Improved Outcomes in Colon and Rectal Surgery part 43 ppt

vs placebo 205–6 vs sphincterotomy 206 calcium channel antagonists 203–5 medical therapy 201 nitrates 201–3 randomized controlled trial botulinum toxin 205 calcium channel antagonists 20

vs placebo 205–6

vs sphincterotomy 206

calcium channel antagonists 203–5

medical therapy 201

nitrates 201–3

randomized controlled trial

botulinum toxin 205

calcium channel antagonists 204

complications of 208–10

surgical therapy 206–8

anal dilation 207

refractory fissures 208

sphincterotomy 207–8

chronic constipation see constipation

chronic diverticulitis 254

surgical treatment 254

best timing 254

vs medical treatment 254

chronic pilonidal disease

surgical therapy 216

see also pilonidal disease

Ciprofloxacin 337

cisapride 73

Citrucel® 179

clean intermittent catheterization (CIC) 401

cleft lift procedure 220

Cleveland Clinic Florida 247

Clinical Outcomes of Surgical Therapy (COST) trial 59, 140

Clopidogel 135

Clostridium difficile 103

cocaine 19

Cochrane Database Review 28

Colazal 337

colchicine 367

colectomy 370

colocolic intussusception 115

colon cancer 322

colon injury

abdominal injury 376–8

anastomosis 380

diversion 378–80

meta-analyses investigation 380

primary repair 378, 379, 380

arguments of 378

randomized trials investigation 379

resection 379–80

colonic inertia see slow-transit constipation

colonic transit studies 362–3

radiopaque marker test 363

scintigraphic technique 363–4

colonic transit studies 93

colonoscopy 132

perforation rage 136

sedation 133

colorectal cancer 105–7

diverticulitis

detection and differentiation 105

metastasis 106

postoperative complications 107

recurrence 106–7

staging 105–6

Colorectal Quality Measures 165

colorectal transit 117

colostomy closure outcomes of 384 colostomy 234, 375 colovesical fistula 396

Commission on Cancer (CoC) Joint Quality Measures 165

complex diverticulitis 255 complex perineal injury 389–90

computed tomography 390 pelvic fracture 390

computed tomographic colonography (CTC) 110–12 advanced adenoma 110–11

benefits 111 complications 111 limitations 111–12 optical colonoscopy 112 postoperative surgery 112 technique 111

computed tomography (CT scan) 99 appendix 108

bowel trauma 101–2 cecal volvulus 109 colitides 103–4 colorectal cancer 105–8 contrast enhanced multidector CT 100 diverticulitis 104–5

inflammatory bowel disease (IBD) 102–3 pneumatosis 100

pneumoperitoneum 100–1 sigmoid volvulus 109 small bowel obstruction

CT enteroclysis 110 diagnosis and causes 109–10 ischemia 110

paralytic/adynamic ileus 110 tumors 108–9

unenhanced multidector CT 99–100 Condyloma Acuminatum 155 condyloma 155

congestive heart failure 5 conservative therapy 200 acute anal fissure 200 constipation 361 balloon expulsion test 94 biofeedback therapy 367–8 biofeedback 94

colectomy, successful outcomes 370 colonic transit studies 362–4 colonic transit studies 93 complications 370 defecography 93 limitations 93

drugs associated with 362

functional constipation 361 initial evaluation 362

medical condition 361

medical treatment 365–7 high-fiber diet 365 medications 366 stimulant laxatives 367 MRI 94

