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Book Details
Abstract
Colorectal Surgery meets the needs of surgeons in higher training and practising consultants for a contemporary and evidence-based account of this sub-specialty that is relevant to their general surgical practice. It is a practical reference source incorporating the most current information on recent developments, management issues and operative procedures. The text is thoroughly referenced and supported by evidence-based recommendations wherever possible, distinguishing between strong evidence to support a conclusion, and evidence suggesting that a recommendation can be reached on the balance of probabilities.
This is a title in the Companion to Specialist Surgical Practice series whose eight volumes are an established and highly regarded source of information for the specialist general surgeon.
- The Companion to Specialist Surgical Practice series provides a current and concise summary of the key topics within each major surgical sub-specialty.
- Each volume highlights evidence-based practice both in the text and within the extensive list of references at the end of every chapter.
- An expanded authorship team across the series includes additional European and World experts with an increased emphasis on global practice.
- The contents of the series have been extensively revised in line with recently published evidence.
- New techniques, such as percutaneous and transcutaneous tibial nerve stimulation for faecal incontinence as well as extralevator abdomino-perineal excision, are fully covered.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Colorectal Surgery: A Companion to Specialist Surgical Practice | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Contributors | vii | ||
| Series Editors' preface | ix | ||
| Editors' preface | xi | ||
| Acknowledgements | xi | ||
| Evidence-based practice in surgery | xiii | ||
| Chapter 1: Anorectal investigation | 1 | ||
| Introduction | 1 | ||
| Anatomy and physiology of the anal canal | 1 | ||
| Rectoanal inhibitory reflex | 2 | ||
| Manometry | 3 | ||
| Ambulatory manometry | 5 | ||
| Anal and rectal sensation | 5 | ||
| Rectal compliance | 6 | ||
| Pelvic floor descent | 6 | ||
| Electrophysiology | 6 | ||
| Electromyography | 7 | ||
| Pudendal nerve terminal motor latency | 7 | ||
| Spinal motor latency | 7 | ||
| Defecography/evacuation proctography | 8 | ||
| Dynamic pelvic MRI | 8 | ||
| Dynamic transperineal and three-dimensional pelvic floor ultrasound | 8 | ||
| Scintigraphy | 9 | ||
| Imaging the rectum and anal sphincters | 9 | ||
| Anal endosonography/endorectal ultrasound | 9 | ||
| Endocoil receiver MRI | 9 | ||
| Imaging in rectal cancer | 10 | ||
| Imaging in anal sepsis and anal fistulas | 11 | ||
| Imaging in faecal incontinence | 11 | ||
| Summary | 13 | ||
| References | 13 | ||
| Chapter 2: Colonoscopy and flexible sigmoidoscopy | 17 | ||
| Introduction | 17 | ||
| Indications and contraindications | 17 | ||
| Flexible sigmoidoscopy vs. colonoscopy | 17 | ||
| Contraindications | 17 | ||
| Sedation | 17 | ||
| Insertion technique | 18 | ||
| Handling and scope control | 18 | ||
| Insertion and steering | 18 | ||
| Tips for insertion and steering | 18 | ||
| Patient position change | 19 | ||
| Abdominal hand pressure | 19 | ||
| Three-dimensional imager | 19 | ||
