Book Reviews

Infection  in Surgical Practice
J.D. Williams, E.W. Taylor
Arnold Publishers ISBN 0340763051
£80.50

There have been textbooks on surgical infection published before, mostly from the USA, but Mr Eric Taylor has edited a similar book to this one in 1992. This is not a second edition, although it bears similarities to its namesake. The presentation, style and comprehensive editing make it a very readable, complete and up-to-date text.

The thrust is an in-depth approach to the management of infection in surgical patients. There is a wealth of information on relevant microbiology, resistance and the hazards of potential and established infection. Advice on prescribing for chemoprophylaxis and antibiotic therapy is sound but the evidence base for selection, dosing and timing is not at a Cochrane review level. The opinions are good but many of the chapters are not extensively referenced.

Clinical input into the book is relatively lacking with the chapters being written at a ratio of surgeon: microbiologist at 1:4. Disappointingly, as a result, there is not extensive cover of the clinical aspects of sepsis and organ failure or management of antibiotic-related colitis, for example.

The book is aimed at surgical trainees approaching the inter-collegiate examination, senior surgeons and clinical microbiologists. It certainly achieves this aim but somehow falls in the middle of surgeons’ or microbiologists’ interests so that not all sections of the book will appeal to each specialty. The first seven general chapters are excellent reviews in this field and are written by appropriate authors. The second specific 21 chapters are not useful when outside the readers’ interest but some, for example implant infection and infection related to trauma, retain general appeal.

D.J. Leaper
University Hospital of North Tees
Hardwick
Stockton on Tees, U.K.

Handbook of Post-Operative Complications 
DJ Leaper and AL G Peel
Oxford University Press
ISBN 0192630709 £22.50

On first seeing the title of the book, I felt rather paranoid at being asked to review Handbook of post-operative complications! Why me? Is the Editor trying to send me a message?

This book is a product of Oxford pocket medical series and very well lives up to the usual high standard of similar books from the same stable. It is edited by two very reputable authors who have assembled contributors from every speciality necessary for such a subject.

The chapters in the book are nicely subdivided into various parts - general complications followed by complications after every type of surgery. General surgery with every allied surgical speciality and obstetrics and gyneacology have been covered. There is even a chapter on complications after interventional vascular radiology and very rightly too because the first person on the scene after such complications would usually be the basic surgical trainee (BST). Each chapter is further subdivided into sections. There are blank pages before and after each chapter and section. I suspect this is intentional - what a good way to encourage readers to write in their own notes.

The text is supplemented by line diagrams and algorithms to complement the written material. All complications are appropriately subdivided into early and late. BSTs taking the second part of the MRCS should note how to answer in the examination. Not only are the complications enumerated, but also the cause and prevention of the complications touched upon. The text on post-operative pyrexia is very aptly illustrated by pictures of temperature charts of atelectasis, wound infection and intra-abdominal sepsis - a salutary method of getting an important message across. The general advice regarding the use of drugs is summarised in a wonderful mnemonic - NESCAFE. I shall leave it to the readers to find out what it stands for. There is a superbly written chapter on medico-legal aspects.

Consultants who ultimately carry the can, and those acting as expert witnesses will find everything that is necessary in a nutshell. In this day and age when medical negligence cases are rife, this chapter should have been the first one and not the last. This is not a criticism but just personal view on the importance of the topic.

The book is very modestly priced. There is, therefore, no excuse for any BST (including PRHO) not to have their own copy. Once they have invested in the book, they will find it useful also in later life for the MRCS examination; the answers to many questions asked in the critical care viva are in there. Relevant physiology is also covered; particularly cardiovascular and respiratory physiology are fairly comprehensive for a “handbook”.

This book should be in the HDU or ITU and on the general ward for the benefit of the BST and the nurses who should be using it as a guide for instant referral. It is extensively indexed, a help to the trainee on any surgical ward round to refer to the book, as and when necessary. I think it is an essential tool on the daily ward round, particularly, as the book nicely fits in the white coat pocket (for those who still wear one).

