Farquharson’s Textbook of Operative General Surgery, 10th Edition

Book Preface

Eric Farquharson was a young consultant at Edinburgh Royal Infirmary when Operative Surgery was first published in 1954, but it was as a General Surgical trainee in the 1930s that he started the project. Surgical training was then very different from that of today and he perceived the need for a textbook that could guide a trainee surgeon through an unfamiliar operation. He did not set out to write a technical step by step manual but rather a book which, in addition to describing the anatomy and operative details, would explain the aims of an operation and give guidance where there was a choice of surgical options. The difficulties that might be encountered were explored and the basis on which intraoperative decisions had to be made was discussed.

During the 1960s and 70s the book became a standard text for the old Surgical Fellowship examinations when a candidate was expected to describe a wide range of operations. Eric Farquharson’s vision, though, was less of an examination text, confined to a library, but more of a book that would be readily available in the operating theatre and of value to the practising surgeon.

Surgical training has changed and General Surgery has fragmented in many countries into a number of subspecialties, though there is still a need for a broad range of knowledge and skills for all who participate in the emergency surgical on-call rota. Therefore, as editors we have strived to remain faithful to the original philosophy. The additional editor since the last edition is a grandson of Eric Farquharson. He is at the same stage of his surgical career as his grandfather was when he planned the First Edition and has been in the ideal position to contribute from the perspective of the trainee.

The book has been extensively updated with the involvement of many surgical specialists. All the common operations in the General Surgical subspecialties that are likely to be encountered during Higher Surgical Training are described and, additionally, basic techniques are explained for the junior trainee. Although surgeons in training no longer anticipate that they will be expected to undertake unfamiliar operations without supervision, unforeseen circumstances can still arise. With increasing specialisation, even experienced surgeons can sometimes be involved in a surgical emergency, or an intraoperative complication, requiring an operative procedure in a subspecialty other than their own.

A short list of references is given at the end of each chapter. These are a personal selection, including some interesting historical papers, but no attempt has been made to provide a comprehensive bibliography.

In many parts of the world General Surgery has remained a more all-encompassing surgical discipline and in remote hospitals General Surgeons may be the only surgicalspecialists. When transfer and referral options are unavailable, these surgeons may have to offer a limited service in orthopaedics, neurosurgery, urology and obstetrics. For this reason some operations in other surgical disciplines are included, and here the emphasis is more on what might be achievable in difficult circumstances rather than a more sophisticated procedure if this would be impractical outside a specialist centre.

When many specialists are involved, balance and consistency of style become increasingly challenging. Eric Farquharson was very aware of this difficulty and advocated single authorship as the only practical solution. This is no longer possible and most chapters are now a collaborative effort between the editors and one or more other contributors. However, consistency and cross-referencing between chapters have remained of paramount importance during the editorship.

We hope that this classic textbook will remain of value to General Surgeons, whether already well established in surgery or just embarking on a surgical career.

Margaret Farquharson
James Hollingshead
Brendan Moran

Contents
Preface to the First Edition vii
Preface to the Tenth Edition viii
Acknowledgements ix
Contributors x
CHAPTERS
1. Skills and tools: knots to robots 1
2. Surgery of the skin and subcutaneous tissue 15
3. Surgery of the breast and axilla 31
4. Soft tissue surgery: muscles, tendons, ligaments and nerves 45
5. Surgery of bone and amputations 63
6. Vascular surgical techniques: vascular access and trauma 85
7. Operative management of vascular disease 107
8. Cardiothoracic surgery for the general surgeon 137
9. Neurosurgery for the general surgeon 151
10. Surgery of the neck 165
11. Surgery of the face and jaws 189
12. Special considerations in abdominal and gastrointestinal surgery 201
13. Surgical access to the abdomen and surgery of the abdominal wall 209
14. General techniques in abdominal and gastrointestinal surgery 227
15. Emergency abdominal surgery 241
16. Surgery of intra-abdominal malignancy 255
17. Classic operations on the upper gastrointestinal tract 263
18. Operative management of upper gastrointestinal disease 291
19. Gallbladder and biliary surgery 321
20. Surgery of the pancreas, spleen and adrenal glands 339
21. Surgery of the liver 359
22. Classic operations on the small and large bowel 377
23. Operative management of small and large bowel disease 411
24. Surgery of the anus and perineum 435
25. Surgery of the groin and external genitalia 459
26. Urological surgery for the general surgeon 483
27. Gynaecology and obstetrics for the general surgeon 503
Appendix I: Preoperative preparation 517
Appendix II: Intraoperative care 525
Appendix III: Postoperative care 533
Index 541