Maingot

Operaciones
abdominales
D E G I M O P R I M E R A EDICIN

MAINGOT

Operaciones
abdominales
DEGIMOPRIMERA

EDICIN

Jferny Aguado Vattico

Editores:

. .
.
,
RESIDENTE CIRUGIA GENERAL
MichaelJ. Zinner, M D , ACS
37559
Surgeon-in-Chief and Chairman
D e p a r t m e n t o f Surgery
Brigham and Women's Hospital
Clinical Director
D a n a - F a r b e r / B r i g h a m a n d W o m e n ' s Cncer C e n t e r
Moseley Professor o f Surgery
Harvard Medical School
B o s t o n , Massachusetts
M

Stanley W. Ashley, M D , FACS

Snior S u r g e o n a n d V i c e C h a i r m a n
D e p a r t m e n t o f Surgery
Brigham and Women's Hospital
Staff S u r g e o n
D a n a - F a r b e r / B r i g h a m a n d W o m e n ' s Cncer C e n t e r
Sawyer Professor o f Surgery
Harvard Medical School
B o s t o n , Massachusetts
Traduccin:
R. G a b r i e l a L e n Jimnez
B e r n a r d o Rivera Muoz

c
G r a w

MXICO BOGOT BUENOS AIRES CARACAS GUATEMALA LISBOA

MADRID NUEVA YORK SAN JUAN SANTIAGO
A U C K L A N D L O N D R E S MILN M O N T R E A L N U E V A D E L H I
S A N F R A N C I S C O S I D N E Y S I N G A P U R ST. L O U I S T O R O N T O

Editor sponsor: Javier de Len Fraga

Correccin de estilo: Luis A r t u r o Leero Leal e Ignacio Snchez H e r r e r a
Supervisor de edicin: Ansberto H o r a c i o Contreras Coln
Supervisor de produccin: Jos Luis Gonzlez H u e r t a

NOTA

La medicina es una ciencia en constante desarrollo. Conforme surjan nuevos conocimientos, se requerirn cambios
de la teraputica. El (los) autor(es) y los editores se han esforzado para que los cuadros de dosificacin medicamentosa sean precisos y acordes con lo establecido en la fecha de publicacin. Sin embargo, ante los posibles errores
humanos y cambios en la medicina, ni los editores ni cualquier otra persona que haya participado en la preparacin
de la obra garantizan que la informacin contenida en ella sea precisa o completa, tampoco son responsables de
errores u omisiones, ni de los resultados que con dicha informacin se obtengan. Convendra recurrir a otras fuentes de datos, por ejemplo, y de manera particular, habr que consultar la hoja informativa que se adjunta con cada
medicamento, para tener certeza de que la informacin de esta obra es precisa y no se han introducido cambios
en la dosis recomendada o en las contraindicaciones para su administracin. Esto es de particular Importancia con'
respecto a frmacos nuevos o de uso no frecuente. Tambin deber consultarse a los laboratorios para recabar
informacin sobre los valores normales.

MAINGOT. OPERACIONES ABDOMINALES

Prohibida la reproduccin total o parcial de esta obra,
por cualquier medio, sin autorizacin escrita del editor.

Educacin
D E R E C H O S R E S E R V A D O S 2008, respecto a la primera edicin en espaol por,
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COLABORADORES
James W. Fleshman, Jr., M D
Chief, Secton o f C o l o n a n d Rectal Surgery
Professor o f Surgery
D e p a r t m e n t o f Surgery
W a s h i n g t o n University S c h o o l o f M e d i c i n e
St. L o u i s , M i s s o u r i

Yuman Fong, M D
M u r r a y F. B r e n n a n C h a i r i n Surgery
D e p a r t m e n t o f Surgery
M e m o r i a l Sloan-Kettering Cncer C e n t e r
N e w York, N e w York

FrankA. Frizelle, M B ChB, MMedSc, FRACS, FACS

Professor o f Colorectal Surgery
Colorectal U n i t
D e p a r t m e n t o f Surgery
Christchurch Hospital
Christchurch, New Zealand

;
Robert D. Fry, M D
E m i l i e a n d R o l a n d T. d e H e l l e n b r a n t h Professor o f
Surgery
Chief, Divisin o f C o l o n a n d Rectal Surgery
University o f Pennsylvania
P h i l a d e l p h i a , Pennsylvania

Thomas R. Gadacz, M D
C h a r b o n n i e r Professor
D e p a r t m e n t o f Surgery
M e d i c a l College o f G e o r g i a
Evans, G e o r g i a

Atul A. Gawande, M D , M P H
Surgeon
Brigham and Women's Hospital
Assistant Professor o f Surgery
Harvard Medical School
Boston, Massachusetts

Caprice C. Greenberg, M D , M P H
Associate Surgeon
Brigham and Women's Hospital
Instructor i n Surgery
Harvard Medical School
Boston^ Massachusetts

J . Michael Henderson, M B ChB, FRCS

Professor o f Surgery
Cleveland C l i n i c L e r n e r College o f M e d i c i n e o f Case
Western Reserve University
C h a i r m a n , D e p a r t m e n t o f G e n e r a l Surgery
T h e Cleveland C l i n i c F o u n d a t i o n
Cleveland, O h i o

