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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1393_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Preface
- •Contents
- •Contributors
- •Progression of Sepsis
- •Recurrent Abscess
- •Delayed Wound Healing
- •Wound Contraction Deformities
- •Iatrogenic Fistula
- •Chronic Fistula
- •Incontinence
- •Part II: Prevention Strategies
- •A Practical Approach to Anorectal Infections
- •1 Surgery for Anorectal Abscess
- •Complications of Surgery for Cryptoglandular Anorectal Infections
- •Introduction
- •Part I: Complications
- •Neurovascular Injuries
- •Persistent Sepsis
- •The Role of Adjunctive Imaging
- •Conclusions
- •Fournier’s Gangrene Complications, Prevention, and Treatment
- •Etiology
- •Symptoms and Signs
- •References
- •2 Fistulotomy
- •Introduction
- •Complications of Fistulotomy
- •Setons—A Method to Prevent Incontinence with Fistulotomy?
- •High Versus Low Fistulotomy
- •Other Complications of Fistulotomy
- •Finding the Internal Opening
- •Cancer
- •Crohn’s Disease
- •The Non-healing Wound
- •References
- •3 Anorectal Fistula Surgery: Sphincter Sparing Operations
- •Fibrin Sealant
- •Brief Description
- •Results
- •Incontinence
- •Abscess
- •Unique Complications
- •Implications for Further Treatment
- •Anal Fistula Plugs
- •Brief Description
- •Results
- •Incontinence
- •Abscess
- •Unique Complications
- •Implications for Further Treatment
- •Flaps (Endorectal Advancement Flap and Dermal Advancement Flap)
- •Brief Description
- •Results
- •Incontinence
- •Unique Complications
- •Implications for Further Treatment
- •LIFT Procedure
- •Brief Description
- •Results
- •Incontinence
- •Unique Complications
- •Implications for Further Treatment
- •References
- •4 Hemorrhoids
- •Complications of Excisional Hemorrhoidectomy
- •Pain
- •Perianal Infiltration of Local Anesthetics
- •Liposomal Bupivacaine
- •Catheter Delivery Systems
- •NSAIDS and Cox-2 Inhibitors
- •Acetaminophen
- •Metronidazole
- •Glyceryl-Tri-Nitrate (GTN)
- •Urinary Retention
- •Postoperative Hemorrhage
- •Early Hemorrhage
- •Late or Delayed Hemorrhage
- •Infection
- •Anal Stenosis
- •Mucosal Ectropion
- •Incontinence
- •Constipation
- •Complications of Stapled Hemorrhoidopexy
- •Pain
- •Infectious Complications
- •Genitourinary Complication
- •Defecatory Complications
- •Bleeding
- •“Air Leaks”
- •Rectovaginal Fistula
- •Staple Line Dehiscence
- •Complication of Sutured Hemorrhoidopexy
- •Non-excisional Hemorrhoidectomy
- •Introduction
- •Anatomy and Grading System
- •Excision of Thrombosed External Hemorrhoids
- •Complication of Excision of Thrombosed External Hemorrhoid
- •Early Complications
- •Late Complications
- •Rubber Band Ligation for Internal Hemorrhoids
- •Complications of Rubber Band Ligation Complications
- •Early Complications
- •Late Complications
- •Infrared Coagulation
- •Complications of Infrared Coagulation
- •Early Complications
- •Late Complications
- •Injection Sclerotherapy
- •Complications of Injection Sclerotherapy
- •Early Complications
- •Late Complications
- •Suture Hemorrhoidopexy
- •Complications of Suture Hemorrhoidopexy
- •Early Complications
- •Late Complications
- •LigaSureTM Hemorrhoidectomy
- •Complications of LigaSureTM Hemorrhoidectomy
- •Early Complications
- •Late Complications
- •Laser Hemorrhoidectomy
- •Complications of Laser Hemorrhoidectomy
- •Early Complications
- •Late Complications
- •Cryotherapy
- •Complications of Cryotherapy
- •Early Complications
- •Late Complications
- •Traditional Chinese Medicine
- •Hemorrhoids and Cancer
- •References
- •5 Anal Fissure
- •Incontinence, a History
- •Myths Concerning Fissure and Incontinence
- •What Else?
- •References
- •6 Pilonidal Cyst
- •Overview
- •Management
- •Conservative Approaches
- •Surgical Approach
- •Complications
- •Misdiagnosis
- •References
- •7 Hidradenitis Suppurativa
- •Delayed Healing and Its Management
- •Fistulas
- •Anal Stricture
- •Recurrence of Perianal Hidradenitis Suppurativa After Surgical Treatment
- •Squamous Cell Carcinoma Arising in Hidradenitis Suppurativa
- •The Microbiology of Hidradenitis Suppurativa
- •Summary
- •References
- •8 Perineal Repair of Rectal Prolapse
- •What Are the Options?
- •Altemeier Procedure
- •Trans-Anal Evisceration After Perineal Proctectomy
- •Ischaemia
- •Bleeding
- •Stricture, etc
- •Delorme Procedure
- •Reports Comparing Two or More Procedures
- •Thiersch
- •Staples
- •Randomized Controlled Trials
- •References
- •9 Rectocele Repair (ODS)
