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Maingot's Abdominal Operations, 8th Edition, Vol. 1 & 2

Article  in  Annals of Surgery · November 1986

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Vol. 204 * No. 5 BOOK REVIEWS
amputation, which stresses its role as a reconstructive surgical
technique, makes the text complete.
Most of the contributors are recognized authorities who in-
corporate their personal results into the chapters. The chapters
are generally concise and very well written, although there is
some repetition. The references are particularly complete, pro-
viding classic articles as well as recent publications. The book
is handsomely bound and the print easy to read. Tables and
figures are, for the most part, clear and effective. The reproduc-
tion of arteriograms is variable.
In summary, this monograph is thorough, current, concise,
and well written. It should serve as an excellent guide for residents
and attending surgeons who are faced with the problem of the
ischemic leg.
RAYMOND G. MAKHOUL, M.D.
Durham, North Carolina
Pioneering Research in Surgical Shock and Cardiovascular Sur-
gery: Vivien Thomas and His Work with Alfred Blalock. Vivien
T. Thomas. 245 pp. Philadelphia, University of Pennsylvania
Press. 1985. $24.95.
ANYONE ENTERING the Johns Hopkins Hospital from Broadway
first passes the impressive two-story-high statue of Christ, whose
arms are outstretched to the weary and heavy-laden; then, at
the corridor a left turn and then a right bring one to the Blalock
Building, the lobby of which displays two portraits, one each on
opposing walls. One of the portraits is, appropriately enough, of
Alfred Blalock, the esteemed father of cardiac surgery. The other
is of one Vivien Thomas. But Thomas? Who is he? You say that
he is admired, respected, and emulated by everyone, from the
"Professor" and all who trained under him right on throughout
the ranks of Hopkins' personnel? You say that a major share of
the credit for the pioneering cardiac surgical advances made at
Hopkins during the '40s and '50s belongs to him? You say that
he has earned only a high school diploma but was awarded an
honorary Doctor of Laws degree from Hopkins? And that he
"broke the ice" for employment of black people at Hopkins?
You say that his formal remarks during the ceremony dedicating
his portrait had the audience guffawing one moment and sniffling
away the tears the next? How can we learn more about this
remarkable man?
We need wait no longer. Vivien (as everyone who ever knew
him respectfully calls him) has written ofhis life in a delightfully
candid and scholarly manner: the story of his many trials, which
often gave way to victories, of his innovations, which often were
overlooked but later justly credited, of his adherence to the high
principles and discipline that he first learned from his parents,
and overall how his dedicated and skilled work as Dr. Blalock's
chief technician gave him deep satisfaction and ultimately rec-
ognition. Little space is given to his personal life (other than to
establish the fact of a constant devotion to his family), but much
detail is provided of Vivien's various professional duties, routines,
tasks, and challenges. In fact, this quality offactual detail should
make the book a valuable resource for the in-depth student of
surgical history.
Frankly, I savored every page of this book, from the beginnings
at Vanderbilt on through and beyond the Blalock years at Hop-
kins. Its several themes are interwoven in masterly fashion: an
uneducated black man breaking new paths of opportunities for
his race, a technician making original and innovative contri-
butions that often took some time to be credited properly, the
progressive unfolding from an intimate perspective of an exciting
607
whole new subspecialty of surgery having massive potential im-
plications, and several others.
I found myself wondering, however whether another reader
who had not happened to have Hopkins in his or her background
would become as engrossed as those of us who did. I think they
would-and might just possibly enjoy the experience even more,
since this particular legend might for them be less familiar in
advance and, therefore, prove the more fresh and absorbing. In
any event, I recommend without qualification that you (of
whatever background) should pick up the book and begin; I
think you might be surprised at the captivating interest of its
story.
Vivien laid the book to rest with a 1985 copyright date. Later
that same year Vivien himself was laid to rest. Those who at-
tended that final ceremony assure me that it was accompanied
by the same spirit of joyfuil sincerity and inspiration that char-
acterized Vivien Thomas' life and that permeate his book about
that life.
DWIGHT C. McGOON, M.D.
