BOOK
Current Therapy in Colon and Rectal Surgery E-Book
Victor W. Fazio | James M. Church | Conor P Delaney | Ravi P Kiran
(2016)
Additional Information
Book Details
Abstract
For more than 25 years, Current Therapy in Colon and Rectal Surgery has been the go-to resource for preparing for the American Board of Surgery certification exam. Following in this tradition, the 3rd Edition offers a comprehensive, contemporary summary of treatment options for colorectal diseases, with a focus on practical clinical science and applications. In a single, portable volume, you’ll find complete coverage of new diagnostic modalities, medical therapeutics, and surgical treatment options, including minimally invasive surgery. Easy to read and digest, it provides a quick consultation with experts on the essentials of colon and rectal surgery.
- Consult this title for a quick overview before you enter the OR, and use it as a review tool for board certification and recertification.
- Nearly 100 succinct chapters, just 3 or 4 pages each, written by leading experts in colorectal surgery.
- Five chapters devoted exclusively to different aspects of rectal cancer.
- Other key topics include minimally invasive surgery, reparative surgery, maturing outcomes, and managing surgical risk.
- New chapters focus on hot topics such as intestinal transplants, enhanced recovery programs, and the management of peristomal hernias.
- Updated information on the molecular biology of colorectal cancer and its implications for therapy.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| IFC | ES1 | ||
| Current therapy in colon and rectal surgery | i | ||
| Copyright | ii | ||
| Dedication | iii | ||
| Contributors | v | ||
| Preface to the third edition | xiii | ||
| Acknowledgments | xiv | ||
| Contents | xv | ||
| 1 - ANAL AND PERIANAL REGION | 1 | ||
| 1 - Anatomy and Physiology of the Colon, Rectum, and Anal Canal* | 3 | ||
| ANATOMY OF THE COLON AND RECTUM | 3 | ||
| Colon | 3 | ||
| Course and Peritoneal Coverings | 3 | ||
| Rectum | 3 | ||
| Peritoneal Relations and Fascial Attachments | 3 | ||
| ARTERIAL SUPPLY | 4 | ||
| Superior Mesenteric Artery | 4 | ||
| Inferior Mesenteric Artery | 4 | ||
| Collateral Circulation | 5 | ||
| VENOUS DRAINAGE | 5 | ||
| Superior Mesenteric Vein | 5 | ||
| Inferior Mesenteric Vein | 5 | ||
| LYMPHATIC DRAINAGE | 5 | ||
| INNERVATION | 5 | ||
| COLON AND RECTUM PHYSIOLOGY | 6 | ||
| Colonic Physiology | 6 | ||
| Absorption and Secretion | 6 | ||
| Digestion | 6 | ||
| Propulsion and Storage | 6 | ||
| ANAL CANAL ANATOMY | 7 | ||
| Lining | 7 | ||
| Muscles of the Anorectal Region | 8 | ||
| Perineal Body | 8 | ||
| Pelvic Floor Muscles | 8 | ||
| Innervation of the Anus | 8 | ||
| Motor Innervation | 8 | ||
| Sensory Innervation | 9 | ||
| Arterial Supply of the Anus | 9 | ||
| Lymphatic Drainage of the Anus | 9 | ||
| Venous Drainage of the Anus | 9 | ||
| ANAL CANAL PHYSIOLOGY | 9 | ||
| Mechanisms of Continence | 9 | ||
| Defecation | 9 | ||
| Physiologic Testing | 9 | ||
| Anal Manometry | 9 | ||
| Defecography by Fluoroscopy or Magnetic Resonance Imaging | 10 | ||
| Balloon Expulsion Test | 10 | ||
| Saline Continence Test | 10 | ||
| Rectal Compliance | 10 | ||
| Electromyography | 10 | ||
| Nerve Stimulation Techniques | 10 | ||
| Suggested Reading | 11 | ||
| 2 - Hemorrhoids | 12 | ||
| EXTERNAL HEMORRHOIDS | 12 | ||
| ANATOMY AND ETIOLOGY OF INTERNAL HEMORRHOIDS | 12 | ||
| CLINICAL EVALUATION | 12 | ||
| NONEXCISIONAL OPTIONS | 13 | ||
| Medical Management | 13 | ||
| Sclerotherapy | 13 | ||
| Energy-Based Destruction | 13 | ||
| Hemorrhoidal Ligation with Rubber Bands | 13 | ||
| EXCISIONAL HEMORRHOIDECTOMY | 13 | ||
| Instrumentation for Excisional Hemmorrhoidectomy | 14 | ||
| PROCEDURE FOR PROLAPSING HEMORRHOIDS (STAPLED HEMMORHOIDOPEXY) | 14 | ||
| DOPPLER-GUIDED HEMORRHOIDAL DEARTERIALIZATION | 14 | ||
| POSTOPERATIVE MANAGEMENT AFTER HEMORRHOID SURGERY | 14 | ||
| CONCLUSION | 15 | ||
| Suggested Reading | 15 | ||
| 3 - Chronic Anal Fissure | 16 | ||
| INTRODUCTION | 16 | ||
| DIAGNOSIS | 16 | ||
| PATHOPHYSIOLOGY | 16 | ||
| High-Pressure Chronic Anal Fissure | 16 | ||
| Low- and Normal-Pressure Chronic Anal Fissure | 16 | ||
| MANAGEMENT | 17 | ||
| Topical Creams | 17 | ||
| Botulinum Toxin | 17 | ||
| Fissurectomy | 17 | ||
| Cutaneous Advancement Flap | 18 | ||
| Lateral Internal Sphincterotomy | 18 | ||
| Surgical Technique | 18 | ||
| Risk of Incontinence | 18 | ||
| Tailored Sphincterotomy | 18 | ||
| Treatment of Low/Normal Pressure Chronic Anal Fissure | 18 | ||
| SUMMARY: CHOICE OF TREATMENT | 19 | ||
| Suggested Reading | 19 | ||
| 4 - Anorectal Abscess | 21 | ||
| SURGICAL ANATOMY | 21 | ||
| ETIOLOGY | 21 | ||
| NATURAL HISTORY OF THE DISEASE AND SPREAD PATHWAYS | 21 | ||
| CLINICAL FEATURES | 21 | ||
| Perianal Abscess | 21 | ||
| Ischiorectal Abscess | 21 | ||
| Intersphincteric Abscess | 22 | ||
| Supralevator Abscess | 22 | ||
| Deep Postanal Abscess | 22 | ||
| Submucosal Abscess | 22 | ||
| DIAGNOSIS | 22 | ||
| Treatment of Anorectal Abscesses | 22 | ||
| Large Abscesses | 22 | ||
| Searching for a Fistula | 22 | ||
| Ischiorectal Abscess | 23 | ||
| Intersphincteric Abscesses | 23 | ||
| Supralevator Abscess | 23 | ||
| Submucosal Abscess | 23 | ||
| Role of Antibiotics and Biopsy | 23 | ||
| Postoperative Care | 23 | ||
| Complications | 23 | ||
| RECURRENCE AND THE DEVELOPMENT OF FISTULA IN ANO | 23 | ||
| Suggested Reading | 23 | ||
| 5 - Anal Fistula | 24 | ||
| INTRODUCTION | 24 | ||
| ETIOLOGY | 24 | ||
| CLASSIFICATION | 24 | ||
| PRESENTATION | 24 | ||
| DIAGNOSIS AND EVALUATION | 24 | ||
| Preparation and Examination | 25 | ||
| 2 - RECTAL AND PARARECTAL REGION | 91 | ||
| 19 - Fecal Incontinence | 93 | ||
| INTRODUCTION AND INCIDENCE | 93 | ||
| CAUSES | 93 | ||
| ASSESSMENT | 93 | ||
| TREATMENT | 94 | ||
| Medical Management | 94 | ||
| Biofeedback | 94 | ||
| Surgery | 94 | ||
| Anal Sphincter Repair (Sphincteroplasty) | 94 | ||
| Postanal Repair | 95 | ||
| Anal Encirclement | 95 | ||
| Muscle Transposition | 95 | ||
| Sacral Nerve Stimulation | 95 | ||
| Posterior Tibial Nerve Stimulation | 96 | ||
| Continence Enemas | 96 | ||
| Stem Cells, Bulking Agents, and Other Techniques | 96 | ||
| Fecal Diversion | 96 | ||
| CONCLUSIONS | 96 | ||
| Suggested Readings | 97 | ||
| 20 - Rectal Stricture: Etiology and Management | 98 | ||
| DEFINITION | 98 | ||
| PRESENTATION AND DIAGNOSIS | 98 | ||
| ETIOLOGY | 98 | ||
| BENIGN RECTAL STRICTURES | 98 | ||
| Rectal Strictures Related to Inflammatory Bowel Disease | 98 | ||
| MALIGNANT RECTAL STRICTURES | 100 | ||
| SUMMARY | 100 | ||
| Suggested Readings | 100 | ||
| 21 - Management of Fecal Impaction | 102 | ||
| INTRODUCTION | 102 | ||
| ETIOPATHOLOGY | 102 | ||
| Presentation | 102 | ||
| DIAGNOSIS | 103 | ||
| TREATMENT | 103 | ||
| Medical Treatment | 103 | ||
| Digital Evacuation | 103 | ||
| Enemas and Colonic Lavage | 103 | ||
| Oral Solutions | 104 | ||
| Stool Softeners | 104 | ||
| Laxatives | 105 | ||
| Endoscopic Disimpaction | 105 | ||
| SURGERY | 105 | ||
| Acute | 105 | ||
| Chronic | 105 | ||
| PREVENTION | 105 | ||
| CONCLUSION | 105 | ||
| Suggested Reading | 105 | ||
