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Rural Surgery
Matthias W. Wichmann • David C. Borgstrom Nadine R. Caron • Guy Maddern(Editors)
Rural Surgery
Challenges and Solutions for the Rural Surgeon
EditorsMatthias W. Wichmann, FRACSDepartment of General SurgeryMount Gambier General Hospital andFlinders University Rural Medical School276-300 Wehl Street NorthMount Gambier, SA [email protected]
David C. Borgstrom, MD, FACSDepartment of SurgeryBassett Medical CenterOne Atwell RoadCooperstown, NY 13326 [email protected]
Nadine R. Caron, MD, MPH, FRCSCUniversity of British Columbia-Northern Medical Program Prince George, [email protected]
Guy Maddern, MDDepartment of Surgery The Queen Elizabeth Hospital 28 Woodville RdWoodville South, SA [email protected]
The following figures are published with the kind permission of the respective owner
Figures: 4.1, 4.3, 4.4, 4.5, 7.2, 7.3, 12.1, 12.3, 14.1, 14.2, 15.1, 15.2, 15.3, 30.1, 30.2, 30.3, 37.1, 37.2, 39.1, 39.2, 39.3, 39.4, 40.1, 40.2, 40.3, 40.4, 40.5, 53.1, 53.2, 53.3, 53.5, 61.1, 61.2, 61.4, 63.1, 63.2
Jauch K-W, Mutschler W, Wichmann MW (2007), Chirurgie Basisweiterbildung, Springer-Verlag, Berlin, Heidelberg
ISBN 978-3-540-78679-5 e-ISBN 978-3-540-78680-1DOI 10.1007/978-3-540-78680-1Springer Heidelberg Dordrecht London New York
Library of Congress Control Number: 2011923337
© Springer-Verlag Berlin Heidelberg 2011
This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law.
The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
Product liability: The publishers cannot guarantee the accuracy of any information about dosage and appli-cation contained in this book. In every individual case the user must check such information by consulting the relevant literature.
Cover design: eStudioCalamar, Figueres/Berlin
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
To Juliane, Antoinette, Jakobus, and Evangelia – thank you for taking me “down under”!
Matthias W. Wichmann
To Donna, Catherine, and Samantha. Thank you for your love, confidence, and support.
David C. Borgstrom
To our fellow rural surgeons around the world.
Guy Maddern
To Gary F. Purdue† (1945–2010) – gifted surgeon, friend, humanitarian.
David C. Borgstrom
vii
We are very pleased to present our contribution to the developing field of rural surgery.
Rural surgery requires the surgeon to always be prepared for a procedure or an intervention that he or she might not have done or seen either frequently or recently – this is the best definition of the challenge facing rural surgery. It does summarize well what the challenges of daily work for rural surgeons can be. These challenges become more complex due to the fact that expert support or advice and the technology require-ments that often accompany them are frequently far away or not available.
With this textbook on rural surgery we want to provide up-to-date information for senior as well as junior surgeons working in nonmetropolitan hospitals around the world. The book is a guide to get through the challenges of starting a surgical practice in a rural environment and can provide the scientific background for the routine work of the experienced rural surgeon. The book also aims to assist surgeons who provide locum services and may not always be used to working alone in a new environment.
We hope that this book will become a valuable companion for surgeons working in the field of rural surgery around the world.
The editors started to work on this project in 2007 when David Borgstrom came to present at the Annual Scientific Meeting of the Provincial Surgeons of Australia (PSA) in Whyalla (sp) (South Australia). Matthias Wichmann, Guy Maddern, and David Borgstrom agreed to edit a textbook on rural surgery based on the recent experience of one of the Australian editors (MW) who at that time was just beginning to adjust to the challenge and rewards of a rural surgical practice after moving to Australia from Germany. Nadine R. Caron soon joined the editorial team and we started to col-lect contributing authors around the world.
We are very grateful to all the contributing authors for their input into this text-book. Their expertise and knowledge will help to make rural surgeons more comfort-able with difficult situations and treatment decisions in our daily practice and serve as a resource for the future rural surgeons who will pursue this rewarding career.
The editors would also like to express their gratitude to the team of the Springer-Verlag in Germany. From the start the publisher was very supportive of the idea to edit a book on rural surgery. We are especially thankful to Mrs. Stephanie Benko and Mrs. Rosemarie Unger and Mrs. Dakshinamoorthy Mahalakshmi for their help and assistance.
Preface
viii Preface
We trust that you will enjoy this book and that it will be a valuable support for your work in rural surgery.
