Cambridge University Press

978-0-521-13722-5 - Fundamentals of Surgical Practice, Third Edition

Edited by Andrew N. Kingsnorth and Douglas M. Bowley
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Fundamentals of Surgical
Practice
Third Edition

in this web service Cambridge University Press

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Cambridge University Press

978-0-521-13722-5 - Fundamentals of Surgical Practice, Third Edition
Edited by Andrew N. Kingsnorth and Douglas M. Bowley
Frontmatter
More information

Fundamentals of Surgical
Practice
Third Edition
Edited by

Andrew N. Kingsnorth MS, FRCS, FACS

Consultant Surgeon, Derriford Hospital and Honorary Professor of Surgery,
Peninsula College of Medicine and Dentistry, Plymouth, UK

Douglas M. Bowley FRCS [Gen Surg]

Consultant Surgeon, Heart of England NHS Foundation Trust and Senior Lecturer,
Academic Department of Military Surgery and Trauma,
Royal Centre for Defence Medicine, Birmingham, UK

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Cambridge University Press

978-0-521-13722-5 - Fundamentals of Surgical Practice, Third Edition
Edited by Andrew N. Kingsnorth and Douglas M. Bowley
Frontmatter
More information

CAMBRID GE UNIVERSIT Y PRESS

Cambridge, New York, Melbourne, Madrid, Cape Town,
Singapore, Sao Paulo, Delhi, Tokyo, Mexico City
Cambridge University Press
The Edinburgh Building, Cambridge CB2 8RU, UK
Published in the United States of America by Cambridge University
Press, New York
www.cambridge.org
Information on this title: www.cambridge.org/9780521137225


c Cambridge University Press 1998, 2006, 2011

This publication is in copyright. Subject to statutory exception and to

the provisions of relevant collective licensing agreements, no
reproduction of any part may take place without the written permission
of Cambridge University Press.
First published by Greenwich Medical Media 1998
Second Edition published by Cambridge University Press 2006
Third Edition published 2011
Printed in the United Kingdom at the University Press, Cambridge
A catalogue record for this publication is available from the British
Library
Library of Congress Cataloguing in Publication data
Fundamentals of surgical practice / edited by Andrew N. Kingsnorth,
MS, FRCS, FACS, Consultant Surgeon, Derriford Hospital and
Honorary Professor of Surgery, Peninsula College of Medicine and
Dentistry, Plymouth, UK, Douglas M. Bowley, FRCS [Gen Surg],
Consultant Surgeon, Heart of England NHS Foundation Trust and
Senior Lecturer, Academic Department of Military Surgery and
Trauma, Royal Centre for Defence Medicine, Birmingham, UK. Third
Edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-521-13722-5 (pbk.)
1. Surgery. I. Kingsnorth, Andrew N., 1948 editor.
II. Bowley, Douglas M., editor.
[DNLM: 1. Surgical Procedures, Operative. WO 500]
RD32.F86 2011
617 dc22
2010048439
ISBN 978-0-521-13722-5 Paperback
Cambridge University Press has no responsibility for the persistence or
accuracy of URLs for external or third-party internet websites referred
to in this publication, and does not guarantee that any content on such
websites is, or will remain, accurate or appropriate.
Every effort has been made in preparing this book to provide accurate
and up-to-date information which is in accord with accepted standards
and practice at the time of publication. Although case histories are
drawn from actual cases, every effort has been made to disguise the
identities of the individuals involved. Nevertheless, the authors, editors
and publishers can make no warranties that the information contained
herein is totally free from error, not least because clinical standards are
constantly changing through research and regulation. The authors,
editors and publishers therefore disclaim all liability for direct or
consequential damages resulting from the use of material contained in
this book. Readers are strongly advised to pay careful attention to
information provided by the manufacturer of any drugs or equipment
that they plan to use.

