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…
First degree Second degree Third degree Fourth degree Findings Bulge into the lumen of the anal canal ± painless bleeding Protrude at the time of a bowel movement and reduce spontaneously…
Figure 28.1 Anal fissure in posterior midline Preoperative Care Approximately half of all fissures resolve with conservative management, which consists of increased fiber and water intake and warm sitz baths….
Figure 6.1 This figure illustrates the proper decubitus positioning for a laparoscopic transabdominal adrenalectomy. It is very important to ensure that the inferior costal margin is positioned at the “break”…
