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I.M.SechenovFirstMoscowStateMedicalUniversity Moscow,Russia
MichaelA.Valente,DO,FACS,FASCRS
AssistantProfessorofSurgery ProgramDirector,ColorectalSurgeryResidency DepartmentofColorectalSurgery ClevelandClinic Cleveland,Ohio
BrianT.Valerian,MD,FACS,FASCRS
AssociateProfessorofSurgery DepartmentofSurgery SectionofColonandRectalSurgery AlbanyMedicalCollege Albany,NewYork
H.DavidVargas,MD,FASCRS
StaffSurgeonandColonRectalSurgeryFellowshipProgramDirector DepartmentofColonandRectalSurgery OchsnerClinicFoundation StaffSurgeonandMedicalDirectorEndoscopyServices DepartmentofColonandRectalSurgery OchsnerMedicalCenter NewOrleans,Louisiana
ChristinaV.Warner,MD
ResearchFellow DivisionofColonandRectalSurgery SurgicalResident DepartmentofSurgery UniversityofIllinoisatChicago Chicago,Illinois
MartinR.Weiser,MD,FACS,FASCRS
ProfessorofSurgery DepartmentofSurgery WeillCornellMedicalSchool AttendingSurgeon DepartmentofSurgery
MemorialSloanKetteringCancerCenter NewYork,NewYork
EricG.Weiss,MD,FACS,FASCRS,FACG
AffiliateProfessorandAffiliateDean FloridaAtlanticUniversityCollegeofMedicine ClinicalProfessorandAffiliateDean FloridaInternationalUniversityCollegeofMedicine ClinicalProfessor DepartmentofSurgery NovaSoutheasternUniversity’sCollegeofAllopathicMedicine ClinicalAssistantProfessorofSurgery ClevelandClinicLernerCollegeofMedicineofCaseWesternReserve
University ChiefAcademicOfficer EducationCenterDirector DIOandChairmanofGraduateMedicalEducation AssociateResidencyProgramDirector,ColorectalResidency DepartmentofColorectalSurgery ClevelandClinicFlorida Weston,Florida
YuxiangWen,MD
DepartmentofSurgery UniversityofMississippiMedicalCenter Jackson,Mississippi
StevenD.Wexner,MD,PhD(Hon),FACS,FRCS,FRCS(Ed),
FRCSI(Hon),FASCRS,FACG
Director,DigestiveDiseaseCenter Chair,DepartmentofColorectalSurgery ClevelandClinicFlorida Weston,Florida AffiliateProfessor FloridaAtlanticUniversityCollegeofMedicine BocaRaton,Florida ClinicalProfessor FloridaInternationalUniversityCollegeofMedicine Miami,Florida
AffiliateProfessor UniversityofSouthFloridaCollegeofMedicine Tampa,Florida ProfessorofSurgery OhioStateUniversity Columbus,Ohio
CharlesB.Whitlow,MD,FACS,FASCRS
Chairman DepartmentofColonandRectalSurgery OchsnerMedicalCenter NewOrleans,Louisiana
MatthewZ.Wilson,MD,MSc,FACS
AssistantProfessorofSurgery DepartmentofSurgery DartmouthHitchcockMedicalCenter Lebanon,NewHampshire
JoshuaH.Wolf,MD
DepartmentofSurgery SinaiHospital Baltimore,Maryland
AlbertM.Wolthuis,MD,FACS,FASCRS
AssistantProfessor DepartmentofAbdominalSurgicalOncology CatholicUniversityofLeuven—FacultyofMedicine ClinicalHead DepartmentofAbdominalSurgery UniversityHospitalsLeuven Leuven,Belgium
CindyWu,MD
StaffSurgeon DepartmentofSurgery WellSpanHealthGoodSamaritanHospital Lebanon,Pennsylvania
HeatherYeo,MD,MHS,FACS,FASCRS
AssistantProfessorofSurgery DepartmentofSurgery WeillCornellMedicine AttendingSurgeon DepartmentofSurgery NewYorkPresbyterian-WeillCornellMedicalCenter NewYork,NewYork
ToniaYoung-Fadok,MD,MS,FACS,FASCRS
ProfessorofSurgery DivisionofColonandRectalSurgery MayoClinic Phoenix,Arizona
W
ForewordtotheFirstEdition
eliveinahigh-technologyworldwherethe“miracles”ofmodern surgerymakeheadlinenewsaroundtheglobe.Itisnolonger
surprisingtohearofyetanotherstart-upmedicaltechnology companythatpromisesanewsurgicaldevicethatwillsavecountless lives,improveoutcomes,andsignificantlydecreasepainandsuffering. Peoplefindthemselvesmesmerizedbywatching“keyholesurgery” broadcastinhighdefinitiontotheirhometelevisionandfindit surprisinglyelegantandbloodlesscomparedwiththeirpriormental pictureofsurgeonsatwork.Soitisperhapsunderstandablethatmany patientstodaygoonlinetofindsurgeonsandinstitutionsofferingthe newestapproachesandlatesttechnology.Itseemsasthoughthemodern surgeonarmedwithhigh-techdevicesanddigitalizedequipmentshould beinvincible.Indeed,itiseasyforsurgeonstobeinappropriatelyswept upbythesirensongoftechnicalinnovation.
