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980	SECTION 7	Spleen

	Procedure

STEP 1	Access and insertion of trocars
	The patient is positioned in a 45-degree right lateral position. The surgeon and the

	camera assistant stand at the patient’s abdominal side, video-monitor on the opposite
	site. The ﬁrst trocar (umbilical, 12mm) is inserted in an open technique (T1) and the
	pneumoperitoneum (14mmHg) is introduced.

Further trocars are inserted under visual control in the left lower abdomen (T2, 10mm) and in the left midaxillary line just below the costal margin (T3, 10mm). If needed, additional trocars are placed semicircularly in relation to the spleen (dotted line).

STEP 2	Aspiration of the cyst contents and resection of the cyst wall
	The cyst is opened in an avascular region with electrocautery and the contents aspired.

	The adhesions to the surrounding tissue are dissected and the spleen needs to be
	completely mobilized as for a laparoscopic splenectomy. Care should be taken with the
	diaphragmatic adhesions, which can be particularly dense.

Laparoscopic Unrooﬁng of Splenic Cysts	981

STEP 3

The cyst wall is unroofed using diathermy or harmonic shears until unaffected splenic parenchyma is reached. During the resection of the cyst, meticulous hemostasis is important to prevent impairment of the view. To minimize the risk of recurrence, the largest possible amount of cyst wall should be resected.

The excised tissue is placed in an endoscopic plastic bag and removed.

When technically feasible, an omentum patch is placed in the remaining cyst cavity and the trocar incisions are closed without drainage.

982 SECTION 7 Spleen

Postoperative Tests

See chapter “Open Splenectomy.”

Postoperative Complications

See chapter “Open Splenectomy.” ■ Cyst recurrence

Tricks of the Senior Surgeon

■Complete mobilization of the spleen prior to resection of the cyst wall is imperative.

■To reduce the risk of bleeding, use dissection with a stapler device in situations where the cyst wall is covered with normal splenic parenchyma. This is especially useful in the region of splenic hilus.

■Use an open approach in parasitic and neoplastic cysts.

Subject Index

abdominothoracic en bloc esophagectomy

	with high intrathoracic anastomosis
–	contraindications 89
–	indications 89

access 5

– esophageal surgery 14

– establishing pneumoperitoneum 16

–	incision		10
–	–	cervical	14
–	–	bilateral subcostal			13
– –		J-shaped		13
– –		midline	10
– –		subcostal		12
–	laparoscopic surgery				16
– thoracotomy				14
– upper midline laparotomy						14
– veress needle				16
– with the open technique						17
achalasia 139
– Dor fundoplication					141
– Heller myotomy 140

– postoperative complications					142
adenoma		339
– periampullary 833
– – transduodenal resection					834
anastomosis
–	drains	39
–	of the portal vein			472
antrectomy
–	contraindications			147
–	indications		147
– vagotomy			148

argon-plasma coagulation of the septum 124

ascites 654, 663, 675

Balfour retractor				25
balloon catheter gastrostomy							230
beach chair position					7
Beger procedure				875
bile duct
–	injury		525
– –		E1–E3 lesion		634
– –		hepaticojejunostomy				631
– –		Hepp-Couinaud approach					634
–	–	incision 632
–	–	intrahepatic duct			638
–	–	isolated right hepatic duct					636
– –		partial hepatectomy				638
– –		preparation		632
– –		stent	634
–	–	timing of repair			632

–	reconstruction				475
–	resection
– –		access	567
–	–	bilioenteric anastomosis 575
– –		caudate lobe			571, 577
–	–	clinical evaluation				56
– –		complications			582
–	–	connective tissue dissection 567
–	–	contraindications				565
–	–	demarcation of the liver capsule 578
–	–	distal	568
– –		endoscopy		566
–	–	hepatic artery			570, 576
– –		hepatic duct			565
–	–	indications		565
–	–	intrahepatic			573, 580
– –		Kocher maneuver				568
–	–	laboratory tests				566
–	–	left hepatic resection 570
–	–	left portal vein			570
–	–	liver capsule			572


– –		lymph node dissection						567, 581
– –		pericaval segment					572
– –		portal vein		576
– –		radiology		566
–	–	reconstruction			575, 581
–	–	right hepatic lobe					577
–	–	right hepatic resection						576
–	–	right hepatic vein				577
– –		Roux-en-Y loop				575
– –		short hepatic vein					571
–	–	skeletonization				569
–	–	surgical preparation					566
–	–	transection		579
biliary
– cystadenoma				430
–	dyskinesia		811
–	tract 523
–	tree
– –		congenital malformation						525
biliary-enteric anastomosis 525
Billroth II reconstruction							150
– gastrojejunostomy						151
bisegmentectomy					394
Blake drain			35
Bookwalter retractor						23
Braun‘s anastomosis						153

