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ABBREVIATIONS
Medical Terms
ABS Artificial bowel sphincter
AFAP Attenuated variant of familial adenomatous polyposis
AIN Anal intraepithelial neoplasia
APR Abdominoperineal resection
ARDS Acute respiratory distress syndrome
ASA Context-dependent: acetylsalicylic acid (medication)
ASA Context-dependent: American Society of Anesthesiologists ( risk classification)
ASCA Anti-Saccharomyces cerevisiae antibodies (Crohn disease marker)
ASCUS Atypical squamous cells of uncertain significance
ATZ Anal transitional zone
BE Barium enema
BRBPR Bright red blood per rectum
CBC Complete blood count
CEA Carcinoembryonic antigen
CHRPE Congenital hypertrophy of the retinal pigment epithelium
CMV Cytomegalovirus
CT Computed tomography
DALM Dysplasia-associated lesion or mass (in ulcerative colitis)
DIC Disseminated intravascular coagulation
DVT Deep vein thrombosis
EAS External anal sphincter
EGD Esophagogastroduodenoscopy
EMG Electromyogram
ERUS Endorectal ultrasound
FAP Familial adenomatous polyposis
FIQL Fecal incontinence quality of life score
5-FU 5-Fluorouracil
GERD Gastroesophageal reflux disease
GI Gastrointestinal
GIST Gastrointestinal stromal tumor
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GYN Gynecologic
HAART Highly active antiretroviral therapy
HIV Human immunodeficiency virus
HNPCC Hereditary nonpolyposis colon cancer (Lynch I/II)
H&P History and physical (examination)
HPF High-power field (microscopy)
HPV Human papillomavirus
HSIL High-grade squamous intraepithelial lesions
HSV Herpes simplex virus
IAS Internal anal sphincter
IBD Inflammatory bowel disease (Crohn disease, ulcerative colitis, indeterminate colitis)
IBS Irritable bowel syndrome
ICU Intensive care unit
I&D Incision and drainage (abscess)
IMA Inferior mesenteric artery
IMRT Intensity-modulated radiation therapy
IMV Inferior mesenteric vein
IPAA Ileal J-pouch anal anastomosis
IPS Irritable pouch syndrome
IRA Ileorectal anastomosis
LAR Low anterior resection
LBO Large bowel obstruction
LGV Lymphogranuloma venereum
LIS Lateral internal sphincterotomy
LLQ Left lower quadrant
LSIL Low-grade squamous intraepithelial lesions
LUQ Left upper quadrant
LV Leucovorin
MACE Malone antegrade colonic enema
MAP MYH-associated polyposis
MELD Model for end-stage liver disease
MRCP Magnetic resonance cholangiopancreatography
MRI Magnetic resonance imaging
MRSA Methicillin-resistant Staphylococcus aureus
MSI Microsatellite instability
MSM Men who have sex with men
MSS Microsatellite stability
NGT Nasogastric tube
NPO Nothing by mouth (nulla per os)
NSAID Nonsteroidal anti-inflammatory drug
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O&P Ova and parasites
OR Operating room
pANCA Perinuclear antineutrophil cytoplasmic antibodies (marker for ulcerative colitis)
PC/IPAA Proctocolectomy/ileal J-pouch anal anastomosis
PE Pulmonary embolism
PET Positron emission tomography
PET-CT Positron emission tomography combined with CT
PID Pelvic inflammatory disease
POD Postoperative day
PPD Purified protein derivative (tuberculosis test)
PPH Procedure for prolapse and hemorrhoids
PSARP Posterior sagittal anorectoplasty
PSC Primary sclerosing cholangitis
PT Prothrombin time
PTT Partial thromboplastin time
RAIR Rectoanal inhibitory reflex
RBC Red blood cell
RLQ Right lower quadrant
RUQ Right upper quadrant
SBO Small bowel obstruction
SCC Squamous cell cancer
SCFA Short-chain fatty acids
SMA Superior mesenteric artery
SMV Superior mesenteric vein
SRUS Solitary rectal ulcer syndrome
STD Sexually transmitted disease
TEM Transanal endoscopic microsurgery
TIPS Transjugular intrahepatic portosystemic shunt
TME Total mesorectal excision
TNM Tumor nodes metastases (tumor staging system)
TPN Total parenteral nutrition
UC Ulcerative colitis
VAC Vacuum-assisted closure
WBC White blood cells
XRT Chemoradiation
Oncological Outcome Parameters
DFS Disease-free survival
NED No evidence of disease (cancer follow-up)
ORR Objective response rate (sum of complete and partial response)
OS Overall survival
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PFS Progression-free survival
TTP Time to tumor progression
Organizations
ACCP American College of Chest Physicians
ACPGBI Association of Coloproctology of Great Britain and Ireland
ASCRS American Society of Colon and Rectal Surgeons
ESCP European Society of Coloproctology
EORTC European Organization for Research and Treatment of Cancer
ISUCRS International Society of University Colon and Rectal Surgeons
NCI National Cancer Institute (USA)
NIH National Institutes of Health (USA)
SCIP Surgical Care Improvement Project
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Authors
Andreas M. Kaiser
Associate Professor of Clinical Colorectal Surgery
USC Department of Colorectal Surgery
Keck School of Medicine, University of Southern California
Los Angeles, California
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McGraw-Hill Manual: Colorectal Surgery
Andreas M. Kaiser
Preface Copyright Authors
Abbreviations
Chapter 1
Symptoms and Differential Diagnosis
Chapter 2
Evaluation Tools
Chapter 3
Anatomy and Physiology
Chapter 4
Diseases and Problems
Chapter 5
Operative Techniques
Chapter 6
Nonsurgical Management
Chapter 7
Perioperative Management
Appendix I
Medications
Appendix II
Diagnostic Guides
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Copyright Information
McGraw-Hill Manual: Colorectal Surgery
Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Printed in the United States of America. Except as
permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form
or by any means, or stored in a data base or retrieval system, without the prior written permission of the publisher.
