E-Book, Englisch, 284 Seiten
Scott-Conner Chassin's Operative Strategy in Colon and Rectal Surgery
1. Auflage 2010
ISBN: 978-0-387-68370-6
Verlag: Springer US
Format: PDF
Kopierschutz: 1 - PDF Watermark
E-Book, Englisch, 284 Seiten
ISBN: 978-0-387-68370-6
Verlag: Springer US
Format: PDF
Kopierschutz: 1 - PDF Watermark
This book includes step-by-step depictions of twenty-eight operative procedures in colorectal surgery. Chassin's Operative Strategy in Colon and Rectal Surgery is a succinct analysis of surgical procedures for colorectal disorders. Spanning from well-established legacy procedures to the most up-to-date minimally invasive approach, this brilliantly illustrated atlas particularly discusses the theoretical basis of the operations as well as the strategies crucial to evading common pitfalls.
Weitere Infos & Material
1;Preface;7
2;Table of Contents;8
3;Contributors;12
4;Part I Large Intestine;13
4.1;1 Concepts in Surgery of the Large Intestine;14
4.1.1;BENIGN CONDITIONS;14
4.1.1.1;Diverticular Disease;14
4.1.1.2;Volvulus;15
4.1.1.3;Ischemic Colitis;16
4.1.1.4;Rectal Prolapse;16
4.1.1.5;Familial Polyposis and Hereditary Colon Cancer Syndromes;17
4.1.1.6;Inflammatory Bowel Disease;18
4.1.1.6.1;Crohn’s Colitis;18
4.1.1.6.2;Ulcerative Colitis;18
4.1.1.6.3;Indeterminate Colitis;19
4.1.1.7;Polyps;19
4.1.2;MALIGNANT CONDITIONS;20
4.1.2.1;Colorectal Cancer;20
4.1.2.1.1;Extent of Resection;20
4.1.2.1.2;Colorectal Cancer with Synchronous Pathology;20
4.1.2.1.3;Synchronous Benign or Premalignant Conditions;20
4.1.2.1.4;Synchronous Cancer;21
4.1.2.1.5;Preoperative Evaluation;21
4.1.2.1.6;Neoadjuvant Therapy for Rectal Adenocarcinoma;22
4.1.2.2;Squamous Carcinoma of the Anus;22
4.1.2.3;Surgical Approach and Strategy;22
4.1.2.4;Specific Interoperative Considerations During Operations for Colorectal Cancer ;24
4.1.2.5;Strategies for Complex Situations;24
4.1.2.6;Primary Anastomosis versus Staged Procedures;25
4.1.2.6.1;Technical Factors for Safe Anastomosis;26
4.1.2.6.2;Other Factors Affecting Anastomotic Healing;27
4.1.2.6.3;Technical Considerations and Adjuncts;27
4.1.3;INTESTINAL POUCH RESERVOIRS;28
4.1.4;INTESTINAL STOMAS;28
4.1.5;POSTOPERATIVE CARE;30
4.1.5.1;Management of Altered Sphincter Function;30
4.1.5.2;Urogenital Function;31
4.1.6;CANCER SURVEILLANCE;31
4.1.7;POUCH SURVEILLANCE;31
4.1.8;REFERENCES;32
4.2;2 Right Colectomy for Cancer;36
4.2.1;INDICATIONS;36
4.2.2;PREOPERATIVE PREPARATION;36
4.2.3;PITFALLS AND DANGER POINTS;36
4.2.4;OPERATIVE STRATEGY;36
4.2.5;OPERATIVE TECHNIQUE (Right and Transverse Colectomy);40