- •Complications After STARR and How to Deal with Them
- •Common Complications
- •Failure to Resolve ODS
- •Faecal Urgency and Incontinence
- •Persistent Pain
- •Bleeding and Haematoma Formation
- •Urinary Retention
- •Stricturing
- •Rarer Complications
- •Conclusion
- •Complications of Rectocele Repair
- •Introduction
- •Presentation and Workup
- •Surgical Approaches and Their Complications
- •Transvaginal Approach
- •Transrectal Approach
- •Transperineal Approach
- •Medical Management
- •Summary
- •References
- •10 Complications of Rectovaginal Fistula Repair
- •Introduction
- •Anatomy
- •Perineal Body
- •Sphincter Complex
- •Puborectalis Muscle
- •Pubococcygeus Muscle
- •Levators
- •Deep Transverse Perineal Muscle
- •Superficial Transverse Perineal Muscle
- •Bulbospongiosus Muscle
- •Rectovaginal Septum
- •General Complications Related to the Repair of RVF
- •Recurrence
- •Bleeding
- •Sepsis
- •GI Complications
- •Genitourinary Complication
- •Complications Related to Particular Repairs
- •Transanal Approaches
- •Rectal Advancement Flap
- •Rectal Sleeve Advancement
- •Vaginal Advancement Flap
- •Dermal Advancement Flap
- •Fistulectomy with Layer Closure
- •Plug Repair
- •Fibrin Glue
- •Transperineal Approaches
- •Ligation of Intersphincteric Fistula Tract
- •Sphincteroplasty (with and Without Levatorplasty) with Repair of Fistula
- •Episioproctotomy
- •Transperineal Anatomical Deconstruction with Layered Anatomical Closure
- •Transperineal Repair with Gracilis Muscle Interposition
- •Martius Flap
- •Indocyanine Green
- •Mesh Interposition
- •Transabdominal Operations
- •Bricker Procedure
- •Pull-Through Procedures
- •Omental Interposition
- •Diversion
- •Conclusion
- •References
- •11 Incontinence
- •Introduction
- •Etiology and Evaluation of Fecal Incontinence
- •Treatment of Fecal Incontinence
- •Surgical Anal Sphincter Repair
- •Outcomes
- •Complications
- •Sacral Nerve Stimulation
- •Outcomes
- •Complications
- •Magnetic Anal Sphincter
- •Outcomes
- •Complications
- •Ventral Rectopexy for Fecal Incontinence
- •Outcomes
- •Complications
- •Vaginal Bowel-Control System for Fecal Incontinence
- •Outcomes
- •Complications
- •Rectal Sling for the Treatment of Fecal Incontinence
- •Outcomes
- •Complications
- •Injection Therapy
- •Outcomes
- •Complications
- •Gatekeeper™ Sphincter Augmentation
- •Outcomes
- •Complications
- •Summary
- •References
- •12 Transanal Excision of Rectal Tumor (TEM or TAMIS)
- •Bleeding
- •Incomplete Excision, Fragmentation, and Local Recurrence
- •Urinary Retention
- •Pelvic Sepsis
- •Anal Stricture/Stenosis
- •Urethral Injury
- •Miscellaneous Complications
- •Strategies for Prevention of Complications in Transanal Surgery
- •Bleeding
- •Fragmentation of Lesion
- •Urinary Retention
- •Pelvic Sepsis
- •Anal Stricture/Stenosis
- •References
- •13 Anal Stenosis
- •Introduction
- •Treatment
- •Non-operative Treatment
- •Operative Treatment
- •Flaps
- •Other Techniques
- •Special Consideration: Stenosis in Children
- •Choice of Procedure for Treatment (Table)
- •Conclusion
- •References
- •14 Retrorectal Cyst
- •Introduction
- •Anatomy
- •Differential Diagnosis and Classification
- •Developmental Cysts
- •Malignant Tumors
- •Other Entities
- •Diagnosis and Preoperative Management
- •Preoperative Biopsy
- •Surgical Management
- •Surgical Approach
- •Complications
- •Preoperative Complications
- •Intraoperative and Postoperative Complications
- •Bleeding
- •Rectal Injury/Perforation
- •Infection
- •Incomplete Resection/Recurrence
- •Bowel/Bladder/Sexual/Neurologic
- •Conclusions
- •References
- •15 York Mason Procedure
- •Complications and Management
- •Wound Infections
- •Fecal Fistula
- •Bleeding
- •Fecal Incontinence
- •Recurrences
- •References
- •16 Pull-Through Procedures
- •Introduction
- •Bleeding
- •Anastomotic Disruption
- •Operative Interventions
- •Nonoperative Interventions
- •Chronic, Non-healing Cavity
- •Reconstruction
- •Anastomotic Stricture
- •Prolapse
- •Long-Term Results for Continence and Emptying in Children
- •Conclusion
- •References
- •17 Perineal Wound Post APR
- •Introduction
- •Type of Reconstruction
- •Simple Closure
- •The Rectus Abdominis Musculocutaneous Flap (Figs. 17.3 and 17.4)
- •The Gluteus Maximus Flap
- •The Gracilis Musculocutaneous Flap
- •Pelvic Floor Reconstruction with Biological Mesh
- •Omentoplasty
- •Is There an Optimal Way to Reconstruct the Pelvic Floor and Perineum After an APR?
- •Type of Complications
- •Management of Complications
- •Summary
- •References
- •Index

