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- •Dedication
- •Contributors
- •Foreword
- •Preface
- •Contents
- •Indications/Contraindications
- •Surgery
- •Conclusion
- •Indications/Contraindications
- •Complications
- •Results
- •Surgery
- •Complications
- •Results
- •Conclusions
- •Surgery
- •Complications
- •Results
- •Conclusion
- •Indications/Contraindications
- •Surgery
- •Complications
- •Results
- •Conclusions
- •Indications/Contraindications
- •Surgery
- •Results
- •Conclusions
- •Indications/Contraindications
- •Surgery
- •Complications
- •Results
- •Conclusions
- •Indications/Contraindications
- •Surgery
- •Indications/Contraindications
- •Surgery
- •Complications
- •Results
- •Conclusions
- •Indications/Contraindications
- •Surgery
- •Complications
- •Results
- •Conclusions
- •Introduction
- •Surgery
- •Conclusions
- •Surgery
- •Indications
- •Surgery
- •Complications
- •Conclusions
- •Indications/Contraindications
- •Surgery
- •Complications
- •Results
- •Conclusions
- •Indications/Contraindications
- •Surgery
- •Outcomes
- •Complications
- •Indications/Contraindications
- •Surgery
- •Complications
- •Results
- •Conclusions
- •Indications
- •Contraindications
- •Surgery
- •Complications
- •Conclusion
- •Indications/Contraindications
- •Surgery
- •Complications
- •Cost
- •Results
- •Conclusions
- •Surgery
- •Complications
- •Results
- •Conclusions
- •Introduction
- •Surgery
- •Complications
- •Results
- •Conclusions
- •Introduction
- •Conclusions
- •Introduction
- •Indications/Contraindications
- •Surgery


Colonand
RectalSurgery
AbdominalOperations

Colonand
Rectal
Surgery
Abdominal
Operations
SECOND
EDITION
EDITEDBY
StevenD.Wexner,MD,PhD(Hon),FACS,
FRCS,FRCS(Ed),FRCSI(Hon),FASCRS,
FACG
Director,DigestiveDiseaseCenter
Chair,DepartmentofColorectalSurgery
ClevelandClinicFlorida
Weston,Florida
AffiliateProfessor
FloridaAtlanticUniversityCollegeofMedicine
BocaRaton,Florida
ClinicalProfessor
FloridaInternationalUniversityCollegeof
Medicine
Miami,Florida
AffiliateProfessor
UniversityofSouthFloridaCollegeofMedicine
Tampa,Florida
ProfessorofSurgery
OhioStateUniversity
Columbus,Ohio
JamesW.Fleshman,MD,FACS,FASCRS
HelenBuchananandStanleyJosephSeeger
ProfessorandChairman
DepartmentofSurgery
BaylorUniversityMedicalCenter
ProfessorofSurgery
TexasA&MHealthSciences
Dallas,Texas
SERIESEDITOR
JosefE.Fischer,MD,FACS,DM(Hon)

Lund,FRCS(E)(Hon)
WilliamV.McDermottDistinguishedProfessor
ofSurgery
HarvardMedicalSchool
ChristianR.HolmesProfessorofSurgeryand
Chair
DepartmentofSurgery
UniversityofCincinnatiCollegeofMedicine,
Emeritus
Chair,DepartmentofSurgery
BethIsraelDeaconessMedicalCenter,
Emeritus
Boston,Massachusetts

