Abdomen, vagal structures of, 263-264

Abdominal wall, 123-203; see also Hernias

anterior anatomy of, 123-125 blood supply to, 126-128 fossae of, 164-165 incisions of, see Incisions of

anterior abdominal wall lower, layers of, 163-164 nerve supply to, 128, 129

surgical techniques for, 142-157; see also specific surgi­cal techniques

Abdominoperineal resection, 453-456

Achalasia, 252-256 Adrenal glands, 573-589

anatomy of, 573-576 anterior exposure of, 577 general description of, 573-574 lymphatic drainage of, 576 posterior approach to, 584-585 surgical techniques for, 577-

589; see also specific surgi­cal techniques

thoracolumbar approach to, 589

vascular system of, 574-576

659

Index

Adrenalectomy, 577-589 anterior approach, 577-583 left, 577-581, 583, 584 posterior approach, 584-

588 right, 581-583, 584-585 unilateral or bilateral, 582-583,

585-588 Ampulla of Vater, 323, 333-335,

360 Analcanal,406-413

arterial supply, 413-415 general anatomy, 408-413 lining of, 412 muscles of, 409-411 pectinate line and, 413

Anal columns of Morgagni, 412

Anal fissure, 463 Anal fistulectomy, 461-464 Anal sphincter, external, 410,

411 Anorectal digital examination,

456-459 Anorectal landmarks for sig­

moidoscopic examination, 457-459

Anorectal procedures, 456-470

Anorectal ring, 407

660 Index

Anorectum anatomy of, 401-406 colon and, 401-470 surgical techniques for, 425-

470; see also specific surgi­cal techniques

Antecolic gastrojejunostomy, 272,274

Antral boundary, location of, 281-283

Antrectomy, guide for, 281 Antrum-body junction, 282 Anus

nerve supply to, 423-424 spaces of, 409-410

Aortic opening, 211 Appendectomy, 392-399

laparoscopic, 629-631 Appendix, 389-399

anatomy of, 389-391 blood supply to, 389-390 lymphatic drainage of, 390-

391 mesenteryof,389 relations and positions of, 389 surgical techniques for, 392-

399; see also specific surgi­cal techniques

Arcuate ligament, median, 211 Arcuate line, Douglas', 130 Arterial plexuses, skin, 1 Ascending colon, 401-402 Auerbach's plexus, 318 Auricular nerve, great, 49, 58, 84,

85 Auriculotemporal nerve, 49 Autotransplantation, splenic,

565, 568 Axilla, 102

lymph nodes of, 108-109 topography of, 103 walls of, 100-101

Axillary artery, branches of, 107

Axillary dissection, lumpectomy with, 119-121

Axillary fascia, 30 Axillary lymphatic drainage, 109

Bilateral adrenalectomy, 582-583,585-588

Bile ducts common, see Common bile duct hepatocystic, 514, 515 subvesicular, 514

Bile leakage, surgically significant sources of, 514-515

Biliary tract, extrahepatic, see Ex-trahepatic biliary tract

Billroth I gastrectomy, 288-292 Billroth II gastrectomy, 292 Bogros, space of, 135 Branchial cleft cyst or fistula, ex-

cision of, 81-83 Branchial cleft cysts, 52-54 Branchial cleft sinuses, 51-52 Branchial remnants, anatomy of,

50-54 Breast, 99-121

anatomy of, 99-111 anterior wall of, 100 arterial supply of, 106-107 blood supply of, 106-108 deep fascia of, 99-102 general description of, 99 lateral wall of, 101 lymph nodes of, 108-109 lymphatic drainage of, 108-109 medial wall of, 101 morphology of, 102-103 muscles of, 102, 104-105 posterior wall of, 100 sagittal section through, 106 surgical techniques for, 109-

121; see also specific surgi­cal techniques

venous drainage of, 108

Breast biopsy, 112-114 excisional, 112-113 lobectomy versus, 103

Breast evaluation with needle, ra­diologic, 113-114

Buccopharyngeal fascia, 30 Buck's fascia, 129, 130

Camper's fascia, 128, 137 Cancer, total gastrectomy for,

294,297,299,300-305 "Cardiac sphincter," 241 Cardiospasm, 252-256 Carotid sheath, 30 Carotid triangle, 20, 25 Carpal canal, 593, 596 Carpal tunnel, 591-605

anatomical variations of me-dian nerve in, 602

anatomy of, 591-601 canals within, 593, 596 central zone divisions, 601 distal surgical zone, 598 distal zone divisions, 601 middle surgical zone, 596 proximal surgical zone, 597 surgical techniques for, 602-

