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1 / 441 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 > Следующая >>>

Improved Outcomes in

Colon and Rectal Surgery

Edited by

Charles B Whitlow

David E Beck

David A Margolin

Terry C Hicks

Alan E Timmcke

Improved Outcomes in Colon and Rectal Surgery

Edited by

Charles B Whitlow MD

Program Director Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA

David E Beck MD

Chairman Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA

David A Margolin MD

Research Director Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA

Terry C Hicks MD

Associate Chairman Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA

Alan E Timmcke MD

Staff Surgeon Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA

First published in 2010 by Informa Healthcare, Telephone House, 69-77 Paul Street, London EC2A 4LQ. Informa Healthcare is a trading division of Informa UK Ltd. Registered Ofﬁce: 37/41 Mortimer Street, London W1T 3JH. Registered in England and Wales number 1072954.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP.

Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention.

A CIP record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data

Data available on application ISBN-13: 9781920071528

Orders

Informa Healthcare Sheepen Place Colchester Essex CO3 3LP UK

Telephone: +44 (0)20 7017 5540 Email: CSDhealthcarebooks@informa.com

Typeset by C&M Digitals (P) Ltd, Chennai, India Printed and bound in Great Britain by CPI, Antony Rowe, Chippenham, Wiltshire

List of Contributors v Preface ix Foreword xi

1 Preexisting conditions 1

Eric L Marderstein, Siyamek Neragi-Miandoab, and Conor P Delaney

2 Preoperative bowel preparation 14

David A Margolin and Sean Mayfield

3 Anesthesia and intraoperative positioning 19

Lebron Cooper and Larry R Hutson

4 Sepsis 27

Steven Mills and Michael J Stamos

5 Intraoperative anastomotic challenges 33

David E Beck

6 Other intraoperative challenges 44

James T McCormick and Sharon G Gregorcyk

7 Postoperative anastomotic complications 56

Daniel L Feingold

8 General postoperative complications 67

Scott R Steele and Clifford L Simmang

9 Care paths and optimal postop management 79

Surya P M Nalamati and Eric J Szilagy

10 Limitations of anorectal physiology testing 87

Thomas E Cataldo and Syed G Husain

11 Limitations of colorectal imaging studies 97

Travis J Blanchard, Wilson B Altmeyer, and Charles C Matthews

12 Transanal endoscopy 132

Terry C Hicks

13 Laparoscopic colorectal surgery 140

James W Fleshman and Jonathan S Chun

14 Medical legal issues 148

Charles F Gay Jr and Terry C Hicks

15 Miscellanous conditions 154

M Benjamin Hopkins and Alan E Timmcke

16 Quality and outcome measures 159

Janak A Parikh, Sushma Jain, Marcia L McGory, and Clifford Y Ko

17 Hemorrhoidal surgery 168

Dan R Metcalf and Anthony J Senagore

18 Nonoperative therapy for hemorrhoid disease 178

Kerry Hammond and Charles B Whitlow



contents

19 Surgery and nonoperative therapy of perirectal abscesses and anal fistulas 183

Brian R Kann and Charles B Whitlow

20 Surgery and nonoperative therapy of anal fissure 199

Jaime L Bohl and Alan J Herline

21 Surgery for pilonidal disease and hidradenitis suppurativa 215

Paula I Denoya and Eric G Weiss

22 Surgical treatment of fecal incontinence 226

Ann C Lowry and Dimitrios Christoforidis

23 Surgery for rectal prolapse 239

Steven R Hunt

24 Operative and nonoperative therapy for diverticular disease 249

R Scott Nelson and Alan G Thorson

25 Abdominal surgery for colorectal cancer 263

Jason Hall and Rocco Ricciardi

26 Transanal approaches to rectal cancer 271

Sachin S Kukreja and Theodore J Saclarides

27 Abdominoperineal resection 278

W Brian Perry, Fia Yi, Clarence Clark, and Danny Kim

28 Indications and outcomes for treatment of recurrent rectal cancer and colorectal

liver and lung metastasis 286

Harry L Reynolds Jr, Christopher T Siegel, and Jason Robke

29 Chemotherapy for colon and rectal cancer 300

Liliana Bordeianou and Judith L Trudel

30 Radiation therapy: Acute and late toxicity 306

Roland Hawkins

31 Surgery for ulcerative colitis 318

Patricia L Roberts

32 Surgery for Crohn’s disease 331

Jorge Canedo, Tolga Erim, and Steven D Wexner

33 Ostomies 349

Vance Y Sohn and Scott R Steele

34 Operative and nonoperative therapy for chronic constipation 361

Harry T Papaconstantinou

35 Colorectal trauma 375

S David Cho, Sharon L Wright, and Martin A Schreiber

36 Urologic complications of colorectal surgery 395

Scott Delacroix Jr and J Christian Winters

Index 405

List of Contributors

Wilson B Altmeyer MD

Department of Radiology Ochsner Clinic Foundation New Orleans, Louisiana USA

David E Beck MD

Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA

Travis J Blanchard MD

Department of Radiology Ochsner Clinic Foundation New Orleans, Louisiana USA

Jaime L Bohl MD

Department of Surgery Vanderbilt University Nashville, Tennessee USA

Liliana Bordeianou MD

Department of Surgery Division of General and Gastrointestinal Surgery Massachusetts General Hospital Boston, Massachusetts USA