Rochester, Minnesota
Maingot's Abdominal Operations, 8th Edition, Vol. 1 & 2. Sey-
mour I. Schwartz, Harold Ellis. 2441 pp. East Norwalk, Con-
necticut, Appleton-Century-Crofts. 1985. $195.
AMONG THE HANDFUL of surgical texts that have been valued
references for multiple generations of surgeons, Maingot's Ab-
dominal Operations remains as one of the pillars of the general
surgeon's personal library. The eighth edition represents an his-
toric turning point for this classic work, as it is the first edition
that does not bear the personal effort of its creator, Rodney
Maingot. Harold Ellis and Seymour Schwartz have clearly taken
great effort to insure that while this latest edition continues the
authoritative tradition begun 45 years before, it also represents
a contemporary reference on abdominal surgery. With the help
of 78 contributors, the work has been extensively revised and
updated. The primary emphasis continues to be focused on gas-
trointestinal, hepatic, biliary, and pancreatic surgery, with ad-
ditional sections devoted to radiologic and endoscopic diagnostic
procedures, peritonitis and retroperitoneal disorders, and surgery
of the abdominal wall. The real strength of the work continues
to be in the area of surgery of the gastrointestinal tract, liver,
and pancreas.
Particularly outstanding contributions in the sections on in-
testinal surgery include the chapters on neonatal intestinal ob-
struction and Hirschsprung's disease by Lewis Spitz, the chapters
on intestinal obstruction and colon and rectal disorders by Har-
old Ellis, and the chapters "Duodenal and Gastric Ulcer" by
David Johnston, "Partial and Total Gastrectomy" by John S.
Kirkham, and "Complications Following Gastric Operations"
by J. Lynwood Herrington, Jr., and John L. Sawyers, among
others. An excellent review of the application of staplers in gas-
trointestinal surgery is provided by Drs. Steichen and Ravitch.
The sections on hepatic and biliary surgery are remarkably com-
plete and informative. The chapters on hepatic cysts and tumors
by Seymour Schvartz are superb, as is the chapter "Transplan-
tation of the Human Liver" by Drs. Starzl, Iwatsuki, and Shaw.
In addition, the chapters on intra- and extra-hepatic biliary dis-
ease provide an unusually complete and well-illustrated survey
for the student and for the experienced surgeon as well. Finally,
the chapters on disorders of the pancreas and spleen are each
written by internationally recognized authorities in these areas,
and reflect their expertise.
 608 BOOK REVIEWS
In general, the chapters are superbly illustrated, and the op-
erative figures by R. N. Lane and by Pauline Lariviere, a pupil
of Max Br6del, contribute greatly to the overall clarity and
handsomeness of the book. Any criticisms that might be levied
against this work are either minor, such as the poor quality of
reproduction of figures in an isolated chapter, or philosophical,
such as the attempt to include a review of abdominal aortic
aneurysm disease in what is so clearly an otherwise outstanding
reference for intestinal and endocrine surgery of the abdomen.
While the overall scope of the text continues to reflect Maingot's
eclectic interests and prodigious skills in abdominal surgery, the
real value of this eighth edition lies in its use as a definitive
resource for younger surgeons and for experienced operators as
well. It is an outstanding addition to any library and will be
much relied on by those with a serious interest in general surgery.
DANA K. ANDERSEN, M.D.
Brooklyn, New York
Surgical Approaches to Cutaneous Melanoma, Vol. 7 in the Pig-
ment Cell Series. Charles M. Balch. 212 pp. Basel, Switzerland,
Karger. 1985. $72.50.
IT HAS BEEN ESTIMATED that the incidence of malignant mela-
noma has increased 8-12 times over the past 10 years, and,
subsequently, general surgeons are seeing more patients with
this disease. In the text, the editor Charles Balch, has defined
the state of the art concerning the diagnosis, indications for
treatment, and technical details for the operative approach to
malignant melanoma. The 12 chapters draw on a massive
amount of data from the personal experience as well as literature
reviews of well-known experts in the field. Individual chapters
concerning the management of melanoma-in-situ, acceptable
biopsy techniques for handling the primary melanoma in various
body regions, as well as the role of elective and therapeutic lymph
node dissections, are included. Other sections discuss the com-
plications of lymphadenectomy, the role of limb perfusion in
both stages 1 and 2 disease, and the surgical treatment of systemic
metastases. The final chapter outlines simple plastic surgical
techniques useful in closing tissue defects from the wide excision
of the primary melanoma. The technical details of the various
operative procedures are well outlined and illustrated.