4.2.5.1;Incision;40
4.2.5.2;Ligature of Colon Proximal and Distal to Tumor;40
4.2.5.3;Omental Dissection;40
4.2.5.4;Division of Middle Colic Vessels;40
4.2.5.5;Division of Ileocolic Vessels;41
4.2.5.6;Division of Ileal Mesentery;42
4.2.5.7;Division of Right Paracolic Peritoneum;42
4.2.5.8;Identifi cation of Ureter;44
4.2.5.9;Division of Ileum and Colon;44
4.2.5.10;Ileocolic Two-Layer Sutured End-to-End Anastomosis;44
4.2.5.11;Anastomosis by Stapling, Functional End-to-End;48
4.2.5.12;Wound Closure;48
4.2.6;POSTOPERATIVE CARE;48
4.2.7;COMPLICATIONS;52
4.2.8;REFERENCES;52
4.3;3 Laparoscopic Right Hemicolectomy;53
4.3.1;INDICATIONS;53
4.3.2;PREOPERATIVE PREPARATION;53
4.3.3;PITFALLS AND DANGER POINTS;53
4.3.4;OPERATIVE STRATEGY;53
4.3.5;OPERATIVE TECHNIQUE;54
4.3.5.1;Room Setup and Trocar Placement;54
4.3.5.2;Exploration;55
4.3.5.3;Mobilization of the Cecum;56
4.3.5.4;Mobilization of the Hepatic Flexure;56
4.3.5.5;Extracorporeal Resection and Anastomosis;57
4.3.5.6;Re-insufflflation and Inspection;58
4.3.6;POSTOPERATIVE CARE;60
4.3.7;COMPLICATIONS;60
4.3.8;REFERENCES;60
4.4;4 Left Colectomy for Cancer;61
4.4.1;INDICATIONS;61
4.4.2;PREOPERATIVE PREPARATION;61
4.4.3;PITFALLS AND DANGER POINTS;61
4.4.4;OPERATIVE STRATEGY;61
4.4.4.1;Extent of Dissection;61
4.4.4.2;Liberation of Splenic Flexure;61
4.4.4.3;No-Touch Technique;64
4.4.4.4;Technique of Anastomosis;64
4.4.5;OPERATIVE TECHNIQUE;64
4.4.5.1;Incision and Exposure;64
4.4.5.2;Liberation of Descending Colon and Sigmoid;64
4.4.5.3;Division of Renocolic Ligament;64
4.4.5.4;Splenic Flexure Dissection;66
4.4.5.5;Ligation and Division of Inferior Mesenteric Artery;69
4.4.5.6;Division of Mesocolon;69
4.4.5.7;Ligation and Division of Mesorectum;69
4.4.5.8;Insertion of Wound Protector;71
4.4.5.9;Division of Colon and Rectum;71
4.4.5.10;End-to-End Two-Layer Anastomosis, Rotation Method;72
4.4.5.11;End-to-End Anastomosis, Alternative Technique;73
4.4.5.12;Stapled Colorectal Anastomosis;76
4.4.5.13;Stapled Colocolonic Functional End-to-End Anastomosis: Chassin’s Method;81
4.4.5.14;Closure;84
4.4.6;POSTOPERATIVE CARE;84
4.4.7;COMPLICATIONS;84
4.4.8;REFERENCES;84
4.5;5 Laparoscopic Left Hemicolectomy;85
4.5.1;INDICATIONS;85
4.5.2;PREOPERATIVE PREPARATION;85
4.5.2.1;Mechanical Bowel Preparation;85
4.5.2.2;Administration of Prophylactic Antibiotics;85
4.5.2.3;Other Perioperative Steps;85
4.5.3;PITFALLS AND DANGER POINTS;85
4.5.4;OPERATIVE STRATEGY;85
4.5.5;OPERATIVE TECHNIQUE;85
4.5.5.1;Room Setup and Patient Positioning;85
4.5.5.2;Trocar Placement;86
