Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_538_Библиотеки_им_академика_М_И_Перельмана.pdf
X
- •Foreword
- •Preface
- •Contents
- •Contributors
- •Editors
- •Authors
- •Anal Canal Epithelium
- •External Anal Sphincter
- •Hemorrhoids
- •Perineal Body
- •Pelvic Floor Muscles
- •Puborectalis Muscle
- •Iliococcygeus Muscle
- •Pubococcygeus Muscle
- •Mesorectum
- •Presacral Fascia
- •Retrosacral Fascia
- •Waldeyer’s Fascia
- •Denonvilliers’ Fascia
- •Lateral Ligaments
- •Anorectal Spaces
- •Perianal Space
- •Intersphincteric Space
- •Submucous Space
- •Ischioanal/Ischiorectal Space
- •Supralevator Space
- •Retrorectal Space
- •Internal Anal Sphincter
- •Conjoined Longitudinal Muscle
- •Rectal Blood Supply
- •Superior Rectal Artery
- •Middle Rectal Artery
- •Inferior Rectal Artery
- •Cecum
- •The Appendix
- •Ascending Colon
- •Transverse Colon
- •Descending Colon
- •Sigmoid Colon
- •Rectosigmoid Junction
- •Blood Supply
- •Superior Mesenteric Artery
- •Inferior Mesenteric Artery
- •Venous Drainage
- •Lymphatic Drainage
- •Nervous Innervation
- •Embryology
- •Midgut Rotation
- •Non-rotation
- •Malrotation
- •Reversed Rotation
- •Omphalocele
- •Internal Hernias
- •Proximal Colon Duplication
- •Meckel’s Diverticulum
- •Hirschsprung’s Disease
- •Anorectal Malformations
- •Anal Stenosis
- •Membranous Atresia
- •Anal Agenesis
- •Anorectal Agenesis
- •Rectal Atresia or “High Atresia”
- •Persistent Cloaca
- •References
- •2: Colonic Physiology
- •Embryology
- •Colonic Anatomy
- •Introduction
- •Colonic Wall Anatomy
- •Epithelial Types
- •Sodium
- •Potassium
- •Aldosterone
- •Short-Chain Fatty Acid Absorption
- •Vitamin K Absorption
- •Colonic Innervation
- •Pain
- •Colonic Motility
- •Microbiome
- •Conclusion
- •References
- •3: Anorectal Physiology
- •Introduction
- •Anatomy
- •Physiology
- •Normal Continence
- •Patient Positioning
- •Digital Rectal Examination
- •Anoscopy
- •Proctoscopy
- •Endoanal/Endorectal Ultrasound
- •Normal Defecation
- •Physiologic Testing
- •Anal Manometry
- •Pudendal Nerve Terminal Motor Latency
- •Defecography
- •Functional Anorectal Disorders
- •Fecal Incontinence
- •Anorectal Pain
- •Urogynecological Considerations
- •References
- •4: Endoscopy
- •Introduction
- •Anorectal Examination
- •Flexible Endoscopy Techniques
- •Torque
- •Dithering/Jiggle
- •Air Aspiration
- •Slide-By
- •Flexible Sigmoidoscopy
- •Colonoscopy
- •Bowel Preparation
- •Special Considerations
- •Anticoagulated Patient
- •Sedation
- •Instrumentation
- •Colonoscopy Technique
- •Alternative Techniques
- •Chromoendoscopy
- •Narrow Band Imaging
- •Full-Spectrum Endoscopy
- •Changing Patient Position
- •Abdominal Pressure
- •Incomplete Colonoscopy
- •Complications
- •Procedural Complications
- •Perforation
- •Bleeding
- •Post-polypectomy Syndrome
- •Splenic Injury
- •Infectious Complications
- •The Endoscopy Unit
- •Endoscope Processing
- •Quality Measures
- •Withdrawal Time
- •Adenoma Detection Rate
- •Leasing vs Purchasing Endoscopy Equipment
- •Summary
- •References
- •Introduction
- •Forceps
- •Snare
- •Lifting
- •Endoscopic Mucosal Resection
- •Clip
- •Underwater EMR
- •Endoscopic Submucosal Dissection
- •ESD Complications
- •ESD Technique
- •Postoperative Care
- •Endoscopic Suturing
- •Stabilization Platforms
- •Colonic Stenting
- •Stenting Technique
- •Stenting Anastomotic Leaks
- •Conclusion
- •References
- •Abdominal Surgery
- •Anorectal Surgery
- •Preoperative Testing
- •Laboratory Studies
- •Electrocardiogram
- •Chest X-Ray
- •Advanced Diagnostic Imaging
- •Cardiac Evaluation
- •Initial Workup
- •Additional Testing
- •Preoperative Anticoagulation
- •Coronary Stent Management
- •Bridging
- •AICD/Management
- •Pulmonary Assessment
- •Perioperative Steroid Management
- •Diabetes
- •Obesity
- •Malnutrition
- •Solid Organ Transplant Recipients
- •Substance Abuse
- •Alcohol
- •Tobacco
- •Opioids
- •Other Illicit Drugs
- •Immunosuppressive Agents
- •Assessing Frailty
- •Complete Geriatric Assessment
- •Frailty Scores
- •Prehabilitation
- •Exercise
- •Nutrition
- •Psychosocial Therapy
- •Outcomes
- •Conclusion
- •References
- •Enhanced Recovery Models
- •Education
- •Preoperative Optimization
- •Smoking Cessation
- •Preoperative Nutrition
- •Preoperative Anemia
