Essentials of Visceral Surgery: For Residents and Fellows

Preface
Contents
Contributors
Abbreviations
1: Esophagus, Stomach and Duodenum
	1.1 Anatomy and Physiology
		1.1.1 Esophagus
		1.1.2 Stomach
		1.1.3 Duodenum
	1.2 Leading Symptoms and Diagnosis
		1.2.1 Leading Symptoms
			Esophagus
			Stomach
			Upper GI Bleeding
		1.2.2 Diagnosis
			Endoscopy
			Radiology/Nuclear Medicine
		1.2.3 Therapeutic Principles
	1.3 Benign Diseases of the Esophagus
		1.3.1 Diverticular Diseases of the Esophagus
			Etiology
				Zenker’s Diverticulum and Epiphrenic Diverticulum (Pulsion Diverticulum)
				Midesophageal Diverticulum (Traction Diverticulum)
			Forms
				Zenker’s Diverticulum (Hypopharynx)
				Killian-Jamison Diverticulum
				Epiphrenic Diverticulum
			Symptoms
			Therapy
				Zenker-Diverikel
				Epiphrenic Diverticulum
		1.3.2 Achalasia
			Etiology
				Pathogenesis
			Forms
				Primary Achalasia
				Secondary Achalasia
			Symptoms
			Complications
			Staging
			Diagnosis
				Esophagogastroduodenoscopy (EGD)
				Manometry
				X-Ray (Esophagogram)/Computed Tomography
			Therapy
				Medical Therapy
					Principle
					Preparations
				Endoscopic Therapy
					Pneumatic Dilatation
					Endoscopic Injection of Botulinum Toxin
					Peroral Endoscopic Myotomy (POEM)
				Surgical Therapy
					Surgical Therapy Options
					Results After Myotomy
		1.3.3 Esophageal Perforation
			Etiology
			Symptoms
			Diagnosis
				Endoscopy (EGD)
				Computed Tomography of the chest
			Therapy
				Surgical Therapy
				Endoscopic Therapy
				Conservative Therapy
				Prognostic Factors
		1.3.4 Hiatal Hernias
			Etiology
			Types of Hiatal Hernias (. Fig. 1.2)
				Cardiofundal Malposition
				Axial Sliding Hernia
				Paraesophageal Hernia
				Mixed Forms
			Symptoms
				Axial Hernias
				Paraesophageal Hernias
			Therapy
				Symptomatic Therapy
				Surgical Therapy
		1.3.5 Gastroesophageal Reflux Disease (GERD)
			Definition
			Etiology
				Demographics
				Pathophysiology and Risk Factors
			Symptoms
			Diagnosis
				Esophagogastroduodenoscopy (EGD)
				24 h pH-Metry/Impedance Measurement
				Manometry
			Therapy
				Conservative Therapy
				Surgical Therapy
		1.3.6 Guidelines
	1.4 Malignant Diseases of the Esophagus
		1.4.1 Overview
			Esophageal Cancer
			Adenocarcinoma of the Gastroesophageal Junction (AEG)
		1.4.2 Esophageal Carcinoma (Including AEG)
			Definition
			Types
				Adenocarcinoma
					Adenocarcinoma of the Gastroesophageal Junction (AEG)
					Squamous Cell Carcinoma
					Adenosquamous Carcinomas, Undifferentiated Carcinomas
			Epidemiology and Etiology
				Occurrence
				Risk Factors
					Squamous Cell Carcinoma
					Adenocarcinoma
			Tumor Spread
				Continuous Spread
				Lymphogenous Spread
				Hematogenous Spread
			Classification
				UICC/AJCC TNM 8 Classification (2017)
				UICC Stages According to the TNM Classification 8th Version (2017)
			Symptoms
			Diagnosis
				Esophagogastroduodenoscopy (EGD)
				Endosonography
				Thoracic CT, Abdominal CT
				Bronchoscopy
				Panendoscopy
				PET-CT, MRI Abdomen
			Therapy
				Indication
				Multimodal Therapy
					Principles
					Neoadjuvant Radiochemotherapy
					Perioperative Chemotherapy
				Additive/Palliative Therapy
					Principles
					Strategy
				Operative Therapy Principles
					Local Endoscopic Interventional Procedures
					Esophagectomy
			Prognostic Factors
			Follow-Up
				Purpose
				Implementation
	1.5 Benign Diseases of the Stomach
		1.5.1 Gastroduodenal Ulcer Disease
			Etiology
				Appearance
				Risk Factors
			Symptoms
			Diagnosis
				Endoscopy (EGD)
				Radiology
				Further Diagnosis
			Complications
			Therapy
				Conservative Therapy
				Interventional Therapy
				Surgical Therapy
		1.5.2 Guidelines
	1.6 Malignant Diseases of the Stomach
		1.6.1 Gastric Adenocarcinoma
			Definition
			Forms
			Epidemiology and Etiology
				Occurrence
				Risk Factors
			Tumor Spread
			Classification
				TNM 7 Classification (2010)
				UICC Stages According to the TNM Classification
			Symptoms
			Diagnosis
				Esophagogastroduodenoscopy/Endosonography
				Thoracic CT, Abdominal CT
				Diagnostic Laparoscopy
				PET-CT, MRI Abdomen, Bone Scintigraphy
			Therapy
				Indication
				Multimodal Therapy
					Principles
				Perioperative Chemotherapy
				Adjuvant Radiochemotherapy
				Additive/Palliative Therapy
					Principles
					Strategy
				Operative Therapy Principles
			Prognosis
				Prognostic Factors
			Follow-Up
				Goals
				Implementation
		1.6.2 Gastrointestinal Stromal Tumours (GIST)
		1.6.3 Guidelines
	1.7 Diseases of the Duodenum
		1.7.1 Diverticular Disease of the Duodenum
			Incidence
			Types
			Symptoms
			Therapy
			Complications
		1.7.2 Duodenal Cancer
			Etiology and Tumor Manifestation
				Appearance
				Symptoms
			Diagnosis and Therapy
				Diagnosis
				Endoscopic Therapy
				Surgical Therapy
				Multimodal Therapy
				Palliative Therapy
				Prognosis
		1.7.3 Guidelines
	References
2: Small Intestine and Appendix
	2.1 Anatomy of the Small Intestine
		2.1.1 Measured Values
		2.1.2 Limits
		2.1.3 Wall Structure of the Small Intestine
		2.1.4 Circulation
			Arterial Blood Flow
			Venous Drainage
			Lymphatic Drainage
			Mesenteric Base
		2.1.5 Innervation
			Parasympathetic Component
			Sympathetic Component
		2.1.6 Small Intestine Functions
			Digestion and Nutrient Absorption
			Endocrinological Function
			Immunological Function
	2.2 Diseases of the Small Intestine
		2.2.1 Clinical Presentation
			General
			Inflammatory Bowel Disease
				Development
				Symptoms
				Complications
			Neoplastic Intestinal Diseases
				Symptoms
				GIST (Gastrointestinal Stromal Tumors)/Carcinoid Tumors
		2.2.2 Imaging
			Radiological Imaging
				Conventional Abdominal Radiograph
				CT Examination with Contrast Medium
				Colon Contrast Enema
				CT Enterography/MRI Enterography
				Abdominal Sonography
			Endoscopic Imaging
				Colonoscopy/Esophagogastroduodenoscopy (EGD)
				Double Balloon Endoscopy
				Capsule Endoscopy
		2.2.3 Crohn’s Disease
			Pathophysiology
			Diagnosis
			Differential Diagnosis (= Other Inflammatory Bowel Diseases)
		2.2.4 Small Intestinal Neoplasms
			Epidemiology
			Diagnosis
			Histological Classification
				Adenomas
				Hamartomas
				Hemangiomas
				Gastrointestinal Stromal Tumors (GIST)
				Adenocarcinomas
				Lymphomas
				Small Intestine NET (Carcinoid Tumors)
				Metastatic Lesions
		2.2.5 Other Diseases of the Small Intestine
			Diverticula and Meckel’s Diverticula
				Duodenum Diverticulum
				Jejunum and Ileum Diverticula
				Meckel’s Diverticulum
			Ulcerations and Fistulas
				Ulcerations
				Enterocutaneous Fistulas
			Small Bowel Obstruction/Ileus
				Etiology
				Classification of Obstruction/Ileus
				Clinical Presentation
				Complications
				Diagnosis
				Treatment
		2.2.6 Treatment Strategies
			Drug Therapy
				Crohn’s Disease
				Malignant Lesions
				GIST/Small Bowel NET (Carcinoid)
			Surgical Treatment
				General Principles
					Segmental Small Bowel Resection + Anastomosis
					Laparoscopic Resection
					Bypass Procedures
				Treatment of CIBD (E.g. Crohn’s Disease)
					Indications for Surgical Treatment
					Strategy
				Treatment of Benign Lesions
				Treatment of Malignant Lesions
	2.3 Vermiform Appendix
		2.3.1 Anatomy of the Vermiform Appendix
			Normal Anatomy