Mount Gambier, SA, Australia Matthias W. Wichmann, FRACS
ix
Part I Challenges of Rural Surgery
1 Rural Surgical Education: The Australian Approach . . . . . . . . . . . . . 3Guy Maddern and Matthias W. Wichmann
2 Surgery for Rural America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5David C. Borgstrom
3 Surgery in Rural Canada: Challenges and Possible Solutions . . . . . . 7Nadine R. Caron and Stephen J. Pinney
Part II Pre- and Postoperative Care
4 Fundamentals of Surgical Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Hanno Niess, Karl-Walter Jauch, and Christiane J. Bruns
5 Palliative Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Matthias W. Wichmann
6 Fiber Optic Endoscopy: Bronchoscopy . . . . . . . . . . . . . . . . . . . . . . . . . 31Matthias W. Wichmann and Fritz W. Spelsberg
7 Fiber Optic Endoscopy: Gastroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . 35Matthias W. Wichmann and Fritz W. Spelsberg
8 Fiber Optic Endoscopy: Colonoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . 41Matthias W. Wichmann and Fritz W. Spelsberg
9 Endoscopy for Rural Surgeons: ERCP . . . . . . . . . . . . . . . . . . . . . . . . . 47Ian C. Roberts-Thomson
10 Rigid Endoscopy: Cystoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Mark Lloyd and John Miller
Contents
x Contents
11 Rural Surgical Audit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55David A.K. Watters
12 Acute Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67Edmund A.M. Neugebauer, Astrid Althaus, and Christian Simanski
13 Prophylaxis of Venous Thromboembolism . . . . . . . . . . . . . . . . . . . . . . 77Robert A. Fitridge and Simon McRae
14 Nutrition of the Surgical Patient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85Florian Brackmann, Wolfgang H. Hartl, and Peter Rittler
15 Surgical and Hospital-Acquired Infections . . . . . . . . . . . . . . . . . . . . . . 99Wolfgang Böcker and Wolf Mutschler
16 Antimicrobial Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107Christian P. Schneider and Beatrice Grabein
17 Preoperative Risk Assessment in Rural Surgery . . . . . . . . . . . . . . . . . 133Teresa Bueti, Munawar Rana, and Matthias W. Wichmann
18 Perioperative Fluid Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139Peter Rittler and Wolfgang H. Hartl
19 Analgesia and Sedation in Intensive Care . . . . . . . . . . . . . . . . . . . . . . . 145Christian Waydhas
Part III Operative Care
20 Anti-reflux Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157Glyn Jamieson
21 Gastric Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163Matthias W. Wichmann
22 Gallbladder Surgery: Laparoscopic Cholecystectomy and Management of Bile Duct Stones in the Rural Setting . . . . . . . . . 169Harsh A. Kanhere and Andrew D. Strickland
23 Liver Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181Faud Alkhoury, Christine Vancott, and Randall Zuckerman
24 Pancreatic Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187Markus Trochsler, Thomas Satyadas, and Harsh A. Kanhere
Contents xi
25 Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195Martin Bruening
26 Surgery of the Spleen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201Matthias W. Wichmann
27 Complications After Bariatric Surgery . . . . . . . . . . . . . . . . . . . . . . . . . 205Brent White
28 Appendicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217Kerstin S. Schick and Johannes N. Hoffmann
29 Bowel Obstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223Saukat T. Esufali
30 Diverticulitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231Matthias W. Wichmann and Karl-Walter Jauch
31 Therapy of Sepsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237Johannes N. Hoffmann
32 Bowel Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245Peter Hewett and Cu Tai Lu
33 Rectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251Peter Hewett
34 Stoma Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255Nick Rieger
35 Acute Abdominal Pain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259Hajir Nabi
36 Gastrointestinal Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267Friesen W. Randall
37 Mesenteric Ischaemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275Heinrich Stiegler, Florian Brackmann, and Laura Holzner
38 Management and Surgery of Inflammatory Bowel Diseases . . . . . . . . 281William Roediger
39 Proctology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289Alexander Herold and Laura Holzner
40 Abdominal Wall Hernias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299Reinhold A. Lang and Martin K. Angele
xii Contents
41 Thyroid Surgery for the Community General Surgeon . . . . . . . . . . . . 309Anthony J. Chambers and Janice L. Pasieka
42 Parathyroid Surgery in the Non-Tertiary Center . . . . . . . . . . . . . . . . . 315Anthony J. Chambers and Janice L. Pasieka
43 Adrenal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323Marlon A. Guerrero and Wen Shen
44 Breast Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331David Walsh
45 Skin Cancer: Current Surgery for This Common Problem . . . . . . . . 341R. Gwyn Morgan
46 Pediatric Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351Thao T. Marquez, Mara B. Antonoff, and Daniel A. Saltzman
47 Vascular Surgery: Acute Limb Ischaemia . . . . . . . . . . . . . . . . . . . . . . . 359Mark Hamilton
48 Vascular Surgery: Management of the Diabetic Foot. . . . . . . . . . . . . . 369Mark Hamilton
49 Minor Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375Eric Mooney
Part IV Relevant Orthopaedics for General Surgeons
50 Simple Orthopaedic Procedures and Common Diagnoses. . . . . . . . . . 389David Wysocki and René Zellweger
51 Carpal Tunnel Release. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407Hajir Nabi
52 Dupuytren’s Contracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411Barney McCusker
53 Hand Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415Andreas Frick and Christiane G. Frick
Part V Other Relevant Operative Specialities for General Surgeons
54 Rural Obstetrics and Gynaecology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425Colin Weatherill
Contents xiii
55 Urological Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433John Miller, Clair Whelan, and Kulendran Sivapragasam
56 Otolaryngologic Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451Cynthia Bonatucci Fisher
Part VI Emergency Care
57 Airway Management: A Surgical Perspective. . . . . . . . . . . . . . . . . . . . 465Adrian Anthony
58 Management of the Severely Injured . . . . . . . . . . . . . . . . . . . . . . . . . . . 483Adrian Anthony
59 Rural Burn Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501Gary F. Purdue† and Brett D. Arnoldo
60 A Guide to Neurotrauma for the Rural Surgeon . . . . . . . . . . . . . . . . . 507David Omahen and Stephen J. Hentschel
61 Abdominal Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529Wolfgang E. Thasler
62 Trauma Surgery: Neck Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535Harsh A. Kanhere and Robert A. Fitridge
63 Open Extremity Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541Ekkehard Euler
64 Traumatic Injuries of the Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547Rudolf Beisse and Christoph Siepe
65 Trauma Surgery, Orthopaedic – Pelvic Fracture . . . . . . . . . . . . . . . . . 555Tim Pohlemann, Daniel Köhler, and Christopher Tzioupis
66 Trauma Surgery: Vascular Emergencies . . . . . . . . . . . . . . . . . . . . . . . . 563Robert A. Fitridge and Mark Hamilton
67 Thoracic Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 571Christian Müller
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577