| 22 - Rectal Prolapse | 107 | ||
| INTRODUCTION | 107 | ||
| PATHOPHYSIOLOGY | 107 | ||
| CLINICAL FEATURES | 107 | ||
| PREOPERATIVE CONSIDERATIONS | 107 | ||
| SURGICAL OPTIONS | 108 | ||
| Perineal Repairs | 108 | ||
| Abdominal Procedures | 108 | ||
| Recommendations | 109 | ||
| Problems | 109 | ||
| MANAGEMENT OF RECURRENT PROLAPSE | 109 | ||
| Suggested Reading | 109 | ||
| 23 - Solitary Rectal Ulcer Syndrome | 111 | ||
| INTRODUCTION | 111 | ||
| CAUSE | 111 | ||
| PATHOPHYSIOLOGY | 111 | ||
| CLINICAL FEATURES | 111 | ||
| DIAGNOSIS | 112 | ||
| MANAGEMENT | 112 | ||
| Nonoperative Management | 112 | ||
| Surgery | 113 | ||
| CONCLUSIONS | 113 | ||
| Suggested Reading | 113 | ||
| 24 - Rectocele | 114 | ||
| DEFINITION | 114 | ||
| CAUSES | 114 | ||
| SYMPTOMS | 114 | ||
| DIAGNOSIS | 114 | ||
| MANAGEMENT | 115 | ||
| SURGICAL TREATMENT | 115 | ||
| Transanal Repairs | 115 | ||
| Transvaginal Repairs | 115 | ||
| Transperineal Repairs | 116 | ||
| Comparison of Approaches | 116 | ||
| SUMMARY | 116 | ||
| Suggested Reading | 117 | ||
| 25 - Rectal Foreign Bodies | 118 | ||
| EPIDEMIOLOGY | 118 | ||
| EVALUATION | 118 | ||
| CLASSIFICATION | 118 | ||
| American Association for the Surgery of Trauma Rectal Organ Injury Scale | 118 | ||
| Location of the Foreign Body | 119 | ||
| Intraperitoneal or Extraperitoneal | 119 | ||
| EXTRACTION | 119 | ||
| MANAGEMENT | 119 | ||
| POSTEXTRACTION CARE | 120 | ||
| Suggested Reading | 120 | ||
| 26 - Diagnosis and Management of Sacral and Retrorectal Tumors | 121 | ||
| INTRODUCTION | 121 | ||
| ANATOMY OF THE RETRORECTAL SPACE | 121 | ||
| CLASSIFICATION SYSTEMS | 121 | ||
| CONGENITAL/DEVELOPMENTAL LESIONS | 122 | ||
| Germ Cell Tumors | 122 | ||
| Tailgut Cysts | 123 | ||
| Duplication Cysts | 123 | ||
| Anterior Sacral Meningocele | 124 | ||
| Chordoma | 124 | ||
| Osseous Tumors | 125 | ||
| Neurogenic Tumors | 127 | ||
| Nonosseous Mesenchymal Tumors | 127 | ||
| INFLAMMATORY LESIONS | 127 | ||
| METASTATIC LESIONS | 127 | ||
| DIAGNOSTIC APPROACHES TO SACRAL AND RETRORECTAL TUMORS | 127 | ||
| OPERATIVE APPROACHES | 128 | ||
| SUMMARY | 130 | ||
| Suggested Reading | 130 | ||
| 27 - Management of Rectal Villous Tumors | 132 | ||
| INTRODUCTION | 132 | ||
| RECTAL ANATOMY AND PHYSIOLOGY | 132 | ||
| CLINICALLY SIGNIFICANT ASSOCIATIONS OF RECTAL FUNCTION | 132 | ||
| THERAPEUTIC OPTIONS RESULTING FROM THE LOCATION OF THE RECTUM | 132 | ||
| RECTAL VILLOUS TUMORS | 132 | ||
| ASSESSING THE LESION FOR CANCER | 132 | ||
| TREATMENT | 132 | ||
| Endoscopic Polypectomy | 132 | ||
| Transanal Excision | 133 | ||
| Transanal Endoscopic Microsurgery/Transanal Minimally Invasive Surgery | 134 | ||
| Delorme Procedure | 134 | ||
| Trans-sacral Resection | 134 | ||
| Anterior Resection | 134 | ||
| FOLLOW-UP | 134 | ||
| Suggested Reading | 134 | ||
| 28 - Preoperative Evaluation of the Patient with Rectal Cancer: Staging and Strategy | 135 | ||
| INTRODUCTION | 135 | ||
| CLINICAL ASSESSMENT | 135 | ||
| History | 135 | ||
| Physical Examination | 135 | ||
| ENDOSCOPIC EVALUATION AND BIOPSY | 135 | ||
| PREOPERATIVE STAGING WITH IMAGING MODALITIES | 136 | ||
| Locoregional Evaluation | 136 | ||
| Tumor Stage and the Circumferential Resection Margin | 136 | ||
| Nodal Staging | 137 | ||
| Extramural Venous Invasion | 138 | ||
| Locoregional Imaging Synoptic Reports | 138 | ||
| Distant Metastatic Evaluation | 138 | ||
| Serum Tumor Markers | 139 | ||
| ROLE OF MULTIDISCIPLINARY CANCER CONFERENCES | 139 | ||
| Suggested Readings | 140 | ||
| 29 - Cancer of the Rectum: Neoadjuvant Therapy | 141 | ||
| INTRODUCTION | 141 | ||
| RADIOTHERAPY TRIALS | 141 | ||
| ROLE OF CIRCUMFERENTIAL RESECTION MARGIN | 141 | ||
| MULTIMODALITY TREATMENT APPROACHES | 141 | ||
| RANDOMIZED TRIALS COMPARING NEOADJUVANT SHORT-COURSE RADIOTHERAPY WITH CHEMOTHERAPY–LONG-COURSE RADIOTHERAPY | 142 | ||
| RADIATION TREATMENT VOLUMES | 142 | ||
| RADIATION-RELATED TOXICITIES | 142 | ||
| OTHER PERIOPERATIVE RADIATION TREATMENT OPTIONS | 142 | ||
| Boosting the Dose | 142 | ||
| INTRAOPERATIVE RADIATION THERAPY | 144 | ||
| INTENSITY-MODULATED RADIATION THERAPY | 144 | ||
| HIGH-DOSE-RATE ENDORECTAL BRACHYTHERAPY | 144 | ||
| SUMMARY | 144 | ||
| Suggested Reading | 144 | ||
| 30 - Cancer of the Rectum: Operative Management | 146 | ||
| INTRODUCTION | 146 | ||
| KEY ANATOMIC POINTS | 146 | ||
| PRESURGICAL PATIENT PREPARATION AND EVALUATION | 146 | ||
| PREOPERATIVE DECISION MAKING | 147 | ||
| Deciding Between an Open or Laparoscopic Approach | 147 | ||
| Should a Stapled or Hand-Sewn Restorative Procedure Be Performed? | 147 | ||
| SURGICAL PRINCIPLES | 147 | ||
| Total Mesorectal Excision | 147 | ||
| Ligation of the Inferior Mesenteric Artery | 147 | ||
| Distal Resection Margins | 147 | ||
| Choice of Anastomotic Configuration | 147 | ||
| Drainage | 148 | ||
| Diverting Stoma | 148 | ||
| KEY STEPS OF SURGICAL PROCEDURES | 148 | ||
| Low Anterior Resection | 148 | ||
| Positioning and Equipment | 148 | ||
| Trocar Placement | 148 | ||
| Exposure of the Operating Field | 148 | ||
| Identification of Inferior Mesenteric Vessels and Left Ureter | 148 | ||
| Division of the Vessels and Splenic Flexure Mobilization | 148 | ||
| Mobilization and Division of the Rectum | 148 | ||
| Exteriorization of the Specimen | 149 | ||
| Creation of the Anastomosis | 149 | ||
| Desufflation and Closure of Trocar Incisions | 149 | ||
| Abdominoperineal Resection | 149 | ||
| Closure of the Anal Opening | 149 | ||
| Mobilization of the Rectum | 149 | ||
| Proximal Division of the Left Colon | 149 | ||
| Perineal Dissection and Exteriorization | 149 | ||
| Closure of Pelvic Wound and Trocar Incisions and Creation of the Colostomy | 149 | ||
| PELVIC EXENTERATION | 150 | ||
| Surgical Approaches | 150 | ||
| Assessment Before Exenteration | 150 | ||
| Signs of Irresectability | 150 | ||
| Sacrectomy | 150 | ||
| Pelvic Sidewall Disease | 150 | ||
| Anterior Compartment/Urogenital Disease | 150 | ||
| Central Recurrence | 150 | ||
| Bladder Reconstruction | 150 | ||
| Perineal Reconstruction | 150 | ||
| OUTCOMES: SURVIVAL AND LOCAL RECURRENCE | 150 | ||
| Suggested Reading | 151 | ||
| 31 - Local Treatment of Rectal Cancer | 152 | ||
| INTRODUCTION | 152 | ||
| PREOPERATIVE EVALUATION | 152 | ||
| INITIAL SELECTION | 153 | ||
| SURGICAL TECHNIQUE | 153 | ||
| Patient Preparation | 153 | ||
| Transanal Excision | 153 | ||
| Transanal Endoscopic Microsurgery/Transanal Endoscopic Operation | 153 | ||
| Transanal Minimally Invasive Surgery | 154 | ||
| MANAGEMENT OF THE SPECIMEN | 154 | ||
| FOLLOW-UP | 154 | ||
| RESULTS | 154 | ||
| Local Excision for T1N0 Rectal Cancer | 154 | ||
| Local Excision for T2N0 Rectal Cancer | 154 | ||
| Salvage Resection after Local Excision | 155 | ||
| ALTERNATIVE TO LOCAL EXCISION: ENDOCAVITARY CONTACT RADIATION | 155 | ||
| CONCLUSIONS: ALGORITHM FOR TREATMENT BY LOCAL EXCISION | 156 | ||
| 32 - Locally Recurrent Rectal Cancer: Management and Follow-up | 157 | ||
| INTRODUCTION | 157 | ||
| NOMENCLATURE OF PELVIC RECURRENCE | 157 | ||
| CLINICAL EVALUATION FOR SUSPECTED PELVIC RECURRENCE | 157 | ||
| MANAGEMENT OF PELVIC RECURRENCE | 158 | ||