			Localization Variations (According to Wakeley and Testut & Latarjet)
			Circulation and Lymphatic Drainage
			Histological Features
	2.4 Diseases of the Appendix
		2.4.1 Appendicitis Vermiformis
			Physiopathology
			Symptoms
				Initial Symptoms
				Progressive Symptoms (Due to Inflammation of the Surrounding Structures)
			Clinical Presentation: Biochemistry
				Clinical Presentation
				Biochemistry
			Imaging
				Ultrasound (US)
				Computer Tomography (CT)
				Diagnostic Laparoscopy
			Differential Diagnosis
				Operative Differential Diagnosis
				Non-Operative Differential Diagnosis
				Gynaecological Differential Diagnosis
			Surgical Treatment Modalities
				Treatment Strategy
					Early Surgical Appendectomy
					Antibiotic Treatment
				Laparoscopic Appendectomy
					Minimally Invasive (Laparoscopic) Appendectomy = Currently the Gold Standard
					Controversy with Normal Appearing Appendix at Laparoscopy
					Resection Technique
					Evidence-Based Approach
				Open Appendectomy
					McBurney Incision
					Median Laparotomy
			Drug Therapy
				Uncomplicated Appendicitis
				Severe Complications (Depicted by Imaging)
				Treatment Strategy
		2.4.2 Malignant Diseases
			Mucocele of the Appendix
				Pathophysiology
				Epidemiology
				Clinical Presentation
				Diagnosis
					Tumor Marker (Preoperative)
					Sonography
					CT Abdomen
					Colonoscopy
				Treatment
					Retention Cysts
					Appendix Mucoceles
					Ruptured Mucocele (= Pseudomyxoma Peritonei/Mucinous Carcinomatosis)
				Forecast
					Prognostic Factors
					Course of the Disease
					Survival
			Carcinoid Tumors: Neuroendocrine Tumors of the Appendix
				Epidemiology
				Diagnosis
					Non-functional NET
					Functional NET
					Environment Diagnosis
			Treatment (According to Recommendations of the American National Cancer Institute and ENETS)
				Aftercare
			Noncarcinoid Tumors of the Appendix
				Classification According to World Health Organisation (WHO) (. Table 2.2)
				Clinical Presentation
				Treatment
	References
3: Colon
	3.1 Anatomy and Physiology
		3.1.1 Definition and Limits
		3.1.2 Tasks
		3.1.3 Location and Classification
		3.1.4 Measured Values
		3.1.5 Characteristic Features of the Colon
		3.1.6 Blood Supply and Drainage
			Arteries
			Veins
			Lymphatic Drainage (. Fig. 3.1)
	3.2 Benign Diseases of the Colon
		3.2.1 Diverticulosis and Diverticulitis
			Definitions
				Colon Diverticulum
				Diverticular Disease
				Diverticulitis (= Pathological)
			Epidemiology
			Etiology/Pathogenesis
			Risk Factors
			Complications
			Symptoms
			Classifications
			Diagnosis
				Medical History (Medication, Tobacco Consumption)
					Clinical Examination
					Laboratory Tests
				Diagnostic Imaging
			Therapy
				Prophylaxis of Diverticulitis
					Primary Prophylaxis
					Secondary Prophylaxis
				Conservative Therapy
					Asymptomatic Diverticulosis
					Complicated Diverticulitis
				Surgical Therapy
					Surgery Indications
					Surgical Strategy
		3.2.2 Colonic Polyps
			Definition
			Epidemiology
			Classification (. Table 3.4)
			Symptoms
			Diagnosis
			Therapy
				Endoscopic Therapy
				Guideline: Polypectomy
					Implementation
					Postpolypectomy Strategy
					Follow-up
					Surgical Therapy
					Follow-Up Care After Colonoscopic Ablation
		3.2.3 Ulcerative Colitis
			Definition
			Epidemiology
			Etiology
				Etiopathogenesis
				Course
			Clinical Presentation
				Intestinal Manifestations
				Extraintestinal Manifestations (15–20%)
				Course
				Complications
			Diagnosis
				Anamnesis
				Complete Physical Examination
				Lab
				Imaging
				Endoscopy
			Differential Diagnosis
			Therapy
				Conservative-Medical Therapy
				Uncomplicated Ulcerative Colitis
					Proctitis
					Left-Sided Colitis
					Complicated/Severe Ulcerative Colitis
					Time-Adapted Approach
				Surgical Therapy
					Surgery Indications
					Standard Surgery: Restorative Proctocolectomy
					Follow-Up
					Alternative Procedure
				Preventive Care (Cancer Prophylaxis)
		3.2.4 Chronic Constipation
			Definition
			Epidemiology
			Etiology
			Diagnosis
				Anamnesis
				Physical Examination
				Further Diagnosis
			Therapy
				Step-By-Step Therapy (. Fig. 3.2)
				Surgery
		3.2.5 Guidelines
	3.3 Colon Cancer and Hereditary CRC Syndromes
		3.3.1 Colon Carcinoma
			Definition
			Epidemiology
			Etiology and Pathogenesis
				Risk Categories
				Protective Factors
				Pathogenesis
			Classification
				TNM Classification (2017)
				UICC Staging of Colorectal Cancer
				Histological Grading
			Symptoms
				Complications
			Diagnosis
				Standard Investigations
				Guideline-Based Preoperative Diagnostic of Tumor Staging
				Colorectal Cancer Screening (in the Asymptomatic Population)
				Guideline: Polypectomy
			Therapy
				Treatment Strategy
				Surgical Therapy
					Principles of Surgical Therapy
					Postoperative Complications
					Principles for Specific Situations
					Principles in Metastatic Colon Cancer
				Adjuvant Chemotherapy
					Indications
					Contraindications
					Standard Chemotherapy = FOLFOX (5-FU/Folinic Acid/Oxaliplatin)
				Palliative Chemotherapy
			Oncologic Follow-up
			Prognosis
		3.3.2 HNPCC (Hereditary Non-polyposis Colorectal Cancer): Lynch Syndrome
			Definition
			Epidemiology
			Etiology
			Diagnosis
				Anamnesis
				Test for Mismatch Repair Defect
			Prevention
			Surgical Therapy
		3.3.3 Other Hereditary CRC Syndromes
			Familial Adenomatous Polyposis (FAP)
				Definition
				Etiology
				Tumour Spectrum
				Prevention
				Therapy
				Follow-Up
			Hamartomatous Polyposis Syndromes
				Definition
				Prophylaxis
				Diagnosis and Therapy
		3.3.4 Guidelines
	Reference
		Suggested Reading
4: Rectum
	4.1 Anatomy and Physiology
		4.1.1 Definition, Location and Structure
			Definition
			Location
			Limits
		4.1.2 Anatomy and Embryology
			Topographic Anatomy
			Blood Supply and Drainage
			Innervation
		4.1.3 Physiology
			Special Functions of the Rectum
	4.2 Benign Diseases
		4.2.1 Benign Neoplasms/Malformations
			Polyps/Adenomas (Chap. 3)
			Schwannomas, Leiomyomas, Angiomyomas
			Hirschsprung’s Disease
			Infiltrating Endometriosis
		4.2.2 Rectal Prolapse
			Definition, Classification, Differential Diagnosis, Epidemiology
				Definition
				Classification
				Differential Diagnoses
				Epidemiology
			Etiology and Pathogenesis
			Symptoms and Diagnosis
				Symptoms
				Diagnosis
				Therapy
				Non-surgical Therapy
				Surgical Therapy
				Perineal and Transanal Procedures
				Abdominal Procedures
	4.3 Malignant Diseases
		4.3.1 Histological Tumour Entities
		4.3.2 Rectal Cancer
			Definition
			Forms/Classification
			Epidemiology and Etiology
			Tumor Spread
			Classification
				Classification According to Mason (Clinical Staging)
				TNM Classification (2017)
			Derivation of UICC Stages from TNM Classification
				Symptoms
			Diagnosis
				Rectal Digital Examination
				Rigid Rectoscopy
				Colonoscopy
				Endorectal Ultrasound
				MRI Pelvis
				Thoracic CT, Abdominal CT
				PET-CT
			Therapy
				Indication
				Neoadjuvant Therapy
				Long-Term Radiochemotherapy (Preferred in Germany and USA)
				Short-Term Therapy (Preferred in the Netherlands, Poland and Scandinavia)
			Adjuvant Therapy
				Modalities
				Results
			Additive/Palliative Therapy
				Principles
				Strategy
			Operative Therapy Principles