Calot‘s triangle 529, 555 carcinoma of the lower esophagus

	and gastric cardia	55
–	contraindications	55
–	indications 55
–	left-sided thoracotomy 55

–lower mediastinal lymphadenectomy 60


– para-aortic lymph node removal						58
–	reconstruction			61
Caroli syndrome				339
catheter 41
cavo-cavostomy
– end-to-side			471
–	side-to-side 471
central pancreatectomy					781, 783
cervical esophagectomy					47
–	contraindications 47
– esophagojejunal anastomosis						53
–	indications		47
–	postoperative complications 54
–	preparation
–	–	of the cervical region 49
–	–	of the jejunal loop			51

– vascular anastomosis 52 cervical lymphadenectomy 103 cholangiocarcinoma 339 cholangiography 528, 542

cholecystectomy	525
– laparoscopy	527

–open 527

–sepsis 539 cholecystojejunostomy

– access 612
– cholecystectomy		613
– choledochal duct		614
–	contraindications	611
–	exposure 612

– hepatoduodenal ligament 613

–	indications	611
– jejunum 614
–	obstruction	620

– postoperative complications 621


– running suture			615
–	side-to-side anastomosis					614
–	stay sutures	614
choledochal cyst			542
– cholangiocarcinoma					641
–	classiﬁcation		641
– complications			648
–	contraindications			642
– distal common bile duct						647
– hepaticojejunostomy					648
– incidence		641
–	indications	642
–	intraoperative ultrasound					643
–	kocherization		644
–	mobilization		645
– operative treatment					641
–	retrograde dissection				643
–	right subcostal incision					643
choledochocholedocotomy						632
choledochoduodenostomy						525, 632
– access 625
–	anterior wall anastomosis					629
– choledochojejunostomy						623
– choledochotomy				627, 630
– common bile duct stone						623

984	Subject Index


–	contraindications					623
– dudenotomy					627
– enterotomy				630
–	indications			623
–	Kocherization				544, 630, 658, 676, 691,
	766, 834, 888
–	posterior wall anastomosis								628
– postoperative complications									630
– preparation				624
–	side-to-side anastomosis							623
–	stenosis		630
choledochojejunostomy							587, 881
– access 612
– cholecystectomy						613
– choledochal duct						614
–	contraindications					611
– end-to-side anastomosis								611, 618
– exposure			612
– hepatoduodenal ligament									613
–	indications			611
– jejunum			614
– obstruction				620
– postoperative complications									621
– running suture					615
–	side-to-side anastomosis							611, 614, 617
–	stay sutures			614
choledochotomy					553, 554
– laparoscopic					558
cholelithiasis			542
chronic pancreatitis
– Beger procedure						875
– choledochojejunostomy								587, 881
– duodenojejunostomy							858
–	enteric ductal drainage
–	–	contraindications					753
–	–	indications			753
–	–	lateral pancreaticojejunostomy 755
– – Puestow procedure							753
– Frey procedure					864
– pancreaticojejunostomy								856, 873, 880
– pancreatoduodenectomy								851
– proximal pancreatectomy								849
circular stapler				30
coagulopathy				339
colorectal metastases						339

common bile duct exploration			525, 553
conventional gastrostomy
– balloon catheter gastrostomy			230
–	contraindications 227
–	gastroplasty	232
–	indications	227

– postoperative complications				233
– stapled continent gastrostomy				231
– temporary tube gastrostomy				228
cruroplasty		277
cryoshock 407
cryosurgery
–	contraindications		403
– cryoshock		407
–	indications	403
– postoperative complications				407
–	postoperative tests		407
–	preoperative investigation
	and preparation for the procedure 403
cystoduodenostomy			734

cystogastrostomy	731
cystojejunostomy	736

D2 lymphadenectomy		171
denervation, pain management
–	contraindications	745
–	indications 745
–	intraoperative chemical
	splanchnicectomy	746
– postsplanchnicectomy 751
–	splanchnic nerves (greater/lesser/least)
	745
– sympathetic chain/ganglia 745
– thoracoscopic splanchnicectomy			747
devascularization procedure,
	see gastroesophageal devascularization
dissection of the greater curvature			65
distal pancreatectomy
– complications 946
–	contraindications	791, 792, 929

