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Review on Upper Digestive Surgery—Oesophagus, Stomach and Small Intestine
  1. R C MASON

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Review on Upper Digestive Surgery—Oesophagus, Stomach and Small Intestine. Edited by TV Taylor, A Watson, RCN Williamson (Pp 1112; illustrated; £180.00). Philadelphia: WB Saunders, 1999. ISBN 0702 014346.

This is a new comprehensive text covering upper gastrointestinal surgery other than HPB but also includes the small intestine which is a frequently forgotten part of the gastrointestinal tract coming as it does between the colorectal and upper gastrointestinal surgeons. It is an extremely comprehensive and inclusive textbook which is both its strength and in other senses its weakness. There is no real subject in the oesophagus, stomach, duodenum, and small bowel which is not covered to some degree within the text. In such a large text however the up to date nature of chapters varies with the bibliography, in some cases being up to the late 1990s but in others being really the early 1990s. The text is well laid out apart from the colour plates which are put at the beginning rather than as inclusive parts of the text, with clear diagrams, tables, and figures. It manages to combine well what is in essence a textbook of surgery along with a textbook of operative surgery. Each chapter is well referenced. Some of the best chapters in fact are those on miscellaneous conditions or on the rarities. Such a comprehensive text is invaluable to the junior resident who is seeking to write up a case report in what is perceived as an unusual condition.

In some ways the weaknesses of this text stem from the comprehensive nature of the text. Oesophageal cancer and gastric cancer are covered as separate entities. It is now generally recognised that in the western world cancer of the oesophagus and stomach in 75% of cases is an adenocarcinoma found within 5 cm of the gastro-oesophageal junction rather than either purely oesophageal or purely gastric. The separation of these two diseases into two separate chapters in separate parts of the book is a weakness and tends to underestimate this particular problem. Barrett's oesophagus is also dealt with in a rather cursory fashion. Barrett's oesophagus and its management as well as Barrett's cancer as a major complication is currently one of the most popular issues of upper gastrointestinal surgery. Perhaps in future editions this disease can be looked at as a separate entity that bridges the stomach and oesophagus. There is also increasing awareness of the importance of quality of life issues, particularly in the treatment of patients with cancer and this, although dealt with, will require expansion.

The chapters on peptic ulceration are now, to a large degree, of almost historical interest. The subject is covered extensively but with the recognition of Helicobacter pylori and non-steroidal drugs and their pharmacological management, the role of surgery for chronic peptic ulcer has all but disappeared. It would be interesting to know when anybody last performed a highly selective vagotomy. The chapters for the surgical treatment of chronic peptic ulcer are also of historic interest only, as is the discussion about the most appropriate way to do a highly selective vagotomy. Gastric secretion tests, other than in patients with suspected Zollinger-Ellison syndrome, again are now a thing of the past.

These minor considerations apart, this is a well written, well referenced, and well illustrated textbook. I am sure it will have a place in all major libraries and libraries within individual departments. It is unlikely to appeal however to the individual, largely on the basis of its size and cost, and the ready availability of smaller but focused textbooks on the upper gastrointestinal tract and oesophageal disease, which by their nature and size tend to be more up to date and focus on controversial issues such as investigation and management of cancer, palliation of malignant disease, multidisciplinary approach to malignant diseases with the combination of surgery and oncology, issues of quality of life, management of gastro-oesophageal reflux, surgical versus medical, and the role of surgery in the treatment of peptic ulceration, which is now largely the simple under running of bleeding ulcers and closing of perforations, backed up by full pharmacological treatment with triple therapy.

These factors are all covered in the textbook but are missed by the full and thorough comprehensive nature which still tends to emphasise possibly a more aggressive surgical approach.

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