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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_890_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Foreword
- •Preface
- •Acknowledgments
- •Contents
- •Contributors
- •A Formal Introduction
- •The Physical Examination
- •Conveying Pathology Results
- •The Team and Teaching
- •The Team’s Role
- •Educational and Informational Resources for Patients
- •Support Groups and Personal Resources
- •Counseling and Consent
- •Physical, Psychological, or Language Barriers
- •The Internet: A Double-Edged Sword
- •1: The First Encounter
- •Introduction
- •Prior to the Encounter
- •The Initial Encounter
- •Navigating a Litany “To Dos”
- •Preemptive Discussion of Potential Complications
- •The Patient’s Family
- •Communicating with Other Physicians
- •Conclusion
- •Summary Pearls
- •References
- •2: Perioperative Risk Assessment
- •Introduction
- •The Healthy Patient
- •Exercise Tolerance
- •Social Habits
- •Medications
- •Anesthetic Issues
- •Preoperative Testing
- •The Comorbid Patient
- •Consultation
- •Cardiovascular Risk Assessment and Risk Reduction
- •Pulmonary Risk Assessment and Risk Reduction
- •Chronic Renal Failure Risk Assessment and Risk Reduction
- •Diabetes Mellitus Risk Assessment and Risk Reduction
- •Hepatic Failure Risk Assessment and Risk Reduction
- •Surgical Site Infection (SSI) Risk Assessment and Reduction
- •Anastomotic Leak: Risk Assessment and Risk Reduction
- •Risk Evaluation and Informed Consent
- •Summary Pearls
- •References
- •3: Perioperative Nutrition Support in Colorectal Surgery
- •Introduction
- •Prevalence and Impact of Malnutrition
- •Patient Assessment
- •Albumin
- •Nitrogen Balance
- •Cancer Cachexia
- •Initiation of Nutritional Support
- •Nutritional Options: Enteral and Parenteral
- •Enteral Feeding
- •Early Enteral Feeding Versus NPO
- •Enteral Shortcomings
- •Aspiration
- •Feeding Tolerance
- •Enteral Complications
- •Total Parenteral Nutrition
- •Complications
- •Catheter
- •Metabolic
- •How to Write TPN
- •Enteral Versus Parenteral
- •Perioperative Management
- •Immunonutrition
- •Total Parenteral Nutrition
- •Postoperative Management
- •Summary/Pearls
- •References
- •4: Diverticulitis: Beyond the Basics
- •Introduction
- •Indications for Surgery
- •Indications for Surgery: Uncomplicated Diverticulitis
- •Risk of Subsequent Attacks of Diverticulitis After Recovery from Uncomplicated Diverticulitis
- •Risk of Developing Complicated Diverticulitis After Recovery from an Attack of Uncomplicated Diverticulitis
- •Risk of Developing Free Perforation/Risk of Requiring Emergency Surgery and Stoma After Recovery from an Episode of Uncomplicated Diverticulitis
- •Smoldering Versus Discrete Attacks of Diverticulitis
- •Severity of Disease and Indications for Surgery
- •Other Considerations in Recommending Resection
- •Risk of Recurrent Diverticulitis After Resection
- •Young Patients and Diverticulitis
- •Laparoscopy and Indications for Surgery
- •Nonoperative Management and Non-resective Treatment
- •My Recommendations for Elective Resection in the Setting of Uncomplicated Disease
- •Complicated Diverticulitis
- •Diverticular Fistulas
- •Diverticular Stricture
- •Diverticular Abscess
- •Patient Positioning
- •Approach to the Procedure
- •Exposure and Lighting
- •Initial Dissection
- •Performing the Anastomosis
- •Alternatives
- •Abdominal Wall Closure
- •Reoperation for Sepsis and Anastomotic Complications After Hartmann Takedown
- •Reoperation for Recurrent Diverticulitis
- •Conclusion
- •Summary Pearls
- •References
- •5: Carcinomatosis: Cytoreduction and Heated Intraperitoneal Chemotherapy (HIPEC) Versus Palliation
- •Perforated Diverticulitis with Purulent or Feculent Peritonitis
- •Reoperative Surgery for Diverticular Disease
- •Reoperative Surgery After Hartmann Resection
- •Timing
- •Preoperative Preparation
- •Preoperative Imaging
- •Intraoperative Considerations
- •Background, Basics, and Rationale
- •General Aspects, Epidemiology
- •Change of Paradigm
- •Anatomy and Embryology
- •History and Rationale for Intraperitoneal Drug Therapy
- •Peritoneal Cancer Index (PCI)
- •HIPEC: Technique, Rationale, and Drugs
- •Multimodal Therapy in Peritoneal Carcinomatosis
- •Second Look Concept
- •Decision Making/Preoperative Work-up
- •Indications and Interdisciplinary Tumor Board
- •Contraindications
- •Quantitative Prognostic Factors (QPIs)
- •Ethical Considerations
- •Intraoperative Work-up
- •Cytoreductive Surgery: Logistics, Strategy, and Technique
- •Oncological Planning
- •Technical Planning
- •Surgical Planning
- •Type of Disease
- •Extent and Location of Disease
- •Approach to “Critical Lesions”
- •Abdominal Wall Assessment
- •Approach to Liver Metastasis
- •HIPEC Planning
- •Anesthesia Planning
- •Nutritional Planning
- •Stoma Planning
- •Perioperative Antibiotic Prophylaxis
- •Venous Thromboembolism Prophylaxis
- •Mechanical Bowel Preparation
- •Skin Preparation
- •Operating Room
- •Induction of Anesthesia and Monitoring
- •Surgical Technique
- •Perioperative Chemotherapy
- •Early Postoperative Intraperitoneal Chemotherapy (EPIC)
- •Complete CRS Not Achievable: What Now?
- •Postoperative Considerations
- •Morbidity and Mortality
- •Complication Management and Patient Follow-Up
- •Pearls and Practical Tips in Peritoneal Cytoreductive Surgery
- •References
- •6: Metastatic Colorectal Cancer
- •Introduction
- •Multidisciplinary Approach
- •Evolution of Care
- •Indications for Operation
- •Should I Biopsy the Metastasis?
