Current therapy in colon and rectal surgery

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Front Cover IFC Current therapy in colon and rectal surgery Copyright Dedication Contributors Preface to the third edition Acknowledgments Contents 1 - ANAL AND PERIANAL REGION 1 - Anatomy and Physiology of the Colon, Rectum, and Anal Canal* ANATOMY OF THE COLON AND RECTUM Colon Course and Peritoneal Coverings Rectum Peritoneal Relations and Fascial Attachments ARTERIAL SUPPLY Superior Mesenteric Artery Inferior Mesenteric Artery Collateral Circulation VENOUS DRAINAGE Superior Mesenteric Vein Inferior Mesenteric Vein LYMPHATIC DRAINAGE INNERVATION COLON AND RECTUM PHYSIOLOGY Colonic Physiology Absorption and Secretion Digestion Propulsion and Storage ANAL CANAL ANATOMY Lining Muscles of the Anorectal Region Perineal Body Pelvic Floor Muscles Innervation of the Anus Motor Innervation Sensory Innervation Arterial Supply of the Anus Lymphatic Drainage of the Anus Venous Drainage of the Anus ANAL CANAL PHYSIOLOGY Mechanisms of Continence Defecation Physiologic Testing Anal Manometry Defecography by Fluoroscopy or Magnetic Resonance Imaging Balloon Expulsion Test Saline Continence Test Rectal Compliance Electromyography Nerve Stimulation Techniques Suggested Reading 2 - Hemorrhoids EXTERNAL HEMORRHOIDS ANATOMY AND ETIOLOGY OF INTERNAL HEMORRHOIDS CLINICAL EVALUATION NONEXCISIONAL OPTIONS Medical Management Sclerotherapy Energy-Based Destruction Hemorrhoidal Ligation with Rubber Bands EXCISIONAL HEMORRHOIDECTOMY Instrumentation for Excisional Hemmorrhoidectomy PROCEDURE FOR PROLAPSING HEMORRHOIDS (STAPLED HEMMORHOIDOPEXY) DOPPLER-GUIDED HEMORRHOIDAL DEARTERIALIZATION POSTOPERATIVE MANAGEMENT AFTER HEMORRHOID SURGERY CONCLUSION Suggested Reading 3 - Chronic Anal Fissure INTRODUCTION DIAGNOSIS PATHOPHYSIOLOGY High-Pressure Chronic Anal Fissure Low- and Normal-Pressure Chronic Anal Fissure MANAGEMENT Topical Creams Botulinum Toxin Fissurectomy Cutaneous Advancement Flap Lateral Internal Sphincterotomy Surgical Technique Risk of Incontinence Tailored Sphincterotomy Treatment of Low/Normal Pressure Chronic Anal Fissure SUMMARY: CHOICE OF TREATMENT Suggested Reading 4 - Anorectal Abscess SURGICAL ANATOMY ETIOLOGY NATURAL HISTORY OF THE DISEASE AND SPREAD PATHWAYS CLINICAL FEATURES Perianal Abscess Ischiorectal Abscess Intersphincteric Abscess Supralevator Abscess Deep Postanal Abscess Submucosal Abscess DIAGNOSIS Treatment of Anorectal Abscesses Large Abscesses Searching for a Fistula Ischiorectal Abscess Intersphincteric Abscesses Supralevator Abscess Submucosal Abscess Role of Antibiotics and Biopsy Postoperative Care Complications RECURRENCE AND THE DEVELOPMENT OF FISTULA IN ANO Suggested Reading 5 - Anal Fistula INTRODUCTION ETIOLOGY CLASSIFICATION PRESENTATION DIAGNOSIS AND EVALUATION Preparation and Examination TREATMENT INTERSPHINCTERIC ANAL FISTULA Clinical Findings TREATMENT Incontinence Risk TRANSSPHINCTERIC ANAL FISTULA Clinical Findings Treatment Cutting Seton Sphincter-Preserving Techniques LIFT ADVANCEMENT FLAP PARTIAL FISTULOTOMY SUPRASPHINCTERIC ANAL FISTULA Fistula Plugs EXTRASPHINCTERIC ANAL FISTULA SPECIAL SITUATIONS Crohn Disease Deep Postanal Space Abscess with a Horseshoe Fistula SUMMARY Suggested Reading 6 - Rectovaginal Fistula DEFINITION CAUSES HISTORY AND PHYSICAL EXAMINATION TREATMENT OPTIONS Medical Nonsurgical Closure Fistula Plug Fibrin Glue Surgical Closure Anal Approach Rectal Advancement Flap Advancement Sleeve Flap Turnbull-Cutait Anastomosis Transvaginal Approach Perineal Approach Ligation of the Intersphincteric Fistula Tract Episioproctotomy Tissue Interposition Gracilis. Placement of muscle (typically the gracilis) between the rectum and vagina via a transperineal approach is an option w... Martius. The Martius flap is another procedure that brings healthy tissue into the area. The patient is usually in the lithotomy... Biologic Mesh. Dissection in the rectovaginal plane and closure of the openings at the anal and vaginal side, followed by placem... SPECIAL CONSIDERATIONS Use of a Stoma Postoperative Care Sexual Function/Vaginal Dryness Recurrence CONCLUSION Suggested Reading 7 - Pilonidal Sinus ETIOLOGY PRESENTATION TREATMENT Asymptomatic Pilonidal Sinus Pilonidal Abscess Chronic Pilonidal Sinus NONOPERATIVE MANAGEMENT Hair Removal SURGERY Lateral Drainage, Curettage, and Midline Pit Excision Local Excision and Healing by Secondary Intention Excision and Wound Closure: Midline or Off-Midline Closure? FLAP-BASED PROCEDURES Karydakis Procedure Cleft Lift Procedure Rhomboid Excision and Flap Repair ADJUNCTS TO OPERATIVE MANAGEMENT Cavity Drainage CONCLUSION Suggested Reading 8 - Perianal Hidradenitis Suppurativa ETIOLOGY CLINICAL PRESENTATION AND EVALUATION ANTIBIOTIC TREATMENT NONANTIBIOTIC TREATMENT SURGICAL TREATMENT SUMMARY Suggested Reading 9 - Management of Pruritus Ani INTRODUCTION ETIOLOGY PRIMARY CAUSES OF PRURITUS ANI Pathophysiology HISTORY EXAMINATION TREATMENT SECONDARY PRURITUS ANI TREATMENT Anorectal Conditions Infections Dermatologic Conditions Neoplastic Causes Systemic Disease TREATMENT OF PRIMARY PRURITUS ANI REFRACTORY OR PERSISTENT PRURITUS ANI SUMMARY Suggested Reading 10 - Cause and Management of Anal Stenosis INTRODUCTION DEFINITION CLASSIFICATION OF ANAL STENOSIS Cause Spasm