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Chassin’s Operative Strategy in General Surgery: An Expositive Atlas

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This fifth edition of Chassin’s Operative Strategy in General Surgery is a major revision that strives to remain faithful to the purpose and tone of Dr. Chassin’s original text. This unique textbook provides an emphasis on surgical strategy that is unmatched by other textbooks of surgical technique. The text explains the conceptual basis of each operation, outlines strategies to avoid common pitfalls, and carefully describes and beautifully illustrates the technical steps of each operation. The fifth edition preserves the unique qualities of its previous edition while providing a comprehensive update. This updated volume also features a vast amount of richly detailed artwork and operative photographs, which help depict operative techniques step-by-step. No other text so successfully combines operative technique with the concept of strategy – that is, key governing principles that dictate safe surgery and avoidance of complications. There are books of technique, there are books about complications, and there are books about the rationale involved in the treatment of various kinds of surgical pathology. Chassin’s combines all three.
Chassin’s Operative Strategy in General Surgery: An Expositive Atlas Fifth Edition comprehensively covers all non-vascular operations commonly performed by general surgeons. This edition expands this comprehensive general surgery reference while remaining true to the special character of the work. The revision expands upon procedures not covered in the previous edition and incorporates new techniques into many other chapters.

Table of contents :
Foreword to the Third Edition
Preface to the Fifth Edition
Contents
Contributors
Part I: General Principles
1: Concepts and Strategies of Surgery
Developing a Concept
Establishing Strategy
Making the Operation Easy
Further Reading
2: Mechanical Basics of Operative Technique
Introduction
Before You Scrub
Preoperative Verification Process
Importance of Surgeon’s Foot and Body Position
Use of Instruments
Scalpel
Metzenbaum Scissors
Electrocautery as a Cutting Device
Forceps
Needle Holder
Hemostat
Further Reading
3: Incision, Exposure, Closure
Achieving Exposure
Incisions for Abdominal Surgery
Avoiding Wound Dehiscence and Hernia
Operative Technique for a Midline Incision
Making the Incision
Open Surgery
Port Insertion During Laparoscopic Surgery
Closure of Midline Incision
Modified Smead-Jones Technique
Standard Running Closure
Interrupted Closure
Skin Closure
Further Reading
4: Dissecting and Suturing
Art of Dissecting Planes
Sewing Technique
Use of a Needle Holder
Selection of Needle
Size of Bite
Distance Between Sutures
Size of Suture Material
Continuous Versus Interrupted Sutures
How Tight the Knot?
Catching Both Walls of Intestine with One Pass of the Needle Holder
Types of Stitches
Simple Everting Skin Stitch
Vertical Mattress (Stewart) Stitch
Continuous Subcuticular Stitch
Skin Staples
Simple Interrupted Fascial Stitch
Continuous Simple Over-and-Over Stitch
Smead-Jones Stitch
Horizontal Mattress Stitch
Hemostatic Figure-of-Eight Stitch
Single-Layer Bowel Anastomosis
Seromuscular Lembert Stitch
Cushing Stitch
Halsted Stitch
Continuous Locked Stitch
Connell Stitch
Technique of Successive Bisection
Intestinal Anastomoses
One Layer or Two?
End-to-End or End-to-Side Technique?
Sutured or Stapled Anastomosis?
Suture Material
Absorbable Sutures
Plain Catgut
Chromic Catgut
Polyglycolic Synthetics
Nonabsorbable Sutures
Natural Nonabsorbable Sutures
Synthetic Nonabsorbable Braided Sutures
Synthetic Nonabsorbable Monofilaments
Monofilament Stainless Steel Wire
Knot-Tying Technique
Further Reading
5: Surgical Stapling: Principles and Precautions
Characteristics of Staples
Surgical Stapling Technology
Linear Stapling Device
Linear Cutting Stapling Device
Circular Stapling Device
Tissue Properties of the Stapled Anastomosis
Causes of Failure Following Stapled Anastomosis
Ischemia
Tension
Tissue Quality
Instrument Failure
Technical Error
Microbiology
Patient Factors
Stapled vs. Hand-Sewn Anastomosis

Reducing Anastomotic Complications in Practice
Hemostasis
Intraoperative Leak Testing
Perfusion Testing
Summary
Further Reading
6: Control of Bleeding
General Principles of Resuscitation
Control of Hemorrhage
Thoracic Hemorrhage
Upper Mediastinum and Pulmonary Hilum
Lung Parenchymal Injuries
Abdominal Hemorrhage
Abdominal Aorta, IVC, and Their Branches
Zones of the Retroperitoneum
Medial Visceral Rotations
Solid Abdominal Viscera
Spleen and Kidney
Liver
Pelvic Hemorrhage
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)
Extremity and Junctional Hemorrhage
Techniques to Achieve Hemostasis
Hemostat and Ligature
Tying in Continuity
Suture Ligation
Clips
Staplers
Electrocautery
Ultrasonic Shears
Further Reading
7: Management of the Contaminated Operation
The Challenge
Preoperative Considerations
Timing of Surgery
Resuscitation Before Surgery
Antibiotic Management
Preoperative Imaging
Intraoperative Considerations
Supportive Measures and Fluid Management
Importance of Surgical Skills and Technique
Source Control
Containing the Contamination
Wound Irrigation
Other Considerations
Postoperative Considerations
Wound Closure
Wound Care
Further Reading
8: Damage Control Laparotomy
Indications

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