,RCSI Handbook
of Clinical Surgery
for Finals FOURTH EDITION
Senior Editors
Gozie Offiah
Arnold Hill
, CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2020 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
International Standard Book Number-13: 978-0-367-82093-0 (Hardback)
International Standard Book Number-13: 978-0-367-82085-5 (Paperback)
This book contains information obtained from authentic and highly regarded sources.
While all reasonable efforts have been made to publish reliable data and information,
neither the author[s] nor the publisher can accept any legal responsibility or liability for any
errors or omissions that may be made. The publishers wish to make clear that any views or
opinions expressed in this book by individual editors, authors or contributors are personal
to them and do not necessarily reflect the views/opinions of the publishers. The information
or guidance contained in this book is intended for use by medical, scientific or health-care
professionals and is provided strictly as a supplement to the medical or other professional’s
own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s
instructions and the appropriate best practice guidelines. Because of the rapid advances in
medical science, any information or advice on dosages, procedures or diagnoses should be
independently verified. The reader is strongly urged to consult the relevant national drug
formulary and the drug companies’ and device or material manufacturers’ printed
instructions, and their websites, before administering or utilizing any of the drugs, devices
or materials mentioned in this book. This book does not indicate whether a particular
treatment is appropriate or suitable for a particular individual. Ultimately it is the sole
responsibility of the medical professional to make his or her own professional judgements,
so as to advise and treat patients appropriately. The authors and publishers have also
attempted to trace the copyright holders of all material reproduced in this publication and
apologize to copyright holders if permission to publish in this form has not been obtained. If
any copyright material has not been acknowledged please write and let us know so we may
rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted,
reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other
means, now known or hereafter invented, including photocopying, microfilming, and
recording, or in any information storage or retrieval system, without written permission
from the publishers.
For permission to photocopy or use material electronically from this work, please access
www.copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center,
Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit
organization that provides licenses and registration for a variety of users. For organizations that
have been granted a photocopy license by the CCC, a separate system of payment has been
arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and
are used only for identification and explanation without intent to infringe.
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the CRC Press Web site at
http://www.crcpress.com
ation: General
,Contents
Eponymous Microvignette 7
Chapter 1 Principles of Surgery 9
Chapter 2 Hernias 33
Chapter 3 Upper Gastrointestinal Surgery 47
Chapter 4 Hepatobiliary Surgery 73
Chapter 5 Colorectal Surgery 99
Chapter 6 Inflammatory Bowel Disease 139
Chapter 7 Peripheral Vascular Disease 153
Chapter 8 Breast Disorders 179
Chapter 9 Endocrine Disorders 193
Chapter 10 Urology 219
Chapter 11 Cardiothoracic Surgery 241
Chapter 12 Major Trauma 253
Chapter 13 Plastic Surgery 269
Chapter 14 Orthopaedic Surgery 291
Chapter 15 Neurosurgery 315
Chapter 16 Otorhinolaryngology (ENT) 335
References 364
3
,Senior Editors:
Prof Arnold Hill
Head of School of Medicine and Professor of Surgery,
Royal College of Surgeons in Ireland
Dr Gozie Offiah
Senior Lecturer in Surgery, Royal College of Surgeons in Ireland
Text and Image Editors:
Dr Roisin Tully – Clinical Lecturer, Royal College of Surgeons in Ireland
Dr Ryan Roopnarinesingh - Clinical Tutor, Royal College of Surgeons in Ireland
Illustrators: Authors:
Dr Kevin Quinlan Dr Joan Lennon
Dr Eoin Kelleher Dr Michael Quirke
Mr Firas Ayoub
Contributors: Dr Roisin Tully
Dr Tahir Abbasi Dr Ryan Roopnarinesingh
Mr Waqas Butt Dr Melanie Cunningham
Mr Edrin Iskander Dr Raluca Mitru
Mr Ghazi Ismael Dr Arielle Coomara
Mr Moataz Khogali Dr Daniel Creegan
Dr Kulsoom Nizami Dr Nauar Knightly
Mr Monim Salih Dr Donata Lankaite
Dr Anneela Shah Dr Celia Fernandez
Mr Igor Soric Dr Emily Rutherford
Dr Emma Tong Dr Evan Fahy
Dr Mark Twyford Dr Jill Mulrain
Mr Thavakumar Subramaniam Mr Mohammed Ben Husien
Mr Prasanna K Venkatesh Dr Rachel Wu
Dr Hind Zaidan Mr Nawar Masarani
Mr Ahmed Hussain Dr Sherif Mamdouh
Dr Lindi Snyman
Dr Eilish Galvin
Dr Sheila Duggan Consultant Expert Reviewers:
