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Evidence-Based Practices in Gastrointestinal, Colorectal and Hepatobiliary Surgery
Govind Nandakumar
SECTION 1: GENERAL CHAPTERS
1:
Topics in Intraoperative Gastrointestinal Pathology for Practicing Surgeons
BACKGROUND
REVIEW
Colorectal Cancer Resection Specimens
Evaluation of Resection Margins
Evaluation of Extent of Disease
Mimics of Colorectal Carcinoma
Hepatic Resections for Primary Hepatocellular Tumors
Hepatocellular Carcinoma
Hepatocellular Adenoma
Focal Nodular Hyperplasia
Resection for Tumors of the Intrahepatic Biliary Tree
Cholangiocarcinoma
Benign Bile Duct Lesions
CONCLUSION
2:
Hepatic, Biliary and Pancreatic Imaging
IMAGING OF THE LIVER
Imaging Modalities
Fatty Liver
Hemochromatosis
Cirrhosis
LESIONS OF THE LIVER
Benign Developmental Hepatic Cyst
Hemangioma
Hepatic Abscess
Hepatocellular Carcinoma
Intrahepatic Cholangiocarcinoma
Hepatic Adenoma
Focal Nodular Hyperplasia
METASTASES
IMAGING OF THE BILIARY SYSTEM
Normal Biliary Anatomy
Introduction to Biliary Imaging
Bile Duct Dilatation
Benign Ductal Dilatation
Choledocolithiasis
Postoperative Ductal Dilatation
Primary Sclerosing Cholangitis
Choledochal Cysts
Malignant Ductal Dilatation
Ampullary Carcinoma
Cholangiocarcinoma
Pneumobilia
Normal Gallbladder Anatomy
Cholelithiasis
Acute Cholecystitis
Gallbladder Cancer
IMAGING OF THE PANCREAS
Normal Pancreas Anatomy and Variants
Imaging Modalities
Ultrasound
Computed Tomography—Multiphase
Magnetic Resonance Imaging/Magnetic Resonance Cholangiopancreatography
Secretin-Enhanced MRCP
Positron Emission Tomography/Computed Tomography
Pancreatitis
Acute
Interstitial Edematous (IEP)
Necrotizing
Pancreatic Parenchymal Necrosis Alone
Peripancreatic Necrosis Alone
Pancreatic Parenchymal Necrosis with Peripancreatic Necrosis
Pancreatic and Peripancreatic Collections
Complications
Chronic
Autoimmune
Solid Mass
Adenocarcinoma
Neuroendocrine
Cystic
Inflammatory Fluid Collections
True Cyst
Cystic Neoplasm
Serous
Mucinous
Intraductal Papillary Mucinous Neoplasm
Main-Duct IPMN
Side-Branch IPMN
Solid Pseudopapillary Neoplasm
Postoperative Appearance
Pancreaticoduodenectomy (Whipple)
Distal Pancreatectomy and Splenectomy
3:
Interventional Radiology Techniques
INTRODUCTION
PORTAL HYPERTENSION
Transjugular Intrahepatic Portosystemic Shunts
Technique and Patient Selection Criteria
Results
Complications
Balloon-Occluded Retrograde Transvenous Obliteration
Technique and Patient Selection
Results
Complications
Future Directions for Treatments of Portal Hypertension
BILIARY OBSTRUCTION
Percutaneous Transhepatic Biliary Drainage
Technique and Patient Selection Criteria
Results
Complications
Percutaneous Cholecystostomy
Technique and Patient Selection Criteria
Results
Complications
Future Directions for Percutaneous Biliary System Interventions
PERCUTANEOUS TUMOR ABLATION
Percutaneous Ethanol Injection
Technique and Patient Selection Criteria
Results
Complications
Radiofrequency Ablation
Technique and Patient Selection Criteria
Results
Complications
Microwave Ablation
Technique and Patient Selection Criteria
Results
Complications
Combined Therapies
Future Directions for Ablative Interventions
TRANSARTERIAL INTERVENTIONS
TACE and Drug-Eluting Bead TACE
Technique and Patient Selection Criteria
Results
Complications
Transcatheter Arterial Embolization
Technique and Patient Selection Criteria
Results
Complications
Transarterial Radioembolization
Technique and Patient Selection Criteria
Results
Complications
Combined Therapies
Future Directions for Transarterial Interventions
Portal Vein Embolization
Technique and Patient Selection Criteria
Results
Complications
Future Directions for PVE
CONCLUSION
4:
Radiotherapy for Gastrointestinaland Liver Pathology
BACKGROUND
EVIDENCE-BASED REVIEW
Hepatocellular Carcinoma
Intrahepatic Cholangiocarcinoma
Metastases to Liver
LANDMARK TRIALS
CONCLUSION AND FUTURE DIRECTIONS
5:
Novel Techniques in Advanced Endoscopy
INTERVENTIONAL ENDOSCOPIC ULTRASOUND
Endoscopic Ultrasound-Guided Fiducial Marker Placement
Background
Evidence-Based Review
Procedure
Prevention
Management
Outcomes
Conclusion and Future Directions
Endoscopic Ultrasound-Guided Pancreatic Fluid Collection Drainage and Necrosectomy
Background
Evidence-Based Review
Procedure
Equipment
Prevention
Management
Outcomes
Conclusion and Future Directions
Endoscopic Ultrasound-Guided Biliary and Pancreatic Duct Drainage
Background
Evidence-Based Review
Procedure
Endoscopic Ultrasound Biliary Drainage
Rendezvous
Antegrade
Transmural
Endoscopic Ultrasound Pancreatic Drainage
Drainage Technique
Rendezvous Technique
Prevention
Management
Outcomes
Conclusion and Future Directions
EUS-Guided Gallbladder Drainage
Background
Evidence-Based Review
Procedure
Prevention
Management
Outcomes
Conclusion and Future Directions
Endoscopic Mucosal Resection
Background
Evidence-Based Review
Esophagus
Stomach
Colon and Rectum
Procedure
Equipment
Prevention
Management
Outcomes
Conclusion and Future Directions
Endoscopic Submucosal Dissection
Background
Evidence-Based Review
Procedure
Equipment
Prevention
Management
Outcomes
Conclusion and Future Directions