4.5.5.3;Mobilizing the Left Colon and Identifification of the Left Ureter;86
4.5.5.4;Dissecting the Splenic Flexure and Isolation of the Transverse Mesentery;87
4.5.5.5;Identifification and Transection of the Mesentric Vessels ;89
4.5.5.6;Transection of the Distal Colon or Rectosigmoid Junction;90
4.5.5.7;Exteriorization of the Left Colon;91
4.5.5.8;Performing the Anastomosis;92
4.5.5.9;Closure of the Wound;94
4.5.6;POSTOPERATIVE CARE;96
4.5.7;COMPLICATIONS;96
4.5.8;REFERENCES;96
4.6;6 Low Anterior Resection for Rectal Cancer;97
4.6.1;INDICATIONS;97
4.6.2;PREOPERATIVE PREPARATION;97
4.6.3;PITFALLS AND DANGER POINTS;97
4.6.4;OPERATIVE STRATEGY;97
4.6.4.1;Prevention of Anastomotic Complications;97
4.6.4.2;Which Colorectal Anastomosis: Sutured, Circular Stapled, or Double Stapled?;98
4.6.4.3;Extent of Lymphovascular Dissection;98
4.6.4.4;Indications for Complementary Colostomy or Loop Ileostomy;98
4.6.4.5;Presacral Dissection: Prevention of Hemorrhage;98
4.6.4.6;Presacral Dissection: Preservation of Hypogastric Nerves;101
4.6.4.7;Ureteral Dissection;101
4.6.5;OPERATIVE TECHNIQUE;102
4.6.5.1;Incision and Position;102
4.6.5.2;Exploration and Evisceration of Small Bowel;102
4.6.5.3;Mobilization of Sigmoid;102
4.6.5.4;Lymphovascular Dissection;103
4.6.5.5;Presacral Dissection;106
4.6.5.6;Pelvic Hemostasis;107
4.6.5.7;Mobilization of Proximal Colon;107
4.6.5.8;Preparation of Rectal Stump;110
4.6.5.9;Irrigation of Rectal Stump;110
4.6.5.10;Selection of Anastomotic Technique;110
4.6.5.10.1;Side-to-End Low Colorectal Anastomosis (Baker);110
4.6.5.10.2;Alternative to Colorectal Side-to-End Anastomosis;116
4.6.5.10.3;Circular Stapled Low Colorectal Anastomosis;116
4.6.5.10.4;Double-Stapled Technique for Very Low Colorectal Stapled Anastomosis;123
4.6.5.10.5;Pitfalls and Danger Points of Circular Stapled Colorectal Anastomosis;126
4.6.5.11;Wound Closure and Drainage;128
4.6.6;POSTOPERATIVE CARE;128
4.6.7;COMPLICATIONS;128
4.6.8;REFERENCES;129
4.7;7 Abdominoperineal Resection for Rectal Cancer;130
4.7.1;INDICATIONS;130
4.7.2;PREOPERATIVE PREPARATION;130
4.7.3;PITFALLS AND DANGER POINTS;130
4.7.4;OPERATIVE STRATEGY;130
4.7.4.1;Abdominal Phase;130
4.7.4.1.1;Colostomy;130
4.7.4.1.2;Pelvic Floor;131
4.7.4.2;Perineal Phase;131
4.7.4.2.1;Position;131
4.7.4.2.2;Closure of Perineum;131
4.7.4.2.3;Dissection of Perineum;132
4.7.4.3;Hemostasis;132
4.7.5;OPERATIVE TECHNIQUE;132
4.7.5.1;Position;132
4.7.5.2;Incision and Exploration: Operability;132
4.7.5.3;Mobilization of Sigmoid, Lymphovascular Dissection, and Presacral Dissection;132
4.7.5.4;Pelvic Hemostasis;133