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978-0-521-13722-5 - Fundamentals of Surgical Practice, Third Edition
Edited by Andrew N. Kingsnorth and Douglas M. Bowley
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Contents
List of contributors
Preface x

vii

Section 1 Basic Sciences

Relevant to Surgical Practice

10 Fundamentals of cancer management

Mark Duxbury

Pharmacology and the safe

prescribing of drugs 1
Jamie J. Coleman, Anthony R. Cox and
Nicholas J. Cowley

Fundamentals of general pathology

Gerald Langman

Fundamentals of surgical
microbiology 41
Richard Cunningham

Fundamentals of radiology
Arvind Pallan

Section 4 Perioperative Care of

the Surgical Patient
15

13 Fundamentals of intensive care

Angela L. Neville

54

Surgical techniques and technology

Michael A. Scott and Mark G. Coleman

Professionalism including academic

activities: clinical research, audit,
consent and ethics 94
Evangelos Mazaris, Paris Tekkis and
Vassilios Papalois

71

Fundamentals of palliative and end of

life care 103
Chantal Meystre and Riffatt Hussein

Section 3 The Assessment and

Management of the Surgical Patient
8

Preoperative assessment
Jeffrey L. Tong

Fundamentals of anaesthesia
Jeffrey L. Tong

127
134

181
190

14 Caring for surgical patients:

complications and communication
Douglas M. Bowley

Section 2 Basic Surgical Skills

11 Fundamentals of intestinal failure and

nutrition 173
Tim Campbell Smith and Alistair Windsor
12 Enhanced recovery after surgery
John Evans and Robin H. Kennedy

151

15 Management of sepsis
Mark J. Midwinter

230

248

Section 5 Common Surgical

Conditions
16 Assessment and early treatment of
patients with trauma 253
Ross Davenport and Nigel Tai
17 Fundamentals of the central nervous
system 276
James Palmer and Anant Kamat
18 Fundamentals of head and neck
surgery 306
John K.S. Woo and Walter W.K. King
19 Fundamentals of thoracic surgery 330
Richard S. Steyn and Deborah Harrington

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978-0-521-13722-5 - Fundamentals of Surgical Practice, Third Edition
Edited by Andrew N. Kingsnorth and Douglas M. Bowley
Frontmatter
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Contents

20 Oesophago-gastric surgery
Tim Wheatley

27 Fundamentals of vascular surgery 505

Donald J. Adam, Martin W. Claridge and
Antonius B.M. Wilmink

343

21 Fundamentals of hepatobiliary and

pancreatic surgery 358
Mark Duxbury and Rowan Parks
22 Fundamentals of endocrine surgery
Peter Cant
23 Fundamentals of the breast
Steven D. Heys

392

24 Lower gastrointestinal surgery

Chris Cunningham

430

25 Fundamentals of the genitourinary

system 453
Angela Cottrell and Andrew Dickinson
26 Hernias 480
Andrew N. Kingsnorth

28 Fundamentals of orthopaedics
Jon Clasper
378

29 Fundamentals of plastic surgery

Tania C.S. Cubison

521
537

30 Surgical care of the paediatric patient

Paul K.H. Tam

564

31 Fundamentals of organ
transplantation 608
Matthew Bowles

Index 625

vi

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978-0-521-13722-5 - Fundamentals of Surgical Practice, Third Edition
Edited by Andrew N. Kingsnorth and Douglas M. Bowley
Frontmatter
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Contributors

Donald J. Adam
Consultant Surgeon, Heart of England NHS
Foundation Trust and Senior Lecturer, Department of
Vascular Surgery, Birmingham University,
Birmingham, UK
Matthew Bowles
Consultant Surgeon, Derriford Hospital, Plymouth,
UK
Douglas M. Bowley
Consultant Surgeon, Heart of England NHS
Foundation Trust, and Senior Lecturer, Academic
Department of Military Surgery and Trauma, Royal
Centre for Defence Medicine, Birmingham, UK
Tim Campbell Smith
Department of Colon and Rectal Surgery, University
College London Hospitals, London, UK
Peter Cant
Consultant Surgeon, Department of Surgery,
Derriford Hospital, Plymouth, UK
Martin W. Claridge
Specialist Registrar in Surgery, Birmingham
University Department of Vascular Surgery, Heart of
England NHS Foundation Trust, Birmingham, UK
Jon Clasper
Consultant Surgeon, Frimley Park NHS Foundation
Trust and Defence Professor of Trauma and
Orthopaedics, Academic Department of Military
Surgery and Trauma, Royal Centre for Defence
Medicine, Birmingham, UK
Jamie J. Coleman
Senior Lecturer, Department of Clinical
Pharmacology, College of Medical and Dental
Sciences, University of Birmingham, Birmingham,
UK