| Category I: Asymptomatic Local and Distant Recurrence | 158 | ||
| Category II: Symptomatic Local Recurrence in the Presence of Distant Disease | 158 | ||
| Category III: Unresectable, Isolated Local Recurrence | 158 | ||
| Category IV: Resectable Isolated Local Recurrence | 158 | ||
| Axial Recurrences | 159 | ||
| Anterior Recurrences | 159 | ||
| Posterior Recurrences | 159 | ||
| Lateral Recurrences | 159 | ||
| THE ROLE OF CHEMORADIATION FOR PELVIC RECURRENCE | 159 | ||
| PREOPERATIVE AND INTRAOPERATIVE CONSIDERATIONS | 159 | ||
| RECONSTRUCTION OPTIONS FOR PERINEAL DEFECTS | 160 | ||
| SUMMARY | 160 | ||
| Suggested Reading | 160 | ||
| 33 - Perineal Hernia | 162 | ||
| INTRODUCTION | 162 | ||
| THERAPY | 162 | ||
| Patient Selection | 162 | ||
| Preoperative Preparation | 162 | ||
| Procedures | 162 | ||
| Alternative Methods | 163 | ||
| Postoperative Care | 163 | ||
| Complications | 163 | ||
| PREVENTION | 164 | ||
| SUMMARY | 164 | ||
| Suggested Reading | 164 | ||
| 3 - COLON | 165 | ||
| 34 - Preoperative Preparation of the Patient for Colon and Rectal Surgery | 167 | ||
| INTRODUCTION | 167 | ||
| RISK ASSESSMENT | 167 | ||
| CARDIOVASCULAR ASSESSMENT AND PREOPERATIVE MANAGEMENT | 167 | ||
| PREOPERATIVE PULMONARY ASSESSMENT AND MANAGEMENT | 169 | ||
| MANAGEMENT OF PATIENTS RECEIVING ANTITHROMBOTIC THERAPY | 170 | ||
| MANAGEMENT OF PREOPERATIVE ANEMIA | 171 | ||
| MANAGEMENT OF PREOPERATIVE MALNUTRITION | 172 | ||
| Suggested Reading | 173 | ||
| 35 - Medical Treatment of Ulcerative Colitis and Other Colitides | 174 | ||
| ULCERATIVE COLITIS | 174 | ||
| Diagnosis | 174 | ||
| Treatment | 174 | ||
| Diet | 174 | ||
| 5-Aminosalycilic Acid | 174 | ||
| Mild to Moderate Ulcerative Colitis | 174 | ||
| Proctitis and Left-Sided Ulcerative Colitis | 176 | ||
| Left-Sided Disease | 176 | ||
| Extensive Disease | 177 | ||
| Lack of Response to 5-Aminosalycilic Acid | 177 | ||
| Oral Budesonide | 177 | ||
| Corticosteroids | 177 | ||
| Severe Ulcerative Colitis | 177 | ||
| Cyclosporine | 177 | ||
| Azathioprine and 6-Mercaptopurine | 178 | ||
| Biologic Agents | 178 | ||
| Infliximab | 178 | ||
| Loss of Response. It is known that antibodies can develop in patients receiving anti-TNF-α agents with a loss of response to tre... | 178 | ||
| Infusion Reactions. Mild infusion reactions occur in 5% to 13% of patients, but severe infusion reactions requiring infliximab d... | 179 | ||
| Delayed Reactions. Delayed reactions occur 3 to 12 days after the administration of infliximab. These reactions result from the ... | 179 | ||
| Adalimumab | 179 | ||
| Golimumab | 179 | ||
| How to Choose an Anti-TNF-α Agent | 179 | ||
| Complications | 179 | ||
| What to Do Before Starting Anti-TNF-α Therapy | 179 | ||
| What to Do Once Treatment with an Anti-TNF-α Agent Is Started | 179 | ||
| Antiadhesion Molecules | 180 | ||
| Alternative Therapies | 180 | ||
| Nicotine | 180 | ||
| Clinical Scenarios | 180 | ||
| Quiescent Disease | 180 | ||
| Fulminant or Toxic Colitis | 180 | ||
| General Recommendations for Patients with Severe Ulcerative Colitis | 181 | ||
| Test for C. difficile Toxin A and B | 181 | ||
| Flexible Sigmoidoscopy with Biopsies | 181 | ||
| Deep Vein Thrombosis Prophylaxis | 181 | ||
| Evaluate for Tuberculosis and Hepatitis B | 181 | ||
| Avoid Narcotics and Antidiarrheal Medications | 181 | ||
| Do Not Use Antibiotics | 181 | ||
| Diet as Tolerated | 181 | ||
| Perform Close Observation and Consult Colorectal Surgery upon Admission | 181 | ||
| Vaccinations | 181 | ||
| Pregnancy | 181 | ||
| Cancer Risk | 181 | ||
| Colorectal Cancer Prevention | 183 | ||
| OTHER COLITIDES | 183 | ||
| Microscopic Colitis | 183 | ||
| Diversion Colitis | 183 | ||
| Radiation Colopathy | 184 | ||
| Drug-Induced Colitis | 184 | ||
| Suggested Reading | 184 | ||
| 36 - Chronic Ulcerative Colitis: Surgical Options | 186 | ||
| INTRODUCTION | 186 | ||
| EVOLUTION OF SURGERY FOR ULCERATIVE COLITIS | 186 | ||
| INDICATIONS FOR SURGERY IN PERSONS WITH ULCERATIVE COLITIS | 186 | ||
| OPERATIONS FOR ULCERATIVE COLITIS | 186 | ||
| Ileostomy | 186 | ||
| Straight Ileoanal Anastomosis | 186 | ||
| Subtotal Colectomy | 186 | ||
| Abdominal Colectomy with Ileorectal Anastomosis | 187 | ||
| Ileostomy and Blowhole Colostomy | 187 | ||
| Total Proctocolectomy and Ileostomy | 187 | ||
| Proctectomy Surgical Technique | 187 | ||
| Continent Ileostomy | 187 | ||
| Restorative Proctocolectomy | 188 | ||
| Pouch Configuration and Anastomosis | 188 | ||
| Staging the Procedure | 188 | ||
| Technique of Creation of an Ileoanal J Pouch | 188 | ||
| Problems with Reach of the Pouch | 188 | ||
| OUTCOMES OF ILEAL POUCH–ANAL ANASTOMOSIS | 189 | ||
| Complications after Ileal Pouch–Anal Anastomosis | 189 | ||
| Overall Quality of Life | 189 | ||
| Function of the Pouch | 189 | ||
| Pouchitis | 189 | ||
| Pouch Failure | 189 | ||
| Pouch Fistula | 189 | ||
| Risk of Carcinoma | 189 | ||
| Fertility, Sexual Problems, and Obstetric Outcome | 189 | ||
| Extraintestinal Manifestations | 189 | ||
| Quantification of Risk for Pouch Failure after Ileal Pouch Anal Anastomosis Surgery | 190 | ||
| Salvage of the Failed Pelvic Pouch | 190 | ||
| Suggested Reading | 190 | ||
| 37 - Management of Acute Toxic Colitis and Megacolon | 191 | ||
| INTRODUCTION | 191 | ||
| EPIDEMIOLOGY AND ETIOLOGY | 191 | ||
| PATHOPHYSIOLOGY | 191 | ||
| PRESENTATION | 191 | ||
| DIAGNOSIS | 191 | ||
| EVALUATION | 192 | ||
| MEDICAL MANAGEMENT | 193 | ||
| SURGICAL MANAGEMENT | 195 | ||
| Indications for Surgery | 195 | ||
| Surgical Options | 195 | ||
| CONCLUSION | 196 | ||
| Suggested Reading | 196 | ||
| 38 - Pelvic Pouch: Complications and Their Management | 197 | ||
| INTRODUCTION | 197 | ||
| POUCH DYSFUNCTION | 197 | ||
| INTRAOPERATIVE COMPLICATIONS | 197 | ||
| POSTOPERATIVE COMPLICATIONS | 197 | ||
| Pelvis Sepsis and Anastomotic Leak | 198 | ||
| Postoperative Bleeding from the Pouch | 198 | ||
| Pouch-Perineal and Pouch-Vaginal Fistulae | 198 | ||
| Pouch Sinus | 198 | ||
| Leak from the Tip of the “J” | 199 | ||
| Pouch Prolapse | 199 | ||
| Pouchitis and Cuffitis | 199 | ||
| Crohn Disease of the Pouch | 199 | ||
| Outlet Dysfunction | 199 | ||
| Cancer of the Pouch | 199 | ||
| Pouch Failure | 199 | ||
| ABDOMINOPERINEAL APPROACH FOR POUCH SALVAGE | 199 | ||
| Operative Technique | 200 | ||
| Suggested Reading | 200 | ||
| 39 - Pouchitis and Functional Complications of the Pelvic Pouch | 201 | ||
| INTRODUCTION | 201 | ||
| POUCHITIS | 201 | ||
| ETIOLOGY AND PATHOGENESIS | 201 | ||
| Genetic Factors | 201 | ||
| The Microbiome | 201 | ||
| Mucosal Immunity | 201 | ||
| DIAGNOSIS | 201 | ||
| Categories of Pouchitis | 202 | ||
| TREATMENT | 202 | ||
| IRRITABLE POUCH SYNDROME | 202 | ||
| OTHER FUNCTIONAL DISORDERS | 203 | ||
| CONCLUSIONS | 203 | ||
| Suggested Reading | 203 | ||
| 40 - Continent Ileostomy | 204 | ||
| INTRODUCTION | 204 | ||
| EVOLUTION OF THE CONTINENT ILEOSTOMY | 204 | ||
| TECHNIQUES TO BETTER FIX THE VALVE | 204 | ||
| POUCH DESIGN MODIFICATIONS | 204 | ||
| CURRENT INDICATIONS AND CONTRAINDICATIONS | 205 | ||
| CURRENT SURGICAL TECHNIQUE AND STATUS | 205 | ||
| Key Surgical Points | 205 | ||
