Improved Outcomes in Colon and Rectal Surgery part 1 ppsx

Improved Outcomes in Colon and Rectal Surgery Edited by Charles B Whitlow David E Beck David A Margolin Terry C Hicks Alan E Timmcke www.informahealthcare.com Telephone House, 69-77 Pau

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Improved Outcomes in Colon and

Rectal Surgery

Edited by Charles B Whitlow

David E Beck David A Margolin

Terry C Hicks Alan E Timmcke

www.informahealthcare.com

Telephone House, 69-77 Paul Street,

London EC2A 4LQ, UK

52 Vanderbilt Avenue, New York, NY 10017

Improved Outcomes in Colon

and Rectal Surgery

About the book

Written by many of the world’s leading colorectal surgeons, this evidence-based text investigates the

risks and benefits of colorectal surgeries By using clinical pathways, algorithms, and case discussions,

the authors identify the best practices for patient safety and positive outcomes to ensure that

physicians correctly recognize potential problems and carefully manage complications

Improved Outcomes in Colon and Rectal Surgery is an essential reference for all colorectal surgeons,

fellows and residents, as well as those working in gastroenterology and the medico-legal profession

About the editors

Charles B Whitlow MD, Program Director, Colon and Rectal Surgery Fellowship Program, Ochsner

Medical Center, New Orleans, Louisiana, USA.

David E Beck MD, Chairman, Department of Colon and Rectal Surgery, Ochsner Medical Center, New

Orleans, Louisiana, USA He is President-Elect of the American Society of Colon and Rectal Surgeons

and Editor-in-Chief of Clinics in Colon and Rectal Surgery and the Ochsner Journal.

David A Margolin MD, Colon and Rectal Research Director, Ochsner Medical Center, New Orleans,

Louisiana, USA He is an Associate Editor of Diseases of the Colon and Rectum.

Terry C Hicks MD, Associate Chairman, Department of Colon & Rectal Surgery, Ochsner Medical Center,

New Orleans, Louisiana, USA He is President of the American Board of Colon and Rectal Surgeons

Alan E Timmcke, Staff Colon and Rectal Surgeon, Ochsner Medical Center, New Orleans, Louisiana, USA.

Also available

Ambulatory Colorectal Surgery

Edited by Laurence R Sands and Dana R Sands (ISBN: 9780824727925)

Gastrointestinal Oncology: Evidence and Analysis

Edited by Peter McCulloch, Martin S Karpeh, David J Kerr and Jaffer Ajani (ISBN: 9780849398650)

Neoplasms of the Colon, Rectum, and Anus, Second Edition

Authored by Philip H Gordon and Santhat Nivatvongs (ISBN: 9780824729615)

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Improved Outcomes in Colon and Rectal Surgery

Edited by

Charles B Whitlow MD

Program Director

Colon and Rectal Surgery

Ochsner Clinic Foundation

New Orleans, Louisiana

USA

David E Beck MD

Chairman

USA

David A Margolin MD

Research Director

USA

Terry C Hicks MD

Associate Chairman

USA

Alan E Timmcke MD

Staff Surgeon

USA

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

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

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

A CIP record for this book is available from the British Library.