Mark G. Coleman
Consultant Surgeon, Department of Surgery,
Derriford Hospital, Plymouth, UK
Angela Cottrell
Department of Urology, Derriford Hospital,
Plymouth, UK
Nicholas J. Cowley
Specialist Registrar, Department of Anaesthesia,
University Hospitals Birmingham NHS Foundation
Trust, Birmingham, UK
Anthony R. Cox
Lecturer in Clinical Therapeutics, School of
Pharmacy, Aston University, Birmingham,
UK
Tania C.S. Cubison
Consultant Surgeon, Department of Burns,
Reconstruction and Plastic Surgery, Queen Victoria
Hospital, East Grinstead, East Sussex, UK, and Royal
Army Medical Corps, UK
Chris Cunningham
Colorectal Surgeon, Department of Colorectal
Surgery, John Radcliffe Hospital, Oxford, UK
Richard Cunningham
Consultant Microbiologist, Department of
Microbiology, Derriford Hospital, Plymouth,
UK
Ross Davenport
Trauma Research Fellow, Trauma Clinical Academic
Unit, Royal London Hospital, Whitechapel, London,
UK
Andrew Dickinson
Consultant Surgeon, Department of Urology,
Derriford Hospital, Plymouth, UK

vii

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978-0-521-13722-5 - Fundamentals of Surgical Practice, Third Edition
Edited by Andrew N. Kingsnorth and Douglas M. Bowley
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List of contributors

Mark Duxbury
Clinical Scientist and Honorary Consultant Surgeon,
University of Edinburgh, Royal Infirmary, Edinburgh,
UK
John Evans
St. Marks Hospital, Middlesex, UK
Deborah Harrington
Specialist Registrar, Department of Thoracic Surgery,
Heart of England NHS Foundation Trust,
Birmingham, UK
Steven D. Heys
Professor of Surgical Oncology and Consultant
Surgeon, Deputy Head, Division of Applied
Medicine, School of Medicine and Dentistry,
University of Aberdeen, Aberdeen, UK
Riffatt Hussein
Education Fellow, Heart of England NHS Foundation
Trust, Birmingham, UK
Anant Kamat
Consultant Surgeon, Department of Neurological
Surgery, Derriford Hospital, Plymouth, UK
Robin H. Kennedy
Consultant Surgeon, Department of Colorectal
Surgery, St. Marks Hospital, Middlesex, UK
Walter W.K. King
Clinical Professor, Department of Surgery, Chinese
University of Hong Kong and Centre Director, Plastic
and Reconstructive Surgery Centre, Hong Kong
Sanatorium and Hospital, Hong Kong
Andrew N. Kingsnorth
Consultant Surgeon, Derriford Hospital and
Honorary Professor of Surgery, Peninsula College of
Medicine and Dentistry, Plymouth, UK
Gerald Langman
Consultant Histopathologist, Heart of England NHS
Foundation Trust, Birmingham, UK
Evangelos Mazaris
PhD Student, The West London Renal and Transplant
Centre, Imperial College NHS Healthcare Trust,
Hammersmith Hospital, London, UK