- •What Should I Do with the Primary Lesion in the Patient with Extensive Disease?
- •What Treatment Modality Should Come First?
- •The Obstructed Patient: What Now?
- •Liver
- •Lung
- •Peritoneal Metastases
- •Ovary
- •Brain
- •Controversial Points
- •The Patient with a “Near Obstruction”
- •Role of Radiation for Rectal Cancer in Patients with Stage 4 Disease
- •Technical Pearls
- •Salvage Operation
- •Palliative Care
- •Summary Pearls
- •References
- •7: Enterocutaneous Fistulas
- •Initial Evaluation
- •Controlling Sepsis
- •Managing Patient Expectations and the Importance of “Patience”
- •Evaluation of the Fistula
- •Nutritional Support
- •Postoperative Nutrition
- •Rehabilitation Phase
- •How to Control Fistula Output and Role of Adjunctive Medications
- •Creative Ways for Wound Care
- •Dealing with Medications for Underlying Disease
- •Surgical Evaluation
- •Spontaneous Closure or Not?
- •Timing of Operation
- •Reviewing the Prior Operative Notes: Does It Help?
- •Techniques
- •Preoperative Preparation
- •Surgical Approach
- •Abdominal Wall Reconstruction
- •Dealing with a Stoma
- •Follow-up
- •Postoperative Management
- •Management of Postoperative Complications
- •Wound Infection
- •Bleeding
- •Anastomotic Leakage and Recurrent Enterocutaneous Fistula
- •Who to Operate on?
- •Summary Pearls
- •References
- •8: Enteroatmospheric Fistula
- •Introduction
- •History: The Evolving Concept of EAF
- •Prevention
- •Problem: The Fascia Won’t Close Initially, Now What?
- •An Ounce of Prevention
- •Problem: So You Have an EAF (The Early Phase)
- •Diagnosis
- •Control of Sepsis and Resuscitation
- •Early Nutrition
- •Intermediate Phase
- •Nutrition
- •Pharmacologic Therapy
- •Psychiatric Implications of EAF
- •Late/Chronic Phase
- •Timing of Surgery
- •Optimization: Preparation for Surgery
- •Staged vs. Non-staged Approaches
- •Abdominal Wall Reconstruction (AWR)
- •Biologic or Synthetic Mesh
- •Summary Pearls
- •References
- •9: Technical Tips for Difficult Stomas
- •Introduction
- •Preoperative Assessment
- •Prevention of Parastomal Hernias
- •End Ostomy Creation
- •Loop Ileostomy Creation
- •End-Loop Stomas
- •Laparoscopic Ostomy Creation
- •The Obese Patient
- •The Distended Colon
- •The Compromised Stoma
- •Summary Pearls
- •References
- •10: Continent Ileostomy
- •The Continent Ileostomy: Complications, Their Management, and Its Place in the Future
- •The Kock Pouch
- •Formation of the Ileal Pouch
- •Formation of the Nipple Valve
- •Complications and Their Management
- •Early Complications
- •Late Complications
- •Management of Complications
- •Early Complications
- •Late Complications
- •Sliding of the Nipple Valve and Its Correction
- •Prolapse of Nipple Valve
- •Parastomal Hernia
- •Fistula Through the Nipple Valve
- •Miscellaneous
- •Recurrent Nipple Valve Complications
- •Ileitis (Pouchitis)
- •Epithelial Dysplasia and Cancer Risk
- •Ileal Pouch Adenomas in Patients Operated for with Familial Adenomatous Polyposis (FAP)
- •Pouch Removal
- •Criteria of Selection
- •Concluding Remarks
- •The Continent Ileostomy: Its Place in the Future
- •Summary Pearls
- •References
- •11: Rectal Prolapse: Current Evaluation, Management, and Treatment of a Historically Recurring Disorder
- •Etiology and Epidemiology of Prolapse
- •Diagnosis and Evaluation
- •Types of Operative Repair
- •Perineal Operations
- •Abdominal Operations
- •Laparoscopy and Rectal Prolapse Repair
- •Recurrence After Initial Repair
- •Recurrence After Altemeier Procedure
- •Recurrence After Abdominal Approach
- •Types of Operations for Recurrence
- •Our Treatment Preferences for Rectal Prolapse
- •Initial Rectal Prolapse
- •Perineal Proctosigmoidectomy
- •Incarcerated Rectal Prolapse
- •Concomitant Pelvic Prolapse
- •Recurrent Rectal Prolapse
- •Summary Pearls
- •References
- •12: Obstructive Defecation
- •Evaluation
- •History
- •Physical Examination
- •Endoscopy
- •Adjunctive Tests
- •Colonic Transit Study
- •Balloon Expulsion
- •Anorectal Manometry
- •Electromyography (EMG)
- •Imaging
- •Defecography
- •Perineal Ultrasound
- •Our Recommendations
- •Etiology and Treatment Options
- •Non-relaxing Puborectalis
- •Failure of Initial Management/Surgical Options
- •Our Recommendations
- •Rectoceles
- •Surgical Indications
- •Our Recommendations
- •Internal Intussusception
- •Surgical Treatment
- •Our Recommendations
- •Enterocele
- •Surgical Treatment
- •Our Recommendations
- •Sigmoidocele
- •Solitary Rectal Ulcer Syndrome (SRUS)
- •Our Recommendations
- •Persistent Symptoms
- •Sacral Nerve Stimulation
- •Summary Pearls
- •References
- •13: Fecal Incontinence
- •Evaluation
- •History
- •Physical Examination
- •Testing
- •Treatment Options
- •Conservative Management
- •Other Therapies
- •Physical Retraining (Biofeedback)
- •Anal Plug
- •Radiofrequency Energy (RFE)
- •Injectables
- •Sphincter Repair
- •Sacral Nerve Stimulation (SNS)
- •Controversies in Fecal Incontinence Management
- •Repeat Overlapping Sphincter Repair
- •Managing Expectations of Outcome
- •Is a Stoma Ever the Best Option?