Postoperative Scarring Stenosis Due to Chronic Diarrhea Age-Related Stenosis Other Classification Schemes for Anal Stenosis SYMPTOMS Examination Findings PREVENTION OF POSTOPERATIVE ANAL STENOSIS TREATMENT Nonoperative Management Anal Dilation Surgical Management Anoplasty Postoperative Complications of Anoplasty Suggested Reading 11 - Management of Anal and Perianal Warts BACKGROUND AND EPIDEMIOLOGY PRESENTATION OF DISEASE AND DIAGNOSIS TREATMENT OF ANAL CONDYLOMA Medical Therapies Podophyllum-Based Therapies: Podophyllin and Podofilox Trichloracetic and Bichloracetic Acid Imiquimod Other Medical Treatments Ablative Therapies Cryotherapy Surgical Excision/Fulguration Laser Recurrent Disease Treatment Algorithm CONCLUSION Suggested Reading 12 - Anorectal Venereal Infections BACTERIAL INFECTIONS Gonorrhea Preferred Clinical Approach Chlamydia trachomatis and Lymphogranuloma venereum Preferred Clinical Approach Chancroid Preferred Clinical Approach Granuloma Inguinale Preferred Clinical Approach Syphilis (“The Great Masquerader”) Preferred Clinical Approach VIRAL INFECTIONS Herpes Simplex Virus Preferred Clinical Approach Condylomata Acuminata Clinical Manifestations Treatment Preferred Clinical Approach Electrocautery OTHER DISORDERS Suggested Reading 13 - Management of High-Grade Squamous Intraepithelial Lesion (Formerly Bowen Disease) and Paget Disease INTRODUCTION HIGH-GRADE SQUAMOUS INTRAEPITHELIAL LESION (FORMERLY BOWEN DISEASE) Management PERIANAL PAGET DISEASE Management Suggested Reading 14 - Anal Melanoma and Basal Cell Cancer of the Perianal Region INTRODUCTION EPIDEMIOLOGY AND RISK FACTORS PATHOPHYSIOLOGY CLINICAL PRESENTATION AND DIAGNOSIS SURGERY Management of the Primary Tumor Management of Lymph Nodes SURVIVAL BASAL CELL CANCER OF THE PERIANAL REGION Suggested Reading 15 - Anal Carcinoma INTRODUCTION ANATOMIC CONSIDERATIONS EPIDEMIOLOGY SQUAMOUS CELL CARCINOMA OF THE ANAL CANAL Surveillance Local Excision Inguinal Lymph Node Management Extrapelvic Metastases PERIANAL SQUAMOUS CELL CARCINOMA ANAL CANCER AND HIV INFECTION Suggested Reading 16 - Pelvic Pain A GENERAL APPROACH CHRONIC PROCTALGIA LEVATOR ANI SYNDROME Diagnosis Treatment PROCTALGIA FUGAX COCCYGODYNIA CONCLUSION Selected Readings 17 - Anorectal Congenital Disorders DESCRIPTION OF DEFECTS Perineal Fistula Rectal Atresia Vestibular Fistula Imperforate Anus without Fistula Rectourethral Bulbar Fistula Rectourethral Prostatic Fistula Cloaca Recto-Bladder-Neck Fistula NEONATAL MANAGEMENT MAIN REPAIR Anoplasty Limited Posterior Sagittal Anorectoplasty Posterior Sagittal Anorectoplasty with or without Laparotomy/Laparoscopy Posterior Sagittal Anorectovaginourethroplasty with or without Laparotomy Management of Functional Sequelae Suggested Readings 18 - Hirschsprung Disease INTRODUCTION AND HISTORY ETIOLOGY, PATHOPHYSIOLOGY, AND INCIDENCE CLINICAL MANIFESTATIONS DIAGNOSIS Anorectal Manometry Rectal Biopsy TREATMENT Resuscitation Surgery Main Repair Swenson Procedure Duhamel Procedure Soave Procedure Laparoscopic Procedures Transanal Approach COMPLICATIONS Fecal Incontinence Dehiscence and Retraction Constipation Nonpreventable Complications RESULTS TOTAL COLONIC AGANGLIONOSIS Suggested Reading 2 - RECTAL AND PARARECTAL REGION 19 - Fecal Incontinence INTRODUCTION AND INCIDENCE CAUSES ASSESSMENT TREATMENT Medical Management Biofeedback Surgery Anal Sphincter Repair (Sphincteroplasty) Postanal Repair Anal Encirclement Muscle Transposition Sacral Nerve Stimulation Posterior Tibial Nerve Stimulation Continence Enemas Stem Cells, Bulking Agents, and Other Techniques Fecal Diversion CONCLUSIONS Suggested Readings 20 - Rectal Stricture: Etiology and Management DEFINITION PRESENTATION AND DIAGNOSIS ETIOLOGY BENIGN RECTAL STRICTURES Rectal Strictures Related to Inflammatory Bowel Disease MALIGNANT RECTAL STRICTURES SUMMARY Suggested Readings 21 - Management of Fecal Impaction INTRODUCTION ETIOPATHOLOGY Presentation DIAGNOSIS TREATMENT Medical Treatment Digital Evacuation Enemas and Colonic Lavage Oral Solutions Stool Softeners Laxatives Endoscopic Disimpaction SURGERY Acute Chronic PREVENTION CONCLUSION Suggested Reading 22 - Rectal Prolapse INTRODUCTION PATHOPHYSIOLOGY CLINICAL FEATURES PREOPERATIVE CONSIDERATIONS SURGICAL OPTIONS Perineal Repairs Abdominal Procedures Recommendations Problems MANAGEMENT OF RECURRENT PROLAPSE Suggested Reading 23 - Solitary Rectal Ulcer Syndrome INTRODUCTION CAUSE PATHOPHYSIOLOGY CLINICAL FEATURES DIAGNOSIS MANAGEMENT Nonoperative Management Surgery CONCLUSIONS Suggested Reading 24 - Rectocele DEFINITION CAUSES SYMPTOMS DIAGNOSIS MANAGEMENT SURGICAL TREATMENT Transanal Repairs Transvaginal Repairs Transperineal Repairs Comparison of Approaches SUMMARY Suggested Reading 25 - Rectal Foreign Bodies EPIDEMIOLOGY EVALUATION CLASSIFICATION American Association for the Surgery of Trauma Rectal Organ Injury Scale Location of the Foreign Body Intraperitoneal or Extraperitoneal EXTRACTION MANAGEMENT POSTEXTRACTION CARE Suggested Reading 26 - Diagnosis and Management of Sacral and Retrorectal Tumors INTRODUCTION ANATOMY OF THE RETRORECTAL SPACE CLASSIFICATION SYSTEMS CONGENITAL/DEVELOPMENTAL LESIONS Germ Cell Tumors Tailgut Cysts Duplication Cysts Anterior Sacral Meningocele Chordoma Osseous Tumors Neurogenic Tumors Nonosseous Mesenchymal Tumors