Surgery Essence Pritesh Kumar Singh
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1Surgery Essence2
3Surgery Essence
Fourth Edition
Pritesh Kumar Singh MBBS (MAMC), MS (Surgery, LHMC), FMAS, FIAGES Director, PGEI Chief Advisor of Editorial Board—PGMEE, Jaypee Publishers Ex. Senior Resident, Lady Hardinge Medical College and Associated Sucheta Kriplani Hospital Kalawati Saran Children's Hospital and Ram Manohar Lohia Hospital New Delhi, India
4
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© 2016, Jaypee Brothers Medical Publishers
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All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
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Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
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Surgery Essence
Third Edition: 2015
Fourth Edition: 2016
9789385999567
Printed at
5Dedicated to
My Parents
and
Uncle, Dr CP Singh6
7Editors
ENDOCRINE SURGERY
  • Dr Ashish Jakhetiya (MCh, Surgical Oncology, AIIMS)
  • Dr Subham Garg (MCh, Surgical Oncology, TATA)
  • Dr Subham Jain (MCh, Surgical Oncology, TATA)
  • Dr Niket Harsh (MS, Surgery, MAMC)
HEPATOBILIARY PANCREATIC SURGERY
  • Dr Swati Agarwal (DNB, Surgical Oncology)
  • Dr Harsh Shah (MCh, GI Surgery, GB Pant Hospital)
  • Dr Vaibhav Varshney (MCh, GI Surgery, GB Pant Hospital)
  • Dr Amit Jain (MCh, GI Surgery, GB Pant Hospital)
GASTROINTESTINAL SURGERY
  • Dr Vaibhav Varshney (MCh, GI Surgery, GB Pant Hospital)
  • Dr Harsh Shah (MCh, GI Surgery, GB Pant Hospital)
  • Dr Swati Agarwal (DNB, Surgical Oncology)
  • Dr Amit Jain (MCh, GI Surgery, GB Pant Hospital)
UROLOGY
  • Dr Gaurav Kochar (MCh, Urology)
  • Dr Manoj Kumar Das (MCh, Urology)
  • Dr Suhani (Assistant Professor, Surgery, AIIMS)
  • Dr Animesh Singh (MCh, Urology, AIIMS)
CARDIOTHORACIC VASCULAR SURGERY
  • Dr Tarun Raina (MCh, CTVS, GB Pant Hospital)
  • Dr Vivek Wadhva (MCh, CTVS, PGI Chandigarh)
PLASTIC SURGERY
  • Dr Ritesh Anand (MCh, Plastic Surgery)
  • Dr Alok Tiwari (MCh, Plastic Surgery)
NEUROSURGERY
  • Dr Amit Kumar Singh (MCh, Neurosurgery, RML Hospital)
  • Dr Ishu Bishnoi (MCh, Neurosurgery, GB Pant Hospital)
  • Dr Shivender Sobti (MCh, Neurosurgery, RML Hospital)
  • Dr Ugan Singh (MCh, Neurosurgery)
HEAD AND NECK
  • Dr Ashish Jakhetiya (MCh, Surgical Oncology, AIIMS)
  • Dr Subham Garg (MCh, Surgical Oncology, TATA)
  • Dr Subham Jain (MCh, Surgical Oncology, TATA)
  • Dr Niket Harsh (MS, Surgery, MAMC)
SURGICAL ONCOLOGY
  • Dr Ashish Jakhetiya (MCh, Surgical Oncology, AIIMS)
  • Dr Subham Garg (MCh, Surgical Oncology, TATA)
  • Dr Subham Jain (MCh, Surgical Oncology, TATA)
  • Dr Niket Harsh (MS, Surgery, MAMC)
GENERAL SURGERY
  • Dr Niket Harsh (MS, Surgery)
  • Dr Mayank Agarwal (MS, Surgery)
  • Dr Mohit Garg (MS, Surgery)
  • Dr Gunjan Desai (MS, Surgery)8
9Preface to the Fourth Edition
I thought writing the preface for the fourth time would be an easier job but it is actually a lot tougher because now you already know me very well. This brings many responsibilities with it, the most important of which is to keep the students satisfied.