- •Defects in the Internal Sphincter Only or Other Types of Lateral Sphincter Defects
- •How to Manage Concomitant Pelvic Floor Disorders (i.e., Rectal Prolapse, Rectocele) if Repairing the Sphincter
- •Future Treatments
- •Magnetic Ring
- •Anal Sling
- •Posterior Tibial Stimulation
- •Summary Pearls
- •References
- •14: Local Treatment of Rectal Cancer (TEM Versus TAMIS Versus Transanal Excision)
- •Introduction
- •Patient Selection
- •Staging the Lesion
- •Why Do Lesions Recur After Local Excision?
- •Location
- •Impact of Lymph Nodes
- •So Whom Should You Select for a Transanal Approach (for Cure)?
- •Operative Approaches
- •“Traditional” Local Excision
- •Minimally Invasive Options
- •Transanal Endoscopic Microsurgery (TEM)
- •Transanal Minimally Invasive Surgery (TAMIS)
- •The Role of Radiation Therapy
- •Summary Pearls
- •Take-Home Points
- •References
- •15: Recurrent Rectal Cancer
- •Introduction
- •Presentation
- •Preoperative Evaluation and Staging
- •Preoperative Planning
- •Physical Examination
- •Carcinoembryonic Antigen
- •Radiologic Imaging
- •Local Disease
- •Computed Tomography (CT)
- •Magnetic Resonance Imaging (MRI)
- •FDG-PET
- •Distant Disease
- •Imaging Summary Recommendations
- •Histology
- •Multimodal Therapy
- •Role of Neoadjuvant Therapy
- •Intraoperative Radiation Therapy (IORT)
- •Surgical Technique
- •Preoperative Regimen
- •Rectal Washout
- •Resection
- •Types of Procedures
- •Sacral Resections
- •Pelvic Floor Reconstruction
- •Postoperative Complications
- •Stoma
- •Oncologic Outcomes of Multimodal Therapy
- •Palliative Management
- •Radiation
- •Self-expanding Metallic Stents (SEMS)
- •Surgery: Fecal Diversion vs. Palliative Resection
- •Multidisciplinary Approach
- •Centers of Excellence
- •Summary Pearls
- •References
- •16: The Approach to the Rectal Cancer Patient with a Suspected Complete Clinical Response: Selection of Patients to the Watch and Wait Strategy
- •Introduction
- •Indications for Neoadjuvant Therapy
- •Types of Neoadjuvant Therapy
- •Assessing Tumor Response: Why?
- •Assessing Tumor Response: When and How?
- •Local Excision of the Tumor Site
- •Radiological Imaging
- •Carcinoembryonic Antigen (CEA)
- •Summary Pearls: Final Decision Management
- •Additional Therapy
- •References
- •17: Ileal Pouch Complications
- •Introduction
- •Factors Associated with Pouch Failure
- •Pelvis Sepsis
- •Evaluation of Pouch Dysfunction
- •MRI Pelvis
- •CT Enterography
- •Tests of Anorectal Physiology
- •Surgical Decision-Making
- •Intraoperative Challenges During Ileoanal Pouch Creation and Anastomosis
- •Problems with Reach of the Pouch
- •Ischemia of the Pouch
- •Problems with Stoma Creation
- •Management of Surgical Complications Related to the Pouch
- •Early Complications
- •Anastomotic Disruption and Pelvic Abscess
- •Postoperative Bleeding from the Pouch
- •Late Complications
- •Pouch-Vaginal Fistula (PVF)
- •Investigations
- •Treatment Options for PVF
- •Local Procedures
- •Advancement Flap Repair
- •Fibrin Glue, Fistula Plug, Biologic Mesh Repair, and Gracilis Muscle Interposition
- •Failure of Flap Repair
- •Perineal Pouch Advancement
- •Redo IPAA
- •Loop Ileostomy
- •Pouch-Perineal Fistula (PPF)
- •Pouch Sinus
- •Crohn’s Disease of the Pouch
- •Incontinence
- •Outlet Dysfunction
- •Pouch Prolapse
- •Leak from the Tip of the “J”
- •J-Pouch to K-Pouch (Continent Ileostomy) Conversion
- •Pouch Failure: Permanent Diversion with Pouch In Situ or Pouch Excision?
- •Cancer of the Pouch
- •Redo Pouch Surgery
- •Operative Technique
- •Summary Pearls
- •References
- •18: The Failed Anastomosis
- •The Healing Anastomosis
- •The Anatomical Perspective
- •Mucosa
- •Submucosa
- •Muscularis Propria
- •Serosa
- •The Physiologic Perspective
- •Proliferative Phase
- •Remodeling
- •Failed Anastomotic Healing
- •Tissue Perfusion
- •Macrovascular Anatomy
- •Sudeck’s Point
- •Rectal Stump
- •Microvascular Anatomy
- •Arterial Oxygen Tension
- •Summary Pearl
- •Risk Factors
- •Patient-Related
- •Poor Nutritional Status
- •Immunosuppression
- •Steroids
- •Crohn’s Disease
- •Radiation
- •Diverticulitis and Emergency Surgery
- •Peritonitis
- •“Loaded Colon”
- •Hemodynamic Instability
- •Location
- •Obesity and Male Gender
- •Operative Risk Factors
- •Blood Loss, Transfusions, and Operative Time
- •Intraoperative Complications
- •Total Mesorectal Excision (TME)
- •Tension and Splenic Flexure Mobilization
- •Drains
- •Laparoscopy
- •Omental Wrapping
- •Simultaneous Liver Resection
- •Proximal Diversion
- •Mechanical Bowel Preparation (MBP)
- •Prevention
- •Intraoperative Anastomotic Assessment
- •Laser Fluorescence Angiography
- •Intraoperative Air Leak Test
- •Intraoperative Endoscopic Assessment
- •Intraoperative Dye Test
- •Intraluminal Devices
- •Transanal Decompression Devices
- •Intraluminal Barriers
- •Compression Anastomosis
- •Extraluminal Devices
- •Managing the Failed Anastomosis
- •Anastomotic Leaks
- •Clinical Manifestations
- •Making a Timely Diagnosis
- •Determining the Appropriate Intervention
- •Symptomatic Versus Asymptomatic
- •Postoperative Sepsis
- •Presence of Diverting Ostomy
- •Diversion, Resection, and Revision
- •Suture Repair
- •Management Unique to the Crohn’s Patient
- •Management After the Acute Setting
- •Endoscopic Vacuum-Assisted Closure (Endoluminal VAC) or Endo-Sponge™
- •Fibrin Glue
- •Covered Stents
- •Transanal Repair
- •Redo Surgery
- •Anastomotic Stenosis
- •Pathophysiology
- •Symptoms and Clinical Course
- •Treatment
- •Balloon Dilation
- •Stents
- •Complete Obstruction
- •Surgical Revision
- •Anastomotic Stenosis Summary
- •References
- •19: Pelvic Bleeding
- •Introduction
- •Risk Factors for Major Bleeding
- •Prevention
- •Controlling Bleeding
- •Summary Pearls
- •References
- •20: Hemorrhoidal Disease: Postoperative Complications
- •The Hemorrhoidal Consult
- •Dietary and Bowel Habits
- •Colonoscopy
- •Antiplatelet Agents and Anticoagulants
- •“Every pain in the bottom is not a hemorrhoid” – How to deal with patients and referring providers when this is not hemorrhoids and they are convinced it is
- •Surgical Decision-Making: How to Decide on What Surgery to Do (Open, Closed, Energy, PPH, THD)
- •Transanal Hemorrhoidal Dearterialization (THD)
- •Hemorrhoidal Crisis: What Do You Decide to Do at the Time?
