Atlas of Gastrointestinal Surgery

561 Pages·2006·47.53 MB·English

by  John L. Cameron

cameron_front.qxd 8/22/06 4:47 PM Page i
ATLAS OF
G
ASTROINTESTINAL
S
URGERY
V O L U M E
O N E
S E C O N D
E D I T I O N
J L. C , MD, FACS
OHN AMERON
The Alfred Blalock
Distinguished Service Professor
The Johns Hopkins University School of Medicine
Baltimore, Maryland
C S , MA, CMI
ORINNE ANDONE
Medical Illustrator
Assistant Professor
Department of Art as Applied to Medicine
Johns Hopkins University School of Medicine
Baltimore, Maryland
2007
BC Decker Inc
Hamilton
cameron_front.qxd 8/22/06 4:47 PM Page ii
BC Decker Inc
P.O. Box 620, L.C.D. 1
Hamilton, Ontario L8N 3K7
Tel: [phone]
Fax: [phone]
E-mail: [email protected]
www.bcdecker.com
©2007 BC Decker Inc
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. First edition, 1990.
07 08 09 10/LEGO/9 8 7 6 5 4 3 2 1
ISBN 1-55009-270-7
Printed in Italyby Legatoria Editoriale Giovanni Olivotto
Production Editor: Petrice Custance; Typesetter: Norm Reid;Cover Designer: Lisa Mattinson
Sales and Distribution
United States UK, Europe, Scandinavia, Middle East Mexico and Central America
BC Decker Inc Elsevier Science ETM SA de CV
P.O. Box 785 UK, Europe, Scandinavia, Middle East, Africa Calle de Tula 59
Lewiston, NY 14092-0785 Elsevier Ltd. Colonia Condesa
Tel: [phone] Books Customer Services 06140 Mexico DF, Mexico
Fax: [phone] Linacre House Tel: [phone]
E-mail: [email protected] Jordan Hill Fax: [phone]
www.bcdecker.com Oxford E-mail: [email protected]
OX2 8DP, UK
Canada Tel: [phone] Brazil
BC Decker Inc Fax: [phone] Tecmedd Importadora E Distribuidora De
50 King St. E. E-mail: [email protected] Livros Ltda.
P.O. Box 620, LCD 1 Avenida Maurílio Biagi, 2850
Hamilton, Ontario L8N 3K7 Singapore,Malaysia,Thailand, Philippines, City Ribeirão, Ribeirão Preto – SP – Brasil
Tel: [phone] Indonesia, Vietnam, Pacific Rim, Korea CEP: 14021-000
Fax: [phone] Elsevier Science Asia Tel: [phone]
E-mail: [email protected] 583 Orchard Road Fax: [phone]
www.bcdecker.com #09/01, Forum E-mail: [email protected]
Singapore 238884
Foreign Rights Tel: [phone] India, Bangladesh, Pakistan, Sri Lanka
John Scott & Company Fax: [phone] Elsevier Health Sciences Division
International Publishers’Agency Customer Service Department
P.O.Box 878 Australia, New Zealand 17A/1, Main Ring Road
Kimberton, PA19442 Elsevier Science Australia Lajpat Nagar IV
Tel: [phone] Customer Service Department New Delhi – 110024, India
Fax: [phone] Locked Bag 16 Tel: [phone]
E-mail: [email protected] St. Peters, NewSouth Wales 2044 Fax: [phone]
Australia E-mail: [email protected]
Japan Tel: [phone]
Igaku-Shoin Ltd. Fax: [phone]
Foreign Publications Department E-mail: [email protected]
3-24-17 Hongo www.elsevier.com.au
Bunkyo-ku, Tokyo, Japan 113-8719
Tel: [phone]
Fax: [phone]
E-mail: [email protected]
Notice: The authors and publisher havemade every effort to ensure that the patient care recommended herein, including choice of drugs and drug dosages, is in accord with the
accepted standard and practice at the time of publication. However, since research and regulation constantly change clinical standards, the reader is urged to check the product
information sheet included in the package of each drug, which includes recommended doses, warnings, and contraindications. This is particularly important with new or infre-
quentlyused drugs. Any treatment regimen, particularly one involving medication, involves inherent risk that must be weighed on a case-by-case basis against the benefits antic-
ipated. The reader is cautioned that the purpose of this book is to inform and enlighten; the information contained herein is not intended as, and should not be employed as, a
substitute for individual diagnosis and treatment.