6:
Pediatric Gastrointestinal and Hepatobiliary Surgery
GENERAL ASPECTS OF SURGERY IN CHILDREN
PEDIATRIC FOREGUT SURGERY
Esophageal Atresia and Tracheoesophageal Fistula
Diagnosis
Preoperative Planning
Operative Technique
Postoperative Management
Complications
Special Considerations for Long-Gap EA
Gastroesophageal Reflux
Pyloric Stenosis
Surgery
Foregut Duplication
Bezoar
MIDGUT AND HINDGUT PEDIATRIC SURGERY
Malrotation, Midgut Volvulus, Ladd's Operation
Embryologic Considerations
Diagnosis
Surgical Approach
Intestinal Atresia
Meckel Diverticulum
Intussusception
Necrotizing Enterocolitis
Management
Appendicitis
Management
Hirschsprung Disease
Management
Operative Treatment
Anorectal Malformations
Diagnosis
Management
Operative Treatment
HEPATOBILIARY SURGERY IN CHILDREN
Cholecystitis and Cholelithiasis
Pancreatitis
Choledochal Cysts
Technique
Outcomes
Biliary Atresia
Open Technique
Complications
Cholangitis
Termination of Biliary Drainage
Outcomes
CONCLUSION AND FUTURE DIRECTIONS
7:
Early Recovery after Gastrointestinal Surgery
INTRODUCTION
AIM AND RATIONALE OF THE ERAS PATHWAY
COMPONENTS OF ERAS
PREOPERATIVE INTERVENTIONS
Preoperative Counseling
Preoperative Optimization
Curtailed Preoperative Fasting and Carbohydrate Loading
Avoidance of Bowel Preparation
Antibiotic and Venous Thromboembolism Prophylaxis
Preanesthetic Medication
PERIOPERATIVE INTERVENTIONS
Standard Anesthetic Protocol and Use of Thoracic Epidural
Goal-Directed Intraoperative Fluid Therapy
Prevention of Hypothermia
Surgical Technique
Avoidance of Nasogastric Tubes
Avoidance of Drains
POSTOPERATIVE INTERVENTIONS
Prevention of Postoperative Nausea and Vomiting
Postoperative Analgesia
Early Postoperative Feeding
Early Removal of Urinary Catheters
Early Mobilization
Other Postoperative Interventions
AUDIT
OUTCOMES OF THE ERAS PATHWAY
CONCLUSION
8:
Nutrition for the Gastrointestinal and Hepatobiliary Surgery Patient
INTRODUCTION
PREOPERATIVE NUTRITION OPTIMIZATION
ENTERAL AND PARENTERAL NUTRITION SUPPORT
SELECTION OF EN FORMULA
ORAL DIET ADVANCEMENT
POSTOPERATIVE MEDICAL NUTRITION THERAPY GUIDELINES
Low-Fiber Diet
Protein Needs
Lactose Intolerance
Bone Mineral Disease
MEDICAL NUTRITION THERAPY FOR SPECIFIC SURGERIES
Post-Whipple Procedure
Dumping Syndrome
Post-ileal Pouch with Anal Anastomosis after Proctocolectomy
Post-Esophagectomy
CONCLUSION
9:
Stoma Care
PREOPERATIVE CONSIDERATIONS
STOMAL COMPLICATIONS
Necrosis
Melanosis Coli
Mucocutaneous Separation
Retraction
Stenosis
Laceration (Trauma)
Bleeding
Prolapse
Hernia
Fistula
PERISTOMAL SKIN COMPLICATIONS
Irritant Dermatitis
Treatment of Irritant Dermatitis
Caput Medusae
Treatment Caput Medusae
Candidiasis
Treatment of Candidiasis
Folliculitis
Treatment of Folliculitis
Mucosal Transplantation
Pseudoverrucous
Treatment of Pseudoverrucous
Pyoderma Gangrenosum
Treatment of Pyoderma Gangrenosum
OTHER SKIN COMPLICATIONS
Psoriasis
Mechanical Trauma
PSYCHOLOGICAL IMPACT
CONCLUSION
10:
Genetic Counseling and Genetic Testing for Colorectal Cancer Risk—A Case-based Review
INTRODUCTION
GENETIC COUNSELING
Components of a Genetic Counseling Session
Contracting
Obtaining Medical and Family History Information
Risk Assessment
Genetics Discussion
Informed Consent and Sample Collection
Results Disclosure
Psychosocial Counseling
Structure of a Genetic Counseling Session
INTRODUCTION TO HEREDITARY COLORECTAL CANCER SYNDROMES
HEREDITARY COLORECTAL CANCER SYNDROMES WITHOUT SIGNIFICANT POLYPOSIS
Lynch Syndrome
Background
Description
Cancer Risks
Inheritance
Etiology of Cancer
Identification of At-Risk Patients
Tumor Screening
Diagnostic Genetic Testing
Surveillance/Management
Treatment of Cancer
Variants of LS
Constitutional Mismatch Repair Deficiency Syndrome
Familial Colorectal Cancer Type X
ADENOMATOUS POLYPOSIS SYNDROMES
Familial Adenomatous Polyposis
Background
Description
Inheritance
Etiology of Cancer
Genotype-Phenotype Correlations
SNPs in APC
Identification of At-Risk Patients
Diagnostic Germline Genetic Testing
Colorectal Surveillance/Management
Extracolonic Surveillance/Management
In Awe and Fear of the Scalpel
Attenuted Familial Adenomatous Polyposis
Description
Inheritance
Genotype-Phenotype Correlations
Diagnostic Genetic Testing
Colorectal Surveillance/Management
Extracolonic Surveillance
MUTYH-associated Polyposis
Nomenclature
Description
Inheritance
Etiology of Cancer
Genotype-Phenotype Correlations
Identification of At-Risk Patients
Diagnostic Genetic Testing
Surveillance/Management
MUTYH Heterozygotes
Polymerase Proofreading-associated Polyposis
When the Cause of Adenomatous Polyposis Remains Undefined
HAMARTOMATOUS POLYPOSIS SYNDROMES
PTEN-Hamartoma Tumor Syndrome (Cowden Syndrome)
Peutz-Jeghers Syndrome
Juvenile Polyposis Syndrome
Hereditary Mixed Polyposis Syndrome
OTHER POLYPOSIS SYNDROMES
Serrated Polyposis Syndrome (Hyperplastic Polyposis Syndrome)
OTHER HEREDITARY SYNDROMES WITH GI FINDINGS
TYPES OF GENETIC TESTS AND TECHNOLOGIES
Syndrome-specific Gene Tests
Site-specific Gene Tests
Multigene Panels
Whole Exome Sequencing
Whole Genome Sequencing
CONCLUSION
ACKNOWLEDGMENTS
SECTION 2: ESOPHAGUS
11:
Benign Disorders of the Esophagus
