Atlas of Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery

990 Pages·2007·18.83 MB·English

by  Pierre-Alain Clavien

EDITORS Pierre-Alain Clavien
Michael G.Sarr
Yuman Fong
Atlas of Upper Gastrointestinal
and Hepato-Pancreato-Biliary Surgery
Panco Georgiev (Associate Editor)
EDITORS Pierre-Alain Clavien
Michael G.Sarr
Yuman Fong
Atlas of Upper
Gastrointestinal
and Hepato-
Pancreato-
Biliary Surgery
Panco Georgiev(Associate Editor)
With 950 Illustrations
123
EDITORS Pierre-Alain Clavien,MD,PhD
Department of Surgery
University Hospital Zurich
Raemistrasse 100,8091 Zurich,Switzerland
Michael G.Sarr,MD
Department of Surgery
Division of Gastroenterologic and General Surgery
Mayo Clinic College of Medicine
200 First Street SW,Rochester,MN 55905,USA
Yuman Fong,MD
Department of Surgery
Gastric and Mixed Tumor Service
Memorial Sloan-Kettering Cancer Center
1275 York Avenue,New York,NY 10065,USA
Panco Georgiev,MD(Associate Editor)
Department of Surgery
University Hospital Zurich
Raemistrasse 100,8091 Zurich,Switzerland
Madeleine Meyer(Staff Assistant)
Department of Surgery
University Hospital Zurich
Raemistrasse 100,8091 Zurich,Switzerland
ISBN 978-3-540-20004-8 Springer Berlin Heidelberg New York
Library of Congress Control Number:2006933609
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Editor:Gabriele M.Schröder,Heidelberg,Germany
Desk Editor:Stephanie Benko,Heidelberg,Germany
Production:LE-TEX Jelonek,Schmidt &.Vöckler GbR,Leipzig,Germany
Illustrations:Jörg Kühn,Heidelberg,Germany
Cover Design:Frido Steinen-Broo,eStudio Calamar,Spain
Typesetting:am-productions GmbH,Wiesloch,Germany
Printing and Binding:Stürtz GmbH,Würzburg,Germany
Printed on acid-free paper 24/3180YL – 5 4 3 2 1 0
Acknowledgments
The creation ofan atlas covering the entire scope ofupper gastrointestinal and hepato-
pancreato-biliary surgery is undoubtedly dependent on a team effort,which is possible
only with the support and enthusiasm ofmany individuals.First ofall,an atlas is a series
ofdrawings,which should transmit the appropriate knowledge in an artistic way.
We are deeply indebted to Mr.Jörg Kühn,who so successfully undertook the daunting
task ofcreating an entirely new and exhaustive visual depiction ofmany upper gastro-
intestinal and hepato-pancreato-biliary procedures.His imagination,ingenuity,under-
standing ofsurgical anatomy,and artistic skill have produced what we believe is the
definitive rendering oftoday’s upper gastrointestinal and hepato-pancreato-biliary
operations.
A very special acknowledgment should go to Panco Georgiev.Panco is a bright
young resident,who devoted an incredible amount oftime and effort to coordinating
and supervising the entire atlas on behalfofthe Editors.We are also indebted to
Madeleine Meyer,StaffAssistant in the Zurich office,who also put tireless efforts into
assisting the Editors in many oftheir tasks.
Finally,we would like to thank the entire staffat Springer,particularly Gabriele
Schröder and Stephanie Benko,as well as Judith Diemer from LE-TeX,who were
very supportive from the first idea ofthis atlas,and maintained their enthusiasm
until the end.
Pierre-Alain Clavien
Michael Sarr
Yuman Fong
Preface
Knowledge ofanatomy and precise surgical technique remain the foundation ofhigh
quality surgery.A knowledgeable surgeon,equipped with excellent theoretical and clin-
ical skills,will only be accomplished when he or she masters the operative techniques of
the practice ofsurgery.The legacy ofan academic surgeon or a surgical educator relies
in great part on the transmission ofhis or her surgical abilities.During the last few
years,we as surgical educators felt more and more that teaching surgical skills and tech-
niques are compromised due to the plethora ofnew information dealing with other
aspects ofsurgery.The number ofnew procedures and techniques developed since the
early 1990s,for example,laparoscopic liver resection or Roux-en-Y gastric bypass,
although offering obvious advantages for the patients,constitute a real technical chal-
lenge for us surgeons.Therefore,possibly more than ever before,surgeons need to
acquire sound knowledge about the various surgical procedures and techniques avail-
able.
