Principles of Surgery

This book has been conveniently and scientifically divided into three easy to read sections, namely the preoperative care, the operating room environment and procedures and the section dealing with postoperative care and complications.

The chapter on pre-operative investigation sets the right tone for ordering the correct, relevant and only the necessary investigations. When and why do the full blood count or why order an X-ray of the chest is succinctly stated. This will save many hardships for the laboratory and the radiology department grappling with a mountain of unnecessary and ill thought out investigations.

Commonly occurring and complicating conditions are mentioned and clear guidelines used to best prepare these patients for surgery. Very importantly, a home truth is conveyed – “Discharge planning begins at pre-assessment or on admission”, thus emphasising that a discharge process is not an after-thought but a programmed activity. Preparation for surgery explains unambiguously various risk assessment scoring systems and principles of thromboprophylaxis and antibiotic prophylaxis. An important mention on factors to help plan the order of the operating list is not lost on the reader.

The book also attempts in brief to unravel the often complex and uninteresting administrative jargon of modern hospital practice including integrated care pathways (ICPs), clinical governance, importance of multidisciplinary meetings and infection control practices. Unusually and abruptly sections on ATLS techniques and airway management seem out of place in this section.

Section two gives us an interesting overview in the design of an operating room with all its ancillary activities, location of the operating suites and staffing requirements. Maybe not of clinical interest but very useful and important nonetheless, this section will find favour amongst more senior surgical colleagues. This chapter deals admirably with gloves and goggles, shaving and sterilisation but probably oversteps it scope in describing requirements for the anaesthesia machine, operating table and Hospital Sterile Supplies Unit (HSSU).

Anaesthesia techniques and monitoring, and more importantly techniques for care of the anaesthetised patient and transfer of the anaesthetised patient are very useful and legally mandatory. The section deals well with sutures and blades, diathermy and drains but the section on tourniquets could have been covered better and in more depth. A brief on LASERS are out of place clearly and the treatment is too superficial to be of ANY benefit to anyone. Basic surgical techniques starts out quite admirably with cutting instruments and closure but somewhere along the way becomes a hotch potch of abscesses and minimal scar surgery. These could have been better organised and better treated.

Postoperative care and complication is superbly tackled and common problems delineated to maintain a high index of suspicion for diagnosis and treatment. Postoperative analgesia and fluid and electrolyte management are briefly described. This section urges the readers, rightly so to look proactively for these complications and treat them more efficiently.

The final section dealing with discharges and rehabilitation is well covered and touches upon almost every detail in planning a smooth return home or to rehabilitation. Palliative care, physiotherapy and delayed complications are outlined. The section on surgery and the law could and should have been more detailed. A section on note keeping and importance of dating and signing and timing a prescription or a discharge or an entry into the patients’ notes was missing altogether and will hopefully be incorporated in future editions. More illustrations would have been welcome.

In summary, this is a useful, handy and fairly comprehensive manual on the basic principles of surgery. Light on the eye and easy on the pocket, this little powerhouse of knowledge is a recommended addition to your collection.

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