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Anorectal surgery
Book Reviews
Manual of Surgical Therapeutics.
By Robert E. Condon and Lloyd M. Nyhus. Boston Little, Brown, 1988. 419 pages. $22.50.
One should judge all educational endeavors by precisely stated goals and objectives. Clearly, this text fulfills these objectives, and indeed, exceeds some of them. As an effort to “bring together in a single volume material needed for quick review by surgical house officers and students faced with clinical problems,” the book deserves high praise. Most of the commonly encountered patient care problems are included. Nonop erative issues are emphasized, as is the fact that this is not an encyclopedia of surgery but a day-to-day cookbook filled with recipes for analytical, stepby-step assessment and intervention for surgical patients. The style renders the information easily accessible; it is user friendly. Outlines highlighted by boldface type for emphasis are helpful and ap propriate. Admittedly, the format of opinionated discussion without reference or other alternatives is somewhat disappointing but well within the stated goals of a rapid reference, demonstrating at least one successful way to manage each problem. Few of the treatment regimens outlined stray from the traditional, time-tested methods utilized by most practitioners of good surgical care. The demonstration of accurate clinical observation utilizing a careful history and physical examination found in virtually every chapter is most commendable in this era of the admitting office-to-scanner approach to the patient and emphasizes that sound surgical practice demands close verbal and tactile contact with the patient rather than a hands-off attitude. Although many chapters are excellent, I found those dealing with the approach to acutely injured patients (especially general principles and
40
head and cervical injuries); problems encountered in the emergency room (ocular emergencies); fluid and electrolyte therapy; and the rewritten chapters on surgical nutrition, cancer chemotherapy, and psychiatric disorders to be particularly noteworthy for the concise organization and presentation of issues not adequately dealt with in some surgical curriculums. I enthusiastically recommend this manual as a how-to coat-pocket primer, but use of a companion surgical text is mandatory so that the information contained therein, such as in-depth viewpoint analysis, encyclopedic inclusion of detailed subject matter, operative alternatives, and an expanded reference list, can supplement the outlines presented. Norman J. Snow,
MD
Cleveland, OH Anorectal Surgery.
Edited by Jerome J. DeCosse and Ian P. Todd. London,- Churchill Livingstone, 1988. 257 pages.
This volume is the most recent in the ongoing Clinical Surgery International series by Churchill Livingstone Publishers, which aims to examine areas of contemporary interest to residents and practicing surgeons. Contributors include some of the most prominent surgeons in the field. The editors state the volume to be a “comprehensive scholarly look at the scientific and clinical picture” of anorectal surgery. In this, they have largely succeeded, with very extensive and upto-date references at the end of each chapter. References to the literature are, however, occasionally overwhelming, and because of this, some chapters are tedious. The review of manometry and anorectal physiology is somewhat weak and does not provide a basic understanding of the evaluation of pelvic floor abnormalities and anorectal function. With several exceptions, most chapters are relatively void of
THE AMERICAN JOURNAL OF SURGERY
illustrations. Although not a text of operative technique, discussion of surgical treatment and selection of the best operation for a particular problem is often far too brief. The topic of constipation is well presented. The chapter on rectal prolapse includes a detailed description of the author’s technique but only briefly refers to other procedures. The discussion of anal fissure and 6tula by Mr. Killingback is excellent and easy to read; however, the illustrations may be unclear to readers not familiar with anal anatomy and they are not well labeled. Although the section on sexually transmitted disease includes a brief discussion of AIDS, it does not provide much help ful clinical information, The chapter on perianal Crohn’s disease by Mr. Alexander-Williams was quite enjoyable, as were those on epidermoid cancer and presacral tumors. The description of operative approaches to the distal rectum was very clear, well organized, and adequately illustrated. Subjects that are either not included or not covered in depth include anal anatomy, techniques of anesthesia for anorectal surgery, and the treatment of radiation enteritis, rectovaginal fistulas, anal strictures, pilonidal disease, and hidradenitis suppurativa. On the whole, the book is well written by superbly qualified surgeons, with a scholarly presentation of the recent literature on many sub jects in anorectal surgery. This volume is generally not a how-to book and presupposes a fair amount of background knowledge by the reader. For this reason, it would be a valuable reference more suited to senior residents and practicing surgeons with a special interest in the field, although the $90.00 price may be rather prohibitive to the former.
VOLUME 158 NOVEMBER 1989
Susan Galandiuk, MD Louisville, KY
Manual of Surgical Therapeutics.