In bringing forth a new surgical atlas,we were motivated by the desire to create a
comprehensive and educational atlas focusing on the upper abdomen and emphasizing
all details ofoperative techniques including tricks from experienced surgeons.In view
ofthe availability ofmany textbooks describing non-technical aspects ofsurgery,we
purposely avoided writing a text addressing the disease processes,but instead concen-
trated on the operative procedures,which are evolving rapidly.The techniques described
are the real message ofthe atlas.We standardized the text associated with each proce-
dure,covering a list ofthe most common indications and contraindications,a step-by-
stepdescription ofthe procedure,a list ofthe most common complications,and finally
the tricks ofthe experienced surgeon.We also included an introductory section covering
the basic principles ofoperative surgery including operative accesses,positioning ofthe
patient,and the use ofretractors,drains,and staplers.This section,contrary to the
specific procedures,was written by residents and junior staffsurgeons at the University
Hospital ofZurich under the direct supervision ofthe Editors.
While a surgeon 50years ago could treat diseases from head to toe,this concept has
evolved,and today some degree ofspecialization is the rule worldwide.Most countries
or accrediting authorities are designing various boards for sub-specializations;indeed,
after a broad training in general surgery,many young surgeons will move on further
into a specific field.Upper gastrointestinal and hepato-pancreato-biliary surgery are
emerging as specialized fields ofgeneral surgery,including common procedures
belonging to the scope ofgeneral surgery as well as complex procedures,that should be
performed only by specialized surgeons.We opted for a comprehensive approach of
upper gastrointestinal and hepato-pancreato-biliary surgery,covering most open and
laparoscopic procedures ranging from straightforward procedures such as laparoscopic
cholecystectomy to the more complex procedures,such as spleno-renal shunt and liver
or pancreas transplantation.
This Atlas ofUpper Gastrointestinal and Hepato-Pancreato-Biliary Surgery presents
illustrations created by a single artist.This approach is key to following a procedure,
step-by-step,in a consistent and attractive manner.In selecting contributors from
around the world,we sought surgeons who had extensive and recognized experience
with the procedure.Most ofthe contributors are established educators and have
successfully mentored many young surgeons.
VIII Preface
The Atlas ofUpper Gastrointestinal and Hepato-Pancreato-Biliary Surgery is subdi-
vided into seven sections,each coordinated by a section editor in a close collaboration
with the artist.A balance was achieved in each procedure to highlight the educational
message in combination with the art ofmedical drawing.Based on the personal experi-
ence ofthe expert authors,a few tricks are presented at the end ofeach procedure.Some
procedures,such as those related to portal hypertension,are becoming less popular.
This atlas may contribute significantly to saving the accumulating knowledge ofthese
demanding surgical procedures.
The Atlas ofUpper Gastrointestinal and Hepato-Pancreato-Biliary Surgery is intended
for students and residents in surgery and for fellows specializing in upper gastroin-
testinal and hepato-pancreato-biliary surgery preparing themselves for the operation.
At the same time,this atlas will be useful for specialists and general surgeons,who may
compare their techniques with the one described herein or find some additional help
or tricks when performing rare procedures.
In summary,we believe that the Atlas ofUpper Gastrointestinal and Hepato-
Pancreato-Biliary Surgery is truly a new atlas,new in concept,and new in scope.
We hope that specialists as well as surgeons at various levels oftraining will benefit
from this huge effort,combining the work ofmany experts,a gifted artist,and the
publisher.