–hand-assisted laparoscopic technique 941

–	indications 791, 929
– laparoscopic ultrasonography 940
–	pancreatic ﬁstula

– postsplenectomy thrombocytosis 946

–	sinistral portal hypertension 929
– splenic vein thrombosis								929
–	splenic-preserving					938, 940
distal splenorenal shunt (DSRS)									653
–	antibiotic prophylaxis						654
– arteriography				654
–	ascites	654, 663
–	chylous ascites			659, 663
–	coagulation status					654
–	contraindications					653
–	devascularization					656
– endoscopic therapy						654
– hepatic function					653
–	indications		653
–	inferior margin of the pancreas								656
–	inferior mesenteric vein							657
–	investigation and preparation								654
–	left adrenal vein				659
–	left gastric vein			662
–	left gonadal vein				659
–	left renal vein			658, 659, 662
– postoperative complications									663
–	postoperative tests					663
– shunt thrombosis						663
–	splenic vein		653, 657, 662
–	– pancreatic tributaries							658
– – preparation				660
– super mesenteric vein							656
– superior mesenteric vein								657
– vascular ultrasonography								654
Dor fundoplication					133, 141
drainage		33
drains
– anastomosis drains						39
– Blake		35

–	catheters	41
– complete drainage system 36
–	Jackson-Pratt		35
– Morison‘s pouch 40
–	passive drains
– – Easy Flow			34
– – Penrose		34
–	predisposed spaces for collections 40
–	prophylactic drainage 37

– – evidence-based recommendations

39
– therapeutic drainage			40
dudenojejunostomy		778
duodenal stump
– management	281
– – duodenojejunostomy				282
– – Foley catheter		283
– – postoperative complications					284
– – von Sonnenberg catheter 283
– – Whipple procedure			284
duodenectomy, pancreas-sparing					303
duodenojejunostomy			282, 845
duodenotomy	890
duodenum
– local excision
– – posterior duodenal wall				162
– – postoperative complications					163
– – ventral duodenal wall				160
– transection	170, 214

Easy Flow drain		34
Echinococcus multilocularis 339
endodissection		106, 111
endoscopic gastrostomy
–	contraindications		235
–	indications	235
– PEG removal		240
– postoperative complications 241
– pull through		239
–	transillumination		237
endoscopy 651
epiphrenic diverticula
–	contraindications		127
– Dor fundoplication			133
– exposure and resection
	of the diverticulum		129

– exposure of the gastro-esophageal

	junction and myotomy		130
–	indications	127
– laparoscopic procedure			131
– postoperative complications				134
–	reconstruction of the cardia			130
–	resection	132

–	thoracic approach 128
esophageal cancer
–	three-ﬁeld lymphadenectomy

– – cervical lymphadenectomy 103

–	–	contraindications 99
–	–	indications 99

– – T-shaped neck incision 102

Subject Index	985

esophagectomy			47, 63
esophagus
–	blunt mobilization			67
–	cervical, dissection			73
–	devascularization			718
–	transection	95, 109, 173, 723
–	transhiatal dissection 69
exploration of common bile duct
–	Calot‘s triangle		555
– choledochotomy				554
–	contraindications			553
–	indications	553

– laparoscopic approach		553
– – control cholangiography			557
– – ﬂexible choledochoscopy			557
– – ﬂuoroscopic guidance		556
– – stone clearance	557
– – stone extraction	556

– – visual cholangioscopic guidance 556

–	open approach	563
–	transcystic route	553
exposure 21

ﬁbrin glue 975 Foley catheter 283

foramen of Winslow 676

French position	6
Frey procedure	864

gallbladder 523
– cancer
– – adenocarcinoma					541
–	–	aortocaval nodal dissection					545
–	–	biliary reconstruction				551
–	–	calciﬁcation (porcelain bladder)						541
– – cholangiography					542
– – choledochal cyst					542
–	–	cholelithiasis		543
–	–	connective tissue dissection					544
–	–	contraindications			541
–	–	cystic duct	552
–	–	hepatic artery		546
–	–	indications	541
– – inﬂammation				541
– – Kocherization				544
–	–	liver resection		551
– – lymph node dissection						542
– – magnetic resonance cholangio-
		pancreatography (MRCP) 542
–	–	palliation	542
–	–	pancreaticobiliary duct junction						542
– – pancreaticoduodenectomy							545

–– percutaneous cholangiography (PTC) 542

– – porta hepatis 546

–	–	portal vein 550
–	–	Pringle maneuver 547

– –		radical cholecystectomy					542, 543
–	–	retropancreatic nodal dissection						545
– –		Roux-en-Y loop				549
– –		staging		552
– –		stent	551
–	–	surgical staging				541
– –		tumors		550
–	–	umbilical ﬁssure				547
gallstones
– common bile duct stones							553
– laparoscopic choledochotomy 553
– stone migration 553
–	surgical treatment					525
gastrectomy				143
– laparoscopic					211
– subtotal			143
–	total 165
gastric
– tube construction						72
–	ulcer
– –		bleeding			159
– –		perforated			157
gastrinoma				819–821
gastrinoma triangle						887
– exploration					885
– – duodenotomy						890
–	–	intraoperative ultrasonography						888
gastroenterostomy
–	contraindications					221
–	indications				221