Library of Congress Cataloging-in-Publication Data

Data available on application

ISBN-13: 9781920071528

Orders

Informa Healthcare

Sheepen Place

Colchester

Essex CO3 3LP

UK

Telephone: +44 (0)20 7017 5540

Email: CSDhealthcarebooks@informa.com

Typeset by C&M Digitals (P) Ltd, Chennai, India

Printed and bound in Great Britain by CPI, Antony Rowe, Chippenham, Wiltshire

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Contents

List of Contributors v

1 Preexisting conditions 1

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

2 Preoperative bowel preparation 14

David A Margolin and Sean Mayfield

3 Anesthesia and intraoperative positioning 19

Lebron Cooper and Larry R Hutson

Steven Mills and Michael J Stamos

5 Intraoperative anastomotic challenges 33

David E Beck

6 Other intraoperative challenges 44

James T McCormick and Sharon G Gregorcyk

7 Postoperative anastomotic complications 56

Daniel L Feingold

8 General postoperative complications 67

Scott R Steele and Clifford L Simmang

9 Care paths and optimal postop management 79

Surya P M Nalamati and Eric J Szilagy

10 Limitations of anorectal physiology testing 87

Thomas E Cataldo and Syed G Husain

11 Limitations of colorectal imaging studies 97

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

12 Transanal endoscopy 132

Terry C Hicks

13 Laparoscopic colorectal surgery 140

James W Fleshman and Jonathan S Chun

14 Medical legal issues 148

Charles F Gay Jr and Terry C Hicks

15 Miscellanous conditions 154

M Benjamin Hopkins and Alan E Timmcke

16 Quality and outcome measures 159

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

17 Hemorrhoidal surgery 168

Dan R Metcalf and Anthony J Senagore

18 Nonoperative therapy for hemorrhoid disease 178

Kerry Hammond and Charles B Whitlow

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

Brian R Kann and Charles B Whitlow

20 Surgery and nonoperative therapy of anal fissure 199

Jaime L Bohl and Alan J Herline

21 Surgery for pilonidal disease and hidradenitis suppurativa 215

Paula I Denoya and Eric G Weiss

22 Surgical treatment of fecal incontinence 226

Ann C Lowry and Dimitrios Christoforidis

23 Surgery for rectal prolapse 239

Steven R Hunt

24 Operative and nonoperative therapy for diverticular disease 249

R Scott Nelson and Alan G Thorson

25 Abdominal surgery for colorectal cancer 263

Jason Hall and Rocco Ricciardi

26 Transanal approaches to rectal cancer 271

Sachin S Kukreja and Theodore J Saclarides

27 Abdominoperineal resection 278

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

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

liver and lung metastasis 286

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

29 Chemotherapy for colon and rectal cancer 300

Liliana Bordeianou and Judith L Trudel

30 Radiation therapy: Acute and late toxicity 306

Roland Hawkins

31 Surgery for ulcerative colitis 318

Patricia L Roberts

32 Surgery for Crohn’s disease 331

Jorge Canedo, Tolga Erim, and Steven D Wexner

33 Ostomies 349

Vance Y Sohn and Scott R Steele

34 Operative and nonoperative therapy for chronic constipation 361

Harry T Papaconstantinou

35 Colorectal trauma 375

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

36 Urologic complications of colorectal surgery 395

Scott Delacroix Jr and J Christian Winters

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List of Contributors

Wilson B Altmeyer MD

Department of Radiology

USA

David E Beck MD

USA

Travis J Blanchard MD

USA

Jaime L Bohl MD

Department of Surgery

Vanderbilt University

Nashville, Tennessee

USA

Liliana Bordeianou MD

Division of General and Gastrointestinal Surgery

Massachusetts General Hospital

Boston, Massachusetts

USA

Jorge Canedo MD

Department of Colorectal Surgery

Cleveland Clinic Florida

Weston, Florida

USA

Thomas E Cataldo MD

Warren Alpert Medical School of Brown University

Brown Program in Colon and Rectal Surgery

Rhode Island Hospital/Lifespan Health System

Providence, Rhode Island

USA

S David Cho MD

Oregon Health and Science University

Portland, Oregon

USA

Dimitrios Christoforidis MD

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

Jonathan S Chun MD

Section of Colon and Rectal Surgery Washington University School of Medicine

St Louis, Missouri USA

Clarence Clark MD

Department of General Surgery Wilford Hall Medical Center and the University of Texas Health Science Center, San Antonio

Lackland AFB, Texas USA

Lebron Cooper MD

Department of Anesthiology Ochsner Clinic Foundation New Orleans, Louisiana USA

Scott E Delacroix, Jr., MD

Department of Urology Louisiana State University Health Sciences Center New Orleans, Louisiana

University of Texas, MD Anderson Cancer Center Houston, Texas

USA

Conor P Delaney MD MCh PhD

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

USA

Paula I Denoya MD

Department of Colorectal Surgery Cleveland Clinic Florida

Weston, Florida USA

Tolga Erim MD

Weston, Florida USA

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lst of contrbutors

Daniel L Feingold MD

Section of Colorectal Surgery

Columbia University

New York, New York

USA

James W Fleshman MD

Section of Colon and Rectal Surgery

Washington University School of Medicine

St Louis, Missouri

USA

Charles F Gay Jr

Adams and Reeds Attorneys and Counselors at Law

USA

Sharon G Gregorcyk MD

Texas Colon and Rectal Specialists

Dallas, Texas

USA

Jason Hall MD

Department of Colon and Rectal Surgery

Lahey Clinic

Tufts University

Burlington, Massachusetts

USA

Roland Hawkins MD

Radiation Oncology

Ochsner Cancer Institute

USA

Kerry Hammond MD

Division of General Surgery

Medical University of South Carolina

Charleston, South Carolina

USA

Alan J Herline MD

Vanderbilt University

Nashville, Tennessee

USA

Terry C Hicks MD

USA

M Benjamin Hopkins MD

Department of Colon and Rectal Surgery

USA

Steven R Hunt MD

Colon and Rectal Surgery Section Division of General Surgery Washington University

St Louis, Missouri USA

Syed G Husain MD

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

USA

Larry R Hutson MD

Department of Anesthiology Ochsner Clinic Foundation New Orleans, Louisiana USA

Sushma Jain MBBS MPH

David Geffen School of Medicine at UCLA Department of Surgery

Los Angeles, California USA

Brian R Kann MD

Cooper University Hospital UMDNJ-Robert Wood Johnson Medical School-Camden Department of Surgery

