Chapter
Blood Supply of the Colon and Rectum
Venous System and Lymphatic Drainages
Water and Electrolyte Absorption
Products of Bacterial Metabolism
Control of Intestinal Motility
External Inspection and Digital Rectal Examination
Rigid Proctosigmoidoscopy
Computed Tomographic Colography
Water-Soluble Contrast Media Studies
Fecal Immunochemical Test
Tests for Enteritis and Sexually Transmitted Diseases
Evaluation of Small Intestine
Magnetic Resonance Imaging
Positron Emission Tomography
Cinedefecography and Pelvic Magnetic Resonance Imaging
Pudendal Nerve Terminal Motor Latency and Electromyography
Endosonography of Normal Anal Canal
Endosonography of the Normal Rectum
Serologic Biomarkers for Inflammatory Bowel Disease
3 Preoperative Management
Overall Preoperative Management Issues
Routine Preoperative Testing
Continuing or Holding Medications
Preoperative Management of Patients with Known Diseases
Patients With Cardiac Disease
Special Considerations in Patients With Cardiac Disease
Patients With Coronary Stents
Patients With Automatic Implanted Cardioverter Defibrillator or Pacemaker
Patients With Pulmonary Hypertension
Patients With Pulmonary Disease
Patients With Liver Disease
Patients With Hypertension
Patients With Sleep Apnea
Patients on Antithrombotic Medications
Prophylaxis Against Common Problems
Surgical Site Infection Prophylaxis
Venous Thromboembolism Prophylaxis
Nausea and/or Vomiting and Ileus Prophylaxis
4 Postoperative Management
Gastrointestinal Tract Function and Enteral Feeding
Deep Vein Thrombosis Prophylaxis
Pain Management after Colorectal Surgery
Patient-Controlled Analgesia
Postoperative Epidural Analgesia
Nonsteroidal Anti-inflammatory Drugs
Postoperative Management of Preoperative Medications
Immediate Recovery and Anesthetic Technique
Fluids and Urinary Retention
Restoration of Normal Bowel Function
Postoperative Clinical Pathways
5 General Postoperative Complications and How to Prevent Them
Postoperative Care and Factors
Wound and Fascial Dehiscence
Surgeon Controlled Factors in the Operating Room
Deep Vein Thrombosis and Pulmonary Embolism
Surgeon Controlled Factors in the Operating Room
Surgeon Controlled Factors in the Operating Room
Postoperative Care and Factors
Differential Diagnosis and Diagnosis
Excisional Hemorrhoidectomy
Techniques of Historical Relevance
Thrombosed External Hemorrhoids
Immune Compromised Patients
Inflammatory Bowel Disease
Anorectal Varices From Portal Hypertension
Management of Hemorrhoids in the Anticoagulated Patient
Hemorrhoids and Radiation Proctitis
Presentation and Diagnosis
Treatment—Nonoperative Therapy
Oral and Topical Sphincter Relaxants
Botulinum Toxin Injection
Anatomic Considerations and Etiology
Presentation and Examination
Anatomic Considerations and Etiology
Presentation and Examination
9 Complex Colorectal Fistulas
Presentation and Diagnosis
Treatment—Nonoperative Therapy
Presentation and Diagnosis
Treatment—Nonoperative Therapy
Presentation and Diagnosis
Treatment—Nonoperative Therapy
Presentation and Diagnosis
Treatment—Nonoperative Therapy
Fibrin Glue and Anal Fistula Plug
Tissue Interposition Procedures
Transabdominal Operations
Presentation and Diagnosis
Treatment—Nonoperative Therapy
Presentation and Diagnosis
Treatment—Nonoperative Therapy
Transabdominal Approaches
10 Pilonidal Disease and Hidradenitis Suppurativa
Complex Pilonidal Disease
Pilonidal Disease and Carcinoma
Hidradenitis Suppurativa and Carcinoma
11 Anogenital Condyloma and Other Sexually Transmitted Diseases
Approach to the Patient with a Presumed Sexually Transmitted Disease
Chlamydia and Lymphogranuloma Venereum
Granuloma Inguinale (Donovanosis)
Human Papilloma Virus, Anal Intraepithelial Neoplasia, Anal Dysplasia, and Anal Cancer
Buschke-Löwenstein Tumor: Giant Anal Condyloma
III Colorectal Malignancy
12 Screening for Colorectal Cancer
Computed Tomography Colonography
Polyp Detection and Management
High-Magnification Chromoendoscopy
Computed Tomographic Colonography
Polyposis and Other Syndromes
Familial Adenomatous Polyposis
Upper Gastrointestinal Polyps
Other Extraintestinal Lesions
Attenuated Familial Adenomatous Polyposis
Hereditary Nonpolyposis Colon Cancer
Hamartomas and Hamartomatous Polyposes
Cronkhite-Canada Syndrome
Ruvalcaba-Myhre-Smith Syndrome
14 Colon Cancer Evaluation and Staging
Staging and Prognostic Factors
Clinical Prognostic Factors
Histologic, Biochemical, and Genetic Factors
Microsatellite Instability
Lymphovascular Invasion/Perineural Invasion
Sentinel Lymph Node Biopsy
Practice Parameters for Detection of Colorectal Neoplasms as Defined by the Standards Committee, the American Society of Colon and Rectal Surgeons*
Moderate Risk Individuals
Inflammatory Bowel Disease
15 Surgical Management of Colon Cancer
Antimicrobial Prophylaxis
General Principles of Resection
Specific Management Situations
Synchronous Tumors or Polyposis Syndromes
Prophylactic Oophorectomy
Concurrent Management of Colon Cancer and Liver Metastases
Laparoscopy in Colon Cancer
Prognosis After Colectomy for Colon Cancer
16 Management of Rectal Cancer
Anatomy, Physical Examination, and Rigid Sigmoidoscopy
Discussion With the Patient
Magnetic Resonance Imaging
Positron Emission Scanning
Neoadjuvant Chemotherapy and Radiation
Preoperative Versus Postoperative Adjuvant Therapy in Rectal Cancer
Local and Regional Disease
Transanal Endoscopic Microsurgery
Need for Postoperative Chemotherapy
Adjuvant Therapy for Colon Cancer
Overview of Chemotherapeutic Agents
Leucovorin (Folinic Acid)
Common Combination Regimens
Recommendations for Adjuvant Therapy by Colon Cancer Stage
Adjuvant Therapy for Rectal Cancer
Colorectal Cancer Surveillance
Rationale for Postoperative Surveillance
History and Physical Examination
Surveillance Schedules: Is Intensive Follow-Up Beneficial?