Herand Abcarian · Jose Cintron
Richard Nelson Editors
Complications of
Anorectal Surgery
Prevention
and Management
123

Complications of Anorectal Surgery

Herand Abcarian•Jose Cintron
Richard Nelson
Editors
Complications
of Anorectal Surgery
Prevention and Management
123

Editors
Herand Abcarian
Division of Colon and Rectal Surgery
University of Illinois at Chicago
Chicago, IL
USA
Jose Cintron
Division of Colon and Rectal Surgery
John H. Stroger Jr. Hospital of Cook County
Chicago, IL
USA
Richard Nelson
Epidemiology/Biometry Division, School of
Public Health
University of Illinois at Chicago
Chicago, IL
USA
ISBN 978-3-319-48404-4 ISBN 978-3-319-48406-8 (eBook)
DOI 10.1007/978-3-319-48406-8
Library of Congress Control Number: 2016954713
© Springer International Publishing AG 2017
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part
of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission
or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are exempt from
the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this
book are believed to be true and accurate at the date of publication. Neither the publisher nor the
authors or the editors give a warranty, express or implied, with respect to the material contained herein or
for any errors or omissions that may have been made.
Printed on acid-free paper
This Springer imprint is published by Springer Nature
The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

We would like to dedicate this book to a dear
friend and recently deceased colleague,
Leela M Prasad, whose wisdom was seldom
withheld, spot on and always greatly appre-
ciated, and also one of the finest surgeons we
all have ever seen.

Preface
There are many texts in which we can find techniques of various anorectal procedures. The interested surgeon can easily find descriptions and illustrations of each
surgical technique. However, what is more difficult to find is the prevention and
treatment of many complications following anorectal operations.
Complications of surgical procedures are without a doubt the greatest source of
disquiet for every surgeon. We never feel more alone when one of our patients has
suffered a complication that has caused them suffering and never more comforted
when we find that our mates have experience with the same complication. It is one
of the major purposes of our annual clinical congresses: conversation, commiseration, consolation, a.k.a., GOBAGSATT (good old boys—and girls—sitting around
talking trash) and ultimately education.
We present in this book the complications that have been suffered by our own
patients and/or by those of our closest friends. Some are common and can only be
avoided most of the time. Others are rare, and in some cases just weird. But if it has
happened once, it will happen twice. Many can be prevented, which we hope to
facilitate with this book.
Chicago, IL, USA Herand Abcarian, M.D.
Chicago, IL, USA Jose Cintron, M.D.
Chicago, IL, USA Richard Nelson, M.D.
vii

Contents
1 Surgery for Anorectal Abscess .............................. 1
Adrian E. Ortega, Timothy F. Feldmann, Ariane M. Abcarian
and Herand Abcarian
2 Fistulotomy
............................................. 29
Richard Nelson
3 Anorectal Fistula Surgery: Sphincter Sparing Operations
Marc Singer
4 Hemorrhoids
............................................ 61
Jose Cintron, Ariane M. Abcarian, Herand Abcarian,
Kristine Makiewicz and Marc I. Brand
5 Anal Fissure
............................................. 109
Richard Nelson
6 Pilonidal Cyst
........................................... 119
Sany Thomas and Johan Nordenstam
7 Hidradenitis Suppurativa
.................................. 133
Jacqueline Harrison and Francois Dagbert
8 Perineal Repair of Rectal Prolapse
.......................... 147
Richard Nelson
9 Rectocele Repair (ODS)
................................... 161
Steven Brown, Salvador G. Guevara and Linda M. Farkas
10 Complications of Rectovaginal Fistula Repair
.................. 181
Slawomir Marecik, Ariane M. Abcarian and Leela M. Prasad
11 Incontinence
............................................. 209
Christina Warner and Anders Mellgren
........ 39
12 Transanal Excision of Rectal Tumor (TEM or TAMIS)
Kunal Kochar and Vivek Chaudhry
......... 227
ix

