Atlas of General Surgery > General Surgery

The ideal reference for over 150 common operations
The Atlas of General Surgery is a highly practical, how-to reference for the most frequently performed operations. The
book opens with a section on general aspects of surgery, such as the application of sutures, drains, catheters, venous
ports, and punctures. The main section demonstrates the operations in step-by-step format, covering the anatomic
regions including the skin and soft tissues, the neck, the thoracic wall and cavity, the abdominal cavity, the
retroperitoneum, and the external genital organs. The author also covers surgery for hernias, colorectal surgery,
pediatric surgery, vascular surgery, amputations, and trauma surgery. For precise and quick orientation, each surgical
chapter presents a brief introduction to surgical preparation, anesthesia, positioning, relevant anatomy, risks,
complications, and postoperative care, and then illustrates the operative technique through excellent drawings and
detailed legends.
Key features:
Covers all common surgeries any general surgeon needs to know
Step-by-step guide to each operative procedure
More than 1,200 high-quality drawings demonstrate surgical anatomy and technique, with each illustration showing one
operative step
Didactic page layout allows for easy comprehension of the material
Practical tips, tricks, and pitfalls highlight crucial information
Ideal for all surgeons in training the Atlas of General Surgery is a handy, one-volume text that provides an overview
of this broad field. It also serves as a valuable reference for the bookshelf of practicing surgeons who would like to
consult a rapid review before surgery.
Table of Contents

General Aspects 1
General Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1 Preliminary Remarks on the Surgical Intervention . . . . 2
2 Use of Scalpel, Needle Holder, Forceps, and Scissors . . . 4
3 Ligation and Suture Ligation . . . . . . . . . . . . . . . . . . . . . . 6
4 Knots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
5 Skin Suture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
6 Drains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
7 Urinary Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
8 Venous Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
9 Central Venous Port . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
10 Venous Cutdown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
11 Joint Punctures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
12 Pleural Punctures (Thoracentesis) . . . . . . . . . . . . . . . . . . 31
13 Urinary Bladder Puncture . . . . . . . . . . . . . . . . . . . . . . . . 33
14 Ascites Puncture (Paracentesis) . . . . . . . . . . . . . . . . . . . 34
15 Fine-Needle Aspiration Biopsy . . . . . . . . . . . . . . . . . . . . 35
16 Arterial Puncture and Arterial Catheterization . . . . . . . 36
Operations 39
Skin and Soft Tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
17 Excision of Skin Lesions . . . . . . . . . . . . . . . . . . . . . . . . . 40
18 Removal of Soft Tissue Tumors . . . . . . . . . . . . . . . . . . . . 43
19 Removal of Inguinal Lymph Node . . . . . . . . . . . . . . . . . . 45
20 Wound Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
21 Secondary Suture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
22 Carbuncle of the Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
23 Bursectomy (Elbow) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
24 V-Y Advancement Flap . . . . . . . . . . . . . . . . . . . . . . . . . . 55
25 Z-plasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
26 Split-Skin Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
27 Ganglion (Wrist) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
28 Panaritium (Felon) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
29 Paronychia (Run-around) . . . . . . . . . . . . . . . . . . . . . . . . 64
30 Ingrown Toenail (Unguis Incarnatus; One-third Wedge
Resection) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
31 Removal of Cervical Lymph Node . . . . . . . . . . . . . . . . . . 69
32 Tracheotomy (Open and Percutaneous Tracheostoma) . 71