limitations 94 pelvic floor physiology tests 364

Rome III diagnostic criteria 361

routine evaluation 362

small bowel transit 94

surgical intervention 368–70

timing 369

treatment 361

Contigen® 233

continent ileostomy 351

proctocolectomy with 320–2

Coronary Artery Revascularization Prophylaxis (CARP) 4

corticosteroids 337

cramping 367

Crohn’s disease

after surgery

health-related quality of life (HRQL) 344

postoperative occurrence 343

clinical features 331

computed tomography (CT scan) 102

evaluations of

blood test 332

double balloon enteroscopy (DBE) 335

imaging techniques 332–5

PET scan 335–6

stool marker 332

fever 331

and indeterminate Colitis 327

medical therapy 336

5-Aminosalicylates (5-ASA) 336–7

antibiotics 337

biologic response modifiers 338

corticosteroids 337

immunomodulators 337–8

postoperative recurrence, prevention of 338–9

nutritional therapy 339

surgical intervention

bypass surgery 343

resection 342–3

stricture biopsy 342

strictureplasty 341–2

surgical treatment

abscess 340

bleeding 341

indications for 339

obstruction 341

perforation 339–40

perianal crohn’s disease 340–1

toxic megacolon 341

symptoms of 331

cryotherapy 155, 291

CT enteroclysis 110

cyclosporine 338

damage control surgery (DCS) 381–2

damage-control laparotomy 46–7, 47

deep venous thrombosis (DVT) 71–2

defecography 93, 117, 240, 364

in constipation, limitations of 93

scintigraphic 363–4

dehiscence 324–5

delayed bladder injury 396

delayed hemorrhage 135

Delorme’s procedure 241, 242–3

Denonvilliers’ fascia 267

Depositions 151

destructive injury 389 detrusor function 401 devascularization injury 398 diabetes 8

diagnostic laparoscopy 387 diagnostic peritoneal lavage (DPL) 376 dietary modification 178

Dipentum 337 Diprivan 133 diverticular disease immunosuppressed patients 254–5 incidence of 250

intra-operative classification 250 nonoperative therapy 250@

operative therapy 249, 255–7 complications of 257 Hartmann reversal 256–8 postoperative resection 258–9 procedures of 258–9

timing of closure 259 diverticulitis 143–4, 250 acute complicated 253 outcomes 253 recurrence, risk of 253 surgical intervention 253–4 chronic diverticulitis 254 complex diverticulitis 254 diverticulosis 250

acute uncomplicated 251 age 251–2

outcomes 251 progression, of disease 251 recurrence, risk of 252 postoperative surgery 258–9 procedures 258

diverting ostomies 352 Donabedian model 160 double balloon enteroscopy (DBE) 335 doxycycline 157

Duke Activity Status Index 4 duodenum stricture 343 Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography (DECREASE-V) 4

DVT prophylaxis 22

DVT see deep venous thrombosis (DVT)

dynamic graciloplasty 231–2 dysplasia 326

E Coli see Escherichia coli

Eastern Cooperative Oncology Group (ECOG) 304 elective colectomy 258

elective colon resections 14 electomyography

in fecal incontinence with limitations 91 electrocardiogram 4

preoperative baseline 4 electrolyte 15

electromyography (EMG) 364 concentric needle 89–90 rectal prolapse 239–40 single fiber 90 surface 90 Elsberg syndrome 157

Emergency Department 249

end ileostomy 351

end ostomies 350–1

endometriosis 115

endorectal advancement flap 340

endoscopic ablation therapy 314

endoscopic ultrasound (EUS) 335

enterovesical fistula 396, 397

EORTC 310

epidural anesthetic 21–2

ERBITUX® 301

erythema 28

erythromycin 73

Escherichia coli 14, 386

evisceration 283

excisional hemorrhoidectomy 169–72

extrasphincteric fistulas 186

fecal bolus 227

fecal contamination 282–3

fecal continence 87

fecal incontinence, surgery for 87, 174

biofeedback 92

limitations 92

electromyography, limitations 91

manometry 87–8, 88

limitations 89

ultrasound, limitations 92

anorectal physiology tests (ARP) 228–9

epidemiology 226

etiology

anal sphincter 226

central nervous system 227

fecal bolus 227

rectum 226–7

evaluation

historical 227–8

physical 228

severity, assessment of 227

risk factors 227

treatment

antegrade colonic enema 233

artificial bowel sphincter 231

biofeedback 229

dynamic graciloplasty 231–2

injectable bulking agents (IBA) 233

medical therapy 229

sacral nerve stimulation 232–3

sphincteroplasty 229–31

fentanyl 21, 133

Ferguson hemorrhoidectomy 170, 171

FFCF trial 310

FiberChoice® 179

Fibercon® 179

fibrin glue 187–8

Fibrin Glue 340

fibrinclot 340

fissures see anal fissures

fistula 174, 219, 340

fistula-in-ano

carcinoma associated with 193

classifications 184

fistulotomy 186, 340

flexion distraction injury 376

Flint grade 378

fluoroscopy 112–17 barium enema 112–15 physiologic examinations 117 anorectal manometry 117 balloon proctography 117 colorectal transit 117 defecography 117 water-soluble contrast enema 115–17 focused abdominal sonography for trauma (FAST) 376–7 evaluation 376

