“Surgical Treatment – Evidence-Based and Problem-Oriented” is based upon a concept which the editors believe will become increasingly important in the preparation of clinical textbooks in the 21^st century, namely the quality of the evidence upon which currently accepted clinical practice is based needs to be assessed frankly and taken into account when recommendations for patient treatment are made. As is apparent in many of the chapters in this volume, the authors are frequently forced to conclude that a higher level of evidence than is currently available would be necessary in order establish the validity of the currently accepted management of a wide variety of common surgical problems. The editors believe this is a fact of which both students and surgical practitioners need to be aware, so that they may be prepared to update and alter their clinical decision making on the basis of higher levels of evidence when these become available. The editors also hope that increasing awareness of the low level of evidence upon which much present day surgical practice is based will prompt surgeons from many countries to plan or at least participate in clinical trials to achieve a higher quality of evidence upon which to base a more rational clinical practice.

This volume was designed to supplement rather than replace standard textbooks of surgery. It does not strive to be comprehensive, but does include most aspects of what is currently considered “general surgery” in the United States and a number of other countries. It is deliberately compact and lightweight, and the editors hope that it is sufficiently portable to be used at the bedside by busy medical students, residents, and surgical practitioners.

Again, in contrast to many standard surgical textbooks this small volume is clearly international in its perspective with chapters authored by acknowledged experts from North America, Europe, Asia, Australia, and New Zealand. It will be apparent to the reader that patient management in several areas of general surgery may still differ widely from region to region even in our ever more interconnected world, yet each author has been asked to assess rigorously the level of evidence upon which operative and nonoperative treatment recommendations are made. As the quality of available evidence advances in a number of surgical areas, the editors believe that clinical management will perforce become more uniform in most countries. Because the quality of evidence is anticipated to improve at an increasing rate over the next 2 decades, the editors plan to update this small volume frequently so that its readers can be assured of an accurate assessment of evidence based surgical practice for many years to come.

René G. Holzheimer

John A. Mannick