Dimitrios Christoforidis MD

Department of Visceral Surgery, CHUV-University of Lausanne Lausanne, Switzerland

Jonathan S Chun MD

Section of Colon and Rectal Surgery Washington University School of Medicine St Louis, Missouri USA

Clarence Clark MD

Department of General Surgery Wilford Hall Medical Center and the University of Texas Health

Science Center, San Antonio Lackland AFB, Texas USA

Lebron Cooper MD

Department of Anesthiology Ochsner Clinic Foundation New Orleans, Louisiana USA

Scott E Delacroix, Jr., MD

Department of Urology Louisiana State University Health Sciences Center New Orleans, Louisiana University of Texas, MD Anderson Cancer Center Houston, Texas USA

Jorge Canedo MD

Department of Colorectal Surgery Cleveland Clinic Florida Weston, Florida USA

Thomas E Cataldo MD

Warren Alpert Medical School of Brown University Brown Program in Colon and Rectal Surgery Rhode Island Hospital/Lifespan Health System Providence, Rhode Island USA

S David Cho MD

Department of Surgery Oregon Health and Science University Portland, Oregon USA

Conor P Delaney MD MCh PhD

Department of Surgery Division of Colorectal Surgery University Hospitals Case Medical Center Cleveland, Ohio USA

Paula I Denoya MD

Department of Colorectal Surgery Cleveland Clinic Florida Weston, Florida USA

Tolga Erim MD

Department of Colorectal Surgery Cleveland Clinic Florida Weston, Florida USA



lst of contrbutors

Daniel L Feingold MD

Section of Colorectal Surgery Columbia University New York, New York USA

James W Fleshman MD

Section of Colon and Rectal Surgery Washington University School of Medicine St Louis, Missouri USA

Charles F Gay Jr

Adams and Reeds Attorneys and Counselors at Law New Orleans, Louisiana USA

Sharon G Gregorcyk MD

Texas Colon and Rectal Specialists Dallas, Texas USA

Jason Hall MD

Department of Colon and Rectal Surgery Lahey Clinic Tufts University Burlington, Massachusetts USA

Roland Hawkins MD

Radiation Oncology Ochsner Cancer Institute New Orleans, Louisiana USA

Kerry Hammond MD

Division of General Surgery Medical University of South Carolina Charleston, South Carolina USA

Alan J Herline MD

Department of Surgery Vanderbilt University Nashville, Tennessee USA

Terry C Hicks MD

Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA

Steven R Hunt MD

Colon and Rectal Surgery Section Division of General Surgery Washington University St. Louis, Missouri USA

Syed G Husain MD

Brown Program in Colon and Rectal Surgery Warren Alpert Medical School of Brown University Rhode Island Hospital/Lifespan Health System Providence, Rhode Island USA

Larry R Hutson MD

Department of Anesthiology Ochsner Clinic Foundation New Orleans, Louisiana USA

Sushma Jain MBBS MPH

David Geffen School of Medicine at UCLA Department of Surgery Los Angeles, California USA

Brian R Kann MD

Cooper University Hospital UMDNJ-Robert Wood Johnson Medical School-Camden Department of Surgery Camden, New Jersey USA

Danny Kim MD

Department of General Surgery Wilford Hall Medical Center and the University of Texas Health

Science Center, San Antonio Lackland AFB, Texas USA

Clifford Y Ko MD MS MSHS

David Geffen School of Medicine at UCLA Department of Surgery Los Angeles, California USA

Sachin S Kukreja MD

Section of Colon and Rectal Surgery Department of General Surgery Rush University Medical Center Chicago, Illinois USA

M Benjamin Hopkins MD

Department of Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA



Ann C Lowry MD

Colon & Rectal Surgery Associates Ltd St Paul, Minnesota USA

lst of contrbutors

James T McCormick DO

Department of Surgery Division of Colon and Rectal Surgery Western Pennsylvania Hospital and the Forbes Regional Campus Temple University School of Medicine Philadelphia, Pennsylvania USA

Marcia L McGory MD PhD

David Geffen School of Medicine at UCLA Department of Surgery Los Angeles, California USA

Eric L Marderstein MD MPH

Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio USA

David A Margolin MD

Colon and Rectal Surgery The Ochsner Clinic Foundation New Orleans, Louisiana USA

Charles C Matthews MD

Department of Radiology Ochsner Clinic Foundation New Orleans, Louisiana USA

Sean Mayfield MD

Colon and Rectal Surgery The Ochsner Clinic Foundation New Orleans, Louisiana USA