I can proudly say that all my students have contributed a lot to get me to this place, where I am today. They have helped me in becoming a better teacher, a better author and most importantly a better human being. I take this opportunity to thank all of you. The happiness you all give me keeps me telling always to work harder to bring a positive change in the life of my students. This will be reflected in the pages of this book. I always strive to provide a winning edge to my students.
Higher education has become necessary, as graduation alone is found inadequate in this highly competitive and dynamic world. Trends in the way the questions are being asked are changing continuously. I am pleased to present this edition of Surgery Essence replete with new trends in the field of surgery. The recent questions and their concepts have been highlighted and have been written in a way that will help the students to remember and reproduce them in the examination hall. The information provided is cogent but concise to save the precious time, as we all know the clock is ticking. Time is one thing that can never be recovered once gone. Be careful!
I am passionate about excellence. Excellence in the field of education and in my efforts to groom my students to make them confident enough, that they lose the fear of failure. In order to succeed, your desire for success should be greater than your fear of failure.
PG entrance examination has made the medical world very competitive and has made it imperative for students to acquire all the skills and competencies to deliver results. My aim as an author is to provide students with a learning experience which when amalgamated with perseverance and commitment helps them in achieving goals.
I still am not sure about one thing that who is more happy when a student achieves something, the student or the teacher, but I am very sure that the teacher is more satisfied when he sees his students achieving what they deserve and desire. I am working day and night to get that satisfaction and you have to work equally hard so that you do not let me down.
I always tell my students to dream big but not while sleeping. When you dream of moon, you will at least fall amongst stars. But these dreams should always be accompanied with intelligence and hard work. To guide you work intelligently this book and the author, both are there with you throughout the year. But the hard work is totally in your hands. Accept responsibility for your life. Know it is you who will get you where you want to go, no one else.
I believe that all my students should know the importance of challenges. Challenges are what make life interesting and overcoming them is what makes life meaningful. For the time being the only challenge that you should be facing is to secure a good rank in the entrance exam. One of the most important keys to success is having the discipline to do what you know you should do, even when you do not feel like doing it. Nobody ever wrote down a plan to be broke, lazy or stupid. These things happen when you do not have a plan.
I should now conclude with my prayers and wishes for all of you. Hope you all reach your dreams. All the best…
drpriteshsingh
drpriteshsingh
drpriteshsingh
drpriteshsingh
Pritesh Kumar Singh
MBBS (MAMC), MS (Surgery, LHMC), FMAS, FIAGES
Director, PGEI
Chief Advisor of Editorial Board—PGMEE, Jaypee Publishers
Ex. Senior Resident, Lady Hardinge Medical College and
Associated Sucheta Kriplani Hospital
Kalawati Saran Children's Hospital and Ram Manohar Lohia Hospital
New Delhi, India
11Acknowledgments
I would like to express my greatest gratitude to the people who have helped and supported me throughout my project.
I wish to thank my parents for their undivided support and interest, who inspired me and encouraged me to go my own way, without whom I would be unable to complete my project.
First of all I would like to thank my beloved wife Dr Usica Singh for her constant support and motivation. She helped me in updating the book from the latest editions of standard textbooks. She helped me throughout this project by giving her valuable advises and feedbacks regarding improvement of the book.
I want to thank active members of PGEI family for their encouragement, support and feedback especially Dr Suyog Sahu, Mr Niraj Salunke, Dr Rituparna Majumdar, Dr Debdatta Majumdar, Mr Raja Rao and Dr Sushanta Bhanja.
I express my sincere thanks to my friends Dr Niket Harsh (MS, Surgery, MAMC) and Dr Saurabh Rai (MS, Orthopedics). They provided me the explanations of difficult and controversial questions.
I am grateful to Dr MP Arora for the continuous support for the project, from initial advice and contacts in the early stages of conceptual inception and through ongoing advice and encouragement to this day.
I sincerely thank my uncle Dr SD Maurya (President SELSI and Ex. Professor of Surgery, SNMC, Agra) for his valuable advice and knowledge regarding the surgery subject and surgical skills, which helped me a lot in preparation of certain topics of surgery given in this book.
I wish to express my sincere thanks to Dr OP Pathania and Dr S Thomas.