INFLAMMATORY LESIONS METASTATIC LESIONS DIAGNOSTIC APPROACHES TO SACRAL AND RETRORECTAL TUMORS OPERATIVE APPROACHES SUMMARY Suggested Reading 27 - Management of Rectal Villous Tumors INTRODUCTION RECTAL ANATOMY AND PHYSIOLOGY CLINICALLY SIGNIFICANT ASSOCIATIONS OF RECTAL FUNCTION THERAPEUTIC OPTIONS RESULTING FROM THE LOCATION OF THE RECTUM RECTAL VILLOUS TUMORS ASSESSING THE LESION FOR CANCER TREATMENT Endoscopic Polypectomy Transanal Excision Transanal Endoscopic Microsurgery/Transanal Minimally Invasive Surgery Delorme Procedure Trans-sacral Resection Anterior Resection FOLLOW-UP Suggested Reading 28 - Preoperative Evaluation of the Patient with Rectal Cancer: Staging and Strategy INTRODUCTION CLINICAL ASSESSMENT History Physical Examination ENDOSCOPIC EVALUATION AND BIOPSY PREOPERATIVE STAGING WITH IMAGING MODALITIES Locoregional Evaluation Tumor Stage and the Circumferential Resection Margin Nodal Staging Extramural Venous Invasion Locoregional Imaging Synoptic Reports Distant Metastatic Evaluation Serum Tumor Markers ROLE OF MULTIDISCIPLINARY CANCER CONFERENCES Suggested Readings 29 - Cancer of the Rectum: Neoadjuvant Therapy INTRODUCTION RADIOTHERAPY TRIALS ROLE OF CIRCUMFERENTIAL RESECTION MARGIN MULTIMODALITY TREATMENT APPROACHES RANDOMIZED TRIALS COMPARING NEOADJUVANT SHORT-COURSE RADIOTHERAPY WITH CHEMOTHERAPY–LONG-COURSE RADIOTHERAPY RADIATION TREATMENT VOLUMES RADIATION-RELATED TOXICITIES OTHER PERIOPERATIVE RADIATION TREATMENT OPTIONS Boosting the Dose INTRAOPERATIVE RADIATION THERAPY INTENSITY-MODULATED RADIATION THERAPY HIGH-DOSE-RATE ENDORECTAL BRACHYTHERAPY SUMMARY Suggested Reading 30 - Cancer of the Rectum: Operative Management INTRODUCTION KEY ANATOMIC POINTS PRESURGICAL PATIENT PREPARATION AND EVALUATION PREOPERATIVE DECISION MAKING Deciding Between an Open or Laparoscopic Approach Should a Stapled or Hand-Sewn Restorative Procedure Be Performed? SURGICAL PRINCIPLES Total Mesorectal Excision Ligation of the Inferior Mesenteric Artery Distal Resection Margins Choice of Anastomotic Configuration Drainage Diverting Stoma KEY STEPS OF SURGICAL PROCEDURES Low Anterior Resection Positioning and Equipment Trocar Placement Exposure of the Operating Field Identification of Inferior Mesenteric Vessels and Left Ureter Division of the Vessels and Splenic Flexure Mobilization Mobilization and Division of the Rectum Exteriorization of the Specimen Creation of the Anastomosis Desufflation and Closure of Trocar Incisions Abdominoperineal Resection Closure of the Anal Opening Mobilization of the Rectum Proximal Division of the Left Colon Perineal Dissection and Exteriorization Closure of Pelvic Wound and Trocar Incisions and Creation of the Colostomy PELVIC EXENTERATION Surgical Approaches Assessment Before Exenteration Signs of Irresectability Sacrectomy Pelvic Sidewall Disease Anterior Compartment/Urogenital Disease Central Recurrence Bladder Reconstruction Perineal Reconstruction OUTCOMES: SURVIVAL AND LOCAL RECURRENCE Suggested Reading 31 - Local Treatment of Rectal Cancer INTRODUCTION PREOPERATIVE EVALUATION INITIAL SELECTION SURGICAL TECHNIQUE Patient Preparation Transanal Excision Transanal Endoscopic Microsurgery/Transanal Endoscopic Operation Transanal Minimally Invasive Surgery MANAGEMENT OF THE SPECIMEN FOLLOW-UP RESULTS Local Excision for T1N0 Rectal Cancer Local Excision for T2N0 Rectal Cancer Salvage Resection after Local Excision ALTERNATIVE TO LOCAL EXCISION: ENDOCAVITARY CONTACT RADIATION CONCLUSIONS: ALGORITHM FOR TREATMENT BY LOCAL EXCISION 32 - Locally Recurrent Rectal Cancer: Management and Follow-up INTRODUCTION NOMENCLATURE OF PELVIC RECURRENCE CLINICAL EVALUATION FOR SUSPECTED PELVIC RECURRENCE MANAGEMENT OF PELVIC RECURRENCE Category I: Asymptomatic Local and Distant Recurrence Category II: Symptomatic Local Recurrence in the Presence of Distant Disease Category III: Unresectable, Isolated Local Recurrence Category IV: Resectable Isolated Local Recurrence Axial Recurrences Anterior Recurrences Posterior Recurrences Lateral Recurrences THE ROLE OF CHEMORADIATION FOR PELVIC RECURRENCE PREOPERATIVE AND INTRAOPERATIVE CONSIDERATIONS RECONSTRUCTION OPTIONS FOR PERINEAL DEFECTS SUMMARY Suggested Reading 33 - Perineal Hernia INTRODUCTION THERAPY Patient Selection Preoperative Preparation Procedures Alternative Methods Postoperative Care Complications PREVENTION SUMMARY Suggested Reading 3 - COLON 34 - Preoperative Preparation of the Patient for Colon and Rectal Surgery INTRODUCTION RISK ASSESSMENT CARDIOVASCULAR ASSESSMENT AND PREOPERATIVE MANAGEMENT PREOPERATIVE PULMONARY ASSESSMENT AND MANAGEMENT MANAGEMENT OF PATIENTS RECEIVING ANTITHROMBOTIC THERAPY MANAGEMENT OF PREOPERATIVE ANEMIA MANAGEMENT OF PREOPERATIVE MALNUTRITION Suggested Reading 35 - Medical Treatment of Ulcerative Colitis and Other Colitides ULCERATIVE COLITIS Diagnosis Treatment Diet 5-Aminosalycilic Acid Mild to Moderate Ulcerative Colitis Proctitis and Left-Sided Ulcerative Colitis Left-Sided Disease Extensive Disease Lack of Response to 5-Aminosalycilic Acid Oral Budesonide Corticosteroids Severe Ulcerative Colitis Cyclosporine Azathioprine and 6-Mercaptopurine Biologic Agents Infliximab Loss of Response. It is known that antibodies can develop in patients receiving anti-TNF-α agents with a loss of response to tre... Infusion