- •Postoperative Regimen
- •Bowel Management and Avoiding Constipation
- •Pain Control with Narcotics, NSAIDS
- •Sitz Baths: Do They Work?
- •Preoperative Counseling and Postoperative Instructions
- •Banding
- •Stapled Hemorrhoidopexy
- •Excisional Hemorrhoidectomy
- •Complications of Hemorrhoidectomy: What Are They, How Often Do They Occur, and How to Approach and Manage Them?
- •Urinary Retention
- •Hemorrhage
- •Whitehead Deformity
- •Fecal Incontinence
- •Anal Stricture
- •Chronic Open Wounds
- •Wet Anus and Pruritus Ani
- •Chronic Pain
- •Skin Tags (They Want It Flat!)
- •Recurrent Hemorrhoids
- •Banding Complications
- •Pain
- •Bleeding
- •Vasovagal Symptoms and Syncope
- •Sepsis
- •Recurrence
- •Stapled Hemorrhoidopexy (PPH)
- •Indications: When Should We Be Using This Procedure?
- •Chronic Pain
- •Recurrence
- •Sphincter Damage
- •Too Low Stapler Placement: Post-PPH Syndrome
- •Bleeding
- •Preventing Complications
- •Technical Tips: Excisional Hemorrhoidectomy
- •Patient Selection
- •Fluid Restriction (Urinary Retention)
- •Summary Pearls
- •References
- •21: Fistula-in-Ano
- •Background
- •Pathophysiology
- •Evaluation and Workup
- •History
- •Physical Examination
- •Imaging Studies
- •Fistulography
- •CT Scan
- •Endoanal Ultrasound
- •Treatment
- •General Principles
- •Operative Management
- •Lay-Open Technique (Fistulotomy)
- •Setons
- •Anorectal Advancement Flap
- •Fibrin Glue
- •Anal Fistula Plug
- •LIFT Procedure
- •Fistulectomy
- •Dermal Flaps
- •Results
- •My Approach
- •Complications
- •Incontinence
- •Recurrence
- •Special Considerations
- •Extrasphincteric Fistula
- •Crohn’s Disease
- •Fistula-in-Ano in the HIV-Positive Patient
- •Rectourethral Fistulas
- •Summary Pearls
- •References
- •22: Anal Intraepithelial Neoplasia (AIN)/High-Grade Squamous Intraepithelial Lesion (HSIL)
- •Introduction and Controversy
- •Lack of Adoption
- •HSIL and Anal Cancer: The Problem
- •Treatment
- •High-Resolution Anoscopy (HRA): Initial Examination and Technique
- •Dealing with Recurrence
- •Coding
- •Follow-Up
- •Topical Agents
- •Infrared Coagulation
- •Vaccination
- •Special Situations: The HIV (+) Patient
- •Anal Cytology and Screening/ Surveillance Intervals
- •Final Thoughts
- •Summary Pearls
- •References
- •23: Chronic Anal Pain
- •Introduction
- •Acute Anal Pain
- •Thrombosed External Hemorrhoid (Fig. 23.1)
- •Anal Fissure (Fig. 23.3)
- •Anorectal Abscess/Fistula (Fig. 23.4)
- •Acute or Chronic Anal Pain
- •Hidradenitis Suppurativa (Fig. 23.6)
- •Pruritus Ani (Fig. 23.7)
- •Retrorectal Tumors
- •Bicycle Seat Issues
- •Prostatitis
- •Constipation
- •Gynecological Sources
- •Proctitis/Pouchitis
- •Radiation
- •Anorectal Stricture
- •Anal Cancer
- •Foreign Bodies
- •Rectal Prolapse
- •Neurogenic Pain
- •Infectious Causes of Anal Pain (Table 23.2)
- •Gonorrhea
- •Herpes Simplex, Genitalis, and Zoster
- •Syphilis
- •H . ducreyi (Chancroid)
- •Chlamydia (LGV)
- •Chronic Anal Pain
- •Levator Spasm
- •Epidemiology
- •Management
- •Coccygodynia
- •Pudendal Neuralgia
- •Summary Pearls
- •References
- •24: Complex Pilonidal Disease and Acute and Chronic Perineal Wounds: Point – Counterpoint
- •Surgical Management of Complex or Recurrent Pilonidal Sinus
- •Pilonidal Cystectomy Combined with Fasciocutaneous Advancement Flap
- •My Approach (Dr. Orangio)
- •A Case of Recurring Draining Sinuses
- •Healing by Secondary Intention (Dr. Abcarian)
- •My Approach (Dr. Abcarian)
- •Point: Counterpoint
- •Dr. Abcarian and Dr. Orangio
- •Management of the Perineal Wound
- •Disease Process
- •Low Rectal Cancer and Anal Canal Cancer
- •Management of the Nonhealing Chronic Perineal Wounds
- •Disease Process
- •Nonoperative Treatment
- •Operative Management
- •Summary Pearls
- •References
- •26: The Morbidly Obese Patient
- •Introduction
- •Abdominal Obesity: Not All Obesity Is the Same
- •Preoperative Evaluation
- •Systems-Based Evaluation and Prevention Tips
- •Laparoscopic Colectomy in the Obese Patient
- •Lesion Localization
- •The Value of Your Assistant
- •Patient Setup, Port Placement, and Exposure
- •Dissection Techniques
- •Specimen Extraction and Ideal Wound Placement
- •The Role of Hand-Assisted Laparoscopic Colectomy in the Obese Patient
- •Technical Considerations
- •Pelvic Dissection
- •Ileal Pouch-Anal Anastomosis (IPAA) in the Obese Patient
- •Rectal Cancer in the Obese Patient
- •Anorectal Surgery in the Obese Patient
- •Anorectal Fistulas
- •Sphincteroplasty
- •Hemorrhoidectomy
- •Summary Pearls
- •References
- •27: The Pediatric Patient
- •Introduction
- •Anorectal Disease
- •Perianal Abscess and Fistula-in-Ano
- •Hemorrhoids
- •Anal Fissure
- •Rectal Prolapse
- •Constipation
- •Evaluation
- •Treatment
- •Surgery: Sphincter Procedures, Antegrade Continence Enema, and Stoma
- •Incontinence
- •Functional Non-retentive Fecal Soiling
- •Anorectal Malformations
- •Spinal Pathology
- •Sphincter Damage
- •Anorectal Crohn’s Disease
- •Crohn’s Colitis
- •Ileocolic Crohn’s Disease
- •Chronic Ulcerative Colitis
- •Ulcerative Colitis Emergencies
- •Polyposis Syndromes
- •Summary Pearls
- •Examination
- •Preoperatively and Intraoperatively
- •Postoperatively
- •Conclusion
- •References
- •28: Functional Problems Following Colorectal Surgery
- •Introduction