FOLFIRI 301 FOLFOX 300 Frykman-Goldberg procedure 245–6 functional constipation 361

see also constipation

gabapentin 68 gastrointestinal (GI) bleeding 122 gastrointestinal obstruction 341 gastrointestinal scintigraphy 121–2 Gastrointestinal Tumor Study Group and North Central Cancer Treatment Group 308

Gatrointestinal Stroma Tumors (GIST) 109 German Rectal Cancer Trial 302

glyceryl trinitrate (GTN) 200, 202 Goldman risk model 3

gracilis transposition 341 Hand Assisted Laparoscopic (HAL) Colectomy 255 Harmonic Scalpel® hemorrhoidectomy 172 Harmonic Scalpel® 172

Hartmann colostomy

outcomes of 256

reversal 256–7 healthcare 263 Heineke–Mikulicz procedure 341 hemorrhage 134–5, 281

anastomosis 41 delayed bleeding 174 intraoperative 281 intraoperative 44–6 postoperative bleeding 173–4 postoperative 281–2 hemorrhoid

anatomy and pathophysiology 178 bleeding 178

classifications 181

clinical evaluation 178 grading system 178 nonoperative therapy for 178 techniques, comparison of 181–2 treatment

conservative management 178–9 infrared photocoagulation 181 rubber band ligation 179–80 sclerotherapy 179

hemorrhoidal surgery 168 anatomy/etiology 168–9 clinical evaluation 169 excisional hemorrhoidectomy 169–72 nonexcisional options 169

postoperative complications

anal fistula 174

anal stenosis 174

anal tags 175

constipation and fecal impaction 174

fecal incontinence 174

hemorrhage 173–4

infection 174

mucosal ectropion 174

pain 172

urinary retention 172–3

sagical section and anal cushion 168

special situation

anorectal varices 175

postpartum hemorrhoids 175

heparin 22

hepatic artery infusional (HAI) therapy 290–1

hepatic disease 6

hepatic metastasis, chemoembolization of 123

herpes simplex virus (HSV) 156–7

hidradenitis suppurativa 215

diagnosis 222

nonoperative management 222–3

pathophysiology 221–2

surgical management

excision 223

high-molecular-weight polyethylene glycol (PEG) 366–7

HIV/AIDS 7

human immunodeficiency virus 156

human papillomavirus (HPV) 155

hydrocortisone cream 155

hyperbaric local anesthetic 21

hyperbaric oxygen 314

hypercoaguable syndromes 9

hypersomolar oral saline laxative 15

hypertonic NaP 15

hypobaric local anesthetics 21

iatrogenic injury 266

iatrogenic perforation 144

iatrogenic ureteral injuries 397

distal one third 398–9

middle one third 398

proximal one third 398

idiopathic hypertrophic subaortic stenosis (IHSS) 22

IFL 301

ileal pouch-anal anastomosis (IPAA) 325, 351

ileal-rectal anastomosis (IRA) 351

ileocolic resection 342

ileocoloc intussusception 110, 115

ileonal pouch procedure

abdominal colectomy 322

complications 323–326

controversies 326–7

functional result 323

proctocolectomy 319–23

ileorectal anastomosis

with abdominal colectomy 322

ileostomy 352

selective omission 327

ilioinguinal and iliohypogastric nerve block 23

image-guided percutaneous biopsy 123

imaging studies 97

abdominalradiography 97–99 bowel obstruction and dilatation 97–8 cecal volvulus 99

pneumoperitoneum 97 sigmoid volvulus 98–9 toxic megacolon 98 computed tomographic colonography (CTC) 110–12 advanced adenoma 110–11

benefits 111 complications 111 limitations 111–12 optical colonoscopy 112 postoperative surgery 112 technique 111

computed tomography (CT scan) 99 appendix 108

bowel trauma 101–2 cecal volvulus 109 colitides 103–4 colorectal cancer 105–8 contrast enhanced multidector CT 100 diverticulitis 104–5