OVERVIEW
12:
Gastroesophageal Reflux Disease
BACKGROUND
REVIEW OF LANDMARK STUDIES
MINIMALLY INVASIVE GASTRIC FUNDOPLICATION
Preoperative Planning
Surgical Anatomy
Laparoscopic and Robotic Nissen Fundoplication
OPERATIVE TIPS
13:
Surgical Options for Achalasia
INTRODUCTION
LAPAROSCOPIC HELLER MYOTOMY
Landmark Trials
Preoperative Planning
Surgical Anatomy
Step-by-Step Illustration of Procedure
Operative Tips
Complications
Outcomes
PERORAL ENDOSCOPIC MYOTOMY (POEM)
Landmark Trials
Preoperative Planning
Surgical Anatomy
Step-by-Step Illustration of Procedure
Operative Tips
Complications
Outcomes
CONCLUSION AND FUTURE DIRECTIONS
14:
Surgical Treatment of Esophageal Diverticula
BACKGROUND
ZENKER'S DIVERTICULUM
Pathophysiology
Preoperative Planning
DIVERTICULECTOMY AND MYOTOMY
Open Approach
Endoscopic Techniques
Transoral Repair of Zenker's Diverticulum
Stapled Technique
Limitations
Management
Outcomes
THORACIC DIVERTICULA
Midesophageal or Traction Diverticula
Epiphrenic Diverticulum
Surgical Indications
Surgical Approach
Outcomes
Management
CONCLUSION AND FUTURE DIRECTIONS
15:
Endoscopic Treatment for Achalasia: Peroral Endoscopic Myotomy
BACKGROUND
EVIDENCE-BASED REVIEW
PROCEDURE
Preoperative Planning (Table 1)
Surgical Anatomy
Step-by-Step Illustration of Procedure
Equipment
Operative Tips
Complications
Prevention
Management
OUTCOMES
CONCLUSION AND FUTURE DIRECTIONS
16:
Barrett's Esophagus
BACKGROUND
Evidence-Based Review
Epidemiology
Pathogenesis and Risk Factors
Progression to Adenocarcinoma
Diagnosis
Surveillance and Treatment
Landmark Trials
Procedures
Photodynamic Therapy
Cryotherapy
Radiofrequency Ablation
Endoscopic Mucosal Resection
Esophagectomy
PREOPERATIVE PLANNING
SURGICAL ANATOMY
STEP-BY-STEP ILLUSTRATION OF PROCEDURE
OPERATIVE TIPS
COMPLICATIONS
OUTCOMES
CONCLUSION AND FUTURE DIRECTIONS
17:
Malignant Disorders of the Esophagus
OVERVIEW
18:
Short- and Long-term Outcomes in Esophageal Cancer
INTRODUCTION
POSTOPERATIVE AND SHORT-TERM OUTCOMES
Complications
LONG-TERM SURVIVAL
Early Stage Disease
Locally Advanced Disease
Induction Chemotherapy
Induction Chemoradiation
CONCLUSION
19:
Esophagectomy
OVERVIEW
PREOPERATIVE EVALUATION
OPEN ESOPHAGECTOMY
Ivor Lewis Esophagectomy
McKeown (Tri-Incisional or “Three-Hole”) Esophagectomy
Transhiatal Esophagectomy
Left Thoracoabdominal Esophagectomy
MINIMALLY INVASIVE ESOPHAGECTOMY
Minimally Invasive Ivor Lewis
Minimally Invasive McKeown
Robotic-Assisted Esophagectomy
CONCLUSION
FUTURE DIRECTIONS
20:
Robotically Assisted Minimally Invasive Ivor Lewis Esophagectomy
BACKGROUND
EVIDENCE-BASED REVIEW
Randomized Controlled Trials
Prospective, Single Cohort and Observational Study
Retrospective Review
PREOPERATIVE PLANNING
ANESTHETIC CONSIDERATIONS
PROCEDURE AND SURGICAL ANATOMY
Endoscopic Evaluation
Robotically-Assisted Abdominal Phase
Robotically Assisted Thoracoscopic Phase
POSTOPERATIVE CARE
ILLUSTRATIONS
COMPLICATIONS
OUTCOMES (LITERATURE REVIEW)
CONCLUSION AND FUTURE DIRECTIONS
SECTION 3: STOMACH
21:
Gastric Bypass and Biliopancreatic Diversion
BACKGROUND
EVIDENCE-BASED REVIEW: INDICATIONS
EVIDENCE-BASED REVIEW: PHYSIOLOGY
LANDMARK TRIALS
PROCEDURES
Preoperative Planning
Surgical Anatomy
RYGB Steps
BPD/DS Steps
OPERATIVE TIPS
COMPLICATIONS
Perioperative Safety
DVT/PE
Anastomotic Leaks
Internal Hernias
Strictures
Marginal Ulcers
Dumping Syndrome
Nutritional Complications
OUTCOMES IN BARIATRIC SURGERY
Weight Loss
Mortality
Diabetes Mellitus
Cardiovascular Outcomes
Nonmetabolic Effects
CONCLUSION
22:
Laparoscopic Adjustable Gastric Banding and Sleeve Gastrectomy
BACKGROUND
EVIDENCE-BASED REVIEW
LANDMARK TRIALS
PREOPERATIVE PLANNING
SURGICAL ANATOMY
PROCEDURE: LAPAROSCOPIC AGB
Surgical Steps
Operative Tips
Complications
Gastric Prolapse
Port Infection
Band Erosion
Band or Port Leak
Outcomes
PROCEDURE: LAPAROSCOPIC SG
Surgical Steps
Operative Tips
Complications
Leak
Bleeding
Nutritional Deficiencies
Gastroesophageal Reflux Disease
Stricture
Outcomes
CONCLUSION AND FUTURE DIRECTIONS
23:
Role of Surgery in Developing Economies
BACKGROUND
SYNERGISM OF GROWING ECONOMIES AND ILLNESSES
EVIDENCE-BASED REVIEW
Evolution of Bariatric Surgery
Obesity: Scenario in Developing and Developed Countries
Promoters of Obesity
Obesity: Impact on Longevity
Obesity: Economic Impact
Obesity and Comorbid Illness
Management Guidelines
Medical Therapy
Surgical Therapy
Laparoscopic Adjustable Gastric Band
Laparoscopic Sleeve Gastrectomy
Laparoscopic Roux-en-Y Gastric Bypass
Laparoscopic Minigastric Bypass
Biliopancreatic Diversion and Biliopancreatic Diversion with Duodenal Switch
Banded Vertical Gastroplasty and Bypass
Indications and Contraindications
Bariatric Surgery: Risks and Benefits
Bariatric Surgery: Economic Impact
Surgical Interventions after Bariatric Surgery
Obesity: Perceptions of Public and Professionals
Advances in Bariatric Surgery
Combating Obesity: Leadership and Initiatives2,6,7,11,31,37,53,57,64
LANDMARK TRIALS
PROCEDURES
Introduction
Preoperative Assessment67–69
Weight Loss and Exercise Regimen
Multidisciplinary Team
Anesthesia in Bariatric Practice
Bariatric Surgery: Complications
Bariatric Surgery Follow-Up
