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10 Anastomotic Techniques for Crohn’s Surgery 275
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minimally invasive techniques have been applied in CD surgery. Indeed, minimally invasive approaches, including laparoscopic and robotic approaches, have
shown to be safe and effective in ileocaecal resection and restoration of bowel
continuity. The potential benefits of these approaches are enormous, starting from
reduced postoperative pain, quicker return of bowel function, decreased postoperative morbidity, and decreased adhesion formation. These factors taken together
are all beneficial in case of further surgery for CD recurrence. The laparoscopic
approach is the recommended approach by CD surgical management guidelines
[7]. Currently, much research has targeted the comparison of laparoscopic versus
the robotic platforms, especially regarding ileocaecal resection and intracorporeal
versus extracorporeal ileocaecal anastomosis [78, 79]. There is a trend towards
better outcomes for ileocaecal resection in primary and secondary disease with
totally laparoscopic and totally robotic techniques. However, there are concerns
with regard to the implementation of complex CD-specific procedures and techniques (i.e. Kono-S anastomosis, stricturoplasties, and enteroentero-anastomosis)
in minimally invasive approaches. It is highly likely that increased surgeon experience, dedicated surgical training, and versatility of technological platforms will
allow for an expansion in the routine use of minimally invasive approaches in
CD surgery. Moreover, if specific anastomotic configurations start to show definite
advantages (i.e., SSA and Kono-S), it is possible that in the future procedures can
be tailored depending of patient presentations, making management on one side
more standardized, and on the other more patient-specific.
It must be emphasized that surgeon skills, preference and single centre experience are key factors in defining the most suitable approach for each patient.
Tailoring of the surgical plan for each specific patient and unique disease presentation is crucial for the development of an optimal surgical strategy, especially in
recurrent disease.
Danksagung Disclosures The authors have no disclosures.
Funding No funding was received for this manuscript.
Conflict of Interests The authors have no conflict of interest to declare that are relevant to the
content of this chapter.
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The Modern Management
https://t.me/med1917
of Haemorrhoids
Steven R. Brown
Abstract
Haemorrhoidal disease has been recognised and treated for millennia. An extensive portfolio of literature has built up, particularly in the last 40 years. Despite
this, the optimal management remains confusing, mainly because of the contradictory nature of some literature, much of which is of poor methodological
quality. Even guidelines vary in their quality and subsequent recommendations.
Undoubtedly management has altered, with an increasing ethos to tailor treatment according to patient wishes and the severity of disease. Novel innovations
are rife and driven by the fact that industry recognises a common condition with
outcomes, particularly pain that can be improved. This chapter summarises the
current quality evidence and concludes with an evidence-based algorithm of
care highlighting areas where future evidence may change management.
11
Keywords
Haemorrhoids•Rubber band ligation•Sclerotherapy•Haemorrhoidectomy
Stapled haemorrhoidopexy•Doppler guided ligation•Radio frequency
ablation
Key Points
•
Haemorrhoidal disease is a common cause of presentation to the colorectal clinic
where conservative management is often appropriate.
•
The principles of shared decision making with the patient are paramount when
deciding whether intervention for haemorrhoids should be performed.
S. R. Brown (B)
Department of Surgery, Sheffield Teaching Hospitals, Sheffield, UK
e-mail: Steven.brown13@nhs.net
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024
M. Evans e t al. (eds.), Coloproctology, https://doi.org/10.1007/978-3-031-59630-8_11
•
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