Oscar Joe Hies, M D

Section o f Gastrointestinal Surgery
David Geffen S c h o o l o f M e d i c i n e
University o f C a l i f o r n i a at L o s Angeles
L o s Angeles, C a l i f o r n i a
Scott G . Houghton, M D
Research Fellow
D e p a r t m e n t o f Surgery
Gastroenterology Research U n i t
Mayo C l i n i c College o f M e d i c i n e
Rochester, M i n n e s o t a
Ralph H . Hruban, M D
D e p a r t m e n t o f Pathology
T h e J o h n s H o p k i n s M e d i c a l Institutions
Baltimore, Maryland
John G . Hunter, M D
M a c k e n z i e Professor a n d C h a i r
D e p a r t m e n t o f Surgery
O r e g o n H e a l t h a n d Science University
Portland, Oregon
Roger D. Hurst, M D
Associate Professor o f Surgery
University o f C h i c a g o
Pritzker S c h o o l o f M e d i c i n e
C h i c a g o , Illinois
Danny O . Jacobs, M D , M P H
Professor a n d C h a i r m a n
D e p a r t m e n t o f Surgery
D u k e University M e d i c a l C e n t e r
Durham, North Carolina
Patrick J . Javid, M D
D e p a r t m e n t o f Surgery
Brigham and Women's Hospital
C l i n i c a l Fellow i n Surgery
Harvard Medical School
Boston, Massachusetts
Andreas M . Kaiser, M D , FACS
Assistant Professor o f C l i n i c a l Surgery
D e p a r t m e n t o f Colorectal Surgery
Keck School of Medicine
University o f S o u t h e r n C a l i f o r n i a
L o s Angeles, C a l i f o r n i a
Edward Kelly, M D , FACS
Associate Surgeon
Brigham and Women's Hospital
Assistant Professor o f Surgery
Harvard Medical School
Boston, Massachusetts

ix

CONTENIDO
Colaboradores

vii

Prefacio

xv

SECCIN I. INTRODUCCIN

12. C o m p l i c a c i o n e s de lcera
Timothy J. Broderick /Jeffrey B. Matthews

13. Estmago y d u o d e n o : p r o c e d i m i e n t o s
operatorios
377
Subroto Paul /David I. Soy bel / MichaelJ. Zinner

1. U n a historia enfocada de l a ciruga

Seymourl. Schwartz

14. A d e n o c a r c i n o m a gstrico
Murray F. Brennan

2. M a n e j o preoperatorio y posoperatorio
Zara Cooper / Edward Kelly

15. T u m o r e s d e l estroma gastrointestinal

Monica M. Bertagnolli

3. E n d o s c o p i a e intervencin endoscpica
Edward Lin / Aaron S. Fink

35

16. O b e s i d a d mrbida y sus operaciones

Danny O. Jacobs / Malcolm K Robinson

417
439 .
455

m SECCIN V. INTESTINO DELGADO Y COLON

m SECCIN II. PARED ABDOMINAL

4. Incisiones, cierres y manejo de l a h e r i d a
e n el a b d o m e n
Bryan M. Burt / Ali Tavakkolizadeh /
Stephen J. Ferzoco

353

71

17. Obstruccin intestinal

479
Scott G. Houghton / Antonio Ramos de la Medina /
Michael G. Sarr

5. H e r n i a s
Patrick J. Javid / David C. Brooks

103

18. E n f e r m e d a d diverticular d e l c o l o n
Angus J. M. Watson /Frank A. Frizelle

509

6. Estomas intestinales
Ira J. Kodner / Thomas E. Read

141

19. E n f e r m e d a d de C r o h n
Fabrizio Michelassi / RogerD. Hurst /
Alessandro Fichera

521

20. Colitis ulcerosa

James M. Becker / ArthurF. Stucchi

551

21. Apndice y apendicectoma

Douglas S. Smink /David I. Soybel

589

22. T u m o r e s d e l intestino delgado

Douglas Turner / Barbara Lee Bass

613

23. T u m o r e s d e l c o l o n
Andreas M. Kaiser/Joseph W. Nunoo-Mensah /
RobertW. Beart.Jr.

625

7. Absceso a b d o m i n a l y fstula entrica

179
Amy R. Evenson / Gautam Shrikhande /JosefE. Fischer

u SECCIN III. ESFAGO

8. Trastornos esofgicos benignos
Todd Woltman / Brant K Oelschlager

203

8A. E n f e r m e d a d p o r reflujo gastroesofgico

Thadeus L. Trus / Jeffrey H. Peters

231

9. Cncer d e l esfago
Simn Law/John Wong
10. P r o c e d i m i e n t o s quirrgicos para resecar
y reemplazar e l esfago
Philip A. Linden /David J. Sugarbaker

271

u SECCIN VI. RECTO Y ANO

305

SECCIN IV. ESTMAGO Y DUODENO

11. Trastornos gstricos benignos
Michael W. Mulholland / Diane M. Simeone

333

24. Trastornos benignos d e l anorrecto (piso de

la pelvis, fisuras, hemorroides, fstulas)
Jennifer K Lowney /James W. Fleshmanjr.