– laparoscopic technique						225
– open
– – hand-sewing technique 222
– – stapling technique 224
– postoperative complications							226
gastroesophageal devascularization
–	contraindications				703
–	devascularization of the greater
	curvature		716
–	devascularization of the lesser
	curvature		717
– esophageal transection						703, 707
– extensive paraesophageal
	devascularization				703
–	indications			703
–	isolation of the distal esophagus 722
– porto-azygos disconnection
	with spleen preservation					715
– postoperative complications							704
–	postoperative tests				704
–	pyloroplasty			705, 719, 724
– splenectomy				705, 710, 720
– thoracoabdominal esophageal
	transection			705
– transection of the esophagus							723
– vagus nerves				706, 712
gastroesophageal junction
–	limited resection
–	–	contraindications			93
–	–	indications		93

– –		jejunogastrostomy 97
–	–	postoperative complications	98
–	–	transection of the esophagus	95

–– transposition of the proximal jejunum segment 96

gastroesophageal reﬂux disease (GERD)

	operation
– conventional approach			261
– –		choice of procedure	262
– –		ligamentum teres (round ligament)
		plasty 265
– –		postoperative complications		267
–	–	total Nissen fundoplication		263
– laparoscopic approach
–	–	contraindications 249
–	–	indications 249
– –		Nissen fundoplication	250
–	–	partial fundoplication	257
– –		postoperative complications		256
– –		Toupet fundoplication	258

gastrointestinal anastomosis stapler 29 gastrojejunostomy 151, 778 gastroplasty 232

gastroplication		229
gastrostomy
– conventional		227
–	endoscopic	235
–	laparoscopic-assisted 243

GERD, see gastroesophageal reﬂux disease giant hemagnioma 339

glucagonoma 819–821

helix hydro-jet			321
Heller myotomy 140
hemihepatectomy				341, 353, 363
– extended			363
– hanging maneuver					335
–	left 353
–	left living donor			491
–	right	341
–	right living donor			491
hepatectomy			388, 571
hepatic vein harvesting					338
hepaticojejunostomy					525, 777
hepatitis		339
hepatocellular carcinoma						339
Hepp-Couinaud approach						634
hiatal hernia			274

high intrathoracic anastomosis 90

hook
–	diathermy	532
–	dissection	532

ileostomy	900
incision 10
insulinoma	819–821
interposition graft 665
intrahepatic
– balloon tamponade 451
– biliodigestive anastomosis

–	–	anterior anastomosis 594
–	–	anterior stitches 593

986	Subject Index

– – biliary lumen			591
–	–	contraindications 591
– – end-to-side procedure				592
–	–	extrahepatic bile duct		591
–	–	identiﬁcation of transected bile duct
		592
–	–	indications	591

– – lumen identiﬁcation 596

– – multiple exposed ducts				596
– – open caudate duct			599
– – posterior anastomosis				594
–	–	posterior stitches	593
–	–	side-to-side procedure		599

intraoperative chemical splanchnicectomy 746

islet cell neoplasms 819–821

Jackson-Pratt drain	35
jejunogastrostomy	97

Kelly clamp 320
Kirschner retractor		25
Klatskin tumor	339
Kocher maneuver		568, 676, 691, 766, 834,
888
Kocherization	544, 630

LAGB, see laparoscopic adjustable gastric

	banding
laparoscopic
– adjustable gastric banding (LAGB)								297
– cholecystectomy
–	–	anatomical variations					533
– –		anesthetic monitoring					528
– –		C-arm ﬂuoroscopy				531
– –		cholangiography				528, 531
– –		complications		534
–	–	contraindications				527
– –		hook diathermy			532
– –		hook dissection			530
–	–	indications 527
–	–	liver function tests				527
–	–	posterior peritoneal attachment						529
–	–	retraction and dissection of Calot‘s
		triangle	529
–	–	transumbilical incision					528
– –		Trendelenburg position					528
– –		ultrasonography			527
– choledochotomy				558
– –		drainage	561
– –		postoperative complications 562
–	–	postoperative tests				562

– –		stone clearance assessment					560
– –		stone extraction			559
– –		suture	561
–	cyst
– –		cystogastrostomy			740
– – unrooﬁng				979
– gastrectomy
– –		anastomosis		218
–	–	contraindications			211
–	–	indications		211
– –		postoperative complications					220
– –		transection of duodenum 214
– –		transection of the stomach				216
– partial splenectomy					971
– splenectomy				961
–	staging for pancreatic cancer					917
laparoscopic-assisted gastrostomy							243
laparoscopy			525
– access with the open technique							17
– placement of accessory ports						18
–	retractors		26
ligament
–	gastro-splenic			955, 956, 959, 968, 969
–	of Treitz		666
–	spleno-colic 959, 971
–	spleno-renal			956, 959, 968, 969

