Book Book

Surgical Emergencies

BMJ 1999; 319 doi: (Published 28 August 1999) Cite this as: BMJ 1999;319:584
  1. Roger Saadia, professor of surgery
  1. University of the Witwatersrand, Johannesburg, South Africa

    Eds John Monson, Kevin O'Malley

    Blackwell Science, £75, pp 448

    ISBN 0632 050 470

    Rating: Embedded ImageEmbedded ImageEmbedded ImageEmbedded Image

    The past two decades have seen rapid advances in the diagnosis and treatment of surgical emergencies. These can be accounted for by both technological progress and conceptual developments. Examples of technological advances include the inroads of laparoscopy, previously the monopoly of gynaecologists, into general surgery and the expanding field of radiological imaging. Conceptual progress may initially seem less dramatic but is perhaps even more important. It has taken several forms, such as the better definition of old entities—for example, the systemic inflammatory response syndrome (SIRS) or the new terminology describing the local complications of acute pancreatitis—and the challenging of traditional dogma—such as non-operative management of severe liver injuries or gunshot wounds of the abdomen.

    Of course, technological and conceptual progress are closely interrelated and impact on each other. The distinction between infected or non-infected pancreatic necrosis would have remained clinically meaningless without the technique of image guided fine needle aspiration of the necrotic tissue and bacteriological analysis. Overall, progress in the management of acutely ill (or injured) surgical patients is to be measured, at least partially, not in how much less aggressive we have become but how much less invasive, sparing our patients dangerous diagnostic procedures or unnecessary operations.

    This book has certainly succeeded in each of its chapters in accounting for the modern developments in surgical emergencies and trauma. Of course, one could disagree with the occasional (usually small) point This is a reflection on the persistence of controversies in surgery despite the steady advance of evidence based medicine. I was particularly impressed by the book's appropriate blending of sound and trusted clinical principles with advice on how best to investigate and treat a given clinical situation, at a time when options have been multiplied and complicated by refinements in technology. The chapters on trauma have refreshingly transcended the basic approach taught in the advanced trauma life support (ATLS) programme and provide useful algorithms even for the practised surgeon. The illustrations (photographs and drawings) are of an extremely high standard.


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