663

25. Cncer d e l recto

Kimberly Moore Dalal /Ronald Bleday

693

26. Cncer d e l ano

Najjia N. Mahmoud / Robert D. Fry

727

Vi

CONTENIDO

27. C o m p l i c a c i o n e s de intervencin
quirrgica a n o r r e c t a l
Mark Lae Welton / AndrewA. Shelton

747

41. Cncer d e l pncreas y otros cnceres

periampollares
Richard D. Schulick / John L. Cameron
42. T u m o r e s e n d o c r i n o s d e l pncreas
BuckminsterJ. Farrow/James C. Thompson /
Courtney M. Townsend, Jr. / B. Mark Evers

u SECCIN VII. HGADO

28. Absceso heptico y e n f e r m e d a d qustica
del hgado
Kathleen K Christians / Henry A. Pitt

757

m SECCIN X. BAZO

29. Neoplasias hepticas primarias benignas

y malignas
PeterJ. Alien / Yuman Fong

783

43. E l bazo
Gina Adrales / Thomas R Gadacz

30. Metstasis colorrectales (reseccin, bombas, ablacin c o n radiofrecuencia y crioablacin)

813
Richard S. Swanson
31. Hipertensin p o r t a l
/. Michael Henderson

1031
1055

1075

SECCIN XI. CIRUGA DE MNIMA

INVASIN

831
44. F u n d a m e n t o s de l a intervencin quirrgica
laparoscpica
Ashley Haralson Vernon /John G. Hunter

u SECCIN VIII. VESCULA Y CONDUCTOS BILIARES

1099

32. Colecistectoma (abierta y laparoscpica)

AlexanderP. Nagle / NathanielJ. Soper /
James R Hies

847

45. Vas biliares

Ketan R. Sheth / Ricardo M. Bonnor /
Theodore N. Pappas

1125

33. Coledocoliasis y colangitis

David W. McFadden / Ankesh Nigam

865

46. Reparacin de h e r n i a
Bardia Amirlak / Sumeet K. Mittal /
RobertJ. Fitzgibbons, Jr.

889

35. Cncer de la vescula y los conductos biliares . . . . 921

Edward E. Whang / MichaelJ. Zinner

47. Reseccin d e l intestino d e l g a d o / c o l o n

Michael M. Davies / Heidi Nelson
48. Reparacin de h e r n i a hiatal y
miotoma de H e l l e r
Ashley Haralson Vernon /John G. Hunter

1151

34. Quiste d e l c o l d o c o y estrecheces biliares

Genevieve B. Melton / Keith D. Lillemoe

1183

m SECCIN IX. PNCREAS

49. Esplenectoma laparoscpica

Capuce C. Greenberg / Ali Tavakkolizadeh /
David C. Brooks

36. M a n e j o de l a pancreatitis aguda

Thomas E. Clancy / Stanley W. Ashley
37. C o m p l i c a c i o n e s de pancreatitis agela
(incluso seudoquistes)
John A. Windsor / Patrick Schweder

939

961

38. Pancreatitis crnica

OscarJoe Hies / Howard A. Reber

983

39. Trastornos de las ampollas d u o d e n a l e s

Michael Rosen / Andrew L. Warshaw

999

40. Neoplasias qusticas d e l pncreas

1015
ChristopherJ. Sonnenday / Michael R. Marohn /
Ralph H. Hruban / Charles J. Yeo

1113

1169

50. Intervencin quirrgica torcica videoasistida

(VATS) d e l esfago
1191
Michael S. Kent /James D. Luketich
51. Adrenalectoma laparoscpica
AtulA. Gawande /FrancisD. Moore,Jr.
52. Ciruga laparoscpica para obesidad
mrbida
Stacy A. Brethauer / Bipan Chand /
Philip R. Schauer

1205

1217

53. Estadificacin y derivacin

laparoscpicas
Kevin C. P. Conbn / Angela T. Riga

1245

ndice alfabtico

1267

COLABORADORES
Gina Adrales, M D
Assistant Professor of Surgery
D e p a r t m e n t o f Surgery
M e d i c a l College o f G e o r g i a
Augusta, G e o r g i a

PeterJ. Alien, M D
Associate Professor of Surgery
D e p a r t m e n t o f Surgery
M e m o r i a l Sloan-Kettering Cncer C e n t e r
N e w York, N e w York

Bardia Amirlak, M D
D e p a r t m e n t o f Surgery
C r e i g h t o n University S c h o o l o f M e d i c i n e
Omaha, Nebraska

Stanley W. Ashley, M D , FACS

Snior S u r g e o n a n d V i c e C h a i r m a n
D e p a r t m e n t o f Surgery
Brigham and Women's Hospital
Staff S u r g e o n
D a n a - F a r b e r / B r i g h a m a n d W o m e n ' s Cncer C e n t e r
Sawyer Professor o f Surgery
Harvard Medical School
Boston, Massachusetts

Barbara Lee Bass, M D , FACS

J o h n F. a n d C a r o l y n B o o k o u t Distinguished
Endowed Chair
D e p a r t m e n t of Surgery
The Methodist Hospital
H o u s t o n , Texas

Robert W. Beart, Jr., M D , FACS

D e p a r t m e n t of C o l o r e c t a l Surgery
Keck School of Medicine
University o f S o u t h e r n C a l i f o r n i a
L o s Angeles, C a l i f o r n i a

James M . Becker, M D , FACS

James U t l e y Professor o f Surgery
Chairman and Surgeon-in-Chief
D e p a r t m e n t of Surgery
Boston University M e d i c a l C e n t e r
Boston, Massachusetts

Monica M . Bertagnolli, M D
Associate Surgeon
Brigham and Women's Hospital
C e n t e r for Sarcoma a n d B o n e O n c o l o g y
Dana-Farber Cncer Instute
Associate Professor of Surgery
Harvard Medical School
Boston, Massachusetts

Ronald Bleday, M D
Chief, Divisin of C o l o n a n d Rectal Surgery
Brigham and Women's Hospital
Associate Professor of Surgery
Harvard Medical School
Boston, Massachusetts

Ricardo M . Bonnor, M D
C l i n i c a l Associate
D u k e University M e d i c a l C e n t e r
Durham, North Carolina

Murray F. Brennan, M D
C h a i r m a n , D e p a r t m e n t of Surgery
M e m o r i a l Sloan-Kettering Cncer C e n t e r
Professor o f Surgery
W e i l l M e d i c a l College of C o r n e l l University
New York, N e w York