x Contents
13 Anal Stenosis ............................................ 235
Jennifer Blumetti
14 Retrorectal Cyst
......................................... 247
Kristen Donohue and Nell Maloney Patel
15 York Mason Pro cedure
.................................... 265
Ariane M. Abcarian and Herand Abcarian
16 Pull-Through Procedures
.................................. 277
Kristin Vercillo and Jennifer Blumetti
17 Perineal Wound Post APR
................................. 297
Torbjörn Holm
Index
...................................................... 319

Contributors
Ariane M. Abcarian Division of Colon and Rectal Surgery, John H. Stroger
Hospital of Cook County, Chicago, IL, USA
Herand Abcarian Division of Colon and Rectal Surgery, University of Illinois at
Chicago, Chicago, IL, USA
Jennifer Blumetti Colon and Rectal Surgery Residency Program, Stroger Hospital
of Cook County, Chicago, IL, USA
Marc I. Brand Section of Colon and Rectal Surgery, Department of General
Surgery, Rush University Medical Center, Chicago, IL, USA
Steven Brown Thornbury Hospital, Sheffield, South Yorkshire, UK
Vivek Chaudhry Division of Colon and Rectal Surgery, John H. Stroger Hospital
of Cook County, Chicago, IL, USA
Jose Cintron Division of Colon and Rectal Surgery, John H. Stoger Hospital of
Cook County, Chicago, IL, USA
Francois Dagbert Division of Colon and Rectal Surgery, John H. Stroger Hospital
of Cook County, Chicago, IL, USA
Kristen Donohue Department of Surgery, Rutgers: Robert Wood Johnson Medical School, New Brunswick, NJ, USA
Linda M. Farkas Division of Colon and Rectal Surgery, Department of Surgery,
University of California, Davis, Sacramento, CA, USA
Timothy F. Feldmann Capital Medical Center, Olympia, WA, USA
Salvador G. Guevara Division of Colon and Rectal Surgery, Department of
Surgery, University of California, Davis, Sacramento, CA, USA
Jacqueline Harrison Division of Colon and Rectal Surgery, John H. Stroger
Hospital of Cook County, Chicago, IL, USA
Torbjörn Holm Department of Molecular Medicine and Surgery, Karolinska
Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden
xi

xii Contributors
Kunal Kochar Division of Colon and Rectal Surgery, John H. Stroger Hospital of
Cook County, Chicago, IL, USA
Kristine Makiewicz Section of Colon and Rectal Surgery, Department of General
Surgery, Rush University Medical Center, Chicago, IL, USA
Nell Maloney Patel Department of Surgery, Rutgers: Robert Wood Johnson
Medical School, New Brunswick, NJ, USA
Slawomir Marecik Division of Colon and Rectal Surgery, Advocate Lutheran
General Hospital, Park Ridge, IL, USA; Division of Colon and Rectal Surgery,
University of Illinois at Chicago, Chicago, IL, USA
Anders Mellgren Division of Colon and Rectal Surgery, Department of General
Surgery, University of Illinois at Chicago, Chicago, IL, USA
Richard Nelson Epidemiology/Biometry Division, School of Publi c Health,
University of Illinois at Chicago, Chicago, IL, USA
Johan Nordenstam Division of Colon and Rectal Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
Adrian E. Ortega LAC+USC Medical Center, University of Southern California,
Los Angeles, CA, USA
Leela M. Pra sad Division of Colon and Rectal Surgery, Advocate Lutheran
General Hospital, Park Ridge, IL, USA; Division of Colon and Rectal Surgery,
University of Illinois at Chicago, Chicago, IL, USA
Marc Singer Division of Colon and Rectal Surgery, Rush University Medical
Center, Chicago, IL, USA
Sany Thomas Division of Colon and Rectal Surgery, Department of Surgery,
University of Illinois at Chicago, Chicago, IL, USA
Kristin Vercillo Colon & Rectal Surgery Resident, Stroger Hospital of Cook
County, Chicago, USA
Christina Warner Department of General Surgery, University of Illinois at
Chicago, Chicago, IL, USA
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