Inthiskindofworld,onemightquestiontheutilityofyetanother surgicaltextbook,especiallyonedevotedtooperativetechnique. Fortunately,editorsStevenWexnerandJamesFleshmanhavecreateda uniquepublicationthatisafarcryfromthetraditionaltextbookofthe past.Thelistofcontributingauthorsincludesseasonedmastersurgeons schooledintraditionaltechniquesandhighlyinnovativeresearchersand entrepreneurswhoareexploringnewfrontiersofsurgicaltechnology. Overthecourseoftheirbusyclinicalcareers,theeditorsthemselveshave successfullybridgedbothperspectives.Theiruniqueexperiencesare apparentinthisnew,tightlyeditedandhighlypracticaltextbookthat emphasizestriedandtrueopentechniquesandnew,lessinvasive techniques.
Drs.WexnerandFleshmanunderstandthatsurgicaloutcomesare dependentonmanyfactorsincludingclinicalacumenandmature judgmenttoguideindividualizeddecisionmaking.Buttheyalsoknow thatsurgeonsmustmasterbasicoperativeskillsanddevelopafull reservoirofdifferenttechniquesthatcanbeusedtofitthedemandsof thecaseathand.Asimportantly,theyknowthatnomatterhow revolutionaryorexciting,technologyhasitslimits.Innovationis providingnewtools,butitisthesurgeon’sskillindecidingwhattoolsto useandthewayinwhichtheyareusedthatdeterminesthesurgical outcome.Operativetechniqueremainscriticaltominimizepatient morbidity,curecancerandotherlife-threateningconditions,and preservefunctionandqualityoflife.Allcolonandrectalsurgeonswill findthisbooktobeavaluableadjuncttotheirpractice.Theartist’scolor drawingsaresuperbandanatomicallycorrect.Thetextiseasytoread,
veryfocused,andusefulforbusysurgeons.Icongratulatetheeditorsfor bringingthisbooktous.
DavidA.Rothenberger,MD
August1,2011
S

Foreword

urgeryisbothanartandascience,andthereisnosubstitutefor acquiringbothknowledgeandskilltothehighestlevelforthebest
outcomesforourpatients.Whenwetalkaboutmasteringasubject wemeanjustthis.Masterycomesfromrepeatingandrefininga procedureuntilitisasgoodaswecangetit.Inthisweneedthehelpand guidanceofmastersurgeons,andtheseexcellenttwovolumesprovide justthat.Inthissecondedition,thetechniqueshavebeenbroughtright uptodatewithstep-by-stepdescriptionsoftheessentialoperationsin colorectalsurgerybycarefullychosenexpertsintheirfield.Itislavishly illustrated,andthereisaccesstoacompanionwebsitewithanimage bankandvideosoftheprocedures.SteveWexnerandJimFleshmanhave doneagreatjobinrevisingandrenewingthisoutstandingcoupleof volumesintheMasterTechniquesseries.
