Textbook of surgery: The biological basis of modern surgical practice: David C. Sabiston, Jr., ed., Philadelphia, 1991, W.B. Saunders, 2240 pages, $75

Abstract

Textbook of surgery: The biological basis of modern surgical practice David C. Sabiston, Jr., ed., Philadelphia, 1991, W.B. Saunders, 2240 pages, $75. This handsome volume is the fourteenth edition of the classic Christopher Textbook of Surgery, which was first published in 1936 and was last revised 5 years ago. It is a proud tradition, and in most respects the editor and more than 230 chapter authors have admirably discharged their most formidable responsibility: to condense the accumulated wisdom of all surgical disciplines into a work of significant educational value for the present generation of medical students and house officers and for a few puzzled veterans for whom the odd case (or recertification) is close at hand. This is not an easy assignment or perhaps even an attainable one; therefore it is not too surprising that the work is more successful in some specialty areas than in others. Although standard texis like this grace the shelf of every seasoned surgeon, the target audience undoubtedly consists of students and general surgery residents. These readers need a historic perspective concerning surgical developments that they have not personally experienced and up-to-date information regarding diagnosis, management, and results. Conceding that publication schedules make it impossible for the Textbook of Surgery to cite references less than 2 years old, there still is an obligation to provide contemporary, if not absolutely current, clinical data. Most of the chapters easily meet this expectation, including those on metabolism, prostaglandins, transplant and cancer immunology, breast disease, endocrine surgery, peptic ulcer, portal hypertension, and colorectal disorders, to name only a few. The chapters on hepatobiliary disease also are quite good, although it seems curious that barely 100 words (and no illustrations) were devoted to laparoscopic cholecystectomy despite the fact that the galley proofs probably were prepared as recently as 1990. From a subspecialty perspective, the sections on cardiac surgery, pediatric surgery, orthopedics, neurosurgery, and urology are articulate, effectively illustrated, and well referenced. Vascular surgery (arterial, venous, and lymphatic) is summarized in 35 chapters that comprise about 175 pages. Despite their brevity excellent reviews are provided for such topics as graft materials, distal lower extremity bypass, endovascular therapy, trauma, vasospastic diseases, and visceral revascularization. In comparison, some of the material in other chapters can only be considered obsolete. A diameter of 7 cm, not 4 cm or even 5 cm, is given as the appropriate size criterion for elective resection of infrarenal aortic aneurysms, according to a 1969 article. Stanley Crawford's experience with more than 1000 thoracoabdominal procedures receives only a single citation for the 23 patients he had treated before 1974. The bibliography for carotid endarterectomy, arguably the most controversial operation in the United States during the past decade, includes only 16 references and just two since 1985. The most recent reference in the chapter on aortoiliac occlusive disease was published in 1979. Such important oversights may not be recognized by countless students and residents who use standard texts as their primary sources of information, and they should be corrected in the next edition. Notwithstanding these and a few other imperfections, however, the Textbook of Surgery still deserves the public trust and admirably so.