				Local Limited Procedures
				Rectal Resection
				Abdominoperineal Rectal Extirpation
			Prognosis
				Prognostic Factors
				5-Year Survival Rates
			Follow-up
				Targets
				Time Intervals
				Special Features
		4.3.3 Guidelines
	Further Reading
		Suggested Reading
5: Anorectum
	5.1 Anatomy and Physiology
		5.1.1 Anatomy
		5.1.2 Physiology
	5.2 Benign Diseases
		5.2.1 Hemorrhoidal Disease
			Definition
			Classification
			Epidemiology
			Etiology
			Symptoms
			Diagnosis
			Differential Diagnosis
			Therapy
				Basic Therapy
				Conservative and Interventional/Semioperative Therapy
				Sclerotherapy (Blond or Blanchard or Bensaude procedures)
				Infrared Coagulation
				Rubber Ring Ligation (According to Barron)
				Doppler-Guided Hemorrhoidal Artery Ligation (HAL)
				Recto-Anal Repair
				Surgical Therapy
				Milligan-Morgan Hemorrhoidectomy
				Ferguson Hemorrhoidectomy
				Subanodermal Resection (Parks Procedure)
				Stapler Hemorrhoidopexy (Longo Procedure)
				Therapy Strategy for Grade 4 Hemorrhoids
				Complications
		5.2.2 Anal Vein Thrombosis
			Definition
			Epidemiology
			Etiology
			Triggering Factors
			Symptoms
			Diagnosis
			Differential Diagnosis
			Therapy
				Conservative Therapy
				Surgical Therapy
				Complications
		5.2.3 Anal Fissure
			Definition
			Acute Anal Fissure
			Chronic Anal Fissure
			Epidemiology
			Etiology
				Main Cause = Heavy Pressing
				Other Causes
				Symptoms
				Diagnosis
				Differential Diagnosis
			Therapy
				Conservative Therapy
				Surgical Therapy
				Complications
		5.2.4 Anorectal Abscess
			Definition
			Epidemiology
			Etiology
				Cryptoglandular Origin
				Rarer causes
				Symptoms
				Diagnosis
				Differential Diagnosis
			Therapy
				Conservative Therapy
				Surgical Therapy
				Complications
		5.2.5 Anorectal Fistulas
			Definition and Classification
				Definition
				Classification of Anorectal Fistulas (According to Course)
				Epidemiology
				Etiology
				Cryptoglandular Origin
				Rarer Forms of Fistula
				Symptoms
				Diagnosis
				Differential Diagnosis
			Therapy
				Conservative Therapy
				Surgical Therapy
				Complications
		5.2.6 Pilonidal Sinus
			Definition
			Epidemiology
			Etiology
				Risk Factors
				Pathophysiology
			Symptoms
				Asymptomatic Form
				Acute Abscessed Form
				Chronic Form
				Diagnosis
				Differential Diagnosis
			Therapy
				Conservative Therapy
				Surgical Therapy
				Complications
		5.2.7 Fecal Incontinence
			Definition
			Clinical Classification
			Score Classification
			Epidemiology
			Etiology
				Pathophysiology
				Risk Factors
				Symptoms
				Diagnosis
			Therapy
				Conservative Therapy
				Surgical Therapy
				Complications
		5.2.8 Anorectal Voiding Dysfunction (Outlet Constipation)
			Definition
				Definition
				Classification
				Epidemiology (Of All Forms of Constipation)
				Etiology
				Symptoms
				Diagnosis
			Therapy
				Surgical Therapy
				Complications
	5.3 Malignant Disease: Anal Carcinoma
		5.3.1 Definition
			Anal Carcinoma
			Classification: TNM Classification
			Anal Margin Carcinoma
		5.3.2 Epidemiology
		5.3.3 Aetiology
		5.3.4 Symptomatology
		5.3.5 Diagnosis
		5.3.6 Differential Diagnosis
		5.3.7 Therapy
			Conservative Therapy
			Surgical Therapy
			Complications
	5.4 Guidelines
	Suggested Reading
6: Endocrine Organs
	6.1 Anatomy and Physiology of the Thyroid Gland
		6.1.1 Embryology and Anatomy
			Macroscopy
			Microscopy
			Localization
			Blood Supply
			Development
		6.1.2 Physiology
			Thyroid Hormones (Thyroxine, T4, and Triiodothyronine, T3)
			Control Loop (Negative Feedback)
			Calcitonin
	6.2 Diseases of the Thyroid Gland
		6.2.1 Epidemiology
			Goiter and Multinodular Goiter
			Hyperthyroidism (Thyroid Autonomy)
			Autoimmune Diseases
			Thyroid Cancer
		6.2.2 General Methods of Investigation
			Clinical Examination
			Laboratory Thyroid Function Tests
				Basic Diagnosis (For Each Patient)
				Specific Diagnosis (For Further Clarification)
			Imaging Studies
				Ultrasound
				Computer Tomography (CT)
				Magnetic Resonance Imaging (MRI)
				Nuclear Medicine Diagnosis
			Fine Needle Aspiration Cytology (FNA)
				Principle
				Interpretation of the Cytological Findings
				Diagnostic Strategy
		6.2.3 Basics of Surgical Therapy, Complications and Postoperative Care
			Preoperative Measures
			Basics of Surgical Therapy
			Minimally Invasive Surgical Techniques
			Cervical Lymphadenectomy (LAD) for Thyroid Cancer
				Surgical Anatomy and Classification Systems
				Pathophysiology
				Sentinel Node Biopsy Technique
				Selective LAD (“Berry Picking”)
				Compartment-Oriented LAD
			Postoperative Complications
				Bleeding Needing Revision
				Recurrent Laryngeal Nerve Lesion
				Parathyroid Hypofunction (= Hypoparathyroidism; . Fig. 6.6)
				Thyrotoxic Crisis
				Tracheomalacia
				Postoperative Care
		6.2.4 Benign Thyroid Diseases
			Hypothyroidism
				Definition
				Symptoms
				Diagnosis
				Therapy
			Hyperthyroidism
				Definition
				Etiology
			Symptomatology (. Table 6.2)
				Toxic Nodules (= Autonomies)
					Definition
					Epidemiology
					Symptoms
					Diagnosis
					Therapy
			Immunothyreopathy: Graves’ Disease
				Definition
				Epidemiology
				Pathophysiology
				Symptoms
				Diagnosis
				Therapy
			Thyroiditis
			Acute Thyroiditis
				Pathogenesis
				Symptoms
				Diagnosis
				Therapy
			Subacute Thyroiditis (De Quervain)
				Pathogenesis
				Symptoms
				Diagnosis
				Therapy
			Autoimmune Thyroiditis
				Symptoms
				Diagnosis
				Therapy
			Special Forms of Thyroiditis
				Traumatic Thyroiditis
				Drug-Induced Thyroiditis
			Goiter and Nodular Goiter
				Definition
					Goiter
					Nodular Goiter
					Pathogenesis
				Diagnosis
					Clinical Examination
					Ultrasound
					Scintigraphy (7 Sect. 6.2.2)
					FNA
					Laboratory (Standard Levels, 7 Sect. 6.2.2, Laboratory Thyroid Function Tests)
				Therapy
					Medical Therapy and Prophylaxis
					Surgical Therapy
		6.2.5 Malignant Thyroid Diseases
			Cancers of the Thyroid Gland
				Definition (. Table 6.13)
				Papillary Thyroid Cancer (PTC)
					Epidemiology
					Molecular Pathology BRAF Mutation: Approx. 50% of PTC
					Prognosis
					Therapy Principles
				Follicular Thyroid Cancer (FTC)
					Epidemiology
					Molecular Pathology
					Prognosis
					Therapy Principles
				Poorly Differentiated Thyroid Cancer
					Epidemiology
					Molecular Pathology
					Prognosis
					Therapy Principles
				Anaplastic Thyroid Cancer
					Epidemiology
					Molecular Pathology
					Prognosis
					Therapy Principles
				Medullary Thyroid Cancer (MTC)
					Epidemiology
					Molecular Pathology
					Prognosis
					Therapy Principles
					Familial Non-Medullary Thyroid Cancer (7 Sect. 6.3)
					Rare Thyroid Cancers
			Primary Malignant Lymphoma of the Thyroid Gland
			Primary Sarcomas of the Thyroid Gland
			Metastases in the Thyroid Gland
		6.2.6 Workup of a Solitary or Dominant Thyroid Nodule
			Epidemiology
			Symptoms
			Diagnosis
				Medical History and Clinical Examination
				Laboratory Diagnosis (7 Sect. 6.2.2 Laboratory Thyroid Functuon Tests)
					Ultrasound
					Scintigraphy
			FNA (7 Sect. 6.2.2 Fine Needle Aspiration Cytology) (. Fig. 6.3)
				Therapy
				Indications for Surgical Therapy
				Indications for Conservative Therapy
				Operative Therapy Principles