Dr Fiona Kiernan Prof Frank Cunningham
Dr Carolyn Power Prof Raghu Varadarajan
Dr Kevin Quinlan Prof Martin Corbally
Dr Daniel Kane Mr Peter Naughton
Mr Enda Hannan Dr Criona Walshe
Mr Anthony Hoban Mr Barry O’Sullivan
Mr Wail Mohammed Prof James Paul O’Neill
Dr Azlena Ali Beegan Mr Colm Power
Dr Niamh Adams Prof Tom Walsh
Dr Cyrille Payne Prof Ciaran Bolger
Mr Amr HA Nour Prof Frank Murray
Mr Peter O’Leary Dr Aoibhlinn O’Toole
Mr Andrew Coveney Prof John O’Byrne
Dr Liz Concannon Mr Niall Davis
Dr Gerard Kelly Mr Seamus McHugh
Dr Ciaran Stanley Mr Muhammad Hamid Majeed
4
, Preface
The RCSI Handbook of Clinical Surgery for Finals is designed for RCSI medical
students in their final year attending the three RCSI medical schools in Dublin,
Bahrain and Malaysia; with the objective of addressing the knowledge and skills
that a student needs to pass surgery final medical year exams. These core
knowledge and skills are the same needed to be a competent doctor in clinical
practice. There has been excellent feedback from the first three editions of the
book from students in RCSI and other Irish medical schools.
This new edition of the RCSI Handbook of Clinical Surgery for Finals was reviewed
by several experts in the individual specialities. We have also added relevant
surgical anatomy to the chapters that will be useful and will add context to your
reading. This RCSI Handbook of Clinical Surgery for Finals should be used as an
adjunct to all clinical attachments and formal taught programme material. It has
been designed as a handbook, rather than a textbook, so as to be useful at the
patient bedside and in the library. We are proud to be part of the RCSI Handbook
of Clinical Surgery for Finals and wish you the best of luck with your final exams.
Arnold Hill & Gozie Offiah
July 2019
5
of Clinical Surgery
for Finals FOURTH EDITION
Senior Editors
Gozie Offiah
Arnold Hill
, CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2020 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
International Standard Book Number-13: 978-0-367-82093-0 (Hardback)
International Standard Book Number-13: 978-0-367-82085-5 (Paperback)
This book contains information obtained from authentic and highly regarded sources.
While all reasonable efforts have been made to publish reliable data and information,
neither the author[s] nor the publisher can accept any legal responsibility or liability for any
errors or omissions that may be made. The publishers wish to make clear that any views or
opinions expressed in this book by individual editors, authors or contributors are personal
to them and do not necessarily reflect the views/opinions of the publishers. The information
or guidance contained in this book is intended for use by medical, scientific or health-care
professionals and is provided strictly as a supplement to the medical or other professional’s
own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s
instructions and the appropriate best practice guidelines. Because of the rapid advances in
medical science, any information or advice on dosages, procedures or diagnoses should be
independently verified. The reader is strongly urged to consult the relevant national drug
formulary and the drug companies’ and device or material manufacturers’ printed
instructions, and their websites, before administering or utilizing any of the drugs, devices
or materials mentioned in this book. This book does not indicate whether a particular
treatment is appropriate or suitable for a particular individual. Ultimately it is the sole
responsibility of the medical professional to make his or her own professional judgements,
so as to advise and treat patients appropriately. The authors and publishers have also
attempted to trace the copyright holders of all material reproduced in this publication and
apologize to copyright holders if permission to publish in this form has not been obtained. If
any copyright material has not been acknowledged please write and let us know so we may
rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted,
reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other
means, now known or hereafter invented, including photocopying, microfilming, and
recording, or in any information storage or retrieval system, without written permission
from the publishers.
For permission to photocopy or use material electronically from this work, please access
www.copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center,
Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit
organization that provides licenses and registration for a variety of users. For organizations that
have been granted a photocopy license by the CCC, a separate system of payment has been
arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and
are used only for identification and explanation without intent to infringe.