- •Perioperative Hyperglycemia
- •Bowel Preparation
- •In-hospital Preoperative Enhanced Recovery Elements
- •Multimodal Analgesia (MMA)
- •Intraoperative Enhanced Recovery Elements
- •Multimodal Analgesia
- •Intentional Fluid Management
- •Minimally Invasive Surgical Approaches
- •Postoperative Enhanced Recovery
- •Multimodal Analgesia
- •Standard Discharge Criteria
- •Future Directions
- •Summary
- •References
- •8: General Postoperative Complications
- •Introduction
- •Risk Factors
- •Morbidities
- •Nutrition
- •Smoking
- •Preoperative Anemia
- •Sarcopenia
- •Obesity
- •Functional Exercise Capacity
- •Open Surgical Approach
- •Assessing Risk Factors
- •Addressing Risk Factors
- •Postoperative Complications
- •Gastrointestinal Complications (#1)
- •Ileus (Functional Bowel Obstruction)
- •Postoperative Small Bowel Obstruction (Mechanical Bowel Obstruction)
- •Hematologic Complications (#2)
- •Venous Thromboembolism
- •Infectious Complications (#3)
- •Surgical Site Infection (SSI)
- •Anastomotic Leaks
- •Wound Dehiscence
- •Other Infectious Complications
- •Pulmonary Complications (#4)
- •Postoperative Respiratory Failure
- •Pneumonia
- •Pulmonary Aspiration
- •Renal Complications (#5)
- •Acute Kidney Injury
- •Postoperative Urinary Retention
- •Cardiac Complications (#6)
- •Myocardial Infarction
- •Dysrhythmias
- •Neurological Complications (#7)
- •Perioperative Cerebrovascular Accidents
- •Sexual Dysfunction
- •Postoperative Delirium
- •Conclusion
- •References
- •9: Anastomotic Construction
- •Introduction
- •Operative Planning
- •Mobilization
- •Small Bowel Mobilization
- •Colonic Mobilization
- •Splenic Flexure Mobilization
- •Special Mobilization Techniques
- •Retroileal Anastomosis or Ileal Mesenteric Window
- •Right Colon De-Rotation (Deloyer’s Procedure)
- •Perfusion
- •Low Pelvic Anastomosis
- •Sutured Anastomosis
- •Stapled Anastomosis
- •Compression Ring Anastomosis
- •References
- •10: Anastomotic Complications
- •Anastomotic Leak
- •Risk Factors
- •Diagnosis
- •Outcomes After Anastomotic Leak
- •Anastomotic Fistula
- •Blind Loop Syndrome
- •Anastomotic Bleeding
- •Anastomotic Stricture
- •References
- •Anal Fissure
- •Medical/Pharmaceutical Treatment
- •Topical Agents
- •Botulinum Toxin Injection
- •Operative Treatment
- •Lateral Internal Sphincterotomy (LIS)
- •Technique
- •Outcomes
- •Local Advancement Flaps
- •Atypical Fissures
- •Anal Fissure, Conclusion
- •Anal Stenosis
- •Symptoms
- •Evaluation
- •Treatment
- •Nonoperative Treatment
- •Surgical Treatment
- •Rectal Advancement Flap
- •Y-V Advancement Flap
- •V-Y Advancement Flap
- •Diamond (Rhomboid) Flap
- •House Flap
- •U Flap (Island Flap Anoplasty)
- •Rotational S Flap
- •Technical Aspects
- •Flap Aftercare
- •Prevention
- •Anal Stenosis, Conclusions
- •References
- •Introduction
- •Cryptoglandular Pathophysiology
- •Cryptoglandular Abscess
- •Diagnosis
- •Treatment
- •Acute Fistula Management
- •Post-drainage Care
- •Post-drainage Antibiotics
- •Anal Fistula
- •Presentation/Symptoms
- •Fistulography
- •Computed Tomography (CT)
- •Magnetic Resonance Imaging (MRI)
- •Endoanal Ultrasound (EAUS)
- •Treatment Strategies
- •Fistulotomy
- •Setons
- •Draining Seton
- •Cutting Seton
- •Fibrin Glue
- •Fistula Plug
- •Endorectal Advancement Flap (ERAF)
- •Novel Surgical Therapies
- •Fistula Tract Laser Closure (FiLaC™)
- •Video-Assisted Anal Fistula Treatment (VAAFT)
- •Stem Cell Therapy
- •Recommendation
- •References
- •Introduction
- •Etiology
- •Clinical Presentation
- •Diagnostic Evaluation
- •Transanal Approach
- •Transperineal Approach
- •Posterior Approach
- •Transabdominal Approach
- •Other Approaches
- •Conclusion
- •References
- •15: Rectovaginal Fistula
- •Obstetrical
- •Crohn’s Disease
- •Cryptoglandular
- •Radiation Injury
- •Surgical Techniques
- •Perineal Approach
- •Episioproctotomy
- •Transverse Perineal Repair
- •Transrectal Approaches
- •Rectal Sleeve Advancement
- •Vaginal Approach
- •Tissue Transposition Repairs
- •Bioprosthetic Products
- •Abdominal Approaches
- •Conclusion
- •References
- •Pilonidal Disease
- •Introduction
- •Diagnosis
- •Treatment
- •Managing Patient Expectations
- •Nonsurgical Treatment
- •Antibiotics
- •Phenol
- •Fibrin Glue
- •Surgical Treatments
