Clinical decision making in colorectal surgery.

Foreword
Preface
	Second Edition Clinical Decision Making
Acknowledgments
Contents
Editors and Contributors
Editors
Contributors
Part I: Evaluation and Perioperative
	1: Anorectal Examination
		Refer to Algorithm in Fig. 1.1
		Conclusion
		Suggested Reading
	2: Anorectal and Colonic Evaluation
		Refer to Algorithm in Fig. 2.1
		Suggested Reading
	3: Physiologic Testing
		Refer to Algorithm in Fig. 3.1
		Refer to Algorithm in Fig. 3.3
		Suggested Reading
	4: Mechanical Bowel Preparation for Elective Colon and Rectal Surgery
		Refer to Algorithm in Fig. 4.1
		Single Center Studies
		Special Considerations
			Localization of Small Lesions
			Low Rectal or Coloanal Anastomosis
			Laparoscopic Colon and Rectal Surgery
			Technical Aspects and Spillage Control
			Bowel Preparation with Oral Antibiotics Alone
			Clostridium difficile Infection
			Risk of Cancer Recurrence
		Meta-analyses of Randomized Controlled Studies
		Multi-center Studies
		Suggested Reading
	5: Perioperative Assessment and Risk Stratification
		Refer to Algorithm in  Fig. 5.1
		Summary
		Suggested Reading
	6: Enhanced Recovery Pathways in Colorectal Surgery
		Introduction
		A. Preoperative Management
			Refer to Algorithm in Fig. 6.1
				Patient Education and Engagement
				Evaluation, Optimization, Nutrition and Prehabilitation
				Mechanical Bowel Preparation and Oral Antibiotics
				Reduction of Pre-operative Fasting and Carbohydrate Loading
		B. Intraoperative Care
			Minimally Invasive Colorectal Surgery
			Intraoperative Fluid Administration
			Analgesia
			Venous Thromboembolism Prophylaxis
			Surgical Site Infection Prevention
			Role of Anesthesia
			Avoiding Unnecessary Tubes, Drains, and Lines
		C. Postoperative Recovery
			Postoperative Analgesia
			Intravenous Fluid Management
			Early Oral Feeding
			Early Ambulation
			Postoperative Ileus: Prevention and Treatment
			Discharge Planning, Follow-Up, and Coordination of Care
		D. Quality Pathway Evaluation Measures
		Conclusion
		Suggested Reading
	7: Hematochezia and Melena
		Refer to Algorithm in Fig. 7.1
			Types and Assessment (Table 7.1)
		Refer to Algorithm in Fig. 7.2
			Melena Caused by Upper Gastrointestinal Bleeding
		Refer to Table 7.3
			Hematochezia Caused by Anorectal Bleeding
		Refer to Fig. 7.2
			Severe Hematochezia Causing Hemodynamic Instability
		Suggested Reading
	8: Anal Disease in the Neutropenic Patient
		Refer to Algorithm in Fig. 8.1
		Suggested Reading
	9: Evaluation and Perioperative: Anal Mass
		Refer to Algorithm in Fig. 9.1
		Suggested Reading
Part II: Anal Conditions
	10: Anal Conditions: Anal Fissure/Recurrent Anal Fissure
		Refer to Algorithm in Fig. 10.1
		Suggested Reading
	11: Anal Conditions: Anal Stenosis and Stricture
		Refer to Algorithm in  Fig. 11.1
		Suggested Reading
	12: Anorectal Abscess
		Refer to Algorithm in Fig. 12.1
		Suggested Reading
	13: Anal Conditions: Fistula-in-Ano
		Refer to Algorithm in Fig. 13.1
		Suggested Reading
	14: Anal Conditions: Rectovaginal Fistula
		Refer to Algorithm in Fig. 14.1
			Background
		Etiology
		Evaluation
			A. In Office Evaluation
			B. Imaging
			C. Examination Under Anesthesia
		Treatment
			D. Initial Treatment
			E. Choosing the Surgical Repair
			F. Fistulotomy
			G. Tissue Advancement Flaps
			H. Episioproctotomy
			I. Anoplasty
			J. Rectal Sleeve Advancement Flap
		Ileoanal Pouch-Vaginal Fistulas