Pierre-Alain Clavien,Zurich
Michael Sarr,Rochester
Yuman Fong,New York
Contents
SECTION 1 General Principles 1
Pierre-Alain Clavien,Michael G.Sarr
Introduction 3 OOO
Pierre-Alain Clavien,Michael G.Sarr
Positioning and Accesses 5 OOO
Yvonne Knoblauch,Dieter Hahnloser
Retractors and Principles of Exposure 21 OOO
Tim Gessmann,Markus Schäfer
Surgical Staplers 27 OOO
Nicolas Attigah,Markus Schäfer
Principles of Drainage 33 OOO
Henrik Petrowsky,Stefan Wildi
SECTION 2 Esophagus,Stomach and Duodenum 43
Jakob R.Izbicki
Introduction 45 OOO
Jakob R.Izbicki
Cervical Esophagectomy 47 OOO
Wolfram T.Knoefel,Rainer Schmelzle
Left Thoracoabdominal Approach for Carcinoma
of the Lower Esophagus and Gastric Cardia 55 OOO
Shoji Natsugoe,Masamichi Baba,Takashi Aikou
Subtotal Esophagectomy:Transhiatal Approach 63 OOO
Stefan B.Hosch,Emre F.Yekebas,Jakob R.Izbicki
Subtotal En-Bloc Esophagectomy:Abdominothoracic Approach 79 OOO
Stefan B.Hosch,Asad Kutup,Jakob R.Izbicki
Abdominothoracic En-Bloc Esophagectomy
with High Intrathoracic Anastomosis 89 OOO
Asad Kutup,Emre F.Yekebas,Jakob R.Izbicki
X Contents
Limited Resection of the Gastroesophageal Junction
with Isoperistaltic Jejunal Interposition 93 OOO
Asad Kutup,Emre F.Yekebas,Jakob R.Izbicki
Three-Field Lymphadenectomy for Esophageal Cancer 99 OOO
Masamichi Baba,Shoji Natsugoe,Takashi Aikou
Minimally Invasive Esophagectomy 105 OOO
RudolfBumm,Hubertus Feussner
Zenker’s Diverticula:Open Approach 117 OOO
Claus F.Eisenberger,Christoph Busch
Endoscopic Treatment of Zenker’s Diverticulum 123 OOO
Uwe Seitz
Epiphrenic Diverticula 127 OOO
Chris G.Collins,Gerald C.O’Sullivan
Techniques of Local Esophagoplasty in Short Esophageal Strictures 135 OOO
Asad Kutup,Emre F.Yekebas,Jakob R.Izbicki
Operation for Achalasia 139 OOO
Luigi Bonavina,Alberto Peracchia
Subtotal Gastrectomy,Antrectomy,Billroth II and Roux-en-Y Reconstruction
and Local Excision in Complicated Gastric Ulcers 143 OOO
Joachim Ruh,Enrique Moreno Gonzalez,Christoph Busch
Total Gastrectomy with Conventional Lymphadenectomy 165 OOO
Jürg Metzger
Total Gastrectomy with Radical Systemic Lymphadenectomy
(Japanese Procedure) 179 OOO
Mitsuru Sasako
Transhiatal Esophagogastrectomy 189 OOO
Enrique Moreno Gonzalez,Juan C.Meneu Diaz,Asad Kutup,
Jakob R.Izbicki,Almudena Moreno Elola-Olaso
Laparoscopic Gastrectomy 211 OOO
Geert Kazemier,Johan F.Lange
Gastroenterostomy 221 OOO
John Tsiaoussis,Gregory G.Tsiotos
Conventional Gastrostomy (Kader Procedure):
Temporary or Permanent Gastric Fistula 227 OOO
Asad Kutup,Emre F.Yekebas
Contents XI
Percutaneous Endoscopic Gastrostomy 235 OOO
Capecomorin S.Pitchumoni
Laparoscopic-Assisted Gastrostomy 243 OOO
Tim Strate,Oliver Mann
Operation for GERD:Laparoscopic Approach 249 OOO
Ketan M.Desai,Nathaniel J.Soper
Operation for GERD:Conventional Approach 261 OOO
Karim A.Gawad,Christoph Busch
Operation for Paraesophageal Hernia 269 OOO
Jean-Marie Michel,Lukas Krähenbühl
Management of the Duodenal Stump 281 OOO
Matthias Peiper,Wolfram T.Knoefel
Operation for Morbid Obesity 285 OOO
Markus Weber,Markus K.Müller,Michael G.Sarr
Pancreas-Sparing Duodenectomy 303 OOO
Claus F.Eisenberger,Jakob R.Izbicki,Michael G.Sarr
SECTION 3 Liver 309
Pierre-Alain Clavien
Introduction 311 OOO
Pierre-Alain Clavien
Terminology of Liver Anatomy and Resections:
The Brisbane 2000 Terminology 313 OOO
Steven M.Strasberg
Techniques of Liver Parenchyma Dissection 319 OOO
Mickaël Lesurtel,Pierre-Alain Clavien
Techniques of Vascular Exclusion and Caval Resection 327 OOO
Felix Dahm,Pierre-Alain Clavien
Hanging Maneuver for Anatomic Hemihepatectomy
(Including Living-Donor Liver Transplantation) 335 OOO
Jacques Belghiti,Olivier Scatton
Liver Resections 339 OOO
Panco Georgiev,Pierre-Alain Clavien