Reactions. Mild infusion reactions occur in 5% to 13% of patients, but severe infusion reactions requiring infliximab d... Delayed Reactions. Delayed reactions occur 3 to 12 days after the administration of infliximab. These reactions result from the ... Adalimumab Golimumab How to Choose an Anti-TNF-α Agent Complications What to Do Before Starting Anti-TNF-α Therapy What to Do Once Treatment with an Anti-TNF-α Agent Is Started Antiadhesion Molecules Alternative Therapies Nicotine Clinical Scenarios Quiescent Disease Fulminant or Toxic Colitis General Recommendations for Patients with Severe Ulcerative Colitis Test for C. difficile Toxin A and B Flexible Sigmoidoscopy with Biopsies Deep Vein Thrombosis Prophylaxis Evaluate for Tuberculosis and Hepatitis B Avoid Narcotics and Antidiarrheal Medications Do Not Use Antibiotics Diet as Tolerated Perform Close Observation and Consult Colorectal Surgery upon Admission Vaccinations Pregnancy Cancer Risk Colorectal Cancer Prevention OTHER COLITIDES Microscopic Colitis Diversion Colitis Radiation Colopathy Drug-Induced Colitis Suggested Reading 36 - Chronic Ulcerative Colitis: Surgical Options INTRODUCTION EVOLUTION OF SURGERY FOR ULCERATIVE COLITIS INDICATIONS FOR SURGERY IN PERSONS WITH ULCERATIVE COLITIS OPERATIONS FOR ULCERATIVE COLITIS Ileostomy Straight Ileoanal Anastomosis Subtotal Colectomy Abdominal Colectomy with Ileorectal Anastomosis Ileostomy and Blowhole Colostomy Total Proctocolectomy and Ileostomy Proctectomy Surgical Technique Continent Ileostomy Restorative Proctocolectomy Pouch Configuration and Anastomosis Staging the Procedure Technique of Creation of an Ileoanal J Pouch Problems with Reach of the Pouch OUTCOMES OF ILEAL POUCH–ANAL ANASTOMOSIS Complications after Ileal Pouch–Anal Anastomosis Overall Quality of Life Function of the Pouch Pouchitis Pouch Failure Pouch Fistula Risk of Carcinoma Fertility, Sexual Problems, and Obstetric Outcome Extraintestinal Manifestations Quantification of Risk for Pouch Failure after Ileal Pouch Anal Anastomosis Surgery Salvage of the Failed Pelvic Pouch Suggested Reading 37 - Management of Acute Toxic Colitis and Megacolon INTRODUCTION EPIDEMIOLOGY AND ETIOLOGY PATHOPHYSIOLOGY PRESENTATION DIAGNOSIS EVALUATION MEDICAL MANAGEMENT SURGICAL MANAGEMENT Indications for Surgery Surgical Options CONCLUSION Suggested Reading 38 - Pelvic Pouch: Complications and Their Management INTRODUCTION POUCH DYSFUNCTION INTRAOPERATIVE COMPLICATIONS POSTOPERATIVE COMPLICATIONS Pelvis Sepsis and Anastomotic Leak Postoperative Bleeding from the Pouch Pouch-Perineal and Pouch-Vaginal Fistulae Pouch Sinus Leak from the Tip of the “J” Pouch Prolapse Pouchitis and Cuffitis Crohn Disease of the Pouch Outlet Dysfunction Cancer of the Pouch Pouch Failure ABDOMINOPERINEAL APPROACH FOR POUCH SALVAGE Operative Technique Suggested Reading 39 - Pouchitis and Functional Complications of the Pelvic Pouch INTRODUCTION POUCHITIS ETIOLOGY AND PATHOGENESIS Genetic Factors The Microbiome Mucosal Immunity DIAGNOSIS Categories of Pouchitis TREATMENT IRRITABLE POUCH SYNDROME OTHER FUNCTIONAL DISORDERS CONCLUSIONS Suggested Reading 40 - Continent Ileostomy INTRODUCTION EVOLUTION OF THE CONTINENT ILEOSTOMY TECHNIQUES TO BETTER FIX THE VALVE POUCH DESIGN MODIFICATIONS CURRENT INDICATIONS AND CONTRAINDICATIONS CURRENT SURGICAL TECHNIQUE AND STATUS Key Surgical Points Typical Pouch Function COMPLICATIONS OF A CONTINENT ILEOSTOMY Perioperative Complications Early Complications Late Complications Valve Slippage Parastomal Hernia Crohn Disease Pouchitis Valve Stenosis Pouch Excision WHAT TO DO WHEN A PATIENT PRESENTS ACUTELY WITH THE INABILITY TO INTUBATE HIS OR HER POUCH CONCLUSIONS Suggested Reading 41 - Unhealed Perineal Wound INTRODUCTION SPECIAL SITUATIONS LEADING TO AN UNHEALED PERINEAL WOUND CAUSES Technical Factors Patient-Specific Factors Crohn Disease Radiation PREVENTION Preoperative Intraoperative Reconstruction of the Perineum with a Flap DIAGNOSIS/WORKUP NONOPERATIVE TREATMENT OPERATIVE MANAGEMENT SUMMARY Suggested Reading 42 - Medical Management of Crohn Disease INTRODUCTION MEDICAL THERAPIES 5-Aminosalicylates Antibiotics Corticosteroids Immunomodulators Biologic Agents Combination Therapy PERIANAL AND FISTULIZING CROHN DISEASE APPROACH TO MANAGEMENT OF CROHN DISEASE SURGERY POSTOPERATIVE RECURRENCE SMOKING NUTRITION Suggested Reading 43 - Management of Crohn Colitis MEDICAL MANAGEMENT OPERATIVE INDICATIONS PREOPERATIVE CONSIDERATIONS OPERATIVE APPROACH OPERATIVE OPTIONS Disease of the Colon Alone Disease of the Rectum Alone Disease of the Colon and Rectum SPECIAL SITUATIONS Medications Abscess Severe Colitis Growth Retardation Fistula Neoplasia OUTCOME SUMMARY Suggested Reading 44 - Management of Perianal Crohn Disease INTRODUCTION PATHOPHYSIOLOGY OTHER CONSIDERATIONS PRESENTATIONS Anal Sepsis Anal Tags Fissures Stenosis Perianal Skin Irritation Internal Hemorrhoidal Prolapse TREATMENT OF SEPSIS: ABSCESS AND FISTULA RECTO/ANOVAGINAL FISTULA OTHER MANIFESTATION OF PERIANAL CROHN DISEASE SUMMARY Suggested Reading 45 - Cecal Ulcer INTRODUCTION CAUSES DIAGNOSIS MANAGEMENT CONCLUSION Suggested Reading 46 - Pseudomembranous Clostridium Difficile Colitis INTRODUCTION PRESENTATION OF CLOSTRIDIUM DIFFICILE INFECTION DIAGNOSIS MEDICAL MANAGEMENT SURGICAL MANAGEMENT CONCLUSION