ligamentum teres (round ligament) plasty

	265
liver
–	auxiliary transplantation
–	–	fulminant liver failure				513
–	–	partial orthotopic			515, 520
–	–	subfulminant liver failure					513
–	benign non-parasitic cysts
–	–	contraindications			425
–	–	enucleation of biliary cystadenoma
		430
–	–	indications		425
–	–	laparoscopic resection				432
– –		laparoscopic unrooﬁng of a simple
		cyst 426
– –		open unrooﬁng of a simple cyst						428
–	–	preoperative investigation and prepa-
	ration for the procedure					425
–	–	repair of vasculobiliary injuries						431
– –		resection		425
– – unrooﬁng				425
– Couinaud segments					314
–	function tests			527
–	hydatid cysts
– –		pericystectomy			435
– –		preoperative treatment					435
–	laparoscopic resection					391
–	–	left lateral sectionectomy					385, 394
–	–	living donor left lateral sectionectomy
	for liver transplantation in children							398
–	–	of cysts	432
– –		Pringle maneuver			394
– –		wedge resection			397
– midplane			314
– parenchyma dissection techniques								319
–	–	bipolar forceps 320
–	–	dissecting sealer			324
– –		Kelly clamps 320
–	–	ultrasonic dissection				322

– –		ultrasound cutting 323
–	–	water jet dissection (helix hydro-jet,
		Erbe) 321
–	partial cadaveric transplantation 479
–	–	hepatic venous outﬂow, alternative
		management in split liver
		transplantation 488
–	–	in-situ split liver donor procedure for
		an adult and a pediatric recipient 481

–– in-situ splitting for two adult recipients 483

–	–	left graft implantation (pediatric) 487
–	–	middle hepatic vein splitting 489
–	–	right graft split liver implantation (2
		adults) 486
–	–	right graft split liver implantation
		(adult/pediatric) 484

–– right living donor liver implantation 486

–	Pringle 327
–	resection
–	–	acute/chronic hepatitis						339
– –		adenoma	339
–	–	alternative second order division								317
–	–	benign non-parasitic liver cysts								425
– –		bisegmentectomy				315, 316
– –		Brisbane 2000 terminology							313
– –		Caroli syndrome			339
–	–	caval resection		327
– –		central hepatectomy				388
– –		cholangiocarcinoma				339
– –		coagulopathy		339
–	–	colorectal metastases					339
–	–	contraindications			339
–	–	Echinococcus multilocularis							339
– –		extended hemihepatectomy							315, 363
– –		extended hepatectomy						315
–	–	ﬁrst order division			314
– –		giant hemangioma				339
– –		hanging maneuver				335
– –		hepatic inﬂow occlusion						327
– –		hepatocellular carcinoma						339
–	–	indications	339
– –		inﬂow occlusion			328
– –		Klatskin tumor		339
– –		left hemihepatectomy					314, 353
– –		left hepatectomy			314, 353
– –		left medial sectionectomy 387
–	–	left trisectionectomy				368
– – modiﬁed hanging maneuver for
		middle hepatic vein harvesting								338
– –		neuroendocrine tumor						339
– –		of segment 2 and 3				385
– –		of segment 4		387, 388
– –		of segment 7		378
– –		of segment 8		373, 381, 388
– –		portal hypertension				339
– –		postoperative complications							340
–	–	postoperative tests				340
–	–	preoperative investigation							339
– –		Pringle maneuver			328
– –		reconstruction of vena cava							333
–	–	right anterior sectionectomy							381
– –		right hemihepatectomy						314, 341
– –		right hepatectomy				314, 341

Subject Index	987

– –		right paramedian sectoriectomy						381
–	–	right trisectionectomy					363
– –		second order division					315
– –		sectionectomy		315, 373
– –		sectorectomy		317
– –		segmentectomy			316, 373
–	–	third order division				316
– –		thrombopenia		339
–	–	total vascular exclusion					328
– –		trisectionectomy			315
–	–	vascular exclusion			327
– –		wedge resection			373, 389
– section			314
– sector			317
–	split-liver transplantation						479
–	transplantation, orthotopic 463
– –		anastomosis of the portal vein						472
– –		anhepatic stage			468
–	–	arterial anastomosis				473
–	–	bile duct reconstruction					475
– –		cava-sparing technique					467, 468, 470
–	–	classical technique with resection
		of IVC	466, 468, 469
–	–	contraindications			463
– –		end-to-end anastomosis of vena
		cava	470
– –		end-to-side cavo-cavostomy 471

–– full left hemiliver graft, procurement 504

– –		hanging maneuver 335
– –		hepatic artery thrombosis 478
–	–	implantation of left living donor liver
		506
–	–	indications	463
– –		left hemiliver donor procedure and
		implantation	499

