This 20th or “Score” edition of Sabiston’s Textbook of Surgery represents both a culmination and the continuation of the record of the 19 preceding editions, each of which scored their goal of serving as surgery’s English language evidence-based reference work. The tradition of providing expansive update information, including detailed exposition of surgical pathophysiology to assist the surgeon in his/her adaptation of generic data for an innovative solution of an atypical clinical problem, has been maintained in this edition. The first two sections of this edition characterize, in detail, the systemic and organ specific responses to injury, describe perioperative management (including anesthesia), and cover the diagnosis and treatment of surgical infections and other surgical complications. The third section is devoted to trauma and critical care in recognition of the fact that surgical intervention is in itself a controlled form of trauma and that critical care expertise is essential to optimize surgical outcomes. Those initial three sections also contain chapters on ethics and professionalism, critical analysis of outcomes, patient safety issues, surgical aspects of mass casualty incidents, and a preview of the potential benefits of emerging technologies such as informatics, electronics, and robotics. Collectively the information in those sections prepares the reader to evaluate and use the current best-evidence-based recommendations for the management of surgical disease of organ systems and tissues as presented in the subsequent nine sections. The last section consists of seven chapters in which essential subspecialty-specific principles are enunciated and related to general surgery practice to complete the picture of surgery as a medical discipline. This new edition, which is designed to meet the information format preferences of medical students, residents, fellows, and practicing surgeons of all ages, is available in both print and electronic format including that for e-readers such as Kindle. Additionally, this edition has a website called Expert Consult (www.expertconsult.com), which enables the reader to obtain enhanced content such as interactive images that can be used to generate slideshow presentations and annotated test-yourself material, and, with variable magnification, optimize visualization of specific image details.