- •Scope of the Problem
- •Colectomy
- •Proctectomy
- •Rectal Cancer
- •Ulcerative Colitis and Familial Cancer Syndromes
- •Anorectal Procedures
- •Prolapse Surgery
- •Management
- •Diarrhea
- •Fecal Incontinence
- •Constipation/Obstructed Defecation
- •Summary Pearls
- •References
- •29: Short Bowel Syndrome
- •Introduction
- •Pathophysiology
- •Small Intestinal Resection
- •Loss of the Ileocecal Valve
- •Loss of the Colon
- •Crohn’s Disease
- •Mesenteric Ischemia
- •Radiation Enteritis
- •Clinical Manifestations
- •Diagnosis and Assessment
- •Medical Management
- •Parenteral Nutrition
- •Complications Associated with Long-Term Parenteral Nutrition
- •Enteral Nutrition and Oral Diet
- •Pharmacologic Agents
- •Growth Factors
- •Surgical Management
- •Restoration of Intestinal Continuity
- •Procedures to Slow Intestinal Transit
- •Procedures to Lengthen Residual Bowel
- •Other Non-transplant Procedures
- •Small Bowel Transplantation
- •Future Directions
- •Outcomes
- •Summary Pearls
- •References
- •30: The Intraoperative Consult
- •Initial Mindset
- •Initial Evaluation
- •Positioning
- •Initial Survey
- •Examination
- •Exposure/Operative Procedure
- •Common Intraoperative Consults
- •Extensive Adhesions
- •Injury to Large or Small Bowel
- •Injury to Rectum
- •Mass
- •Cancer and Polyps
- •Endometriosis
- •Meckel’s Diverticulum
- •Presacral Bleeding
- •Ischemic Bowel
- •Vaginal Delivery Complications
- •Endoscopic Complications
- •Intraoperative Conditions
- •Laparoscopic Approach Desired
- •Not Marked for a Stoma
- •Damage Control: How Do You Bail?
- •Communication with Family
- •Legal Issues and Documentation
- •Summary Pearls
- •References
- •31: Laparoscopic Complications
- •Introduction
- •Tips to Avoiding Complications at the Beginning
- •Positioning
- •Dealing with the Small Bowel
- •Trocar- and Instrument-Related Injuries
- •Unique Complications: Right Colectomy
- •Exposure
- •Identifying the Correct Dissection Plane
- •Identifying/Handling the Duodenum
- •Major Vascular Pedicle Ligation
- •The Right Ureter
- •Unique Complication: Sigmoidectomy
- •Exposure/Mobilization of the Left Kidney
- •Identifying the Ureter
- •Splenic Flexure
- •Redo Operation and Conversion
- •Summary Pearls
- •References
- •32: Laparoscopy, Robotics, and Endoscopy
- •Laparoscopy: Introducing Technology in Colorectal Surgery
- •Hand-Assisted Laparoscopic Surgery (HALS)
- •Future Direction: Robotic Technology
- •Single-Incision Laparoscopy Surgery
- •Evolving Endoscopic Techniques
- •Endoscopic Mucosal Resection (EMR)
- •Endoscopic Submucosal Dissection (ESD)
- •Combining Laparoscopy and Endoscopy
- •The Cost of New Technology
- •Summary Pearls, Patient Selection, and Personal Preferences
- •Conclusion
- •References
- •33: Technical Aspects
- •Introduction
- •Intestinal Anastomosis
- •Stapled Versus Hand Sewn and Single Versus Double Layer


Contents
Part I Preoperative
1 The First Encounter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Lee E. Smith and Anjali S. Kumar
2 Perioperative Risk Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
W. Donald Buie and Anthony R. MacLean
3 Perioperative Nutrition Support in Colorectal Surgery. . . . . . . . . . . . . . . . . . . . 29
Justin A. Maykel
Part II The Abdomen
4 Diverticulitis: Beyond the Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Patricia L. Roberts
5 Carcinomatosis: Cytoreduction and Heated Intraperitoneal Chemotherapy
(HIPEC) Versus Palliation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Björn L.D.M. Brücher, Avital Itzhak, Anton Bilchik, Aviram Nissan,
and Alexander Stojadinovic
6 Metastatic Colorectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Steven Mills and Michael J. Stamos
7 Enterocutaneous Fistulas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Willem A. Bemelman and Marja M. Boermeester
8 Enteroatmospheric Fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Eric Keith Johnson
9 Technical Tips for Diffi cult Stomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Alia Whitehead, Adrian Seah, and Peter Cataldo
10 Continent Ileostomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Leif Hultén and Helge E. Myrvold
Part III The Pelvis
11 Rectal Prolapse: Current Evaluation, Management, and Treatment
of a Historically Recurring Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Dana M. Hayden and Steven D. Wexner
12 Obstructive Defecation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Ann C. Lowry and Jennifer Lynn Irani
13 Fecal Incontinence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Tracy L. Hull
xi

xii
14 Local Treatment of Rectal Cancer (TEM Versus TAMIS Versus
Transanal Excision) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
John H. Marks and Harry Reynolds
15 Recurrent Rectal Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Todd D. Francone and Martin R. Weiser
16 The Approach to the Rectal Cancer Patient with a Suspected
Complete Clinical Response: Selection of Patients to the Watch
and Wait Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Rodrigo O. Perez and Angelita Habr-Gama
17 Ileal Pouch Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Ravi Pokala Kiran and Victor W. Fazio