605; see also specific surgi­cal techniques

upper proximal zone divisions, 600

Carpal tunnel syndrome, surgical treatment of, 602-605

Cecopexy, 425-426 Cecostomy, 427 Cecum, 389,401,402

identifying, 392 Celiac vagal division, 265-

267 Cervical cysts, 52-54 Cervical esophagus, 237 Cervical fistulas, 50-51 Cervical sinuses, 51-52

Index 661

Cervical triangle anterior, anatomy of, 19-26 posterior, anatomy of, 26-27

Chief cells, 260 Cholangiogram, operating room,

529-531 Cholecystectomy, 482, 525-529

from above downward, 526, 527-528

from below up, 526, 528, 529 laparoscopic, 625-629

Choledochal cystectomy, 544-548 Choledochoduodenostomy, 543,

544, 545 Coccygeus muscle, 407 Colectomy

extent of, for cancer, 435 left, 436, 442 right, 435, 436-441 total, and ileoanal anastomosis

with mucocectomy, 449-453

triple staple procedure, 442-449 Colic artery, middle, 286-287,

414 Colles' fascia, 129, 130 Colles' reflected inguinalliga­

ment, 132, 133 Colon

anatomy of, 401-406 anorectum and, 401-470 ascending, 401-402 blood supply of, 413-417 descending, 403 general anatomy, 408-409 lymphatic drainage of, 417-423 right, 401, 416

volvulus of, 402, 403 sigmoid, 403, 405 surgical techniques for, 425-

470; see also specific surgi­cal techniques

transverse, 402-403

662 Index

Colon resection, 419-421, 435-456

Colon surgery, decalogue, 425 Colostomy, 427-434

closure of, 432, 435, 436 end,430-433 loop, 427-430 Prasad end loop, 432, 434-435

Common bile duct, 324, 517-520 exploration of, 531-537, 539,

540 measurements of diameter of,

520 relation of pancreas and, 519

Condon procedure, 187-188 Conjoined area, defined, 132 Continence, anal, 424

pelvic diaphragm and, 407 Cooper's pectineal ligament, 130-

132, 134, 138 Cricopharyngeal muscle, 234-

235 Cystic artery, origins of, 520-521,

522,523 Cystic duct, 515 Cystic skin lesions, 7-8 Cystoduodenostomy, 362-363,

366 Cystogastrostomy, 361-362, 364-

366 Cystohepatic junction, types of,

513,516 Cystojejunostomy, 363, 367

Dermis, 1-2 Descending colon, 403 Diaphragm, 205-231

anatomy of, 205-211 apertures of, 208 attachments of muscles of, 209 blood supply of, 214-215 lymphatic drainage of, 215-

216

nerve supply to, 216, 217 openings of, 206-211 surgical techniques for, 220-

231; see also specific surgi­cal techniques

Diaphragmatic crura, 205, 206, 207

Diaphragmatic hernia, 220-231 traumatic, 231

Diaphragmatic-mediastinal rela­tions, 211-213

Digital examination, anorectal, 456-457,458-459

Douglas' arcuate line, 130 Dowd-Ponka repair, 200-203 Duodenal cuff, ischemia of, 285 Duodenal diverticulum, 335 Duodenal Graham patch, 275-

276 Duodenal papilla of Vater, 333-

336 Duodenal stump, difficult, 293 Duodenojejunostomy, 324, 326,

358,359 Duodenum, 311-326

anatomyof,311-318 bare areas of, 328 exposure and mobilization of,

320-324 first part of, 259

surgical applications, 319 fourth part of, surgical applica-

tions, 320 general description of, 311-312 lymphatic drainage of, 317-318 mobilization of, 283 nerve supply of, 318 second part of, surgical applica­

tions, 319 surgical anatomy and repair of

vascular compression of, 324-326

surgical anatomy of, 312-313

surgical techniques for, 319-326; see also specific surgi­cal techniques

T-closure of, 284 third part of, surgical applica­

tions,319-320 variations of arteries to, 285 vascular system of, 313, 315-

317

End colostomy, 430-435 Epidermis, 1-2 Epigastric hernias, 155-157 Epiploic appendages, 408-409,

