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Chassin’s Operative Strategy in Colon and Rectal Surgery
Carol E.H. Scott-Conner, MD, PhD
Professor of Surgery University of Iowa Carver College of Medicine Iowa City, Iowa
Chassin’s Operative Strategy in Colon and Rectal Surgery
Illustrations by Casper Henselmann
Carol E.H. Scott-Conner, MD, PhD Professor of Surgery University of Iowa Carver College of Medicine Iowa City, IA 52242 USA
Library of Congress Control Number: 2006930265
ISBN-10: 0-387-33043-7 ISBN-13: 978-0387-33043-3
Printed on acid-free paper.
© 2006 Springer Science+Business Media, LLC Reprinted from Carol E.H. Scott-Conner: Chassin’s Operative Strategy in General Surgery, third edition, copyright 2002 Springer Science+Business Media, LLC.
All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of informa­tion storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identifi ed as such, is not to be taken as an expression of opinion as to whether or not they are subject to propri­etary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omis­sions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Printed in the United States of America. (BS/MVY)
9 8 7 6 5 4 3 2 1
springer.com
To Harry
Carol E.H. Scott-Conner
To Charlotte
Jameson L. Chassin
More than half of the fi rst volume of Chassin’s Operative Strategy in General Surgery, introduced in 1980, was devoted to surgery of the small and large
intestine and anorectum. This unusually rich and detailed coverage was maintained and even expanded in subsequent editions. The “big” Chassin’s has become an invaluable resource for the surgical community.
In recent years, colorectal surgery has become a specialty unto itself, practiced by both colorectal and general surgeons. This volume, Chassin’s Operative Strategy in Colon and Rectal Surgery, seek to provide the gold standard content of the large volume with the focus and specifi city needed by colorectal surgeons. Practiced clinicians, fellows, and residents will all fi nd valuable clinical guidance in these chapters.
Colorectal surgery is a rapidly-evolving surgical fi eld. Since the last edition of the full volume of Chassin’s, laparoscopic colon surgery has become the new standard of care for many patients. Thus, we have added four new, previously unpublished chapters to this new volume:
• laparoscopic right hemicolectomy
• laparoscopic left hemicolectomy
• laparoscopic abdominoperineal resection and total proctocolectomy with end ileostomy
• laparoscopic stoma construction and closure

Preface

Written by Steven D. Wexner, these new chapters provide the reader with the latest techniques in colorectal surgery. In addition to the clear, compre­hensive text, these new chapters are enhanced by 52 lavish new illustrations by Caspar Henselmann, the skilled artist whose work has illuminated every edition of this text.
It is our hope that the reader will fi nd Chassin’s Operative Strategy in Colon and Rectal Surgery a useful distillation of the best of the “old” and the “new” strategies and techniques in colorectal surgery.
Carol E.H. Scott-Conner, MD, PhD
ix
Contents
Preface ix Contributors xv
Part I
Large Intestine
1
Concepts in Surgery of the Large Intestine 3
Danny M. Takanishi and Fabrizio Michelassi
Benign Conditions 3 Malignant Conditions 9 Intestinal Pouch Reservoirs 17 Intestinal Stomas 17 Postoperative Care 19 Cancer Surveillance 20 Pouch Surveillance 20 References 21
2
Right Colectomy for Cancer 25
Indications 25 Preoperative Preparation 25 Pitfalls and Danger Points 25 Operative Strategy 25 Operative Technique (Right and Transverse Colec­tomy) 29 Postoperative Care 37 Complications 41 References 41
3
Laparoscopic Right Hemicolectomy 42
Steven D. Wexner and Susan M. Cera
Indications 42 Preoperative Preparation 42 Pitfalls and Danger Points 42 Operative Strategy 42 Operative Technique 43 Postoperative Care 49 Complications 49 References 49
4
Left Colectomy for Cancer 50
Indications 50 Preoperative Preparation 50 Pitfalls and Danger Points 50 Operative Strategy 50 Operative Technique 53 Postoperative Care 73 Complications 73 References 73
5
Laparoscopic Left Hemicolectomy 74
Steven D. Wexner
Indications 74 Preoperative Preparation 74 Pitfalls and Danger Points 74 Operative Strategy 74 Operative Technique 74 Postoperative Care 85 Complications 85 References 85
