brazil ha já cannella,
Todo o frade é redoleiro.
Bate no ferro o ferreiro
E o marido na mulher,
Porque um e mais outro quer,
E gostam da tal asneira,
E não ha mister peneira
Quem farinha não tiver
Todas as côres são tintas,
Duro pau é supipira,
Quem é manso não tem ira,
Do zengá se fazem cintas:
Portugal tem ricas quintas,
E cada uma tem seu dono,
O que quer dormir tem somno,
O que dorme está dormindo,
O que veio tem já vindo
E toda a solfa tem tono.

Ha pelo entrudo filhozes,

Não ha carne na quaresma,
É todo o fedelho—lesma,
No poder os reis são crozes:
Quem tem dente come nozes,
O que quebra está quebrando,
Quem come está manducando,
O que corre vai correndo,
O que bebe está bebendo
E quem joga está jogando.

Dico vere veritates,

Crede mihi, vou fallando,
E quanto mais for andando,
Magis dicam asnitates:
No Recife ha mil mascates
Sobreposse mercadores,
Geme quem padece dores,
É o ... todo vento,
Freiras moram no convento,
E quem quer tem seus amores.
As madrinhas são comadres,
Chocolate tem cacau
Passa dez não é pacau,
Clerigos todos são padres:
É cego não ver por grades,
O limão todo é azedo,
O que tem pavor tem medo,
É boa a mulher que ....,
Não é boa a ... mole,
A pedra grande é penedo.

Quem tem boca vai a Roma,

Quem tem sangue faz chouriços,
As abelhas têm cortiços,
A zabelê sua coma:
O ruim assucar é broma,
A canada tem quartilho,
Não tem pé a mão de milho,
Coruja não é canario,
Livro velho é calendario,
O maná não é quintilho.

É o memento lembrança
Das almas do outro mundo,
A panella tem seu fundo,
E quem herdou teve herança:
É zombar estar de chança,
Muitos filhos tem Antonio
Nunes, do seu matrimonio,
Que dos outros não sabemos;
Aposto que já entendemos
Em que é purga o antimonio.
Os sapatos levam sola,
A carne de boi é vacca,
A ... em criança é caca,
É redonda toda a bola:
Passarinho na gaiola
Está prezo na cadeia,
O gatinho bravo meia,
São frades os franciscanos,
O homem velho já tem annos,
A formosa não é feia.

Quem vai só—vai solitario,

Quem tem fome excusa môlho,
O ... tem no meio ôlho,
Tem a mulher ordinario:
Chama-se a pessa Calvario;
Cidades tem Portugal,
Ouro é o que ouro val,
Pratos de côr tem rabique,
Não se faz renda sem pique,
Todo o salgado tem sal.

Peccados mortaes são septe,

E dez são os mandamentos,
Septe são os Sacramentos,
O estojo tem canivete:
Os frades com seu topete
Não pagam luguel de cazas,
Os anjinhos levam azas,
Cães de fila todos mordem,
Sacramento sexto é ordem,
Ganhou o que fez mais vazas.
Estas pois e outras verdades,
Amigo, que aqui vos digo,
São as de que sou amigo;
.........................
O mais são só asnidades
D’esses que dizem rodeios,
Porque só por estes meios
Se falla bem portuguez;
Tudo o mais é ser francez,
E trazer na boca freios.
 JUSTIÇA
QUE FAZ O P. NA HONRA HYPOCRITA PELOS ESTRAGOS QUE
ANDA FAZENDO NA VERDADEIRA HONRA

Uma cidade tão nobre[2],

Uma gente tão honrada,
Veja-se um dia louvada
Desde o mais rico ao mais pobre:
Cada pessoa o seu cobre;
Mas si o diabo me atiça,
Que indo a fazer-lhes justiça,
Algum saia a justiçar,
Não me poderão negar
Que por direito e por lei
Esta é a justiça que manda El-Rei.

[2] Lisboa.

O fidalgo de solar
Se dá por envergonhado
De um tostão pedir prestado
Para o ventre sustentar:
Diz que antes o quer furtar,
Por manter a negra honra,
Que passar pela deshonra
De que lh’o neguem talvez:
Mas si o vires nas galés
Com honras de vice-rei,
Esta é a justiça que manda El-Rei.
 A donzella embiocada,
Mal trajada, peior comida,
Antes quer na sua vida
Ter saia que ser honrada:
É publica amancebada
Por manter a negra honrinha,
E si lh’o chama a visinha,
E lh’o ouve a clerizia,
Dão com ella na enxovia,
E paga a pena da lei:
Esta é a justiça que manda El-Rei.

A casada com adorno,

E o marido mal vestido,
Crêde que este tal marido
Pentêa monho de ...
Si disser pelo contorno
Que si soffre a frei Thomaz,
Por manter a honrinha o faz;
Esperae pela pancada,
Que com carocha pintada
De Angola ha de ser vis-rei:
Esta é a justiça que manda El-Rei.