410 Esophageal hernia, see Hiatus

hernia Esophageal hiatus, 206-207

narrowing, 210 structures at or near, 217, 218-

219 Esophageal hiatus and crura, 241 Esophageal triangle, 239 Esophageal wall

structure of, 243-245 weak areas of, 240

Esophagojejunal anastomosis, Roux-en-Y, 302

Esophagus, 233-256 anatomy of, 233-248 arterial supply of, 246 blood supply of, 245, 246, 247 cervical, 237 congenital short, 220, 221, 224 constrictions of, 233-234 curves of, 234 general description of, 233-234 length of, 233 lymphatics of, 245-248 nerve supply to, 245 surgical techniques for, 249-

256; see also specific surgi­cal techniques

Index 663

thoracic, 237-240 topography and relations of,

234-245 venous drainage of, 247

Evacuation, 424 Excisional biopsy

breast, 112-113 liver, 497-498

Exomphalos, 160 Extended proximal vagotomy, 307 Extrahepatic biliary tract, 513-

548 anatomy of, 513-524 blood supply of, 521-524 lymphatic drainage of, 523, 524 surgical techniques for, 525-

548; see also specific surgi­cal techniques

vascular relations of, 513 Extraperitoneal hernia repair,

650-655

Facial artery, 21 Facial nerve

identification of, 49-50, 58 parotid gland and, 47

False capsule of thyroid, 35, 66 Falx inguinalis, 132, 133 Feeding jejunostomy, 387 Femoral canal, 166-168 Femoral hernias, 176, 177-182

recurrent, 191-193 repair above inguinal ligament,

178-180 repair below inguinal ligament,

180-182 Finney pyloroplasty, 279, 280 Fistulectomy, anal, 461-462, 463,

464 Flexor retinaculum

division of, 605 size of, 595 superficial relations of, 596

664 Index

Foramen cecum, 35, 43-44, 80-81

Fossae of anterior abdominal wall, 164-165

Four-layer anastomosis, 298-299

Fruchaud's myopectineal orifice, 136,138

Full-thickness skin grafts, 12 Fundoplasty, partial, 256 Fundoplication, Nissen, laparo-

scopic, 639-645

Gallaudet fascia, 129, 130 Gallbladder, 475, 515, 517, 525,

526,529,530,537 Gastrectomy, 280-305

Billroth I, 288-292 Billroth II, 292, 293, 294 subtotal distal, 288-294 total, for cancer, 294, 297, 299,

300-305 Gastric antrum, 258-259 Gastric arteries

left, complications of ligation of, 283-284

posterior, 287-288 Gastric necrosis, 284-285 Gastric remnant, ischemia of,

283-284 Gastric resection, guides for,

280-281 Gastric ulcer

perforated, 276-277 subcardial, high anterior or

posterior, 277 Gastric units, 257-260

distal, 257, 258-260 proximal, 257-258

Gastric wall, 260 Gastrocolic ligament, 261 Gastroduodenal artery, control of

hemorrhage from, 285

Gastroesophageal junction, 240-241,242,258,552

lymphatic drainage of, 248 Gastrohepatic ligament, 243, 260,

474 Gastrojejunostomy, 271-274,

358,650 antecolic, 272, 274 retrocolic, 271-272, 273-274

Gastrolienal ligament, 243, 551, 552,553

Gastrophrenic ligament, 261 Gastroschisis, 160 Gastrosplenic ligament, 243, 551,

552,553 Gastrostomy, 268-270

laparoscopic, 632-636 Stamm, 268-270 Witzel, 269, 270

Gastrostomy incisions, 284 Gastrotomy with direct observa­

tion,282 Giant prosthetic reinforcement of

visceral sac (GPRVS), 193, 195

Gilbert sutureless mesh-plug re­pair, 195-196

Gimbernat's lacunar ligament, 130,131

GPRVS (giant prosthetic rein­forcement of visceral sac), 193, 195

Graham patch, duodenal, 275-276 Groin, anatomical entities of,

128-141 Groin hernias, see Inguinal her­

nias

Hartmann's pouch, 517 Heineke-Mikulicz pyloroplasty,

278,279 Heller's procedure, modified,

252-256

Hemorrhoidectomy, 463-465, 466-467

Hemorrhoids external,464 incision and drainage of exter-

nal thrombosed, 465, 467 Henle's ligament, 132, 133 Hepatic anomalies, 476 Hepatic artery, 476-477, 480-