- •Complex Surgical Treatment
- •Karydakis Flap
- •Rhomboid Flap (aka Limberg Flap)
- •Cleft Lift Flap (Bascom Procedure)
- •Minimally Invasive Treatments
- •Trephination
- •Wound Healing Adjuncts
- •Hidradenitis Suppurativa
- •Introduction
- •Treatment
- •Medical Therapy
- •Topical Therapy
- •Systemic Antibiotics
- •Biologics
- •Other Medical Therapies
- •Laser Therapies
- •Surgery
- •Conclusions
- •References
- •Introduction
- •Pathophysiology
- •Etiology
- •Fecal Soilage
- •Dermatologic Diseases
- •Diagnostic Approach
- •Laboratory Testing
- •Treatment
- •First Encounter
- •Conclusions
- •References
- •Introduction
- •Anorectal Immunology
- •Asymptomatic
- •Symptomatic
- •Bacterial Sexually Transmitted Infections
- •Chlamydia
- •Diagnosis
- •Treatment
- •Lymphogranuloma Venereum
- •Diagnosis
- •Treatment
- •Gonorrhea
- •Diagnosis
- •Treatment
- •Syphilis
- •Diagnosis
- •Treatment
- •Chancroid
- •Diagnosis
- •Treatment
- •Donovanosis
- •Diagnosis
- •Treatment
- •Herpes Simplex Virus
- •Genital Warts
- •Giant Condyloma
- •Molluscum Contagiosum
- •Ectoparasitic Sexually Transmitted Diseases
- •Conclusion
- •References
- •19: Anal Intraepithelial Neoplasia
- •Introduction
- •Incidence
- •Epidemiology
- •Progression
- •Diagnosis
- •Treatment
- •Expectant Management
- •Topical Therapies
- •Trichloroacetic Acid (TCA)
- •5-Flurorouracil (5FU)
- •Cidofovir
- •Imiquimod
- •Local Ablative Therapies
- •Wide Local Excision
- •Treatment Summary
- •Surveillance/Prevention
- •Conclusion
- •References
- •20: Anal Cancer
- •Physical Examination
- •Radiologic Evaluation
- •Anal Anatomy
- •Perianal Squamous Cell Carcinoma
- •Anal Canal Squamous Cell Carcinoma
- •Chemotherapy
- •Radiation Therapy
- •Inguinal Lymph Node Metastases
- •Surgery
- •Surveillance
- •Anal Adenocarcinoma
- •Verrucous Carcinoma
- •Melanoma
- •Perianal Paget’s Disease (Intraepithelial Adenocarcinoma)
- •Basal Cell Carcinoma
- •Gastrointestinal Stromal Tumor (GIST)
- •Conclusion
- •References
- •21: Presacral Tumors
- •Introduction
- •Anatomic Considerations
- •Clinical Presentations
- •Physical Examination
- •Imaging Studies
- •Preoperative Biopsy
- •Tailgut Cysts
- •Enterogenous Cysts
- •Teratomas
- •Chordomas
- •Meningoceles
- •Neurogenic Tumors
- •Osseous Tumors
- •Miscellaneous Lesions
- •Currarino Syndrome
- •Management
- •Multidisciplinary Team
- •Neoadjuvant Therapy
- •Preoperative Considerations
- •Surgical Approach
- •Posterior Approach
- •Minimally Invasive Approaches
- •Outcomes
- •Conclusions
- •References
- •Introduction
- •Sporadic Versus Inherited Colorectal Cancer
- •Sporadic Colorectal Cancer
- •Mutations
- •Chromosomal Alterations
- •Right vs. Left CRC
- •Young Onset CRC
- •Epidemiology
- •Management
- •Inherited CRC
- •Lynch Syndrome (Hereditary Non-polyposis CRC)
- •Genetic Mutation
- •Lynch Syndrome Variants
- •Turcot Syndrome
- •Muir-Torre Syndrome
- •Familial CRC X
- •Screening Recommendations
- •Surgical Treatment
- •Medical Treatment
- •POLE/POLD1-Related Hereditary Cancer
- •Familial Adenomatous Polyposis
- •Genetic Mutations
- •Extracolonic Manifestations
- •Screening Recommendations
- •Attenuated FAP
- •Gardner Syndrome
- •Surgical Treatment
- •MUTYH-Associated Polyposis
- •Serrated Polyposis Syndrome
- •Diagnosis
- •Treatment
- •Hamartomatous Polyposis Syndromes
- •Juvenile Polyposis
- •Peutz-Jeghers Syndrome
- •Cowden Syndrome
- •Conclusion
- •References
- •Overview
- •Colorectal Cancer Precursor Lesions
- •Adenomas
- •Serrated Polyps
- •Colorectal Cancer Carcinogenic Pathways
- •Adenoma-Carcinoma Pathway
- •Serrated Pathway
- •Lesion Assessment
- •Endoscopic Mucosal Resection (EMR) Technique
- •Endoscopic Submucosal Dissection Technique
- •Recurrence Following Endoscopic Resection
- •Surveillance After Endoscopic Resection
- •Conclusion
- •References
- •Fecal Sampling
- •Flexible Sigmoidoscopy
- •Computed Tomography (CT) Colonography
- •Colonoscopy
- •Delineating Colon Versus Rectum
- •TNM Staging
- •History
- •Physical Examination
- •Proctoscopy
- •Colonoscopy
- •Tumor Localization
- •Blood Work
- •Imaging
- •Computed Tomography (CT) Scan
- •PET-CT
- •Endorectal Ultrasound
- •Preoperative Evaluation
- •Pathologic Features: Pre-Resection
- •Lymphovascular Invasion (LVI)