I wish to express my sincere thanks to Dr Manoj Andley, Professor of surgery, LHMC, New Delhi for helping me throughout this project. His caring and fatherly attitude for the unit as well as towards his residents needs a mention. His excellent way of teaching and presentation helped me a lot in making various explanations in the book. His hard working and caring attitude towards patients is source of inspiration for me and surgery residents.
I am very thankful to Dr Ashok Kumar, Professor of surgery, LHMC, New Delhi for his valuable and indispensable help. His unique ideas regarding presentation of explanations helped me a lot in this project. It is with the help of his valuable suggestions, guidance and encouragement, that I was able to complete this project.
I am very thankful to Dr SK Tudu, Professor of Surgery, Lady Hardinge Medical College for the valuable help. He was always there to show us the right track when we needed his help. It is with the help of his valuable suggestions, guidance and encouragement, that I was able to complete this project.
I wish to express my sincere thanks to Dr Lalit Aggarwal, Dr Gyan Saurabh, Dr Sudipta Saha, Dr P Rahul, Assistant Professor of Surgery, Lady Hardinge Medical College for guiding me to complete general surgery topics.
I wish to express my sincere thanks to Dr Pawan Kumar, Dr Priya Hazrah, Dr Nikhil Talwar, Dr Ezaz Siddiqui, Dr Ashish Arsia, Dr Sadan Ali, Dr Jitender and Dr Kusum Meena, Assistant Professors of Surgery, Lady Hardinge Medical College for their indispensable contribution.
I would like to thank Dr UC Garga, Professor of Radiology, Dr RML Hospital, New Delhi, for his special guidance for radiology and valuable advices for improvement of the book and boosting my morale to bring this project.
I express my extreme gratitude for immense inspiration from my family members specially:
  • Dr Avinash Kumar Singh (Urologist)
  • Mr Abhay Kumar Singh (MBA, IMT, Ghaziabad)
  • Mr Ritesh Kumar Singh (B Tech, MBA, Symbiosis, Pune)
  • Ms Monika Singh (B Tech, Computer Science)
  • Mr Rohit Kumar Singh (B Tech, Computer Science)
  • Dr Kundan Kumar Patel (MBBS, GSVM, Kanpur)
  • Dr Jigyasa Singh (MS, Gynae IMS, BHU)
  • Dr Ambuj Kumar Singh (MBBS, Era Medical College, Lucknow)
  • Dr Charu Singh (Dermatologist)
  • Mrs Deepasha Singh (MBA, IMT, Ghaziabad)
  • Ms Pratibha Singh (M Tech, Computer Science)
  • Ms Khushboo Singh (B Tech, Computer Science)
  • Dr Anita Singh (MD, Pediatrics, KGMC, Lucknow)
  • Dr Akanksha Singh (DGO, KGMC)
  • Mr Abhishek Kumar Singh (B Tech, IIT Kharagpur)
  • Mr Rahul Kumar Singh (B Tech)
I would like to specially thank my friends for their invaluable help and advice from time to time specially:
  • Dr Niket Harsh
  • Dr Suarabh Rai
I feel pleasure in conveying my sincere thanks to my friends and colleagues specially:
  • Dr Shipra Goel (MD, Microbiology)
  • Dr Mayank Agarwal (MS, Surgery)
12A special thank of mine goes to Dr Parul Gautam, (MD, Pathology, MAMC), who helped me in completing the project and exchanged her interesting ideas, thoughts which made this project easy and accurate. Her help for topics related to tumor and pathology is indispensable.
I am equally grateful to my friend Dr Sushant Bhanja (MD, Pediatrics), who gave me moral support and guided me in different matters regarding the topics related to Pediatric surgery. He has been very kind and patient, whilst suggesting me the outlines of this project and correcting my doubts.
