A
Davidson
Title
Surgery
Principles & Practice of
6th Edition
Commissioning Editor: Laurence Hunter
Senior Development Editor: Ailsa Laing
Project Manager: Lucy Boon
Illustration Manager: Gillian Richards
Illustrators: Gillian Lee and Barking Dog Illustrators
A
Davidson
Title
Surgery
Principles & Practice of
6th Edition
Edited by
O. James Garden BSc MB ChB MD FRCS(Glas) FRCS(Ed) FRCP(Ed) FRACS(Hon) FRCSCan(Hon)
Regius Professor of Clinical Surgery, Clinical Surgery, University of Edinburgh;
Honorary Consultant Surgeon, Royal Infirmary of Edinburgh, UK
Andrew W. Bradbury BSc MB ChB MD MBA FRCS(Ed)
Sampson Gamgee Professor of Vascular Surgery and Director of Quality Assurance and
Enhancement, College of Medical and Dental Sciences, University of Birmingham;
Consultant Vascular and Endovascular Surgeon, Heart of England NHS Foundation Trust,
Birmingham, UK
John L.R. Forsythe MD FRCS(Ed) FRCS(Eng)
Consultant Transplant and Endocrine Surgeon, Transplant Unit, Royal Infirmary of Edinburgh;
Honorary Professor, Clinical Surgery, University of Edinburgh, UK
Rowan W. Parks MB BCh BAO MD FRCSI FRCS(Ed)
Professor of Surgical Sciences, Clinical Surgery, University of Edinburgh;
Honorary Consultant Hepatobiliary and Pancreatic Surgeon, Royal Infirmary of Edinburgh, UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012
© 2012 Elsevier Ltd. All rights reserved.
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This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).
First edition 1985
Second edition 1991
Third edition 1995
Fourth edition 2002
Fifth edition 2007
Sixth edition 2012
ISBN 978-0-7020-4316-1
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using
such information or methods they should be mindful of their own safety and the safety of others,
including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the
most current information provided (i) on procedures featured or (ii) by the manufacturer of each
product to be administered, to verify the recommended dose or formula, the method and duration
of administration, and contraindications. It is the responsibility of practitioners, relying on their own
experience and knowledge of their patients, to make diagnoses, to determine dosages and the best
treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
any liability for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or
ideas contained in the material herein.
The
Publisher's
policy is to use
paper manufactured
from sustainable forests
Printed in China
Contents
Section 1 PRINCIPLES OF PERIOPERATIVE CARE
1 Metabolic response to injury, fluid and electrolyte
balance and shock 3
S.R. McKechnie • T.S. Walsh
2 Transfusion of blood components and plasma products 27
R.H.A. Green • M.L. Turner
3 Nutritional support in surgical patients 38
K.C.H. Fearon • G.L. Carlson
4 Infections and antibiotics 45
S. Gossain • P.M. Hawkey
5 Ethics, preoperative considerations, anaesthesia
and analgesia 56
R.E. Melhado • D. Alderson
6 Principles of the surgical management of cancer 80
M.A. Potter
7 Trauma and multiple injury 90
C.E. Robertson • D.W. McKeown
8 Practical procedures and patient investigation 103
R.W. Parks
9 Postoperative care and complications 119
R.W. Parks
10 Day surgery 127
D. McWhinnie
Section 2 GASTROINTESTINAL SURGERY
11 The abdominal wall and hernia 137
A.C. de Beaux
12 The acute abdomen and intestinal obstruction 147
S. Paterson-Brown
13 The oesophagus, stomach and duodenum 167
R.H. Hardwick
14 The liver and biliary tract 192
O.J. Garden
15 The pancreas and spleen 215
C.J. McKay • C.R. Carter
16 The small and large intestine 233
M.G. Dunlop
17 The anorectum 263
M.G. Dunlop
Section 3 SURGICAL SPECIALTIES
18 Plastic and reconstructive surgery 281
J.D. Watson
19 The breast 302
J.M. Dixon
20 Endocrine surgery 325
T.W.J. Lennard
21 Vascular and endovascular surgery 345
A.W. Bradbury • T.J. Cleveland
22 Cardiothoracic surgery 379
R.R. Jeffrey
23 Urological surgery 399
L.H. Stewart • S.M. Finney
24 Neurosurgery 424
I.R. Whittle • L. Myles
25 Transplantation surgery 444
L.P. Marson • J.L.R. Forsythe
26 Ear, nose and throat surgery 459
J.A. Wilson
27 Orthopaedic surgery 476
J.C. McKinley • I. Ahmed
Index 491
vi
Preface vii
The sixth edition of Principles and Practice of Surgery con- It is our intention that this edition is relevant to doctors
tinues to build on the success and popularity of previous and surgeons practising in other parts of the world. The four
editions and its companion volume Davidson’s Principles editors welcome the contributions of Professors Venkatramani
and Practice of Medicine. Many medical schools now deliver Sitaram and Pawanindra Lal whose remit as co-editors on our
undergraduate curricula which focus principally on associated International Edition is to ensure the book’s content
ensuring generic knowledge and skills, but the continu- is fit for purpose in those parts of the world where disease
ing success of Principles and Practice of Surgery over the last patterns and management approaches may differ.
