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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 |