		6.2.7 Guidelines
	6.3 Familial Malignant Syndromes of the Thyroid Gland
		6.3.1 Introduction (. Table 6.14)
			Genetics
		6.3.2 Hereditary Medullary Thyroid Carcinoma
			Medullary Thyroid Carcinoma (MTC)
				Clinical Presentation
				Diagnosis
				Treatment
			Multiple Endocrine Neoplasia 2A (MEN 2A)
				Epidemiology
				Genetics
				Clinical Presentation
				Diagnosis
				Treatment (. Table 6.15)
			Multiple Endocrine Neoplasia 2B (MEN 2B)
				Epidemiology
				Genetics
				Clinical Presentation
				Diagnosis
				Therapy (. Table 6.15)
			Familial Medullary Thyroid Carcinoma (FMTC)
				Epidemiology
				Genetics
				Clinical Presentation
				Diagnosis
				Treatment
		6.3.3 Familial Papillary Thyroid Carcinoma (FPTC)
			Clinical Presentation
			Diagnosis
			Screening Recommendations
				Treatment
		6.3.4 Rare Genetic Syndromes Associated with Thyroid Cancer
			Familial Adenomatous Polyposis (FAP)
				Epidemiology
				Genetics
				Clinical Presentation
				Diagnosis
				Treatment
			Gardner Syndrome
				Definition and Epidemiology
				Genetics
				Clinical Presentation
				Diagnosis
				Treatment
			Cowden Syndrome
				Epidemiology
				Genetics
				Clinical Manifestations
				Diagnosis
				Management
				Treatment
			Carney Complex I
				Epidemiology
				Genetics
				Presentation
				Diagnosis
				Treatment
		6.3.5 Guidelines
	6.4 Anatomy and Physiology of the Parathyroid Gland
		6.4.1 Anatomy
			Localization
			Blood Supply
		6.4.2 Physiology (. Fig. 6.4)
			Parathormone (PTH)
			Calcium (Ca++)
			Control Loop (Negative Feedback)
	6.5 Diseases of the Parathyroid Gland
		6.5.1 Benign Parathyroid Diseases
			Primary Hyperparathyroidism (pHPT)
				Definition
				Forms
					Sporadic pHPT
					Hereditary pHPT (7 Sect. 6.3)
				Epidemiology
				Symptoms
				Diagnosis
				Laboratory Diagnosis (. Fig. 6.5)
				Diagnostic Imaging
				Genetic Workup
			Differential Diagnosis (. Fig. 6.6)
				Secondary (sHPT), Tertiary HPT (tHPT) (See Below)
					Familial Hypocalciuric Hypercalcemia (FHH)
				Milk-Alkali Syndrome
				Lithium Therapy
				Malignancy-Associated Hypercalcemia
				Granulomatous Disease
				Endocrinopathies
				Drugs
				Immobilization, Bed Rest
			Therapy
				Indications for Medical Therapy
				Indications for Surgical Therapy
				Operative Therapy Principles
				Complications (Section “Postoperative Complications”)
					Reoperation
			Secondary Hyperparathyroidism (sHPT)
				Definition
				Etiology (. Table 6.24)
				Renal sHPT
			Extrarenal sHPT (= Differential Diagnosis) (. Table 6.23)
				Symptoms
				Diagnosis (. Fig. 6.5)
				Therapy
					Conservative/Medical = Primary Therapy of sHPT
					Surgical Therapy
				Postoperative Follow-Up: Like pHPT (See Above “pHPT”)
			Tertiary Hyperparathyroidism (tHPT)
				Definition
				Etiology
				Therapy
			Hypoparathyroidism
				Epidemiology
				Symptoms
				Diagnosis
				Etiology
				Therapy
		6.5.2 Parathyroid Cancer
			Epidemiology
			Symptoms
			Diagnosis
			Therapy
		6.5.3 Guidelines
	6.6 Anatomy and Physiology of the Adrenal Gland
		6.6.1 Embryology
		6.6.2 Anatomy
			Topographic Anatomy
			Location
			Blood Supply
			Innervation
			Histological Anatomy
				Adrenal Cortex
				Adrenal Medulla
			Positional Relationships
		6.6.3 Physiology
			Steroid Hormones
				Glucocorticoids
					Effects of Glucocorticoids
				Regulation (. Fig. 6.8)
				Mineralocorticoids
					Effects of Mineralocorticoids
				Regulation (. Fig. 6.9)
				Adrenal Sexual Steroids
					Effects of Adrenal Sexual Steroids
					Regulation
				Catecholamines
					Regulation
					Effects of Catecholamines
	6.7 Diseases of the Adrenal gland
		6.7.1 Primary Hyperaldosteronism (Conn Syndrome)
			Definition
			Etiopathogenesis
				Etiologies
			Pathogenesis (7 Sect. 6.6.3)
				Clinical Presentation
			Diagnosis (See Algorithm . Fig. 6.10)
				Laboratory Adrenal Function Tests
				Etiological Diagnosis
				Diagnostic Imaging
				Selective Venous Sampling
				Therapy
				Medical (Drug) Therapy
				Surgical Therapy
				Results
		6.7.2 Cortisol-Producing Adrenal Adenoma
			Definition
				Cushing’s Syndrome
				Cushing’s Disease
				ACTH Syndrome
			Epidemiology and Etiology
				Clinical Signs
			Diagnosis
				Laboratory Adrenal Function Tests
				Overnight Cortisol Suppression Test
				Free Cortisol 24 h Urine Test
				48-h Low-Dose Dexamethasone Test
			Etiological Diagnosis
				ACTH in Plasma
			Therapy
			Surgical Therapy
				Cushing’s Disease
				Ectopic ACTH Secretion Syndrome
				Cushing’s Syndrome in Adrenal Tumor (Adenoma or Carcinoma)
				Medical (Drug) Therapy
		6.7.3 Pheochromocytoma
			Definition
			Epidemiology
			Clinical Signs
				Arterial Hypertension
				Other Symptoms
			Diagnosis
				Laboratory Function Tests
				Etiological Diagnosis = Localisation Diagnosis
				CT Scan
				MRI
				MIBG Scintigraphy
			Therapy
				Preoperative Preparation
					Background
					Principle
			Surgical Therapy
				Strategy
				Principles of Surgical Therapy (7 Sect. 6.7.7)
				Postoperative Monitoring/Follow-Up
				Chemotherapy
				Radiotherapy
				Palliative Therapy
		6.7.4 Adrenocortical Carcinoma
			Definition
			Epidemiology and Prognosis
				Epidemiology
				Prognosis
			Clinical Signs
				Unclear Abdominal Complaints
				Symptoms of Overproduction of Adrenocortical Hormones
			Diagnosis
				Biochemical Screening
				Imaging
				Therapy
			Surgical Therapy
				Strategy
				Postoperative Follow-Up
				Chemotherapy
				Radiotherapy
		6.7.5 Adrenal Incidentaloma
			Definition
			Epidemiology
			Clinical Evidence
				Functional Incidentalomas
				Non-functional Incidentalomas
			Evaluation Algorithm
			Therapy
				Indications for Surgical Therapy
			Strategy
		6.7.6 Adrenal Metastases
			Epidemiology
			Clinical Signs
			Diagnosis
			Therapy
				Surgical Therapy
		6.7.7 Principles of Adrenal Surgery
			General (. Fig. 6.13)
				Decisive Factors for the Choice of a Procedure
			General Rule
			Open Adrenalectomy
				Indications
				Technique
			Laparoscopic Adrenalectomy
				Advantages (Compared to Open Access)
				Good Candidates for Laparoscopic Adrenalectomy
			Retroperitoneoscopic Adrenalectomy
				Indications
				Advantages
				Contraindications
		6.7.8 Guidelines
	References
		Further Reading
7: Bariatric and Metabolic Surgery
	7.1 Epidemiology
		7.1.1 Incidence
		7.1.2 Health Economic Consequences
	7.2 Pathophysiology and Principle of Action of Bariatric Surgery
		7.2.1 Pathophysiology
		7.2.2 Working Principle of Bariatric Surgery
			Restrictive Methods
			Hypoabsorptive Methods
			Combined Methods
	7.3 Clinical Evidence
		7.3.1 Bariatric Surgery: Laparoscopic Versus Open
		7.3.2 Bariatric Surgery: Prospective Controlled Studies
		7.3.3 Metabolic Consequences of Bariatric Surgery
		7.3.4 Mortality: Bariatric Surgery Versus Drug Therapies
	7.4 Specific Current Bariatric Interventions
		7.4.1 Roux-Y Gastric Bypass “Gastric Bypass”
		7.4.2 Banded Gastric Bypass
		7.4.3 Laparoscopic Adjustable Gastric Banding (LAGB)
		7.4.4 Biliopancreatic Diversion (BPD)
		7.4.5 Biliopancreatic Diversion with Duodenal Switch (BPD/ DS)
		7.4.6 Gastric Sleeve Resection
	7.5 Complications
		7.5.1 Mortality
			Causes of Mortality
			Risk Factors
		7.5.2 Gastrointestinal Complications
			Nausea and Vomiting
			Dumping Syndrome
			Deficiency Symptoms
			Other Gastrointestinal Complications