4.7.5.5;Perineal Dissection;133
4.7.5.6;Management of Pelvic Floor;139
4.7.5.7;Colostomy;140
4.7.6;POSTOPERATIVE CARE;145
4.7.6.1;Perineal Care;145
4.7.6.2;Colostomy Care;145
4.7.7;COMPLICATIONS;145
4.7.8;REFERENCES;146
4.8;8 Laparoscopic Abdominoperineal Resection and Total Proctocolectomy with End Ileostomy;147
4.8.1;ABDOMINOPERINEAL RESECTION;147
4.8.2;INDICATIONS;147
4.8.3;PREOPERATIVE PREPARATION;147
4.8.4;PITFALLS AND DANGER POINTS;147
4.8.5;OPERATIVE TECHNIQUE;147
4.8.5.1;Room Setup and Trocar Placement;147
4.8.5.2;Exploration of the Abdominal Cavity;147
4.8.5.3;Mobilization of the Sigmoid/Rectosigmoid Colon;149
4.8.5.4;Division of the Inferior Mesenteric Vessels;149
4.8.5.5;Division of the Sigmoid/Descending Colon;149
4.8.5.6;Rectal Mobilization;149
4.8.5.7;Perineal Dissection and Specimen Removal;149
4.8.6;TOTAL PROCTOCOLECTOMY WITH END ILEOSTOMY;154
4.8.7;INDICATIONS;154
4.8.8;PREOPERATIVE PREPARATION;154
4.8.9;PITFALLS AND DANGER POINTS;154
4.8.10;OPERATIVE TECHNIQUE;154
4.8.10.1;Room Setup and Trocar Placement;154
4.8.11;COMPLICATIONS;160
4.8.12;POSTOPERATIVE CARE;160
4.9;9 Subtotal Colectomy with Ileoproctostomy or Ileostomy and Sigmoid Mucous Fistula;161
4.9.1;INDICATIONS;161
4.9.2;PREOPERATIVE PREPARATION;161
4.9.3;PITFALLS AND DANGER POINTS;161
4.9.4;OPERATIVE STRATEGY;161
4.9.5;OPERATIVE TECHNIQUE;161
4.9.5.1;Placement of Ileostomy;161
4.9.5.2;Operative Position;162
4.9.5.3;Incision;162
4.9.5.4;Evacuation of Stool;162
4.9.5.5;Dissection of Right Colon and Omentum;162
4.9.5.6;Dissection of Left Colon;162
4.9.5.7;Division of Mesocolon;162
4.9.5.8;Ileostomy and Sigmoid Mucous Fistula;165
4.9.5.9;Ileoproctostomy;167
4.9.5.10;Subtotal Colectomy Combined with Immediate Total Proctectomy;167
4.9.5.11;Needle-Catheter Jejunostomy;169
4.9.5.12;Closure of the Abdominal Incision;169
4.9.6;POSTOPERATIVE CARE;169
4.9.7;COMPLICATIONS;169
4.9.8;REFERENCES;169
4.10;10 Ileoanal Anastomosis with Ileal Reservoir Following Total Colectomy and Mucosal Proctectomy;170
4.10.1;INDICATIONS;170
4.10.2;CONTRAINDICATIONS;170
4.10.3;PREOPERATIVE PREPARATION;170
4.10.4;PITFALLS AND DANGER POINTS;170
4.10.5;OPERATIVE STRATEGY;170
4.10.5.1;Mucosectomy;170
4.10.5.2;Abdominal Dissection;171
4.10.5.3;Rectal Dissection;171
4.10.5.4;Division of Waldeyer’s Fascia;171
4.10.5.5;Temporary Loop Ileostomy and Ileostomy Closure;171
4.10.5.6;Ileoanostomy;171
4.10.5.7;Constructing the Ileal Reservoir;171
4.10.6;OPERATIVE TECHNIQUE;172
4.10.6.1;Mucosal Proctectomy Combined with Total Colectomy;172
4.10.6.1.1;Perineal Approach;172
