Additional Information
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.
For this Sixth Edition the authorship team across the series has been expanded to include additional European and World experts, with an increased emphasis on global practice. Throughout all six volumes the contents have been extensively revised in line with recently published evidence. Detailed supportive key references are provided and are also included within the comprehensive list of references in the accompanying ebook. Links to recommended online videos have been added where appropriate.
- The Companion to Specialist Surgical Practice series provides a current and concise summary of the key topics within the major sub-specialties of general surgery.
- Each volume highlights evidence-based practice both in the text and within the extensive list of references at the end of every chapter.
This edition of Colorectal Surgery includes new chapters on surgery for colon cancer, and on the management of advanced and recurrent colorectal cancer. New techniques for the minimally invasive treatment of rectal cancer are included for the first time, as are a number of new procedures for fistula. The latest evidence for total mesocolic excision is included for the first time, together with clear descriptions of the technique.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Inside Front Cover | ES2 | ||
| Colorectal Surgery | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Series Editors’ preface | vii | ||
| Editors’ preface | ix | ||
| Evidence-based practice in surgery | xi | ||
| Contributors | xiii | ||
| Chapter 1: Anorectal investigation | 1 | ||
| Introduction | 1 | ||
| Anatomy and physiology of the anal canal | 1 | ||
| Rectoanal inhibitory reflex | 2 | ||
| Manometry | 2 | ||
| Ambulatory manometry | 4 | ||
| Anal and rectal sensation | 5 | ||
| Rectal compliance | 5 | ||
| Pelvic floor descent | 6 | ||
| Electrophysiology | 6 | ||
| Electromyography | 6 | ||
| Pudendal nerve terminal motor latency | 7 | ||
| Spinal motor latency | 7 | ||
| Defecography/evacuation proctography | 7 | ||
| Dynamic pelvic MRI | 7 | ||
| Dynamic transperineal and three-dimensional pelvic floor ultrasound | 8 | ||
| Scintigraphy | 8 | ||
| Imaging the rectum and anal sphincters | 8 | ||
| Anal endosonography/endorectal ultrasound | 8 | ||
| Endocoil receiver MRI | 9 | ||
| Imaging in rectal cancer | 9 | ||
| Imaging in anal sepsis and anal fistulas | 10 | ||
| Imaging in faecal incontinence | 11 | ||
| Summary | 12 | ||
| Key references | 12 | ||
| Chapter 2: Colonoscopy and flexible sigmoidoscopy | 14 | ||
| Introduction | 14 | ||
| Indications and contraindications | 14 | ||
| Flexible sigmoidoscopy vs colonoscopy | 14 | ||
| Contraindications | 14 | ||
| Sedation | 14 | ||
| Insertion technique | 15 | ||
| Handling and scope control | 15 | ||
| Insertion and steering | 15 | ||
| Tips for insertion and steering | 15 | ||
| Patient position change | 15 | ||
| Abdominal hand pressure | 16 | ||
| Three-dimensional imager | 16 | ||
| Withdrawal technique | 16 | ||
| Withdrawal time | 16 | ||
| Optimal examination technique | 16 | ||
| Bowel preparation | 17 | ||
| Position change | 17 | ||
| Antispasmodics | 18 | ||
| Rectal and caecal retroflexion | 18 | ||
| Quality assurance | 18 | ||
| Endoscopy training | 18 | ||
| New techniques in endoscopic mucosal visualisation | 19 | ||