Camden, New Jersey USA

Danny Kim MD

Clifford Y Ko MD MS MSHS

Sachin S Kukreja MD

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

USA

Ann C Lowry MD

Colon & Rectal Surgery Associates Ltd

St Paul, Minnesota USA

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James T McCormick DO

Division of Colon and Rectal Surgery

Western Pennsylvania Hospital and the Forbes Regional Campus

Temple University School of Medicine

Philadelphia, Pennsylvania

USA

Marcia L McGory MD PhD

David Geffen School of Medicine at UCLA

Los Angeles, California

USA

Eric L Marderstein MD MPH

Division of Colorectal Surgery,

Department of Surgery,

University Hospitals Case Medical Center,

Cleveland, Ohio

USA

David A Margolin MD

The Ochsner Clinic Foundation

USA

Charles C Matthews MD

USA

Sean Mayfield MD

The Ochsner Clinic Foundation

USA

Dan R Metcalf MD

SMDC Health System

Duluth, Minnesota

USA

Steven Mills MD

University of California

Irvine, California

USA

Surya PM Nalamati

Henry Ford Health System

Department of Surgery/Colon & Rectal Group

Detroit, Michigan

USA

R Scott Nelson DO

Colon & Rectal Surgery, Inc Omaha, Nebraska

USA

Siyamek Neragi-Miandoab MD

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

USA

Harry T Papaconstantinou MD

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

USA

Janak A Parikh MD

W Brian Perry MD

Department of General Surgery Wilford Hall Medical Center and the University

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

USA

Harry L Reynolds Jr MD

University Hospital of Cleveland Cleveland, Ohio

USA

Rocco Ricciardi MD MPH

Department of Colon and Rectal Surgery Lahey Clinic

Tufts University Burlington, Massachusetts USA

Patricia L Roberts MD

Department of Colon and Rectal Surgery Lahey Clinic Medical Center

Burlington, and Tufts University School of Medicine Boston, Massachusetts

USA

J Robke MD

University Hospital of Cleveland Cleveland, Ohio

USA

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Theodore J Saclarides MD

Section of Colon and Rectal Surgery

Department of General Surgery

Rush University Medical Center

Chicago, Illinois

USA

Martin A Schreiber MD

Division of Trauma and Critical Care

Oregon Health and Science University

Portland, Oregon

USA

Christopher T Siegel MD

University Hospital of Cleveland

Cleveland, Ohio

USA

Anthony J Senagore MD MS MBA

Spectrum Health System

Grand Rapids, Michigan

USA

Clifford L Simmang MD

Texas Colon and Rectal Surgeons

Dallas, Texas

USA

Vance Y Sohn MD

Madigan Army Medical Center

Tacoma, Washington

USA

Michael J Stamos MD

University of California

Irvine, California

USA

Scott R Steele MD

Madigan Army Medical Center

Tacoma, Washington

USA

Eric J Szilagy MD

Department of Surgery/Colon & Rectal Group

Henry Ford Health System

Detroit, Michigan

USA

Alan G Thorson MD

Colon & Rectal Surgery, Inc

Omaha, Nebraska

USA

Alan E Timmcke MD

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

Judith L Trudel MD, MSc, MHPE

University of Minnesota

St Paul, Minnesota USA

Eric G Weiss MD

Weston, Florida USA

Steven D Wexner MD

Department of Colorectal Surgery Ohio State University and

Department of Surgery, Division of General Surgery University of South Florida College of Medicine Cleveland Clinic Florida

Weston, Florida USA

Charles B Whitlow MD

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

J Christian Winters MD FACS

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

USA

Sharon L Wright MD

Department of Surgery Oregon Health and Science University Portland, Oregon

USA

Fia Yi MD

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Preface

Quality measures and outcomes are receiving greater attention

by the lay and medical communities The occurrence or

mis-management of complications often results in poor outcomes,

increased cost, and significant morbidity Answering the call for

transparency and improvement requires action by all involved

in the care of patients Collection of objective data and quality

measures allows documentation of optimal care and desired

out-comes while identifying areas for improvement

The goal of this text is to present the current knowledge of

outcomes, as well as the techniques for minimizing and managing

complications from the common diseases and procedures of this

specialty This information will aid providers in optimizing care

and encourage research in outcome and quality measurement

Improved Outcomes of Colon and Rectal Surgery represents

the collaborative efforts of many individuals The contributing

authors were selected for their knowledge of colorectal surgery and

ability to present their surgical judgment and experience in written

form They represent a spectrum of experienced providers who

have made significant contributions to younger individuals who

will shape the future of their specialty In addition to reviewing the available literature, they have described their personal approach

to complications in colorectal surgery Numerous technical descriptions and highlights from multiple discussions held in surgical locker rooms, morbidity and mortality conferences, and the hallways of conferences and symposiums have been included Using this approach, we hope this text will provide initial guidance

to the less experienced provider and stimulate additional thought and research to the more experienced provider

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

Charles B Whitlow, MD David E Beck, MD David A Margolin, MD Terry C Hicks, MD Alan E Timmcke, MD

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