482 aberrant, 480 intrahepatic distribution of,

481 Hepatic ducts, 513-516

accessory, 516 anomalous, 514-515 right, left, and common, 513-

514 variations of, 515

Hepatic resections, 498-512 anatomical landmarks for,

498-499 trauma and, 502-503, 509-512

Hepatic veins, 483-484 intrahepatic distribution of,

485 Hepatocystic triangle, 520-521 Hepatoduodenalligament, 260,

474 Hepatogastric ligament, 243, 474 Hepatojejunostomy, 358, 359 Hernias

diaphragmatic, 220-231 traumatic, 231

epigastric, 155-157 esophageal, see Hiatus hernia external supravesical, 177 femoral, see Femoral hernias groin, see Inguinal hernias hiatus, see Hiatus hernia inguinal, see Inguinal hernias lateral ventral, 160-163 lumbar, 199-203

Index 665

myoaponeurotic incisional, see Myoaponeurotic incisional hernias

Spigelian, 160-163 surgical techniques for, 157-

203,220-231; see also spe­cific surgical techniques

through linea alba, 155-157 umbilical, see Umbilical her­

nias Herniorrhaphy, Lichtenstein's

tension-free, 193, 194 Hesselbach's interfoveolar liga-

ment, 133 Hesselbach's triangle, 131, 136 Hiatal ring, 207, 210 Hiatus, vagal structures at, 264-

265 Hiatus hernia, 220-231

combined sliding and paraeso­phageal,220, 221,223

paraesophageal, 220, 221, 223, 226-231

sliding, 220, 221, 222, 224-226 Hoarseness, postoperative, 41-42 Hodgkin's disease, staging proce­

dure for, 569-571 Hydrocele, 197-198

pediatric, 198 Hypersplenism, 559 Hypertension, portal, 491-493

neoanal anastomosis with muco­cectomy, total colectomy and, 449-453

Ileocecal valve, anatomy of, 372-373

Ileococcygeus muscle, 407 Iliohypogastric and ilioinguinal

nerve courses, 147, 148 Iliopectineal arch, 135-136 Iliopubic tract, 133, 134, 137, 138 Incision, relating, 175-176

666 Index

Incisional hernias, myoaponeu­rotic, see Myoaponeurotic incisional hernias

Incisions of anterior abdominal wall, 142-157

dehiscence of, 148-149 lower abdomen, 145-147 lower midline, 145 McBurney, 148 oblique, 147-148 pararectus, 143, 144, 145 Pfannenstiel, 145-147 rectus (paramedian), 143, 144,

145,146 subcostal, 147-148 surgical anatomy of, 142, 143 thoracoabdominal, 143, 148 transverse, 143, 145-147 upper abdomen, 145 upper midline, 144-145 varieties of, 143 vertical, 144-145

Incomplete vagotomy, 307-308 Inframesocolic compartment, 323 Ingrown toenail, treatment of,

15-18 Inguinal canal, 136-138

contents of, 166 "strong" posterior wall of, 137 walls of, 165 "weak" posterior wall of, 138

Inguinal hernias, 163 Condon procedure for, 187-188 direct, 173-175 indirect, 168-172

sliding, 172-173 laparoscopic repair of, 650-658 male and female pediatric, 183 Nyhus procedure for, 183-187 prosthesis, use of, 191 recurrent, 191-193 Shouldice technique for, 188-

191 surgical anatomy of, 163-168

Inguinal ligament, Poupart's, 130, 131

Inguinal region, nerves of, 140 Interfoveolar ligament, Hessel­

bach's, 133 Intersphincteric spaces, 409 Intrahepatic duct system, 476,

477 terminology and pattern of,

478 Intrahepatic segmental ducts, 479 Intrasplenic dissection, 565-566 Intussusception, 376, 377

surgery for, 382, 384 surgical anatomy of, 376-377

Ischiorectal abscess, 459, 461, 462

Ischiorectal space, 409

"Jackson's veil," 402, 404 Jejunostomy, 270

feeding, 387 laparoscopic, 636-639 Witzel, 384-386

Killian, triangle of, 234-235 Kocher maneuver, 320

Lacunar ligament, Gimbernat's, 130, 131

Laimer's divertimula, 234 Laparoscopic anatomy, 621-624 Laparoscopic appendectomy,