–– left lateral segment graft, procurement 502

–– living donor left sectionectomy

in children 398

– – living-donor transplantation 335

– – management of the most common

	complications 478
– – piggyback technique		467, 468, 470
– – post-anhepatic stage		473
– – postoperative complications			477
– –	postoperative tests	477
– – pre-anhepatic stage		465
– –	preoperative investigation and
	preparation for the procedure		464
– – primary non-function		478
– –	rejection 478

–– right living donor hemihepatectomy 491

– – right lobe living donor workup				491
– – side-to-side cavo-cavostomy			471
– – venovenous bypass 476
– trauma
–	–	grading of hepatic injuries	441
–	–	indications for laparoscopic	442
– – intrahepatic balloon tamponade				451
– – non-operative management			442

–– Organ Injury Scale of the American Association for the Surgery of Trauma (AAST-OIS) 441

– – packing		449
– – postoperative complications							452
– – postoperative management							452
low-diameter mesocaval shunt
– angiography		665
–	contraindications		665
–	indications	665
–	inferior vena cava		665
–	infrarenal inferior vena cava					667
–	investigations and preparation						665
–	ligament of Treitz		666
– mesenteric vein			666
– postoperative complications						673
–	postoperative tests			673
– root of the mesocolon					666
–	superior mesenteric vein				665, 670
– ultrasonography with Doppler							665
– uncinate process of the pancreas							666
–	variceal bleeding		665
lymph node dissection				542, 574
lymphadenectomy			83
– of the hepatoduodenal ligament							66
–	of gastrinoma triangle				889

–	indications		675
–	inferior vena cava				677, 681
– Kocher maneuver					676
– Kocherization				676
– patency		684
– expanded polytetraﬂuoroethylene
	(ePTFE)	678
– portal hypertension 675
–	portal vein		680, 681
–	postoperative tests				684
–	variceal bleeding				675
morbid obesity operation						286
–	contraindications				286
–	indications		286
–	laparoscopic adjustable gastric banding
	(LAGB)	297
– postoperative complications 300
– Roux-en-Y gastric bypass						288
–	vertical banded gastroplasty (VBG) 294
Morison‘s pouch				40
MRCP, see magnetic resonance
	cholangiopancreatography
myotomy		121, 130

magnetic resonance cholangiopancreatography (MRCP) 542

mediastinal lymph node removal 60

mesocaval shunt		665
–	caval anastomosis 669
–	complications	673

–exposure of superior mesenteric vein 666

–	indications 665
–	polytetraﬂuoroethylene (PTFE) 669
– portal hypertension 665
–	variceal bleeding 665

mid common bile duct (MCBD) resection

	585
–	biliary-enteric continuity 589
–	contraindications 585
–	division

– – of the distal common bile duct 587

–– of the proximal common bile duct 587

– exploration	586
– exposure	586
– Hepp-Couinaud reconstruction			589
– indications	585
– mucosa-to-mucosa anastomosis			590
– postoperative complications		590
– preoperative investigations and
preparation of the procedure		585

–side-to-side retrocolic Roux-en-Y hepaticojejunostomy 589

8MM interposition portocaval shunt

–	ascites 675, 684
– caval anastomosis		678
– complications 684
–	contraindications 675
– foramen of Winslow		676
–	hepatic inferior vena cava 676

necrosectomy
– closed lavage			895
– closed packing			901
– complications			914
–	contraindications			893
– contrast-enhanced CT					894
–	FNA-aspirating culture				893
– ileostomy		900
–	indications	893
–	necrotizing pancreatitis				894
– nephroscope			911
– percutaneous			910
– planned repeated				904
–	stuffed Penrose drain				903
– sump drain		899
–	Water-Pik irrigator			907
– wound zipper			908
nephroscope		911
neuroendocrine tumor 339
Nissen fundoplication				250, 263, 279

O‘Sullivan-O‘Connor retractor				25
omentectomy		181
Omnitract retractor			24
onlay pancreatojejunostomy				803
open cholecystectomy
–	contraindications		535
–	indications	535
organ procurement			453
– back-table work			461

–en bloc pancreas-liver procurement 454

988	Subject Index

–pancreas removal for islet transplantation 460

–procurement of intestine for transplantation 460

orthotopic liver transplantation, see liver

palliative bypass
– access		601
–	biliary-enteric anastomosis 605
–	contraindications		601
–	general principles		602
–	hilus	601
–	indications 601
–	intrahepatic duct		601
–	left hepatic duct		603

– ligamentum teres approach			601, 606
– partial hepatectomy		608
– postoperative complications			610
–	postoperative test	610
– proximal right sectoral duct			609
–	right hepatic duct	609
–	right portal pedicle	609