cameron_front.qxd 8/22/06 4:47 PM Page iii
C
ONTENTS
Gall bladder and Biliary Tract
Laparoscopic Cholecystectomy 3
Laparoscopic Bile Duct Exploration: Transcystic Approach 14
Laparoscopic CBD Exploration: Choledochotomy Approach 16
Open Cholecystectomy 18
Common Duct Exploration 25
Sphincteroplasty 32
Side-to-Side Choledochoduodenostomy 37
Resection of a Benign Bile Duct Stricture with Reconstruction Utilizing a Hepaticojejunostomy 42
Resection of a Proximal Cholangiocarcinoma (Klatskin Tumor) with Reconstruction via
Bilateral Hepaticojejunostomies 57
Resection of a Proximal Cholangiocarcinoma with Hepatic Lobectomy and Reconstruction
with a Hepaticojejunostomy 69
Proximal Cholangiocarcinoma: Palliation by Transhepatic Stenting and Hepaticojejunostomy 79
Resection of Hepatic Duct Bifurcation, Dilatation of Intrahepatic Biliary Tree, and Prolonged
Stenting with Transhepatic Biliary Stents for Sclerosing Cholangitis 87
Resection of Choledochal Cyst 97
Transhepatic Stenting for Caroli’s Disease 104
Wedge Resection of Liver and Regional Lymph Node Dissection, Resection of the Extrahepatic
Biliary Tree with Hepaticojejunostomy, for Carcinoma of the Gall bladder 114
The Liver
Anatomy of the Liver 123
Hepatic Ultrasonography: Open and Laparoscopic 125
Major Resections: Right Hepatectomy 129
Extended Right Hepatectomy (Right Trisectorectomy) 137
Left Hepatectomy 139
Extended Left Hepatectomy (Trisectorectomy) 145
Minor Resections: Segmental Resection: Right Posterior Sectorectomy 149
Left Lateral Sectorectomy 154
Nonanatomic Resection of Liver 158
Laparoscopic Resection of Liver 162
Resection Simple Cyst of Liver: Laparoscopic and Open 165
Management of Hydatid Cyst 171
Hepatic Hemangioma Enucleation 176
Other Hepatic Procedures: Liver Tumor Ablation 179
Hepatic Artery Infusion Pump 182
Surgical Drainage of Liver Abscess 187
Shunts
Interposition Mesocaval Shunt 193
Distal Splenorenal Shunt 204
Portacaval Shunt 211
Mesoatrial Shunt 222
cameron_front.qxd 8/22/06 4:47 PM Page iv
iv Atlas of Gastrointestinal Surgery
The Pancreas
Longitudinal Pancreaticojejunostomy: Puestow Procedure 231
Distal Pancreatectomy for Chronic Pancreatitis 242
Ninety-Five Percent Distal Pancreatectomy for Chronic Pancreatitis 251
Local Pancreatic Head Resection with Lateral Pancreaticojejunostomy (The Frey Procedure) 254
Duodenal Preserving Pancreatectomy for Chronic Pancreatitis (The Beger Procedure) 260
Accessory Duct Papillotomy for Pancreas Divisum 267
Drainage of Pancreatic Pseudocyst into a Roux-en-Y Jejunal Loop 270
Drainage of Pancreatic Pseudocyst into the Stomach 277
Drainage of Pancreatic Pseudocyst into the Duodenum 281
Pancreaticoduodenectomy (Pylorus-Preserving Whipple Procedure) 284
Palliative Bypasses for Unresectable Periampullary Cancer 306
Distal Pancreatectomy for Tumor 310
Central Pancreatectomy with Pancreaticogastrostomy 317
Laparotomy for Insulinoma 321
Débridement and Drainage of Pancreatic Abscess 326
Diverticularization of the Duodenum and Pancreatic Drainage for Combined
Duodenal and Pancreatic Trauma 335
Pyloric Exclusion and Pancreatic Drainage for Combined Duodenal and Pancreatic Trauma 339
The Spleen
Splenectomy 345
Laparoscopic Splenectomy 350
Splenectomy for a Massive Spleen 355
Management of Splenic Trauma by Splenorrhaphy 363
Management of Splenic Trauma By Partial Splenic Resection 368
Management of Splenic Trauma By Mesh Splenorrhaphy 374
Drainage of Splenic Abscess 378
The Esophagus
Antireflux Surgery – An Overview 383