		Vaginal Approaches
			K. Tissue Interposition
			L. Redo Colo-anal Anastomosis, Immediate and Delayed
		Conclusion
		Suggested Reading
	15: Anal Conditions: Anorectal Crohn’s Disease—Fistula
		Introduction
		Refer to Algorithm in  Fig. 15.1
		Conclusion
		Suggested Reading
	16: Anorectal Crohn’s Disease: Anal Stenosis and Anal Fissure
		Refer to Algorithm in Fig. 16.1
		Refer to Algorithm in Fig. 16.3
		Suggested Reading
	17: Management of Internal Hemorrhoids
		Refer to Algorithm in Fig. 17.1
		Suggested Reading
	18: Anal Conditions: External Hemorrhoids
		Introduction
		Refer to Algorithm in Fig. 18.1
		Refer to Algorithm in Fig. 18.2
		Refer to Algorithm in Fig. 18.4
		Suggested Reading
	19: Anal Conditions: Pilonidal Disease/Complex and Recurrent Pilonidal Disease
		Refer to Algorithm in Fig. 19.1
			A. History and Presentation
			B. Physical Examination
			C. Incision and Drainage Only
			D. Hair Removal
			E. Phenol Injection
			F. Excision and Primary Repair
			G. Excision and Healing by Secondary Intention
			H. Flap-Based Procedures
		Suggested Reading
	20: Anal Conditions: Pruritus Ani
		Refer to Algorithm in Fig. 20.1
		Suggested Reading
	21: Anal Conditions: Hidradenitis Suppurativa
		Refer to Algorithm in Fig. 21.1
		Suggested Reading
	22: Anal Conditions: Anorectal Trauma
		Refer to Algorithm in Fig. 22.1
		Suggested Reading
	23: Anal Conditions: STDs
		Refer to Algorithm in Fig. 23.1
			Anal Conditions: Sexually Transmitted Diseases
		Suggested Reading
	24: Anal Considerations: Fournier’s Gangrene
		Refer to Algorithm in Fig. 24.1
		Suggested Reading
	25: Non-healing Perineal Wounds
		Refer to Algorithm in Fig. 25.1
		Suggested Reading
	26: Anal Intraepithelial Neoplasms
		Refer to Algorithm in Fig. 26.1
		Diagnoses
		Suggested Reading
	27: Anal Conditions: Anal Margin Tumors
		Refer to Algorithm in Fig. 27.1
		Suggested Reading
	28: Invasive Anal Canal Neoplasia
		Refer to Algorithm in Fig. 28.1
		Suggested Reading
Part III: Pelvic Floor
	29: Pelvic Floor Conditions: Rectal Prolapse/Recurrence
		Refer to Algorithm in Fig. 29.1
		Suggested Reading
	30: Pelvic Floor Conditions: Rectal Intussusception
		Refer to Algorithm in Fig. 30.1
		Suggested Reading
	31: Pelvic Outlet Obstruction
		Refer to Algorithm in Fig. 31.1
		Suggested Reading
	32: Pelvic Floor Conditions: Biofeedback
		Refer to Algorithm in Fig. 32.1
			Background
		Pelvic Floor Dysfunction
		Biofeedback Therapy
		Suggested Reading
	33: Pelvic Floor Conditions: Fecal Incontinence
		Refer to Algorithm in Fig. 33.1
			A. History and Physical: Etiology, Severity, and Comorbidities
			B. Optimization of Diet and Medical Management
				Dietary Modifications
				Fiber Supplementation
				Medications
				Biofeedback
			C. Treat Anatomic Etiology (When Possible)
			D. Suspected Recent Sphincter Injury
			F. Sphincteroplasty
				End-to-End Sphincteroplasty
				Overlapping Sphincteroplasty: Figs. 33.2, 33.3, and 33.4
			G. Sacral Nerve Stimulation (SNS)—See Figs. 33.5 and 33.6
				Tibial Nerve Stimulation
			H. Sphincter Replacement
				Graciloplasty
				Gluteoplasty
				Artificial Bowel Sphincter (ABS)/Magnetic Anal Sphincter (MAS)
			J. Ostomy
		∗Other Therapies
			Injectables
			RF Remodeling
		Conclusion
		Suggested Reading
	34: Pelvic Floor Conditions: Diarrhea
		Refer to Algorithm in Fig. 34.1
		Refer to Algorithm in Fig. 34.3
		Suggested Reading
	35: Chronic Constipation
		Introduction