		7.5.3 Other Complications
			Complications in the SOS Study (Sjöström 2013)
	7.6 Historical Interventions and Interventions in the Context of Studies
		7.6.1 Historical Interventions
			Jaw Wiring
			Adjustable Gastric Banding (Vertical Banded Gastroplasty)
			Jejunoileal Bypass (Intestinal Bypass)
			Stomach Partitioning
		7.6.2 Interventions in the Context of Studies
			Laparoscopic Gastric Plication “Gastric Plication”
			Endoscopic Sleeve Gastroplasty “Gastric Plication”
			Mini Gastric Bypass
			Ileal Transposition with/Without Sleeve Gastrectomy
			Laparoscopic “Jejunal Sleeve” (On Gastric Bypass/Sleeve)
			Laparoscopic Single Anastomosis Duodenal Switch (SADI-S)
			Myoelectric Gastric Stimulation
	7.7 Metabolic Surgery
		7.7.1 Definition
		7.7.2 Scientific Basis
	7.8 S3 Guidelines (February 2018)
		7.8.1 Quality Assurance
		7.8.2 Diagnosis and Evaluation
		7.8.3 Indication
		7.8.4 Choice of Procedure
		7.8.5 Technical Aspects and Complications
		7.8.6 Aftercare
		7.8.7 Guidelines
	References
		Suggested Reading
8: Liver, Gallbladder and Bile Ducts
	8.1 Anatomy and Physiology of the Liver
		8.1.1 Definitions
		8.1.2 Macroscopic and Microscopic Anatomy
			Macroscopic Anatomy
				Ligaments and Ligamentous Attachments
				Functional Subdivision
			Microscopic Anatomy
		8.1.3 Tasks of the Liver and Functional Liver Volume
			Tasks of the Liver
			Blood Formation Site (Embryonic Period)
				Protein Biosynthesis and Degradation
				Cleavage of Carbohydrates and Glycogen Storage
				Central Organ of Lipometabolism
				Special Metabolic Services
				Detoxification Function (Through Biotransformation)
				Central Organ of the Trace Element Metabolism
				Immunological Function
			Functional Liver Volume After Resection
				Functional Liver Volume After Resection (FLR)
				FLR Targets
				Measurement of FLR
		8.1.4 Location
			Position Projection
		8.1.5 Measured Values
			Weight
			Linear Readings
		8.1.6 Blood Supply and Drainage
			Blood Supply and Drainage of the Liver
				Arterial Inflow = Hepatic Artery
				Portal Venous Inflow = portal vein
				Venous Outflow
		8.1.7 Terminology of Liver Resections (. Fig. 8.1)
			Anatomical (= Typical) Liver Resections
			Atypical Liver Resections
	8.2 Diseases of the Liver
		8.2.1 Benign Diseases
			Hepatocellular Adenomas
				Definition and Subtypes
					Definition
					Subtypes
				Epidemiology and Risk Factors
					Epidemiology
					Risk Factors
				Symptoms and Complications
				Diagnosis
				Surgery Indication
			Focal Nodular Hyperplasia (FNH)
				Definition
				Epidemiology
				Diagnosis
				Complications
			Therapy
				Conservative Approach: Generally
					Surgical Therapy
				Hemangiomas
					Definition
					Epidemiology
				Clinical Presentation and Complications
					Clinical Presentation
					Complications
					Diagnosis
			Therapy
				Conservative Therapy
				Surgical Therapy
			Echinococcosis
				Definition
			Clinical Presentation
				E. granulosus (Cysticus, Unilocularis), Dog Tapeworm
				E. multilocularis (alveolaris), Fox Tapeworm
				Diagnosis
			Therapy
				Surgical Therapy
		8.2.2 Malignant Diseases of the Liver
			Primary Tumors
				Hepatocellular Carcinoma (HCC)
					Epidemiology and Risk Factors
					Early Detection
					Special Forms
					Clinical presentation and Classification
					Diagnosis
					Surgical Therapy
			Intrahepatic Cholangiocarcinoma: CCC
				Definition
				Epidemiology
				Symptoms and Classification
				Diagnosis
				Therapy
			CCC of the Common Hepatic Duct Bifurcation: Klatskin Tumors
				Definition
				Epidemiology
				Symptoms and Classification
				Prognosis
				Therapy
			Liver Metastases
				Indications
				Therapy
		8.2.3 Technique of Liver Resection
			Planning of the Resection
				Technical Conditions
				Parenchyma Conditions
				Caution
				Strategy of Resection
			Resection Type
				Minor Resection (<3 Segments)
				Major Resection
				Technology
				Possible Complications
	8.3 Liver Transplantation
		8.3.1 General and Legal Basis
			(National) Legal Basis
				Definition
			Indication and Listing
				Indication for Liver Transplantation
				Listing
			Organ Allocation
				Eurotransplant
				Principles of Organ Allocation
		8.3.2 Evaluation and Follow-Up of Liver Function
			Clinical Follow-Up
			Laboratory Parameters of Liver Synthesis and Excretion
			Hepatocellular Integrity
			Biliary Integrity
			Synthesis Performance of the Liver
			Excretory Capacity of the Liver
			Scoring Systems for Liver Function and Prognosis
			Child-Pugh Score (. Table 8.1)
			MELD Score
		8.3.3 Indications for Liver Transplantation: Relevant Underlying Diseases in Adults
			Chronic Liver Disease
				Underlying Disease for Liver Cirrhosis
				Cholestatic Liver Disease
			Chronic Drug Toxicity
				Metabolic Diseases/Genetic Diseases
				Other Diseases
				Acute Liver Disease
			Malignant Diseases of the Liver
				Hepatocellular Carcinoma (HCC)
				Cholangiocarcinoma (CCC)
			Epithelioid Hemangioendothelioma
		8.3.4 Contraindications for Liver Transplantation
			Lack of Patient Adherence/Psychosocial Problems
			High Age
			Cardiovascular and Pulmonary Concomitant Diseases
			Infections
			Extrahepatic Metastases
		8.3.5 Surgical Principles
			Patient Positioning
			Laparotomy
			Recipient Hepatectomy
			Machine Perfusion of the liver
			Implantation
			Vena Cava Anastomosis
			Portal Vein Anastomosis
			Reperfusion
			Portal vein
			Hepatic artery
			Bile Duct
			Postoperative Phase
	8.4 Anatomy and Physiology of the Gallbladder and Bile Ducts
		8.4.1 Gallbladder (Vesica Biliaris)
		8.4.2 Bile Ducts
		8.4.3 Blood Supply and Drainage of the Gallbladder and Bile Ducts
			Blood Supply of the Extrahepatic Bile Ducts + Gallbladder
			Blood Supply of the Intrahepatic Bile Ducts
	8.5 Diseases of the Gallbladder and Bile Ducts
		8.5.1 Benign Diseases of the Gallbladder
			Cholecystolithiasis
				Definition
				Epidemiology
				Classification
				Symptoms
				Complications
			Diagnosis
				Clinical Presentation
				Lab Chemistry
				Imaging Non-Invasive Procedures
				Imaging Invasive Procedures
				Further Etiological Clarification
			Therapy
				Conservative Therapy
				Surgical Therapy
			Gallbladder Polyps
				Definition
				Epidemiology
				Clinical Presentation
				Diagnosis
			Therapy
				Surgical Therapy
				Conservative Therapy
			Acute Cholecystitis
				Definition
			Pathophysiology
				Course
				Other Risk Factors
			Symptoms
				Symptoms
				Complications of Acute Cholecystitis
			Diagnosis
				Clinical Presentation
				Lab
				Sonography
				Therapy
				Indication
				OP Procedure
		8.5.2 Benign Diseases of the Bile Ducts
			Choledocholithiasis
				Definition
				Epidemiology
				Clinical Presentation
			Therapy
				Indication
			Choledochal Cysts
				Definition
				Epidemiology
				Pathogenesis
				Clinical Presentation
				Diagnosis
				Therapy
		8.5.3 Gallbladder Carcinoma
			Epidemiology
			Symptoms
			Diagnosis
				Sonography
				CT Abdomen and Thorax
				Alternative MRI with Magnetic Resonance Cholangiopancreatography (MRCP)
			TNM Classification and Staging (UICC 2010)
				TNM Classification
			Therapy
				Surgical Therapy
				OP Indication/Strategy
				Adjuvant Therapy
	References
		Further Reading
		Suggested reading
9: Pancreas
	9.1 Anatomy and Physiology
		9.1.1 Definition, Location and Structure