NeilMortensen
Oxford,UnitedKingdom
August7,2017
T
PrefacetotheFirstEdition
heMasteryofColorectalSurgerytextbookisatwo-volume compendiumthatdemonstratesvirtuallyallofthecurrently
employedtechniquesforabdominalandanorectalsurgery.Allof thechaptershavebeenwrittenbyinternationallyacclaimedexperts,each ofwhomwasgivenliterarylicensetoallowthebooktobemorecreative andlessrigorouslyformatted.Althoughsometechniquesareself­explanatoryandtheauthorsthereforeconcentratedtheirverbiageupon resultsandcontroversiessurroundingaparticulartechnique,other proceduresaredescribedinamorealgorithmicmanner.Specifically, sometechniquesrequireamuchmoreheavilyweighteddescriptionof preoperativeand/orpostoperativeparametersratherthanintraoperative variables.Thematchingofillustrationsandvideoshasalsobeentailored tosuittheneedsofeachchapter.Becauseofthequantityofmaterial,the bookisdividedintotwovolumes:onethatincludestheabdominaland theotherthatincludesanorectalprocedures.Whilemanytextbooksvie fortheattentionofsurgeonsintrainingandsurgeonsinpractice,the Masteryseries,editedbyDr.JosefFischer,hasestablisheditselfasthe resourceforexpertmanagementofeachtheme.Therefore,thisbookwas deliberatelycraftedtoaugmentratherthantoreplaceseveralother excellentrecentlypublishedtextbooks.Itisourhopethatthesevolumes beusedinthatcontext,sothatthereadercanlearnthefundamentalsand basicsusingmanyotherexcellentsourcematerialsandthenrelyupon theMasteryofColorectalSurgerybooksformoreclarityintermsof reviewofveryspecificprocedures.Inthatsamemanner,thesebooks performareadypreoperativeresourcebeforeembarkinguponindividual procedures.
WewishtothankJosefFischerwithhavingentrusteduswiththis latestofhisliteraryoffspring.Theprojecttookaconsiderableamountof timeandeffort,andwecertainlythankhimforhispatience.Inaddition, wethankourrespectivestaffinWestonandinSaintLouis,especiallyLiz Nordike,HeatherDean,Dr.FabioPotenti,andDebbieHoltonfortheir extensiveeffortsaswellasNicoleDernoskiatWoltersKluwer.Wewish toexpressoursincerestanddeepestgratitudetoeachandevery contributorfortheirtime,attention,expertise,andcommitmenttothe project.Withoutourindividualchapterauthors,thisworkwouldnot exist.Weknowthateachofthemhasmanysignificantcompeting obligationsfortheirlimitedtimeandthankthemforhavingparticipated tosuchanimportantdegreeinthisproject.Last,ourappreciationgoesto ourfamiliesfortheirloveandsupportasitisalwaystimeawayfrom themthatallowsustoproducethesetypesofbooks.Inparticular,
appreciationgoestoLindaFleshmanandtoWesleyandTrevorWexner.
StevenD.Wexner
JamesFleshman
S

Preface

ixyearshaveelapsedsincewepublishedthetwovolumesofMaster TechniquesinGeneralSurgeryonColorectalSurgeryincluding
anorectalandabdominaloperations.Owingtotheoverwhelming popularityofthatbook,wearepleasedandproudtoofferyouthissecond edition.Weareindebtedtotheauthorsandcoauthorsofthe117chapters inthesetwovolumes.Wehopethatyouwillagreewithusthatthesetwo volumesprovidebeautifullyillustrated,authoritativelywrittenchapters aboutvirtuallyeverycurrentlypracticedcolorectalsurgicaltechnique.
Wehaveendeavoredtomakeeachchapterrelativelyfocusedrather thanbroad,andtheauthorshave,asrequested,presentedclinically relevantmaterialthatcanbereadilydigested.Wehavedeliberately avoidedpublishingacomprehensivecompendiumabouteachsubject. Thus,manyareasareaddressedwithmultiplechapterseachofwhichhas itsownveryspecificviewandoffersclinicalguidanceonthebasisof practicalexpertise.Althoughthepreferencesoftheauthorsvary,many facetswithinthesetwovolumesarequiteconsistentincludingtheworld­renownednatureoftheauthorsandcoauthors,theconsistentlyhigh qualityoftheartwork,andthestyleofthechapters.Wehopethatreaders willagain,aswasthecasewiththefirstedition,findthesecondeditionof thesetwovolumestobeanexcellentclinicalresourceoftenconsultedfor bothpatientmanagementandacademicendeavors.
Weagainthanktheauthorsandcoauthorsofthese117chaptersfor theirtime,efforts,energy,expertise,andcooperationwiththeauthor guidelines,whichenabledustoofferyouthissecondedition.
StevenD.Wexner
JamesFleshman