| Typical Pouch Function | 206 | ||
| COMPLICATIONS OF A CONTINENT ILEOSTOMY | 207 | ||
| Perioperative Complications | 207 | ||
| Early Complications | 207 | ||
| Late Complications | 207 | ||
| Valve Slippage | 207 | ||
| Parastomal Hernia | 207 | ||
| Crohn Disease | 207 | ||
| Pouchitis | 207 | ||
| Valve Stenosis | 207 | ||
| Pouch Excision | 207 | ||
| WHAT TO DO WHEN A PATIENT PRESENTS ACUTELY WITH THE INABILITY TO INTUBATE HIS OR HER POUCH | 208 | ||
| CONCLUSIONS | 208 | ||
| Suggested Reading | 208 | ||
| 41 - Unhealed Perineal Wound | 209 | ||
| INTRODUCTION | 209 | ||
| SPECIAL SITUATIONS LEADING TO AN UNHEALED PERINEAL WOUND | 209 | ||
| CAUSES | 209 | ||
| Technical Factors | 209 | ||
| Patient-Specific Factors | 209 | ||
| Crohn Disease | 209 | ||
| Radiation | 209 | ||
| PREVENTION | 210 | ||
| Preoperative | 210 | ||
| Intraoperative | 210 | ||
| Reconstruction of the Perineum with a Flap | 210 | ||
| DIAGNOSIS/WORKUP | 211 | ||
| NONOPERATIVE TREATMENT | 211 | ||
| OPERATIVE MANAGEMENT | 211 | ||
| SUMMARY | 212 | ||
| Suggested Reading | 212 | ||
| 42 - Medical Management of Crohn Disease | 213 | ||
| INTRODUCTION | 213 | ||
| MEDICAL THERAPIES | 213 | ||
| 5-Aminosalicylates | 213 | ||
| Antibiotics | 213 | ||
| Corticosteroids | 213 | ||
| Immunomodulators | 213 | ||
| Biologic Agents | 214 | ||
| Combination Therapy | 214 | ||
| PERIANAL AND FISTULIZING CROHN DISEASE | 215 | ||
| APPROACH TO MANAGEMENT OF CROHN DISEASE | 215 | ||
| SURGERY | 216 | ||
| POSTOPERATIVE RECURRENCE | 216 | ||
| SMOKING | 216 | ||
| NUTRITION | 216 | ||
| Suggested Reading | 216 | ||
| 43 - Management of Crohn Colitis | 217 | ||
| MEDICAL MANAGEMENT | 217 | ||
| OPERATIVE INDICATIONS | 217 | ||
| PREOPERATIVE CONSIDERATIONS | 217 | ||
| OPERATIVE APPROACH | 217 | ||
| OPERATIVE OPTIONS | 218 | ||
| Disease of the Colon Alone | 218 | ||
| Disease of the Rectum Alone | 218 | ||
| Disease of the Colon and Rectum | 218 | ||
| SPECIAL SITUATIONS | 219 | ||
| Medications | 219 | ||
| Abscess | 219 | ||
| Severe Colitis | 219 | ||
| Growth Retardation | 220 | ||
| Fistula | 220 | ||
| Neoplasia | 220 | ||
| OUTCOME | 220 | ||
| SUMMARY | 221 | ||
| Suggested Reading | 221 | ||
| 44 - Management of Perianal Crohn Disease | 222 | ||
| INTRODUCTION | 222 | ||
| PATHOPHYSIOLOGY | 222 | ||
| OTHER CONSIDERATIONS | 222 | ||
| PRESENTATIONS | 222 | ||
| Anal Sepsis | 222 | ||
| Anal Tags | 222 | ||
| Fissures | 222 | ||
| Stenosis | 223 | ||
| Perianal Skin Irritation | 223 | ||
| Internal Hemorrhoidal Prolapse | 223 | ||
| TREATMENT OF SEPSIS: ABSCESS AND FISTULA | 223 | ||
| RECTO/ANOVAGINAL FISTULA | 224 | ||
| OTHER MANIFESTATION OF PERIANAL CROHN DISEASE | 224 | ||
| SUMMARY | 224 | ||
| Suggested Reading | 225 | ||
| 45 - Cecal Ulcer | 226 | ||
| INTRODUCTION | 226 | ||
| CAUSES | 226 | ||
| DIAGNOSIS | 226 | ||
| MANAGEMENT | 227 | ||
| CONCLUSION | 227 | ||
| Suggested Reading | 227 | ||
| 46 - Pseudomembranous Clostridium Difficile Colitis | 228 | ||
| INTRODUCTION | 228 | ||
| PRESENTATION OF CLOSTRIDIUM DIFFICILE INFECTION | 228 | ||
| DIAGNOSIS | 228 | ||
| MEDICAL MANAGEMENT | 229 | ||
| SURGICAL MANAGEMENT | 229 | ||
| CONCLUSION | 230 | ||
| Suggested Reading | 230 | ||
| 47 - Cytomegalovirus Ileocolitis and Kaposi Sarcoma in HIV/AIDS | 231 | ||
| INTRODUCTION | 231 | ||
| CYTOMEGALOVIRUS COLITIS | 231 | ||
| SURGERY | 232 | ||
| KAPOSI SARCOMA | 232 | ||
| Suggested Reading | 233 | ||
| 48 - Diagnosis and Management of Acute Colonic Diverticulitis | 234 | ||
| INTRODUCTION | 234 | ||
| PRESENTATION | 234 | ||
| DIAGNOSTIC EVALUATION | 234 | ||
| MEDICAL MANAGEMENT | 235 | ||
| SURGICAL MANAGEMENT | 235 | ||
| Surgery | 237 | ||
| Suggested Reading | 237 | ||
| 49 - Surgical Treatment of Diverticulitis and its Complications | 239 | ||
| INTRODUCTION | 239 | ||
| UNDERSTANDING DIVERTICULAR DISEASE AND ITS MANAGEMENT | 239 | ||
| ACUTE UNCOMPLICATED DIVERTICULITIS | 239 | ||
| Who Requires Elective Surgery after Uncomplicated Diverticulitis? | 239 | ||
| COMPLICATED DIVERTICULITIS | 240 | ||
| Acute Diverticulitis Complicated by Abscess Formation: Converting an Emergency Situation into a Semi-Elective Procedure | 240 | ||
| Acute Diverticulitis Complicated by Purulent or Feculent Peritonitis: Surgical Options in the Emergency Setting | 241 | ||
| Hartmann Procedure and Reversal | 241 | ||
| COMPLICATED DIVERTICULITIS WITH FISTULA FORMATION | 242 | ||
| Colovesical Fistulas: Diagnosis and Management | 242 | ||
| Colovaginal Fistulas: Diagnosis and Management | 242 | ||
| Colocutaneous Fistulas: Diagnosis and Management | 242 | ||
| ACUTE COLONIC OBSTRUCTION: PATIENT SELECTION FOR EMERGENT VERSUS SEMI-ELECTIVE OPERATIONS | 242 | ||
| RECURRENT DIVERTICULITIS IN PATIENTS WHO HAVE PREVIOUSLY UNDERGONE RESECTION FOR DIVERTICULAR DISEASE | 243 | ||
| Suggested Reading | 243 | ||
| 50 - Lower Gastrointestinal Hemorrhage | 244 | ||
| INTRODUCTION | 244 | ||
| ETIOLOGY | 244 | ||
| INITIAL EVALUATION AND RESUSCITATION | 244 | ||
| DIAGNOSTIC TESTING | 245 | ||
| Scintigraphy | 245 | ||
| Multidetector Computed Tomography | 246 | ||
| Angiography | 246 | ||
| Colonoscopy | 246 | ||
| SURGERY | 247 | ||
| THE PROBLEM PATIENT: INTERMITTENT RECURRENT GASTROINTESTINAL BLEEDING | 247 | ||
| Suggested Reading | 248 | ||
| 51 - Large Bowel Obstruction | 249 | ||
| INTRODUCTION | 249 | ||
| CLINICAL AND DIAGNOSTIC EVALUATION | 249 | ||
| SURGICAL MANAGEMENT | 250 | ||
| MALIGNANT AND BENIGN OBSTRUCTION | 250 | ||
| Right-Sided Obstruction | 251 | ||
| Left-Sided Obstruction | 251 | ||
| Self-Expanding Metallic Stents | 252 | ||
| COLONIC VOLVULUS | 253 | ||
| SIGMOID VOLVULUS | 253 | ||
| CECAL VOLVULUS | 254 | ||
| Suggested Reading | 254 | ||
| 52 - Colonic Volvulus | 255 | ||
| INTRODUCTION | 255 | ||
| CECAL VOLVULUS | 255 | ||
| Background and Demographics | 255 | ||
| Pathophysiology | 255 | ||
| Signs and Symptoms | 255 | ||
| Diagnostic Imaging | 255 | ||
| Treatment | 255 | ||
| SIGMOID VOLVULUS | 256 | ||
| Background and Demographics | 256 | ||
| Pathophysiology | 256 | ||
| Signs and Symptoms | 256 | ||
| Diagnostic Imaging | 256 | ||
| Treatment | 256 | ||
| TRANSVERSE COLON VOLVULUS | 258 | ||
| Background and Demographics | 258 | ||
| Pathophysiology | 259 | ||
| Diagnostic Imaging | 259 | ||
| Signs and Symptoms | 259 | ||
| Treatment | 259 | ||
| Suggested Readings | 259 | ||
| 53 - Colonic Pseudo-obstruction (Ogilvie Syndrome) | 260 | ||
| INTRODUCTION | 260 | ||
| EPIDEMIOLOGY | 260 | ||
| ETIOLOGY | 260 | ||
| SIGNS AND SYMPTOMS | 260 | ||
| DIAGNOSIS | 261 | ||
| TREATMENT OPTIONS | 261 | ||
| Initial Management | 261 | ||
| Pharmacologic Management | 261 | ||
| Endoscopic Therapy | 262 | ||
| Surgery | 262 | ||
| SUMMARY | 262 | ||
| Suggested Reading | 262 | ||
| 54 - Management of the Malignant Polyp | 264 | ||
| INTRODUCTION | 264 | ||
| BIOLOGY | 264 | ||
| ASSESSMENT OF POLYPS | 264 | ||
| POLYPECTOMY | 264 | ||
| HISTOLOGY | 264 | ||
| MARGIN | 265 | ||
| NODES | 265 | ||
| SURGICAL CONSIDERATIONS | 265 | ||
| COMORBIDITIES | 266 | ||
| SUMMARY | 266 | ||
| Suggested Reading | 266 | ||
| 55 - Colorectal Cancer Screening and Surveillance | 267 | ||