The chapter by Dr. Wanebo (Charlottesville, VA) was partic-
ularly inciteful in presenting both sides of the most controversial
issue concerning malignant melanoma; that is, the efficacy of
elective node dissections. Sound recommendations are made
for node dissections based on the tumor thickness of the primary
melanoma. Plentiful references are available in this section and
throughout the text for further research.
One shortcoming of the book is the lack of consensus among
the authors concerning the handling of the primary melanoma.
Although this could be influenced by the primary site being dis-
cussed, there was no clear directive as to the absolute minimum
margin needed around the primary melanoma (quoted from
0.5-2.0 cm) or whether the underlying fascia needed to be in-
cluded in the resection.
It is recommended that this monograph should be included
in the library of most medical centers as well as in the personal
library of dermatologists and surgeons who deal with this disease.
DOUGLAS S. REINTGEN, M.D.
Durham, North Carolina
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Ann. Surg November 1986
Comprehensive Textbook on Oncology. A. R. Moossa, Martin
C. Robson, Stephen C. Schimpff. 1307 pp. Baltimore, Williams
& Wilkins. 1986. $125.
DOCrORS MOOSSA, ROBSON, AND SCHIMPFF have put together
an excellent textbook covering the field of oncology. The editors
have provided a uniform presentation from chapter to chapter
despite contributions by multiple authors. The use ofcolor pho-
tographs enhances several of the chapters, and, finally, the print
is easy to read.
The book is divided into two parts. The first part is dedicated
to general concepts in the field of oncology and is divided into
four sections. There is the obligatory section on basic patho-
physiology of neoplasia, an interesting section on principles and
applications of diagnostic methods, and the standard section on
basic principles of cancer therapy. From the point of view of
uniqueness, as well as universal applicability, the last section on
complications of neoplastic diseases is superb. In essence, this
section chronicles the effects of cancer on the patient, the family,
and the doctors caring for the patient with cancer.
The second part deals with individual organ site cancers and
their management. Each chapter is written by an experienced
oncologist, albeit medical, surgical, pediatric, or radiation. Again,
the uniformity of presentation makes each chapter eminently
readable, enjoyable, and understandable. It is remarkably easy
for a reviewer to find fault with a small subsection of a book
dealing with clinical management strategies, but I honestly have
to submit that I cannot do such with this part of Doctor Moossa's
book. In particular, the sections dealing with the cancers treated
by "surgical oncologists" are particularly current and accurate.
This book is a practical, as up-to-date as possible guide to the
management of malignancies and the care of patients with can-
cer. It is not the definitive management book for fulltime on-
cologic specialists, but it is the primer for all physicians who, in
one way of another, deal with patients with cancer. It is a must
for all hospital and surgical departmental libraries, as well as
surgeons who treat patients with cancer. If only the price were
a little more affordable, this would be the oncology text for med-
ical students and surgical housestaff. I personally look forward
to the timely arrival of future editions.
GEORGE A. PARKER, M.D.
Richmond, Virginia
Diseases of the Liver and Biliary System, 7th Edition. Dame
Sheila Sherlock. 578 pp. Oxford, England, Blackwell Scientific
Publications. 1985. $66.50.
THE SEVENTH EDITION of Dame Sheila Sherlock's classic Dis-
eases ofthe Liver and Biliary System is one ofthe few remaining
major medical textbooks by a single author. This edition, like
the previous six, is current, comprehensive, and concise. In fact,
despite a vast increase in knowledge of pathophysiology, diag-
nosis, and treatment of hepatic diseases that has occurred since
the 1981 edition, the book has been lengthened by only 36 pages
and remains less than halfthe size of the other leading textbooks
of hepatology. Yet nothing of importance seems to be missing.
The references are ample and recent, many of them coming
from the 1984 and 1985 medical literature.
The reader benefits from the author's concise and didactic
style, which allows digestion of any single chapter in a relatively
brief period of time. Each chapter relates appropriately to the
whole, resulting in a well-balanced text with a minimum of rep-