Suggested Reading 47 - Cytomegalovirus Ileocolitis and Kaposi Sarcoma in HIV/AIDS INTRODUCTION CYTOMEGALOVIRUS COLITIS SURGERY KAPOSI SARCOMA Suggested Reading 48 - Diagnosis and Management of Acute Colonic Diverticulitis INTRODUCTION PRESENTATION DIAGNOSTIC EVALUATION MEDICAL MANAGEMENT SURGICAL MANAGEMENT Surgery Suggested Reading 49 - Surgical Treatment of Diverticulitis and its Complications INTRODUCTION UNDERSTANDING DIVERTICULAR DISEASE AND ITS MANAGEMENT ACUTE UNCOMPLICATED DIVERTICULITIS Who Requires Elective Surgery after Uncomplicated Diverticulitis? COMPLICATED DIVERTICULITIS Acute Diverticulitis Complicated by Abscess Formation: Converting an Emergency Situation into a Semi-Elective Procedure Acute Diverticulitis Complicated by Purulent or Feculent Peritonitis: Surgical Options in the Emergency Setting Hartmann Procedure and Reversal COMPLICATED DIVERTICULITIS WITH FISTULA FORMATION Colovesical Fistulas: Diagnosis and Management Colovaginal Fistulas: Diagnosis and Management Colocutaneous Fistulas: Diagnosis and Management ACUTE COLONIC OBSTRUCTION: PATIENT SELECTION FOR EMERGENT VERSUS SEMI-ELECTIVE OPERATIONS RECURRENT DIVERTICULITIS IN PATIENTS WHO HAVE PREVIOUSLY UNDERGONE RESECTION FOR DIVERTICULAR DISEASE Suggested Reading 50 - Lower Gastrointestinal Hemorrhage INTRODUCTION ETIOLOGY INITIAL EVALUATION AND RESUSCITATION DIAGNOSTIC TESTING Scintigraphy Multidetector Computed Tomography Angiography Colonoscopy SURGERY THE PROBLEM PATIENT: INTERMITTENT RECURRENT GASTROINTESTINAL BLEEDING Suggested Reading 51 - Large Bowel Obstruction INTRODUCTION CLINICAL AND DIAGNOSTIC EVALUATION SURGICAL MANAGEMENT MALIGNANT AND BENIGN OBSTRUCTION Right-Sided Obstruction Left-Sided Obstruction Self-Expanding Metallic Stents COLONIC VOLVULUS SIGMOID VOLVULUS CECAL VOLVULUS Suggested Reading 52 - Colonic Volvulus INTRODUCTION CECAL VOLVULUS Background and Demographics Pathophysiology Signs and Symptoms Diagnostic Imaging Treatment SIGMOID VOLVULUS Background and Demographics Pathophysiology Signs and Symptoms Diagnostic Imaging Treatment TRANSVERSE COLON VOLVULUS Background and Demographics Pathophysiology Diagnostic Imaging Signs and Symptoms Treatment Suggested Readings 53 - Colonic Pseudo-obstruction (Ogilvie Syndrome) INTRODUCTION EPIDEMIOLOGY ETIOLOGY SIGNS AND SYMPTOMS DIAGNOSIS TREATMENT OPTIONS Initial Management Pharmacologic Management Endoscopic Therapy Surgery SUMMARY Suggested Reading 54 - Management of the Malignant Polyp INTRODUCTION BIOLOGY ASSESSMENT OF POLYPS POLYPECTOMY HISTOLOGY MARGIN NODES SURGICAL CONSIDERATIONS COMORBIDITIES SUMMARY Suggested Reading 55 - Colorectal Cancer Screening and Surveillance SCREENING FOR COLORECTAL CANCER Who Should Be Screened? Determining Risk Screening Average-Risk Persons CANCER PREVENTION TESTS Colonoscopy Flexible Sigmoidoscopy Computed Tomographic Colonography CANCER DETECTION TESTS Fecal Occult Blood Tests Stool DNA SCREENING IN PERSONS AT AN ABOVE-AVERAGE RISK FOR COLORECTAL CANCER Surveillance Colonoscopy in Patients with Adenomatous Lesions at Baseline Surveillance Colonoscopy in Patients with Serrated Lesions at Baseline Surveillance Colonoscopy after Piecemeal Polypectomy Surveillance Colonoscopy after Endoscopic Resection of a Malignant Polyp Surveillance Colonoscopy in Patients with Colorectal Cancer Surveillance Colonoscopy in Patients with Inflammatory Bowel Disease Surveillance Colonoscopy in Patients with a Family History of Colorectal Cancer or Adenomatous Polyps WHEN SHOULD SCREENING AND SURVEILLANCE STOP IN THE AVERAGE-RISK POPULATION? CONCLUSION Suggested Readings 56 - Molecular Genetics of Colorectal Cancer INTRODUCTION GROWTH CONTROL DNA REPAIR CLINICAL SIGNIFICANCE COMPLEXITY Suggested Reading 57 - Polyposis Syndromes INTRODUCTION REGISTRIES DEFINITIONS FAMILIAL ADENOMATOUS POLYPOSIS Genetic Testing Genotype/Phenotype Colorectal Cancer in Familial Adenomatous Polyposis Surgical Options for the Large Bowel Extracolonic Manifestations Ampullary Cancer and Duodenal Adenomas Thyroid Cancer Adrenal Masses Brain Tumors Hepatoblastoma Gardner-Type Manifestations Congenital Hypertrophy of the Retinal Pigmented Epithelium Surveillance The IRA The IPAA Oligopolyposis/Attenuated Familial Adenomatous Polyposis MYH-ASSOCIATED POLYPOSIS (MAP) POLYMERASE PROOFREADING–ASSOCIATED POLYPOSIS SERRATED POLYPOSIS HAMARTOMATOUS POLYPOSES Peutz-Jegher Polyposis Juvenile Polyposis PTEN Tumor Hamartoma Syndrome HEREDITARY MIXED POLYPOSIS SYNDROME Suggested Reading 58 - Desmoid Disease INTRODUCTION BIOLOGY EPIDEMIOLOGY GENETICS AND DESMOID RISK DESMOID SEVERITY: A STAGING SYSTEM MANAGEMENT Setting Expectations A Philosophy of Care Extra-abdominal Desmoid Tumors Abdominal Wall Tumors Intra-abdominal Desmoid Disease Workup Medical Treatment Role of Surgery Complications of Desmoid Disease Small Bowel Obstruction Ureteric Obstruction Abscess/Enterocutaneous Fistula Superior Mesenteric Artery Aneurysm Points about Operating on Persons with Desmoid Disease SUMMARY AND GENERAL COMMENTS ABOUT THE EFFECT OF DESMOID DISEASE ON SURGICAL STRATEGY IN FAMILIAL ADENOMATOUS POLYPOSIS Suggested Reading 59 - Hereditary Nonpolyposis Colorectal Cancer and Lynch Syndrome INTRODUCTION HISTORICAL PERSPECTIVE AND CLARIFICATION OF TERMS GENETIC AND MOLECULAR CAUSE OF LYNCH SYNDROME HISTOLOGIC