- •Perineural Invasion (PNI)
- •Tumor Budding
- •Tumor Grade
- •Histologic Type
- •Pathologic Factors: Post-Resection
- •Extranodal Tumor Deposits
- •Mesorectal Grade
- •Tumor Regression Score
- •Clinical or Imaging-Based Factors
- •Extramural Vascular Invasion (EMVI)
- •Circumferential Radial Margin (CRM) Status
- •Tumor Location
- •Conclusion
- •References
- •Introduction
- •Preoperative Tumor Localization
- •General Surgical Principles
- •No-Touch Technique
- •Lymphadenectomy
- •Mesocolic Excision
- •Adjacent Tissue or Organ Invasion
- •Technical Aspects
- •Hepatic Flexure Colon Cancer
- •Technical Aspects
- •Transverse Colon Cancer
- •Technical Aspects
- •Technical Aspects
- •Sigmoid Colon Cancer
- •Technical Aspects
- •Special Circumstances
- •References
- •26: Rectal Cancer: Neoadjuvant Therapy
- •Introduction
- •Rectal Cancer Staging
- •Adjuvant Radiation
- •Neoadjuvant Radiation
- •The Foundation Trials
- •Short- vs Long-Course Radiation
- •Total Neoadjuvant Chemoradiation Therapy (TNT)
- •Rationale
- •Systemic Chemotherapy Alone
- •Pathologic Complete Response
- •Consolidation vs Induction Chemotherapy
- •Conclusion
- •References
- •27: Rectal Cancer: Local Excision
- •Introduction
- •Patient Selection
- •T1N0
- •Predicting Lymph Node Metastasis
- •Tumor Budding
- •Techniques
- •Transanal Excision
- •Transanal Endoscopic Microsurgery
- •Transanal Minimally Invasive Surgery (TAMIS)
- •Complications
- •Oncologic Results
- •T1 Cancer
- •T2 Cancer
- •Salvage Surgery
- •Conclusion
- •References
- •28: Rectal Cancer: Nonoperative Management
- •Introduction
- •Rationale
- •Accidental Versus Intentional WW
- •Baseline Stage
- •Tumor Location
- •Endoscopic Features
- •Radiological Studies

Contributors
Editors
Scott R. Steele, MD Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH,
USA
Tracy L. Hull, MD Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH,
USA
ThomasE.Read, MD Division of Gastrointestinal Surgery, University of Florida, Gainesville,
FL, USA
Neil Hyman, MD Division of Gastrointestinal Surgery, University of Chicago Medical
Center, Chicago, IL, USA
JustinA.Maykel, MD Department of Surgery, University of Massachusetts Medical School,
Worcester, MA, USA
CharlesB. Whitlow, MD Department of Colon and Rectal Surgery, Ochsner Clinic, New
Orleans, LA, USA
Authors
MaherA.Abbas, MD King’s College Hospital, Dubai, UAE
Karim Alavi, MD, MPH University of Massachusetts Medical School, Department of
Surgery, Division of Colon and Rectal Surgery, Worcester, MA, USA
DennisK.Ames, JD Medical Malpractice Trail Attorney, Santa Ana, CA, USA
JeanH.Ashburn, MD Wake Forest Baptist Health, Department of Surgery, Winston-Salem,
NC, USA
RezaAskari, MD Division of Trauma, Burns, Surgical Critical Care and Acute Care Surgery,
Brigham and Woman’s Hospital, Harvard Medical School, Boston, MA, USA
GlennT.Ault, MD, MSEd University of Southern California– Keck School of Medicine,
Department of Surgery, Division of Colorectal Surgery, Los Angeles, CA, USA
Kenneth S. Azarow, MD Oregon Health Sciences University, Department of Surgery,
Portland, OR, USA
Andrea Chao Bafford, MD University of Maryland School of Medicine, Department of
Surgery, Baltimore, MD, USA
Jennifer S. Beaty, MD Associate Dean for Graduate Medical Education, Des Moines
University Medicine and Health Sciences, Des Moines, IA, USA
xiii

xiv
Willem A. Bemelman, MD, PhD Amsterdam University Medical Centre, Location
Meibergdreef, Department of Surgery, Amsterdam, Netherlands
GretaBernier, MD UW Medicine– Valley Medical Center, Department of Surgery, Renton,
WA, USA
Anuradha R. Bhama, MD Department of Colon and Rectal Surgery, Cleveland Clinic,
Cleveland, OH, USA
Elisa Birnbaum, MD University of Colorado Anschutz Medical Center, Department of
Surgery, Aurora, CO, USA
Joshua I. S. Bleier, MD University of Pennsylvania, Perelman School of Medicine,
Department of Surgery, Philadelphia, PA, USA
LilianaBordeianou, MD, MPH Harvard Medical School, Colorectal Surgery Program at the
Massachusetts General Hospital, Massachusetts General Hospital, Department of Surgery,
Boston, MA, USA
MaryliseBoutros, MD Jewish General Hospital, Division of Colorectal Surgery, Montreal,
QC, Canada