| Withdrawal technique | 19 | ||
| Withdrawal time | 19 | ||
| Optimal examination technique | 20 | ||
| Bowel preparation | 21 | ||
| Position change | 21 | ||
| Antispasmodics | 21 | ||
| Rectal retroflexion | 21 | ||
| Quality assurance | 21 | ||
| Endoscopy training in the UK | 21 | ||
| New optical techniques in endoscopy | 22 | ||
| Chromoendoscopy | 22 | ||
| Narrow band imaging (NBI) | 23 | ||
| High-magnification endoscopy | 23 | ||
| Retrograde viewing devices | 23 | ||
| Confocal laser endomicroscopy | 23 | ||
| Endoscopic therapy | 24 | ||
| Basic therapy | 24 | ||
| Polypectomy | 24 | ||
| Endoscopic mucosal resection (EMR) | 24 | ||
| Lower gastrointestinal (GI) bleeding investigation | 25 | ||
| Colonic decompression | 25 | ||
| Advanced therapy | 26 | ||
| Endoscopic submucosal dissection (ESD) | 26 | ||
| Stricture dilatation and stenting | 26 | ||
| Natural orifice transluminal endoscopic surgery (NOTES) | 26 | ||
| Competing technologies | 26 | ||
| Computed tomography colonography (or virtual colonoscopy) | 27 | ||
| Self-propelling colonoscopes | 27 | ||
| Colon capsule | 27 | ||
| Conclusions | 27 | ||
| References | 28 | ||
| Chapter 3: Inherited bowel cancer | 32 | ||
| Introduction | 32 | ||
| Assessment of risk | 32 | ||
| Chapter 4: Colonic cancer | 49 | ||
| Introduction | 49 | ||
| Natural history | 49 | ||
| Direct spread | 50 | ||
| Lymphatic spread | 50 | ||
| Blood-borne spread | 50 | ||
| Transcoelomic spread | 50 | ||
| Aetiology | 51 | ||
| Genetic factors | 51 | ||
| Diet and lifestyle | 52 | ||
| Predisposing conditions | 52 | ||
| Presentation | 52 | ||
| Investigation | 52 | ||
| Screening | 53 | ||
| Surveillance after adenoma detection | 54 | ||
| Elective surgery | 54 | ||
| Preparation for surgery | 54 | ||
| Blood transfusion | 54 | ||
| Bowel preparation | 55 | ||
| Thromboembolism prophylaxis | 55 | ||
| Antibiotic prophylaxis | 55 | ||
| Bladder catheterisation | 56 | ||
| Resection | 56 | ||
| Splenic flexure carcinoma | 56 | ||
| Advanced tumours | 57 | ||
| Operative technique | 57 | ||
| Right hemicolectomy | 57 | ||
| Left hemicolectomy | 58 | ||
| Anastomosis | 58 | ||
| Appositional serosubmucosal anastomosis | 58 | ||
| Stapled anastomoses | 59 | ||
| Results of anastomotic techniques | 59 | ||
| Drains | 60 | ||
| Postoperative care/complications | 60 | ||
| Anastomotic dehiscence | 60 | ||
| Management of the polyp cancer | 61 | ||
| Emergency management | 61 | ||
| Investigation | 61 | ||
| Management of obstruction | 61 | ||
| Management of perforation | 63 | ||
| Management of advanced disease | 63 | ||
| Operable metastases | 63 | ||
| Inoperable disseminated disease | 63 | ||
| Pathological staging | 64 | ||
| Recommendations for best practice | 65 | ||
| References | 66 | ||
| Chapter 5: Rectal cancer | 69 | ||
| Introduction | 69 | ||
| Objectives of surgery | 69 | ||
| In-hospital mortality | 70 | ||
| Local recurrence | 70 | ||
| Magnetic resonance imaging in assessment of circumferential resection margin and the role of preoperative radiotherapy | 71 | ||
| Complications of preoperative radiotherapy | 71 | ||
| Downstaging rectal cancer with preoperative radiotherapy | 71 | ||
| MRI can predict T stage and CRM status | 72 | ||
| Tumour disruption | 72 | ||
| Extent of excision – TME versus mesorectal transection, pelvic lymphadenectomy and level of vascular ligation | 73 | ||