inflammatory bowel disease (IBD) 102–3 pneumatosis 100

pneumoperitoneum 100–1 sigmoid volvulus 109 small bowel obstruction 109–10 tumors 108–9

unenhanced multidector CT 99–100 fluoroscopy 112–17

barium enema 112–15 physiologic examinations 117 water-soluble contrast enema 115–17 interventional radiology 122–3 chemoembolization of hepatic metastasis 123 gastrointestinal (GI) bleeding 122

image-guided percutaneous biopsy 123 percutaneous abscess drainage (PAD) 122–3 radiofrequency ablation (RFA) 123 magnetic resonance imaging (MRI) 119–20 nuclear medicine imaging

gastrointestinal scintigraphy 121–2 positron emission tomography 120–1 ultrasonography 117–19

endoluminal ultrasound’s (EUS) 119 intraoperative ultrasound 119 transabdominal ultrasound 118 imaging techniques

in crohn’s disease colonoscopy 334 computed tomography scan 334–5 double balloon enteroscopy (DBE) 335 endoscopic ultrasound (EUS) 335 enema 332

magnetic resonance imaging 335 scintigraphy 336

small bowel series 332 transabdominal ultrasound (US) 334 upper edoscopy 332–3

imiquimod 156 immunocompromise 7 immunomodulators 337–8 immunosuppressed patients 254–5

impaired sensorium 5

infections 69–70

surgical site 69–70

urinary tract infections 70

inflatable penile prosthesis (IPP)

components 402

Infliximab 193, 338

infrared photocoagulation 181

injectable bulking agents 233

injection sclerotherapy 179

interventional radiology 122–3

gastrointestinal (GI) bleeding 122

hepatic metastasis, chemoembolization of 123

image-guided percutaneous biopsy 123

percutaneous abscess drainage (PAD) 122–3

radiofrequency ablation (RFA) 123

intestinal stomas 349

intraabdominal hemorrhage 323–4

intraabdominal infections 29

percutaneous drainage 29

intraoperative anastomosis 33

case management 33

challenges 40–1

adjuvants and drains 41

hemorrhage 41

inadequate anastomotic lumen 40–1

leakage 41

proximal protection 41

preanastomotic considerations

bowel preparation 33–4

bowel status 34

exposure 34

obtaining adequate length 35–6

operative principles 33

preoperative discussion and planning 33

staples versus sutures 37

double staple 39

end-to-end 37–9

end-to-side 39–40

side-to-side 39–40

technique 36–7

test 40

types of 37

intraoperative challenges 44

abdominal wall closure 51

adhesive disease 47–9

biologic meshes 52

case management 44

damage control 46–7, 47

hemorrhage 44–6

lesion localization 49–50

preoperative evaluation 44

retention sutures 51

suture material 51

synthetic prostheses 51–2

technique 51

intraoperative positioning

lateral decubitus 24

lithotomy 24

nerves, at risk 24

prone 23–4

supine 23

intraoperative radiation therapy (IORT) 287

intraperitoneal anastomoses 29

intrathecal blockade see spinal blockade

intravenous antibiotics 15

effect of 15

inulin 179 IPAA 322 Irinotecan 303 IROX 301 ischemia 353 isobaric local anesthetics 21 isosorbide dinitrate (IDN) 200 isosorbide mononitrate (IMN) 200

Ivalalon sponge rectopexy 244, 245

jeep disease 215 Kaposi’s sarcoma 156

Karydakis flap 200

Klebsiella 386 Kock pouch 322 Konsyl® 179 laceration injury 398 lactulose 366 laparoscopic colorectal surgery 140 advantages 140–1

colonoscopic perforation 144 disadvantages 141

diverticulitis 143–4 inflammatory bowel disease ulcerative colitis 142–3 instruments 145 purported benefits 140 rectal prolapse 144 stoma 143 technical considerations 144 treatable conditions colon cancer 141–2 trocar placement 144–5 vascular control 145 laparoscopic intraperitoneal surgery 4 laparoscopic surgery 28

laparoscopy 246, 291–2, 377 lateral decubitus positioning 24 lateral fistula 216–16

Leapfrog Group 160–1 criteria 161 purchasing principles 160–1 Lee index 3

leucovorin 300 levamisole 300 lidocaine 19 life-threatening injuries 389 LigaSure™ Vessel Sealing System 291 LigaSure™ 172