		9.1.2 Anatomy and Embryology
			Embryology (. Fig. 9.1)
			Anatomy
		9.1.3 Physiology
			Exocrine Function
			Endocrine Function
			Control of the Functions
	9.2 Benign Diseases
		9.2.1 Acute Pancreatitis
			Definition
			Forms
				Acute Edematous Pancreatitis
				Acute Necrotizing Pancreatitis
			Epidemiology
				Incidence
			Etiology
			Symptoms
			Diagnosis
				Laboratory Diagnosis
				Diagnostic Imaging
				Risk Assessment (. Table 9.1)
			Differential Diagnosis
			Therapy
				Etiology-Oriented Therapy
				Conservative Therapy
				Step-Up Approach
				Operative Therapy Principles
			Prognosis
		9.2.2 Chronic Pancreatitis
			Definition
			Forms
			Complications
			Epidemiology
			Etiology
				Alcohol Abuse (75–90%)
				Nicotine Abuse
				Hyperparathyroidism (with Ca2+ Elevation)
					Hereditary
					Autoimmunological (IgG-4 and Lymphoplasmocytic Infiltrates)
			Symptoms
				Abdominal Pain
				Symptoms Associated with Loss of Function
			Diagnosis
				Genetic Examination
				Laboratory Diagnosis (. Table 9.2)
				Diagnostic Imaging
				Sonography
				Endosonography
				CT/MRI/Magnetic Resonance Cholangiopancreaticography (MRCP)
				ERCP
			Differential Diagnosis
			Therapy
				Treatment Strategy
					Indications for Conservative Therapy
					Indications for Interventional or Surgical Therapy
				Operative Therapy: Principles
					Division: Resecting/Draining Procedures
					Surgical Strategy
				Monitoring and Follow-Up
		9.2.3 Guidelines
	9.3 Malignant Diseases
		9.3.1 Pancreatic Carcinoma
			Definition
			Epidemiology
			Etiology
				Underlying Genetic Defects
				Hereditary Syndromes
			Forms
			Symptoms
			Diagnosis (. Fig. 9.6)
				Patient History + Clinical Examination
					Imaging Techniques
			Therapy
				Curative Therapy
					Preoperative Therapy
					Operation
					Pathology
					Postoperative Complications
					Postoperative Treatment: Adjuvant Chemotherapy
				Palliative Therapy
					Indications
					Therapy Regime
		9.3.2 Guidelines
	9.4 Cystic Neoplasms
		9.4.1 Intraductal Papillary Mucinous Neoplasia (IPMN)
			Definition
			Epidemiology (. Table 9.6)
			Etiology
			Symptoms
			Diagnosis
				CT or MRI
				Imaging Signs
			Therapy (. Fig. 9.10)
				Surgical Therapy of MD-IPMN
					Indication for Surgery
					Aim of the Operation
					Principle
					Postoperative Management After Pancreatectomy
				Surgical Therapy of BD (“Branch-Duct”)-IPMN
					Postoperative Follow-Up
					Conservative Therapy of MD-IPMN (5–9 mm Main Duct) and BD-IPMN
		9.4.2 Serous Cystic Neoplasms (SCN)
			Definition
			Epidemiology (. Table 9.6)
			Symptoms
			Diagnosis
			Therapy
				Surgical Therapy
				Conservative Therapy + Monitoring
		9.4.3 Mucinous Cystic Neoplasia (MCN)
			Definition
			Epidemiology (. Table 9.6)
			Symptoms
			Diagnosis
			Therapy
		9.4.4 Solid Pseudopapillary Neoplasia (SPN)
			Definition
			Epidemiology (. Table 9.6)
			Symptoms
			Diagnosis
			Therapy
				Always Operative
				Principles
		9.4.5 Guidelines
	9.5 Endocrine Neoplasms
		9.5.1 Definition
		9.5.2 Epidemiology
		9.5.3 Symptoms
			Insulinoma
			Gastrinoma (Zollinger-Ellison Syndrome)
			VIPom
			Glucagonom
			Somatostatinoma
			Pancreatic Carcinoid Syndrome
			Non-Functional NET (95%)
		9.5.4 Diagnosis
			Laboratory Diagnosis
				Chromogranin A
				Gastrin
				Fast Test
				Insulin, Plasma Glucose
				5-Hydroxyindoleacetic Acid
			Imaging Techniques
				Contrast Enhanced Ultrasound
				Endosonography
				Multidetector CT
		9.5.5 Therapy
			Benign Solitary NET with Local Resection Option (>2 cm)
			NET Without Local Resection Option
			Local Recurrences or Metastases of NET
			Diffuse Metastasized NET
		9.5.6 Guidelines
	References
10: Kidney Transplantation
	10.1 Introduction
		10.1.1 Legal Framework
		10.1.2 Structure in Germany
			German Foundation for Organ Transplantation
			Eurotransplant
			Transplant Centers
	10.2 Indication for Transplantation and Preparation of the Recipient
		10.2.1 Indication for Transplantation
			Indication = ESRD [End-Stage Renal Disease]
			Contraindications
			Causes of End-Stage Renal Disease
		10.2.2 Recipient Preparation
			Detailed Information—Medical Aspects
			Medical Evaluation
			Diagnostic Procedure
			Detailed Anamnesis and Clinical Examination
			Laboratory Tests
			Apparative Examination
			Screening
			Evaluation by Specialist
			Vaccinations
		10.2.3 Registration in the Waiting List
			Indication/Registration
			Urgency Status
	10.3 Deceased Organ Donation
		10.3.1 Organ Donation and Donor Selection
			Organ Donation
			Donor Selection
			Ischemia Times of Organs
		10.3.2 Organ Allocation
			Allocation Programs
		10.3.3 Organ Retrieval
			Principle
	10.4 Living Kidney Donation
		10.4.1 Prerequisites
		10.4.2 Legal Limits in Germany
		10.4.3 Advantages of Living Kidney Donation
		10.4.4 Donor Evaluation [Preparation and Diagnosis]
			Initial Interview with the Potential Donor
			Detailed Medical Examination (Often Inpatient)
			Presentation to an Ethics Committee
		10.4.5 Donor Operation
			OP Procedure
			Open Surgery
			Laparoscopic/Retroperitoneoscopic
		10.4.6 Risks and Complications
			Mortality
			Morbidity
			Long-Term Risks
		10.4.7 Donor Aftercare
	10.5 Kidney Transplantation
		10.5.1 Back-Table Preparation of the Kidney
		10.5.2 Surgical Technique of Transplantation
			Implantation Site
			Immunosuppression
		10.5.3 En Bloc Renal Transplantation
			Principle
			Advantages
			Disadvantages
		10.5.4 Surgical Complications
			Vascular System (Incidence <5%)
				Postoperative Bleeding/Haematoma
				Arterial Thrombosis
				Graft Vein Thrombosis
				Renal Artery Stenosis
			Urological Complications (Incidence 2–10%)
				Urinary Leakage
				Ureteral Stenosis
				Ureteral Necrosis
			Lymphatic Complications (Incidence 2–18%)
				Lymphocele
	10.6 Postoperative Treatment
		10.6.1 Inpatient Stay
			Content
			Delayed Graft Function (DGF)/Acute Tubular Necrosis (ATN)
		10.6.2 Immunosuppression
			Immunosuppressive Therapy
			Standard Triple Therapy
			Immunological Risk Factors
			Immunosuppressive Agents
			ABO-Incompatible Transplantation (Living Donation)
		10.6.3 Organ Rejection
			Hyperacute Rejection
			Acute Rejection
			Chronic Rejection
		10.6.4 Infections
			Bacterial Infections
			Opportunistic Infections
		10.6.5 Aftercare
	10.7 Results
11: Spleen
	11.1 Spleen: Generalities
		11.1.1 Embryology and Developmental Disorders
			Embryology
			Developmental Disabilities
		11.1.2 Anatomy
			Structure
				Definition (. Fig. 11.1)
				Form
				Variations
			Measurements
				Measurements for Adults
			Location
			Vessels and Innervation
				Vessels
				Innervation
		11.1.3 Physiology
			Filter Function
				Filter/Degradation Organ of the Altered Erythrocytes
				Storage/Degradation Organ of Platelets (and Clotting Products)
			Lymphatic Defense Organ
	11.2 Spleen Diseases
		11.2.1 Benign Haematological Diseases
			Idiopathic Thrombocytopenic Purpura (ITP)
				Definition
				Mechanism
				Epidemiology
				Clinical Examination
				Diagnosis
				Therapy
				Strategy
				Splenectomy
			Hereditary Spherocytosis
				Definition
				Mechanism
				Clinical Examination
				Diagnosis
				Therapy
			Hemolytic Anemia Due to Erythrocyte Enzyme Defect
				Definition
				Clinical Examination
				Therapy
			Haemoglobinopathies
				Definition
				Clinical Examination
				Therapy