Stacy A. Brethauer, M D
A d v a n c e d Laparoscopic a n d Bariatric Surgery
D e p a r t m e n t of G e n e r a l Surgery
The Cleveland Clinic Foundation
Cleveland, O h i o

Timothy J . Broderick, M D , FACS

Associate Professor of Surgery a n d B M E
Chief, Divisin of Gastrointestinal a n d E n d o c r i n e
Surgery
University of C i n c i n n a t i College of M e d i c i n e
Cincinnati, O h i o

David C. Brooks, M D
Snior S u r g e o n
Director, M i n i m a l l y Invasive Surgery
Brigham and Women's Hospital
Associate Professor o f Surgery
Harvard Medical School
Boston, Massachusetts
vii

Vi

COLABORADORES

Bryan M . Burt, M D
D e p a r t m e n t o f Surgery
Brigham and Women's Hospital
C l i n i c a l Fellow i n Surgery
Harvard Medical School
B o s t o n , Massachusetts

John L. Cameron, M D , FACS

A l f r e d B l a l o c k D i s t i n g u i s h e d Service Professor
D e p a r t m e n t o f Surgery
T h e J o h n s H o p k i n s M e d i c a l Institutions
Baltimore, Maryland

Bipan Chand, M D
Director, Surgical E n d o s c o p y
D e p a r t m e n t o f G e n e r a l Surgery
The Cleveland Clinic Foundation
Cleveland, O h i o
Kathleen K Christians, M D
Associate Professor o f Surgery
D e p a r t m e n t o f Surgery
M e d i c a l College o f W i s c o n s i n
Milwaukee, Wisconsin

Thomas E . Clancy, M D
Associate S u r g e o n
Brigham and Women's Hospital
Instructor i n Surgery
Harvard Medical School
B o s t o n , Massachusetts

Kevin C. P. Conlon, M B , MA, M C h , MBA, FACS, FRCSI

Professorial S u r g i c a l U n i t
The Adelaide and Meath Hospital
The National Children's Hospital D u b l i n
University o f D u b l i n - T r i n i t y College D u b l i n
Dublin, Ireland

Zara Cooper, M D
D e p a r t m e n t o f Surgery
Brigham and Women's Hospital
Harvard Medical School
B o s t o n , Massachusetts

Kimberly Moore Dalal, M D

Surgical O n c o l o g y Fellow
M e m o r i a l Sloan-Kettering Cncer C e n t e r
N e w York, N e w Y o r k

Michael M . Davies, MS, FRCS

Divisin o f C o l o n a n d Rectal Surgery
Mayo Clinic and Medical Center
Rochester, M i n n e s o t a

Amy R. Evenson, M D
D e p a r t m e n t o f Surgery
B e t h Israel Deaconess M e d i c a l C e n t e r
B o s t o n , Massachusetts

B. Mark Evers, M D
Professor a n d Robertson-Poth D i s t i n g u i s h e d C h a i r i n
G e n e r a l Surgery
D e p a r t m e n t o f Surgery
T h e University o f Texas M e d i c a l B r a n c h
Galveston, Texas

Bucknhster J . Farrow, M D
D e p a r t m e n t o f Surgery
T h e University o f Texas M e d i c a l B r a n c h
Galveston, Texas

Stephen J . Ferzoco, M D
Assistant C h i e f o f Surgery
Faulkner Hospital
Associate S u r g e o n
Brigham and Women's Hospital and Faulkner Hospital
Assistant Professor o f Surgery
Harvard Medical School
Boston, Massachusetts

Alessandro Fichera, M D
Assistant Professor o f Surgery
University o f Chicago
Pritzker S c h o o l of M e d i c i n e
C h i c a g o , Illinois

Aaron S. Fink, M D
Professor o f Surgery
E m o r y University S c h o o l o f M e d i c i n e
Manager, Surgical a n d Perioperative Care
A t l a n t a Veterans Affairs M e d i c a l C e n t e r
Decatur, G e o r g i a

Josef E . Fischer, M D , FACS

M a l l i n c k r o d t Professor o f Surgery
Harvard Medical School
B o s t o n , Massachusetts;
Chair, D e p a r t m e n t o f Surgery
Surgeon-in-Chief
B e t h Israel Deaconess M e d i c a l C e n t e r
B o s t o n , Massachusetts

Robert J . Fitzgibbons, Jr., M D , FACS

H a r r y E . Stuckenhoff Professor o f Surgery
Associate C h a i r m a n , D e p a r t m e n t o f Surgery
C h i e f , Divisin o f G e n e r a l Surgery
C r e i g h t o n University School o f M e d i c i n e
O m a h a , Nebraska

COLABORADORES

Michael S. Kent, M D
C l i n i c a l Instructor
Divisin o f T h o r a c i c a n d Foregut Surgery
University o f Pittsburgh M e d i c a l C e n t e r
U M P C Presbyterian
Pittsburgh, Pennsylvania

Ira J . Kodner, M D , FACS, FASCRS

Soln & Bettie G e r s h m a n Professor o f Surgery
Section o f C o l o n a n d Rectal Surgery
W a s h i n g t o n University S c h o o l o f M e d i c i n e
St. L o u i s , M i s s o u r i ;
D e p a r t m e n t o f Surgery
Barnesjewish Hospital
St. L o u i s , M i s s o u r i

