By: 24 June 2011

As indicated in the preface, this book from Oliver Pearce comes from the author’s own undertaking and more importantly understanding of postgraduate surgical exams. Aimed as a single book for arming oneself for the omni-uncertain postgraduate exams, this book attempts to present a snapshot of information in a user-friendly format. Commanding impressive clinical and academic appointments the author aims to cater to the syllabus which forms the bulk of content for the UK surgical examination i.e. the MRCS for Surgery-in-general. It is only fitting that the book comprises of all broad surgical specialities and sub-specialities needed therefore. It is interesting to note that this labour of love actually commenced when the author was himself a Specialist Registrar in higher surgical training in Trauma and Orthopaedics. It gives an insight in what the author concluded was the most important knowledge needed for the examination which is rough and grind yet encompassing in all broad specialities.

What is immediately striking about this book is the convenient grouping of all topics under essentially two broad topics of Basic Sciences and Clinical sections. The basic sciences deal with anatomy, physiology, pathology and critical care. The surgical section deals with all broad specialities catering to the Surgery-in-General examination and includes trauma and orthopaedics, general and vascular surgery, ENT and endocrine surgery, Breast surgery and Urology amongst others. This style of grouping makes it easy for readers to focus on areas of their choice and complement their existing knowledge. It also makes for easy reading and assimilation of knowledge and information. The bibliography also draws heavily from the classics in Basic and applied surgical specialities like Basic Pathology (Kumar and Cotran), Last’s Anatomy, Kirk’s General Surgery and Millers review of Orthopaedics to name a few.

Pathology and Practice of surgery gives brief and succinct explanations of the common terminology and though lacking in depth gives the readers a quick overview and a comprehensive coverage of commonly used terms. I was amazed at the speed I could leaf through the section yet managed to retain and reproduce much needed, but often forgotten, basic information. It also made for an overall revision of audits and clinical governance, use of lasers and drains, suture materials and blood products. The physiology and critical care sections also has an easy flow of information. This helps a lot in knowledge retention and concise definitions. I could pick the odd fellow out like grouping diathermy in this section, which I feel could have been better regrouped elsewhere. The clinical information provided is fit for purpose and does not contain any unnecessary details or ambiguities.

The Anatomy sections outline basics and applied anatomical nuances in easy to understand presentation and with aid of simple yet effective line diagrams. Some topics like the Upper Limb are treated too simplistically, yet others like the GI tract anatomy and vascular tree are commendable in their comprehensiveness and content. Surprisingly, orthopaedic content is covered too thinly, perhaps with the notion because we assume that people already know what we know. Operative Surgery begins with the basic concepts in biopsy and appendicectomy, moving on to complex colectomies and hip and knee replacements. The diagrammatic representation for various lower limb amputations is particularly well illustrated and hardly needs textual elucidation. Gastrointestinal surgical procedures are well covered and again the ease of reading and smooth flow of information goes a long way in retaining much of is read. Topics under orthopaedic surgery are well outlined but in my opinion could have done with many more line diagrams, especially for the various non-union and Gardens classification for neck of femur fractures. It is a well known fact that even orthopaedic specialist registrars struggle with something as elementary as the Gardens classification and the sheer volume of these fractures in way of admissions to the orthopaedic department dictates that the trainees are well versed in their terminology. The spinal section is well treated and succinct in its descriptions of various conditions. Illustrations for spondylolisthesis are conspicuous by their absence and the line diagram for disciitis may not be truly necessary.

Vascular surgery is covered in depth yet illustrations again are sorely missing. Deep vein thrombosis overview is very useful and could have been substantially improved by a brief outline of its wretched aftermath and treatment – pulmonary embolism, a not too-uncommon presentation on the postoperative ward. A lot of information and work has gone into ENT procedures but I needed to go back to my illustrated anatomy book by Snell to understand what was being described. Aren’t facts without figures like a ship without sails?

Endocrine surgery is well covered and I enjoyed revising a few basic tenets of thyroid and parathyroid procedures. Urology again suffers from a drought of diagrams and it makes difficult reading for the student whose primary interest may not be in this sub-speciality. Illustrations for the grading and staging of Prostate carcinoma would prove to be very useful for the student in a hurry since a picture conveys more information than a thousand words.

The clinical examination section is not comprehensive and does not need to be. Before reading this text most surgical candidates would be expected to be fairly conversant with a “system” for examining various joints or body parts, yet this section highlights the salient features which “must” form part of the evaluation. It is not only important to “do” but more important in the surgical examinations to “be seen to do”, the various tests and manoeuvres. Detailed tests and signs are obviously beyond the scope of this textbook and the candidate needs to refer to texts mentioned in the bibliography for completeness. This particular section could have been grouped ahead of the surgical sections in the book.

Please approach this book with an illustrated text like Snell’s Anatomy by your side. I enjoyed reading this book and found it immensely useful. I am sure many readers would too.