Mantaj S. Brar, MD, MSc GradStat Mount Sinai Hospital, Department of Surgery,
University of Toronto, Toronto, ON, Canada
W.DonaldBuie, MD, MSc Foothills Medical Center, Departments of Surgery and Oncology,
University of Calgary, Calgary, AB, Canada
Contributors
JamieA.Cannon, MD University of Alabama Birmingham Medical Center, Department of
Surgery/Gastrointestinal Section, Birmingham, AL, USA
Lisa M. Cannon, MD University of Rochester Medical Center, Department of Surgery,
Division of Colon and Rectal Surgery, Rochester, NY, USA
EvieH.Carchman, MD University of Wisconsin, Department of General Surgery, Madison,
WI, USA
JosephC.Carmichael, MD Division of Colon and Rectal Surgery, University of California,
Irvine, Department of Surgery, Orange, CA, USA
PeterA.Cataldo, MD Larner College of Medicine at the University of Vermont, Department
of Surgery, Burlington, VT, USA
HeidiChua, MD Mayo Clinic School of Medicine, Department of Colon and Rectal Surgery,
Rochester, MN, USA
DanielI.Chu, MD University of Alabama at Birmingham, University Hospital, Department
of General Surgery-Gastrointestinal Division, Birmingham, AL, USA
JeffreyL.Cohen, MD, CPE Hartford HealthCare, Hartford, CT, USA
University of Connecticut, Hartford, CT, USA
MichelleCowan, MD University of Washington, Department of Surgery, Seattle, WA, USA
Giovannada Silva, MD Cleveland Clinic Florida, Department of Colorectal Surgery, Weston,
FL, USA
JenniferS.Davids, MD University of Massachusetts Memorial Medical Center, Department
of Surgery, Worchester, MA, USA
BradleyR.Davis, MD, MBA Department of Surgery, Atrium Health, Charlotte, NC, USA

Contributors
xv
TeresadeBeche-Adams, MD Center for Colon & Rectal Surgery at Florida Hospital East,
Orlando, FL, USA
David W. Dietz, MD University Hospitals, Case Western Reserve University School of
Medicine, Department of Surgery, Division of Colorectal Surgery, Cleveland, OH, USA
Eric J. Dozois, MD Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, MN,
USA
DavidA.Etzioni, MD, MSHS Mayo Clinic, Department of Surgery, Phoenix, AZ, USA
DanielL.Feingold, MD Division of Colorectal Surgery, Rutgers University, Department of
Surgery, New Brunswick, NJ, USA
Alessandro Fichera, MD Colon and Rectal Surgery, Baylor University Medical Center,
Department of Surgery, Dallas, TX, USA
Fergal J. Fleming, MD, MPH University of Rochester Medical Center, Department of
Surgery, Rochester, NY, USA
PhillipR.Fleshner, MD Cedars Sinai Medical Center, Department of Surgery, Los Angeles,
CA, USA
ToddD.Francone, MD, MPH Department of Surgery, Division of Colon and Rectal Surgery,
Massachusetts General Hospital, Boston, MA, USA
Charles M. Friel, MD University of Virginia Medical Center, Department of Surgery,
Charlottesville, VA, USA
Wolfgang B. Gaertner, MD, MSc Division of Colon and Rectal Surgery, University of
Minnesota– M Health, Minneapolis, MN, USA
JulioGarcia-Aguilar, MD, PhD Department of Surgery, Memorial Sloan Kettering Cancer
Center, New York, NY, USA
Kelly A. Garrett, MD Weill Cornell Medicine – New York Presbyterian Hospital,
Department of General Surgery, Section of Colon and Rectal Surgery, New York, NY, USA
Susan L. Gearhart, MD, ME HP Johns Hopkins Institutions, Department of Surgery,
Baltimore, MD, USA
SeanC.Glasgow, MD Washington University School of Medicine, Department of Surgery,
St. Louis, MO, USA
Emre Gorgun, MD Cleveland Clinic, Department of Colorectal Surgery, Cleveland, OH,
USA
BrookeH.Gurland, MD Stanford Medical Center, Department of General Surgery, Stanford,
CA, USA
Jason F.Hall, MD, MPH Section of Colon and Rectal Surgery, Boston Medical Center,
Department of Surgery, Boston, MA, USA
Karin M. Hardiman, MD, PhD University of Alabama at Birmingham, Department of
Surgery, Birmingham, AL, USA
AmandaV.Hayman, MD, MPH Division of Gastrointestinal & Minimally Invasive Surgery,
The Oregon Clinic, Portland, OR, USA
TraciL.Hedrick, MD, MSc University of Virginia Health, Charlottesville, VA, USA

xvi
RebeccaHoedema, MD, MS Spectrum Health, Department of Colon and Rectal Surgery,
Grand Rapids, MI, USA
StefanDavidHolubar, MD, MS Cleveland Clinic, Department of Colon and Rectal Surgery,
Cleveland, OH, USA
StevenR.Hunt, MD Washington University School of Medicine, Department of Surgery, St.