4.10.6.1.2;Abdominal Incision and Exposure;173
4.10.6.2;Constructing the Ileal Reservoir;174
4.10.6.3;Ileoanal Anastomosis;177
4.10.6.4;Loop Ileostomy;178
4.10.6.5;Drainage and Closure;179
4.10.7;POSTOPERATIVE CARE;180
4.10.8;COMPLICATIONS;180
4.10.9;REFERENCES;180
4.11;11 Abdominoperineal Proctectomy for Benign Disease;181
4.11.1;INDICATIONS;181
4.11.2;PREOPERATIVE PREPARATION;181
4.11.3;PITFALLS AND DANGER POINTS;181
4.11.4;OPERATIVE STRATEGY;181
4.11.5;OPERATIVE TECHNIQUE;181
4.11.5.1;Abdominal Incision and Position;181
4.11.5.1.1;Mesenteric Dissection;182
4.11.5.2;Rectal Dissection;182
4.11.5.3;Perineal Incision;183
4.11.5.3.1;Division of Levator Diaphragm;184
4.11.5.3.2;Closure of Pelvic Floor;184
4.11.5.4;Ileostomy;184
4.11.5.5;Abdominal Closure;184
4.11.6;POSTOPERATIVE CARE;185
4.11.7;COMPLICATIONS;185
4.11.8;REFERENCES;185
4.12;12 End-Ileostomy;186
4.12.1;INDICATIONS;186
4.12.2;PITFALLS AND DANGER POINTS;186
4.12.3;OPERATIVE STRATEGY;186
4.12.4;OPERATIVE TECHNIQUE;186
4.12.4.1;Preoperative Selection of Ileostomy Site;186
4.12.4.2;Incision;186
4.12.4.3;Fashioning the Ileal Mesentery;186
4.12.4.4;Closure of Mesenteric Gap;187
4.12.4.5;Mucocutaneous Fixation of Ileostomy;190
4.12.5;POSTOPERATIVE CARE;190
4.12.6;COMPLICATIONS;190
4.12.7;REFERENCE;190
4.13;13 Loop Ileostomy;191
4.13.1;INDICATIONS;191
4.13.2;PITFALLS AND DANGER POINTS;191
4.13.3;OPERATIVE STRATEGY;191
4.13.4;OPERATIVE TECHNIQUE;191
4.13.5;POSTOPERATIVE CARE;193
4.13.6;COMPLICATIONS;193
4.13.7;REFERENCES;193
4.14;14 Cecostomy SURGICAL LEGACY TECHNIQUE;194
4.14.1;INDICATIONS;194
4.14.2;PREOPERATIVE PREPARATION;194
4.14.3;PITFALLS AND DANGER POINTS;194
4.14.4;OPERATIVE STRATEGY;194
4.14.5;OPERATIVE TECHNIQUE;194
4.14.5.1;Skin-Sutured Cecostomy;194
4.14.5.1.1;Incision;194
4.14.5.1.2;Exploration of Cecum;194
4.14.5.1.3;Cecal Fixation;194
4.14.5.1.4;Mucocutaneous Suture;194
4.14.5.2;Tube Cecostomy;195
4.14.6;POSTOPERATIVE CARE;196
4.14.7;COMPLICATIONS;196
4.14.8;REFERENCE;196
4.15;15 Transverse Colostomy;197
4.15.1;INDICATIONS;197
4.15.2;PREOPERATIVE PREPARATION;197
4.15.3;PITFALLS AND DANGER POINTS;197
4.15.4;OPERATIVE STRATEGY;197
4.15.4.1;Impending Rupture of Cecum;197
4.15.4.2;Diversion of Fecal Stream;197
4.15.5;OPERATIVE TECHNIQUE;197
4.15.5.1;Incision;197
4.15.5.2;Identification of Transverse Colon;198
4.15.5.3;Immediate Maturation of Colostomy;198
4.15.5.4;Modification of Technique Using a Glass Rod;199
4.15.6;POSTOPERATIVE CARE;199
4.15.7;COMPLICATIONS;199
4.15.8;REFERENCES;200
4.16;16 Closure of Temporary Colostomy;201
4.16.1;INDICATIONS;201
4.16.2;PREOPERATIVE PREPARATION;201