SURGICAL ANATOMY AND OPERATIVE TECHNIQUE
Laparoscopic Adjustable Silicone Band
Laparoscopic Gastric Band: Operative Technique
Laparoscopic Sleeve Gastrectomy
Laparoscopic Sleeve Gastrectomy: Operative Technique
Laparoscopic Minigastric Bypass
Laparoscopic Minigastric Bypass: Operative Technique
Laparoscopic Roux-en-Y Gastric Bypass
Laparoscopic Roux-en-Y Gastric Bypass: Operative Technique
Biliopancreatic Diversion/Duodenal Switch
Operative Tips for Bariatric Surgery
Patient Position
Stapling
Gastric Tubes
Energy Devices
Mesenteric Defects and Ports
Staple-Line Bleeding
Taking Down the Short Gastrics
Fundal Dissection
Instrumentation and Inadvertent Injury
Bowel and Mesentery Handling
Safeguarding the Spleen
Liver Retraction
Uneven Staple Line
Gastric Ischemia
Narrowing or Stricture of the Gastric Tube or Pouch
CONCLUSION AND FUTURE DIRECTIONS
24:
Metabolic Surgery
INTRODUCTION
MECHANISMS OF GLYCEMIC CONTROL AFTER METABOLIC SURGERY
OUTCOMES OF METABOLIC SURGERY
PATIENT SELECTION AND SURGICAL OPTIONS FOR THE OBESE PATIENT WITH T2DM
25:
Gastric Cancer
INTRODUCTION
ETIOLOGY
CLASSIFICATION OF GASTRIC CANCER
SIGNS AND SYMPTOMS OF GASTRIC CANCER
DIAGNOSIS AND STAGING OF GASTRIC CARCINOMA
TREATMENT OF GASTRIC CANCER
Early Cancer (Tis/T1 and Node Negative Disease)
Resectable Cancer (Including Locally Advanced Disease)
Principles of Gastric Cancer Surgery
Subtotal Gastrectomy (Including D2 lymphadenectomy)
Surgical Steps
Chemotherapy and Chemoradiotherapy for Resectable Gastric Adenocarcinoma
Metastatic Cancer
SUMMARY
SECTION 4: LIVER
26:
Anatomic Resections of the Liver
BACKGROUND
ANATOMY
PREOPERATIVE PLANNING
PROCEDURES
Incision and Exposure
Left Lateral Sectionectomy (Segments II and III)
Left Hepatectomy (Segments II–IV)
Extended Left Hepatectomy/Left Trisectionectomy (Segments II–V, VIII)
Right Hepatectomy (Segments V–VIII)
Extended Right Hepatectomy/Right Trisectionectomy (Segments IV–VIII)
POSTOPERATIVE CARE
OPERATIVE TIPS
OUTCOMES
CONCLUSION AND FUTURE DIRECTIONS
27:
Benign Tumors of the Liver
INTRODUCTION AND CLASSIFICATION
INCIDENTAL LIVER TUMORS
CAVERNOUS HEMANGIOMA
Epidemiology
Pathogenesis
Pathology
Clinical Picture and Complications
Investigations
Management
FOCAL NODULAR HYPERPLASIA
Epidemiology
Pathogenesis
Pathology
Clinical Picture and Complications
Investigations
Management
HEPATOCELLULAR ADENOMA
Epidemiology
Pathogenesis
Pathology
Clinical Picture and Complications
Investigations
Treatment
BENIGN CYSTIC TUMORS
Introduction
HEPATOBILIARY CYSTADENOMA WITH OS
Epidemiology
Pathogenesis
Pathology
Clinical Picture and Complications
Investigations
Management
HEPATOBILIARY CYSTADENOMA WITHOUT OS
Incidence
Pathology
Investigations
Management
INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM OF THE BILE DUCT
Epidemiology and Classification
Pathology
Clinical Picture and Complications
Management
Differential Diagnosis
CONCLUSION
28:
Hepatocellular Carcinoma
BACKGROUND
RISK FACTORS
EVIDENCE-BASED REVIEW
LANDMARK TRIALS
PROCEDURE
Preoperative Planning
SURGICAL ANATOMY
Portal Vein
Hepatic Artery
Bile Duct
Hepatic Veins
Couinaud's Segments
STEP-BY-STEP ILLUSTRATION OF PROCEDURE
Exposure, Mobilization, and Assessment
Inflow Control
Total Inflow Occlusion (Pringle Maneuver)
Extrahepatic Approach (Fig. 12)
Anterior Intrahepatic Approach
Posterior Intrahepatic Approach
Outflow Control
PARENCHYMAL TRANSECTION
LAPAROSCOPIC RESECTIONS
ROBOTIC LIVER SURGERY
OPERATIVE TIPS
POSTOPERATIVE COMPLICATIONS
OUTCOMES
CONCLUSION AND FUTURE DIRECTIONS
29:
ntrahepatic and Perihilar Cholangiocarcinoma: Surgical Management
INTRODUCTION
EPIDEMIOLOGY
RISK FACTORS
INTRAHEPATIC CHOLANGIOCARCINOMA
Resection for iCCA
Liver Transplant for iCCA
PERIHILAR CHOLANGIOCARCINOMA
Preoperative Portal Vein Embolization
Preoperative Biliary Drainage
LIVER TRANSPLANTATION FOR PCCA
30:
Colorectal Liver Metastasis
BACKGROUND
INTRODUCTION
SURGICAL ANATOMY
DIAGNOSIS
Blood Investigations
Radiological Investigations
Diagnostic Laparoscopy
MANAGEMENT
Surgical Resection
Nonresectional Procedures
Medical Management
Hepatic Radiotherapy
LANDMARK TRIALS
OPERATIVE TIPS
Complications—Prevention and Management
OUTCOME AND SURVEILLANCE
FUTURE
CONCLUSION
31:
Gallbladder Cancer
BACKGROUND
EVIDENCE-BASED REVIEW OF DIFFERENT ASPECTS OF SURGICAL MANAGEMENT OF GBC
Staging Laparoscopy
Intraoperative Frozen Section
Extent of Liver Resection
Regional Lymphadenectomy
Bile Duct Resection
Hepatopancreaticoduodenectomy
Port-Site Excision
RADICAL CHOLECYSTECTOMY
Surgical Anatomy
Preoperative Planning
Step-by-Step Illustration
Operative Tips
Complications
CONCLUSION AND FUTURE DIRECTIONS
32:
Ex Vivo Resection of Complex Abdominal Masses
INTRODUCTION
EX VIVO SURGERY IN LIVER PATHOLOGY
EX VIVO IN CHOLANGIOCARCINOMAS AND KLATSKIN TUMORS
EX VIVO IN HCC (Table 2)
EX VIVO AND COLORECTAL METASTASES
EX VIVO FOR BENIGN LIVER LESIONS OR LESIONS WITH LOW MALIGNANT POTENTIAL
Operation: Technical Aspects
EX VIVO AND PANCREATIC ADENOCARCINOMA (Table 5)
EX VIVO FOR PANCREATIC LESIONS WITH LOW MALIGNANT POTENTIAL (Table 6)
Operation: Technical Considerations
Case
EX VIVO FOR LESIONS AT THE ROOT OF THE MESENTERY (Table 7)