I would be failing in my duty if I do not express my thanks to all my friends who have really inspired me to write this book specially:
  • Dr Vivek Kumar (MD, Medicine)
  • Dr Harwinder (MS, Orthopedics)
  • Dr Ugan Singh (MCh, Neurosurgery)
  • Dr Bhamini Agal (MS, Gynae, SMS, Jaipur)
  • Dr Anant Pachisia (MD, Anesthesia)
  • Dr Neha Chaudhary (MD, Pediatrics)
  • Dr Nitasha (MS, Ophthalmology)
  • Dr Pragati Meena (MS, Gynae, SMS, Jaipur)
  • Dr Aniket Malhotra (MD, Pediatrics)
  • Dr Anant Shukla (MD, Anesthesia)
I would like to express my sincere thanks to my colleagues at Dr RML Hospital, especially Dr Amit Kumar Singh (MCh, Neurosurgery), Dr Shivender Sobti (MCh, Neurosurgery), Dr Humam (SR, Neurosurgery), Dr Wazid (DNB, Neurosurgery), Dr Uzair (DNB, Neurosurgery), Dr Azaz (DNB, Neurosurgery) and Dr Neeraj (DNB, Neurosurgery).
I would like to express my sincere thanks to my colleagues at Lady Hardinge Medical College and Associated Dr RML Hospital, Dr Sushma Kataria, Dr Gyan Ranjan, Dr Kamal Yadav, Dr Priyank Yadav, Dr Vineet, Dr Munish, Dr Nivedita, Dr Tarun Raina, Dr Sumit Saini and Dr Abhinav Veerwal.
I would like to express my sincere thanks to my colleagues at Lady Hardinge Medical College and Associated Dr RML Hospital, Dr Meenakshi, Dr Ankur, Dr Prashant, Dr Rigved, Dr Munish Raj, Dr Diwakar Pandey, Dr Vikram Deswal, Dr Gunjan Desai, Dr Vikas, Dr Nikunj Jain, Dr Hari Singh, Dr Vimlesh, Dr Mannu, Dr Anshul, Dr Vikas and Dr Abhijeet Jha, Dr Mayank Aggarwal, Dr Vipul Dogra, Dr Abhishek, Dr Kunjan, Dr Sumit, Dr Kartikey, Dr Rao Bhupender.
I would like to express my sincere thanks to my colleagues at Lady Hardinge Medical College and Associated Dr RML Hospital, for their valuable advice, specially:
  • Dr Ravindra Gupta (Ex. SR, RML Hospital)
  • Dr Ritesh Pathak (SR, RML Hospital)
  • Dr Nitin Sardana (Ex-SR, LHMC)
  • Dr Rahul Rai (Ex-SR, LHMC)
  • Dr Anand Yadav (Ex-SR, LHMC)
  • Dr Nihar (MCh-Hepatobiliary Surgery SR, LHMC)
  • Dr Prasad Bhukebag (SR, RML Hospital)
  • Dr Anil Gulwani (MCh, Urology)
  • Dr Arvinda PS (SR, LHMC)
  • Dr Yogender (SR, LHMC)
  • Dr Shiv Navariya (SR, LHMC)
  • Dr Zuber Khan (FNB, Minimal Invasive Surgery, LHMC)
I would like to express my sincere thanks to my colleagues at Maulana Azad Medical College and Associated LNJP Hospital for their valuable advice, specially:
  • Dr Mohit Garg (MS, Surgery)
  • Dr Anurag Mishra (MS, Surgery)
  • Dr Kamal Kishore Gautam (MS, Surgery)
  • Dr Ashish Airen (MS, Surgery)
I would also like to thank my assistant, Rajesh Jha, who often helped me at critical junctures during the completion of this project.
I would also like to thank Mr Varish Sharma and Mr Anurag Sharma of MAMC Bookshop for their encouragement for writing this book.
I would like to thank Dr Ashish Jakhetiya and Dr Inderjeet Yadav, who helped me a lot in gathering different information, collecting data and guiding me from time to time in completing this project. Despite their busy schedules, they gave me different ideas to help make this project unique.
I convey my sincere thanks to Dr Yatin Talwar for his constant encouragement and feedback regarding improvement of quality of explanations.
I convey my sincere thanks to my PGEI Delhi staff members Mr Mohit Singh (Manager, PGEI Patna), and Mr Rajesh Jha (Business Development Executive).
Last but not the least I want to thank all my students who appreciated me for my work and motivated me and finally to God who made all the things possible.
I convey my sincere thanks to Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India for their efforts and suggestions, especially Shri Jitendar P Vij (Group Chairman), for helping me through my idea.1314