629-630 Laparoscopic cholecystectomy,

625-629 Laparoscopic gastrostomy, 632-

636 Laparoscopic highly selective va­

gotomy, 646-650 Laparoscopic inguinal hernia re­

pair, 650-658 Laparoscopic jejunostomy, 636-

639

Laparoscopic Nissen fundoplica­tion, 639-645

Laparoscopic surgery, 621-658; see also specific surgical techniques

Large intestine, see Colon Laryngeal nerves, 39-43

exposure of, 39, 41-43 recurrent

thyroid gland and, 39, 40 vulnerability of, 41

Lateral ventral hernias, 160-163 Left adrenalectomy, 577-581, 584 Left colectomy, 442, 443 Levator ani, 407, 408, 409 Lichtenstein's tension-free herni-

orrhaphy, 193, 194 Linea alba, hernias through, 155-

157 Liver, 471-512

anatomy of, 471-490 blood supply to, 476-477, 480-

485 diaphragmatic surface rela­

tions, 471 excisional biopsy, 497-498, 499 left lateral segmentectomy,

503-504 left lobectomy, 500-502, 504-

505,506,507 lobulation and segmentation

of,475-476 lymphatics of, 485-490 morphology of, 475-476 percutaneous needle biopsy,

497 peritoneal reflections of, 472-

474 rib levels of, 474 right lobectomy, 499-502,505,

507-509,510 surgical techniques for, 491-

512; see also specific surgi­cal techniques

Index 667

topographic anatomy of, 471-472

trisegmentallobectomy, 500-502

visceral surface relations, 471-472,473

Liver resection, see Hepatic resec­tions

Liver trauma, 509-512 Lobectomy, breast biopsy versus,

103 Loop colostomy, 427-430 Lower extremity, veins of, see

Veins of lower extremity Lumbar body wall, 198-199 Lumbar hernias, 199-203 Lumpectomy with axillary dissec-

tion, 119-121 Lungs, rib levels of, 474 Lymph node staging, regional, 10 Lymph nodes, distribution of, in

pancreatectomy, 338 Lymphadenectomy, 10 Lymphatic plexus, skin, 1

Mammary lymphatic drainage, 109

Mandibular nerve, 21 Marginal artery (of Drummond),

415,416 Mastectomy

modified radical, 114-119, 120, 121

anatomy of triangular bed of,109-111

muscles and nerves involved in, 104-105

surgical anatomy of, 109-111 McBurney incision, 148 Meckel's diverticulum, 375-376,

381-382, 383 Mediastinum, 212-213

contents of, 237-239 Meissner's plexus, 318

668 Index

Melanoma, malignant, 9-11 Mesenteric artery

inferior, 414 superior, 413-414, 416

Mesentery of appendix, 389 and colon, 401, 402, 403, 406 dimensions of, 371

Mesh placement, laparoscopic hernia repair, 654-655

Mesh-plug repair, Gilbert suture­less, 195-196

Mesh prosthesis, 153-155, 167-168, 191, 192, 193

Mesh wrap, splenic, 565, 567 Meshing skin grafts, 12 Mesocaval shunt, 491, 493, 494,

496 Mesocolon, 402

average measurements of, 405 Mesoesophagus, 212 Mucocectomy, ileoanal anasto­

mosis with, total colec­tomy and, 449-453

Muscular triangle, 20, 25-26 Mylohyoid muscles, 23, 24 Myoaponeurotic incisional her-

nias, 149-155 etiology and pathogenesis, 149 operating room strategy

for larger defects, 153-155 for very small or small de­

fects, 150-152 preoperative evaluation and

care, 149-150 Myopectineal orifice, Fruchaud's,

136, 138

Nail anatomy of, 6 surgical techniques for, 15-18;

see also specific surgical techniques

toenail, see Toenail

Neck,19-97 anatomy of, 19-54 deep fascia of, 28-30 fasciae of, 27-30 lymph nodes of, 32-34 lymphatics of, 31, 32-34 masses of, 55 spaces of, 30-31 superficial fascia of, 27-28 surgical techniques for, 55-97;

see also specific surgical techniques

Neck dissection, radical, 83-92, 93,94

Nissen fundoplication, laparo­scopic, 639-645

Non-Hodgkin's lymphoma, lim­ited, staging procedure for, 569-571

Nyhus procedure for inguinal her­nias, 183-187

direct hernia, 184-186 indirect hernia, 187

Omentum greater, 286 lesser, 260,472,474

Omphalocele, 160 Operating room cholangiogram,

529-531

Palmar arches, 595 Palmar cutaneous nerve, sites of

penetration of, 604 Pancreas, 327-370

anatomy of, 327-340 arterial supply to, 315-316,

336-337 body of, 331-332

total separation of, 370 ectopic and accessory, 339 evaluation of resectability of,