AcquisitionsEditor:KeithDonnellan
EditorialCoordinator:TimRinehart
EditorialAssistant:LeviBentley
MarketingManager:DanDressler
SeniorProductionProjectManager:AliciaJackson
DesignCoordinator:HollyMcLaughlin
Artist/Illustrator:BodyScientificInternational,LLC
ManufacturingCoordinator:BethWelsh
PrepressVendor:S4CarlislePublishingServices
SecondEdition
Copyright©2019WoltersKluwer.
Copyright©2012LippincottWilliams&Wilkins,aWoltersKluwer
business.Allrightsreserved.Thisbookisprotectedbycopyright.Nopart
ofthisbookmaybereproducedortransmittedinanyformorbyany
means,includingasphotocopiesorscanned-inorotherelectroniccopies,
orutilizedbyanyinformationstorageandretrievalsystemwithout
writtenpermissionfromthecopyrightowner,exceptforbriefquotations
embodiedincriticalarticlesandreviews.Materialsappearinginthis
bookpreparedbyindividualsaspartoftheirofficialdutiesasU.S.
governmentemployeesarenotcoveredbytheabove-mentioned
copyright.Torequestpermission,pleasecontactWoltersKluweratTwo
CommerceSquare,2001MarketStreet,Philadelphia,PA19103,viaemail
atpermissions@lww.com,orviaourwebsiteatlww.com(productsand
services).
987654321
PrintedinChina
LibraryofCongressCataloging-in-PublicationData
Names:Wexner,StevenD.,editor.|Fleshman,JamesW.,editor.
Title:Colonandrectalsurgery.Abdominaloperations/editedbySteven
D.Wexner,JamesW.Fleshman.
Othertitles:Abdominaloperations|Mastertechniquesinsurgery.
Description:Secondedition.|Philadelphia,PA:WoltersKluwer,[2019]|
Series:Mastertechniquesinsurgery|Includesbibliographicalreferences
andindex.
Identifiers:LCCN2017043474|ISBN9781496347237|eISBN:
9781496349002
Subjects:|MESH:Colon—surgery|Rectum—surgery|Abdomen—
surgery|DigestiveSystemSurgicalProcedures—methods
Classification:LCCRD544|NLMWI650|DDC617.5/547—dc23
LCrecordavailableathttps://lccn.loc.gov/2017043474
Thisworkisprovided“asis,”andthepublisherdisclaimsanyandall
warranties,expressorimplied,includinganywarrantiesastoaccuracy,
comprehensiveness,orcurrencyofthecontentofthiswork.
Thisworkisnosubstituteforindividualpatientassessmentbasedon

healthcareprofessionals’examinationofeachpatientandconsideration
of,amongotherthings,age,weight,gender,currentorpriormedical
conditions,medicationhistory,laboratorydata,andotherfactorsunique
tothepatient.Thepublisherdoesnotprovidemedicaladviceor
guidance,andthisworkismerelyareferencetool.Healthcare
professionals,andnotthepublisher,aresolelyresponsiblefortheuseof
thisworkincludingallmedicaljudgmentsandforanyresultingdiagnosis
andtreatments.
Givencontinuous,rapidadvancesinmedicalscienceandhealth
information,independentprofessionalverificationofmedicaldiagnoses,
indications,appropriatepharmaceuticalselectionsanddosages,and
treatmentoptionsshouldbemadeandhealthcareprofessionalsshould
consultavarietyofsources.Whenprescribingmedication,healthcare
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manufacturer’spackageinsert)accompanyingeachdrugtoverify,among
otherthings,conditionsofuse,warningsandsideeffectsandidentifyany
changesindosagescheduleorcontraindications,particularlyifthe
medicationtobeadministeredisnew,infrequentlyusedorhasanarrow
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law,noresponsibilityisassumedbythepublisherforanyinjuryand/or
damagetopersonsorproperty,asamatterofproductsliability,
negligencelaworotherwise,orfromanyreferencetoorusebyany
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LWW.com

Dedication
Thisbookisdedicatedtomyfamily:tomylatefatherIraandmymother
Arlene,foralloftheguidancethattheyhavegivenmethroughoutmylife.
InadditiontomysonsWesleyandTrevorforalthoughIhavehopefully
impartedknowledgetothem,Ihavealsoacquiredaninordinateamount
ofinsightfromthem.Furthermoretomylife-partnerDr.MarianaBerho,
forherwisdom,counsel,andespeciallylove.Thisdedicationwouldbe
incompletewithoutthankingpeoplebesidesmyfamily.Thankyou,Jim
Fleshman,fordecadesoffriendshipduringwhichwehavecollaborated
onmanyendeavorsincludingthisbook.Thankstothehundredsof
alumniwhohaveallowedmetotrytohelpthemhelptheirpatients.I
hopethatthisbookfurthersyoureducationandremindsyouofyourtime
atClevelandClinicFlorida.Thank-youtomyexecutiveassistant,Debbie
Holton,andmypublicationsassistant,ElektraMcDermott,foryour
patience,indulgence,assistance,andperseveranceinthisprojectandin
manyothersbeforeit.
StevenD.Wexner
Onecanneverrepaycompletelytheincrediblegiftthatmyfriends,
colleagues,andacquaintanceshavecontributedtothissetofbooks.As
timegoeson,Iwouldliketothinkthattheywillalllookbackwithpride
toseethatisindeedagreatcontributiontothetrainingandpracticeof
colorectalsurgery.Thank-youisnotenoughbutissincerelygiventoeach
oneofyou.ThankstoSteveWexnerforincludingmeinthiseffortandto
Dr.JosefFischerforhistrust.Iwouldliketodedicatethisbooktomy
wifeLinda,whohastoleratedmymentalabsencesthroughoutmanyof
thelastyear’sweekendsandeveningstoeditthesechapters.WhileIam
sureshewillneverreadthesebooks,shehascontributedsupportand
tolerance.JenniferHernandez,inourdepartmentatBaylorUniversity
MedicalCenter,deservesspecialmentionforherabilityandpatienceto
readmyeditsoneachmanuscriptandforkeepingtrackofthewhole
process.Thankstoyou.
JamesW.Fleshman