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the CRC Press Web site at
http://www.crcpress.com
ation: General
,Contents
Eponymous Microvignette 7
Chapter 1 Principles of Surgery 9
Chapter 2 Hernias 33
Chapter 3 Upper Gastrointestinal Surgery 47
Chapter 4 Hepatobiliary Surgery 73
Chapter 5 Colorectal Surgery 99
Chapter 6 Inflammatory Bowel Disease 139
Chapter 7 Peripheral Vascular Disease 153
Chapter 8 Breast Disorders 179
Chapter 9 Endocrine Disorders 193
Chapter 10 Urology 219
Chapter 11 Cardiothoracic Surgery 241
Chapter 12 Major Trauma 253
Chapter 13 Plastic Surgery 269
Chapter 14 Orthopaedic Surgery 291
Chapter 15 Neurosurgery 315
Chapter 16 Otorhinolaryngology (ENT) 335
References 364
3
,Senior Editors:
Prof Arnold Hill
Head of School of Medicine and Professor of Surgery,
Royal College of Surgeons in Ireland
Dr Gozie Offiah
Senior Lecturer in Surgery, Royal College of Surgeons in Ireland
Text and Image Editors:
Dr Roisin Tully – Clinical Lecturer, Royal College of Surgeons in Ireland
Dr Ryan Roopnarinesingh - Clinical Tutor, Royal College of Surgeons in Ireland
Illustrators: Authors:
Dr Kevin Quinlan Dr Joan Lennon
Dr Eoin Kelleher Dr Michael Quirke
Mr Firas Ayoub
Contributors: Dr Roisin Tully
Dr Tahir Abbasi Dr Ryan Roopnarinesingh
Mr Waqas Butt Dr Melanie Cunningham
Mr Edrin Iskander Dr Raluca Mitru
Mr Ghazi Ismael Dr Arielle Coomara
Mr Moataz Khogali Dr Daniel Creegan
Dr Kulsoom Nizami Dr Nauar Knightly
Mr Monim Salih Dr Donata Lankaite
Dr Anneela Shah Dr Celia Fernandez
Mr Igor Soric Dr Emily Rutherford
Dr Emma Tong Dr Evan Fahy
Dr Mark Twyford Dr Jill Mulrain
Mr Thavakumar Subramaniam Mr Mohammed Ben Husien
Mr Prasanna K Venkatesh Dr Rachel Wu
Dr Hind Zaidan Mr Nawar Masarani
Mr Ahmed Hussain Dr Sherif Mamdouh
Dr Lindi Snyman
Dr Eilish Galvin
Dr Sheila Duggan Consultant Expert Reviewers:
Dr Fiona Kiernan Prof Frank Cunningham
Dr Carolyn Power Prof Raghu Varadarajan
Dr Kevin Quinlan Prof Martin Corbally
Dr Daniel Kane Mr Peter Naughton
Mr Enda Hannan Dr Criona Walshe
Mr Anthony Hoban Mr Barry O’Sullivan
Mr Wail Mohammed Prof James Paul O’Neill
Dr Azlena Ali Beegan Mr Colm Power
Dr Niamh Adams Prof Tom Walsh
Dr Cyrille Payne Prof Ciaran Bolger
Mr Amr HA Nour Prof Frank Murray
Mr Peter O’Leary Dr Aoibhlinn O’Toole
Mr Andrew Coveney Prof John O’Byrne
Dr Liz Concannon Mr Niall Davis
Dr Gerard Kelly Mr Seamus McHugh
Dr Ciaran Stanley Mr Muhammad Hamid Majeed
4
, Preface
The RCSI Handbook of Clinical Surgery for Finals is designed for RCSI medical
students in their final year attending the three RCSI medical schools in Dublin,
Bahrain and Malaysia; with the objective of addressing the knowledge and skills
that a student needs to pass surgery final medical year exams. These core
knowledge and skills are the same needed to be a competent doctor in clinical
practice. There has been excellent feedback from the first three editions of the
book from students in RCSI and other Irish medical schools.
This new edition of the RCSI Handbook of Clinical Surgery for Finals was reviewed
by several experts in the individual specialities. We have also added relevant
surgical anatomy to the chapters that will be useful and will add context to your
reading. This RCSI Handbook of Clinical Surgery for Finals should be used as an
adjunct to all clinical attachments and formal taught programme material. It has
been designed as a handbook, rather than a textbook, so as to be useful at the
patient bedside and in the library. We are proud to be part of the RCSI Handbook
of Clinical Surgery for Finals and wish you the best of luck with your final exams.
Arnold Hill & Gozie Offiah
July 2019
5
