Pain refractory to medical therapy Recurrent pancreatitis secondary to pancreatic duct stenosis Bile duct stenosis Gastric outlet obstruction/duodenal obstruction/colonic obstruction Pancreatic fistula Pseudocyst Pancreatic carcinoma Preoperative Preparation Preoperative Workup Just…
Figure 35.1 Beginning dissection of the posterior sheath. The posterior sheath is incised 1 cm lateral to the linea alba and grasped with an Aliss clamp to aid in retraction…
Figure 33.1 An infraumbilical, semicircular incision is made Figure 33.2 A clamp around the isolated umbilical stalk. Division of the stalk allows access to the hernia defect below Figure 33.3…
Figure 32.1 View through dissecting balloon. Note pubis and Cooper’s ligament bilaterally Figure 32.2 View through dissecting balloon showing left inferior epigastric vessels and direct hernia Direct inguinal hernias are…
Figure 26.1 Normal anorectal anatomy Figure 26.2 Location of anorectal abscesses Perioperative Care Preoperative Preparation Preoperative imaging is not routinely recommended. CT, MRI, or endoanal ultrasound studies may be used…
Figure 42.1 Ultrasound of abscess demonstrating fluid present (Courtesy of Sarah Smith) Contraindications to bedside or in-office drainage of an abscess would include the following and require specialization or additional…
Figure 25.1 Excision of the circular skin disk while applying pressure beneath the abdominal wall protects the underlying bowel Figure 25.2 Exposure of the anterior rectus sheath using blunt dissection…
Figure 41.1 (a, b) Ultrasound mapping of veins, performed in the office (Courtesy of David Melnick, MD) In most cases, a vein 2.5–3 mm or larger would be appropriate to…
Figure 19.1 Metal clamps are placed across the distal mesentery in opposite directions with their tips pointing inwards. A Metzenbaum scissors is then used to divide the mesentery sharply. Silk…
Figure 14.1 Barium Swallow Study in a patient with achalasia showing a mildly dilated esophagus and the classic “bird’s beak” deformity at the gastro-esophageal junction 3. Esophageal manometry: Esophageal…