As for me, although in the autumn of my surgical career, I shall certainly carry my copy in the pocket of my white coat (yes, I still wear one!).

P.K. Datta
Caithness General Hospital
Wick U.K.

Lecture Notes on General Surgery 
10th edition
H. Ellis, Sir R. Caine, C. Watson
Blackwell Publishing
ISBN 0632063718 £16.95

This book is an established classic ‘for all trainee surgeons and medical students’. It is now in its tenth edition having first been published in 1965. Simplicity has always been a key feature of this book in its previous editions and this has been retained for this new improved tenth edition.

The book has been updated throughout. It has managed to maintain some classic chapters, particularly the one on post-operative complications, which has stood the test of time. The book remains in an easy to read format and is liberally supplied with useful tables.

The chapters on hernias is particularly well illustrated, an area that is often difficult for final year medical students to comprehend. The chapter on breast disease is well written and has been updated to include the topic of sentinel node biopsy, however, this topic appears to be missing from the section on melanoma. The chapter on gallstones could be strengthened a little by some details on laparoscopic cholecystectomy.

Other than these minor criticisms, the book is a must for every final year medical student. I enjoyed reviewing this book, having been so familiar with a previous edition at an earlier stage in my surgical career.

A. Hill
St. Vincent’s University Hospital
Dublin
Ireland

Management of abdominal hernias 
Third edition. 
A.N.Kingsnorth and K.A. Leblane
Arnold Publishers
ISBN 034080890X

This is the third edition of this book, originally written by the late Brendan Devlin and now edited by Andrew Kingsnorth and Karl le Blanc. The book has 25 chapters with over 1,200 up to date references on the management of abdominal hernias. In addition, it is accompanied by a CD Rom with eight video clips of around five minutes each on open and laparoscopic repair of abdominal hernias. Chapters 1, 2 and 3 deal with history, essential anatomy and epidemiology and as with the earlier editions are well written and very informative. A chapter on logistics is worthwhile with some good advice to day case patients on wound management and when to return to normal activity.

The authors conclude that the laparoscopic approach for incisional and ventral hernia seems to have a strong economic benefit, in a chapter on the economics of hernia repair. While this may well be the case it is certainly not based on evidence from good randomised clinical trails, unlike the situation with groin hernia repair. Most of the comparisons of hospital stay are based on historical data for open repair and not necessarily relevant to current practice. The chapters on sutures and bio-materials are interesting and deal with most issues apart form the differences in cost of these materials, which in some instances far exceed the total cost of hernia repair itself.

The chapters on general complications of hernia and groin hernias in babies and children are similar to that in the previous editions. The authors quite rightly point out that it may be difficult to differentiate between femoral and inguinal hernias and that differentiation between direct and indirect cannot be sustained clinically, yet in their conclusion they state that every effort should be made to distinguish inguinal from femoral hernias before surgery. They conclude this is especially important for the open approach but not for the laparoscopic method. Surely better advice at open surgery would be to explore the femoral canal in all patients where an obvious inguinal hernia is not found.

The chapters on inguinal hernia repair are fairly standard apart from minor modifications to the original Lichtenstein repair both in the text and the video. The chapter on epigastric and laparoscopic “port site” hernia could have benefited from more detail concerning the latter, particularly on their method of presentation and repair.

The main and important additions to Devlin’s work are the laparoscopic approaches to incisional, ventral and parastomal hernia. This may be the future for repair of these hernias - early results are encouraging and the techniques are well described and illustrated. The video clips, however, would have benefited from a voice-over describing the key steps in repair of such hernias. Overall, I think this should make this edition of Management of Abdominal Hernias a worthwhile purchase for the general surgeon, particularly if contemplating this approach to such hernias.

PJ O’Dwyer
Western Infirmary
Glasgow U.K.