Louis, MO, USA
MehranehD.Jafari, MD University of California– Irvine, Department of Surgery, Orange,
CA, USA
EricK.Johnson, MD Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland,
OH, USA
WilliamForrestJohnston, MD Ochsner Clinic, Department of Colon and Rectal Surgery,
New Orleans, LA, USA
MatthewF.Kalady, MD Department of Surgery, Division of Colon and Rectal Surgery, The
Ohio State University, Columbus, OH, USA
BrianR.Kann, MD Ochsner Health, Department of Colon and Rectal Surgery, New Orleans,
LA, USA
Deborah S. Keller, MS, MD University of California Davis Medical Center, Division of
Colorectal Surgery, Department of Surgery, Sacramento, CA, USA
Contributors
ScottR.Kelley, MD Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, MN,
USA
Gregory D. Kennedy, MD, PhD University of Alabama Medical Center, Department of
Surgery, Birmingham, AL, USA
CindyKin, MD, MS Stanford University, Department of Surgery, Stanford, CA, USA
PokalaRaviKiran, MBBS, MS (Gen Surg), MSc (EBM) Division of Colorectal Surgery,
New Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
DavidA.Kleiman, MD, MSc Lahey Hospital and Medical Center, Department of Colon and
Rectal Surgery, Burlington, MA, USA
MuktaK.Krane, MD University of Washington, Department of Surgery, Seattle, WA, USA
Hiroko Kunitake, MD, MPH Department of General and Gastrointestinal Surgery,
Massachusetts General Hospital, Boston, MA, USA
JennyAlex Ky-Miyasaka, MD, PhD Mount Sinai Hospital, Department of Surgery, New
York, NY, USA
RonG.Landmann, MD Section of Colon and Rectal Surgery, Baptist MD Anderson Medical
Center, Department of Surgery, Jacksonville, FL, USA
DavidW.Larson, MD, MBA Mayo Clinic, Department of Surgery, Rochester, MN, USA
AmyL.Lightner, MD Cleveland Clinic, Department of Colorectal Surgery, Cleveland, OH,
USA
AnthonyR.MacLean, MD Foothills Medical Center, Department of Surgery, University of
Calgary, Calgary, AB, Canada
Helen MacRae, MA, MD Mount Sinai Hospital, Department of Surgery, University of
Toronto, Toronto, ON, Canada

Contributors
xvii
NajjiaN.Mahmoud, MD Division of Colon and Rectal Surgery, University of Pennsylvania,
Department of Surgery, Philadelphia, PA, USA
Nathalie Mantilla, MD Rush University, Cook County Health, Department of Colon and
Rectal Surgery, Chicago, IL, USA
SlawomirMarecik, MD Advocate Lutheran General Hospital, Park Ridge, IL, USA
University of Illinois at Chicago, Chicago, IL, USA
DavidA.Margolin, MD Ochsner Clinic Foundation, Ochsner Clinical School, University of
Queensland, Department of Colon and Rectal Surgery, New Orleans, LA, USA
DavidJ.Maron, MD, MBA Cleveland Clinic Florida, Department of Colorectal Surgery,
Weston, FL, USA
MatthewMartin, MD Scripps Mercy Hospital, Uniformed Services University of the Health
Sciences, San Diego, CA, USA
MichaelF.McGee, MD Northwestern University Feinberg School of Medicine, Department
of Surgery, Division of Gastrointestinal Surgery, Chicago, IL, USA
ShaneMcNevin, MD Providence Sacred Heart, Spokane, WA, USA
Anders Mellgren, MD, PhD Division of Colon & Rectal Surgery, University of Illinois
Chicago, Chicago, IL, USA
Evangelos Messaris, MD, PhD Beth Israel Deaconess Medical Center, Harvard Medical
School, Department of Surgery, Boston, MA, USA
CraigA. Messick, MD The University of Texas MD Anderson Cancer Center, Department
Surgical Oncology, Houston, TX, USA
John Migaly, MD Division of Surgical Oncology, Section of Colorectal Surgery, Duke
University School of Medicine, Durham, NC, USA
StevenMills, MD Division of Colon and Rectal Surgery, University of California, Irvine,
Department of Surgery, Orange, CA, USA
JohnR. T.Monson, MD Digestive Health and Surgery Institute, AdventHealth, Center for
Colon and Rectal Surgery, Orlando, FL, USA
Brendan John Moran, M.Ch., FRCS, FRCSI (Gen) Peritoneal Malignancy Institute,
Basingstoke and North Hampshire Hospital, Department of General and Colorectal Surgery,
Basingstoke, UK
Nancy Morin, MD SMDB Jewish General Hospital, McGill University, Department of
Surgery, Division of Colorectal Surgery, Montreal, QC, Canada
Margarita Murphy, MD East Cooper Medical Center, Department of Surgery, Mount
Pleasant, SC, USA
MatthewG.Mutch, MD Washington University School of Medicine, Department of Surgery,
St. Louis, MO, USA
JamesW.Ogilvie Jr, MD, MS Spectrum Health, Michigan State University, Department of
Colorectal Surgery, Grand Rapids, MI, USA
LuciaCamaraCastroOliveira, MD, PhD Anorectal Physiology Department and Colorectal
Surgery, Hospital Casa de Saude Sao Jose and CEPEMED, Department of Colorectal Surgery,
Rio de Janeiro, Brazil

xviii
IanM.Paquette, MD University of Cincinnati College of Medicine, Department of Surgery–