340 exploration of, 341, 348

general description of, 327-329 head of, 330

total separation of, 370 lymphatic drainage of, 337-338 neck of, 330-331 nerve supply of, 338 parts of, 329-332 relation of common bile duct

and, 519 surgical techniques for, 341-

370; see also specific surgi­cal techniques

tail of, 332 total separation of, 368-369

uncinate process of, 330, 331 venous drainage of, 315-316,

337 Pancreatectomy, 346-360

distal for chronic pancreatitis, 347-

349,350,351 with or without splenectomy,

349-351, 352 distribution of lymph nodes in,

338 partial, 347 total, with or without splenec­

tomy,351 Pancreatic arcades, 336-337 Pancreatic biopsy, transduode­

nal, 360-361 Pancreatic duct (of Santorini),

321,323 Pancreatic ducts, 332-336 Pancreatic heterotopia, 339 Pancreatic pseudocyst, drainage

of, 361-368 Pancreatic trauma, 368-370 Pancreaticoduodenal nodes, 317,

318,340 Pancreaticoduodenectomy, 321,

353-360 with pyloric preservation, 353-

360

Index 669

Pancreaticojejunostomy, 358, 359

end-to-end, 350, 352 Pancreatitis, chronic, distal pan­

createctomy for, 347-349, 350,351

Pancreatocolic ligament, 552, 554

Pancreatosplenic ligament, 552, 554

Parathyroid glands anatomy of, 44 arterial supply of, 36-37, 38 strategy for finding, 74 in thyroid reoperation, 75-76

Parathyroid reoperation, 76-77 Parathyroidectomy, thyroidec­

tomy and, 66-75 Parietal cell vagotomy, 267, 306-

307,310 Parietal cells, 260 Parotid bed, 49 Parotid gland

anatomy of, 45-49 relations of, 45-46, 48 structures traversing, 47, 49

Parotidectomy, 55-61 radical, 59-61

Pars umbilicus, 483, 484 Peau d'orange retraction, 103 Pectinate line, 412, 413, 422 Pectineal ligament, Cooper's,

130-132, 134 Pedicle skin grafts, 12 Pelvic diaphragm, continence

and,407 Pelvirectal space, 409 Peptic ulcer, perforated, 275-277 Percutaneous needle biopsy,

liver, 497 Perforated gastric ulcer, 276-277 Perforated peptic ulcer, 275-277 Perihepatic spaces, 485-490 Perithyroid sheath, 35

670 Index

Peritoneal reflections of liver, 472-475 of rectum, 406

Peritoneum, 406 Pfannenstiel incision, 145-147 Pharyngoesophageal diverticu-

lum, 249-252 Pharyngoesophageal junction,

234-236 Pheochromocytoma, 579 Phrenic nerves, major branches

of,216 "Phrenicocolic ligament," 552,

554 Phrenoesophagealligament, 242-

243 Phyrigian cap, 517 Pilonidal cyst excision, 467-470 Pleura, rib levels of, 474 Pneumopreperitoneum, 650 Porta hepatis, 482 Portacaval shunt, 492, 496 Portal hypertension, 491-493 Portal shunts, 491-493 Portal vein, 482-483

intrahepatic distribution of, 484

Portasystemic shunts, types of, 492-493

Postage-stamp skin grafts, 12 Poupart's inguinal ligament, 130,

131 Prasad end loop colostomy, 432,

434-435 Preperitoneal hernia repair, trans-

abdominal, 655-658 Presplenic fold, 552, 554 Pretracheal space, 237 Prosthetic material, use of, 191 Prosthetic reinforcement of vis-

ceral sac, giant (GPRVS), 193, 195

Pubococcygeus muscle, 407

Puborectalis muscle, 407 Pudendal nerve, 423-424 Puestow procedure, 341-346 Pyloric preservation, pancreatico-

duodenectomy with, 353-360

Pyloric stenosis, 277-278 Pyloroduodenal junction, 259 Pyloroplasty, 278-280

Finney, 279, 280 Heineke-Mikulicz, 278, 279

Pylorus, 259

Radical neck dissection, 83-92, 93,94

Radiologic breast evaluation with needle, 113-114

Rectouterine or rectovesical pouch,406

Rectum, 406 arteries of, 415, 417 blood supply of, 413-417,

418 general anatomy, 409 nerve supply to, 423-424 peritoneal reflections of, 406 spaces around, 408, 409