– round ligament approach, see ligamen-

	tum teres approach
– segment 3 and 4			603
–	side-to-side hepaticojejunostomy					607
pancreas
– carcinoma 763
– divisum
–	–	sphincteroplasty		805
–	removal for islet transplantation					460
– resection for neoplasms
–	–	central resection		781
– –		complications	779
–	–	contraindications		763
– –		distal pancreatectomy			791
– –		dudenojejunostomy			778
– –		gastrojejunostomy		778
– –		hepaticojejunostomy			777
–	–	indications 763
–	–	intraoperative ultrasonography				784

–– neoadjuvant radiation/chemotherapy 765

– – laparoscopy 765
– – pancreaticojejunostomy	776, 788
– – pancreatoduodenectomy	765
– – postoperative tests 779

–	–	postsplenectomy vaccination 791
–	–	pyloruspreserving 768, 851

–– superior mesenteric vein resection 774, 775

–transplantation


– –		backtable preparation			840
– –		complications	847
–	–	contraindications		839
– –		duodenojejunostomy			845
–	–	indications 839
– –		portocaval anastomosis			842
– –		portomesenteric anastomosis 844
–	–	postoperative tests		847
pancreas-sparing duodenectomy
–	contraindications		303

–	indications 303
– postoperative complications						308
–	reconstruction		306
– resection of the duodenum						304
pancreatic
– duct
– –		catheter drainage			809
–	enucleation
– –		complications		832
–	–	contraindications			819
– –		gastrinoma	819–821
– –		glucagonoma		819–821
–	–	indications	819
– –		insulinoma	819–821
–	–	intraoperative ultrasonography 824,
		826, 830
–	–	islet cell neoplasms			819–821
–	–	laparoscopic enucleation				828, 830,
		831
– –		open enucleation			826
–	–	postoperative tests			832
– –		somatostatinoma			819–821
–	ﬁstula
– –		enteric drainage		799
– –		enteric drainage		799
– –		onlay pancreatojejunostomy 803
– –		onlay Roux-en-Y limb 799

–pseudocyst drainage

–– biopsy of the wall of the pseudocyst 732

– – chemical splanchnicectomy 746

– – complications 743
– – cystoduodenostomy	736
– – cystogastrostomy 731
– – infected pseudocyst	729
– – laparoscopic cystogastrostomy		740
– – pain management	745
– – postoperative care	743
– – thoracoscopic splanchnicectomy		747

pancreaticojejunostomy 776, 856, 873, 880

pancreatoduodenectomy 545, 765, 851

para-aortic lymph node removal					58
paraesophageal devascularization					705,
	706
paraesophageal hernia operation
–	anterior gastroplasty			279
–	hiatal hernia		274
– laparoscopy
–	–	contraindications		269
–	–	indications	269
– laparotomy
–	–	contraindications		270
–	–	indications	270
–	Nissen fundoplication			279
–	posterior cruroplasty			277

– postoperative complications 280 paraesophagogastric devascularization


	712
PEG removal			240
Penrose drain			34, 903
periampullary neoplasm
–	laparoscopic staging			917, 920
–	–	contraindications		917
–	–	indications 917

– laparoscopic ultrasonography 926

periampullary villous neoplasm
– complications				838
–	contraindications				833
–	indications		833
– postoperative care					838
– transduodenal excision						834
pericystectomy				435
polytetraﬂuoroethylene (PTFE)							678
porcelain bladder				541
portal hypertension					339, 549, 653, 665
– banding		651
– endoscopy			651
–	liver transplantation 651
–	non-cardioselective beta-blockade							651
– pathophysiology 651
–	sclerotherapy			651
–	transjugular intrahepatic portal systemic
	shunt (TIPS)		651
portasystemic encephalopathy (PSE)								701
porto-azygos diconnection						715
portocaval shunt
–	ascites	701
–	bleeding esophageal/gastric varices
	687
– caudate lobe				695
–	contraindications				687
– Doppler ultrasonography						687
–	end-to-side portocaval anastomosis
	700
–	hepatic vein catheterization						687
–	indications		687
–	inferior vena cava				691, 696
– Kocher maneuver					691
– portal hypertension					687
–	portal pressure			696
–	portal vein		693, 696
– portasystemic encephalopathy (PSE)
	701
– postoperative care					701
– postoperative complications							701
– preoperative preparation						688

–side-to-side portocaval anastomosis 698

– visceral arterography		687
positioning
– beach chair position		7
– for esophageal surgery			8
– French position	6
– lateral decubitus	8
– screw position 8
– supine position	5
postsplanchnicectomy		751
postsplenectomy
– thrombocytosis	946
– vaccination 791
Pringle maneuver	394
– gallbladder cancer 548
pseudocyst
– biopsy of the wall	732
– infected 729
– – cystoduodenostomy			737
– – cystogastrostomy		731
– – cystojejunostomy		736