Operation: Technical Considerations
Case
SUMMARY
33:
Operative Techniques for Liver Transplantation
BACKGROUND
HISTORY
PREOPERATIVE PLANNING
OPERATIVE TECHNIQUES
Abdominal Incision and Exposure
Native Hepatectomy
Implantation of Donor Liver
Hemostasis and Closure
34:
Perioperative Management of Liver Transplantation
INTRODUCTION
PATHOPHYSIOLOGY AND PREOPERATIVE EVALUATION
INTRAOPERATIVE MONITORING
Hemodynamic Monitoring and Management
Fluid Management and Coagulation Monitoring
Neurologic Monitoring
SURGICAL TECHNIQUES
CHALLENGES ASSOCIATED WITH TRANSPLANTATION
Acute Liver Failure
Patients with Renal Failure
POSTOPERATIVE CARE AFTER LIVER TRANSPLANTATION
Immunosuppression
COMPLICATIONS
Graft and Patient Survival
35:
Indications and Contraindications for Liver Transplantation
INTRODUCTION
ALLOCATION SYSTEMS
PREOPERATIVE EVALUATION
INDICATIONS
Alcoholic Liver Disease
Viral Hepatitis
Cholestatic Liver Disease
Malignant Diseases of the Liver
Metabolic Liver Disease
Vascular Disorders
Fulminant Liver Failure
CONTRAINDICATIONS
Absolute Contraindications
Relative Contraindications
LIVING DONOR LIVER TRANSPLANTATION
CONCLUSION
SECTION 5: PANCREAS
36:
Management of Acute and Chronic Pancreatitis: Focus on Surgical Management
ACUTE PANCREATITIS
Background
Evidence-Based Review
Landmark Trials
Procedure
Preoperative Planning
Surgical Anatomy
Step-by-Step Illustration of Procedure
Operative Tips
Complications
Prevention
Management
Outcomes
Conclusion and Future Directions
CHRONIC PANCREATITIS
Background
Evidence-Based Review
Landmark Trials
Procedures
Pancreaticoduodenectomy
Preoperative Planning
Surgical Anatomy
Step-by-Step Illustration of Procedure
Operative Tips
Complications
Outcomes
Duodenum-Preserving Pancreatic Head Resection
Preoperative Planning
Surgical Anatomy
Step-by-Step Illustration of Procedure
Operative Tips
Complications
Outcomes
Total Pancreatectomy with Autologous Islet Cell Transplantation
Preoperative Planning
Surgical Anatomy
Step-by-Step Illustration of Procedure
Operative Tips
Complications
Outcomes
Caudal Pancreaticojejunostomy
Preoperative Planning
Surgical Anatomy
Step-by-Step Illustration of Procedure
Operative Tips
Complications
Outcomes
Longitudinal Pancreaticojejunostomy
Preoperative Planning
Surgical Anatomy
Step-by-Step Illustration of Procedure
Operative Tips
Complications
Outcomes
Longitudinal Pancreaticojejunostomy with Limited Pancreatic Head Resection
Preoperative Planning
Surgical Anatomy
Step-by-Step Illustration of Procedure
Operative Tips
Complications
Outcomes
Izbicki V-Shaped Ventral Pancreatic Excision with Pancreaticojejunostomy
Preoperative Planning
Surgical Anatomy
Step-by-Step Illustration of Procedure
Operative Tips
Complications
Outcomes
CONCLUSION AND FUTURE DIRECTIONS
37:
Pancreatic Cancer
INTRODUCTION
Incidence, Epidemiology, and Risk Factors
Presentation and Differential Diagnosis
Pathology
Molecular Genetics
Precursor Lesions
DIAGNOSTIC APPROACH
Prognosis and Staging
Tumor Markers
Diagnostic Imaging
Transabdominal Ultrasound
Abdominal CT
Magnetic Resonance Imaging
Positron Emission Tomography
Tissue Sampling
Percutaneous Biopsy
Endoscopic Ultrasound with Biopsy
Staging Laparoscopy
SURGICAL MANAGEMENT
General Preoperative Planning
Pancreatic Head and Porta Hepatis
Anatomic Considerations
Clinical Considerations
Pancreatic Neck and Uncinate Process
Anatomic Considerations
Clinical Considerations
Pancreaticoduodenectomy
Mobilization and Determination of Resectability
Mobilization of the Colon and the Kocher Maneuver
Dissection of the Superior Mesenteric Vein and Creation of a Retropancreatic Tunnel
Identification of the Gastroduodenal Artery
Identification of the Portal Vein, Completion of the Retropancreatic Tunnel and Commitment to Resection
Resection
Division of the Stomach, Pancreas, and Jejunum
Division of the Pancreas and Removal of the Specimen
Vascular Resection and Reconstruction
Reconstruction Following Pancreaticoduodenectomy
Pancreatic, Biliary and Enteric Reconstruction
Postoperative Care
Complications
Pancreatic Fistula
Delayed Gastric Emptying
Postpancreatectomy Hemorrhage
OTHER PROCEDURES
Pancreatic Body and Tail
Anatomic Considerations
Clinical Considerations
Distal Pancreatectomy
Operative Technique
Postoperative Care
Extended Distal Pancreatectomy with Resection of the Celiac Axis (Modified-Appleby Procedure)
Total Pancreatectomy
OUTCOMES AND CONSIDERATIONS
LANDMARK TRIALS
CONCLUSION
38:
Borderline Resectable Pancreatic Cancer
INTRODUCTION
EVIDENCE-BASED REVIEW
Definition of Borderline Resectable Pancreatic Cancer
Evaluation of Borderline Resectable Pancreatic Cancer
Pretreatment Considerations
Treatment
Role of Venous Resections
Role of Arterial Resections
Role of Neoadjuvant Therapy
Prognostic Markers
LANDMARK TRIALS
PREOPERATIVE PLANNING
SURGICAL ANATOMY
Artery First Approaches
OPERATIVE TIPS FOR VEIN RESECTION
Operative Steps
POSTOPERATIVE MANAGEMENT AND COMPLICATIONS
OUTCOMES
FUTURE TRENDS
Biomarkers
Trials
Standardized Registries
CONCLUSION
39:
Endocrine Tumors of the Pancreas
ANATOMY AND PHYSIOLOGY OF THE PANCREAS
BACKGROUND
DIAGNOSIS
INSULINOMA
GASTRINOMA
VIPoma
GLUCAGONOMA
SOMATOSTATINOMA