By Robert E. Condon and Lloyd M. Nyhus. Boston Little, Brown, 1988. 419 pages. $22.50.
One should judge all educational endeavors by precisely stated goals and objectives. Clearly, this text fulfills these objectives, and indeed, exceeds some of them. As an effort to “bring together in a single volume material needed for quick review by surgical house officers and students faced with clinical problems,” the book deserves high praise. Most of the commonly encountered patient care problems are included. Nonop erative issues are emphasized, as is the fact that this is not an encyclopedia of surgery but a day-to-day cookbook filled with recipes for analytical, stepby-step assessment and intervention for surgical patients. The style renders the information easily accessible; it is user friendly. Outlines highlighted by boldface type for emphasis are helpful and ap propriate. Admittedly, the format of opinionated discussion without reference or other alternatives is somewhat disappointing but well within the stated goals of a rapid reference, demonstrating at least one successful way to manage each problem. Few of the treatment regimens outlined stray from the traditional, time-tested methods utilized by most practitioners of good surgical care. The demonstration of accurate clinical observation utilizing a careful history and physical examination found in virtually every chapter is most commendable in this era of the admitting office-to-scanner approach to the patient and emphasizes that sound surgical practice demands close verbal and tactile contact with the patient rather than a hands-off attitude. Although many chapters are excellent, I found those dealing with the approach to acutely injured patients (especially general principles and
40
head and cervical injuries); problems encountered in the emergency room (ocular emergencies); fluid and electrolyte therapy; and the rewritten chapters on surgical nutrition, cancer chemotherapy, and psychiatric disorders to be particularly noteworthy for the concise organization and presentation of issues not adequately dealt with in some surgical curriculums. I enthusiastically recommend this manual as a how-to coat-pocket primer, but use of a companion surgical text is mandatory so that the information contained therein, such as in-depth viewpoint analysis, encyclopedic inclusion of detailed subject matter, operative alternatives, and an expanded reference list, can supplement the outlines presented. Norman J. Snow,
MD
Cleveland, OH Anorectal Surgery.
Edited by Jerome J. DeCosse and Ian P. Todd. London,- Churchill Livingstone, 1988. 257 pages.
This volume is the most recent in the ongoing Clinical Surgery International series by Churchill Livingstone Publishers, which aims to examine areas of contemporary interest to residents and practicing surgeons. Contributors include some of the most prominent surgeons in the field. The editors state the volume to be a “comprehensive scholarly look at the scientific and clinical picture” of anorectal surgery. In this, they have largely succeeded, with very extensive and upto-date references at the end of each chapter. References to the literature are, however, occasionally overwhelming, and because of this, some chapters are tedious. The review of manometry and anorectal physiology is somewhat weak and does not provide a basic understanding of the evaluation of pelvic floor abnormalities and anorectal function. With several exceptions, most chapters are relatively void of
THE AMERICAN JOURNAL OF SURGERY
illustrations. Although not a text of operative technique, discussion of surgical treatment and selection of the best operation for a particular problem is often far too brief. The topic of constipation is well presented. The chapter on rectal prolapse includes a detailed description of the author’s technique but only briefly refers to other procedures. The discussion of anal fissure and 6tula by Mr. Killingback is excellent and easy to read; however, the illustrations may be unclear to readers not familiar with anal anatomy and they are not well labeled. Although the section on sexually transmitted disease includes a brief discussion of AIDS, it does not provide much help ful clinical information, The chapter on perianal Crohn’s disease by Mr. Alexander-Williams was quite enjoyable, as were those on epidermoid cancer and presacral tumors. The description of operative approaches to the distal rectum was very clear, well organized, and adequately illustrated. Subjects that are either not included or not covered in depth include anal anatomy, techniques of anesthesia for anorectal surgery, and the treatment of radiation enteritis, rectovaginal fistulas, anal strictures, pilonidal disease, and hidradenitis suppurativa. On the whole, the book is well written by superbly qualified surgeons, with a scholarly presentation of the recent literature on many sub jects in anorectal surgery. This volume is generally not a how-to book and presupposes a fair amount of background knowledge by the reader. For this reason, it would be a valuable reference more suited to senior residents and practicing surgeons with a special interest in the field, although the $90.00 price may be rather prohibitive to the former.
VOLUME 158 NOVEMBER 1989
Susan Galandiuk, MD Louisville, KY