Dan R Metcalf MD

SMDC Health System Department of Surgery Duluth, Minnesota USA

Steven Mills MD

University of California Irvine, California USA

Surya PM Nalamati

Division of Colon and Rectal Surgery Henry Ford Health System Department of Surgery/Colon & Rectal Group Detroit, Michigan USA

R Scott Nelson DO

Colon & Rectal Surgery, Inc Omaha, Nebraska USA

Siyamek Neragi-Miandoab MD

Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio USA

Harry T Papaconstantinou MD

Department of Surgery Scott & White Hospital and Clinic Texas A&M University System Health Science Center Temple, Texas USA

Janak A Parikh MD

David Geffen School of Medicine at UCLA Department of Surgery Los Angeles, California USA

W Brian Perry MD

Department of General Surgery Wilford Hall Medical Center and the University

of Texas Health Science Center, San Antonio Lackland AFB, Texas USA

Harry L Reynolds Jr MD

University Hospital of Cleveland Cleveland, Ohio USA

Rocco Ricciardi MD MPH

Department of Colon and Rectal Surgery Lahey Clinic Tufts University Burlington, Massachusetts USA

Patricia L Roberts MD

Department of Colon and Rectal Surgery Lahey Clinic Medical Center Burlington, and Tufts University School of Medicine Boston, Massachusetts USA

J Robke MD

University Hospital of Cleveland Cleveland, Ohio USA



lst of contrbutors

Theodore J Saclarides MD

Section of Colon and Rectal Surgery Department of General Surgery Rush University Medical Center Chicago, Illinois USA

Martin A Schreiber MD

Division of Trauma and Critical Care Oregon Health and Science University Portland, Oregon USA

Christopher T Siegel MD

University Hospital of Cleveland Cleveland, Ohio USA

Anthony J Senagore MD MS MBA

Spectrum Health System Grand Rapids, Michigan USA

Clifford L Simmang MD

Texas Colon and Rectal Surgeons Dallas, Texas USA

Vance Y Sohn MD

Department of Surgery Madigan Army Medical Center Tacoma, Washington USA

Michael J Stamos MD

University of California Irvine, California USA

Alan E Timmcke MD

Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA

Judith L Trudel MD, MSc, MHPE

University of Minnesota St Paul, Minnesota USA

Eric G Weiss MD

Department of Colorectal Surgery Cleveland Clinic Florida Weston, Florida USA

Steven D Wexner MD

Department of Colorectal Surgery Ohio State University and Department of Surgery, Division of General Surgery University of South Florida College of Medicine Cleveland Clinic Florida Weston, Florida USA

Charles B Whitlow MD

Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA

J Christian Winters MD FACS

Department of Urology Female Pelvic Medicine and Reconstructive Surgery Louisiana State University Health Sciences Center New Orleans, Louisiana USA

Scott R Steele MD

Department of Surgery Madigan Army Medical Center Tacoma, Washington USA

Eric J Szilagy MD

Department of Surgery/Colon & Rectal Group Division of Colon and Rectal Surgery Henry Ford Health System Detroit, Michigan USA

Alan G Thorson MD

Colon & Rectal Surgery, Inc Omaha, Nebraska USA



Sharon L Wright MD

Department of Surgery Oregon Health and Science University Portland, Oregon USA

Fia Yi MD

Department of General Surgery Wilford Hall Medical Center and the University of Texas Health

Science Center, San Antonio Lackland AFB, Texas USA

Preface

Quality measures and outcomes are receiving greater attention by the lay and medical communities. The occurrence or mismanagement of complications often results in poor outcomes, increased cost, and signiﬁcant morbidity. Answering the call for transparency and improvement requires action by all involved in the care of patients. Collection of objective data and quality measures allows documentation of optimal care and desired outcomes while identifying areas for improvement.

The goal of this text is to present the current knowledge of outcomes, as well as the techniques for minimizing and managing complications from the common diseases and procedures of this specialty. This information will aid providers in optimizing care and encourage research in outcome and quality measurement.

Improved Outcomes of Colon and Rectal Surgery represents the collaborative efforts of many individuals. The contributing authors were selected for their knowledge of colorectal surgery and ability to present their surgical judgment and experience in written form. They represent a spectrum of experienced providers who have made signiﬁcant contributions to younger individuals who

will shape the future of their specialty. In addition to reviewing the available literature, they have described their personal approach to complications in colorectal surgery. Numerous technical descriptions and highlights from multiple discussions held in surgical locker rooms, morbidity and mortality conferences, and the hallways of conferences and symposiums have been included. Using this approach, we hope this text will provide initial guidance to the less experienced provider and stimulate additional thought and research to the more experienced provider.

The editors gratefully acknowledge the efforts of the many individuals who made this book possible. This text carries on the vision of previous editors and contributors to the ﬁrst two editions of Complications in Colon and Rectal Surgery.

Charles B Whitlow, MD

David E Beck, MD

David A Margolin, MD

Terry C Hicks, MD

Alan E Timmcke, MD



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Contents

Preface