Nissen Fundoplication 386
Laparoscopic Nissen Fundoplication 391
Toupet Fundoplication: Open and Laparoscopic 398
Belsey Mark IV Antireflux Procedure 403
Collis-Nissen Repair for Esophageal Stricture and Shortened Esophagus 411
Short Segment Colon Interposition for Benign Esophageal Stricture 415
Repair of Paraesophageal Hernia 425
Resection of Zenker’s Diverticulum 429
Suspension of Zenker’s Diverticulum 433
Resection of Epiphrenic Esophageal Diverticulum with Esophagomyotomy and Belsey Repair 435
Achalasia: Heller Esophagomyotomy and Belsey Repair 441
Achalasia: Laparoscopic Heller Esophagomyotomy and Toupet Repair 446
Esophageal Spasm: Long Esophagomyotomy and Belsey Repair 451
Open Resection of Esophageal Leiomyoma 457
Video-Assisted Thoracic Surgical Resection of Esophageal Leiomyoma 460
Esophagogastrectomy: Separate Abdominal and Thoracic Incisions 464
Esophagogastrectomy through a Left Thoracoabdominal Incision 475
Transhiatal Blunt Esophagectomy with Esophagogastrostomy 480
Transhiatal Blunt Esophagectomy with Long Segment Colon Interposition 493
Esophageal Reconstruction Following Total Laryngopharyngectomy:
Pharyngogastrostomy or Reconstruction Utilizing Free Jejunal Graft 503
Esophageal Reconstruction Using Substernal Colon 512
Boerhaave’s Syndrome: Esophageal Repair 522
Boerhaave’s Syndrome: Esophageal Exclusion, Diversion and Closure 525
Repair of Cervical Esophageal Perforation 530
Repair of Thoracic Esophageal Perforation 533
Repair of Acquired Tracheoesophageal Fistula 537
cameron_front.qxd 8/22/06 4:47 PM Page v
C
ONTRIBUTORS
John L. Cameron, MD, FACS
Michael A. Choti, MD
Keith D. Lillemoe, MD
Mark Talamini, MD
Stephen Yang, MD
Charles J. Yeo, MD
Department of Surgery
Johns Hopkins University School of Medicine
Baltimore, Maryland
Corinne Sandone, MA, CMI
Department of Art as Applied to Medicine
Johns Hopkins University School of Medicine
Baltimore, Maryland
cameron_front.qxd 8/22/06 4:47 PM Page vi
E ’ P
DITOR S REFACE
This is the first of a two-volume atlas that represents the 2nd edition of our work published fourteen years ago. The distin-
guishing characteristic of the second edition is the same as for the first edition – the artist Corinne Sandone. She has estab-
lished herself as one of the outstanding surgical illustrators of her era in this country. Her combining of accurate anatomical
renderings, with unique angles and perspectives, via her magnificent watercolor technique, make her work unique. Because
of her superb contribution, she is not only listed as the illustrator, but also as a coeditor of the atlas.
The first chief of surgery at the Johns Hopkins Hospital, Dr. William Stewart Halsted, was one of the pioneers of gas-
trointestinal surgery in this country. In the 1880s, when the great surgeons of Europe were attempting to anastomose intes-
tine, with a high failure rate, Halsted was the first to demonstrate that intestinal sutures should include the sub-mucosal layer,
and not just the muscular layer of the intestine. This contribution led to the development of the field of gastrointestinal sur-
gery. Halsted also made unique contributions to the area of biliary tract and gall bladder surgery, and was the first surgeon
in the world to successfully resect a periampullary tumor. After Halsted’s death, the next great era at Hopkins involved
the emergence of cardiac surgery. Dr. Alfred Blalock and his brilliant trainees were important players in the development
and emergence of this field.