Current Surveillance Guidelines
18 Treatment of Metastatic or Recurrent Colorectal Cancer
Natural History of Disease
Epidemiology and Risk Factors
High-Grade Squamous Intraepithelial Lesion or Bowen Disease
Invasive Squamous Cell Carcinoma of the Anal Margin
Squamous Cell Carcinoma of the Anal Canal
Follow-Up Evaluation and Outcomes
Uncommon Anal Canal Neoplasms
Gastrointestinal Stromal Tumors
Small Cell Carcinoma/Neuroendocrine Tumors
20 Miscellaneous Neoplasms
Clinical Presentation and Diagnosis
Gastrointestinal Stromal Tumors
Gastrointestinal Lymphoma
Colorectal and Anal Complications of Leukemia
IV Infl ammatory Conditions
21 Inflammatory Bowel Disease
Epidemiology of Inflammatory Bowel Disease
Pathogenesis of Inflammatory Bowel Disease
Inflammatory Bowel Disease Genetics
Clinical History and Presentation
Medical Management of Inflammatory Bowel Disease
Mild to Moderate Ulcerative Colitis
Mild to Moderate Crohn Disease
Moderate to Severe Ulcerative Colitis and Crohn Disease
Moderate to Severe Crohn Disease: Induction and Maintenance With Anti-Tumor Necrosis Factors
Moderate to Severe Crohn Disease: Anti-Integrin Agents
Severe and Fulminant Ulcerative Colitis
Maintenance of Remission in Ulcerative Colitis and Crohn Disease
Anti-Tumor Necrosis Factor Therapy
Diagnostic Considerations in Treatment Failures
Inflammatory Bowel Disease Surgery: The Medical Perspective
Postoperative Recurrence of Crohn Disease
22 Surgical Management of Ulcerative Colitis
Ileal Pouch Anal Anastomosis
Biologics and Ileal Pouch Anal Anastomosis
23 Surgery for Crohn Disease
Extraintestinal Manifestations
Disease Locations and Specific Operative Management
Upper Gastrointestinal Disease
Prophylaxis against Recurrent Disease
Pathophysiology of Diverticulitis
Acute Uncomplicated Diverticulitis
Recurrent Uncomplicated Diverticulitis
Acute Complicated Diverticulitis: Perforation and Abscess
Chronic Complicated Diverticulitis: Stricture and Fistula
Common Complications of Operation
Uncommon Complications of Operation
25 Lower Gastrointestinal Hemorrhage
Anoscopy and Rigid Sigmoidoscopy
Computed Tomographic Angiography
Obscure Gastrointestinal Bleeding
Intraoperative Enteroscopy
26 Radiation, Ischemic, and Infectious Colitides
Radiation Therapy and Bowel Injury
Clinical Aspects of Toxicity from Radiotherapy
Treatment of Radiation Proctitis
Patient-Administered Topical Therapy
Physician-Delivered Topical Therapy: Formalin
Hyperbaric Oxygen Therapy
Treatment of Other Chronic Radiation Complications
Conclusions on Radiation Therapy
Vascular Anatomy of the Colon
Special Circumstances: Vascular Surgery Patients
Conclusions on Ischemic Colitis
Clostridium difficile Toxin
Antidiarrheals and Symptomatic Therapy
Empiric Antibiotic Therapy
Enterohemorrhagic Escherichia coli
Enterotoxigenic Escherichia coli
Clostridium difficile Antibiotic-Associated Enterocolitis
Conclusions on Infectious Colitis
27 Large and Small Bowel Obstruction
Presentation, Diagnosis, and Initial Treatment
Nonoperative Treatment: Adhesive Small Bowel Obstruction
Bowel Obstruction after Previous Laparoscopic Surgery
Other Treatment Considerations
Operative Technical Points
Early Postoperative Bowel Obstruction
Prevention of Adhesion Formation
Prevention of Hernia Formation
Colonic Pseudo-obstruction (Ogilvie Syndrome)
28 Intestinal Stomas and Their Complications
Preoperative Counseling and Stoma Sitting
29 Incontinence and Rectocele
Normal Mechanism of Continence
Etiologies of Incontinence
Anterior Overlapping Sphincteroplasty
Artificial Bowel Sphincter
Obstetric Sphincter Injury
Fecal Incontinence in Men
Biologic Material and Mesh Implants
Perineal Proctosigmoidectomy (Altemeier Procedure)
Mucosal Proctosigmoidectomy (Delorme Procedure)
Recurrent Rectal Prolapse
31 Pruritus Ani and Other Perianal Dermatoses
32 Colon and Rectal Trauma
Diagnostic Peritoneal Lavage
Primary Repair Versus Fecal Diversion
Resection and Damage Control Laparotomy
Stapled Versus Hand-Sewn Anastomosis
Foreign Bodies of the Rectum
Role of the Preoperative Biopsy
Combined Abdominal and Posterior Approach
Colorectal Surgery
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