| Assisted-viewing devices | 19 | ||
| Chromoendoscopy | 19 | ||
| High-magnification endoscopy | 20 | ||
| Endoscopic therapy | 20 | ||
| Basic therapy | 20 | ||
| Polypectomy | 20 | ||
| Endoscopic mucosal resection (EMR) | 21 | ||
| Investigation of acute lower gastrointestinal (GI) bleeding | 22 | ||
| Colonic decompression | 22 | ||
| Advanced therapy | 23 | ||
| Endoscopic submucosal dissection (ESD) | 23 | ||
| Stricture dilatation and stenting | 23 | ||
| Novel therapies | 23 | ||
| Competing technologies | 23 | ||
| Computed tomography colonography (or virtual colonoscopy) | 23 | ||
| Self-propelling colonoscopes | 24 | ||
| Colon capsule | 24 | ||
| Conclusions | 24 | ||
| Key references | 24 | ||
| Chapter 3: Colorectal cancer | 26 | ||
| Introduction | 26 | ||
| Natural history | 26 | ||
| Direct spread | 27 | ||
| Lymphatic spread | 27 | ||
| Blood-borne spread | 27 | ||
| Transcoelomic spread | 27 | ||
| Aetiology | 27 | ||
| Genetic factors | 27 | ||
| Diet and lifestyle | 28 | ||
| Predisposing conditions | 28 | ||
| Presentation | 28 | ||
| Investigation | 29 | ||
| Screening | 29 | ||
| Surveillance after adenoma detection | 30 | ||
| The malignant polyp | 30 | ||
| Surgery | 32 | ||
| Adjuvant therapy | 32 | ||
| Management of advanced disease | 33 | ||
| Operable metastases | 33 | ||
| Advanced local disease | 33 | ||
| Inoperable disseminated disease | 34 | ||
| Pathological staging | 34 | ||
| Summary recommendations for best practice | 34 | ||
| Key references | 36 | ||
| Chapter 4: Colorectal cancer and genetics | 37 | ||
| Introduction | 37 | ||
| Assessment of risk | 37 | ||
| Chapter 5: Surgery for colon cancer | 51 | ||
| Preparation of the patient for elective surgery | 51 | ||
| General issues | 51 | ||
| Bowel preparation | 51 | ||
| Venous thromboembolism prophylaxis | 51 | ||
| Blood transfusion | 52 | ||
| Antibiotic prophylaxis | 52 | ||
| The principles of surgery | 52 | ||
| The evidence for CME | 52 | ||
| Dissection in the mesocolic plane | 52 | ||
| Central vascular ligation | 52 | ||
| The extent of longitudinal resection | 54 | ||
| Practical guidance on the extent of resection | 55 | ||
| Laparoscopic or open surgery? | 56 | ||
| Vascular variations of the colon | 57 | ||
| Obesity and difficulties in laparoscopic surgery | 57 | ||
| Anastomotic leakage | 57 | ||
| Diagnosis | 59 | ||
| Management | 60 | ||
| Defunctioning stoma | 60 | ||
| Emergency management | 60 | ||
| Obstruction | 60 | ||
| Management of obstruction | 60 | ||
| Perforation | 61 | ||
| Future developments | 61 | ||
| Acknowledgements | 62 | ||
| Key references | 62 | ||
| Chapter 6: Surgery for rectal cancer | 63 | ||
| Introduction | 63 | ||
| Objectives of surgery | 63 | ||
| In-hospital mortality | 63 | ||
| Local recurrence | 64 | ||
| Circumferential resection margin and the role of preoperative radiotherapy | 64 | ||
| Complications of preoperative radiotherapy | 65 | ||
| Downstaging rectal cancer with preoperative radiotherapy | 65 | ||
| MRI can predict T stage and CRM status | 66 | ||
| Considerations for decision-making | 66 | ||
| Tumour disruption | 66 | ||
| Extent of excision – TME versus mesorectal transection, pelvic lymphadenectomy and level of vascular ligation | 67 | ||
| TME | 67 | ||
| Lateral pelvic lymph nodal involvement | 68 | ||
| High versus low inferior mesenteric artery ligation | 68 | ||
| Implantation of viable cells | 68 | ||