Ligation of Intersphincteric Fistula Tract (LIFT) 189

linaclotide 367 liposuction 357–8 lithotomy 389 positioning 24 litigation injury 398 liver metastasis 289

adjuvant therapy 291

assessing resectability 289–91

operative approach

laparoscopy 291–2

open resection 292

outcomes 292

treatment of 289

local anesthesia 19, 389

drugs 19

perianal block 20

relative potency 19

systemic toxicity 20

loop end stomas 351–2

loop ileostomy 327

loop ostomies 352

loose hair 215

Lovenox® 135

low-molecular weight heparin (LMWH) 22

lubiprostone 367

lung metastasis 292

assessing resectability 293

operative approach 294

outcomes 294–5

treatment of 292

video assisted thoracoscopic surgery (VATS) 294

magnetic resonance imaging (MRI) 94, 119–20

in constipation, limitations of 94

malignancy 326

malnutrition 6–7

mannitol 15

manometry 87–8, 88

for incontinence

value and limitations of 89

marsupialization 218

mechanical bowel preparation (MBP) 15, 16

randomized controlled trials 16–17, 28

Meckel’s diverticulum 104

medical legal issues 148

affordable liability insurance, lack of 148–9

documentation

chart 150

high-risk areas 149

informed consent 149–50

malpractice suit, anatomy of

initial phase 150–1

ploys 150–2

pretrial discovery 151

testing your memory 151

trials 152

physician-patient relationship 149

medical therapy

chronic anal fissure 199–6

fecal incontinence 229

melanosis coli 367

meperidine 133

mepivacaine 19

mesh rectopexy 243

mesh sling repair 244

metabolic disease 7

Metamucil® 179

methotrexate 338

Methylcellulose 179

Metronidazole 337 microfibrillar collagen 266 midazolam 133

Milligan-Morgan hemorrhoidectomy 169–70, 171

misoprostol 367 modified abdominoplasty 356–7 flap dissection 356, 357 caring 356–7

Monitored Anesthetic Care (MAC) 20–1 morbid obesity 355–8

preoperative stoma marking 356 preoperative weight loss 356 mucosal ectropion 174 mucosectomy

vs double-stapled technique 326–7 multidector computed tomography (MCDT) 99–110

see also computed tomography

National Healthcare Safety Network (NHSN) 27 National Cancer Institute (NCI) 165

National Comprehensive Cancer Network (NCCN) 165, 290

National Initiative on Cancer Care Quality (NICCQ) 164 National Nosocomial Infections Surveillance (NNIS) System 27

National Quality Forum (NQF) 164, 165

National Surgery Quality Improvement Project (NSQIP) 3, 162

National VA Surgical Risk Study (NVASRS) 162 nausea 72

neisseria gonorrhea 157 neoadjuvant chemoradiotherapy 302 tumors 302

nephropexy 398 neurologic system 8–9 Parkinson’s disease 8–9 neutropenic colitis 104 Nichols-Condon antibiotic 14 nifedipine ointment 204 nipple valve slippage manifestations of 322 nitrates 200, 201–3

vs calcium channel antagonists 204 sphincterotomy 203

nitroglycerin (NTG) 200 nitroglycerin transdermal patch 200

NJ 135 node-positive rectal cancer 302–3 neoadjuvant chemoradiotherapy for 302 T3

adjuvant chemotherapy alone for 302–3 nonabsorbable disaccharides 366 nonbladed trocars 145

noncutting Seton 340 nuclear medicine imaging gastrointestinal scintigraphy 121–2 positron emission tomography 120–1 obesity 7–8

olsalazine 337 omentoplasty 283 open abdominal repairs 244 oral antibiotic prophylaxis 28 Oral antibiotics 14