Reflected inguinal ligament, Colles', 132, 133

Relaxing incision, 175-176 Retrocolic gastrojejunostomy,

271-272,273-274 Retrovisceral space, 237 Riedel's lobe, 476, 479 Right adrenalectomy, 581-582,

584-585 Right colectomy, 436-441 Roux-en-Y esophagojejunal anas­

tomosis, 302, 304 Roux-en-Y procedure, 361, 362,

363,367 Rule of 7,55 Rule of 80, 55

Saphenectomy, 615-620 great saphenous vein, 615-618 small saphenous vein, 619-620

Saphenofemoral junction, 610 Saphenous vein

great,608-611,615-618 small, 608, 610-611, 619-620

Scalp anatomy of, 2-6 arterial blood supply of, 4, 5 lymphatic network of, 5-6 mnemonic, 2-3 nerve distribution in, 4, 5,6 surgical technique for, 13-15 surgicoanatomical notes, 3-4

Scarpa's fascia, 128-130, 137 Selective vagotomy, 306 Seton procedure, 462, 463, 464 Shouldice technique, 188-191 Sigmoidoscopic examination,

456-457,459-460 anorectal landmarks for, 457,

459 Sistrunk procedure, 44 Skin, 1-2

anatomy of, 1-2 blood supply of, 1-2 surgical techniques for, 7-12;

see also specific surgical techniques

Skin grafts, 11-12 Skin lesions

benign, 7-8 malignant, 8-11

Small bowel, resection of, for tu­mor, 379-381

Small intestine, 371-387 abnormal development of,

375-376 anatomical guidelines for sur­

gery, 377-378 anatomy of, 371-378 blood supply to, 373-374

Index 671

general description of, 371-373 layers of wall of, 371-372 length of, 371 lymphatic drainage of, 374-375 section through wall of, 372 surgical techniques for, 379-

387; see also specific surgi­cal techniques

Spermatic cord, 136, 137-138, 192,193

Sphincter of Boyden, 334 Sphincteroplasty, 538-543 Spigelian hernias, 160-163 Spleen, 549-571

accessory, 557-558 anatomy of, 549-558 general description of, 549-551 location of, 549 lymphatic drainage of, 555, 557 peritoneal attachments of, 552 segmental anatomy of, 555, 557 surgical techniques for, 559-

571; see also specific surgi­cal techniques

vascular system of, 555, 556 Splenectomy, 559-567

distal pimcreatectomy with or without, 349-351, 352

due to hematologic disorders, 559

due to hemorrhage secondary to trauma, 559

partial, 565-568 total, incision for, 560 total pancreatectomy with or

without, 351 Splenic artery, 555

branches of, 316, 337 compression of, 564 ligation of, 561, 565 occlusion of, 568-569 relation of splenic vein and,

556

672 Index

Splenic autotransplantation, 565, 568

Splenic borders, 550 Splenic ligaments

chief, 551, 553 minor, 552, 554

Splenic mesh wrap, 565, 567 Splenic pedicle, 553

ligation of, 560-565 Splenic remnant, 571 Splenic rupture, 566 Splenic vein, 555-556

anatomy of, 556 compression of, 564 ligation of, 562 mobilization of, 491 relation of splenic artery and,

556 Splenocolic ligaments, 554, 564 Splenorenal shunts, 493

distal, 493, 494, 495 Splenorrhaphy, 566 Split-thickness skin grafts, 11-12 Stamm gastrostomy, 268-270 Stomach,257-310

anatomy of, 257-267 blood supply of, 261, 262 distribution of vagus nerves to,

265-267 lymphatic drainage of, 261,

262,263 mobilization of, 283 supradiaphragmatic true, 220,

223 surgical techniques for, 268-

310; see also specific surgi­cal techniques

T-closure of, 284 Stoppa procedure, 153-154, 193,

195 Subcutaneous tissue

anatomy of, 1-2 blood supply of, 1-2

Submammary space, 102, 106 Submandibular triangle, 19-23,

24 basement of, 23, 24 contents of, 21, 22 floor of, 23, 24 lymphatic drainage of, 23 roof of, 19-21