18 The Failed Anastomosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Nathan Smallwood, Matthew G. Mutch, and James W. Fleshman
19 Pelvic Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Amit Merchea and Bruce G. Wolff
Part IV Anorectal Disease
20 Hemorrhoidal Disease: Postoperative Complications . . . . . . . . . . . . . . . . . . . . . 313
Stefan D. Holubar and David E. Rivadeneira
Contents
21 Fistula-in-Ano. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
David E. Beck
22 Anal Intraepithelial Neoplasia (AIN)/High-Grade Squamous
Intraepithelial Lesion (HSIL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Mark Lane Welton
23 Chronic Anal Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
Richard P. Billingham and Amir L. Bastawrous
24 Complex Pilonidal Disease and Acute and Chronic Perineal Wounds:
Point – Counterpoint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
Herand Abcarian and Guy Robert Orangio
Part V Special Situations
25 Considerations in the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Joshua I.S. Bleier and Robert D. Fry
26 The Morbidly Obese Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Jonathan E. Efron and H. David Vargas
27 The Pediatric Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
Tiffany Tanner, Nathan P. Zwintscher, Robert A. Cusick, and Kenneth S. Azarow
28 Functional Problems Following Colorectal Surgery. . . . . . . . . . . . . . . . . . . . . . . 435
Lillias Holmes Maguire, Stanley Goldberg, and Liliana Bordeianou
29 Short Bowel Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447
Ilun Yang and Robin P. Boushey
30 The Intraoperative Consult. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463
H. Randolph Bailey and Terah C. Isaacson

Contents
xiii
31 Laparoscopic Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477
Joongho Shin and Sang W. Lee
32 Laparoscopy, Robotics, and Endoscopy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Deborah S. Keller and Conor P. Delaney
33 Technical Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
Bradley Davis and Janice F. Rafferty
34 Colon and Rectal Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517
Matthew J. Martin and Carlos V.R. Brown
35 When Vascular Surgery Calls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 545
Benjamin W. Starnes
Part VI Beyond the Operating Room
36 Facing Our Failures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 553
David A. Rothenberger and Howard M. Ross
37 Teaching and Training for Laparoscopic Colorectal Resection. . . . . . . . . . . . . . 565
Bradley J. Champagne and Helen MacRae
38 The Surgeon Investigator: Balancing Research and Clinical Practice . . . . . . . . 577
Nancy N. Baxter
39 Medicolegal and Ethical Dilemmas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 587
Jason D. Keune and Ira J. Kodner
40 Economic Issues Impacting Surgical Care Delivery. . . . . . . . . . . . . . . . . . . . . . . 599
Anthony J. Senagore
41 Defi ning Competence and the Role of the Board . . . . . . . . . . . . . . . . . . . . . . . . . 605
David J. Schoetz Jr.
42 Knowing When to Say “When” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611
Alan G. Thorson
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 617


Contributors
Herand Abcarian , MD, FACS Division of Colon and Rectal Surgery,
Department of Surgery , University of Illinois at Chicago, John Stroger Hospital
of Cook County , Chicago , IL , USA
Kenneth S. Azarow , MD Division of Pediatric Surgery, Department of Surgery ,
Oregon Health Science University , Portland , OR , USA
Oregon Health Science University, Doernbecher Children’s Hospital , Portland , OR , USA
H. Randolph Bailey , MD, FACS Division of Colon and Rectal Surgery , The University
of Texas Health Science Center, Methodist Hospital , Houston , TX , USA
Amir L. Bastawrous , MD, MBA, FACS, FASCRS Department of Colorectal Surgery ,
Swedish Colon and Rectal Clinic, Swedish Hospital Medical Center, Madison ,
Seattle , WA , USA
Nancy N. Baxter , MD, PhD, FRCSC, FACS Division of General Surgery ,
University of Toronto, St Michael’s Hospital , Toronto , ON , Canada
David E. Beck , MD, FACS, FASCRS Department of Colon and Rectal Surgery ,
Ochsner Clinic Foundation , New Orleans , LA , USA
Willem A. Bemelman , MD, PhD Department of Surgery , Academic Medical Center,
University of Amsterdam , Amsterdam , WZ, The Netherlands
Anton Bilchik , MD, PhD, FACS Department of Surgery , John Wayne Cancer Institute ,
Santa Monica , CA , USA
Richard P. Billingham , M.D., FACS, FASCRS Department of Colorectal Surgery ,
Swedish Colon and Rectal Clinic, Swedish Hospital Medical Center,
Madison , Seattle , WA , USA
Joshua I. S. Bleier , MD, FACS, FASCRS Division of Colon and Rectal Surgery,
Department of Surgery , Pennsylvania Hospital/Hospital of the University
of Pennsylvania, University of Pennsylvania , Philadelphia , PA , USA
Marja M. Boermeester , MD, PhD Department of Surgery , Academic Medical Center,
University of Amsterdam , Amsterdam , AZ, The Netherlands
Liliana Bordeianou , MD, MPH Department of Surgery , Massachusetts General
Hospital and Harvard Medical School , Boston , MA , USA
Robin P. Boushey , BSc, MD, PhD, CIP, FRCSC Department of Surgery ,
The Ottawa Hospital , Ottawa , ON , Canada