Simn Law, MS, MA(Cantab), MBBChir, FRCS(Edin),

FACS
Professor o f Surgery
D e p a r t m e n t o f Surgery
University o f H o n g K o n g M e d i c a l C e n t r e
Queen Mary Hospital
H o n g K o n g , People's R e p u b l i c o f C h i n a

Keith D. Lillemoe. M D
Jay L . Grosfeld Professor o f Surgery a n d C h a i r m a n
D e p a r t m e n t o f Surgery
I n d i a n a University S c h o o l o f M e d i c i n e
Indianapolis, I n d i a n a

Edward Lin, D O
Assistant Professor o f Surgery
E m o r y Endosurgery U n i t
Divisin o f Gastrointestinal a n d G e n e r a l Surgery
E m o r y University S c h o o l o f M e d i c i n e
Atlanta, Georgia

James D. Luketich, M D
Professor o f Surgery
C h i e f , Divisin o f T h o r a c i c a n d Foregut Surgery
University o f Pittsburgh M e d i c a l C e n t e r
U M P C Presbyterian
Pittsburgh, Pennsylvania

Najjia N . Mahmoud, M D
Assistant Professor o f Surgery
Divisin o f C o l o n a n d Rectal Surgery
University o f Pennsylvania
P h i l a d e l p h i a , Pennsylvania

Michael R. Marohn, D O
D e p a r t m e n t o f Surgery
T h e J o h n s H o p k i n s M e d i c a l Institutions
Baltimore, M a r y l a n d

Jeffrey B. Matthews, M D , FACS

C h r i s t i a n R. H o l m e s Professor o f Surgery
C h a i r m a n , D e p a r t m e n t o f Surgery
University o f C i n c i n n a t i College o f M e d i c i n e
Cincinnati, O h i o

David W. McFadden, M D , FACS

Professor a n d C h a i r m a n
D e p a r t m e n t o f Surgery
West V i r g i n i a University
Surgeon-in-Chief
West V i r g i n i a University H o s p i t a l
M o r g a n t o w n , West V i r g i n i a

Genevieve B. Melton, M D
D e p a r t m e n t o f Surgery
T h e J o h n s H o p k i n s M e d i c a l Institutions
Columbia, Maryland

Philip A. Linden, M D
Surgical Associate, T h o r a c i c Surgery
Divisin o f T h o r a c i c Surgery
Brigham and Women's Hospital
Assistant Professor o f Surgery
Harvard Medical School
B o s t o n , Massachusetts

Fabrizio Michelassi, M D
Lewis A t t e r b u r y Stimson Professor o f Surgery
C h a i r m a n , D e p a r t m e n t o f Surgery
W e i l l M e d i c a l College o f C o r n e l l University
Surgeon-in-Chief
N e w York Presbyterian H o s p i t a l
Weill C o r n e l l Medical Center
N e w York, N e w York

Jennifer K. Lowney, M D
Assistant Professor o f Surgery
Section o f C o l o n a n d Rectal Surgery
W a s h i n g t o n University S c h o o l o f M e d i c i n e
St. L o u i s , M i s s o u r i

Sumeet K. Mittal, M D
Assistant Professor o f Surgery
D e p a r t m e n t o f Surgery
C r e i g h t o n University S c h o o l o f M e d i c i n e
Omaha, Nebraska

COLABORADORES
Francis D . M o o r e , J r . , M D
C h i e f , G e n e r a l a n d Gastrointestinal Surgery
Brigham and Women's Hospital
Professor o f Surgery
Harvard Medical School
Boston, Massachusetts

M i c h a e l W. M u l h o l l a n d , M D , P h D
D e p a r t m e n t o f Surgery
University o f M i c h i g a n
A n n Arbor, Michigan

A l e x a n d e r P. N a g l e , M D
Assistant Professor o f Surgery
Divisin o f G a s t r o i n t e s t i n a l / E n d o c r i n e Surgery
D e p a r t m e n t o f Surgery
N o r t h w e s t e r n University
Feinberg School o f Medicine
C h i c a g o , Illinois

Heidi Nelson, M D
D e p a r t m e n t o f Surgery
Mayo Clinic and Medical Center
Rochester, M i n n e s o t a

Ankesh Nigam, M D , FACS

Associate Professor
Section o f Surgical O n c o l o g y
D e p a r t m e n t o f Surgery
A l b a n y M e d i c a l College
Albany, N e w York

J o s e p h W. N u n o o - M e n s a h , B M B S , F R C S ( E n g )
D e p a r t m e n t o f Surgery
Manchester Royal I n f i r m a r y
Manchester, U n i t e d K i n g d o m

B r a n t K. Oelschlager, M D
T h e Swallowing C e n t e r a n d
D e p a r t m e n t o f Surgery
T h e University o f W a s h i n g t o n M e d i c a l C e n t e r
Seattle, W a s h i n g t o n

T h e o d o r e N . Pappas, M D , F A C S
Professor, D e p a r t m e n t o f Surgery
D u k e University M e d i c a l C e n t e r
Durham, North Carolina

Subroto P a u l , M D
D e p a r t m e n t o f Surgery
Brigham and Women's Hospital
C l i n i c a l Fellow i n Surgery
B o s t o n , Massachusetts

Jeffrey H . Peters, M D , F A C S
Professor a n d C h a i r m a n
University o f Rochester S c h o o l o f M e d i c i n e a n d
Dentistry
Surgeon-in-Chief
Strong M e m o r i a l H o s p i t a l
D e p a r t m e n t o f Surgery
Rochester, N e w York

Henry A . Pitt, M D
Professor o f Surgery
I n d i a n a University
Indianapolis, I n d i a n a