| Tme | 73 | ||
| Lateral pelvic lymph nodal involvement | 74 | ||
| High versus low inferior mesenteric artery ligation | 74 | ||
| Implantation of viable cells | 74 | ||
| Quality of life | 74 | ||
| Preservation of continence by restorative resection | 75 | ||
| Distal clearance margin | 75 | ||
| Tumour height – the importance of rectal palpation (PR) | 76 | ||
| Quality of the anal function | 76 | ||
| Abdominoperineal excision | 76 | ||
| Reconstruction (colonic pouch, end-to-side or end-to-end anastomosis) | 77 | ||
| Sexual and urinary disturbance | 77 | ||
| Temporary defunctioning stomas | 77 | ||
| Follow-up | 77 | ||
| Synchronous tumours | 78 | ||
| Metachronous tumours | 78 | ||
| Surveillance for local and distant recurrence | 78 | ||
| The way forward | 78 | ||
| References | 78 | ||
| Chapter 6: Adjuvant therapy for colorectal cancer | 82 | ||
| Introduction | 82 | ||
| Adjuvant chemotherapy for colorectal cancer | 82 | ||
| Refining the role of fluoropyrimidine chemotherapy | 82 | ||
| Oral fluoropyrimidine therapy | 83 | ||
| Doublet chemotherapy | 83 | ||
| Addition of ‘targeted’ therapy to chemotherapy | 85 | ||
| Patient selection for adjuvant chemotherapy | 85 | ||
| Acute and long-term toxicity | 85 | ||
| Timing and duration of chemotherapy | 86 | ||
| Adjuvant therapy for rectal cancer | 86 | ||
| Radiotherapy | 86 | ||
| Evidence base for the use of adjuvant radiotherapy in resectable rectal cancer | 87 | ||
| Short-course radiotherapy and TME | 87 | ||
| Preoperative concurrent chemoradiotherapy | 88 | ||
| Short-course radiotherapy or preoperative CRT? | 88 | ||
| Short-course radiotherapy and delay to surgery | 89 | ||
| Late toxicity and second malignancy | 89 | ||
| Patient selection | 89 | ||
| Sphincter preservation | 89 | ||
| Organ preservation | 89 | ||
| Conclusion | 91 | ||
| References | 92 | ||
| Chapter 7: Anal cancer | 95 | ||
| Introduction | 95 | ||
| Epidermoid tumours | 95 | ||
| Aetiology and pathogenesis | 95 | ||
| Premalignant lesions | 96 | ||
| Histological types | 97 | ||
| Patterns of spread | 97 | ||
| Clinical presentation | 97 | ||
| Investigation | 98 | ||
| Clinical staging | 98 | ||
| Treatment | 98 | ||
| Historical | 98 | ||
| Current | 98 | ||
| Radiation-alone therapy | 98 | ||
| Chemo-irradiation therapy (combined modality therapy) | 99 | ||
| Role of surgery today | 100 | ||
| Initial diagnosis | 100 | ||
| Lesions at the anal margin | 100 | ||
| Treatment complications and disease relapse | 100 | ||
| Inguinal metastases | 101 | ||
| Treatment of intraepithelial neoplasia | 101 | ||
| Rarer tumours | 101 | ||
| Adenocarcinoma | 101 | ||
| Malignant melanoma | 102 | ||
| References | 102 | ||
| Chapter 8: Diverticular disease | 103 | ||
| Historical perspectives | 103 | ||
| Anatomical and physiological perspectives | 103 | ||
| Incidence and geographical differences | 103 | ||
| Race and geography | 103 | ||
| Age and gender | 104 | ||
| Diet | 104 | ||
| Aetiology and pathogenesis | 104 | ||
| Lifestyle | 104 | ||
| Smoking | 105 | ||
| Non-steroidal anti-inflammatory drugs (NSAIDs) | 105 | ||
| Diverticulitis | 105 | ||
| The extent of the problem | 105 | ||
| Classification | 105 | ||
| Segmental colitis associated with diverticulosis | 106 | ||
| Diagnosis and imaging | 106 | ||
| Treatment | 108 | ||