4.16.3;PITFALLS AND DANGER POINTS;201
4.16.4;OPERATIVE STRATEGY;201
4.16.5;OPERATIVE TECHNIQUE;201
4.16.5.1;Incision;201
4.16.5.2;Fascial Dissection;201
4.16.5.3;Peritoneal Dissection;202
4.16.5.4;Closure of Colon Defect by Suture;202
4.16.5.5;Closure of Colonic Defect by Staples;203
4.16.5.6;Resection and Anastomosis of Colostomy;205
4.16.5.7;Closure of Abdominal Wall;205
4.16.5.8;Management of Skin Wound;205
4.16.6;POSTOPERATIVE CARE;205
4.16.7;COMPLICATIONS;205
4.16.8;REFERENCES;205
4.17;17 Laparoscopic Stoma Construction and Closure;206
4.17.1;INDICATIONS;206
4.17.2;PREOPERATIVE PREPARATION;206
4.17.3;PITFALLS AND DANGER POINTS;206
4.17.4;OPERATIVE STRATEGY;206
4.17.5;OPERATIVE TECHNIQUE;206
4.17.5.1;Loop Ileostomy;206
4.17.5.1.1;Room Setup and Trocar Placement;206
4.17.5.1.2;Choosing a Loop of Terminal Ileum;208
4.17.5.1.3;Exposing the Ileum;208
4.17.5.2;Loop Sigmoid Colostomy;209
4.17.5.2.1;Room Setup and Trocar Placement;209
4.17.5.2.2;Dissecting the Left Parietocolic Attachment;209
4.17.5.2.3;Exteriorizing the Sigmoid Loop;209
4.17.5.3;End Sigmoid Colostomy/Mucous Fistula;213
4.17.5.3.1;Operating Room Setup and Trocar Placement;213
4.17.5.3.2;Identification of the Ureter;214
4.17.5.3.3;Incision of the Mesocolon and Division of the Sigmoid Colon;214
4.17.5.3.4;Exteriorizating the Proximal Sigmoid Colon;216
4.17.5.4;Transverse Colostmy;216
4.17.5.4.1;Operating Room Setup and Trocar Placement;216
4.17.5.4.2;Dissecting the Omentum;218
4.17.5.5;Hartmann’s Take Down;218
4.17.5.6;Operating Room Setup, Trocar Placement, and Stoma Mobilization;218
4.17.5.6.1;Dissecting the Rectal Stump;220
4.17.5.6.2;Mobilization of the Left Colon;220
4.17.5.6.3;Performing the Anastomosis;220
4.17.5.6.4;Testing the Anastomosis;222
4.17.6;POSTOPERATIVE CARE;222
4.17.7;COMPLICATIONS;222
4.17.7.1;General Complications;222
4.17.7.2;Complications Related to Stoma Construction;222
4.17.7.3;Complication Related to Stoma Closure;222
4.17.8;REFERENCES;222
4.18;18 Operations for Colonic Diverticulitis (Including Lower Gastrointestinal Bleeding);223
4.18.1;INDICATIONS;223
4.18.2;PREOPERATIVE PREPARATION;223
4.18.3;OPERATIVE STRATEGY;223
4.18.4;OPERATIVE TECHNIQUE;223
4.18.4.1;Primary Resection and Anastomosis;223
4.18.4.1.1;Incision;223
4.18.4.1.2;Liberation of Sigmoid and Left Colon;223
4.18.4.1.3;Division of Mesocolon;224
4.18.4.1.4;Anastomosis;224
4.18.4.1.5;Abdominal Closure;224
4.18.4.2;Primary Resection with End- Colostomy and Mucous Fistula;224
4.18.4.3;Emergency Sigmoid Colectomy with End-Colostomy and Hartmann’s Pouch;225