Antonio Ramos De la Medina, M D

D e p a r t m e n t o f Surgery
M a y o C l i n i c College o f M e d i c i n e
Rochester, M i n n e s o t a

Thomas E . Read, M D , FACS, FASCRS

Chief, Divisin o f C o l o n a n d Rectal Surgery
P r o g r a m Director, C o l o n a n d Rectal Surgery Residency
Western Pennsylvania H o s p i t a l
C l i n i c a l C a m p u s o f Temple University S c h o o l o f
Medicine
Pittsburgh, Pennsylvania;
Associate Professor o f Surgery
T e m p l e University S c h o o l o f M e d i c i n e
P h i l a d e l p h i a , Pennsylvania

Howard A. Reber, M D
Section o f Gastrointestinal Surgery
D a v i d Geffen S c h o o l o f M e d i c i n e
University o f C a l i f o r n i a at L o s Angeles
L o s Angeles, C a l i f o r n i a

Angela T. Riga, M D , MSc, AFRCS

Professorial Surgical U n i t
Royal Surrey H o s p i t a l
G u i l d f o r d , Surrey
United Kingdom

Malcohn K. Robinson, M D
Surgeon
Director, M e t a b o l i c S u p p o r t Service
Director, P r o g r a m for Weight M a n a g e m e n t
Brigham Women's Hospital
Assistant Professor o f Surgery
Harvard Medical School
Boston, Massachusetts

Xi

COLABORADORES

Michael Rosen, M D
G e n e r a l Surgery
Massachusetts G e n e r a l H o s p i t a l
B o s t o n , Massachusetts

Diane M . Simeone, M D
D e p a r t m e n t o f Surgery
University o f M i c h i g a n
A n n Arbor, Michigan

Douglas S. Smink, M D , M P H
D e p a r t m e n t o f Surgery
Brigham and Women's Hospital
Instructor i n Surgery
Harvard Medical School
B o s t o n , Massachusetts

Michael G . Sarr, M D
James C. Masson Professor o f Surgery
D e p a r t m e n t o f Surgery
Gastroenterology Research U n i t
Mayo Clinic College of Medicine
Rochester, M i n n e s o t a

Philip R. Schauer, M D
Director, A d v a n c e d Laparoscopic a n d Bariatric Surgery
D e p a r t m e n t o f G e n e r a l Surgery
T h e Cleveland Clinic Foundation
Cleveland, O h i o

Richard D. Schulick, M D , FACS

Associate Professor o f Surgery, Oncology,
a n d Obstetrics
T h e J o h n s H o p k i n s M e d i c a l Institutions
Baltimore, M a r y l a n d

Gynecology,

Seymour I. Schwartz, M D
Distinguished A l u m n i Professor o f Surgery
University o f Rochester S c h o o l o f M e d i c i n e a n d
Dentistry
Rochester, N e w Y o r k

Patrick Schweder, BA, MA, M B ChB

A u c k l a n d City H o s p i t a l
Grafton, Auckland
New Zealand

Andrew A. Shelton, M D
Assistant Professor
D e p a r t m e n t o f Surgery
Stanford University S c h o o l o f M e d i c i n e
Stanford, C a l i f o r n i a

Retan R. Sheth, M D
C l i n i c a l Associate
D u k e University M e d i c a l C e n t e r
Durham, North Carolina

Gautam Shrikhande, M D
D e p a r t m e n t o f Surgery
B e t h Israel Deaconess M e d i c a l C e n t e r
B o s t o n , Massachusetts

Christopher J . Sonnenday, M D , M H S
D e p a r t m e n t o f Surgery
T h e J o h n s H o p k i n s University S c h o o l o f M e d i c i n e
Baltimore, Maryland

N a t h a n i e l J . Soper, M D
James R. Hies Professor o f Surgery
D e p a r t m e n t o f Surgery
N o r t h w e s t e r n University
Feinberg School of Medicine
C h i c a g o , Illinois

David I. Soybel, M D
Snior Staff Surgeon
Brigham and Women's Hospital
Associate Professor o f Surgery
Harvard Medical School
B o s t o n , Massachusetts

Arthur F. Stucchi, PhD

Associate Research Professor
Departments o f Surgery, Pathology, a n d L a b o r a t o r y
Medicine
B o s t o n University S c h o o l o f M e d i c i n e
B o s t o n , Massachusetts

David J . Sugarbaker, M D
C h i e f , Divisin o f T h o r a c i c Surgery
Brigham and Women's Hospital
P h i l l i p E . L o w e Snior Surgeon
C h i e f , D e p a r t m e n t o f Surgical Services
Dana-Farber Cncer Institute
R i c h a r d E . W i l s o n Professor o f Surgical O n c o l o g y
Harvard Medical School
B o s t o n , Massachusetts

Richard S. Swanson, M D
Snior S u r g e o n
Brigham and Women's Hospital
Associate Professor o f Surgery
Harvard Medical School
B o s t o n , Massachusetts

COLABORADORES X
Ali Tavakkolizadeh, M B , BS
Associate S u r g e o n
Brigham and Women's Hospital
Instructor i n Surgery
Harvard Medical School
Boston, Massachusetts

Mark Lae Welton, MD

Associate Professor
C h i e f , C o l o n a n d Rectal Surgery
D e p a r t m e n t o f Surgery
Stanford University S c h o o l o f M e d i c i n e
Stanford, C a l i f o r n i a

James C. Thompson, M D
A s h b e l S m i t h Professor o f Surgery
D e p a r t m e n t o f Surgery
T h e University o f Texas M e d i c a l B r a n c h
Galveston, Texas