–	–	laparo-endoscopic drainage 740
–	–	laparoscopic drainage 740

Subject Index	989

PTFE, see polytetraﬂuoroethylene Puestow procedure 753, 755 pyloroplasty 705, 719, 724

radiofrequency ablation of liver tumors

–	contraindications 409
– guidance imaging modality						410
–	indications		409
– laparoscopic approach					413
– open technique				410
– postoperative complications						415
–	postoperative testing				415
–	preoperative investigation and prepara-
	tion for the procedure				409
– probe selection				410
retractor		21
–	arm retractor		22
–	Balfour	25
– Bookwalter			23
–	closed ring		22
–	in laparoscopic surgery				26
–	Kirschner 25
–	O‘Sullivan-O‘Connor 25
– Omnitract
– Rochard		25
– systems		22
– Thompson			23
Rochard retractor				25
Roux-en-Y
–	gastric bypass			288
–	reconstruction			154, 174

– – postoperative complications 155

screw position 8

secretum stimulation test 805

sectionectomy			373
–	left lateral	385, 394
–	left medial	387
–	right anterior		381
sectoriectomy			381
segmentectomy			373

selective hepatic intra-arterial

	chemotherapy
–	complications 423
–	contraindications 417

–dealing with atypical arterial anatomy 422

–	indications 417
–	postoperative studies	423
–	preoperative studies	417

septum, argon-plasma coagulation 124 short esophageal stricture

–	contraindications 135
–	indications 135

– technique of anastomosis 135

shunt thrombosis	663
somatostatinoma	819–821

von Sonnenberg catheter 283 spincter of Oddi dysfunction 811 sphincteroplasty

–for pancreas divisum

–– catheter drainage of pancreatic duct 809

– –		complications		810
–	–	contraindications			805
–	–	indications	805
– –		of minor duct		808
–	–	postoperative tests			910
–	–	secretum stimulation test 805
– –		sphincterotomy of minor duct 808
– for papillary dysfunction: stenosing
	papillitis 811
– of minor duct			808

–transduodenal 812 sphincterotomy

–for papillary dysfunction: stenosing

papillitis		811
– of minor duct			808
splanchnicectomy 746
– chemical		746
– thoracoscopic			747
spleen
– accessory		959, 962
– cysts 979
– preservation			973
– trauma	973
– vessels	954, 957, 962, 963, 968–971, 975
splenectomy		705, 710, 720
– laparoscopic			961

–open 954

–partial 954

staging of pancreatic cancer 764

–	laparoscopic 917
stapler 27
–	circular 30

–GIA (gastrointestinal anastomosis stapler) 29

–	TIA (transverse anastomosis stapler)				28
–	types of mechanical staplers			28
stenosing papillitis 811
stomach
–	local excision		156
–	–	bleeding gastric ulcers 159
–	–	perforated gastric ulcers		157
–	transection		216
subtotal en bloc esophagectomy
– abdominothoracic approach
–	–	contraindications 79
–	–	indications	79
– –		radical en bloc lymphadenectomy			83
subtotal esophagectomy

–transhiatal approach

–– blunt mobilization of the esophagus 67

–	–	cervical anastomosis 75
–	–	construction of the gastric tube 72
–	–	contraindications 63

–– dissection of the cervical esophagus 73

–– dissection of the greater curvature 65


–	–	indications 63
– –		lymphadenectomy of the hepato-
		duodenal ligament 66
– –		postoperative complications 77
–	–	reconstruction		74
–	–	transhiatal esophageal dissection 69
subtotal gastrectomy
–	contraindications			143
–	indications		143
–	resection		146

Sugiura procedure, see gastroesophageal devascularization

supine position 5

temporary tube gastrostomy	228
terminolateral anastomosis	205
Thompson retractor 23

thoracoabdominal esophageal transection

	705
thoracoscopic
– esophagectomy
–	–	contraindications 105
–	–	indications 105
– –		positioning and exposure 107

– – transection of the esophagus 109

– splanchnicectomy 747 thoracotomy 14

three-ﬁeld lymphadenectomy for esophageal cancer

– cervical lymphadenectomy 103

–	contraindications 99
–	indications 99

– T-shaped neck incision 102 thrombopenia 339

TIPS, see transjugular intrahepatic portal

	systemic shunt
total gastrectomy
–	contraindications		165
– D2 lymphadenectomy				171
–	indications	165
– Japanese procedure				179
– postoperative complications						178
– Roux-en-Y reconstruction					174
–	transection
– – of the distal esophagus					173
– – of the duodenum				170
transampullary septectomy					815
transhiatal esophagogastrectomy
–	antiperistaltic reconstruction					196
–	combined transhiatal transthoracic
	esophagectomy		207
–	contraindications		189
–	determination of the essential length
	193
–	indications	189
–	isoperistaltic reconstruction					195
–	laterolateral anastomosis				206
– postoperative complications						210
– pull-through procedure					204
–	terminolateral anastomosis					205

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