| Conservative and medical options | 108 | ||
| Emergency surgery | 110 | ||
| Historical perspectives | 110 | ||
| Laparoscopic peritoneal lavage for generalised purulent peritonitis | 110 | ||
| Resection with primary anastomosis | 111 | ||
| Elective resection: facts, fiction and functional outcome | 111 | ||
| Diverticular haemorrhage | 113 | ||
| References | 114 | ||
| Chapter 9: Ulcerative colitis | 119 | ||
| Introduction | 119 | ||
| Epidemiology | 119 | ||
| Aetiopathogenesis | 119 | ||
| Clinical presentation | 120 | ||
| Extraintestinal manifestations | 120 | ||
| Musculoskeletal | 120 | ||
| Hepatopancreatobiliary | 121 | ||
| Dermatological | 121 | ||
| Thromboembolic | 121 | ||
| Ophthalmological | 121 | ||
| Diagnosis and evaluation | 122 | ||
| Microbiology | 122 | ||
| Endoscopy | 122 | ||
| Histopathology | 122 | ||
| Imaging | 123 | ||
| Colorectal cancer and surveillance | 123 | ||
| Severity assessment | 124 | ||
| Medical management | 125 | ||
| Proctitis | 125 | ||
| Mild to moderate distal colitis | 125 | ||
| Mild to moderate extensive colitis | 126 | ||
| Severe colitis | 126 | ||
| Surgical management | 126 | ||
| Emergent/urgent | 127 | ||
| Elective | 128 | ||
| Proctocolectomy with end ileostomy | 128 | ||
| Proctocolectomy with continent ileostomy | 128 | ||
| Ileorectal anastomosis | 129 | ||
| Restorative proctocolectomy/ileal pouch–anal anastomosis (IPAA) | 129 | ||
| Double-stapled technique | 130 | ||
| Hand-sewn technique | 130 | ||
| Outcomes in stapled versus hand-sewn anastomosis | 130 | ||
| Complications following pouch surgery | 133 | ||
| Functional outcomes | 136 | ||
| References | 137 | ||
| Chapter 10: Crohn's disease | 141 | ||
| Introduction | 141 | ||
| Epidemiology | 141 | ||
| Aetiology | 141 | ||
| Smoking and oral contraception | 141 | ||
| Infection | 142 | ||
| Genetic | 142 | ||
| Pathogenesis | 142 | ||
| Pathology | 142 | ||
| Distribution | 142 | ||
| Macroscopic appearance | 143 | ||
| Microscopy | 143 | ||
| Pitfalls in differentiating Crohn's colitis from ulcerative colitis | 143 | ||
| Clinical | 144 | ||
| Gastrointestinal symptoms | 144 | ||
| Systemic symptoms | 144 | ||
| Extraintestinal manifestations | 144 | ||
| Physical signs | 145 | ||
| Paediatric age group | 145 | ||
| Pregnancy | 145 | ||
| Investigations | 146 | ||
| Laboratory | 146 | ||
| Radiology | 146 | ||
| Endoscopy | 148 | ||
| Disease activity assessment and quality of life | 148 | ||
| Phenotyping | 148 | ||
| Differential diagnosis | 148 | ||
| Small-bowel Crohn's disease | 148 | ||
| Large-bowel Crohn's disease | 149 | ||
| Medical treatment | 149 | ||
| Multidisciplinary care | 150 | ||
| Aminosalicylates | 150 | ||
| Steroids | 150 | ||
| Antibiotics | 151 | ||
| Nutrition for therapy | 151 | ||
| Immunomodulatory therapy | 151 | ||
| ‘Biological agents’ | 151 | ||
| Surgery and immunosuppression | 152 | ||
| Prophylaxis against recurrent disease after surgery | 153 | ||
| Other drugs | 153 | ||
| Surgery | 153 | ||
| Development of surgery | 153 | ||
| Risk of operation and re-operation | 153 | ||
| Risk factors for recurrence | 154 | ||
| Principles of surgery for Crohn's disease | 154 | ||
| Perioperative considerations | 154 | ||
| Technique | 154 | ||
| Surgery for small-bowel and ileocolic Crohn's disease | 155 | ||
| Indications | 155 | ||
| Gastroduodenal disease | 155 | ||