oral lavage 133

oral preparations 15

polyethylene glycol (PEG) 15

sodium phosphate (NaP) 15

ostomy

complications with

ischemia 353

morbid obesity 355–8

parastomal hernias 354–5

prolapse 355

retraction 353

skin 353

stenosis 353–4

dissected free 357

preoperative stoma marking 350

psychological impact 349–50

reversal 358

types of 350–3

ostomy necrosis 353

outcome measures 161–5

and quality measures 165

overlapping sphincteroplasty 230

Oxaliplatin 303

pain management 67–8

paralytic ileus 110

parastomal hernias 354–5

parenteral antibiotic prophylaxis 14

Parkinson’s disease 8–9

patient-controlled epidural analgesia

(PCEA) 21

pectins 179

pelvic floor dysfunction 361

biofeedback therapy 367–8

and slow-transit constipation 362

pelvic floor physiology tests

anorectal manometry 364

balloon expulsion test 364

defecography 364

electromyography (EMG) 364

pelvic hemorrhage 266

pelvic kidneys 400

pelvic nerve 401

pelvic sepsis 29–30, 389–90

manifestations 324

penetrating colon injury

damage control surgery (DCS) 381–2

penetrating colon injury 380–1

practice patterns 382

primary repair versus diversion

arguments of 378–80

meta-analyses investigation 380

randomized trials investigation 379

penicillin G 157

percutaneous abscess drainage

(PAD) 122–3

perianal crohn’s disease

elective surgery 340

surgical treatment 340

perineal hernia 283

perineal proctosigmoidectomy 241–2

perineal rectosigmoidectomy 240

perineal sinus 282

perineal wound complications 282

perirectal abscesses Crohn’s disease 192 diagnosis 184–5 etiology 183–4 HIV-positive patient 193 incontinence 190–2 non-surgical management 192–3 recurrence 189–90

surgical therapy advancement flap 186–7 anal fistula plug 188–9 extrasphincteric fistulas 186 fibrin glue 187–8

fistulotomy 186 incision and drainage 185–6 seton placement 186

PET scan see positron emission tomography scan 335–6

phenol sclerotherapy 217

Physician Quality Reporting Initiative (PQRI) 161, 163–4

Physiologic and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) 2, 257

pilonidal disease 215 acute disease 216

advanced procedures for 220

Bascom operation 219 chronic disease 216 chronic pilonidal disease 217 diagnosis 215–16

historical perspective 215 limited excision 219 marsupialization 218–19 nonhealing wounds 220 nonsurgical treatment 216–17 phenol sclerotherapy 217

procedures for 217

sacral wound 220 surgery for 219–20 wide local excision 217–18 plain films 97

Plavi® 135 Plavix 8 pneumonia 71 pneumoperitoneum 97 abdominalradiography 97 computed tomography (CT scan) 100–1 podophyllin 155–6

polyethylene glycol (PEG) 15 polyethylene glycol electrolyte lavage solution (PEG-ELS) 366 polypectomy 135

polyvinyl alcohol sponge rectopexy 244, 245

positron emission tomography (PET) scan 120–1, 335–6 positron emission tomography with fluorine 18–labeled fluoro-2-deoxy-D-glucose (FDG-PET) 335–6

Post Dural Puncture Headache (PDPH) 22 posterior bladder injury 396

posterior mesh fixation 244 posthemorrhoidectomy pain 172 postoperative complications 67 atelectasis

pneumonia 71 prevention 71 bleeding 69 case management 67

deep venous thrombosis 71–2

infections

surgical site 69–70

urinary tract 70

nausea and vomiting 72

pain 67–8

prolonged ileus 72–3

retained foreign bodies 73–5

time out” and sided surgery concerns 75

urinary retention 70–71

postoperative hemorrhage 323–4

postoperative ileus 140

postoperative patient

pelvic sepsis 29–30

with sepsis 27

postoperative pneumonia 25

postoperative pulmonary complications (PPCs) 5

postpartum hemorrhoids 175

postpolypectomy bleeding 135

anticoagulant recommendations 135

management of 134

pouch anal fistulas 325

pouch vaginal fistulas 325

pouchitis 322, 326

prednisone 337

premenopausal females 2

preoperative bowel preparation 14

in elective colon resections 14

objectives 14

preoperative cardiac disease 3–4

ACC 4

hypertension 3

preoperative medical condition 1

aging 8

anesthesia consultation 1

cardiovascular disease 3–4

diabetes 8

documentation 3

hepatic disease 6

HIV/AIDS 7

hypercoaguable disorders 9

immuncompromise 7

malnutrition 6–7

metabolic disease 7

neurologic system 8–9

obesity 7

premenopausal females 2

prevent postoperative complications 1

pulmonary disease 5

renal disease 5–6

using scoring systems 2

preoperative risk assessment

scoring systems 2

prilocaine 19

Priritis ani 154

causes of 154–5

measures 155

soilage 154

procaine 19

procedure for prolapse and hemorrhoids (PPH) 172, 173

proctectomy

fecal contamination 282–3

proctitis 157

proctocolectomy with brooke ileostomy indications 319–20 operative technique 320 outcomes 320