| Quality of life | 68 | ||
| Preservation of continence by restorative resection | 68 | ||
| Distal clearance margin | 69 | ||
| Tumour height – the importance of rectal palpation (PR) | 70 | ||
| Aspects of anal and neo-rectal function | 70 | ||
| Low rectal cancer and the English National Low Rectal Cancer Programme (LOREC) | 70 | ||
| Abdominoperineal excision (APE) | 70 | ||
| Reconstruction (colonic pouch, end-to-side or end-to-end anastomosis) | 71 | ||
| Sexual and urinary disturbance | 71 | ||
| Temporary defunctioning stomas | 71 | ||
| Alternative approaches to standard surgery for rectal cancer | 71 | ||
| Papillon/contact radiotherapy | 71 | ||
| Transanal endoscopic microsurgery (TEMS) and transanal minimally invasive surgery (TAMIS) | 72 | ||
| Laparoscopic surgery for rectal cancer | 72 | ||
| Robotic rectal cancer surgery | 72 | ||
| Transanal TME (TA-TME) for rectal cancer | 72 | ||
| Non-operative approach for rectal cancer by'watch and wait' after chemoradiotherapy | 73 | ||
| Alternative non-surgical options in rectal cancer | 73 | ||
| Follow-up | 73 | ||
| Synchronous tumours | 73 | ||
| Metachronous tumours | 73 | ||
| Surveillance for local and distant recurrence | 73 | ||
| The way forward | 74 | ||
| Key references | 74 | ||
| Chapter 7: Perioperative chemotherapy and radiotherapy for colorectal cancer | 75 | ||
| Introduction | 75 | ||
| Adjuvant chemotherapy for colorectal cancer | 75 | ||
| Acute and long-term toxicity | 76 | ||
| The elderly | 77 | ||
| Stage II disease | 77 | ||
| Addition of ‘targeted’ therapy to chemotherapy | 77 | ||
| Timing and duration of adjuvant chemotherapy | 77 | ||
| Adjuvant chemotherapy in rectal cancer | 77 | ||
| Radiotherapy | 78 | ||
| Evidence base for the use of adjuvant radiotherapy in resectable rectal cancer | 79 | ||
| Short-course radiotherapy and TME | 79 | ||
| Preoperative concurrent chemoradiotherapy | 79 | ||
| Short-course radiotherapy versus preoperative CRT | 80 | ||
| Short-course radiotherapy and delay to surgery | 80 | ||
| Late toxicity and second malignancy | 81 | ||
| Patient selection | 81 | ||
| Sphincter preservation | 82 | ||
| Organ preservation | 83 | ||
| Future directions: intensification of neoadjuvant treatment | 83 | ||
| Addition of a second concurrent chemotherapy agent during LCCRT | 83 | ||
| Neoadjuvant chemotherapy | 84 | ||
| Key references | 85 | ||
| Chapter 8: Advanced and recurrent colorectal cancer | 86 | ||
| Introduction | 86 | ||
| Incidence | 86 | ||
| Diagnosis and staging of advanced and recurrent CRC | 87 | ||
| Histological confirmation and biomarkers | 87 | ||
| Radiology | 87 | ||
| Computed tomography | 87 | ||
| Magnetic resonance imaging | 87 | ||
| Positron emission tomography | 87 | ||
| Ultrasonography | 87 | ||
| The advanced colorectal cancer MDT | 88 | ||
| Locally advanced primary and recurrent rectal cancer | 88 | ||
| Radiotherapy | 88 | ||
| Perineal excision | 89 | ||
| Pelvic multivisceral exenteration | 89 | ||
| Patterns of rectal cancer recurrence | 89 | ||
| Types of pelvic clearance | 90 | ||
| Sacrectomy | 91 | ||
| Perineal reconstruction | 91 | ||
| Colorectal peritoneal metastases (CRPM) | 91 | ||
| CRS/HIPEC | 92 | ||
| Scoring systems | 92 | ||
| Patient Selection | 93 | ||
| Colorectal liver metastases | 93 | ||
| Key references | 95 | ||
| Chapter 9: Anal cancer | 96 | ||
| Introduction | 96 | ||