Os lettrados peralvilhos,
Citando o mesmo doutor
A favor do réu e auctor,
Comem de ambos os carrilhos:
Si se diz pelos corrilhos
Sua prevaricação,
A desculpa que vos dão
É a honra de seus parentes;
E entonces os requerentes
Fogem d’esta infame grei:
Esta é a justiça que manda El-Rei.
 O clerigo julgador,
Que’as causas julga sem pejo,
Não reparando que eu vejo
Que erra a lei e erra o doutor:
Quando vem do monsenhor
A sentença revogada,
Por saber que foi comprada
Pelo gimbo ou pelo abraço,
Responde o padre madraço:
Minha honra é minha lei;
Esta é a justiça que manda El-Rei.

O mercador avarento
Quando a sua conta extende,
No que compra e no que vende
Tira duzentos por cento:
Não é elle tão jumento
Que não saiba que em Lisboa
Se lhe ha de dar na gamboa;
Mas comido já o dinheiro,
Diz que a honra está primeiro,
E que honrado a toda a lei.
Esta é a justiça que manda El-Rei.

A viuva auctorisada,
Que não possue vintem,
Porque o marido de bem
Deixou a casa empenhada:
Alli entra a fradalhada,
Qual formiga em correição,
Dizendo que á casa vão
Manter a honra da casa;
Si a vires arder em brasa,
Que ardeu a honra entendei.
Esta é a justiça que manda El-Rei.
 O Adonis da manhãa,
O Cupido em todo o dia,
Que anda correndo a coxia
Com recadinhos á irmãa,
E si lhe cortam a lãa
Diz que anda naquelle andar
Pela honra conservar
Bem tractado e bem vestido;
Eu o verei tão despido,
Que até as costas lhe verei.
Esta é a justiça que manda El-Rei.

Si vires um dom abbade

Sôbre o pulpito cioso,
Não lhe chameis religioso,
Chamae-lhe embora de frade:
E si o tal Paternidade
Rouba as rendas do convento,
Para acudir ao sustento
Da ..., como da peita
Com que livra de suspeita
Do Geral, do Vice-Rei,
Esta é a justiça que manda El-Rei.
 DIALOGO
ENTRE O DEMONIO E A ALMA

Cantavam naquelle tempo os chulos da Bahia certas

cantigas por uma toada triste que rematava, dizendo:
«Banguê, que será de ti?» Mas outros mais piedosos
reduziam a mesma canção ao Divino finalizando assim: «Meu
Deus, que será de mim?» E o P. entre o temporal e o eterno
de uma o outra chularia introduziu uma alma christãa
resistindo ás tentações do demonio com a glosa de ambos os
extremos:

Meu Deus, que será de mim?

Banguê, que será de ti?

Alma—Si o descuido do futuro

E a lembrança do presente
É em mim tão continente,
Como do mundo murmuro?
Será porque não procuro
Temer do principio o fim?
Será porque sigo assim
Cegamente o meu peccado?
Mas si me vir condemnado,
Meu Deus, que será de mim?
Dem.—Si não segues meus enganos
E meus deleites não segues,
Temo que nunca socegues
No florido de teus annos:
Vê como vivem ufanos
Os descuidados de si:
Canta, baila, folga e ri;
Porque os que não se alegraram,
Dous infernos militaram:
Banguê, que será de ti?

Alma—Si para o céu me creastes,

Meu Deus, á imagem vossa,
Como é possivel que possa
Fugir-vos, pois me buscastes?
E si para mim tractastes
O melhor remedio e fim;
Eu, como ingrato Caim,
D’este bem tão esquecido,
Tendo-vos tão offendido,
Meu Deus, que será de mim?

Dem.—Todo o cantar allivia

E todo o folgar alegra,
Toda a branca, parda e negra
Tem sua hora de folia:
Só tu na melancolia
Tens allivio? Canta aqui
E torna a cantar alli,
Que d’esse modo o practicam
Os que alegres prognosticam
Banguê, que será de ti?
Alma—Eu para vós—offensor,
Vós para mim—derretido?
Eu—de vós tão esquecido,
E vós de mim—Redemptor?
Ai como sinto, Senhor,
De tão mau principio o fim,
Si me não valeis assim,
Como áquelle que na cruz
Feristes com vossa luz?
Meu Deus, que será de mim?

Dem.—Como assim na flor dos annos

Colhes o fructo amargoso?
Não vês que todo o penoso
É causa de muitos damnos?
Deixa, deixa desenganos,
Segue os deleites, que aqui
Te offereço, porque alli
Os mais que cantando vão,
Dizem na triste canção:
Banguê, que será de ti?

Alma—Quem vos offendeu, Senhor?