with continent ileostomy operative technique 320 outcomes 320–2 with ileoanal pouch 322 indications 322 operative technique 322–3 outcome 323

prolapse 355 prone positioning 23–4, 389 jack-knife position 21 prophylactic antibiotics 27 prophylactic sigmoid resection 255 pseudodiverticula 114

pseudomonal species 386 Psoas hitch 399

psuedomembranous colitis 103–4 psychiatric evaluation 23 psyllium 179

PTQ implantsTM 233 pulmonary disease 5 American College of Physicians 5 risk factors 5

purse-string stitch, repair of 38–9, 38

quality measures assessment and improvement,

in surgery 159

process measures 161, 162, 163–4

structural measures 160–1 definition 159

Donabedian model 160 Leapfrog Group 160–1 criteria 161 purchasing principles 160–1 and outcome measures 165 radiation therapy 306 acute adverse effects 310–11 adjuvant treatment 307–10 chronic late adverse effect 312–13 chronic rectal effects 313–14 neoadjuvant treatment 308 surgical complications 311–12 radiofrequency ablation (RFA) 123 randomized controlled trials 16 mechanical bowel preparation (MBP) 15, 16 rapid plasma regain (RPR) 157

rectal carcinoma

staging 306

rectal injury classic components of 387 foreign bodies 388

high-risk factors of 387

intraperitoneal injury 387–8 management of

fecal diversion 387 modified steps 388 traditional steps 388

rectal procidentia 239

rectal prolapse

abdominal fixation procedures 144

anal physiology 239–40

defecography 240

evaluation and investigations 239

operative procedures 240–1

anal encirclement 243–4

Delorme’s procedure 242–3

laparoscopic approach 246

mesh sling repair 244

open abdominal repairs 244

perineal proctosigmoidectomy 241

perineal repairs 241

posterior mesh fixation 244

resection rectopexy 245–6

suture rectopexy 244–5

physical exam 239

recurrent prolapse 246–7

surgery for

Recto-Anal inhibitory reflex (RAIR) 89

recurrent rectal cancer 286

assessing resectability 286

chemotherapy and radiation 287

operative treatment 287, 289

outcomes 288

refractory fissures 208

regional anesthesia 21–3

central neuraxial blockade 21–2

ilioinguinal and iliohypogastric

nerve block 23

Transversus Abdominis Plane

(TAP) block 22–3

renal disease 5–6

resection 379–80

resection rectopexy 245–6

restorative proctocolectomy 327

Cesarean sections 323

with ileoanal pouch 322

indications 322

operative technique 322–3

outcomes 323

retrograde urethrogram (RUG) 395

Rhomboid flap 200

Ripstein procedure 243, 244

RTOG 310

rubber band ligation 179–80

sacral foramina 232

sacral nerve stimulation (SNS) 232

efficacy of 232

functional result 233

indications for 232–3

selection criteria 232

sacral neuromodualtor 402

sacral wound healing 221

sacrococcygeal fascia 217, 220, 221

Sanofi-Aventic 135

scintigraphy 336

sclerotherapy 179

seat belt sign” 376

secretagogues 367

sedation 389 senna 367 sepsis 27 intraabdominal infections 28 pelvic sepsis 29–30

postoperative patient 27 surgical site infection 27–8 seton placement 186 severe diarrhea postoperative radiation therapy 310 sexual dysfunction 323, 401–2 erection 402

male and female patients 401 modalities 402

short-chain fatty acids (SCFA) 314 sigmoid volvulus 98–9, 115 skin infection 27

skin 27 functions 27 wound infection 27 slow-transit constipation 361 and pelvic floor dysfunction 362 total abdominal colectomy and ileorectal anastamosis 369 small bowel crohn’s disease imaging techniques 336 small bowel obstruction small bowel transit constipation 94 sodium phosphate (NaP) 15, 133 dosages 15