| Epidermoid tumours | 96 | ||
| Aetiology and pathogenesis | 96 | ||
| Premalignant lesions | 97 | ||
| Histological types | 98 | ||
| Patterns of spread | 98 | ||
| Clinical presentation | 98 | ||
| Investigation | 99 | ||
| Clinical staging | 99 | ||
| Treatment | 99 | ||
| Historical | 99 | ||
| Current | 99 | ||
| Radiation-alone therapy | 99 | ||
| Chemo-irradiation therapy (combined modality therapy) | 100 | ||
| Role of surgery today | 101 | ||
| Initial diagnosis | 101 | ||
| Lesions at the anal margin | 101 | ||
| Treatment complications and disease relapse | 101 | ||
| Inguinal metastases | 102 | ||
| Long-term outcomes | 102 | ||
| Treatment of intraepithelial neoplasia | 102 | ||
| Rarer tumours | 103 | ||
| Adenocarcinoma | 103 | ||
| Malignant melanoma | 103 | ||
| Key references | 103 | ||
| Chapter 10: Diverticular disease | 105 | ||
| Historical perspectives | 105 | ||
| Terminology | 105 | ||
| Anatomical and physiological perspectives | 105 | ||
| Incidence and geographical differences | 105 | ||
| Race and geography | 105 | ||
| Age and gender | 106 | ||
| Diet | 106 | ||
| Aetiology and pathogenesis | 106 | ||
| Lifestyle | 107 | ||
| Smoking | 107 | ||
| NSAIDs | 107 | ||
| Diverticulitis | 107 | ||
| The extent of the problem | 107 | ||
| Classification | 107 | ||
| Segmental colitis-associated diverticulosis | 108 | ||
| Diagnosis and imaging | 108 | ||
| Treatment | 110 | ||
| Conservative and medical options | 110 | ||
| Emergency surgery | 111 | ||
| Historical perspectives | 111 | ||
| Laparoscopic peritoneal lavage for generalised purulent peritonitis | 112 | ||
| Resection with primary anastomosis | 114 | ||
| Elective resection – facts, fiction and functional outcome | 115 | ||
| Diverticular haemorrhage | 115 | ||
| Key references | 116 | ||
| Chapter 11: Ulcerative colitis | 117 | ||
| Introduction | 117 | ||
| Epidemiology | 117 | ||
| Aetiopathogenesis | 117 | ||
| Clinical presentation | 118 | ||
| Extraintestinal manifestations | 118 | ||
| Musculoskeletal | 118 | ||
| Hepatopancreatobiliary | 118 | ||
| Dermatological | 119 | ||
| Thromboembolic | 119 | ||
| Ophthalmological | 119 | ||
| Diagnosis and evaluation | 119 | ||
| Microbiology | 119 | ||
| Endoscopy | 120 | ||
| Histopathology | 120 | ||
| Imaging | 120 | ||
| Serology and microbiome | 121 | ||
| Colorectal cancer and surveillance | 121 | ||
| Severity assessment | 122 | ||
| Medical management | 122 | ||
| Proctitis | 123 | ||
| Mild to moderate distal colitis | 123 | ||
| Mild to moderate extensive colitis | 123 | ||
| Severe colitis | 124 | ||
| Surgical management | 124 | ||
| Emergency/urgent | 124 | ||
| Elective | 125 | ||
| Proctocolectomy with end ileostomy | 125 | ||
| Proctocolectomy with continent ileostomy | 126 | ||
| Ileorectal anastomosis | 126 | ||
| Restorative proctocolectomy/ileal pouch–anal anastomosis (IPAA) | 126 | ||
| Double-stapled technique | 127 | ||
| Hand-sewn technique | 127 | ||
| Outcomes in stapled versus hand-sewn anastomosis | 128 | ||
| Complications following pouch surgery | 130 | ||
| Functional outcomes | 133 | ||
| Key references | 134 | ||
| Chapter 12: Crohn’s disease | 135 | ||
| Introduction | 135 | ||
| Epidemiology | 135 | ||
| Aetiology | 135 | ||
| Smoking and oral contraception | 135 | ||
| Infection | 135 | ||
| Genes and the microbiome | 136 | ||
| Pathogenesis | 136 | ||
| Pathology | 136 | ||
| Distribution | 136 | ||
