Book Review

Gastroenterology — Surgical and Medical

The Gastrointestinal Surgical Patient: Preoperative and Postoperative Care

N Engl J Med 1994; 331:553August 25, 1994

Article

The Gastrointestinal Surgical Patient: Preoperative and Postoperative Care
Edited by Eamonn M. Quigley and Michael F. Sorrell. 583 pp., illustrated. Baltimore, Williams & Wilkins, 1994. $85. ISBN: 0-683-07001-0

Because preoperative and postoperative care are the domain of the surgeon, I would not ordinarily have considered reading a book on this subject edited by two nonsurgeons. However, the old axiom “Prejudice stems from ignorance” has proved true once again. Ignoring this book would have been a mistake, as it would be for any gastroenterologist, gastrointestinal surgeon, gastrointestinal radiologist, specialist in intensive care, or reader who simply wishes to learn more about the diseases of the gastrointestinal tract that usually require surgical intervention.

This books is unique in several respects. First, its scope is limited. The editors do not attempt to cover the entire discipline of hepatogastroenterology, but restrict themselves to the diseases of the liver and gastrointestinal tract that relate to surgery. Second, the book is focused. Concentrating clearly on the clinical aspects of diseases, the authors have declined to follow the traditional pattern of historical, etiologic, and pathophysiologic dissertations. Thus, the book is eminently practical. Yet, though limited and practical, it is comprehensive, covering the “gastrointestinal surgical patient” from every possible angle.

In the first of three sections, the focus is on the general preoperative evaluation of patients who require gastrointestinal surgery. Many of the concepts advanced here are applicable not only to patients with gastrointestinal disorders, but also to any patient who must undergo a major operation. The second section -- the best, in my opinion -- gives this book its identity. Its eight chapters describe in a thorough and generally well-referenced fashion not only the care of patients after hepatobiliary or gastrointestinal operations, but also, most important, the many gastrointestinal complications that affect patients who undergo operations on organs far removed from the gastrointestinal tract. “Critical Care Aspects,” “Gastrointestinal Hemorrhage,” and “Sepsis” are simply superb chapters that provide critical information for the management of seriously ill patients.

The third section addresses problems related to specific procedures on individual organ systems. All complications -- from a leaking anastomosis to the wide variety of postgastrectomy syndromes -- are thoroughly analyzed, and vital information is provided to surgeons and physicians. Because each chapter is written by a different specialist, there is, as in most multiauthored books, a heterogeneity in the depth at which topics are covered: some chapters are thorough (e.g., “Preoperative Nutritional Assessment”), and others are more superficial (e.g., “Postoperative Pancreatitis”). Nevertheless, I believe this eminently practical book is well suited to the needs of all clinicians who are likely to deal with patients undergoing gastrointestinal procedures or with surgical patients in whom gastrointestinal problems develop during the postoperative period.

Carlos A. Pellegrini, M.D.
University of Washington, Seattle, WA 98105