soft tissue infection 27 sorbitol 366

sphincteroplasty fecal incontinence 229–30 functional result

follow-up 230

sphincterotomy 207

vs botulinum toxin (BT) 206

vs calcium antagonists 204 nitrates 203

spinal blockade 21 spirochete 157 splenic injury 266 recognition 266

SSI see surgical site infection (SSI) Staphylococcus aureus 222

staple anastomosis

vs suture 37 double staple 39 double staple 39 double staple 39 double staple 39 end-to-end 37–9 end-to-side 39–40

vs sutures 37

stapled anoplasty 170, 173

stenosis 354

Z-plasty repair 352

stimulant laxatives 367 side effects 367 stoma necrosis 353–4 stomal retraction 357–8

stomas 143

living with 349–50

meshing 354

necrosis

conservative management 354

site marking 350

types

diverting ostomies 352

end ostomies 350–2

loop colostomy 352

stricture biopsy 342

stricture 265

strictureplasty 341–2

indication and contraindication 342

sucralfate 314

sulfasalazine 336

superficial injury 389

supine positioning 23

suprapubic catheter 401

Surgical Care Improvement Project (SCIP) 19, 161, 162

common and preventable complications 25

process and outcome measures 25

Surgical Infection Prevention Guideline Writers Workgroup

(SIPGWW) 14

surgical site infection (SSI) 27–8, 69–70

laparoscopic surgery 28

prophylactic antibiotics 27

scaling 27

skin and soft tissue infection 27

surgical therapy

abdominal surgery 264, 265–7

advancement flap 186–7

anal fistula plug 188–9

anal fistula 183, 186–7

chronic anal fissure 201–8

chronic diverticulitis 254

chronic pilonidal disease 216

Crohn’s disease 339–41

extrasphincteric fistulas 186

fecal incontinence 226

fibrin glue 187–8

fistulotomy 186

hidradenitis suppurativa 215

incision and drainage 185–6

perianal crohn’s disease 340

perirectal abscess 183, 185–9

pilonidal disease 217

seton placement 186

on stoma 354

Surgisis® 188

suture anastomosis

vs staple 37

double staple 39

end-to-end 37–9

side-to-side 39–40

vs sutures 37

suture rectopexy 244–5

laparoscopy 246

Swedish Rectal Cancer Trial 302

syphilis 157

systemic inflammatory response syndrome (SIRS) 27

Teflon® 233 Tegaserod 367 temperature and oxygenation 28 test-tube test” 353

tetracaine 19 therapeutic heparin 22 thermal injury 398 Thiersch repair 243–4 thiopurine methyltransferase (TPMT) 337–8 thrombin 266

tissue oxygenation 28 TissueLink Endo SH2.0™ Sealing Hook (SH) 291 total abdominal colectomy

with ileorectal anastamosis 369 total mesorectal excision (TME) 308, 401 toxic megacolon 98, 341

transabdominal ultrasound (US) 334 transanal approach, to rectal cancer benefits 276

complications 275 imaging techniques 271–2 local surgery

disadvantages 276 oncologic advantages of 276

outcomes 276

surgical options 271–2 Transanal Endoscopic Microsurgery (TEM) 273 comparison with 275–6

complication of 275 techniques of 274–5 transanal excision 272 techniques 273 Transanal Endoscopic Microsurgery (TEM) comparision with 275, 276–6

complication of 275 benefits 276

local surgery disadvantages 276 oncologic advantages of 276

outcomes 276

and transanal 273, 275–6 techniques of 274–5 transanal endoscopy 132 colorectal preparation 132–4 hypertonic electrolyte solutions 133 infectious disease complications 134 intravenous sedation 133–4 oral lavage 133

nontechnical complications 132 postpolypectomy syndrome 136–7 proctoscopic perforations 137 technical complications hemorrhage 134–5 perforation 135–6 transanal excision 272 transanal rectal flap advancement 396 transcoccygeal Kraske approach 278 transureteroureterostomy 399 Transversus Abdominis Plane (TAP) block 22–3 Trendelenburg position 23, 246

Treponema pallidum 157

trichloroacetic acid 155