INCIDENTALOMA
OPERATIVE STRATEGIES
Enucleation
Indications
Contraindications
Preoperative Planning
Open Technique
Laparoscopic Technique
Complications
Distal Pancreatectomy
Indications
Contraindications
Preoperative Planning
Open Technique
Spleen-Sparing Operation
Splenectomy Included
Laparoscopic Technique
Spleen-Sparing Operation
Complications
40:
Pancreas Transplantation
BACKGROUND
EVIDENCE-BASED REVIEW
LANDMARK TRIALS
DONOR PROCUREMENT
Preoperative Planning
Surgical Anatomy
Step-by-Step Illustration of Procedure
Operative Tips
PANCREAS TRANSPLANTATION
Preoperative Planning
Surgical Anatomy
Step-by-Step Illustration of Procedure
Bench Preparation
Incision and Exposure
Revascularization
Duct Management Bladder drainage
Enteric drainage
OPERATIVE TIPS
COMPLICATIONS
OUTCOMES
Graft and Patient Survival
CONCLUSION AND FUTURE DIRECTIONS
SECTION 6: SMALL BOWEL AND ABDOMEN
41:
Crohn's Disease of the Small Bowel
BACKGROUND
PREOPERATIVE PLANNING
SURGICAL PROCEDURE
Preparation
Stomach and Duodenum
OPERATIVE TECHNIQUE: GASTROJEJUNOSTOMY
Results
Small Bowel
OPERATIVE TECHNIQUE: STRICTUREPLASTY
Heineke-Mikulicz Strictureplasty
Finney Strictureplasty
Side-to-Side Isoperistaltic Strictureplasty (Michelassi Strictureplasty)
Postoperative Management
Postoperative Complications
Long-Term Results
Laparoscopic Surgery
OPERATIVE TECHNIQUE: LAPAROSCOPIC ILEOCOLIC RESECTION
Kono-S Anastomotic Technique
Results
CONCLUSION
42:
Gastrointestinal Stromal Tumors
INTRODUCTION
BACKGROUND
PATHOLOGY
Molecular Pathogenesis
PROGNOSTIC FEATURES AND RISK STRATIFICATION
CLINICAL PRESENTATION
DIAGNOSIS
CT Scan
Upper Endoscopy
Endoscopic Ultrasound
PET-CT
TREATMENT AND PROGNOSIS
Surgery
Preoperative Planning
Operative Description
Medical Approach
Landmark Trials
FUTURE DIRECTIONS
CONCLUSION
43:
Carcinoid Tumors of the Gastrointestinal Tract
BACKGROUND
CLINICAL PRESENTATIONS AND SYMPTOMS
Laboratory Tests
Imaging for Carcinoid Tumors
Functional Imaging
Endoscopy
Surgical Management of Carcinoids
Gastric Carcinoid Tumor
Carcinoid Tumors of the Duodenum, Small Intestine and Colon
Appendiceal Carcinoid Tumors
Carcinoid Tumors of Rectum
PATHOLOGICAL DIAGNOSIS AND REPORTING OF NET
Current Classification
Microscopy
Surveillance of Carcinoid Tumor
MANAGEMENT OF LOCOREGIONAL UNRESECTABLE OR METASTATIC CARCINOID TUMORS
Resection of Metastatic Disease
Somatostatin Analogs for Symptom Control
Hepatic-Directed Therapies for Metastatic Carcinoid Tumors
Systemic Therapy for Advanced Carcinoid Tumors
Alpha Interferon
Liver Transplantation for Liver Metastases of Carcinoid Tumors
Everolimus for Advanced Carcinoid Tumors
LANDMARK TRIALS
Somatostatin Analogs
Peptide Receptor Radiotherapy
Mammalian Target of Rapamycin Inhibitors
Angiogenesis Inhibitors
Liver-Targeted Interventions
OUTCOMES
Gastric Carcinoid
Small Bowel Carcinoid
Appendiceal Carcinoid
Rectal Carcinoid
CONCLUSION AND FUTURE DIRECTIONS
44:
Trauma of the Gastrointestinal Tract
INTRODUCTION
INITIAL DIAGNOSIS OF ABDOMINAL INJURIES
MANAGEMENT OF HOLLOW VISCUS INJURIES
Esophageal Injuries
INJURIES TO THE STOMACH
DUODENAL INJURIES
SMALL AND LARGE BOWEL INJURIES
RECTAL INJURIES
INJURIES TO THE SPLEEN
LIVER INJURIES
INJURIES TO THE PANCREAS
SECTION 7: COLON
45:
Volvulus
INTRODUCTION
SIGMOID VOLVULUS
Diagnosis of Sigmoid Volvulus
Treatment of Sigmoid Volvulus
CECAL VOLVULUS
ILEOSIGMOID KNOTTING
VOLVULUS OF THE TRANSVERSE COLON OR SPLENIC FLEXURE
COLONIC VOLVULUS IN PREGNANT WOMEN
46:
Diverticulitis
BACKGROUND
EVIDENCE-BASED REVIEW
TRIALS
RATIONALE FOR MINIMALLY INVASIVE APPROACH
Preoperative Planning
Procedure
Setup
Procedure Steps: Minimally Invasive Sigmoid Colectomy (Hand-Assisted or Straight Laparoscopy)
Sigmoid Colon Dissection
Division of the Colon and Rectum, with Anastomosis or End Colostomy Creation
Complications
Operative Tips
CONCLUSION AND FUTURE DIRECTIONS
47:
Surgical Management of Constipation
PREVALENCE
ETIOLOGY AND RISK FACTORS
CLASSIFICATION
DIAGNOSIS AND WORKUP OF CONSTIPATION
HISTORY AND PHYSICAL EXAM
OVERVIEW OF DIAGNOSTIC SCHEMA
DISORDERED DEFECATION STUDIES
Rectal Balloon Expulsion Test
Anal Manometry
Defecography
COLONIC TRANSIT STUDIES
Radiopaque Markers
Radionuclide Gamma Scintigraphy
Medical Management
LIFESTYLE MODIFICATION
MEDICATION THERAPY
BIOFEEDBACK
Surgical Treatment
SURGICAL OPTIONS FOR SLOW TRANSIT CONSTIPATION
Total Abdominal Colectomy with Ileorectal Anastomosis
Fecal Diversion
Antegrade Colonic Enema
Sacral Nerve Stimulation
SURGICAL OPTIONS FOR DEFECATORY DISORDERS
Stapled Transanal Rectal Resection
Reinforcing or Plicating Procedures
CONCLUSION
48:
Surgical Management of Ulcerative Colitis
BACKGROUND
Evidence-based Review
Indications for Surgery in UC
Procedure
PREOPERATIVE PLANNING
Discussion and Consent
Preoperative Assessment and Preparation
Positioning and Preparation
Port Placement
Mobilization of Right Colon and Terminal Ileum
Transverse Colon, Mesentery, and Omentum
Splenic Flexure and Descending Colon
Sigmoid and Descending Colon
Proctectomy
Ileal J-Pouch Formation
Anastomosis
Postoperative Care
Postoperative Complications
CONCLUSION
49:
Surgical Management of Crohn's Colitis
INTRODUCTION
CLINICAL PRESENTATION