FEATURES OF LYNCH TUMORS DIAGNOSING LYNCH SYNDROME Clinical Criteria Models Tumor Testing GENETIC COUNSELING AND TESTING CLINICAL MANIFESTATIONS AND MANAGEMENT COLORECTAL CANCER RISK MANAGEMENT Surveillance Colonoscopy and Polypectomy Chemoprevention Surgery Colectomy in the Absence of Cancer Treatment of Colon Cancer Rectal Cancer in Persons with Lynch Syndrome RISK MANAGEMENT OF EXTRACOLONIC MANIFESTIONS Endometrial and Ovarian Cancer Upper Gastrointestinal Tract Urinary Tract Skin Neoplasms Other Cancers CLINICAL VARIATIONS OF HNPCC AND LYNCH SYNDROME Familial Colorectal Cancer Type X Likely Lynch Syndrome: Amsterdam Criteria with a Microsatellite Instability High Colorectal Cancer, but Germline Testing Is Not ... Tumor Lynch SUMMARY Suggested Reading 60 - Cancer of the Appendix and Pseudomyxoma Peritonei Syndrome INTRODUCTION PATHOLOGY OF APPENDICEAL MALIGNANT TUMORS Carcinoid Tumors Adenocarcinoid Tumors of the Appendix (Goblet Cell Carcinoid) Epithelial (Noncarcinoid) Tumors of the Appendix Mucinous Adenoma and Adenocarcinoma Nonmucinous Adenocarcinoma DIAGNOSIS OF APPENDICEAL MALIGNANT TUMORS Carcinoid Adenocarcinoma and Mucinous Adenocarcinoma Pseudomyxoma Peritonei Syndrome TREATMENT OF APPENDICEAL TUMORS Carcinoid Tumors Appendiceal Adenocarcinoma Management of Appendiceal Neoplasms with Peritoneal Dissemination Perioperative Chemotherapy Serial Debulking CYTOREDUCTIVE SURGERY AND PERIOPERATIVE CHEMOTHERAPY Survival by Completeness of Cytoreduction Survival by Histologic Assessment Survival by Prior Surgical Score Treatment of Adenocarcinoid Appendiceal Malignancy Morbidity and Mortality Rates Peritonectomy Perioperative Chemotherapy Suggested Reading 61 - Surgical Management of Cancer of the Colon INTRODUCTION EPIDEMIOLOGY Prognostic Factors PREOPERATIVE EVALUATION PREOPERATIVE PREPARATION OPERATIVE PRINCIPLES AND TECHNIQUES Exploration Surgical Treatment of Right Colon Cancer Surgical Treatment of Transverse Colon Cancer Surgical Treatment of Splenic Flexure and Descending Colon Cancer Surgical Treatment of Sigmoid Colon Cancer LAPAROSCOPIC COLECTOMY SPECIAL CONSIDERATIONS Obstruction and Perforation Prophylactic Oophorectomy ASSESSMENT OF QUALITY OF COLECTOMY POSTOPERATIVE SURVEILLANCE SUMMARY Suggested Readings 62 - Management of Metastatic Colorectal Cancer INTRODUCTION CHEMOTHERAPY 5-Fu Capecitabine Irinotecan Oxaliplatin MAINTENANCE CHEMOTHERAPY BIOLOGIC AGENTS FIRST-LINE TARGETED OPTIONS THIRD- AND FOURTH-LINE OPTIONS OLIGOMETASTATIC DISEASE ROLE OF RESECTION OF PRIMARY LESION IMMUNOTHERAPY CONCLUSIONS Suggested Reading 63 - Management of Colorectal Liver Metastasis INTRODUCTION DIAGNOSIS AND PREOPERATIVE WORKUP Imaging Serologic and Molecular Markers Histology Needle Biopsy Multidisciplinary Planning STAGING AND PROGNOSIS PROGNOSTIC SCORES TREATMENT Chemotherapy Neoadjuvant Chemotherapy for Resectable Liver Disease Neoadjuvant Chemotherapy for Unresectable Liver Disease Adjuvant Chemotherapy Hepatic Arterial Infusion Resectability Resectable Liver Disease Synchronous Liver Metastasis Unresectable Liver Disease Repeat Resections for Multiple Liver Metastases Local Ablative Therapy Radiofrequency Ablation Microwave Ablation Cryotherapy Irreversible Electroporation Colorectal Liver Metastases with Extrahepatic Spread Lung Peritoneal Lymph Node Involvement Inferior Vena Cava Recurrence SURVEILLANCE CONCLUSION Suggested Readings 64 - Colorectal Metastases to the Lung INTRODUCTION INDICATIONS FOR RESECTION OF COLORECTAL METASTASES OUTCOMES OF PATIENTS UNDERGOING RESECTION AND PROGNOSTIC FACTORS LUNG AND LIVER METASTASIS SURGICAL APPROACH DEVELOPMENT OF A PROSPECTIVE RANDOMIZED TRIAL: THE PULMONARY METASTASECTOMY IN COLORECTAL CANCER TRIAL CONCLUSION Suggested Reading 65 - Nonepithelial Colorectal Tumors INTRODUCTION BENIGN NONADENOMATOUS LESIONS OF THE COLON AND RECTUM Benign Lymphoid Hyperplasia Lipomas Treatment CAVERNOUS HEMANGIOMA Characteristic Features Treatment Surgery (Laparotomy/Laparoscopic) LEIOMYOMA AND LEIOMYOSARCOMA Characteristic Features Surgery PRIMARY LYMPHOMA OF THE COLON AND RECTUM SUMMARY Suggested Reading 66 - Management of Colonic Ischemia INTRODUCTION ETIOLOGY AND PATHOGENESIS CLASSIFICATION CLINICAL PRESENTATION DIAGNOSIS MANAGEMENT OUTCOME SPECIAL TOPICS Ischemic Colitis after Aortic Surgery Colonic Ischemia after Cardiopulmonary Bypass Ischemic Colitis Associated with Colon Carcinoma and Obstructing Colon Lesions Total Colonic Ischemia Ischemic Proctosigmoiditis CONCLUSION Suggested Readings 67 - Colon and Rectal Trauma INTRODUCTION ETIOLOGY DIAGNOSIS Physical Examination Imaging Diagnostic Peritoneal Lavage Laparoscopy TREATMENT Colon Injuries Damage Control Rectal Injuries Overview Diversion Direct Repair Drainage Distal Washout Rectal Foreign Bodies Suggested Reading 68 - Endometriosis of the Colon and Rectum INTRODUCTION PAIN INFERTILITY DIAGNOSIS Physical Examination Endoscopy Imaging SURGICAL MANAGEMENT Results after Surgical Therapy Combined Medical and Surgical Therapy CONCLUSION Suggested Reading 69 - Pneumatosis Cystoides Intestinalis INTRODUCTION ETIOLOGY CLASSIFICATION HISTOLOGY AND GROSS PATHOLOGY SYMPTOMS DIAGNOSIS TREATMENT Suggested Readings 70 - Constipation INTRODUCTION CAUSES CLASSIFYING CONSTIPATION ASSESSMENT History Physical Examination INVESTIGATIONS TREATMENT