Edward E . Whang, M D
Associate S u r g e o n
Brigham and Women's Hospital
Assistant Professor o f Surgery
Harvard Medical School
B o s t o n , Massachusetts

Courtney M . Townsend, Jr., M D

J o h n Woods Harris Distinguished C h a i r m a n
D e p a r t m e n t o f Surgery
T h e University o f Texas M e d i c a l B r a n c h
Galveston, Texas

Thadeus L . Trus, M D , F R C S ( C )
Associate Professor o f Surgery
D e p a r t m e n t o f Surgery
University o f Rochester S c h o o l o f M e d i c i n e a n d
Dentistry
Rochester, N e w Y o r k

Douglas J . Turner, M D
Assistant Professor o f Surgery
Divisin o f G e n e r a l Surgery
University o f M a r y l a n d M e d i c a l C e n t e r
Baltimore, Maryland

Ashley Haralson Vernon, M D

Associate S u r g e o n
Brigham and Women's Hospital
Instructor i n Surgery
Harvard Medical School
Boston, Massachusetts

A n d r e w L. Warshaw, M D , F A C S
C h a i r m a n , D e p a r t m e n t o f G e n e r a l Surgery
Massachusetts G e n e r a l H o s p i t a l
Boston, Massachusetts

Angus J . M . Watson, B S c , M B C h B , F R C S ( E d i n )
Colorectal U n i t
D e p a r t m e n t o f Surgery
Christchurch Hospital
Christchurch, New Zealand

J o h n A . Windsor, BSc, M B C h B , M D , F R A C S , F A C S
Professor o f Surgery
H e a d , D e p a r t m e n t o f Surgery
Faculty o f M e d i c a l a n d H e a l t h Sciences
University o f A u c k l a n d
A u c k l a n d , N e w Zealand

T o d d Woltman, M D
T h e Swallowing Center a n d
D e p a r t m e n t o f Surgery
T h e University o f Washington M e d i c a l C e n t e r
Seattle, W a s h i n g t o n

J o h n Wong, M D , P h D , F R A C S , FACS
Professor o f Surgery
D e p a r t m e n t o f Surgery
University o f H o n g K o n g M e d i c a l C e n t r e
Queen Mary Hospital
H o n g K o n g , People's R e p u b l i c o f C h i n a

Charles J . Y e o , M D , F A C S
Professor a n d C h a i r m a n
S a m u e l D . Gross
D e p a r t m e n t o f Surgery
T h o m a s Jefferson University
P h i l a d e l p h i a , Pennsylvania

Michael J . Zinner, M D , F A C S
Surgeon-in-Chief and Chairman
D e p a r t m e n t o f Surgery
Brigham and Women's Hospital
Clinical Director
D a n a - F a r b e r / B r i g h a m a n d W o m e n ' s Cncer C e n t e r
Moseley Professor o f Surgery
Harvard Medical School
Boston, Massachusetts

PREFACIO
Maingot, Operarones abdominales, siempre h a l l e n a d o u n n i c h o nico. P a r a m u c h o s cirujanos, incluso los editores, e l
texto h a b r i n d a d o constantemente u n a exposicin exhaustiva de las enfermedades quirrgicas d e l a b d o m e n , c o n u n
enfoque e n l a estrategia y l a tcnica operatorias. E l l i b r o
h a servido c o m o u n a referencia necesaria p a r a refrescar
nuestros c o n o c i m i e n t o s antes de u n a operacin frecuente, o e n preparacin p a r a u n a novedosa. Esta edicin es
para e l m i s m o g r u p o de lectores que a q u e l a l c u a l i b a d i rigida l a publicacin original: e l aprendiz de ciruga, as
c o m o e l c i r u j a n o e n ejercicio. Es u n h o n o r y u n privilegio
tener l a o p o r t u n i d a d de editar l a d e c i m o p r i m e r a edicin
de este tratado clsico.
Es evidente que l a ciruga a b d o m i n a l h a cambiado desde l a p r i m e r a edicin de R o d n e y M a i n g o t , p u b l i c a d a e n
1940. N o slo nuestra base de c o n o c i m i e n t o h a a u m e n t a d o
de m a n e r a considerable, sino que los p r o c e d i m i e n t o s e n s
se h a n h e c h o ms complejos. L a subespecializacin actual
e n l a ciruga a b d o m i n a l , consecuencia de estos cambios,
podra incluso p o n e r e n tela de j u i c i o l a necesidad de u n
tratado tan c o m p l e t o . L a e n f e r m e d a d a b d o m i n a l se est d i v i d i e n d o ms entre cirujanos d e l intestino anterior, h e p a tobiliares, pancreticos, colorrectales, e n d o c r i n o s , vasculares y los que practican intervenciones quirrgicas de mn i m a invasin. P a r a esta edicin, hemos r e c o n o c i d o esta
especializacin, y decidimos e l i m i n a r secciones acerca de
traumatismo y vasculopata d e l a b d o m e n , y e n lugar de eso
nos h e m o s concentrado en trastornos d e l tracto gastrointestinal. S i n embargo, seguimos creyendo que p a r a las e n fermedades digestivas, los p r i n c i p i o s bsicos d e l c u i d a d o
quirrgico e n cada u n a de las regiones anatmicas tienen
ms similitudes que diferencias. L a e x p e r i e n c i a e n cualq u i e r a de estos rganos puede p r o p o r c i o n a r informacin
y reforzar e l enfoque p a r a cada u n o de los otros. Pocos
cuestionaran l a necesidad de que e l c i r u j a n o a b d o m i n a l
sea m u y versado e n abordar c u a l q u i e r e n f e r m e d a d inesperada que se encuentre e n e l transcurso de u n proced i m i e n t o planeado. Para m u c h o s de nosotros, Maingot,
Operaciones abdominales h a satisfecho constantemente esa
necesidad. Tambin tenemos l a intencin de que este tratado p e r m a n e z c a enfocado e n e n f e r m e d a d adems de su
formato de rgano/procedimiento.
L a nueva edicin de este tratado es u n a revisin total,
u n l i b r o p o r c o m p l e t o nuevo. H e m o s intentado enfocar e l
l i b r o e n p r o c e d i m i e n t o s operatorios, as c o m o e n nuevos
conceptos e n e l diagnstico y manejo de e n f e r m e d a d abd o m i n a l . P a r a ser coherentes c o n l a t e n d e n c i a de m u c h o s
otros tratados clnicos, hemos r e d u c i d o de m a n e r a considerable l a extensin de esta edicin. A u n q u e e l texto est
condensado, continuamos presentando las o p i n i o n e s y los
c o n o c i m i e n t o s de varios expertos. Seguimos m a n t e n i e n d o
el sabor i n t e r n a c i o n a l , y hemos i n c l u i d o u n a muestra re-