Colon and Rectal Surgery, Cincinnati, OH, USA
DaniellePatterson, MD, SM Johns Hopkins Medical Institutions, Department of Gynecology
and Obstetrics, Baltimore, MD, USA
Rodrigo Oliva Perez, MD, PhD Angelita and Joaquim Gama Institute, Benecencia
Portuguesa de Sao Paolo, Alemao Oswaldo Cruz, Department of Surgical Oncology, Sao
Paulo, Brazil
W. Brian Perry, MD Audie L. Murphy VA Medical Center, Department of Surgery, San
Antonio, TX, USA
WalterR.Peters Jr, MD, MBA Baylor Scott and White Health, Dallas, TX, USA
ClaytonC. Petro, MD Cleveland Clinic, Department of General Surgery, Cleveland, OH,
USA
AjitaPrabhu, MD Cleveland Clinic, Department of Surgery, Cleveland, OH, USA
JanRakinic, MD Southern Illinois University School of Medicine, Department of Surgery,
Springeld, IL, USA
JenniferD. Rea, MD Colorectal Surgical and Gastroenterology Associates, Department of
Colorectal Surgery, Lexington, KY, USA
Contributors
ScottE.Regenbogen, MD, MPH University of Michigan, Division of Colorectal Surgery,
Department of Surgery, Ann Arbor, MI, USA
CraigA.Reickert, MD Wayne State University, Department of Colon and Rectal Surgery,
Detroit, MI, USA
TimothyJ.Ridol, MD, MS Medical College of Wisconsin, Division of Colorectal Surgery,
Department of Surgery, Milwaukee, WI, USA
Michael J. Rosen, MD Cleveland Clinic Center for Abdominal Core Health, Cleveland
Clinic, Department of Surgery, Cleveland, OH, USA
Leslie Roth, MD Brown University, Rhode Island Hospital, Department of Surgery,
Providence, RI, USA
AliSalim, MD Division of Trauma, Burns, Surgical Critical Care and Acute Care Surgery,
Brigham and Woman’s Hospital, Harvard Medical Schoo, Boston, MA, USA
DanaR.Sands, MD Cleveland Clinic Florida, Department of Colorectal Surgery, Weston,
FL, USA
Nicole M. Saur, MD University of Pennsylvania, Division of Colon and Rectal Surgery,
Department of Surgery, Philadelphia, PA, USA
AndrewT.Schlussel, DO Madigan Army Medical Center, Department of Surgery, Tacoma,
WA, USA
BenjaminD.Shogan, MD University of Chicago, Department of Surgery, Chicago, IL, USA
Radhika K. Smith, MD Washington University in St. Louis, Department of Surgery, St.
Louis, MO, USA
MichaelJ.Snyder, MD McGovern School of Medicine, Department of Surgery, Houston,
TX, USA
MichaelJ.Solomon, MB BCH(Hons), BAO, MSc DMEDSC Royal Prince Alfred Hospital,
Department of Colorectal Surgery, Sydney, NSW, Australia

Contributors
xix
Antonino Spinelli, MD, PhD Department of Biomedical Sciences, Humanitas University,
Milan, Italy
IRCCS Humanitas Research Hospital - Division of Colon and Rectal Surgery, Milan, Italy
Kyle Staller, MD, MPH Division of Gastroenterology, Massachusetts General Hospital,
Boston, MA, USA
Emily Steinhagen, MD University Hospitals Cleveland Medical Center, Case Western
Reserve University School of Medicine, Department of Surgery, Cleveland, OH, USA
David B. Stewart, MD Southern Illinois University School of Medicine, Department of
Surgery, Springeld, IL, USA
Luca Stocchi, MD Mayo Clinic Florida, Department of Surgery, Division of Colorectal
Surgery, Jacksonville, FL, USA
ScottA.Strong, MD Northwestern University, Department of Surgery, Chicago, IL, USA
PasithornA.Suwanabol, MD, MS University of Michigan, Division of Colorectal Surgery,
Department of Surgery, Ann Arbor, MI, USA
Patricia Sylla, MD Department of Surgery, Division of Colon and Rectal Surgery, Icahn
School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
Sanda A. Tan, MD, PhD West Florida Healthcare, Department of Surgery, University of
Central Florida, Pensacola, FL, USA
Erin A. Teeple, MD Nemours/AI Dupont Hospital for Children, Department of Surgery,
Wilmington, DE, USA
JulieThacker, MD Department of Surgery, Duke University School of Medicine, Durham,
NC, USA
AmyJ.Thorsen, MD Colon and Rectal Surgery Associates, Minneapolis, MN, USA
V.LianaTsikitis, MD, MBA, MCR Oregon Health and Science University, Department of
General Surgery, Division of Gastroenterology, Portland, OR, USA
Konstantin Umanskiy, MD University of Chicago, Department of Surgery, Chicago, IL,
USA
Michael A. Valente, DO Cleveland Clinic, Department of Colorectal Surgery, Cleveland,
OH, USA
H.DavidVargas, MD Ochsner Clinic Foundation, Department of Colon and Rectal Surgery,
New Orleans, LA, USA
Carol-AnnVasilevsky, MD Jewish General Hospital, Department of Surgery, Montreal, QC,
Canada
JonD.Vogel, MD University of Colorado, Aurora, CO, USA
SarahA.Vogler, MD, MBA Cleveland Clinic, Department of Colorectal Surgery, Cleveland,
OH, USA
EricG.Weiss, MD Cleveland Clinic Florida, Department of Colorectal Surgery, Weston, FL,
USA
MarkH.Whiteford, MD Colon and Rectal Surgery, The Oregon Clinic, Providence Portland