| SCREENING FOR COLORECTAL CANCER | 267 | ||
| Who Should Be Screened? Determining Risk | 267 | ||
| Screening Average-Risk Persons | 267 | ||
| CANCER PREVENTION TESTS | 267 | ||
| Colonoscopy | 267 | ||
| Flexible Sigmoidoscopy | 268 | ||
| Computed Tomographic Colonography | 268 | ||
| CANCER DETECTION TESTS | 269 | ||
| Fecal Occult Blood Tests | 269 | ||
| Stool DNA | 269 | ||
| SCREENING IN PERSONS AT AN ABOVE-AVERAGE RISK FOR COLORECTAL CANCER | 269 | ||
| Surveillance Colonoscopy in Patients with Adenomatous Lesions at Baseline | 269 | ||
| Surveillance Colonoscopy in Patients with Serrated Lesions at Baseline | 270 | ||
| Surveillance Colonoscopy after Piecemeal Polypectomy | 270 | ||
| Surveillance Colonoscopy after Endoscopic Resection of a Malignant Polyp | 271 | ||
| Surveillance Colonoscopy in Patients with Colorectal Cancer | 271 | ||
| Surveillance Colonoscopy in Patients with Inflammatory Bowel Disease | 271 | ||
| Surveillance Colonoscopy in Patients with a Family History of Colorectal Cancer or Adenomatous Polyps | 271 | ||
| WHEN SHOULD SCREENING AND SURVEILLANCE STOP IN THE AVERAGE-RISK POPULATION? | 271 | ||
| CONCLUSION | 271 | ||
| Suggested Readings | 271 | ||
| 56 - Molecular Genetics of Colorectal Cancer | 273 | ||
| INTRODUCTION | 273 | ||
| GROWTH CONTROL | 273 | ||
| DNA REPAIR | 273 | ||
| CLINICAL SIGNIFICANCE | 273 | ||
| COMPLEXITY | 274 | ||
| Suggested Reading | 274 | ||
| 57 - Polyposis Syndromes | 275 | ||
| INTRODUCTION | 275 | ||
| REGISTRIES | 275 | ||
| DEFINITIONS | 275 | ||
| FAMILIAL ADENOMATOUS POLYPOSIS | 275 | ||
| Genetic Testing | 275 | ||
| Genotype/Phenotype | 275 | ||
| Colorectal Cancer in Familial Adenomatous Polyposis | 276 | ||
| Surgical Options for the Large Bowel | 276 | ||
| Extracolonic Manifestations | 276 | ||
| Ampullary Cancer and Duodenal Adenomas | 277 | ||
| Thyroid Cancer | 277 | ||
| Adrenal Masses | 277 | ||
| Brain Tumors | 277 | ||
| Hepatoblastoma | 277 | ||
| Gardner-Type Manifestations | 277 | ||
| Congenital Hypertrophy of the Retinal Pigmented Epithelium | 277 | ||
| Surveillance | 278 | ||
| The IRA | 278 | ||
| The IPAA | 278 | ||
| Oligopolyposis/Attenuated Familial Adenomatous Polyposis | 278 | ||
| MYH-ASSOCIATED POLYPOSIS (MAP) | 278 | ||
| POLYMERASE PROOFREADING–ASSOCIATED POLYPOSIS | 279 | ||
| SERRATED POLYPOSIS | 279 | ||
| HAMARTOMATOUS POLYPOSES | 279 | ||
| Peutz-Jegher Polyposis | 279 | ||
| Juvenile Polyposis | 279 | ||
| PTEN Tumor Hamartoma Syndrome | 280 | ||
| HEREDITARY MIXED POLYPOSIS SYNDROME | 280 | ||
| Suggested Reading | 280 | ||
| 58 - Desmoid Disease | 281 | ||
| INTRODUCTION | 281 | ||
| BIOLOGY | 281 | ||
| EPIDEMIOLOGY | 281 | ||
| GENETICS AND DESMOID RISK | 281 | ||
| DESMOID SEVERITY: A STAGING SYSTEM | 281 | ||
| MANAGEMENT | 282 | ||
| Setting Expectations | 282 | ||
| A Philosophy of Care | 282 | ||
| Extra-abdominal Desmoid Tumors | 282 | ||
| Abdominal Wall Tumors | 282 | ||
| Intra-abdominal Desmoid Disease | 282 | ||
| Workup | 282 | ||
| Medical Treatment | 282 | ||
| Role of Surgery | 283 | ||
| Complications of Desmoid Disease | 283 | ||
| Small Bowel Obstruction | 283 | ||
| Ureteric Obstruction | 283 | ||
| Abscess/Enterocutaneous Fistula | 283 | ||
| Superior Mesenteric Artery Aneurysm | 284 | ||
| Points about Operating on Persons with Desmoid Disease | 284 | ||
| SUMMARY AND GENERAL COMMENTS ABOUT THE EFFECT OF DESMOID DISEASE ON SURGICAL STRATEGY IN FAMILIAL ADENOMATOUS POLYPOSIS | 284 | ||
| Suggested Reading | 284 | ||
| 59 - Hereditary Nonpolyposis\rColorectal Cancer and Lynch Syndrome | 285 | ||
| INTRODUCTION | 285 | ||
| HISTORICAL PERSPECTIVE AND CLARIFICATION OF TERMS | 285 | ||
| GENETIC AND MOLECULAR CAUSE OF LYNCH SYNDROME | 285 | ||
| HISTOLOGIC FEATURES OF LYNCH TUMORS | 285 | ||
| DIAGNOSING LYNCH SYNDROME | 286 | ||
| Clinical Criteria | 286 | ||
| Models | 286 | ||
| Tumor Testing | 286 | ||
| GENETIC COUNSELING AND TESTING | 287 | ||
| CLINICAL MANIFESTATIONS AND MANAGEMENT | 288 | ||
| COLORECTAL CANCER RISK MANAGEMENT | 288 | ||
| Surveillance Colonoscopy and Polypectomy | 288 | ||
| Chemoprevention | 288 | ||
| Surgery | 289 | ||
| Colectomy in the Absence of Cancer | 289 | ||
| Treatment of Colon Cancer | 289 | ||
| Rectal Cancer in Persons with Lynch Syndrome | 289 | ||
| RISK MANAGEMENT OF EXTRACOLONIC MANIFESTIONS | 289 | ||
| Endometrial and Ovarian Cancer | 289 | ||
| Upper Gastrointestinal Tract | 290 | ||
| Urinary Tract | 290 | ||
| Skin Neoplasms | 290 | ||
| Other Cancers | 290 | ||
| CLINICAL VARIATIONS OF HNPCC AND LYNCH SYNDROME | 290 | ||
| Familial Colorectal Cancer Type X | 290 | ||
| Likely Lynch Syndrome: Amsterdam Criteria with a Microsatellite Instability High Colorectal Cancer, but Germline Testing Is Not ... | 290 | ||
| Tumor Lynch | 291 | ||
| SUMMARY | 291 | ||
| Suggested Reading | 291 | ||
| 60 - Cancer of the Appendix and Pseudomyxoma Peritonei Syndrome | 292 | ||
| INTRODUCTION | 292 | ||
| PATHOLOGY OF APPENDICEAL MALIGNANT TUMORS | 292 | ||
| Carcinoid Tumors | 292 | ||
| Adenocarcinoid Tumors of the Appendix (Goblet Cell Carcinoid) | 292 | ||
| Epithelial (Noncarcinoid) Tumors of the Appendix | 292 | ||
| Mucinous Adenoma and Adenocarcinoma | 292 | ||
| Nonmucinous Adenocarcinoma | 293 | ||
| DIAGNOSIS OF APPENDICEAL MALIGNANT TUMORS | 293 | ||
| Carcinoid | 293 | ||
| Adenocarcinoma and Mucinous Adenocarcinoma | 294 | ||
| Pseudomyxoma Peritonei Syndrome | 294 | ||
| TREATMENT OF APPENDICEAL TUMORS | 295 | ||
| Carcinoid Tumors | 295 | ||
| Appendiceal Adenocarcinoma | 296 | ||
| Management of Appendiceal Neoplasms with Peritoneal Dissemination | 296 | ||
| Perioperative Chemotherapy | 297 | ||
| Serial Debulking | 297 | ||
| CYTOREDUCTIVE SURGERY AND PERIOPERATIVE CHEMOTHERAPY | 298 | ||
| Survival by Completeness of Cytoreduction | 298 | ||
| Survival by Histologic Assessment | 298 | ||
| Survival by Prior Surgical Score | 298 | ||
| Treatment of Adenocarcinoid Appendiceal Malignancy | 298 | ||
| Morbidity and Mortality Rates | 299 | ||
| Peritonectomy | 299 | ||
| Perioperative Chemotherapy | 300 | ||
| Suggested Reading | 300 | ||
| 61 - Surgical Management of Cancer of the Colon | 301 | ||
| INTRODUCTION | 301 | ||
| EPIDEMIOLOGY | 301 | ||
| Prognostic Factors | 301 | ||
| PREOPERATIVE EVALUATION | 301 | ||
| PREOPERATIVE PREPARATION | 301 | ||
| OPERATIVE PRINCIPLES AND TECHNIQUES | 302 | ||
| Exploration | 302 | ||
| Surgical Treatment of Right Colon Cancer | 302 | ||
| Surgical Treatment of Transverse Colon Cancer | 304 | ||
| Surgical Treatment of Splenic Flexure and Descending Colon Cancer | 304 | ||
| Surgical Treatment of Sigmoid Colon Cancer | 305 | ||
| LAPAROSCOPIC COLECTOMY | 306 | ||
| SPECIAL CONSIDERATIONS | 306 | ||
| Obstruction and Perforation | 306 | ||
| Prophylactic Oophorectomy | 307 | ||
| ASSESSMENT OF QUALITY OF COLECTOMY | 307 | ||
| POSTOPERATIVE SURVEILLANCE | 307 | ||
| SUMMARY | 307 | ||
| Suggested Readings | 308 | ||
| 62 - Management of Metastatic Colorectal Cancer | 309 | ||
| INTRODUCTION | 309 | ||
| CHEMOTHERAPY | 309 | ||
| 5-Fu | 309 | ||
| Capecitabine | 309 | ||
| Irinotecan | 309 | ||
| Oxaliplatin | 311 | ||
| MAINTENANCE CHEMOTHERAPY | 311 | ||