| Ileocolic disease | 155 | ||
| Ileal and jejunal multisite disease | 156 | ||
| Fistulas and abscesses | 156 | ||
| Enterocutaneous fistulas and intra-abdominal abscess | 156 | ||
| Management principles | 157 | ||
| Spontaneous enterocutaneous fistulas | 157 | ||
| Postoperative fistulas | 157 | ||
| Intra-abdominal fistulas | 157 | ||
| Spontaneous free perforation in the small bowel or colon | 158 | ||
| Surgery for colonic and rectal Crohn's disease | 158 | ||
| Indications | 158 | ||
| Emergency colectomy and colectomy and ileostomy | 158 | ||
| Segmental colectomy | 158 | ||
| Total colectomy and ileorectal anastomosis | 158 | ||
| Panproctocolectomy | 159 | ||
| Restorative proctocolectomy | 160 | ||
| Crohn's colitis and cancer | 160 | ||
| Perianal disease | 160 | ||
| Investigation | 161 | ||
| Medical treatment | 161 | ||
| Anal fissure | 161 | ||
| Abscesses | 161 | ||
| Anal fistulas | 161 | ||
| Rectovaginal fistulas | 162 | ||
| Defunctioning ileostomy for perianal disease | 162 | ||
| Long-term complications of perianal disease | 162 | ||
| Prognosis | 162 | ||
| References | 163 | ||
| Chapter 11: Incontinence | 167 | ||
| Introduction | 167 | ||
| Aetiology | 167 | ||
| Sphincter injury | 167 | ||
| Rectal compliance | 169 | ||
| ‘Idiopathic’ faecal incontinence | 169 | ||
| Presentation | 170 | ||
| History | 170 | ||
| Examination | 170 | ||
| Investigations | 171 | ||
| Management of faecal incontinence in adults | 171 | ||
| Conservative measures | 172 | ||
| Dietary modification and medications | 172 | ||
| Biofeedback, pelvic floor muscle training and electrostimulation | 172 | ||
| Anal plug | 173 | ||
| Surgery | 173 | ||
| Sphincteroplasty | 173 | ||
| Pelvic floor repair (postanal, preanal or total) | 174 | ||
| Sphincter reconstruction – muscle transposition | 174 | ||
| Artificial sphincters | 174 | ||
| Artificial bowel sphincter | 174 | ||
| Magnetic anal sphincter | 176 | ||
| Sacral nerve stimulation | 177 | ||
| Percutaneous and transcutaneous tibial nerve stimulation | 178 | ||
| Injection therapy | 179 | ||
| Stoma | 179 | ||
| Antegrade continence enema | 179 | ||
| End stoma | 179 | ||
| Conclusion | 180 | ||
| References | 181 | ||
| Chapter 12: Functional problems and their surgical management | 184 | ||
| Introduction | 184 | ||
| Rectal prolapse | 184 | ||
| Mucosal prolapse | 184 | ||
| Full-thickness rectal prolapse (see Table 12.1) | 185 | ||
| Choice of surgical approach | 185 | ||
| Perineal approaches | 185 | ||
| Abdominal approaches | 185 | ||
| Laparoscopic approaches | 188 | ||
| The PROSPER trial | 189 | ||
| Recurrent rectal prolapse | 190 | ||
| Obstructive defecation, rectocele and rectal intussusception | 190 | ||
| Rectocele | 190 | ||
| Rectal intussusception | 191 | ||
| Laparoscopic ventral rectopexy | 193 | ||
| Stapled transanal rectal resection (STARR) | 193 | ||
| The external pelvic rectal suspension (EXPRESS) procedure | 195 | ||
| Solitary rectal ulcer syndrome (SRUS) | 196 | ||
| References | 197 | ||
| Chapter 13: Functional problems and their medical management | 202 | ||
| Introduction | 202 | ||
| Irritable bowel syndrome | 202 | ||
| Investigation | 203 | ||
| Treatment | 203 | ||
| Lifestyle modification | 203 | ||
| Pharmacological treatments | 203 | ||
| Psychological treatments | 204 | ||
| Surgery | 204 | ||