33 Exposure of the Jugular Vein . . . . . . . . . . . . . . . . . . . . . 76
34 Subtotal Thyroidectomy . . . . . . . . . . . . . . . . . . . . . . . . . 79
35 Total Thyroidectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
36 Parathyroidectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
37 Zenker Diverticulum . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Thoracic Wall and Cavity . . . . . . . . . . . . . . . . . . . . . . . . . 98
38 Axillary Lymph-Node Clearance . . . . . . . . . . . . . . . . . . . 98
39 Breast Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
40 Subcutaneous Mastectomy . . . . . . . . . . . . . . . . . . . . . . . 103
41 Mastectomy (Auchinclos-Patey) . . . . . . . . . . . . . . . . . . . 105
42 Chest Drain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
43 Median Sternotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
44 Posterolateral Thoracotomy . . . . . . . . . . . . . . . . . . . . . . 116
45 Axillary Thoracotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
46 Atypical Lung Resection Open . . . . . . . . . . . . . . . . . . . . 123
47 Atypical Thoracoscopic Lung Resection . . . . . . . . . . . . . 126
48 Right Superior Lobectomy . . . . . . . . . . . . . . . . . . . . . . . . 129
49 Pneumonectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
50 Thoracoscopic Pleurectomy . . . . . . . . . . . . . . . . . . . . . . . 135
Abdominal Cavity: Diaphragm. . . . . . . . . . . . . . . . . . . . 138
51 Rupture of the Diaphragm . . . . . . . . . . . . . . . . . . . . . . . 138
Abdominal Cavity: Esophagus . . . . . . . . . . . . . . . . . . . . 140
52 Hiatal Hernia Repair (Lortat-Jacob Hiatoplasty) . . . . . . . 140
53 Fundoplication (Nissen-Rosetti and Toupet) . . . . . . . . . 144
54 Laparoscopic Fundoplication . . . . . . . . . . . . . . . . . . . . . . 148
55 Cardiomyotomy for Achalasia (Gottstein-Heller) . . . . . . 154
Abdominal Cavity: Stomach . . . . . . . . . . . . . . . . . . . . . . 156
56 Percutaneous Endoscopic Gastrostomy (PEG) . . . . . . . . 156
57 Gastrostomy (Witzel) . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
58 Closure of a Perforated Ulcer . . . . . . . . . . . . . . . . . . . . . 162
59 Oversewing of a Bleeding Peptic Ulcer . . . . . . . . . . . . . . 165
60 Gastrojejunostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
61 Pyloroplasty (Heineke-Mikulicz, Finney, Jaboulay) . . . . 172
62 Selective Proximal Vagotomy . . . . . . . . . . . . . . . . . . . . . 175
63 Truncal Vagotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
64 Gastroduodenostomy (Billroth I) . . . . . . . . . . . . . . . . . . 182
65 Gastrojejunostomy (Billroth II) . . . . . . . . . . . . . . . . . . . . 190
66 Roux-en-Y Gastrojejunostomy . . . . . . . . . . . . . . . . . . . . . 193
67 Gastrectomy and Longmire Gastric Reconstruction . . . . 195
68 Gastrectomy and Roux-en-Y Gastric Reconstruction . . . 206
Abdominal Cavity: Gallbladder and Bile Ducts . . . . 208
69 Cholecystectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
70 Laparoscopic Cholecystectomy . . . . . . . . . . . . . . . . . . . . 212
71 Exploration of the Common Bile Duct . . . . . . . . . . . . . . 217
72 Hepaticojejunostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Abdominal Cavity: Liver . . . . . . . . . . . . . . . . . . . . . . . . . . 225
73 Wedge Resection of the Liver . . . . . . . . . . . . . . . . . . . . . 225
74 Hepatic Cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
75 Left Hepatic Lobectomy . . . . . . . . . . . . . . . . . . . . . . . . . . 231
76 Hepatic Rupture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
77 Port Catheter of the Hepatic Artery . . . . . . . . . . . . . . . . 240
Abdominal Cavity: Pancreas . . . . . . . . . . . . . . . . . . . . . . 243
78 Necrosectomy of the Pancreas . . . . . . . . . . . . . . . . . . . . 243
79 Pseudocystojejunostomy . . . . . . . . . . . . . . . . . . . . . . . . . 246
80 Resection of the Tail of the Pancreas . . . . . . . . . . . . . . . 250
Abdominal Cavity: Spleen . . . . . . . . . . . . . . . . . . . . . . . . 254
81 Splenectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
82 Partial Splenectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
