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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
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd.
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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
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
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
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
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
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.
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:
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Jogo de trez é a espadilha,
Ao de dous lhe chamam zanga,
Camisa tem sua manga,
Não ha navio sem quilha.
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.
[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.
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.
ROMANCE
PRECEITO I