| Functional constipation | 204 | ||
| Investigation | 205 | ||
| Treatment | 205 | ||
| Dietary fibre supplementation | 205 | ||
| Laxatives, suppositories, enemas and novel prokinetics | 205 | ||
| Behavioural therapy (biofeedback) | 206 | ||
| Surgical treatment for constipation | 206 | ||
| Putative treatments for constipation | 207 | ||
| Idiopathic megarectum and megacolon | 208 | ||
| References | 209 | ||
| Chapter 14: Anal fistula: evaluation and management | 212 | ||
| Introduction | 212 | ||
| Aetiology | 213 | ||
| Management of acute sepsis | 214 | ||
| Classification of anal fistula | 216 | ||
| Assessment | 217 | ||
| Clinical | 217 | ||
| Imaging | 219 | ||
| Physiological | 220 | ||
| Principles of fistula surgery | 221 | ||
| Surgical treatment | 221 | ||
| Fistulotomy | 221 | ||
| Fistulotomy and immediate reconstitution | 223 | ||
| Fistulectomy | 223 | ||
| Setons | 223 | ||
| The loose seton | 223 | ||
| The tight seton | 224 | ||
| The chemical seton | 225 | ||
| Advancement flaps | 225 | ||
| Intersphincteric approaches | 226 | ||
| Plugs and glues ( Table 14.1) | 226 | ||
| Fibrin glue | 226 | ||
| Bioprosthetic plugs | 227 | ||
| Management of the recurrent fistula | 227 | ||
| References | 228 | ||
| Chapter 15: Minor anorectal conditions | 231 | ||
| Haemorrhoids | 231 | ||
| Pathogenesis and aetiology | 231 | ||
| Management | 232 | ||
| Non-prolapsing or mildly prolapsing haemorrhoids | 232 | ||
| Rubber-band ligation | 232 | ||
| Injection sclerotherapy | 233 | ||
| Other methods | 233 | ||
| Irreducible prolapsed piles | 233 | ||
| Stapled haemorrhoidectomy (haemorrhoidopexy) | 234 | ||
| Transanal haemorrhoidal dearterialisation | 234 | ||
| Postoperative problems | 235 | ||
| Sepsis after treatment of haemorrhoids | 235 | ||
| Conclusion | 236 | ||
| Anal fissure | 236 | ||
| Clinical findings | 236 | ||
| Aetiology and classification | 237 | ||
| Initiating factors | 237 | ||
| Perpetuating factors | 238 | ||
| From ‘acute vs. chronic’ to ‘superficial vs. deep’ anal fissure | 238 | ||
| Medical treatment | 239 | ||
| Surgical treatment | 240 | ||
| Recurrent or atypical fissures | 240 | ||
| Conclusion | 241 | ||
| Pruritus ani | 241 | ||
| Aetiology and pathogenesis | 241 | ||
| Diagnosis | 242 | ||
| Treatment | 242 | ||
| Conclusion | 242 | ||
| Pilonidal sinus | 242 | ||
| Aetiology | 242 | ||
| Clinical manifestation | 243 | ||
| Treatment | 243 | ||
| Pilonidal abscess | 243 | ||
| Chronic pilonidal sinus | 243 | ||
| Outpatient options | 243 | ||
| Inpatient options | 244 | ||
| Recurrent pilonidal sinus | 244 | ||
| Conclusion | 245 | ||
| Anal stenosis | 245 | ||
| Aetiology | 246 | ||
| Clinical presentation | 246 | ||
| Treatment | 246 | ||
| Prevention | 246 | ||
| Anal dilatation | 246 | ||
| Sphincterotomy | 247 | ||
| Stricturoplasty | 247 | ||
| Flap procedures | 247 | ||
| Mucosal advancement flap (above to down) | 247 | ||
| Y-V advancement flap (outside to in) | 248 | ||
| V-Y advancement flap (outside to in) | 248 | ||
| Island advancement flap (outside to in) | 248 | ||
| S-anoplasty (outside to in) | 248 | ||
| Conclusion | 248 | ||
| Dietary fibre – more harm than good? | 248 | ||
| References | 249 | ||
| Chapter 16: Sexually transmitted diseases and the anorectum | 253 | ||
| Introduction | 253 | ||
| Viral | 253 | ||
| Human immunodeficiency virus | 253 | ||