| Macroscopic appearance | 137 | ||
| Microscopy | 137 | ||
| Pitfalls in differentiating Crohn’s colitis from ulcerative colitis | 137 | ||
| Clinical | 138 | ||
| Gastrointestinal symptoms | 138 | ||
| Systemic symptoms | 138 | ||
| Extraintestinal manifestations | 138 | ||
| Physical signs | 139 | ||
| Paediatric age group | 139 | ||
| Pregnancy | 139 | ||
| Investigations | 139 | ||
| Laboratory | 139 | ||
| Radiology | 140 | ||
| Endoscopy | 141 | ||
| Disease activity assessment and quality of life | 142 | ||
| Phenotyping | 142 | ||
| Differential diagnosis | 142 | ||
| Small-bowel Crohn’s disease | 142 | ||
| Large-bowel Crohn’s disease | 143 | ||
| Medical treatment | 143 | ||
| Multidisciplinary care | 143 | ||
| Aminosalicylates | 143 | ||
| Steroids | 144 | ||
| Antibiotics | 144 | ||
| Nutrition for therapy | 144 | ||
| Immunomodulatory therapy | 144 | ||
| Biological agents’ | 145 | ||
| Surgery and immunosuppression | 146 | ||
| Prophylaxis against recurrent disease after surgery | 146 | ||
| Other drugs | 146 | ||
| Surgery | 146 | ||
| Development of surgery | 146 | ||
| Risk of operation and re-operation | 147 | ||
| Risk factors for recurrence | 147 | ||
| Principles of surgery for Crohn’s disease | 148 | ||
| Perioperative considerations | 148 | ||
| Technique | 148 | ||
| Surgery for small-bowel and ileocolic Crohn’s disease | 148 | ||
| Indications | 148 | ||
| Gastroduodenal disease | 148 | ||
| Ileocolic disease | 149 | ||
| Ileal and jejunal multisite disease | 149 | ||
| Fistulas and abscesses | 149 | ||
| Enterocutaneous fistulas and intra-abdominal abscess | 150 | ||
| Management principles | 150 | ||
| Spontaneous enterocutaneous fistulas | 150 | ||
| Postoperative fistulas | 150 | ||
| Intra-abdominal fistulas | 151 | ||
| Spontaneous free perforation in the small bowel or colon | 151 | ||
| Surgery for colonic and rectal Crohn’s disease | 151 | ||
| Indications | 151 | ||
| Emergency colectomy and colectomy and ileostomy | 151 | ||
| Segmental colectomy | 151 | ||
| Total colectomy and ileorectal anastomosis | 151 | ||
| Panproctocolectomy | 152 | ||
| Restorative proctocolectomy | 152 | ||
| Crohn’s colitis and cancer | 153 | ||
| Perianal disease | 153 | ||
| Investigation | 153 | ||
| Medical treatment | 153 | ||
| Anal fissure | 154 | ||
| Abscesses | 154 | ||
| Anal fistulas | 154 | ||
| Rectovaginal fistulas | 154 | ||
| Defunctioning ileostomy for perianal disease | 155 | ||
| Long-term complications of perianal disease | 155 | ||
| Prognosis | 155 | ||
| Key references | 155 | ||
| Chapter 13: Intestinal failure | 157 | ||
| Introduction | 157 | ||
| Intestinal failure: criteria for referral | 157 | ||
| Epidemiology | 158 | ||
| Causes | 158 | ||
| Loss of intestinal length | 158 | ||
| Loss of functional absorptive capacity | 158 | ||
| Loss of intestinal absorptive capacity | 159 | ||
| Loss of intestinal function | 159 | ||
| Pathophysiology | 159 | ||
| The three stages of intestinal failure | 159 | ||
| Stage I: hypersecretory phase | 159 | ||
| Stage II: adaptation phase | 159 | ||
| Stage III: stabilisation phase | 159 | ||
| Fluid and electrolytes | 159 | ||
| Nutrients | 160 | ||
| Carbohydrates, proteins and water-soluble vitamins | 160 | ||
| Fat, bile salts and fat-soluble vitamins | 160 | ||
| Adaptation | 160 | ||
| Role of the colon in short-bowel syndrome | 160 | ||