Chantal Meystre
Consultant, Palliative Care Physician, Heart of
England NHS Foundation Trust and Medical
Director, Marie Curie Hospice, Solihull, Birmingham,
UK
Mark J. Midwinter
Consultant Surgeon, University Hospitals
Birmingham NHS Foundation Trust and Defence
Professor of Surgery, Royal Centre for Defence
Medicine, Birmingham, UK
Angela L. Neville
Assistant Professor of Surgery, Harbor-UCLA
Medical Center, Los Angeles, CA, USA
Arvind Pallan
Consultant Radiologist, Heart of England NHS
Foundation Trust, Birmingham, UK
James Palmer
Consultant Surgeon, Department of Neurological
Surgery, Derriford Hospital, Plymouth, UK
Vassilios Papalois
Consultant Transplant and General Surgeon, The
West London Renal and Transplant Centre, Imperial
College NHS Healthcare Trust, Hammersmith
Hospital, London, UK
Rowan W. Parks
Consultant Surgeon, Edinburgh Royal Infirmary and
Reader in Surgery, Department of Clinical and
Surgical Sciences, University of Edinburgh,
Edinburgh, UK
Michael A. Scott
Consultant Surgeon, Department of Surgery,
Gloucestershire Royal Hospital, Gloucester, UK
Richard S. Steyn
Consultant Surgeon, Department of Thoracic
Surgery, Heart of England NHS Foundation Trust,
Birmingham, UK
Nigel Tai
Consultant Trauma and Vascular Surgeon, Trauma
Clinical Academic Unit, Royal London Hospital and
Senior Lecturer, Royal Centre for Defence Medicine,
Birmingham, UK

viii

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Cambridge University Press

978-0-521-13722-5 - Fundamentals of Surgical Practice, Third Edition
Edited by Andrew N. Kingsnorth and Douglas M. Bowley
Frontmatter
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List of contributors

Paul K.H. Tam

Chair Professor and Chief of Paediatric
Surgery and Pro-Vice Chancellor and
Vice-President (Research), The University
of Hong Kong, Queen Mary Hospital,
Hong Kong
Paris Tekkis
Consultant Colorectal Surgeon, Chelsea and
Westminster Hospital and The Royal Marsden
Hospital, London, UK
Jeffrey L. Tong
Consultant Anaesthetist, University Hospitals
Birmingham NHS Foundation Trust, Department
of Anaesthesia and Critical Care, Royal Centre
for Defence Medicine, Birmingham,
UK

Tim Wheatley
Consultant Surgeon, Department of Upper
Gastrointestinal Surgery, Derriford Hospital,
Plymouth, UK
Antonius B.M. Wilmink
Consultant Vascular Surgeon, Birmingham
University Department of Vascular Surgery, Heart of
England NHS Foundation Trust, Birmingham, UK
Alistair Windsor
Consultant Surgeon, Department of Colorectal Surgery,
University College London Hospitals, London, UK
John K.S. Woo
Clinical Associate Professor, Chinese University of
Hong Kong and Consultant, Department of Surgery,
Prince of Wales Hospital, Hong Kong

ix

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978-0-521-13722-5 - Fundamentals of Surgical Practice, Third Edition
Edited by Andrew N. Kingsnorth and Douglas M. Bowley
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Preface

The surgeon of today is witness to unprecedented

change in the delivery of healthcare. Our populations
are ageing and the available options for treatment are
expanding. Surgeons are becoming increasingly specialist and patients in hospital are sicker than ever
before. Pressures on trainees include a shorter working week and there is an emphasis on operating theatre efficiency, which reduces opportunity for supervised trainee operating. Add to this the increasing
scrutiny of an individual surgeons outcomes that can
act to limit a trainees exposure to operative experience. Traditional team structures of surgical firms and
the apprentice-style training have been consigned to
history.
Over recent years, the examination process in
surgery has also changed and the Intercollegiate Surgical Curriculum Project now emphasizes the different domains of surgical practice, based on the CanMEDS framework and underpinned by the principles
of Good Medical Practice. As well as becoming a surgical expert, with the appropriate knowledge, clinical

skills, technical skills and professional attitudes, a surgeon must develop skills as a Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional. These are admirable goals and the examination
system is indeed evolving to assess the full range of
these qualities.
This new edition of Fundamentals of Surgical Practice is aimed at the surgeon in training preparing for
the Intercollegiate MRCS Examination. The book follows the syllabus for the examination, which has been
agreed by, and is common to, the Surgical Royal Colleges of Great Britain and Ireland. The syllabus integrates basic sciences, principles of surgery-in-general
and important generic surgical topics. The authors are
dedicated surgical educators and we hope this book
will communicate some of our passion for surgery to
you as much as we hope it helps you progress in your
professional careers.
Andrew Kingsnorth and Douglas Bowley

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