| Herpes simplex virus | 256 | ||
| Human papillomavirus | 257 | ||
| Buschke–Lowenstein tumour: giant anal condyloma | 260 | ||
| Molluscum contagiosum | 260 | ||
| Bacterial | 261 | ||
| Chlamydia trachomatis and Lymphogranuloma venereum (LGV) | 261 | ||
| Chancroid | 262 | ||
| Neisseria gonorrhoeae | 262 | ||
| Granuloma inguinale (Donovanosis) | 263 | ||
| Syphilis | 264 | ||
| Empirical treatment | 265 | ||
| References | 266 | ||
| Chapter 17: Minimally invasive surgery and enhanced recovery programmes in colorectal disease | 269 | ||
| Introduction | 269 | ||
| Outcomes of laparoscopic colorectal surgery | 269 | ||
| Oncological outcomes | 269 | ||
| Hospital stay and complications | 270 | ||
| Blood loss | 271 | ||
| Mortality | 271 | ||
| Economic considerations | 271 | ||
| Conversion to open surgery | 271 | ||
| The definition of conversion | 271 | ||
| Predicting the risk of conversion | 272 | ||
| Outcome after conversion | 273 | ||
| Benign colorectal conditions suitable for laparoscopic surgery | 273 | ||
| Laparoscopic colorectal technique | 274 | ||
| Difficult aspects of laparoscopic resection | 276 | ||
| The learning curve and training in laparoscopic colorectal surgery | 277 | ||
| Future developments | 278 | ||
| Transanal endoscopic surgery | 278 | ||
| Summary | 279 | ||
| Enhanced recovery programmes | 280 | ||
| Traditional perioperative care | 280 | ||
| Perioperative interventions in enhanced recovery programmes | 281 | ||
| Reducing metabolic stress | 281 | ||
| Preoperative bowel preparation | 281 | ||
| Perioperative fluid balance | 281 | ||
| Surgical technique and wound drainage | 282 | ||
| Mobilisation | 282 | ||
| Pain control | 282 | ||
| Enhanced recovery trials | 282 | ||
| ERPs applied to laparoscopic surgery | 283 | ||
| Who should have ER care? | 283 | ||
| Starting an ERP | 283 | ||
| Summary | 283 | ||
| References | 284 | ||
| Chapter 18: Intestinal failure | 289 | ||
| Introduction | 289 | ||
| Intestinal failure: criteria for referral | 290 | ||
| Epidemiology | 290 | ||
| Causes | 290 | ||
| Loss of intestinal length | 290 | ||
| Loss of functional absorptive capacity | 291 | ||
| Loss of intestinal absorptive capacity | 291 | ||
| Loss of intestinal function | 291 | ||
| Pathophysiology | 291 | ||
| The three stages of intestinal failure | 291 | ||
| Stage I: hypersecretory phase | 291 | ||
| Stage II: adaptation phase | 292 | ||
| Stage III: stabilisation phase | 292 | ||
| Fluid and electrolytes | 292 | ||
| Nutrients | 292 | ||
| Carbohydrates, proteins and water-soluble vitamins | 292 | ||
| Fat, bile salts and fat-soluble vitamins | 292 | ||
| Adaptation | 293 | ||
| Role of the colon in SBS | 293 | ||
| Surgical catastrophe and management | 293 | ||
| Resuscitation | 294 | ||
| Restitution | 294 | ||
| Sepsis | 294 | ||
| Nutrition | 294 | ||
| Fluid and electrolytes | 294 | ||
| Nutritional support | 294 | ||
| Reduction of output | 295 | ||
| Dietary modification | 295 | ||
| Outcome aims and monitoring | 296 | ||
| Total parenteral nutrition | 297 | ||
| Anatomy (mapping) | 297 | ||
| Protection of skin | 297 | ||
| Planned surgery | 298 | ||
| Reconstruction | 298 | ||
| Enterocutaneous fistula | 299 | ||
| Rehabilitation | 299 | ||
| Transplantation | 300 | ||
| Supporting organisations | 300 | ||
| Summary | 301 | ||
| References | 302 | ||
| Index | 305 |