Medical Newer Promotility Agents Biofeedback for Pelvic Floor Dyssynergia Change in Position of Defecation Surgery Outlet Obstruction Constipation Suggested Reading 4 - SMALL INTESTINE 71 - Small Bowel Obstruction EXTENT OF THE PROBLEM CLINICAL PRESENTATION IMAGING MRI and Ultrasound MANAGEMENT OF SMALL BOWEL OBSTRUCTION Nonadhesive Obstruction Hernias Crohn Disease Malignancy Intussusception Gallstone Ileus Bariatric Patient Surgical Technique Adhesive Obstruction Hernias Crohn Disease and Other Inflammatory Conditions Malignancy Intussusception Gallstone Ileus The Bariatric Patient Laparoscopic versus Open Lysis of Adhesions Early Postoperative Bowel Obstruction Prevention of Adhesions SUMMARY Suggested Reading 72 - Medical Management of Short Bowel Syndrome INTRODUCTION ANATOMY OF SHORT BOWEL SYNDROME DIETARY MANAGEMENT OF SHORT BOWEL SYNDROME PHARMACOLOGIC TREATMENT OF SHORT BOWEL SYNDROME PARENTERAL AND ENTERAL NUTRITION HORMONAL TREATMENT FOR SHORT BOWEL SYNDROME COMPLICATIONS ASSOCIATED WITH SHORT BOWEL SYNDROME CONCLUSION Suggested Reading 73 - Surgery for Gut Failure: Auto-Reconstruction and Allo-Transplantation INTRODUCTION GUT ADAPTATION MEDICAL MANAGEMENT SURGICAL REHABILITATION Strategy Autologous Reconstruction Intestinal Lengthening INTESTINAL AND MULTIVISCERAL TRANSPLANTATION Types Indications Contraindications Early Referral Transplantation Surgery Postoperative Management Current Global Activities Long-Term Survival Allograft Function Quality of Life New Insights SUMMARY Suggested Reading 74 - Crohn Disease of the Duodenum, Stomach, and Esophagus INTRODUCTION CLINICAL PRESENTATION INVESTIGATIONS IN UPPER GASTROINTESTINAL CROHN DISEASE MEDICAL TREATMENT ENDOSCOPIC TREATMENT SURGERY SUMMARY Suggested Readings 75 - Management of Small Bowel Crohn Disease INTRODUCTION MEDICAL MANAGEMENT INDICATIONS FOR SURGERY PREOPERATIVE CONSIDERATIONS OPERATIVE APPROACH SURGICAL OPTIONS Bypass Resection Strictureplasty SPECIAL SITUATIONS Medications Abscess Free Perforation Hemorrhage Growth Retardation Fistula Neoplasia Obstruction OUTCOME SUMMARY Selected Reading 76 - Small Bowel Neoplasms INTRODUCTION PRESENTATION DIAGNOSIS MANAGEMENT Adenocarcinoma without Metastatic Disease Carcinoid Tumors Lymphomas GIST Tumors CONCLUSION ACKNOWLEDGMENT Suggested Readings 77 - Neuroendocrine Tumors of the Small and Large Intestine DEFINITION INCIDENCE, EPIDEMIOLOGY, AND RESEARCH CLINICAL PRESENTATION DIAGNOSIS CLASSIFICATION SURGICAL TREATMENT Small Intestine Appendix Colon Rectum Locally Advanced and Metastatic Disease Hedinger Syndrome ADJUVANT THERAPY FOLLOW-UP PROGNOSIS Suggested Reading 78 - Enterocutaneous Fistulas INTRODUCTION PATHOGENESIS GENERAL ASPECTS OF CARE COMPLICATIONS PLAN OF CARE Prevention Stabilization Wound Care Nutritional Support Nasogastric Tubes and Other Drainage Tubes Protection of the Gastric, Duodenal, and Upper Gastrointestinal Tract Mucosa from Ulceration Other Supplements Investigation/Elucidation Therapeutic Decisions Will It Close? The Decision to Operate Definitive Therapy Timing of Surgery Surgery Choice of Incision The Operation Itself Anastomosis Abdominal Wound Closure What Type of Operation Should One Undertake? Gastrostomy and Feeding Jejunostomy The Healing Phase Fibrin Glue Short Bowel Syndrome PROGNOSIS Suggested Reading 79 - Acute and Chronic Mesenteric Ischemia INTRODUCTION ACUTE MESENTERIC ISCHEMIA Clinical Presentation Evaluation Treatment SMA Embolus SMA Thrombus Mesenteric Venous Thrombosis Nonocclusive Mesenteric Ischemia Bowel Viability Laparoscopy CHRONIC MESENTERIC ISCHEMIA Presentation Evaluation Operative Treatment Angioplasty CONCLUSION Suggested Readings 80 - Radiation Enteritis and Proctocolitis BACKGROUND PATHOPHYSIOLOGY PREDISPOSING RISK FACTORS GRADING SYSTEMS DIAGNOSTIC WORKUP PREVENTION MANAGEMENT OF RADIATION ENTERITIS Management of Radiation Injury to the Small Bowel Acute Radiation Enteritis Chronic Radiation Enteritis Management of Radiation Injury to the Colon Acute Radiation Colitis Chronic Radiation Colitis Management of Radiation Injury to the Rectum Topical Therapy Hyperbaric Oxygen Medical Therapy Endoscopic Management Surgery CONCLUSION Suggested Readings 5 - COMPLICATIONS (AND OTHER MISCELLANEOUS TOPICS) 81 - Colorectal Surgery in the High-Risk Patient INTRODUCTION IDENTIFICATION OF THE HIGH-RISK PATIENT MINIMIZING RISK ASSOCIATED WITH EMERGENCY SURGERY MINIMIZING RISK ASSOCIATED WITH CARDIAC DISEASE MINIMIZING RISK ASSOCIATED WITH PULMONARY DISEASE MINIMIZING RISK ASSOCIATED WITH IMMUNOSUPPRESSION Steroids Diabetes Chemoradiotherapy MINIMIZING RISK ASSOCIATED WITH MALNUTRITION MINIMIZING RISK ASSOCIATED WITH HEPATIC DISEASE MINIMIZING RISK ASSOCIATED WITH RENAL DISEASE MINIMIZING RISK IN MORBIDLY OBESE PATIENTS Suggested Reading 82 - Reoperative Pelvic Surgery INTRODUCTION ANATOMIC FACTORS The Ureters Presacral Veins Pelvic Nerves POSTOPERATIVE CHANGES IN THE PELVIS Approach to Reoperative Pelvic Surgery Preoperative Planning Timing Patient Preparation Define the Anatomy Anticipate and Prepare for a Difficult Case Functional Considerations Intraoperative Conduct Patient Positioning Optimizing Visibility and Exposure Access to the Pelvis Identification of Specific Pelvic Structures Ureter Bladder Rectal Stump Vagina Autonomic Nerves Control of Bleeding Drainage