ISBN 978-0-07-159070-9
MHID 0-07-159070-6
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and
drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their
efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication.
However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any
other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in
every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from
use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other
sources. For example and in particular, readers are advised to check the product information sheet included in the package of each
drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been
made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in
connection with new or infrequently used drugs.
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Preface
Healthcare with its high degree of specialization, the rapid and dynamic technical revolution, and fast-pace day-to-day activities has
become increasingly complex and demanding at all levels of providers. Colorectal Surgery—as the historically first subspecialty
within the realm of surgery to establish its own training programs and board certification—is no exception. Margins for making
mistakes have decreased, while the daily pressure continues to increase with shortened hospitalizations and more rapid patient
turnovers. Doing the right thing in a particular situation means knowing about possible strategies and alternatives with their likely
outcomes.
There are numerous excellent, very comprehensive textbooks on colorectal surgery which remain the backbone of in-depth study
and knowledge acquisition. For a rapid “double-check review” of the evidence, the amount of available data and information from
these and other heavy -weight sources tends to be overwhelming. The role of a short and concise handbook is never designed to
replace the standard textbooks but to complement them and to provide a handy, quick, and well organized “on-the-move” reference
when there is no time to halt.
The McGraw-Hill Manual in Colorectal Surgery is intended to serve as this quick, highly structured notes-style source of information
about colorectal diseases and their management. The book is written for established colorectal surgeons, general surgeons, and
other specialists likewise, as well as for students, residents, and fellows in those areas, who deal with patients, prepare/study for an
operation or presentation, or need a rapid refresher text for the boards or maintenance of certification (MOC) exams. The content
was chosen such that the major areas of the colorectal core curriculum are covered according to national and professional
guidelines. The central focus and point of view is the one of colorectal surgery, whereas covering every possible detail and common
general surgery principles would have been beyond the scope of this manual.
The text is divided in seven chapters plus two appendices:
Symptoms and Differential Diagnosis
Evaluation Tools
Anatomy and Physiology
Diseases and Problems
Operative Techniques
Nonsurgical Management
Perioperative Management
Appendix I Medications
Appendix II Diagnostic Guides
Topics in each of these chapters are written in notes-style format. To avoid lengthy sentences, the arrow symbol (→) is liberally
used as a logical downstream linker to indicate what follows—logically, medically, anatomically, in pathogenesis, or with regards to
the management. Common abbreviations used throughout the text are explained in the appendix.
The text follows a predictable structure to allow the reader to focus on all aspects of a particular topic or just the parts relevant to
their momentary needs. The content covers the majority and all relevant aspects outlined in the curriculum for colorectal
residencies, defines the standard of care according to published guidelines, and highlights ongoing controversies within colorectal
surgery. Furthermore, it provides a description of the most common surgical procedures of the specialty in a step-by-step fashion.
Where applicable, ICD-9 codes have been added to the topic headings. In addition to the table of contents, cross references to
chapters with related topics are placed at the bottom of each topic in order to facilitate navigation within the text and book.
Illustrations are not the main focus of this guide, but are incorporated for selected key aspects that benefit from the visual support.
The author and the publisher are equally aware of the changing preferences and interpersonal variability in the way information is
carried around and accessed these days. The traditional print edition in pocket-size format will therefore be supplemented with
alternate e-media formats (eg, AccessSurgery)—(a) to follow an increasing demand, and (b) with the intent to maintain accuracy of
the information by timely updates and revisions. Regardless of the chosen medium, the readers are advised to consult more
extensive information where needed to gain adequate detail in specific areas. Recommendations for selection and dosing of
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medications can only serve as a general idea, but will always need to be verified before being applied to an individual patient's
care.
Andreas M. Kaiser, MD FACS
Los Angeles, California
March 2008