Contributors
PiyushAggarwal,MD
Fellow
AdvancedColorectalOncology
DepartmentofSurgery
MemorialSloanKetteringCancerCenter
NewYork,NewYork
AzahA.Althumairi,MD
Professor
DepartmentofSurgeryandUrology
ExecutiveViceChair
ChiefDivisionofColorectalSurgery
DepartmentofSurgery
JohnsHopkinsUniversity
Baltimore,Maryland
DonatoF.Altomare,MD
AssociateProfessorofSurgery
DepartmentofEmergencyandOrganTransplantation
UniversityAldoMoroofBari
AssociateProfessorofSurgery
DepartmentofEmergencyandOrganTransplantation
AziendaOspedalieroUniversitariaPoliclinicoBari
Bari,Italy
VikramAttaluri,MD,FACS,FASCRS
Partner,SCPMG
SouthernCaliforniaPermanenteMedicalGroupKaiserPermanenteLos
AngelesMedicalCenter
LosAngeles,California
Se-JinBaek,MD,PhD
ClinicalAssistantProfessor
DivisionofColorectalSurgery,DepartmentofSurgery
KoreaUniversityCollegeofMedicine

ClinicalAssistantProfessor
DivisionofColorectalSurgery,DepartmentofSurgery
KoreaUniversityAnamHospital
Seoul,Korea
DebbieBakes,MD
ClinicalFellow
DepartmentofColonandRectalSurgery
UniversityofMiami—MillerSchoolofMedicine
Miami,Florida
DavidE.Beck,MD,FACS,FASCRS
ProfessorandChairmanEmeritus
DepartmentofColonandRectalSurgery
OchsnerClinic
TheUniversityofQueenslandSchoolofMedicine
OchsnerClinicalSchool
NewOrleans,Louisiana
CigdemBenlice,MD
DepartmentofGeneralSurgery
ClevelandClinicFoundation
Cleveland,Ohio
RobertD.Bennett,MD
Fellow,ColonandRectalSurgery
DepartmentofColonandRectalSurgery
UniversityofLouisvilleSchoolofMedicine
Fellow,ColonandRectalSurgery
DepartmentofColonandRectalSurgery
UniversityofLouisvilleHospital
Louisville,Kentucky
GretaV.Bernier,MD
AssistantProfessor
DepartmentofSurgery
UniversityofWashington
Seattle,Washington
MitchellBernstein,MD,FACS,FASCRS

AssociateProfessor
DepartmentofSurgery
NYULangoneSchoolofMedicine
Chief
DivisionofColonandRectalSurgery
NYULangoneMedicalCenter
NewYork,NewYork
EdwardBorrazzo,MD,FACS
AssociateProfessorofSurgery
DepartmentofSurgery
LarnerCollegeofMedicine,UniversityofVermont
Chief,DivisionofGeneralandGastrointestinalSurgery
DepartmentofSurgery
UniversityofVermontMedicalCenter
Burlington,Vermont
CharlesE.Butler,MD,FACS
ProfessorandChairman
DepartmentofPlasticSurgery
UniversityofTexasMDAndersonCancerCenter
Houston,Texas
WinstonM.T.Chan,MD
FellowinColorectalSurgery
BaylorUniversityMedicalCenter
Dallas,Texas
ManishChand,MBBS,BSc,MBA,FRCS,PhD
AssociateProfessor
DivisionofSurgeryandInterventionalSciences
UniversityCollegeLondon
Consultant
GIServices
UniversityCollegeLondonHospital
London,UnitedKingdom
WilliamC.ChapmanJr.,MD
ResearchFellow
DepartmentofSurgery
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