Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Operaciones
abdominales
D E G I M O P R I M E R A EDICIN
MAINGOT
Operaciones
abdominales
DEGIMOPRIMERA
EDICIN
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
c
G r a w
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.
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,
M c G R A W - H I L L I N T E R A M E R I C A N A E D I T O R E S , S.A. de C. V.
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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
;
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
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
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
3. E n d o s c o p i a e intervencin endoscpica
Edward Lin / Aaron S. Fink
35
417
439 .
455
353
71
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
551
589
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
203
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
333
663
693
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
757
m SECCIN X. BAZO
783
43. E l bazo
Gina Adrales / Thomas R Gadacz
1031
1055
1075
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
1099
847
1125
865
46. Reparacin de h e r n i a
Bardia Amirlak / Sumeet K. Mittal /
RobertJ. Fitzgibbons, Jr.
889
1151
1183
939
961
983
999
1113
1169
1205
1217
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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-
XWi
PREFACIO