Uma creatura vossa?
Como é possivel que eu possa
Offender meu Creador?
Triste de mim peccador,
Si a gloria que daes sem fim,
Perdida num Serafim
Se perder em mim tambem?
Si eu perder tamanho bem,
Meu Deus, que será de mim?
Dem.—Si a tua culpa merece
Do teu Deus toda a esquivança,
Folga no mundo e descança
Que o arrepender aborrece:
Si o peccado te entristece,
Como já em outros vi,
Te prometto desde aqui
Que os mais da tua facção
E tu no inferno dirão:
Banguê, que será de ti?
 CONTRA
OS INGRATOS MURMURADORES DO BEM QUE
ACTUALMENTE RECEBEM DA MÃE UNIVERSAL, QUE OS
AFFAGA, SE QUEIXA A BAHIA, CONFESSANDO-SE DAS
CULPAS, QUE LHE DÃO, PELOS PRECEITOS DO DECALOGO

ROMANCE

Já que me põem a tormento

Murmuradores noviços,
Carregando sobre mim
Suas culpas e delictos;
Por credito do meu nome,
E não por temer castigo,
Confessar quero os peccados
Que faço, e que patrocino.
E si alguem tiver a mal
Descobrir este sigillo,
Não me infame que eu serei
Pedra em poço, ou seixo em rio.
Sabei, céu, sabei estrellas,
Escutae, flores e lirios,
Montes, serras, peixes, aves,
Lua, sol, mortos e vivos,
Que não ha nem póde haver,
Desde o Sul ao Norte frio,
Cidade com mais maldades,
Nem provincia com mais vicios,
Do que sou eu, porque em mim
Recopilados e unidos
Estão junctos quantos têm
Mundos e reinos distinctos.
Tenho Turcos, tenho Persas,
 Homens de nação impios,
Mogores, Armenios, Gregos,
Infieis e outros gentios.
Tenho ousados Mermidonios,
Tenho Judeus, tenho Assyrios,
E de quantas seitas ha
Muito tenho, e muito abrigo.
E sinão digam aquelles
Presados de vingativos,
Que sanctidade têm mais
Que um Turco e que um Mohabito!
Digam idolatras falsos,
Que estou vendo de continuo
Adorarem ao dinheiro,
Gula, ambição e amoricos!
Quantos com capa christãa
Professam o judaismo,
Mostrando hypocritamente
Devoção á Lei de Christo!
Quantos com pelle de ovelha
São lobos enfurecidos,
Ladrões, falsos, aleivosos,
Embusteiros e assassinos!
Estes por seu mau viver,
Sempre pessimo e nocivo,
São os que me accusam damnos,
E põem labéos inauditos.
Mas o que mais me atormenta
É ver que os contemplativos,
Sabendo a minha innocencia,
Dão a seu mentir ouvidos.
Até os mesmos culpados
Têm tomado por capricho,
Para mais me difamarem
Pôrem pela praça escriptos,
Onde escrevem sem vergonha,
Não só brancos, mas mestiços,
 Que para os bons sou inferno,
E para os mais paraizo.
Oh velhacos insolentes,
Ingratos, mal procedidos!
Si eu sou essa que dizeis,
Porque não largais meu sitio?
Porque habitais em tal terra,
Podendo em melhor abrigo?
Eu pego em vós? eu vos rogo?
Respondei: dizei, maldictos?
Mandei acaso chamar-vos,
Ou por carta, ou por aviso?
Não viestes para aqui
Por vosso livre alvedrio?
A todos não dei entrada,
Tractando-vos como a filhos?
Que razão tendes agora
De difamar-me atrevidos?
Meus males de quem procedem?
Não é de vós? claro é isso:
Que eu não faço mal a nada
Por ser terra e matto arisco.
Si me lançais má semente
Como quereis fructo limpo?
Lançae-a boa, e vereis
Si vos dou cachos optimos.
Eu me lembro que algum tempo,
Isto foi no meu principio,
A semente que me davam
Era boa e de bom trigo.
Por cuja causa meus campos
Produziam pomos lindos,
De que ainda se conservam
Alguns remotos indicios.
Mas depois que vós viestes
Carregados, como ouriços,
De sementes invejosas
 E legumes de maus vicios;
Logo declinei comvosco,
E tal volta tenho tido,
Que o que produzia rozas
Hoje só produz espinhos.
Mas para que se conheça
Si fallo verdade ou minto,
E quanto os vossos enganos
Têm difamado meu brio:
Confessar quero de plano
O que encubro por servir-vos,
E saiba quem me moteja
Os premios que ganho nisso.
Já que fui tão pouco attenta,
Que a luz da razão e o sizo
Não só quiz cegar por gosto,
Mas ser do mundo ludibrio.
Vós me ensinastes a ser
Das inconstancias archivo,
Pois nem as pedras que gero
Guardam fé aos edificios.
Por vosso respeito dei
Campo franco e grande auxilio
Para que se quebrantassem
Os mandamentos divinos.
Cada um por suas obras
Verá contra quem me explico,
Sem andar excogitando
Para quem se aponta o tiro.

PRECEITO I

Que de quilombos que tenho.

Com mestres superlativos,
Nos quaes se ensina de noite
Os calundús e feitiços!