		11.2.2 Other Benign Diseases
			Splenic Cysts
				Classification
				Clinical Examination
				Epidemiology
				Therapy
			Splenic Abscess
				Risk Factors
				Clinical Examination
				Diagnosis
				Therapy
		11.2.3 Malignant Diseases
			Lymphomas
			Leukemia
			Non-hematological Malignant Tumors
		11.2.4 Spleen Trauma
			Epidemiology
			Pathophysiology
			Diagnosis
				Anamnesis
				Clinical Examination
				Ultrasound Examination
			Therapy
		11.2.5 Post-splenectomy Morbidity
			Asplenia: Pathophysiology
			Prophylactic Therapy in Asplenia Patients
	References
		Further Reading
12: Peritoneum
	12.1 Anatomy and Physiology of the Peritoneum
		12.1.1 General Anatomy
			Definition
			Structure (Histology)
			Division
		12.1.2 Physiology (Tasks) of the Peritoneum
			Organ Mobility
			Resorption
			Immunological Tasks (= Defence)
	12.2 Benign Diseases of the Peritoneum
		12.2.1 Peritonitis
			Definition
			Etiology
				Primary Peritonitis (Without Previous Abdominal Disease)
				Secondary Peritonitis
				Spontaneous Bacterial Peritonitis (e.g. in Ascites, Liver Cirrhosis)
					Special Form: Peritonitis After CAPD Catheter Insertion
			Classification
			Symptoms
			Diagnosis
			Therapy
				Surgical Therapy
				Conservative Therapy
		12.2.2 Peritoneal Adhesions
			Epidemiology
			Clinical Presentation
			Diagnostic Imaging
			Therapy
	12.3 Pseudomyxoma Peritonei
		12.3.1 Definition
		12.3.2 Classification
		12.3.3 Aetiology
		12.3.4 Clinical Presentation
		12.3.5 Therapy
		12.3.6 Prognosis
	12.4 Malignant Diseases of the Peritoneum
		12.4.1 Mesothelioma
			Definition
			Epidemiology
			Clinical Presentation
			Prognosis
			Therapy
		12.4.2 Peritoneal Carcinomatosis
			Epidemiology
			Clinical Presentation
			Diagnosis
				Imaging Techniques
				Staging Laparoscopy
			Therapy
				Systemic Chemotherapy
	12.5 Cytoreductive Surgery (CRS) and HIPEC
		12.5.1 Curative CRS and HIPEC
			Theoretical Approach
			Concept and Goals
			Indication
				Risk-Benefit Analysis
		12.5.2 Prophylactic/Adjuvant CRS and HIPEC
			Indications
			Evidence
			Learning Curve
		12.5.3 Palliative Therapeutic Concepts for Ascites
		12.5.4 Complications
			Most Common Complications
			Strategies to Minimize Complications
		12.5.5 Results
		12.5.6 PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)
		12.5.7 Guidelines
	References
		Suggested Reading
13: Hernia
	13.1 Anatomy and Classification
		13.1.1 Hernia Anatomy
		13.1.2 Epidemiology
			Hernia Incidence
			Hernia Distribution
		13.1.3 Pathogenesis and Classification
			Pathogenesis
			Hernia Classification
		13.1.4 Hernia-Specific Complications
			Intestinal Incarceration
			Hernia
			Mains Clamping
	13.2 General Diagnosis and Therapy Principles
		13.2.1 Diagnosis
			Physical Examination
			Sonography
			Further Investigations
		13.2.2 Therapy Principles
			Procedure for Surgical Therapy
	13.3 Incisional Hernia
		13.3.1 Definition
		13.3.2 Incidence
		13.3.3 Aetiology
		13.3.4 Clinical Presentation
		13.3.5 Diagnosis
			Clinical Examination
			Sonography
			CT or MRI
		13.3.6 Surgical Therapy
			Open Procedures
				Suture Procedure
				Sublay Technique
				Abdominal Wall Replacement
				Laparoscopic Procedures
			Special Procedures
				Component Separation According to Ramirez
		13.3.7 Guidelines
	13.4 Inguinal and Femoral Hernia
		13.4.1 Anatomy, Definition and Classification
			Anatomy
			Definition
			Division
		13.4.2 Epidemiology
			Inguinal Hernia
			Femoral Hernia
		13.4.3 Pathophysiology
		13.4.4 Clinical Presentation
			Asymptomatic Small Inguinal Hernia
			Symptomatic Inguinal Hernia
			Complications
			Femoral Hernia
		13.4.5 Diagnostic Procedures
			Palpation of the Inguinal Canal
			Sonography
			CT/MRI Examination
		13.4.6 Therapeutic Principles
			Evidence-Based Strategy (. Fig. 13.3)
				EHS (European Hernia Society) Recommendation
				Principles
				Complications
				Intraoperative EHS Classification (2007)
			Surgical Technology
				Inguinal Hernia
					Operative Procedure
						Shouldice Herniotomy
						Aftercare
		13.4.7 Guidelines
	13.5 Umbilical and Epigastric Hernia
		13.5.1 Umbilical Hernia
			Definition
			Division
		13.5.2 Epigastric Hernia
			Definition
		13.5.3 Clinical presentation
		13.5.4 Diagnosis
		13.5.5 Therapy
		13.5.6 Guideline
		13.5.7 Differential Diagnosis: Rectus Diastasis
			Definition
			Etiology and Pathogenesis
			Clinical Presentation
			Therapy
	13.6 Parastomal Hernia
		13.6.1 Definition
		13.6.2 Epidemiology
		13.6.3 Risk Factors and Prevention
			Risk Factors
			Prevention
		13.6.4 Clinical Presentation
		13.6.5 Relevant Complications
		13.6.6 Therapy
			Open Procedures
			Minimally Invasive Procedures
		13.6.7 Guidelines
	13.7 Other Rare Hernias
		13.7.1 Spieghel’s Hernia (Hernia Lineae Semilunaris)
		13.7.2 Hernia Obturatoria
		13.7.3 Hernia Ischiadica
		13.7.4 Hernia Perinealis
		13.7.5 Lumbar Hernia
	References
		Further Reading
14: Gastrointestinal Stromal Tumors and Sarcomas
	14.1 Gastrointestinal Stromal Tumours (GIST)
		14.1.1 Definition
		14.1.2 Epidemiology and Tumour Localisation
			Epidemiology
			Localization
			Tumor Biology
			Risk Factors
		14.1.3 Clinical Presentation
			Manifestation
			Symptoms
			Prognosis at Diagnosis
		14.1.4 Pathology
			Conventional Histology
			Immune Phenotype
			Mutation Detection
		14.1.5 Diagnosis
			Diagnostic Imaging
			Tissue Biopsy
		14.1.6 Therapy
			Surgical Therapy
				Indication
				General Principles
				GIST of the Stomach
			Adjuvant Treatment
				Antibodies (Ab) Against the Tyrosine Kinase Receptor
				Second-Line Therapy
			Neoadjuvant Treatment
				Goals
				Indications/Target Organs
				Multimodal Therapy
				Results of Neoadjuvant Therapy
			Assessment of the Therapeutic Success in Imaging
				Computer Tomography (CT scan)
				Positron Emission Tomography (PET)
		14.1.7 Guidelines
	14.2 Soft Tissue Tumours of the Extremities
		14.2.1 General: Classification
			Epidemiology
				General Information
				STS Body-Distribution Pattern
				Rare Hereditary Risk Factors
				Acquired Risk Factors
		14.2.2 Clinical Presentation
			Anamnesis
			Investigation
		14.2.3 Diagnosis
			Local Diagnosis
				Ultrasound (Unclear Swelling of the Extremity)
				Native X-Ray Imaging in 2 Planes
				Magnetic Resonance Imaging (MRI): Gold Standard
				Fluorodeoxyglucose (FDG)-PET
			Diagnosis of Local and General Spread
				Pathophysiology
				Diagnosis
				Biopsy
				General
				Excisional Biopsy
				Open Incisional Biopsy
				Punch Biopsy
		14.2.4 Classification
			Histological Classification
				Most Common Entities
			Staging and Grading
				Staging
				Grading
				UICC Stages According to the TNM Classification
		14.2.5 Prognosis
			Main Prognostic Determinants for Non-Metastatic Tumours
			5-Year Survival for Patients with STS of the Extremities
		14.2.6 Therapeutic Principles
			Sarcoma Centre: Tumour Board—Interdisciplinary, Multimodal Therapy
			Surgery
				Oncosurgical Resective Surgery
					Wide Excision
					Compartment Resection
					Limb Amputation
					Reconstructive Surgery
					Surface Restoration
					Functional Restoration
					Tumor Recurrence Surgery
					Tumor Metastases Surgery
			Radiotherapy
				Principle
				Application
				Neoadjuvant Radiotherapy
				Intraoperative Radiotherapy
			Chemotherapy
				Hyperthermia/Isolated Limb Perfusion
			Tumor Follow-up
