Book Review

Surgery

N Engl J Med 2002; 346:299-300January 24, 2002

Article

Surgery
Edited by John D. Corson and Robin C.N. Williamson. 1664 pp., illustrated. St. Louis, Mosby, 2001. $175. ISBN: 0-7234-3069-1

To publish a one-volume textbook of surgery at the beginning of the new millennium is a challenging task, especially in view of the fragmentation of surgery into subspecialties. As growth of the surgical specialties continues, the role and future of general surgeons will require redefinition. Surgery is the result of a remarkable collaboration of more than 250 authors worldwide.

The book differs from other textbooks in the profusion of color illustrations. In addition, different sections have different color codes — a helpful, user-friendly aid. The comprehensive index and the accompanying CD-ROM, which contains 1700 selected color photographs, diagrams, and illustrations, are valuable tools that are simple to use. All the chapters have a uniform style, and there are few repetitions despite the large number of contributors. The number and quality of color photographs illustrating findings in typical diseases, characteristic radiographic and other images, and drawings of operative techniques are remarkable.

The most interesting and useful aspect of the book is the exhaustive and clear description of clinical scores and classifications, risk indexes, and algorithms, which are frequently difficult to find in the literature outside one's specialty. Another unique feature is the practical-problem section that concludes each chapter or individual section. Representative examples of these focus on anesthesia in the morbidly obese patient, acute abdominal pain in pregnancy, abdominal aortic aneurysm with coexisting cancer, and incidental adrenal adenoma. Each problem takes up one page and includes illustrations and a brief summary of the diagnostic dilemma and management options. Most of these 82 practical problems are controversial yet pertinent, and a real effort has been made to clarify issues that are often addressed only vaguely in other textbooks.

The writing of this book was initiated more than four years ago, and the obvious problem was to ensure that the text would be up to date when published. Although the most recent references are not included, the information on epidemiology, physiology, and physiopathology appears to be current. Some recent advances in endoscopic treatment, however, are missing.

The information covered in the first two sections on surgical principles, critical care, and trauma is beyond the scope of any single surgical subspecialty. The section on surgical principles in particular will be useful to all surgeons. Special consideration of elderly or morbidly obese patients and specific chapters on information technology and economic issues reflect changes in management and treatment. Basic medical statistics could have been summarized in this section. Minimal-access surgery is well described, but recent evidence of its benefits over conventional surgery or the risk of seeding of tumor cells through sites of trocar insertion is not included. The prediction that robotics may eventually aid surgeons has already come to fruition. The second section, on trauma, is exhaustive and organ-oriented and deals with specific types of injury. The chapter on initial surgical care will be particularly interesting to general surgeons, since it addresses the advantages and limitations of the techniques of rapid exposure of different regions.

The third section, on gastrointestinal surgery, is the largest, and it discusses conditions at the frontiers of medicine and surgery. It is appropriately bowel-oriented, whereas the chapters on disorders of the liver and pancreas are somewhat incomplete. As specialist surgeons, we may initially be disappointed, but the book highlights the reality of the limited space that surgical subspecialties occupy within the field in terms of the incidence of disease and the impact on the medical community.

The sections on vascular, breast, and endocrine surgery are exhaustive and didactic. An obvious effort has been made to elucidate the most common management issues through decision-making algorithms. A section devoted to transplantation surgery covers all organs and is relevant and useful. The last section encompasses cardiothoracic, genitourinary, pediatric, head and neck, skin, and soft-tissue surgery, which are covered with the general surgeon in mind.

The book is extremely well written. All surgeons, except perhaps orthopedists, will find it interesting. Most surgeons outside the university-hospital setting face a wide range of diseases, and support in a broad field is always welcome. Surgery achieves the purpose that the editors set out to accomplish, and they deserve compliments on their efforts. The only disadvantages of the book are its size and weight; nonetheless, a copy of this book should be in every surgical unit and reference library.

Jacques Belghiti, M.D.
Beaujon Hospital, Clichy 92118, France
j.bel@bjn.ap-hop-paris.fr