| BIOLOGIC AGENTS | 311 | ||
| FIRST-LINE TARGETED OPTIONS | 312 | ||
| THIRD- AND FOURTH-LINE OPTIONS | 312 | ||
| OLIGOMETASTATIC DISEASE | 312 | ||
| ROLE OF RESECTION OF PRIMARY LESION | 313 | ||
| IMMUNOTHERAPY | 313 | ||
| CONCLUSIONS | 313 | ||
| Suggested Reading | 313 | ||
| 63 - Management of Colorectal Liver Metastasis | 314 | ||
| INTRODUCTION | 314 | ||
| DIAGNOSIS AND PREOPERATIVE WORKUP | 314 | ||
| Imaging | 314 | ||
| Serologic and Molecular Markers | 314 | ||
| Histology | 314 | ||
| Needle Biopsy | 314 | ||
| Multidisciplinary Planning | 314 | ||
| STAGING AND PROGNOSIS | 314 | ||
| PROGNOSTIC SCORES | 315 | ||
| TREATMENT | 315 | ||
| Chemotherapy | 315 | ||
| Neoadjuvant Chemotherapy for Resectable Liver Disease | 315 | ||
| Neoadjuvant Chemotherapy for Unresectable Liver Disease | 315 | ||
| Adjuvant Chemotherapy | 315 | ||
| Hepatic Arterial Infusion | 316 | ||
| Resectability | 316 | ||
| Resectable Liver Disease | 316 | ||
| Synchronous Liver Metastasis | 316 | ||
| Unresectable Liver Disease | 317 | ||
| Repeat Resections for Multiple Liver Metastases | 317 | ||
| Local Ablative Therapy | 317 | ||
| Radiofrequency Ablation | 317 | ||
| Microwave Ablation | 318 | ||
| Cryotherapy | 318 | ||
| Irreversible Electroporation | 318 | ||
| Colorectal Liver Metastases with Extrahepatic Spread | 318 | ||
| Lung | 318 | ||
| Peritoneal | 318 | ||
| Lymph Node Involvement | 318 | ||
| Inferior Vena Cava | 318 | ||
| Recurrence | 318 | ||
| SURVEILLANCE | 318 | ||
| CONCLUSION | 318 | ||
| Suggested Readings | 318 | ||
| 64 - Colorectal Metastases to the Lung | 320 | ||
| INTRODUCTION | 320 | ||
| INDICATIONS FOR RESECTION OF COLORECTAL METASTASES | 320 | ||
| OUTCOMES OF PATIENTS UNDERGOING RESECTION AND PROGNOSTIC FACTORS | 320 | ||
| LUNG AND LIVER METASTASIS | 321 | ||
| SURGICAL APPROACH | 321 | ||
| DEVELOPMENT OF A PROSPECTIVE RANDOMIZED TRIAL: THE PULMONARY METASTASECTOMY IN COLORECTAL CANCER TRIAL | 322 | ||
| CONCLUSION | 322 | ||
| Suggested Reading | 322 | ||
| 65 - Nonepithelial Colorectal Tumors | 323 | ||
| INTRODUCTION | 323 | ||
| BENIGN NONADENOMATOUS LESIONS OF THE COLON AND RECTUM | 323 | ||
| Benign Lymphoid Hyperplasia | 323 | ||
| Lipomas | 323 | ||
| Treatment | 323 | ||
| CAVERNOUS HEMANGIOMA | 323 | ||
| Characteristic Features | 324 | ||
| Treatment | 325 | ||
| Surgery (Laparotomy/Laparoscopic) | 325 | ||
| LEIOMYOMA AND LEIOMYOSARCOMA | 326 | ||
| Characteristic Features | 326 | ||
| Surgery | 326 | ||
| PRIMARY LYMPHOMA OF THE COLON AND RECTUM | 326 | ||
| SUMMARY | 327 | ||
| Suggested Reading | 327 | ||
| 66 - Management of Colonic Ischemia | 328 | ||
| INTRODUCTION | 328 | ||
| ETIOLOGY AND PATHOGENESIS | 328 | ||
| CLASSIFICATION | 328 | ||
| CLINICAL PRESENTATION | 329 | ||
| DIAGNOSIS | 330 | ||
| MANAGEMENT | 330 | ||
| OUTCOME | 331 | ||
| SPECIAL TOPICS | 331 | ||
| Ischemic Colitis after Aortic Surgery | 331 | ||
| Colonic Ischemia after Cardiopulmonary Bypass | 332 | ||
| Ischemic Colitis Associated with Colon Carcinoma and Obstructing Colon Lesions | 332 | ||
| Total Colonic Ischemia | 332 | ||
| Ischemic Proctosigmoiditis | 332 | ||
| CONCLUSION | 333 | ||
| Suggested Readings | 333 | ||
| 67 - Colon and Rectal Trauma | 334 | ||
| INTRODUCTION | 334 | ||
| ETIOLOGY | 334 | ||
| DIAGNOSIS | 334 | ||
| Physical Examination | 334 | ||
| Imaging | 334 | ||
| Diagnostic Peritoneal Lavage | 335 | ||
| Laparoscopy | 335 | ||
| TREATMENT | 336 | ||
| Colon Injuries | 336 | ||
| Damage Control | 337 | ||
| Rectal Injuries | 338 | ||
| Overview | 338 | ||
| Diversion | 338 | ||
| Direct Repair | 338 | ||
| Drainage | 338 | ||
| Distal Washout | 338 | ||
| Rectal Foreign Bodies | 339 | ||
| Suggested Reading | 340 | ||
| 68 - Endometriosis of the Colon and Rectum | 341 | ||
| INTRODUCTION | 341 | ||
| PAIN | 341 | ||
| INFERTILITY | 341 | ||
| DIAGNOSIS | 341 | ||
| Physical Examination | 341 | ||
| Endoscopy | 341 | ||
| Imaging | 342 | ||
| SURGICAL MANAGEMENT | 342 | ||
| Results after Surgical Therapy | 343 | ||
| Combined Medical and Surgical Therapy | 343 | ||
| CONCLUSION | 343 | ||
| Suggested Reading | 343 | ||
| 69 - Pneumatosis Cystoides Intestinalis | 345 | ||
| INTRODUCTION | 345 | ||
| ETIOLOGY | 345 | ||
| CLASSIFICATION | 345 | ||
| HISTOLOGY AND GROSS PATHOLOGY | 345 | ||
| SYMPTOMS | 345 | ||
| DIAGNOSIS | 346 | ||
| TREATMENT | 347 | ||
| Suggested Readings | 348 | ||
| 70 - Constipation | 349 | ||
| INTRODUCTION | 349 | ||
| CAUSES | 349 | ||
| CLASSIFYING CONSTIPATION | 349 | ||
| ASSESSMENT | 349 | ||
| History | 349 | ||
| Physical Examination | 350 | ||
| INVESTIGATIONS | 350 | ||
| TREATMENT | 351 | ||
| Medical | 351 | ||
| Newer Promotility Agents | 352 | ||
| Biofeedback for Pelvic Floor Dyssynergia | 352 | ||
| Change in Position of Defecation | 352 | ||
| Surgery | 352 | ||
| Outlet Obstruction Constipation | 355 | ||
| Suggested Reading | 355 | ||
| 4 - SMALL INTESTINE | 357 | ||
| 71 - Small Bowel Obstruction | 359 | ||
| EXTENT OF THE PROBLEM | 359 | ||
| CLINICAL PRESENTATION | 359 | ||
| IMAGING | 359 | ||
| MRI and Ultrasound | 360 | ||
| MANAGEMENT OF SMALL BOWEL OBSTRUCTION | 360 | ||
| Nonadhesive Obstruction | 361 | ||
| Hernias | 361 | ||
| Crohn Disease | 361 | ||
| Malignancy | 361 | ||
| Intussusception | 361 | ||
| Gallstone Ileus | 361 | ||
| Bariatric Patient | 361 | ||
| Surgical Technique | 361 | ||
| Adhesive Obstruction | 361 | ||
| Hernias | 362 | ||
| Crohn Disease and Other Inflammatory Conditions | 362 | ||
| Malignancy | 362 | ||
| Intussusception | 363 | ||
| Gallstone Ileus | 363 | ||
| The Bariatric Patient | 363 | ||
| Laparoscopic versus Open Lysis of Adhesions | 363 | ||
| Early Postoperative Bowel Obstruction | 363 | ||
| Prevention of Adhesions | 363 | ||
| SUMMARY | 364 | ||
| Suggested Reading | 365 | ||
| 72 - Medical Management of Short Bowel Syndrome | 366 | ||
| INTRODUCTION | 366 | ||
| ANATOMY OF SHORT BOWEL SYNDROME | 366 | ||
| DIETARY MANAGEMENT OF SHORT BOWEL SYNDROME | 366 | ||
| PHARMACOLOGIC TREATMENT OF SHORT BOWEL SYNDROME | 366 | ||
| PARENTERAL AND ENTERAL NUTRITION | 366 | ||
| HORMONAL TREATMENT FOR SHORT BOWEL SYNDROME | 369 | ||
| COMPLICATIONS ASSOCIATED WITH SHORT BOWEL SYNDROME | 369 | ||
| CONCLUSION | 370 | ||
| Suggested Reading | 371 | ||
| 73 - Surgery for Gut Failure: Auto-Reconstruction and Allo-Transplantation | 372 | ||
| INTRODUCTION | 372 | ||
| GUT ADAPTATION | 372 | ||
| MEDICAL MANAGEMENT | 372 | ||
| SURGICAL REHABILITATION | 373 | ||
| Strategy | 373 | ||
| Autologous Reconstruction | 373 | ||
| Intestinal Lengthening | 376 | ||
| INTESTINAL AND MULTIVISCERAL TRANSPLANTATION | 376 | ||
| Types | 376 | ||
| Indications | 377 | ||
| Contraindications | 378 | ||
| Early Referral | 378 | ||
| Transplantation Surgery | 378 | ||
| Postoperative Management | 379 | ||
| Current Global Activities | 380 | ||
| Long-Term Survival | 380 | ||
| Allograft Function | 381 | ||
| Quality of Life | 381 | ||
| New Insights | 382 | ||
| SUMMARY | 383 | ||
| Suggested Reading | 383 | ||
| 74 - Crohn Disease of the Duodenum, Stomach, and Esophagus | 385 | ||
| INTRODUCTION | 385 | ||
| CLINICAL PRESENTATION | 385 | ||
| INVESTIGATIONS IN UPPER GASTROINTESTINAL CROHN DISEASE | 385 | ||