25 years indicates that there remains a need for a textbook We remain indebted to the founders of this book,
which is relevant to current surgical practice. We believe Professors Sir Patrick Forrest, Sir David Carter and Mr Ian
that this text provides a ready source of information for Macleod who established the reputation of the textbook
the medical student, for the recently qualified doctor on with students and doctors around the world. We are grate-
the surgical ward and for the surgical trainee who requires ful to Laurence Hunter of Elsevier for his encouragement
an up-to-date overview of the management approach to and enthusiasm and to Ailsa Laing for keeping our con-
surgical pathology. This book should guide the student tributors and the editorial team in line during all stages of
and trainee through the key core surgical topics which publication.
will be encountered within an integrated undergraduate We very much hope that this edition continues the tradi-
curriculum, in the early years of surgical training and in tion and high standards set by our predecessors and that the
subsequent clinical practice. revised content and presentation of the sixth edition satis-
We have striven to improve the format of the text and fies the needs of tomorrow’s doctors.
layout of information. Considerable effort has also been
put into improving the quality of the radiographs and OJG, AWB, JLRF, RWP
illustrations. Edinburgh and Birmingham, 2012
Intentionally left as blank
Contributors ix
Issaq Ahmed Malcolm G. Dunlop
MRCS BEng MB ChB FRCS MD FMedSci
Orthopaedic Registrar, Royal Infirmary of Professor of Coloproctology, University of
Edinburgh, UK Edinburgh; Honorary Consultant Surgeon,
Coloproctology Unit, Western General Hospital,
Derek Alderson Edinburgh, UK
MB BS MD FRCS
Professor of Gastrointestinal Surgery and Barling Kenneth C.H. Fearon
Chair of Surgery, University Hospital Birmingham MD FRCS(Gen)
NHS Foundation Trust and University of Birmingham Professor of Surgical Oncology, University of
College of Medical and Dental Sciences, School of Edinburgh; Honorary Consultant Surgeon, Western
Cancer Sciences, Birmingham, UK General Hospital, Edinburgh
Andrew W. Bradbury Steven M. Finney
BSc MB ChB MD MBA FRCS(Ed) MB ChB MD FRCS(Urol)
Head of Surgery and Professor of Vascular Surgery, Urology Specialist Registrar, Pyrah Department of
University of Birmingham; Consultant Vascular Urology, St James’s University Hospital, Leeds
Surgeon and Director of Research and Development,
Heart of England NHS Foundation Trust Office, John L.R. Forsythe
Birmingham, UK MD FRCS (Edin) FRCS(Eng)
Consultant Transplant Surgeon and Honorary
Gordon L. Carlson Professor, Transplant Unit, Royal Infirmary of
BSc MD FRCS Edinburgh, UK
Consultant Surgeon, Salford Royal NHS Foundation
Trust; Honorary Professor of Surgery, University O. James Garden
of Manchester; Honorary Professor of Biomedical BSc ChB MD FRCS(Glasg) FRCS(Ed) FRCP (Ed) FRACS(Hon)
Science, University of Salford, UK FRCSCan(Hon)
Regius Professor of Clinical Surgery, University of
C. Ross Carter Edinburgh; Honorary Consultant Surgeon, Royal
MB ChB FRCS MD FRCS(Gen) Infirmary of Edinburgh, UK
Consultant Pancreaticobiliary Surgeon, West of
Scotland Pancreatic Unit, Glasgow Royal Infirmary, Savita Gossain
Glasgow, UK BSc MBBS FRCPath
Consultant Medical Microbiologist, Birmingham
Trevor J. Cleveland HPA Laboratory, Heart of England NHS
BMedSci BM BS FRCS FRCR Foundation Trust, Heartlands Hospital,
Consultant Vascular Radiologist, Sheffield Vascular Birmingham, UK
Institute, Sheffield Teaching Hospitals, Sheffield, UK
Rachel H.A. Green
Andrew C. de Beaux MB ChB BMed Biol FRCP FRCPath
MB ChB MD FRCS Clinical Director, West of Scotland Blood
Consultant General and Oesophagogastric Surgeon; Transfusion Centre at Gartnavel General Hospital,
Honorary Senior Lecturer, University of Edinburgh, UK Glasgow, UK
J. Michael Dixon Richard Hardwick
BSc MBChB MD FRCS FRCS(Ed) FRCP MD FRCS
Consultant Surgeon andHonorary Professor, Consultant Surgeon, Cambridge Oesophago-Gastric
Edinburgh Breast Unit, Western General Hospital, Centre, Addenbrookes Hospital,
Edinburgh, UK Cambridge, UK