presentativa tanto de contribuidores de mayor antigedad

experimentados, c o m o de nuevos lderes en l a ciruga gastrointestinal.
P a r a esta edicin se emprendi u n p r o g r a m a de ilustracin extenso. M u c h o s dibujos de lnea se h a n vuelto a
hacer a fin de reflejar e l mtodo preferido de los c o n t r i buidores p a r a realizar ciertos p r o c e d i m i e n t o s quirrgicos.
A l g u n o s de estos dibujos son nuevos y d a n al l i b r o u n aspecto ms m o d e r n o , y mayor c o h e r e n c i a general.
A u n q u e esta edicin est ms enfocada que las e d i c i o - nes previas, m u c h o s temas se h a n aadido o e x p a n d i d o ,
c o m o u n nuevo captulo e n e l que se revisan los tumores
d e l estroma gastrointestinal, y u n a seccin completa sobre
tcnicas laparoscpicas contemporneas, recurso operatorio cada vez ms d o m i n a n t e p a r a e l cirujano a b d o m i n a l e n
ejercicio. E n muchas secciones, hay duplicaciones deliberadas p a r a b r i n d a r ms de u n a perspectiva p a r a u n a enferm e d a d i m p o r t a n t e . Seguimos creyendo que estos puntos
de vista diferentes fortalecen u n tratado tan i m p o r t a n t e
c o m o e l de Maingot.
E n el prefacio de la sexta edicin, R o d n e y M a i n g o t seal que: "dado que toda la literatura es p e r s o n a l , se h a
dado carta b l a n c a a los contribuidores c o n sus secciones
individuales. U n a cierta libertad de estilo y expresin es
estimulante p a r a el lector j u i c i o s o " . A s i m i s m o , hemos tratado de m a n t e n e r l a c o h e r e n c i a p a r a e l lector, pero los
autores tambin h a n recibido u n a carta blanca en sus presentaciones de captulo.
Agradecemos sinceramente al editor previo, e l Dr. Seym o u r Schwartz, p o r sus aportaciones y ayuda e n l a p r e p a racin de esta edicin. S i n su apoyo y gua, n o habramos
p o d i d o p u b l i c a r este l i b r o .
As tambin, deseamos agradecer a l a casa editorial,
M c G r a w - H i l l , y e n particular a M a r c Strauss, J o e R u s k o
y R o b e r t Pancotti, p o r su apoyo inquebrantable durante
el p r o l o n g a d o tiempo de desarrollo de este proyecto. Su
orientacin fue inestimable p a r a t e r m i n a r este proyecto y
concretarlo e n u n solo v o l u m e n . Sus sugerencias y atencin al detalle h i c i e r o n posible superar los i n n u m e r a b l e s
problemas que o c u r r e n e n l a publicacin de u n tratado
tan grande.
H e m o s tenido l a f o r t u n a de contar c o n u n destacado
ilustrador durante l a creacin de este l i b r o . A l igual que
en l a edicin anterior, e l Sr. P h i l i p Ashley p u d o m a n t e n e r
el alto estndar de ilustracin necesario para crear y m a n tener e l tema y l a cohesin e n todo el l i b r o .
Este l i b r o n o podra haberse completado sin l a sabidura y ayuda de nuestro colega d e l c u e r p o docente, el Dr. A l i
Tavakkolizadeh, q u i e n ayud a supervisar l a terminacin
del l i b r o .
P o r ltimo, nuestra asistente editorial que h a sobrevivido a los desafos de este l i b r o , K a r e n " K i t " G i f f e n , h a sido
xv

XWi

PREFACIO

inestimable, y n u n c a habramos p o d i d o hacerlo sin ella.

P a t r i n a Tucker, L i n d a S m i t h , Suzee V i c e n t e y D o r e e n K o n tos tambin prestaron apoyo e h i c i e r o n posible este p r o yecto. Tenemos u n a g r a n d e u d a de gratitud c o n ellas p o r
ayudar c o n cada paso d e l trabajo: mecanografiar manuscritos, editar y leer galeras y pruebas de pgina, y p r o p o r -

cionar estmulo durante los prolongados periodos ridos y

l a preparacin de este texto.
M u c h a s gracias a todos los que h a n p a r t i c i p a d o en l a
creacin y l a publicacin de este tratado.
MichaelJ. Zinner, MD, FACS
Stanley W. Ashley, MD, FACS