				Local Tumor Follow-up
				Systemic Tumor Follow-up
		14.2.7 Guidelines
	14.3 Retroperitoneal Sarcomas
		14.3.1 Epidemiology and Prognosis
			Epidemiology
			Prognosis and Prognostic Factors
		14.3.2 Pathology
		14.3.3 Classification
			AJCC/UICC
			TNM Classification
			UICC Stages According to the TNM Classification
		14.3.4 Molecular Genetics
		14.3.5 Clinical Presentation
			Early Symptoms
			Clinical Symptoms (If Present)
		14.3.6 Diagnosis
			Medical History and Clinical Examination
			Radiology
				Multiphase Spiral CT scan
				MRI
				PET/PET-CT
				Renal Scintigraphy
			Biopsy
				NCCN Guidelines
		14.3.7 Therapy
			Surgical Therapy
				En Bloc Organ Resection
				Principle En Bloc Resection
			Morbidity and Mortality
			Independent Predictive Factors Associated with a Lower Locoregional Tumor Recurrence Rate
			Radiotherapy
				Preoperative Radiotherapy (PrR)
					Main Objectives of the PrR
					Theoretical Advantages of PrR (Nussbaum et al. 2014)
			Intraoperative Radiotherapy (IORT)
				Principle
				Limits of the IORT
				Postoperative Radiotherapy (PostR)
			Chemotherapy
				Preoperative Chemotherapy
				Adjuvant Chemotherapy
		14.3.8 Management of Recurrences
			Incidence
			Treatment of the Recurrence
		14.3.9 Follow up
			Evidence
			Strategy
		14.3.10 Guidelines
	References
15: Perioperative Medicine
	15.1 Preoperative Phase
		15.1.1 Risk Stratification
			Identification of Patient-Related Risks
			Systemic Diseases with High Postoperative Risk
			Perioperative Risk (. Table 15.2)
			Intubation Conditions
		15.1.2 Laboratory and Blood Products
			Blood Management
			Laboratory Diagnosis
		15.1.3 Additional Investigations
			ECG
			Chest X-Ray
			Pulmonary Function Diagnosis
		15.1.4 Perioperative Anticoagulation
			Coronary Artery Disease and Stent Implantation
			Perioperative Thrombosis Prophylaxis
			New Oral Anticoagulants (NOACs/DOACs)
		15.1.5 Medication Management
			Continue
			Convert
			Discontinue
			Endocarditis Prophylaxis
		15.1.6 Information from the Anaesthetist’s Point of View
			Legal Situation (Germany)
			Prerequisite
			Requirement
			Elements of Consent
			Outpatient Interventions
			Living Will or Health Care Proxy
	15.2 Intraoperative Phase
		15.2.1 Intraoperative Monitoring According to AAGBI and BDA Guidelines
		15.2.2 Volume Management
		15.2.3 Hemodynamics
			Pathophysiology
			Risk Factors for Hypotension
			Principles/Goals
		15.2.4 Heat Retention
		15.2.5 Perioperative Antibiotic Therapy
			Incidence of SSI (“Surgical Site Infection”)
			Risk Factors
			Pathogen Spectrum
			Prevention
			Perioperative Antibiotic Prophylaxis (PAP)
	15.3 Postoperative Phase
		15.3.1 Analgesia
			Pathophysiology
			Evidence-Based Analgesia
			Pain Measurement
			Principles
		15.3.2 Postoperative Nausea and Vomiting (PONV)
			Forecasting Systems
			Prophylaxis
			Therapy
		15.3.3 Delirium/Postoperative Cognitive Deficit (POCD)
			Epidemiology
			Division
			Preoperative Evaluation of Risk Factors
			Prevention
			Early Screening
			Therapy
		15.3.4 Recovery Room (PACU)
		15.3.5 Intensive Care Unit (ICU)/Intermediate Care (IMC)
	15.4 Fast Track Surgery
		15.4.1 Definition
		15.4.2 Preoperative Management
		15.4.3 Intraoperative Management
		15.4.4 Postoperative Management
			Analgesia
			Early Mobilization
				Optimized Diet
		15.4.5 Guidelines
	Reference
16: Emergency Surgery
	16.1 Polytrauma: Abdominal Trauma
		16.1.1 Anatomy of the Abdomen
			External Divisions
				Anterior Abdominal Wall
				Lateral Abdominal Wall (= Flank)
				Quadrant/Sector Breakdown
			Internal Divisions
				Abdominal Cavity
				Pelvis
		16.1.2 Injury Mechanisms (Aetiology and Pathophysiology)
			Blunt Abdominal Trauma
			Deceleration Trauma
			Crush Injury
			Compression Injury
			Penetrating Abdominal Trauma
			Stab Wound
			Gunshot Wound
			Impalement Injury (Due to Accidents)
		16.1.3 Management and Diagnosis
			Primary Management
			Anamnesis
			Clinical Presentation
			Laboratory Tests
			Diagnostic Imaging
				X-ray
				Ultrasound Examination
				Computer Tomography
		16.1.4 Therapeutic Procedure
			Conservative Therapy
			Blunt Abdominal Trauma
			Penetrating Abdominal Trauma
			Surgical Therapy
				Circulatory Instability
				Circulatory Stability
				Major Visceral Trauma/Complex Surgery
		16.1.5 Guidelines
	16.2 Ileus/Obstruction
		16.2.1 Definition—Classification
			Definition
			Classification
		16.2.2 Epidemiology
		16.2.3 Pathophysiology
			“Circulus Vitiosus” of Ileus
			Intestinal Distention
		16.2.4 Diagnosis
			Medical History and Symptoms
			Clinical Examination: Status Survey
			Lab
			Quantity/Quality of Gastrointestinal Contents Discharged
			Imaging
				Ultrasound
				Conventional Abdominal Radiograph
				Contrast-Enhanced (Gastrographin) Conventional X-Ray
				Computer Tomography (CT scan)
		16.2.5 Mechanical Ileus (Mechanical Obstruction)
			Etiology and Pathogenesis
				Etiology (. Table 16.1)
				Pathogenesis
			Specific Symptoms
				High Small Bowel Ileus
				Low Small Bowel Ileus
				Large Bowel Obstruction
			Complications
		16.2.6 Paralytic Ileus/Functional Obstruction
			Etiology and Pathogenesis
				Etiology (. Table 16.2)
				Pathogenesis
				Specific Symptoms
		16.2.7 Therapy
			Conservative Therapy
				General Measures
				Antibiotic Therapy
				Drug Stimulation in Paralytic Ileus
			Surgical Therapy
				Goals
				Emergency Indications
				Relative Indications
		16.2.8 Specific Therapy for Certain Types of Ileus
			Paralytic Ileus
				Conservative Therapy
				Surgical/Endoscopic Therapy
			Vascular Ileus
			Strangulation Ileus
			Postoperative Ileus
			Ogilvie’s Syndrome
			Large Bowel Obstruction Due to Colon Cancer
				Conservative Therapy
				Bridge-to-Surgery
				Primary Resection
			Gallstone Ileus
			Volvulus
	16.3 Abdominal Compartment Syndrome
		16.3.1 Definitions
			Intra-Abdominal Pressure (IAP)
			Abdominal Perfusion Pressure (APP)
			Intra-Abdominal Hypertension (IAH)
			Abdominal Compartment Syndrome (ACS)
		16.3.2 Aetiology
			Classification of Abdominal Compartment Syndrome (ACS, . Table 16.3)
			Pathophysiology
		16.3.3 Clinical presentation
			Risk Factors
			Symptoms
		16.3.4 Diagnosis
			Bladder Pressure Measurement (Gold Standard)
			Clinical Presentation
			Imaging
		16.3.5 Therapy
			General Principles of Therapy
				WSACS Guidelines
				Supportive Measures
				Goals
			Conservative Measures
				Improvement of Abdominal Wall Compliance
				Decrease in Intra-Abdominal Volume
			Surgical Measures
				Decompressive Laparotomy
				New Alternatives
				Temporary Abdominal Closure
				Definitive Abdominal Closure
		16.3.6 Guidelines
	16.4 Intestinal Ischemia
		16.4.1 General
		16.4.2 Acute Intestinal Ischaemia
			Epidemiology
			Etiology and Pathogenesis
			Clinical Presentation
				Non-Specific Clinical Presentation
				3-Phase Clinical Course (Rarely Detectable)
			Diagnosis
				Anamnesis
				Laboratory Tests
				Diagnostic Imaging
			Therapy
				Stabilization
				Acute Mesenteric Artery Embolism
				Acute Mesenteric Artery Thrombosis
				Acute Mesenteric Vein Thrombosis
				Ischemic Colitis and Nonocclusive Mesenteric Ischemia (NOMI)
		16.4.3 Chronic Mesenteric Ischaemia (CMI)
			Etiology and Pathogenesis
				Etiology
				Pathogenesis (= Atherosclerosis)
			Clinical Presentation
			Diagnosis
			Therapy
		16.4.4 Guidelines