INDICATIONS FOR SURGERY
Fistulas and Abscesses
Perforation
Carcinoma
FAILURE OF MEDICAL MANAGEMENT
PROCEDURES
Segmental/Total Abdominal Colectomy
Preoperative Planning
Surgical Anatomy
Operative Technique for Total Abdominal Colectomy with IRA—Open Approach
Operative Technique for Total Abdominal Colectomy with IRA—Laparoscopic Approach
Complications and Outcomes
Total Proctocolectomy with End Ileostomy
Preoperative Planning
Surgical Anatomy
Operative Technique for Proctectomy with End Ileostomy—Open Approach
Operative Details—Laparoscopic Proctectomy
Complications and Outcomes
CONCLUSION
50:
Hereditary Nonpolyposis Colorectal Cancer Syndromes
BACKGROUND
HEREDITARY NONPOLYPOSIS COLORECTAL CANCER SYNDROMES (LYNCH SYNDROME, LC)
HAMARTOMATOUS TUMOR SYNDROME
Evidence Based Review: Surgical Management of HNPCC
Preoperative Planning
Genetic Testing
Preoperative Workup
Procedure: Laparoscopic Subtotal Colectomy and Ileorectal Anastomosis
Surgical Anatomy
Step-by-Step Illustration of Laparoscopic Abdominal Total Colectomy
Operative Tips
Complications
Outcomes after Subtotal Colectomy and Ileorectal Anastomosis
CONCLUSION AND FUTURE DIRECTIONS
51:
Inherited Polyposis Syndromes
BACKGROUND
Familial Adenomatous Polyposis
Clinical Presentation
Clinical Variants
Peutz-Jeghers Syndrome
Juvenile Polyposis Syndrome
PTEN Hamartoma Tumor Syndromes
INVESTIGATION OF POLYPOSIS SYNDROMES
MANAGEMENT
Management of Colonic Disease
General Approach—Medical, Endoscopic, and Surgical Management
Preoperative Planning
Surgical Anatomy
Laparoscopic Total Abdominal Colectomy with Ileorectal Anastomosis (IRA)41
Proctocolectomy with Ileal Pouch—Anal Anastomosis ± Loop Ileostomy
Complications
Management of Extracolonic Disease
PREVENTION
CONCLUSION AND FUTURE DIRECTIONS
52:
Difficult Polypectomy
INTRODUCTION
ENDOSCOPIC MUCOSAL RESECTION
Background
Evidence-Based Review
Landmark Trials
Procedure
Preoperative Planning
Surgical Anatomy
Step-by-Step Illustration of Procedure
Operative Tips
Complications
Conclusion and Future Directions
ENDOSCOPIC SUBMUCOSAL DISSECTION
Evidence-Based Review
Landmark Trials
Procedure
Preoperative Planning
Surgical Anatomy
Operative Tips
Complications
Outcomes
Conclusion and Future Directions
COMBINED ENDOSCOPIC AND LAPAROSCOPIC SURGERY
Background
Evidence-Based Review
Landmark Trials
Procedure
Preoperative Planning
Surgical Anatomy
Operative Tips
Outcomes
Conclusion and Future Directions
VIDEO LEGENDS
53:
Laparoscopy for Colon Cancer
INTRODUCTION
COLON CANCER
Short-Term Outcomes
Oncologic Outcomes
Preoperative Considerations
Patient Positioning, Operative Bed, and Monitor Placement
Intraoperative Considerations
RIGHT COLECTOMY
Preoperative Planning
Procedure Details
Procedure Details Medial-to-Lateral Approach
HEPATIC FLEXURE MOBILIZATION
Lateral-to-Medial Approach Right Colectomy
Left, Sigmoid Colectomy and Low Anterior Resection
Preoperative Considerations
Procedure Detail
SPLENIC FLEXURE MOBILIZATION
Lateral-to-Medial Mobilization of the Descending and Sigmoid Colon Lateral-to-Medial Approach
Rectal Dissection
Postoperative Care
CONCLUSION
54:
Cytoreductive Surgery and Intraperitoneal Chemotherapy
INTRODUCTION (BACKGROUND)
TECHNIQUE
Assessment of Overall Disease
Completeness of Cytoreduction
Cytoreduction Technique
Intraperitoneal Chemotherapy
EVIDENCE-BASED REVIEW AND OUTCOMES
Appendiceal Mucinous Neoplasm
Colorectal Cancer
Gastric Cancer
Diffuse Malignant Peritoneal Mesothelioma (DMPM)
Ovarian Cancer
CONCLUSION
LANDMARK STUDIES
SECTION 8: RECTUM
55:
Rectal Prolapse
BACKGROUND
CLINICAL PRESENTATION AND PATIENT EVALUATION
EVIDENCE-BASED REVIEW AND LANDMARK TRIALS
SURGICAL PROCEDURES
Preoperative Preparation
Abdominal Procedures
Abdominal Rectopexy with Sigmoid Colectomy
Abdominal Rectopexy
Ripstein Procedure (Anterior Mesh Sling Rectopexy)
Ivalon Procedure (Posterior Mesh Rectopexy)
Ventral Rectopexy
Minimally Invasive Approach
Postoperative Complications
Perineal Procedures
Perineal Rectosigmoidectomy (Altemeier)
Postoperative Complications
Rectal Mucosal Sleeve Resection (Delorme)
Postoperative Complications
Anal Encirclement (Thiersch)
Postoperative Complications
OUTCOMES
CONCLUSION AND FUTURE DIRECTIONS
56:
Transanal Endoscopic Microsurgery
BACKGROUND
CLINICAL ANATOMY
PREOPERATIVE EVALUATION
OPERATIVE STEPS
POSTOPERATIVE CARE
CLINICAL TIPS AND PITFALLS
57:
Rectal Cancer
BACKGROUND
EVIDENCE-BASED REVIEW AND LANDMARK TRIALS
Surgical Technique
Distal Margin and Extent of Mesorectal Excision
Circumferential Resection Margin
Reconstruction
Laparoscopic Versus Open Approaches
Neoadjuvant Therapy
Role of Neoadjuvant Radiotherapy in the Setting of Optimal Surgery (TME)
Role of Radiosensitizing Chemotherapy in the Delivery of Long-Course Therapy
Neoadjuvant Versus Adjuvant Chemoradiotherapy
Short-Course Radiotherapy Versus Long-Course Chemoradiotherapy
PROCEDURES
Preoperative Planning
Low Anterior Resection
Abdominoperineal Resection
Laparoscopic Approach
COMPLICATIONS
CONCLUSION AND FUTURE DIRECTIONS
58:
Management of Recurrent Rectal Cancer
BACKGROUND
RISK FACTORS FOR RECURRENCE
CLASSIFICATION OF LOCAL RECURRENCE
PRESENTATION AND INCIDENCE