| Surgical catastrophe and management | 161 | ||
| Resuscitation | 161 | ||
| Restitution | 161 | ||
| Sepsis | 161 | ||
| Nutrition | 161 | ||
| Fluid and electrolytes | 161 | ||
| Nutritional support | 162 | ||
| Reduction of output | 162 | ||
| Dietary modification | 163 | ||
| Outcome aims and monitoring | 163 | ||
| Parenteral nutrition | 163 | ||
| Fistuloclysis | 163 | ||
| Anatomy (mapping) | 164 | ||
| Protection of skin | 165 | ||
| Planned surgery | 165 | ||
| Reconstruction | 166 | ||
| Enterocutaneous fistula | 166 | ||
| Rehabilitation | 167 | ||
| Transplantation | 167 | ||
| Supporting organisations | 168 | ||
| Summary | 168 | ||
| Key references | 169 | ||
| Chapter 14: Incontinence | 170 | ||
| Introduction | 170 | ||
| Aetiology | 170 | ||
| Sphincter injury | 170 | ||
| Rectal compliance | 172 | ||
| Idiopathic’ faecal incontinence | 172 | ||
| Presentation | 172 | ||
| History | 172 | ||
| Examination | 173 | ||
| Investigations | 173 | ||
| Management of faecal incontinence in adults | 174 | ||
| Conservative measures | 174 | ||
| Dietary modification and medications | 174 | ||
| Biofeedback and pelvic floor muscle retraining | 175 | ||
| Anal plug | 176 | ||
| Surgery | 176 | ||
| Sphincteroplasty | 176 | ||
| Pelvic floor repair (postanal, preanal or total) | 177 | ||
| Sphincter reconstruction – muscle transposition | 177 | ||
| Artificial sphincters | 178 | ||
| Artificial bowel sphincter | 178 | ||
| Magnetic anal sphincter | 178 | ||
| Sacral nerve stimulation | 178 | ||
| Percutaneous and transcutaneous tibial nerve stimulation | 181 | ||
| Injection therapy | 182 | ||
| Stoma formation | 182 | ||
| Antegrade continence enema | 182 | ||
| End stoma | 182 | ||
| Conclusion | 183 | ||
| Key references | 183 | ||
| Chapter 15: Functional problems and their surgical management | 184 | ||
| Introduction | 184 | ||
| Rectal prolapse | 184 | ||
| Mucosal prolapse | 184 | ||
| Full-thickness rectal prolapse (see Table 15.1) | 184 | ||
| Choice of abdominal or perineal surgical approaches | 186 | ||
| Perineal approaches | 187 | ||
| Abdominal approaches | 188 | ||
| Laparoscopic approaches | 189 | ||
| Recurrent rectal prolapse | 190 | ||
| Obstructive defaecation, rectocele and rectal intussusception | 190 | ||
| Rectocele | 190 | ||
| Rectal intussusception | 191 | ||
| Laparoscopic ventral rectopexy | 193 | ||
| Stapled transanal rectal resection (STARR) | 193 | ||
| Solitary rectal ulcer syndrome (SRUS) | 195 | ||
| Key references | 196 | ||
| Chapter 16: Functional problems and their medical management | 198 | ||
| Introduction | 198 | ||
| Irritable bowel syndrome | 198 | ||
| Investigation | 199 | ||
| Treatment | 199 | ||
| Lifestyle modification | 199 | ||
| Pharmacological treatments | 199 | ||
| Psychological treatments | 200 | ||
| Surgery | 200 | ||
| Functional constipation | 200 | ||
| Investigation | 201 | ||
| Treatment | 201 | ||
| Dietary fibre supplementation | 201 | ||
| Laxatives, suppositories, enemas and novel prokinetics | 201 | ||
| Behavioural therapy (biofeedback) | 202 | ||
| Surgical treatment for constipation | 202 | ||
| Putative treatments for constipation | 203 | ||
| Idiopathic megarectum and megacolon | 203 | ||
| Key references | 204 | ||
| Chapter 17: Anal fistula: evaluation and management | 206 | ||
| Introduction | 206 | ||
| Aetiology | 206 | ||
| Management of acute sepsis | 208 | ||
| Classification of anal fistula | 209 | ||