		Refer to Algorithm in Fig. 35.1
			Diagnosis
			Management
		Suggested Reading
Part IV: Rectal
	36: Retrorectal Tumors
		Refer to Algorithm in Fig. 36.1
		Evaluation
		Risk Assessment
			Pathology: Four Tissue Types
		Treatment
		Suggested Reading
	37: Rectal Cancer: Local Therapy
		Refer to Algorithm in Fig. 37.1
		Local Excision Techniques (Refer to Table 37.2)
		Anatomical Considerations in Selecting Method of Local Excision (Refer to Table 37.2)
		Suggested Reading
	38: Rectal Conditions: Rectal Cancer—Proctectomy
		Refer to Algorithm in Fig. 38.1
		Suggested Reading
	39: Rectal Conditions: Rectal Cancer—Adjuvant and Neoadjuvant Therapy
		Refer to Algorithm in Fig. 39.1
		Suggested Reading
	40: Rectal Conditions: Stage IV Rectal Cancer
		Introduction
		Refer to Algorithm in Fig. 40.1
		Suggested Reading
	41: Rectal Cancer: Watch and Wait
		Refer to Algorithm in Fig. 41.1
		Suggested Reading
	42: Rectal Conditions: Rectal Cancer—Postoperative Surveillance
		Refer to Algorithm in Fig. 42.1
		Suggested Reading
	43: Recurrent Rectal Cancer
		Introduction
		Risk Factors Associated with Local Recurrence
		Refer to Algorithm in Fig. 43.2
			Follow-up and Initial Assessment
		A–C.
		D. Local Recurrence (See Fig. 43.2)
			Classification of Local Recurrence
		E. Evaluation and Planning
		F. Surgical Treatment
		G. Radio-Chemotherapy
			Carbon-Ion Radiation (CIRT)
		H. Distant Recurrence (See Fig. 43.2 and Chap. 40)
		Conclusion
		Suggested Reading
	44: Locally Advanced Rectal Cancer
		Refer to Algorithm in Fig. 44.1
		Suggested Reading
Part V: Colonic
	45: Colonic: Diverticulitis
		Refer to Algorithm in Fig. 45.1
		Suggested Reading
	46: Colonic Conditions: Large Bowel Obstruction
		Refer to Algorithm in Fig. 46.1
		Suggested Reading
	47: Colonic Conditions: Volvulus
		Refer to Algorithm in Fig. 47.1
			Introduction
		Suggested Reading
	48: Colonic Stricture
		Refer to Algorithm in Fig. 48.1
		Suggested Reading
	49: Acute Colonic Pseudo-Obstruction (ACPO): Ogilvie’s Syndrome
		Refer to Algorithm in Fig. 49.1
		Suggested Reading
	50: Colonic Conditions: Irritable Bowel Syndrome (IBS)
		Introduction
		Refer to Algorithm in Fig. 50.1
		Suggested Reading
	51: Colorectal Trauma
		Colon Trauma Refer to Algorithm in Fig. 51.1
		Rectal Trauma Refer to Algorithm in Fig. 51.3
		Suggested Reading
	52: Endometriosis
		Refer to Algorithm in Fig. 52.1
		Suggested Reading
	53: Colonic Conditions: Ulcerative Colitis
		Refer to Algorithm in Fig. 53.1
		Conclusions
		Suggested Reading
	54: Colonic Conditions: Indeterminate Colitis
		See Algorithm in Fig. 54.1
		Suggested Reading
	55: Colonic Conditions: Toxic Colitis
		Refer to Algorithm in Fig. 55.1
			Medical Management
			Risk Assessment
			Surgical Management
		Suggested Reading
	56: Crohn’s Colitis
		Refer to Algorithms in Figs. 56.1 and 56.2
		Suggested Reading
	57: Ischemic Colitis
		Refer to Algorithm in Fig. 57.1
		Suggested Reading
	58: Colonic Conditions: Infectious Colitis
		See Algorithm in Fig. 58.1
		See Algorithm in Fig. 58.2
		See Algorithm in Fig. 58.3
		Suggested Reading
	59: Colonic Conditions: Benign Colonic Neoplasia
		Refer to Algorithm in Fig. 59.1
		Suggested Reading
	60: Familial Adenomatous Polyposis
		Refer to Algorithm in Fig. 60.1
		Suggested Reading
	61: Colonic Conditions: Lynch Syndrome
		Definitions and Classification of Terms
		Refer to Algorithm in Fig. 61.1
			Presentation and Clinical Situations
			Suspected Lynch Syndrome