SPECIFIC CLINICAL SITUATIONS Reversal of Hartmann Procedure for Diverticulitis Recurrent Rectal Cancer Redo Ileoanal Pelvic Pouch Procedure SUMMARY Suggested Reading 83 - Nutritional Support in Colorectal Surgery INTRODUCTION NUTRITIONAL ASSESSMENT INDICATIONS FOR NUTRITIONAL SUPPORT General Indications Severe Malnutrition Postoperative Nutrition Specific CRS Indications Inflammatory Bowel Disease Colorectal Cancer ESTIMATION OF NUTRIENT REQUIREMENTS Calories Protein DIETARY COMPOSITION AND DELIVERY Hospital-Based Diets Clear Liquid Diet Regular Diet Low-Residue Diet Oral Supplements Liquid Formula Diets Enteral Nutrition Access for EN Early Postoperative Feeding: “Fast Track” Parenteral Nutrition Access for PN Concomitant EN and PN Overfeeding NEW DIRECTIONS Immunonutrition Preoperative Carbohydrate Loading SUMMARY Suggested Reading 84 - Prevention and Management of Sepsis BACKGROUND PREVENTION Defining Risk Preventive Measures Bowel Preparation Prophylactic Antibiotics Intact Anastomosis Tension-Free Anastomosis Well-Vascularized Anastomosis Consideration for Diversion Appropriate Use of Drains MANAGEMENT OF INTRA-ABDOMINAL SEPSIS Goal-Directed Hemodynamic Support Evaluation Nonoperative Interventions Operation versus Observation Open Abdomen Return to the Operating Room Suggested Readings 85 - Management of Anastomotic Leak INTRODUCTION WHAT DEFINES A LEAK? PRINCIPLES OF MANAGEMENT EARLY DIAGNOSIS IMAGING CRP LEVELS ENDOSCOPY VARIABLES DIRECTING MANAGEMENT Location: Intraperitoneal versus Extraperitoneal Type of Anastomosis: Ileocolic versus Colorectal/Ileorectal Symptoms: Sepsis versus Symptomatic versus Asymptomatic Previously Diverted: Proximal Diverting Ostomy versus Nondiverted LEAK MANAGEMENT TOOLS ENDO-VACUUM ASSISTED CLOSURE ENDOSCOPIC STENTS, CLIPS, AND GLUE TRANSANAL REPAIR TECHNIQUES TURNBULL-CUTAIT PULL THROUGH SUMMARY Suggested Reading 86 - Complications of Colonoscopy INTRODUCTION RISK MANAGEMENT HEMORRHAGE Steps Prior to Colonoscopy Risk Factors for Bleeding Prevention of Bleeding Treatment of Bleeding PERFORATION Causes of Perforation Diagnosis of Perforation Management of Perforation Suggested Readings 87 - Management of Hemorrhage during Pelvic Surgery INTRODUCTION PERTINENT ANATOMY BLEEDING TACTICS FOR CONTROL OF PELVIC BLEEDING Major Vessel Bleeding Iliac Vessels Minor Vessel Bleeding Presacral Bleeding Pelvic Packing Suture Ligation Thumbtacks Muscle Fragment Welding Bipolar Electrocautery Hemostasis Step-by-Step Technique Hemostatic Agents Mechanical Hemostatic Agents Active Hemostatic Agents Flowable Hemostatic Agents Fibrin Sealants CONCLUSION Selected Reading 88 - Urologic Issues in Colorectal Surgery INTRODUCTION INFECTION URETER BLADDER URETHRA REPRODUCTIVE STRUCTURES NERVES BLOOD VESSELS Suggested Readings 89 - Prevention and Treatment of Complications of Laparoscopic Colorectal Surgery INTRODUCTION GENERAL COMPLICATIONS Contraindications Peritoneal Access Complications Pneumoperitoneum Complications Thromboembolic Complications Electrosurgical Complications Positioning Complications Bleeding Complications Tumor Identification Difficulties Contamination Anastomosis Complications Urologic Complications CONCLUSIONS Suggested Reading 90 - Prevention and Management of Ostomy Complications INTRODUCTION OSTOMY CREATION Preoperative Discussion and Consent Siting the Stoma Creating and Maturing the Stoma End Ileostomy Loop Ileostomy COMPLICATIONS Early Complications Appliance Issues/Skin Irritation Ischemia Stoma Stenosis Retraction Late Complications Parastomal Hernia Prolapse Stricture Peristomal Pyoderma Parastomal Ulcer Abscess and Fistula SUMMARY Suggested Reading 91 - Stoma and Wound Considerations: Nursing Management PREOPERATIVE PREPARATION Preoperative Counseling Stoma Site Marking POSTOPERATIVE MANAGEMENT SPECIAL CONSIDERATIONS Continent ileostomy WOUND MANAGEMENT POSTDISCHARGE FOLLOW-UP COLOSTOMY IRRIGATION ILEOSTOMY LAVAGE CONCLUSION Suggested Readings 92 - Measuring Outcomes INTRODUCTION TYPES OF OUTCOME MEASURES Structural Measures Process Measures Outcome Measures Person-Centered Outcomes MEASURING QUALITY OF LIFE Instruments for Assessing Quality of Life Colorectal Cancer Care Inflammatory Bowel Disease Fecal Incontinence Sexual Function CONSIDERATIONS IN CHOOSING OUTCOME MEASURES SUMMARY Suggested Readings 93 - Medical Documentation and Coding for the Colorectal Surgeon INTRODUCTION PROCESS OF CPT CODE DEVELOPMENT CPT CODING FOR EVALUATION AND MANAGEMENT SERVICES Office Evaluation and Management Coding HOSPITAL-BASED EVALUATION AND MANAGEMENT DOCUMENTATION AND CODING CPT CODING FOR SURGICAL PROCEDURES SUMMARY Suggested Reading 94 - Enhanced Recovery Pathways After Colorectal Surgery BACKGROUND COMPONENTS OF EVIDENCE-BASED CARE EVIDENCE FOR IMPROVED OUTCOME Colonic Surgery Rectal Surgery Other Colorectal Procedures IMPLEMENTATION STRATEGY AND TREATMENT ALGORITHM Colonic Surgery Protocol Rectal Surgery Protocol THE WAY FORWARD Suggested Readings 95 - Managing Complex Ventral/Parastomal Hernias in Colorectal Surgical Patients INTRODUCTION PERMANENT ENTEROSTOMY—PARASTOMAL HERNIA REPAIR Open Repair Laparoscopic Repair TEMPORARY ENTEROSTOMY PROSTHETIC CHOICE HERNIA REPAIR IN INFLAMMATORY BOWEL DISEASE CONCLUSION Selected Reading Index A B C D E F G H I J K L M N O P Q R S T U V W Z IBC