| Assessment | 211 | ||
| Clinical | 211 | ||
| Imaging | 212 | ||
| Physiological | 213 | ||
| Principles of fistula surgery | 214 | ||
| Surgical treatment – general principles and interpreting the evidence | 214 | ||
| Track preparation | 215 | ||
| Fistulotomy | 216 | ||
| Fistulotomy and immediate reconstitution | 216 | ||
| Fistulectomy | 216 | ||
| Setons | 217 | ||
| The loose seton | 217 | ||
| The tight seton | 217 | ||
| The chemical seton | 218 | ||
| Advancement flaps | 218 | ||
| Intersphincteric approaches | 219 | ||
| Infill materials – glues and plugs (Table 17.1) | 219 | ||
| Fibrin glue | 219 | ||
| Bioprosthetic plugs | 220 | ||
| Newer techniques | 220 | ||
| VAAFT (video assisted anal fistula treatment) | 220 | ||
| FiLaC (fistula tract laser closure) | 220 | ||
| OTSC (over the scope clip) | 220 | ||
| Stem cells | 221 | ||
| Management of the recurrent fistula | 221 | ||
| Key references | 222 | ||
| Chapter 18: Minor anorectal conditions | 223 | ||
| Haemorrhoids | 223 | ||
| Anatomy and physiology | 223 | ||
| Aetiology and pathogenesis | 223 | ||
| Classification | 224 | ||
| Symptoms and diagnosis | 224 | ||
| Management | 224 | ||
| First-degree | 225 | ||
| Dietary changes | 225 | ||
| Phlebotonics | 225 | ||
| Second-degree | 225 | ||
| Rubber-band ligation | 225 | ||
| Sclerotherapy | 226 | ||
| Other treatments | 226 | ||
| Third-degree | 226 | ||
| Stapled haemorrhoidopexy | 226 | ||
| Haemorrhoidal arterial ligation/transanal haemorrhoidal dearterialisation | 227 | ||
| Fourth-degree | 227 | ||
| Postoperative problems | 227 | ||
| Postoperative pain | 227 | ||
| Postoperative haemorrhage | 227 | ||
| Anal stenosis | 228 | ||
| Thrombosed haemorrhoids | 228 | ||
| Conclusions | 228 | ||
| Anal fissure | 228 | ||
| Aetiology | 228 | ||
| Classification | 229 | ||
| Symptoms and diagnosis | 229 | ||
| Management | 230 | ||
| Initial treatment – conservative measures | 230 | ||
| Glyceryl trinitrate | 230 | ||
| Diltiazem | 230 | ||
| Botulinum toxin | 230 | ||
| Surgical treatments | 231 | ||
| Anal dilatation | 231 | ||
| Lateral anal sphincterotomy | 231 | ||
| Fissurectomy | 231 | ||
| Anal advancement flap | 231 | ||
| Conclusion | 231 | ||
| Pruritus ani | 231 | ||
| Aetiology and pathogenesis | 232 | ||
| Diagnosis | 232 | ||
| Treatment | 232 | ||
| Conclusion | 233 | ||
| Pilonidal sinus | 233 | ||
| Aetiology | 233 | ||
| Clinical manifestation | 233 | ||
| Treatment | 233 | ||
| Pilonidal abscess | 233 | ||
| Chronic pilonidal sinus | 233 | ||
| Outpatient options | 233 | ||
| Surgical options | 234 | ||
| Recurrent pilonidal sinus | 234 | ||
| Conclusion | 235 | ||
| Anal stenosis | 235 | ||
| Aetiology | 235 | ||
| Clinical presentation | 236 | ||
| Treatment | 236 | ||
| Prevention | 236 | ||
| Anal dilatation | 236 | ||
| Sphincterotomy | 236 | ||
| Stricturoplasty | 236 | ||
| Flap procedures | 237 | ||
| Mucosal advancement flap (above to down) | 237 | ||
| Y–V advancement flap (outside to in) | 237 | ||
| V–Y advancement flap (outside to in) | 237 | ||
| Island advancement flap (outside to in) | 237 | ||
| Conclusion | 237 | ||
| Sexually transmitted diseases | 237 | ||
| Human papillomavirus and anal warts | 238 | ||
| Treatment | 239 | ||
| Buschke–Lowenstein tumour: giant anal condyloma | 240 | ||
| Other STDs affecting the anorectum | 240 | ||
| Key references | 242 | ||
| Index | 245 |