			Management of Lynch Syndrome
			Lynch Syndrome Diagnosis Without Clinical Symptoms or Phenotype
		Suggested Reading
	62: Malignant Colon Polyps
		Refer to Algorithm in Fig. 62.1
		Suggested Reading
	63: Colonic Conditions: Adenomatous Polyps
		Refer to Algorithm in Fig. 63.1
		Suggested Reading
	64: Colon Cancer Surgical Therapy
		Refer to Algorithm in Fig. 64.1
		Suggested Reading
	65: Colonic Conditions: Locally Advanced Colon Cancer
		Refer to Algorithm in Fig. 65.1
		Conclusion
		Suggested Reading
	66: Recurrent Colon Cancer
		Refer to Algorithm in Fig. 66.1
		Suggested Reading
	67: Appendiceal Neoplasms
		Refer to Algorithm in Fig. 67.1
		Suggested Reading
Part VI: Small Bowel
	68: Small Bowel Conditions: Small Bowel Crohn’s Disease
		Refer to Algorithm in Fig. 68.1
		Refer to Algorithm in Fig. 68.2
		Refer to Algorithm in Fig. 68.3
		Suggested Reading
	69: Small Bowel Desmoid Disease
		Refer to Algorithm in Fig. 69.1
		Suggested Reading
	70: Mesenteric Ischemia
		Refer to Algorithm in Fig. 70.1
		Conclusion
		Suggested Reading
	71: Small Bowel Conditions: Small Bowel Obstruction
		Refer to Algorithm in Fig. 71.1
		Suggested Reading
	72: Small Bowel Conditions: Radiation-Induced Small Bowel Disease (RISBD): Radiation Enteritis
		Mechanism of Radiation Injury
			Acute Intestinal Injury in Fig. 72.1
				Epithelial Cell Injury
			Chronic Intestinal Injury (Fig. 72.2)
			Clinical Risk Factors That Increase the Radiation-Induced Intestinal Toxicity: 74-Table 72.1
		Prevention/Reduction of Radiation-Induced Small Bowel Disease
			Radiation Therapy (Table 72.2)
				Radiotherapy Techniques
			Brachytherapy
			Stereotactic Radiation Therapy
			Proton Beam Radiotherapy
			Medical Therapy: Prevention/Reduction of Radiation-Induced Small Bowel Disease (Table 72.3)
		Radioprotectors
			Probiotics
			Prebiotics (Inulin and Fructo-oligosaccharide)
			Amifostine (Ethyol)
			Sucralfate (Aluminum Sucrose Octasulfate)
		Mitigators/Treatment Agents
			Sulfasalazine (5-Aminosalicylic Acid)
			Oral Glutamine
			Cholestyramine
			Pentoxifylline and Tocopherol
			Summary
		Experimental Studies in Animals
			Budesonide (16,17α-Butylidene Dioxy-11β, 21-Dihydroxy-1, 4-Pregnadiene-3, 20-Dione)
			Coniferyl Aldehyde (CA)
			Alpha-Lipoic Acid (ALA)
			Mesenchymal Stems Cells
			Surgical Techniques for Prevention of Radiation-Induced Small Bowl Disease (Table 72.4)
		Refer to Algorithm in Fig. 72.3 Treatment of Radiation-Induced Small Bowel Disease
			Acute Injury
		Surgical Therapy of Chronic Radiation-Induced Small Bowel Disease
			Surgical Procedures: Resection vs. Intestinal By-Pass
			Preoperative Surgical Risk Factors
			Refer to Algorithm in Fig. 72.4 Algorithm of Surgical Therapy Chronic Radiation-Induced Small Bowel Disease (Chronic RISBD): Emergency Procedures
				Small Bowel Hemorrhage
			Perforation
			Refer to Algorithm in Fig. 72.5 Surgical Therapy for Chronic Radiation-Induced Small Bowel Disease (Chronic RISBD): Small Bowel Obstruction
			Refer to Algorithm in Fig. 72.6 Surgical Therapy for Chronic Radiation-Induced Small Bowel Disease: Enterocutaneous Fistula (C)
		Summary Points
		Suggested Reading
	73: Enterocutaneous and Enteroatmospheric Fistula
		Refer to Algorithm in Fig. 73.1
		Suggested Reading
	74: Small Bowel Polyps
		Refer to Algorithm in Fig. 74.1
		Suggested Reading
	75: Small Bowel Lymphoma
		Refer to Algorithm in Fig. 75.1
		Suggested Reading