6
Low Anterior Resection for Rectal Cancer 86
Indications 86 Preoperative Preparation 86 Pitfalls and Danger Points 86 Operative Strategy 86 Operative Technique 91 Postoperative Care 117 Complications 117 References 118
7
Abdominoperineal Resection for Rectal Cancer 119
Indications 119 Preoperative Preparation 119 Pitfalls and Danger Points 119 Operative Strategy 119
xi
xii Contents
Operative Technique 121 Postoperative Care 134 Complications 134 References 135
8
Laparoscopic Abdominoperineal Resection and Total Proctocolectomy with End Ileostomy 136
Steven D. Wexner and Giovanna M. DaSilva
Abdominoperineal Resection 136 Indications 136 Preoperative Preparation 136 Pitfalls and Danger Points 136 Operative Technique 136 Total Proctocolectomy with End Ileostomy 143 Indications 143 Preoperative Preparation 143 Pitfalls and Danger Points 143 Operative Technique 143 Complications 149 Postoperative Care 149
9
Subtotal Colectomy with Ileoproctostomy or Ileostomy and Sigmoid Mucous Fistula 150
Indications 150 Preoperative Preparation 150 Pitfalls and Danger Points 150 Operative Strategy 150 Operative Technique 150 Postoperative Care 158 Complications 158 References 158
10
Ileoanal Anastomosis with Ileal Reservoir Following Total Colectomy and Mucosal Proctectomy 159
Indications 159 Contraindications 159 Preoperative Preparation 159 Pitfalls and Danger Points 159 Operative Strategy 159 Operative Technique 161 Postoperative Care 169 Complications 169 References 169
11
Abdominoperineal Proctectomy for Benign Disease 170
Indications 170 Preoperative Preparation 170 Pitfalls and Danger Points 170 Operative Strategy 170 Operative Technique 170 Postoperative Care 174 Complications 174 References 174
12
End-Ileostomy 175
Indications 175 Pitfalls and Danger Points 175 Operative Strategy 175 Operative Technique 175 Postoperative Care 179 Complications 179 Reference 179
13
Loop Ileostomy 180
Indications 180 Pitfalls and Danger Points 180 Operative Strategy 180 Operative Technique 180 Postoperative Care 182 Complications 182 References 182
14
Cecostomy: Surgical Legacy Technique 183
Indications 183 Preoperative Preparation 183 Pitfalls and Danger Points 183 Operative Strategy 183 Operative Technique 183 Postoperative Care 185 Complications 185 Reference 185
15
Transverse Colostomy 186
Indications 186 Preoperative Preparation 186 Pitfalls and Danger Points 186 Operative Strategy 186
Contents xiii
Operative Technique 186 Postoperative Care 188 Complications 188 References 189
16
Closure of Temporary Colostomy 190
Indications 190 Preoperative Preparation 190 Pitfalls and Danger Points 190 Operative Strategy 190 Operative Technique 190 Postoperative Care 194 Complications 194 References 194
17
Laparoscopic Stoma Construction and Closure 195
Dan Enger Ruiz and Steven D. Wexner
Indications 195 Preoperative Preparation 195 Pitfalls and Danger Points 195 Operative Strategy 195 Operative Technique 195 Postoperative Care 211 Complications 211 References 211
Complications 222 References 222
Part II
Anus, Rectum, and Pilonidal Region
20
Concepts in Surgery of the Anus, Rectum, and Pilonidal Region 225 Amanda M. Metcalf
Clinical Conditions: Symptoms and Management Concepts 230 References 231
21
Rubber Band Ligation of Internal Hemorrhoids 232
Indications 232 Pitfalls and Danger Points 232 Operative Strategy 232 Operative Technique 232 Postoperative Care 233 Complications 234 References 234
22
18
Operations for Colonic Diverticulitis (Including Lower Gastrointestinal Bleeding) 212
Indications 212 Preoperative Preparation 212 Operative Strategy 212 Operative Technique 212 References 216
19
Ripstein Operation for Rectal Prolapse 217
Indications 217 Preoperative Preparation 217 Pitfalls and Danger Points 217 Operative Strategy 217 Operative Technique 217 Postoperative Care 222
Hemorrhoidectomy 235
Indications 235 Contraindications 235 Preoperative Preparation 235 Pitfalls and Danger Points 235 Operative Strategy 235 Operative Technique 236 Postoperative Care 243 Complications 243 References 243
23
Anorectal Fistula and Pelvirectal Abscess 244
Indications 244 Preoperative Preparation 244 Pitfalls and Danger Points 244 Operative Strategy 244 Operative Technique 246 Postoperative Care 254 Complications 254 References 255