Carlos V. R. Brown , MD, FACS Department of Surgery ,
University of Texas Southwestern – Austin , Austin , TX , USA
xv

xvi
Björn L. D. M. Brücher , MD, PhD, FRCS (Engl), FACS
Department of Surgery , Bon Secours Cancer Institute , Richmond , VA , USA
INCORE = International Consortium of Research of the Theodor-Billroth-Academy ® ,
Richmond , VA , USA
W. Donald Buie , MD, MSC, FRCSC, FACS Department of Surgery ,
University of Calgary, Foothills Medical Centre , Calgary , AB , Canada
Peter Cataldo , MD Department of Surgery , Fletcher Allen Health Center,
University of Vermont , Burlington , VT , USA
Bradley J. Champagne, MD Division of Colon and Rectal Surgery, Department of Surgery ,
Case Western Reserve University School of Medicine, University Hospitals ,
Cleveland , OH , USA
Robert A. Cusick , MD Department of Pediatric Surgery , Children’s Hospital and Medical
Center, Omaha and University of Nebraska Medical Center , Omaha , NE , USA
Bradley Davis , MD Division of Colon and Rectal Surgery, Department of Surgery ,
University of Cincinnati , Cincinnati , OH , USA
Conor P. Delaney , MD, MCh, PhD, FRCSI, FACS, FASCRS Division of Colorectal
Surgery, Department of Surgery , University Hospitals Case Medical Center,
Case Western Reserve University , Cleveland , OH , USA
Contributors
Jonathan E. Efron , MD Ravitch Division, Department of Surgery ,
Johns Hopkins University , Baltimore , MD , USA
Victor W. Fazio , AO, MB, MS, FRACS, FACS, FRCS (Ed Hon),
MD (Pol Hon), FRCSI (Hon) Division of Colorectal Surgery, Department of Surgery ,
Cleveland Clinic Lerner College of Medicine of Case Western University,
Cleveland Clinic Foundation , Cleveland , OH , USA
James W. Fleshman , MD Department of Surgery ,
Baylor University Medical Center , Dallas , TX , USA
Todd D. Francone , MD, MPH Division of Surgery, Department of Colon and
Rectal Surgery , Lahey Clinic , Burlington , MA , USA
Robert D. Fry , MD, FACS, FASCRS Division of Colon and Rectal Surgery, Department
of Surgery , Pennsylvania Hospital, University of Pennsylvania , Philadelphia , PA , USA
Stanley Goldberg , MD Division of Colorectal Surgery, Department of Surgery ,
University of Minnesota , Minneapolis , MN , USA
Angelita Habr-Gama , MD Department of Colorectal Surgery ,
Angelita and Joaquim Gama Institute , Sao Paulo , Brazil
Department of Gastroenterology , University of São Paulo School of Medicine ,
Sao Paulo , Brazil
Dana M. Hayden , MD, MPH Department of General Surgery ,
Loyola University Medical Center , Maywood , IL , USA
Stefan. D. Holubar , MD, MS, FACS Section of Colon and Rectal Surgery ,
Dartmouth- Hitchcock Medical Center, Geisel School of Medicine at Dartmouth,
The Dartmouth Institute for Health Policy Research , Lebanon , NH , USA
Tracy L. Hull , MD Department of Colon and Rectal Surgery , Digestive Disease Institute,
The Cleveland Clinic Foundation , Cleveland , OH , USA

Contributors
xvii
Leif Hultén , MD, PhD, FACS, ACGBI (Hon), ISUCRS (Hon), SICCR (Hon)
The Colorectal Unit, Department of Surgery , Sahigrenska University Hospital SU/O ,
Goteborg , Sweden
Jennifer Lynn Irani , MD Department of Surgery , Harvard Medical School,
Brigham and Women’s Hospital , Boston , MA , USA
Terah C. Isaacson , MD Department of Colon and Rectal Surgery ,
Methodist Houston , Houston , TX , USA
Avital Itzhak , MD, FACS Department of Surgery , Bon Secours Cancer Institute ,
Richmond , VA , USA
Uniformed Services University of the Health Sciences , Bethesda , MD , USA
Eric K. Johnson , MD, FACS, FASCRS Department of Surgery ,
Madigan Healthcare System, Uniformed Services University of the Health Sciences ,
Tacoma , WA , USA
Deborah S. Keller , MD Division of Colorectal Surgery, Department of Surgery ,
University Hospitals, Case Medical Center , Cleveland , OH , USA
Jason D. Keune , MD, MBA Department of Surgery , Washington University School
of Medicine, Barnes-Jewish Hospital , St. Louis , MO , USA
Ravi Pokala Kiran , MBBS, MS (Gen Surgery), FRCS (Eng), FRCS (Glas), FACS,
MSc (EBM) Division of Colorectal Surgery, Department of Surgery ,
New York-Presbyterian/Columbia University Medical Center , New York , NY , USA
Ira J. Kodner , MD, FACS Department of Surgery , Washington University School
of Medicine, Barnes-Jewish Hospital , St. Louis , MO , USA
Anjali S. Kumar , MD, MPH, FACS Section of Colon and Rectal Surgery ,
Medstar Washington Hospital Center, Georgetown University , Washington , DC , USA
Sang W. Lee , MD, FACS, FASCRS Division of Colon and Rectal Surgery ,
Department of Surgery, Weill Cornell Medical College , New York , NY , USA
Ann C. Lowry , MD Division of Colorectal Surgery, Department of Surgery ,
University of Minnesota , Minneapolis , MN , USA
Anthony R. MacLean , MD, FRCSC, FACS Department of Surgery ,
University of Calgary, Foothills Medical Centre , Calgary , AB , Canada
Helen MacRae , MD, FRCSC, FACS, FASCRS Department of Surgery ,
Mount Sinai Hospital and University of Toronto , Toronto , ON , Canada
Lillias Holmes Maguire , MD Division of Gastrointestinal Surgery ,
Massachusetts General Hospital , Boston , MA , USA
John H. Marks , MD, FACS, FASCRS Division of Colorectal Surgery,
Department of Surgery , Main Line Health Systems, Lankenau Medical Center ,
Wynnewood , PA , USA