	76: Small Bowel Conditions: Carcinoid
		Refer to Algorithm in Fig. 76.1
		Refer to Algorithm in Fig. 76.2
		Refer to Algorithm in Fig. 76.3
		Suggested Reading
Part VII: Stomas
	77: Stomal Prolapse
		Refer to Algorithm in Fig. 77.1
		Suggested Reading
	78: Stomas: Parastomal Hernias
		Refer to Algorithm in Fig. 78.1
		Postoperative Management
		Complications
		Results
		Suggested Reading
	79: Stoma Retraction and Stenosis
		Defining the Problem: Retraction
		Defining the Problem: Stomal Stenosis
		Refer to Algorithm in Fig. 79.2A Avoiding Retraction
		Refer to Algorithm in Fig. 79.2B Avoiding Stenosis
		Refer to Algorithm in Fig. 79.2C Management of the Retracted Ileostomy
		Refer to Algorithm in Fig. 79.2C Management of the Retracted Colostomy
		Refer to Algorithm in Fig. 79.2D Management of Stenosed Stoma
		The Role of Laparoscopic Surgery
		Suggested Reading
	80: Stomal Varices
		Background
		Etiology
		Epidemiology
		Clinical Presentation
			Refer to Algorithm in Fig. 80.1
		Evaluation
			Triage and Temporary Control of Bleeding
		Treatment
			Acute Treatment
			Prevention of Recurrent Bleeding
			Treatment of Recurrent Bleeding
			Local Measures
		Surgery
		Reduction in Portal Hypertension
		Summary
		Suggested Reading
	81: Stomas: Peristomal Skin Complication
		Refer to Algorithm in Fig. 81.1
		A.	Chemical
		B.	Mechanical
		C.	Disease
			Pre-existing Conditions
		D.	Infectious
			Bacterial
			Fungal
		E.	 Therapy in Prevention of Peristomal Skin Complications
		F.	 Pressure Ulcers
		Summary
		Suggested Reading
Part VIII: Complications
	82: Complications: Ureteral Injury
		Refer to Algorithm in Fig. 82.1
		Suggested Reading
	83: Splenic Injury Complicating Colorectal Surgery
		Refer to Algorithm in Fig. 83.1
		Suggested Reading
	84: Colonoscopic Complications: Colonic Perforations
		Refer to Algorithm in Fig. 84.1
		Suggested Reading
	85: Complications: Early Anastomotic Complications—Leak, Abscess, and Bleeding
		Intra-abdominal Anastomotic Leak
			Refer to Algorithm in Fig. 85.1
		Pelvic Anastomotic Leaks
			Refer to Algorithm in Fig. 85.2
		Anastomotic Bleeding
			Refer to Algorithm in Fig. 85.4
		Suggested Reading
	86: Late Anastomotic Complications (Stricture and Sinus)
		Refer to Algorithms in Figs. 86.1 and 86.2
		Further Reading
	87: Post-polypectomy Bleeding
		Refer to Algorithm in Fig. 87.1
		Conclusion
		Suggested Reading
	88: Post-polypectomy Complications
		Safety of Colonoscopy
		Electrosurgical Currents
		Polypectomy techniques and Prevention of PPTI
		Complications of Post-Polypectomy Complications and their Treatment
			Post-polypectomy Bleed (see Chap. 87)
			Perforation
			Postpolypectomy Electrocoagulation Syndrome
		Summary of Recommendations
			Refer to Table 88.1 and Algorithm in Fig. 88.2
		Suggested Reading
	89: Presacral Bleeding
		Refer to Algorithm in Fig. 89.1
		Suggested Reading
	90: Complications: Short Gut Syndrome
		Refer to Algorithm in Fig. 90.1
		Refer to Algorithm in Fig. 90.2
		Refer to Algorithm in Fig. 90.3
		Suggested Reading
	91: Complications: Surgical Site Infections
		Refer to Algorithms in Figs. 91.1 and 91.2
		Suggested Reading
	92: Ileal J Pouch Complications
		Refer to Algorithms in Figs. 92.1, 92.3, and 92.4
		Suggested Reading
	93: Complications: Pouchitis
		Refer to Algorithms in Figs. 93.1 and 93.2
		Suggested Reading
	94: Complications: Reoperative Pelvic Surgery
		Refer to Algorithm in Fig. 94.1
		Suggested Reading
Index