Medical Center, Providence Cancer Institute, Gastrointestinal and Minimally Invasive Surgery
Division, Portland, OR, USA

xx
ElizabethC.Wick, MD University of California, San Francisco, Department of Surgery, San
Francisco, CA, USA
KirstenBassWilkins, MD Associated Colon and Rectal Surgeons, PA, Edison, NJ, USA
DennisYang, MD University of Florida, Department of Gastroenterology, Gainesville, FL,
USA
KarenN.Zaghiyan, MD Cedars Sinai Medical Center, Department of Surgery, Los Angeles,
CA, USA
MatthewD. Zelhart, MD Department of Surgery, Tulane University School of Medicine,
New Orleans, LA, USA
Massarat Zutshi, MD Cleveland Clinic, Department of Colorectal Surgery, Digestive
Disease and Surgery Institute, Cleveland, OH, USA
Contributors

Part I
Perioperative/Endoscopy

Anatomy andEmbryology oftheColon,
Rectum, andAnus
JosephC.Carmichael andStevenMills
1
Key Concepts
• The dentate line represents a true division between embryonic endoderm and ectoderm.
• The location of the anterior peritoneal reection is highly
variable and can be signicantly altered by disease such
as rectal prolapse.
• The right and left ischioanal space communicate posteriorly through the deep postanal space between the levator
ani muscle and anococcygeal ligament.
• The junction between the midgut (superior mesenteric
artery) and the hindgut (inferior mesenteric artery) leads
to a potential watershed area in the area of the splenic
exure.
• There is a normal, three-stage process by which the intestinal tract rotates during development beginning with herniation of the midgut followed by return of the midgut to
the abdominal cavity and ending with its xation.
Anatomy oftheAnal Canal andPelvic Floor
Textbooks of anatomy would dene the “anatomic” anal
canal as beginning at the dentate (pectinate) line and extending to the anal verge. This denition is one dened truly by
the embryology and mucosal histology. However, the “surgical” anal canal, as rst dened by Milligan and Morgan [1],
extends from the anorectal ring to the anal verge. The surgical denition of the anal canal takes into account the surrounding musculature that is critical to consider during the
conduct of operations from low anterior resection to anal
stulotomy. The surgical anal canal is formed by the internal
anal sphincter, external anal sphincter, and puborectalis
(Fig. 1.1) and is easily identied on digital examination,
J. C. Carmichael (*) · S. Mills
Division of Colon and Rectal Surgery, University of California,
Irvine, Department of Surgery, Orange, CA, USA
e-mail: jcarmich@hs.uci.edu
ultrasound imaging [2], and magnetic resonance imaging
(MRI) [3].
On average, the surgical anal canal is estimated to be longer in males than in females. Intraoperative measurements of
the posterior anal canal have estimated the surgical anal
canal to be 4.4cm in men compared with 4.0cm in women
[4]. In addition, the anal canal was shown to be a unique
muscular unit in that its length did not change with age.
However, when using MRI, the anatomy of the anal canal
has been characterized differently. MR imaging did not show
a difference in the length of the posterior anal canal in men
and women but did show that the anterior and posterior
external anal sphincter length (not including puborectalis)
was signicantly shorter in women [5].
The anal canal forms proximally where the rectum passes
through the pelvic hiatus and joins with the puborectalis muscle. Starting at this location, the muscular anal canal can be
thought of as a “tube within a tube.” The inner tube is the
visceral smooth muscle of the internal anal sphincter and longitudinal layer that is innervated by the autonomic nervous
system. The outer muscular tube consists of somatic muscles
including the components of the puborectalis and external
anal sphincter [6]. It is the outer muscular tube that provides
conscious control over continence and is strengthened during
Kegel exercises. The external anal sphincter extends distal to
the internal anal sphincter, and the anal canal terminates at the
anal verge where the supercial and subcutaneous portions of
the external anal sphincter join the dermis.
Anal Canal Epithelium
The proximal anal canal has a pink appearance and is lined
by the columnar epithelium of the rectal mucosa. Six to
12mm proximal to the dentate line, the anal transition zone
(ATZ) begins. The ATZ appears purple in color and represents an area of gradual transition of columnar epithelium to
squamous epithelium. In a parallel to cervical anatomy, the
© Springer Nature Switzerland AG 2022
S. R. Steele et al. (eds.), The ASCRS Textbook of Colon and Rectal Surgery, https://doi.org/10.1007/978-3-030-66049-9_1
3
Соседние файлы в папке Библиотека им академика М.И. Перельмана