Division of Colorectal Surgery, Lankenau Medical Center, Wynnewood , PA , USA
Matthew J. Martin , MD, FACS Department of Surgery , Legacy Emanuel Medical Center ,
Portland , OR , USA
Department of Surgery, Madigan Army Medical Center , Tacoma , WA , USA

xviii
Justin A. Maykel, MD Division of Colorectal Surgery, Department of Surgery ,
UMass Memorial Medical Center, University of Massachusetts Medical School ,
Worcester , MA , USA
Amit Merchea , MD Division of Colon and Rectal Surgery, Department of Surgery ,
College of Medicine, Mayo Clinic , Jacksonville , FL , USA
Steven Mills , MD Department of Surgery , University of California, Irvine ,
Orange , CA , USA
Matthew G. Mutch , MD Department of Surgery, Section of Colon and Rectal Surgery ,
Washington University School of Medicine , St. Louis , MO , USA
Helge E. Myrvold , MD, PhD, SEC (Hon) Department of Cancer Research and Molecular
Medicine , Norwegian University of Science and Technology , Trondheim , Norway
Aviram Nissan , MD, FACS Department of Surgery , Hadassah-Hebrew University ,
Jerusalem , Israel
United States Military Cancer Institute , Bethesda , MD , USA
Guy R. Orangio, MD Division of Colon and Rectal Surgery, Department of Surgery ,
Louisiana State University Health Science Center, LSU School of Medicine ,
New Orleans , LA , USA
Rodrigo O. Perez , MD, PhD Division of Colorectal Surgery, Department of
Gastroenterology , University of São Paulo School of Medicine , São Paulo , Brazil
Contributors
Angelita and Joaquim Gama Institute , São Paulo , Brazil
Janice F. Rafferty , MD Division of Colon and Rectal Surgery, Department of Surgery ,
University of Cincinnati , Cincinnati , OH , USA
Harry Reynolds , MD, FACS, FASCRS Colon and Rectal Cancer Surgery ,
Case Western Reserve University, University Hospitals Case Medical Center ,
Cleveland , OH , USA
David E. Rivadeneira , MD, MBA, FACS, FASCRS Division of Colorectal Surgery ,
Huntington and Southside Hospitals Northshore/LIJ Health System, Hofstra University
School of Medicine , Huntington , NY , USA
Patricia L. Roberts , MD Division of Surgery, Department of Colon and Rectal Surgery ,
Lahey Clinic, Tufts University School of Medicine , Burlington , MA , USA
Howard M. Ross , MD, FACS, FASCRS Division of Colon and Rectal Surgery,
Department of Clinical Surgery , Temple University Health System , Red Bank , NJ , USA
David A. Rothenberger , MD, FACS, FASCRS Department of Surgery ,
University of Minnesota Medical Center, Fairview , Minneapolis , MN , USA
David J. Schoetz Jr. , MD Division of Surgery, Department of Colon and Rectal Surgery ,
Lahey Clinic, Tufts University School of Medicine , Burlington , MA , USA
Adrian Seah , MD Department of Surgery , Fletcher Allen Health Care,
University of Vermont , Burlington , VT , USA
Anthony J. Senagore , MD, MS, MBA Division of Colorectal Surgery,
Department of Surgery , Central Michigan College of Medicine , Saginaw , MI , USA
Joongho Shin , MD Department of Surgery , New York-Presbyterian/Weill Cornell
Medical Center , New York , NY , USA

Contributors
xix
Nathan Smallwood , MD Department of Surgery , Baylor University Medical Center ,
Dallas , TX , USA
Lee E. Smith , MD, FACS, FASCRS Section of Colon and Rectal Surgery ,
MedStar Washington Hospital Center, Georgetown University , Washington , DC , USA
Michael J. Stamos , MD Department of Surgery , University of California, Irvine ,
Orange , CA , USA
Benjamin W. Starnes , MD Division of Vascular Surgery, Department of Surgery ,
University of Washington , Seattle , WA , USA
Scott R. Steele, MD Division of Colon and Rectal Surgery, Department of Surgery ,
Madigan Army Medical Center , Fort Lewis , WA , USA
Alexander Stojadinovic , MD, FACS Department of Surgery , Bon Secours Cancer Institute ,
Richmond , VA , USA
Uniformed Services University of the Health Sciences , Bethesda , MD , USA
United States Military Cancer Institute , Bethesda , MD , USA
Tiffany Tanner , MD Department of Surgery , University of Nebraska Medical Center ,
Omaha , NE , USA
Alan G. Thorson , MD, FACS Division of Colon and Rectal Surgery,
Department of Surgery , Creighton University School of Medicine,
The University of Nebraska College of Medicine , Omaha , NE , USA
H. David Vargas , MD Department of Colon and Rectal Surgery ,
Ochsner Clinic Foundation , New Orleans , LA , USA
Martin R. Weiser , MD Department of Surgery , Memorial Sloan-Kettering
Cancer Center , New York , NY , USA
Mark Lane Welton , MD, MHCM, FACS, FASCRS Department of Colon
and Rectal Surgery , Stanford University School of Medicine,
Stanford Hospital and Clinics , Stanford , CA , USA
Steven D. Wexner , MD, PhD (Hon), FACS, FRCS, FRCS(Ed) Department of Colorectal
Surgery , Cleveland Clinic Florida , Weston , FL , USA
Alia Whitehead , MD Department of Surgery , Fletcher Allen Health Center,
University of Vermont , Burlington , VT , USA
Bruce G. Wolff , MD Division of Colon and Rectal Surgery, Department of Surgery ,
College of Medicine, Mayo Clinic , Rochester , MN , USA
Ilun Yang , MD, FRCSC Department of Surgery , McMaster University ,
Hamilton , ON , Canada
Nathan P. Zwintscher , MD Department of Surgery ,
Madigan Healthcare System , Tacoma , WA , USA
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