In the 1970s and 1980s, with new leadership at Hopkins, gastrointestinal surgery again emerged as an important focus
for the department. Beginning in the 1970s and extending up until the present, a school of gastrointestinal surgery emerged
at Hopkins, which has produced many young surgeons who currently hold important chairs of surgery throughout the coun-
try. This atlas includes the techniques, operations, and procedures favored and performed, and in some instances initiated,
by these gastrointestinal surgeons. Thus, the operations included in this atlas are not all inclusive in scope. In many instances
there are other operations and procedures that are used by others, with equally good results.
Successful gastrointestinal surgical outcomes depend upon the surgeon, however, favorable outcomes depend upon having
outstanding and supportive gastroenterologists, radiological interventionists, anesthesiologists, intensivists, nurses, house
staff, and another group that is becoming more and more important to the care of patients with gastrointestinal diseases —
nurse practitioners and physicians’ assistants.
John L. Cameron
October 2006
cameron_front.qxd 8/22/06 4:47 PM Page vii
I ’ P
LLUSTRATOR S REFACE
The illustrations in this atlas are the result of a 20-year collaboration with many outstanding surgeons, including and espe-
cially Dr. John Cameron. Their willingness to have me observe and sketch and, more importantly, their descriptions of steps
which could not be observed directly, contributed to the clarity, accuracy and didactic strength of these images. The sur-
geons’ narratives through the operative steps, including pitfalls and technical details for success, were crucial to my under-
standing and subsequent depictions of their operative techniques.
Technology has provided new tools for the surgeon and the illustrator in the past two decades. These tools, however, do
not replace or substitute for the talent, knowledge, experience and decision-making ability required for success in both
fields. Since work was begun on the first edition of this atlas, new equipment in the operative suite - laparoscopic devices,
intraoperative ultrasound - has been paralleled by developments in the studio equipment - scanners, digitized drawing
tools. These change the way we work, but not the essence of what we do.
The challenge of my work is to provide the clarity, that a camera could never capture, to the operative steps while main-
taining the realism of peering into the operative field. Less relevant is whether I achieve this by pushing wet pigment around
with a traditional paintbrush or by moving pixels with a digitized pen tool. Many of the paintings in the volume are reprints
of the original watercolors, a significant portion have been revised and updated, and many more are new -
created using a combination of traditional and new media.
It has been my pleasure to work with the surgical teams at Hopkins. The second edition of this atlas will further dissemi-
nate their knowledge and techniques, allowing the reader to learn and see what I have had the privilege to observe, under-
stand and illustrate.
Medical illustration began at Johns Hopkins in 1894 with the arrival of Max Brödel to the newly founded School of
Medicine. Working with the early Hopkins faculty, Brödel skillfully illustrated the research publications that documented
the groundbreaking work of William S. Halsted, Harvey Cushing, William H. Welch, William Osler, Howard A. Kelly
and Thomas Cullen. In 1911, the Department of Art as Applied to Medicine was created, formalizing Max Brödel’s
training of exceptional young artists to become capable medical illustrators. Currently in it’s 10th decade, the program
grants a Master of Arts degree to medical illustrators who train alongside medical students and collaborate with Hopkins
clinicians and researchers as their fields evolve.
Corinne Sandone
October 2006
cameron_front.qxd 8/22/06 4:47 PM Page viii
D
EDICATION
To all who participate in the care of the patient with a surgical gastrointestinal disease,
particularly those surgeons who trained or spent time here, and are now building
their own schools of gastrointestinal surgery, this atlas is dedicated.
JLC
For Dan, Carlene and Claudia - smart, funny and kind.
CS
cameron_ch01_gall_01-08.qxd 8/22/06 3:17 PM Page 1
G B
ALL LADDER