Submaxillary gland, resection of, 61-62,63,64

Submental triangle, 20, 23, 25 Subvesicular bile ducts, 514 Supradiaphragmatic true stom-

ach,220,223 Supramesocolic compartment,

323 Supravesical hernias, external,

177 Surgical capsule, 35 Surgical ellipse, 139-141 Surgical techniques, see also spe-

cific surgical techniques for abdominal wall, 142-157 for adrenal glands, 577-589 for anorectum, 456-470 for appendix, 392-399 for breast, 112-121 for carpal tunnel, 602-605 for colon, 425-456 for diaphragm, 220-231 for duodenum, 319-326 for esophagus, 249-256 for extrahepatic biliary tract,

525-548 for hernias, 157-203 laparoscopic, 624-658 for liver, 491-512 for nails, 15-18 for neck, 55-97 for pancreas, 341-370 for scalp, 13-15 for skin, 7-12 for small intestine, 379-387

for spleen, 559-571 for stomach, 268-310 for veins of lower extremity,

615-620 Suspensory muscle or ligament,

312-313,314 Sympathectomy, partial, 267

T-fastener/needle device, 633,635 Temporal artery, biopsy of, 13-

15 Testis, undescended, 183 Thoracic esophagus, 237-240 Thoracic lymphatic ducts, 31, 34,

35 Thoracic nerves, anterior, III Thoracoabdominal incisions,

143, 148 Thoracodorsal nerve, 11 0-111 Thoracolumbar approach to adre­

nal glands, 589 Thorax, vagal structures of, 263 Thyroglossal duct, persistent rem­

nants of, 43-44 Thyroglossal duct cystectomy,

77-81 Thyroid gland

anatomy of, 31, 35-44 arterial supply of, 36-37, 38 capsule of, 35-36 recurrent laryngeal nerves and,

39-43 venous drainage of, 37-39

Thyroid reoperation, 75-76 Thyroidectomy

parathyroidectomy and, 66-75 partial (subtotal), 73-74

Toenail ingrown, treatment of, 15-18 partial excision of, 17 radical excision of, 18 total excision (avulsion) of, 16-

17

Index 673

Trachea, anatomy of, 44-45 Tracheostomy, 92, 94-97 Transabdominal preperitoneal

hernia repair, 655-658 Transduodenal pancreatic biopsy,

360-361 Transpyloric plane, 324 Transversalis fascia, 133-135,

137-138 Transverse colon, 402-403 Transversus abdominis, arch of,

132-133, 134, 136, 137 Trauma

hepatic resections and, 502-509 liver, 509-512 pancreatic, 368-370 splenectomy due to hemor-

rhage secondary to, 559 Traumatic diaphragmatic hernia,

231 Treitz, ligament of, 312-313, 314 Triangle of Calot, 520-521 Triangle of Truesdale, 239 Triple staple procedure, 442-449 True capsule of thyroid, 35 Truncal vagotomy, 266, 305-306,

309-310 Tunica dartos, 129, 130 "Two, four, eight" mnemonic,

422

Umbilical hernias, 157-160 large, 157 repair of, in adults, 158-160 small,157

Umbilical region, anatomy of, 125-126, 127

Umbilical ring and umbilical fas­cia, variations of, 125-126, 127

Undescended testis, 183 Unilateral or bilateral adrena­

lectomy, 582-583, 585-588

674 Index

Vagal structures of hiatus, 264-265 of thorax and abdomen, 263

Vagal trunks, 264 Vagotomy, 305-310

extended proximal, 307 incomplete, 307-308 laparoscopic highly selective,

646-650 parietal cell, 306-307, 310 selective, 306 seven areas of, 308 truncal, 266, 305-306, 309-310

Vagus nerves, 263-267 distribution of, to stomach,

265-267 Valvuloplasty, 256 VANS acronym, 49 Veins oflower extremity, 607-620

anatomy of, 607-614 deep veins, 607-608 direct perforating veins, 611,

612,613

indirect perforating veins, 611, 612

perforating veins, 611-613 superficial veins, 608-611 surgical techniques for, 615-

620; see also specific surgi­cal techniques

valves in, 614 variations in, 613-614 varicosities of, 615-620

Vena cava, inferior, hiatus of, 206

Volar carpal ligament, division of,605

Wharton's duct, excision of stone from, 62, 65

Whipple procedure, 353 Witzel gastrostomy, 269, 270 Witzel jejunostomy, 384-386

Zenker's diverticulum, 234-236