83 Splenic Rupture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
84 Laparoscopic Splenectomy . . . . . . . . . . . . . . . . . . . . . . . 261
Abdominal Cavity: Peritoneum . . . . . . . . . . . . . . . . . . . 264
85 Peritonitis and Laparostoma . . . . . . . . . . . . . . . . . . . . . . 264
86 Peritoneovenous Shunt . . . . . . . . . . . . . . . . . . . . . . . . . . 268
Abdominal Cavity: Small Intestine . . . . . . . . . . . . . . . . 272
87 Segmental Resection of the Small Intestine . . . . . . . . . . 272
88 Intraluminal Stenting of the Small Intestine (Dennis
Tube) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276
89 Meckel Diverticulum . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
90 End Ileostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
91 Loop Ileostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Abdominal Cavity: Large intestine . . . . . . . . . . . . . . . . 292
92 Appendectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
93 Laparoscopic Appendectomy . . . . . . . . . . . . . . . . . . . . 300
94 Loop Transverse Colostomy . . . . . . . . . . . . . . . . . . . . . . 305
95 End Sigmoidostomy (Hartmann Procedure) . . . . . . . . . 309
96 Stoma Closure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
97 Colotomy and Polypectomy . . . . . . . . . . . . . . . . . . . . . 318
98 Palliative Anastomosis between the Distal Ileum and
Transverse Colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
99 Right Hemicolectomy . . . . . . . . . . . . . . . . . . . . . . . . . . 325
100 Ileocecal Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332
101 Tubular Resection of the Sigmoid Colon . . . . . . . . . . . . 334
102 Radical Resection of the Sigmoid Colon . . . . . . . . . . . . 340
103 Laparoscopic Resection of the Sigmoid Colon . . . . . . . 342
104 Left Hemicolectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
105 Anterior Rectum Resection . . . . . . . . . . . . . . . . . . . . . . 355
106 Rectum Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Retroperitoneum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
107 Adrenalectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
108 Laparoscopic Adrenalectomy . . . . . . . . . . . . . . . . . . . . 379
Proctology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
109 Hemorrhoidectomy (Miles-Gabriel) . . . . . . . . . . . . . . . 381
110 Perianal Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
111 Fistula-In-Ano (Including Sliding Flap) . . . . . . . . . . . . . 388
112 Perianal Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 392
113 Lateral Sphincterotomy (Parks) . . . . . . . . . . . . . . . . . . . 395
114 Pilonidal Sinus (Schrudde-Olivari) . . . . . . . . . . . . . . . . 397
External Genital Organs . . . . . . . . . . . . . . . . . . . . . . . . . . 401
115 Testicular Hydrocele . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
116 Vasectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404
Hernias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406
117 Local Anesthesia for Inguinal Hernia Repair . . . . . . . . 406
118 Dissection for Inguinal Hernia Repair . . . . . . . . . . . . . . 409
119 Inguinal Hernia Repair (Shouldice) . . . . . . . . . . . . . . . . 417
120 Inguinal Hernia Repair (Bassini) . . . . . . . . . . . . . . . . . . 421
121 Inguinal Hernia Repair (Lichtenstein) . . . . . . . . . . . . . . 424
122 Transinguinal Preperitoneal Mesh Repair (TIPP) . . . . . 427
123 Preperitoneal Inguinal Hernia Repair . . . . . . . . . . . . . . 431
124 Laparoscopic Inguinal Hernia Repair . . . . . . . . . . . . . . 438
125 Femoral Hernia Repair (Crural Approach) . . . . . . . . . . 443
126 Femoral Hernia Repair (Inguinal Approach;
Lotheissen, McVay) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446
127 Femoral Hernia Repair (Inguinocrural Approach) . . . . 451
128 Epigastric Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454
129 Umbilical Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456
130 Incisional Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460
131 Spigelian Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464

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