| MEDICAL TREATMENT | 386 | ||
| ENDOSCOPIC TREATMENT | 386 | ||
| SURGERY | 386 | ||
| SUMMARY | 387 | ||
| Suggested Readings | 387 | ||
| 75 - Management of Small Bowel Crohn Disease | 388 | ||
| INTRODUCTION | 388 | ||
| MEDICAL MANAGEMENT | 388 | ||
| INDICATIONS FOR SURGERY | 388 | ||
| PREOPERATIVE CONSIDERATIONS | 388 | ||
| OPERATIVE APPROACH | 388 | ||
| SURGICAL OPTIONS | 389 | ||
| Bypass | 389 | ||
| Resection | 389 | ||
| Strictureplasty | 390 | ||
| SPECIAL SITUATIONS | 390 | ||
| Medications | 390 | ||
| Abscess | 390 | ||
| Free Perforation | 390 | ||
| Hemorrhage | 390 | ||
| Growth Retardation | 390 | ||
| Fistula | 390 | ||
| Neoplasia | 390 | ||
| Obstruction | 390 | ||
| OUTCOME | 392 | ||
| SUMMARY | 392 | ||
| Selected Reading | 392 | ||
| 76 - Small Bowel Neoplasms | 393 | ||
| INTRODUCTION | 393 | ||
| PRESENTATION | 393 | ||
| DIAGNOSIS | 393 | ||
| MANAGEMENT | 394 | ||
| Adenocarcinoma without Metastatic Disease | 394 | ||
| Carcinoid Tumors | 394 | ||
| Lymphomas | 395 | ||
| GIST Tumors | 395 | ||
| CONCLUSION | 395 | ||
| ACKNOWLEDGMENT | 395 | ||
| Suggested Readings | 395 | ||
| 77 - Neuroendocrine Tumors of the Small and Large Intestine | 396 | ||
| DEFINITION | 396 | ||
| INCIDENCE, EPIDEMIOLOGY, AND RESEARCH | 396 | ||
| CLINICAL PRESENTATION | 397 | ||
| DIAGNOSIS | 397 | ||
| CLASSIFICATION | 398 | ||
| SURGICAL TREATMENT | 398 | ||
| Small Intestine | 398 | ||
| Appendix | 398 | ||
| Colon | 398 | ||
| Rectum | 398 | ||
| Locally Advanced and Metastatic Disease | 399 | ||
| Hedinger Syndrome | 402 | ||
| ADJUVANT THERAPY | 402 | ||
| FOLLOW-UP | 403 | ||
| PROGNOSIS | 403 | ||
| Suggested Reading | 403 | ||
| 78 - Enterocutaneous Fistulas | 404 | ||
| INTRODUCTION | 404 | ||
| PATHOGENESIS | 404 | ||
| GENERAL ASPECTS OF CARE | 404 | ||
| COMPLICATIONS | 404 | ||
| PLAN OF CARE | 404 | ||
| Prevention | 404 | ||
| Stabilization | 406 | ||
| Wound Care | 406 | ||
| Nutritional Support | 407 | ||
| Nasogastric Tubes and Other Drainage Tubes | 407 | ||
| Protection of the Gastric, Duodenal, and Upper Gastrointestinal Tract Mucosa from Ulceration | 407 | ||
| Other Supplements | 407 | ||
| Investigation/Elucidation | 407 | ||
| Therapeutic Decisions | 407 | ||
| Will It Close? | 407 | ||
| The Decision to Operate | 407 | ||
| Definitive Therapy | 408 | ||
| Timing of Surgery | 408 | ||
| Surgery | 408 | ||
| Choice of Incision | 408 | ||
| The Operation Itself | 408 | ||
| Anastomosis | 409 | ||
| Abdominal Wound Closure | 409 | ||
| What Type of Operation Should One Undertake? | 409 | ||
| Gastrostomy and Feeding Jejunostomy | 410 | ||
| The Healing Phase | 410 | ||
| Fibrin Glue | 410 | ||
| Short Bowel Syndrome | 410 | ||
| PROGNOSIS | 410 | ||
| Suggested Reading | 411 | ||
| 79 - Acute and Chronic Mesenteric Ischemia | 412 | ||
| INTRODUCTION | 412 | ||
| ACUTE MESENTERIC ISCHEMIA | 412 | ||
| Clinical Presentation | 412 | ||
| Evaluation | 413 | ||
| Treatment | 413 | ||
| SMA Embolus | 414 | ||
| SMA Thrombus | 414 | ||
| Mesenteric Venous Thrombosis | 414 | ||
| Nonocclusive Mesenteric Ischemia | 414 | ||
| Bowel Viability | 414 | ||
| Laparoscopy | 415 | ||
| CHRONIC MESENTERIC ISCHEMIA | 415 | ||
| Presentation | 416 | ||
| Evaluation | 416 | ||
| Operative Treatment | 416 | ||
| Angioplasty | 416 | ||
| CONCLUSION | 417 | ||
| Suggested Readings | 417 | ||
| 80 - Radiation Enteritis and Proctocolitis | 418 | ||
| BACKGROUND | 418 | ||
| PATHOPHYSIOLOGY | 418 | ||
| PREDISPOSING RISK FACTORS | 418 | ||
| GRADING SYSTEMS | 418 | ||
| DIAGNOSTIC WORKUP | 418 | ||
| PREVENTION | 419 | ||
| MANAGEMENT OF RADIATION ENTERITIS | 419 | ||
| Management of Radiation Injury to the Small Bowel | 419 | ||
| Acute Radiation Enteritis | 419 | ||
| Chronic Radiation Enteritis | 419 | ||
| Management of Radiation Injury to the Colon | 420 | ||
| Acute Radiation Colitis | 420 | ||
| Chronic Radiation Colitis | 420 | ||
| Management of Radiation Injury to the Rectum | 420 | ||
| Topical Therapy | 421 | ||
| Hyperbaric Oxygen | 421 | ||
| Medical Therapy | 421 | ||
| Endoscopic Management | 421 | ||
| Surgery | 421 | ||
| CONCLUSION | 422 | ||
| Suggested Readings | 422 | ||
| 5 - COMPLICATIONS (AND OTHER MISCELLANEOUS TOPICS) | 425 | ||
| 81 - Colorectal Surgery in the High-Risk Patient | 427 | ||
| INTRODUCTION | 427 | ||
| IDENTIFICATION OF THE HIGH-RISK PATIENT | 427 | ||
| MINIMIZING RISK ASSOCIATED WITH EMERGENCY SURGERY | 428 | ||
| MINIMIZING RISK ASSOCIATED WITH CARDIAC DISEASE | 429 | ||
| MINIMIZING RISK ASSOCIATED WITH PULMONARY DISEASE | 430 | ||
| MINIMIZING RISK ASSOCIATED WITH IMMUNOSUPPRESSION | 431 | ||
| Steroids | 431 | ||
| Diabetes | 431 | ||
| Chemoradiotherapy | 431 | ||
| MINIMIZING RISK ASSOCIATED WITH MALNUTRITION | 432 | ||
| MINIMIZING RISK ASSOCIATED WITH HEPATIC DISEASE | 432 | ||
| MINIMIZING RISK ASSOCIATED WITH RENAL DISEASE | 433 | ||
| MINIMIZING RISK IN MORBIDLY OBESE PATIENTS | 433 | ||
| Suggested Reading | 433 | ||
| 82 - Reoperative Pelvic Surgery | 434 | ||
| INTRODUCTION | 434 | ||
| ANATOMIC FACTORS | 434 | ||
| The Ureters | 434 | ||
| Presacral Veins | 434 | ||
| Pelvic Nerves | 434 | ||
| POSTOPERATIVE CHANGES IN THE PELVIS | 434 | ||
| Approach to Reoperative Pelvic Surgery | 434 | ||
| Preoperative Planning | 434 | ||
| Timing | 434 | ||
| Patient Preparation | 435 | ||
| Define the Anatomy | 435 | ||
| Anticipate and Prepare for a Difficult Case | 435 | ||
| Functional Considerations | 435 | ||
| Intraoperative Conduct | 435 | ||
| Patient Positioning | 435 | ||
| Optimizing Visibility and Exposure | 435 | ||
| Access to the Pelvis | 436 | ||
| Identification of Specific Pelvic Structures | 436 | ||
| Ureter | 436 | ||
| Bladder | 436 | ||
| Rectal Stump | 436 | ||
| Vagina | 437 | ||
| Autonomic Nerves | 437 | ||
| Control of Bleeding | 437 | ||
| Drainage | 437 | ||
| SPECIFIC CLINICAL SITUATIONS | 437 | ||
| Reversal of Hartmann Procedure for Diverticulitis | 437 | ||
| Recurrent Rectal Cancer | 437 | ||
| Redo Ileoanal Pelvic Pouch Procedure | 438 | ||
| SUMMARY | 438 | ||
| Suggested Reading | 438 | ||
| 83 - Nutritional Support in Colorectal Surgery | 439 | ||
| INTRODUCTION | 439 | ||
| NUTRITIONAL ASSESSMENT | 439 | ||
| INDICATIONS FOR NUTRITIONAL SUPPORT | 439 | ||
| General Indications | 439 | ||
| Severe Malnutrition | 439 | ||
| Postoperative Nutrition | 439 | ||
| Specific CRS Indications | 440 | ||
| Inflammatory Bowel Disease | 440 | ||
| Colorectal Cancer | 440 | ||
| ESTIMATION OF NUTRIENT REQUIREMENTS | 440 | ||
| Calories | 440 | ||
| Protein | 440 | ||
| DIETARY COMPOSITION AND DELIVERY | 441 | ||
| Hospital-Based Diets | 441 | ||
| Clear Liquid Diet | 441 | ||
| Regular Diet | 441 | ||
| Low-Residue Diet | 441 | ||
| Oral Supplements | 441 | ||
| Liquid Formula Diets | 441 | ||
| Enteral Nutrition | 441 | ||
| Access for EN | 442 | ||
| Early Postoperative Feeding: “Fast Track” | 443 | ||
| Parenteral Nutrition | 443 | ||
| Access for PN | 443 | ||
| Concomitant EN and PN | 443 | ||
| Overfeeding | 444 | ||
| NEW DIRECTIONS | 444 | ||
| Immunonutrition | 444 | ||
| Preoperative Carbohydrate Loading | 444 | ||
| SUMMARY | 444 | ||
| Suggested Reading | 444 | ||