PATIENT SELECTION
PREOPERATIVE PLANNING
ANATOMIC CONSIDERATIONS AND CONSULTANTS
IMAGING
OPERATIVE TECHNIQUE
Importance of an R0 Resection
Approach to the Pelvis
Retroperitoneal Space
Multivisceral Involvement
Sacral Involvement
INTRAOPERATIVE RADIATION THERAPY
POSTOPERATIVE CARE
COMPLICATIONS
PALLIATIVE TREATMENT
FUTURE DIRECTIONS
ACKNOWLEDGMENT
59:
Laparoscopic Proctectomy
BACKGROUND
EVIDENCE-BASED REVIEW
PREOPERATIVE PREPARATION AND PREVENTION
Introduction
Preoperative Risk Assessment
Bowel Preparation
Parenteral Antibiotics
Prevention of Venous Thromboembolism
Ureteral Stenting
SURGICAL ANATOMY
Introduction—Basic Rectal Anatomy
Surrounding Organs/Structures/Fascia
Nerves
Vasculature and Lymphatics
STEP-BY-STEP: LAPAROSCOPIC LOW ANTERIOR RESECTION
Lateral-to-Medial Approach: Key Steps
Medial-to-Lateral Approach: Key Steps
Medial-to-Lateral Approach: Detailed Description
Patient Positioning
Room Setup
Abdominal Entry
Trocar Placement
Abdominal Exploration
Dissection and IMA Division
Lateral and Splenic Flexture Mobilization
Rectal Mobilization
Rectal Division
Specimen Extraction and Anastomosis Preparation
Anastomosis Creation
Port Extraction and Site Closure
OPERATIVE TIPS
OUTCOMES AND COMPLICATIONS
Introduction
Outcomes of LP
Laparoscopic TME
Pelvic Nerve Injury
Low Anterior Resection Syndrome
Colorectal Anastomotic Reconstruction Outcomes
Management of Complications
CONCLUSION
FUTURE DIRECTIONS
LANDMARK TRIALS AND KEY STUDIES
60:
Robotic Proctectomy
INTRODUCTION
INDICATIONS
Procedure
Room Set-Up
Patient Positioning
Port Placement
Docking the Patient-Side Cart
Vascular Dissection
Medial-to-Lateral Mesocolic Dissection and Mobilization
Splenic Flexure Mobilization
Lateral Mobilization
Pelvic Dissection
Resection, Extraction, and Anastomosis
Planning Your Robotic Operative Approach
Disease Location Matters
Patient Characteristics to Consider
Hybrid versus Totally Robotic Approach
Robotic Accessories
Other Tips and Tricks for Success
In an Emergency
61:
Acute and Chronic Pouch Complications
INTRODUCTION
ACUTE COMPLICATIONS
Pelvic Sepsis/Leak
Hemorrhage
Small Bowel Obstruction
Inadequate Length
CHRONIC COMPLICATIONS OF IPAA
Chronic Pelvic Sepsis
Ileal Pouch Fistulas
Anastomotic Stricture
Sexual Dysfunction
Pregnancy
Pouch Neoplasia
POUCH DYSFUNCTION
Pouchitis
Cuffitis
Irritable Pouch Syndrome
Crohn's Disease and IPAA
Pouch Failure
CONCLUSION
62:
Retrorectal Tumors
BACKGROUND
EVIDENCE-BASED REVIEW
Incidence
Classification
Congenital
Neurogenic
Osseous
Inflammatory
Miscellaneous
Diagnosis
History and Physical Examination
Diagnostic Tests (Table 2)
Preoperative Biopsy
PROCEDURE
Preoperative Planning
Surgical Anatomy
Surgical Approach
Step-by-Step Illustration of Procedure
Posterior Approach
Anterior/Abdominal Approach
Combined Abdominal and Posterior Approach
Operative Tips
COMPLICATIONS
OUTCOMES
Malignant Lesions
Benign Tumors
FUTURE DIRECTIONS
Adjuvant Therapy
Surveillance
Minimally Invasive Techniques
CONCLUSION
SECTION 9: ANUS
63:
Hemorrhoids
BACKGROUND
SURGICAL ANATOMY
PREOPERATIVE PLANNING
CLOSED HEMORRHOIDECTOMY (FERGUSON)
Procedure Steps
Operative Tips
Complications, Prevention and Management
Outcomes
OPEN HEMORRHOIDECTOMY (MILLIGAN-MORGAN)
Procedure Steps
Operative Tips
Complications Prevention and Management
Outcomes
STAPLED HEMORRHOIDOPEXY (PROCEDURE FOR PROLAPSE AND HEMORRHOIDS, PPH)
Procedure Steps
Operative Tips
Complications Prevention and Management
Outcomes
LIGASURE HEMORRHOIDECTOMY
Procedure Steps
Operative Tips
Complications Prevention and Management
Outcomes
TRANSANAL HEMORRHOIDAL DEVASCULARIZATION OR HEMORRHOIDAL ARTERY LIGATION
Procedure Steps
Operative Tips
Complications Prevention and Management
Outcomes
CONCLUSION
64:
Surgical Therapy for Fecal Incontinence
INTRODUCTION
ETIOLOGY
Obstetric Injury
Congenital
Iatrogenic
Neurogenic
Rectal Prolapse
ASSESSMENT
PHYSIOLOGIC TESTING
Anorectal Manometry
Pudendal Nerve Terminal Motor Latency
Endorectal Ultrasound
Defecography
TREATMENT
Medical
Biofeedback
Anal Plugs
Surgical Modalities
Anal Encirclement Procedures
Radiofrequency
Bulking Agents
Overlapping Sphincteroplasty
Postanal Repair
Muscle Transposition
Artificial Bowel Sphincter
Sacral Nerve Stimulation
Diversion
CONCLUSION
65:
Perianal Crohn's Disease
INTRODUCTION
EVALUATION
TREATMENT
SKIN TAGS
ANAL FISSURE AND ULCERATION
STRICTURE
ABSCESS AND FISTULA
CARCINOMA
66:
Anorectal Sexually Transmitted Diseases
INTRODUCTION
BACTERIAL STD
Gonorrhea
Syphilis
Chancroid
Lymphogranuloma Venereum
Herpes
Human Papilloma Virus
67:
Anal Cancer and Anal Intraepithelial Neoplasia
BACKGROUND
Presentation
Anatomy
EVIDENCE-BASED REVIEW
Anal Intraepithelial Neoplasia
Squamous Cell Carcinoma of the Anal Canal and Margin
Anal Canal SCC
Other Rare Anal Neoplasms
LANDMARK TRIALS
PREOPERATIVE PLANNING
SURGICAL ANATOMY
ABDOMINOPERINEAL RESECTION
Procedure and Operative Tips ( 1)
Abdominal Component
Perineal Portion
Complications
Outcomes
TECHNIQUE FOR AIN
High-resolution Anoscopy with Focal Ablation
Procedure and Operative Tips
Complications
Outcomes
CONCLUSION AND FUTURE DIRECTIONS
VIDEO LEGEND
INDEX
TOC
Index
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