| 84 - Prevention and Management of Sepsis | 445 | ||
| BACKGROUND | 445 | ||
| PREVENTION | 445 | ||
| Defining Risk | 445 | ||
| Preventive Measures | 445 | ||
| Bowel Preparation | 445 | ||
| Prophylactic Antibiotics | 445 | ||
| Intact Anastomosis | 445 | ||
| Tension-Free Anastomosis | 445 | ||
| Well-Vascularized Anastomosis | 445 | ||
| Consideration for Diversion | 445 | ||
| Appropriate Use of Drains | 446 | ||
| MANAGEMENT OF INTRA-ABDOMINAL SEPSIS | 446 | ||
| Goal-Directed Hemodynamic Support | 446 | ||
| Evaluation | 446 | ||
| Nonoperative Interventions | 446 | ||
| Operation versus Observation | 447 | ||
| Open Abdomen | 447 | ||
| Return to the Operating Room | 447 | ||
| Suggested Readings | 447 | ||
| 85 - Management of Anastomotic Leak | 448 | ||
| INTRODUCTION | 448 | ||
| WHAT DEFINES A LEAK? | 448 | ||
| PRINCIPLES OF MANAGEMENT | 448 | ||
| EARLY DIAGNOSIS | 448 | ||
| IMAGING | 448 | ||
| CRP LEVELS | 448 | ||
| ENDOSCOPY | 449 | ||
| VARIABLES DIRECTING MANAGEMENT | 449 | ||
| Location: Intraperitoneal versus Extraperitoneal | 449 | ||
| Type of Anastomosis: Ileocolic versus Colorectal/Ileorectal | 449 | ||
| Symptoms: Sepsis versus Symptomatic versus Asymptomatic | 449 | ||
| Previously Diverted: Proximal Diverting Ostomy versus Nondiverted | 450 | ||
| LEAK MANAGEMENT TOOLS | 450 | ||
| ENDO-VACUUM ASSISTED CLOSURE | 450 | ||
| ENDOSCOPIC STENTS, CLIPS, AND GLUE | 450 | ||
| TRANSANAL REPAIR TECHNIQUES | 451 | ||
| TURNBULL-CUTAIT PULL THROUGH | 451 | ||
| SUMMARY | 451 | ||
| Suggested Reading | 451 | ||
| 86 - Complications of Colonoscopy | 452 | ||
| INTRODUCTION | 452 | ||
| RISK MANAGEMENT | 452 | ||
| HEMORRHAGE | 452 | ||
| Steps Prior to Colonoscopy | 452 | ||
| Risk Factors for Bleeding | 453 | ||
| Prevention of Bleeding | 453 | ||
| Treatment of Bleeding | 453 | ||
| PERFORATION | 454 | ||
| Causes of Perforation | 454 | ||
| Diagnosis of Perforation | 454 | ||
| Management of Perforation | 454 | ||
| Suggested Readings | 455 | ||
| 87 - Management of Hemorrhage during Pelvic Surgery | 456 | ||
| INTRODUCTION | 456 | ||
| PERTINENT ANATOMY | 456 | ||
| BLEEDING | 458 | ||
| TACTICS FOR CONTROL OF PELVIC BLEEDING | 458 | ||
| Major Vessel Bleeding | 458 | ||
| Iliac Vessels | 458 | ||
| Minor Vessel Bleeding | 459 | ||
| Presacral Bleeding | 459 | ||
| Pelvic Packing | 459 | ||
| Suture Ligation | 459 | ||
| Thumbtacks | 459 | ||
| Muscle Fragment Welding | 459 | ||
| Bipolar Electrocautery | 459 | ||
| Hemostasis Step-by-Step Technique | 460 | ||
| Hemostatic Agents | 460 | ||
| Mechanical Hemostatic Agents | 460 | ||
| Active Hemostatic Agents | 460 | ||
| Flowable Hemostatic Agents | 461 | ||
| Fibrin Sealants | 461 | ||
| CONCLUSION | 461 | ||
| Selected Reading | 461 | ||
| 88 - Urologic Issues in Colorectal Surgery | 462 | ||
| INTRODUCTION | 462 | ||
| INFECTION | 462 | ||
| URETER | 462 | ||
| BLADDER | 463 | ||
| URETHRA | 464 | ||
| REPRODUCTIVE STRUCTURES | 465 | ||
| NERVES | 465 | ||
| BLOOD VESSELS | 467 | ||
| Suggested Readings | 467 | ||
| 89 - Prevention and Treatment of Complications of Laparoscopic Colorectal Surgery | 468 | ||
| INTRODUCTION | 468 | ||
| GENERAL COMPLICATIONS | 468 | ||
| Contraindications | 468 | ||
| Peritoneal Access Complications | 468 | ||
| Pneumoperitoneum Complications | 468 | ||
| Thromboembolic Complications | 469 | ||
| Electrosurgical Complications | 469 | ||
| Positioning Complications | 469 | ||
| Bleeding Complications | 469 | ||
| Tumor Identification Difficulties | 470 | ||
| Contamination | 470 | ||
| Anastomosis Complications | 470 | ||
| Urologic Complications | 471 | ||
| CONCLUSIONS | 471 | ||
| Suggested Reading | 471 | ||
| 90 - Prevention and Management of Ostomy Complications | 472 | ||
| INTRODUCTION | 472 | ||
| OSTOMY CREATION | 472 | ||
| Preoperative Discussion and Consent | 472 | ||
| Siting the Stoma | 472 | ||
| Creating and Maturing the Stoma | 473 | ||
| End Ileostomy | 474 | ||
| Loop Ileostomy | 474 | ||
| COMPLICATIONS | 474 | ||
| Early Complications | 474 | ||
| Appliance Issues/Skin Irritation | 474 | ||
| Ischemia | 474 | ||
| Stoma Stenosis | 475 | ||
| Retraction | 475 | ||
| Late Complications | 475 | ||
| Parastomal Hernia | 475 | ||
| Prolapse | 475 | ||
| Stricture | 475 | ||
| Peristomal Pyoderma | 475 | ||
| Parastomal Ulcer | 475 | ||
| Abscess and Fistula | 476 | ||
| SUMMARY | 476 | ||
| Suggested Reading | 476 | ||
| 91 - Stoma and Wound Considerations: Nursing Management | 477 | ||
| PREOPERATIVE PREPARATION | 477 | ||
| Preoperative Counseling | 477 | ||
| Stoma Site Marking | 477 | ||
| POSTOPERATIVE MANAGEMENT | 477 | ||
| SPECIAL CONSIDERATIONS | 478 | ||
| Continent ileostomy | 478 | ||
| WOUND MANAGEMENT | 478 | ||
| POSTDISCHARGE FOLLOW-UP | 478 | ||
| COLOSTOMY IRRIGATION | 478 | ||
| ILEOSTOMY LAVAGE | 484 | ||
| CONCLUSION | 484 | ||
| Suggested Readings | 485 | ||
| 92 - Measuring Outcomes | 486 | ||
| INTRODUCTION | 486 | ||
| TYPES OF OUTCOME MEASURES | 486 | ||
| Structural Measures | 486 | ||
| Process Measures | 486 | ||
| Outcome Measures | 487 | ||
| Person-Centered Outcomes | 487 | ||
| MEASURING QUALITY OF LIFE | 487 | ||
| Instruments for Assessing Quality of Life | 488 | ||
| Colorectal Cancer Care | 488 | ||
| Inflammatory Bowel Disease | 488 | ||
| Fecal Incontinence | 488 | ||
| Sexual Function | 488 | ||
| CONSIDERATIONS IN CHOOSING OUTCOME MEASURES | 488 | ||
| SUMMARY | 489 | ||
| Suggested Readings | 489 | ||
| 93 - Medical Documentation and Coding for the Colorectal Surgeon | 490 | ||
| INTRODUCTION | 490 | ||
| PROCESS OF CPT CODE DEVELOPMENT | 490 | ||
| CPT CODING FOR EVALUATION AND MANAGEMENT SERVICES | 490 | ||
| Office Evaluation and Management Coding | 490 | ||
| HOSPITAL-BASED EVALUATION AND MANAGEMENT DOCUMENTATION AND CODING | 491 | ||
| CPT CODING FOR SURGICAL PROCEDURES | 492 | ||
| SUMMARY | 492 | ||
| Suggested Reading | 492 | ||
| 94 - Enhanced Recovery Pathways After Colorectal Surgery | 493 | ||
| BACKGROUND | 493 | ||
| COMPONENTS OF EVIDENCE-BASED CARE | 493 | ||
| EVIDENCE FOR IMPROVED OUTCOME | 493 | ||
| Colonic Surgery | 493 | ||
| Rectal Surgery | 493 | ||
| Other Colorectal Procedures | 493 | ||
| IMPLEMENTATION STRATEGY AND TREATMENT ALGORITHM | 494 | ||
| Colonic Surgery Protocol | 494 | ||
| Rectal Surgery Protocol | 494 | ||
| THE WAY FORWARD | 494 | ||
| Suggested Readings | 495 | ||
| 95 - Managing Complex Ventral/Parastomal Hernias in Colorectal Surgical Patients | 496 | ||
| INTRODUCTION | 496 | ||
| PERMANENT ENTEROSTOMY—PARASTOMAL HERNIA REPAIR | 496 | ||
| Open Repair | 496 | ||
| Laparoscopic Repair | 497 | ||
| TEMPORARY ENTEROSTOMY | 498 | ||
| PROSTHETIC CHOICE | 498 | ||
| HERNIA REPAIR IN INFLAMMATORY BOWEL DISEASE | 499 | ||
| CONCLUSION | 500 | ||
| Selected Reading | 500 | ||
| Index | 501 | ||
| A | 501 | ||
| B | 502 | ||
| C | 503 | ||
| D | 506 | ||
| E | 507 | ||
| F | 507 | ||
| G | 508 | ||
| H | 508 | ||
| I | 509 | ||
| J | 510 | ||
| K | 510 | ||
| L | 510 | ||
| M | 511 | ||
| N | 511 | ||
| O | 512 | ||
| P | 512 | ||
| Q | 514 | ||
| R | 514 | ||
| S | 515 | ||
| T | 516 | ||
| U | 517 | ||
| V | 517 | ||
| W | 518 | ||
| Z | 518 | ||
| IBC | ES2 |