4.18.4.3.1;Indications;225
4.18.4.3.2;Preoperative Preparation;225
4.18.4.3.3;Operative Technique;226
4.18.5;REFERENCES;227
4.19;19 Ripstein Operation for Rectal Prolapse;228
4.19.1;INDICATIONS;228
4.19.2;PREOPERATIVE PREPARATION;228
4.19.3;PITFALLS AND DANGER POINTS;228
4.19.4;OPERATIVE STRATEGY;228
4.19.5;OPERATIVE TECHNIQUE;228
4.19.5.1;Incision;228
4.19.5.2;Incision of Pelvic Peritoneum;229
4.19.5.3;Presacral Dissection;229
4.19.5.4;Application of Mesh;230
4.19.5.5;Closure of Pelvic Peritoneum;230
4.19.5.6;Wound Closure;230
4.19.6;POSTOPERATIVE CARE;233
4.19.7;COMPLICATIONS;233
4.19.8;REFERENCES;233
5;Part II Anus, Rectum, and Pilonidal Region;234
5.1;20 Concepts in Surgery of the Anus, Rectum, and Pilonidal Region;235
5.1.1;CLINICAL CONDITIONS: SYMPTOMS AND MANAGEMENT CONCEPTS;240
5.1.2;REFERENCES;241
5.2;21 Rubber Band Ligation of Internal Hemorrhoids;242
5.2.1;INDICATIONS;242
5.2.2;PITFALLS AND DANGER POINTS;242
5.2.3;OPERATIVE STRATEGY;242
5.2.4;OPERATIVE TECHNIQUE;242
5.2.5;POSTOPERATIVE CARE;243
5.2.6;COMPLICATIONS;244
5.2.7;REFERENCES;244
5.3;22 Hemorrhoidectomy;245
5.3.1;INDICATIONS;245
5.3.2;CONTRAINDICATIONS;245
5.3.3;PREOPERATIVE PREPARATION;245
5.3.4;PITFALLS AND DANGER POINTS;245
5.3.5;OPERATIVE STRATEGY;245
5.3.5.1;Avoiding Anal Stenosis;245
5.3.5.2;Achieving Hemostasis;245
5.3.5.3;Associated Pathology;246
5.3.6;OPERATIVE TECHNIQUE;246
5.3.6.1;Closed Hemorrhoidectomy;246
5.3.6.1.1;Local Anesthesia;246
5.3.6.1.2;Intravenous Fluids;247
5.3.6.1.3;Positioning the Patient;247
5.3.6.1.4;Incision and Dissection;247
5.3.6.2;Radical Open Hemorrhoidectomy;250
5.3.6.2.1;Incision;250
5.3.6.2.2;Excising the Hemorrhoidal Masses;250
5.3.7;POSTOPERATIVE CARE;253
5.3.8;COMPLICATIONS;253
5.3.9;REFERENCES;253
5.4;23 Anorectal Fistula and Pelvirectal Abscess;254
5.4.1;INDICATIONS;254
5.4.2;PREOPERATIVE PREPARATION;254
5.4.3;PITFALLS AND DANGER POINTS;254
5.4.4;OPERATIVE STRATEGY;254
5.4.4.1;Choice of Anesthesia;254
5.4.4.2;Localizing Fistulous Tracts;254
5.4.4.2.1;Goodsall’s Rule;254
5.4.4.2.2;Physical Examination;254
5.4.4.3;Injection of Dye or Radiopaque Material;255
5.4.4.4;Preserving Fecal Continence;255
5.4.4.5;Fistulotomy Versus Fistulectomy;255
5.4.4.6;Combining Fistulotomy with Drainage of Anorectal Abscess;255
5.4.5;OPERATIVE TECHNIQUE;256
5.4.5.1;Anorectal and Pelvirectal Abscesses;256
5.4.5.1.1;Perianal Abscess;256
5.4.5.1.2;Ischiorectal Abscess;256
5.4.5.1.3;Intersphincteric Abscess;256
5.4.5.1.4;Pelvirectal Supralevator Abscess;256
5.4.5.2;Anorectal Fistula;258
5.4.5.2.1;Intersphincteric Fistula;258
5.4.5.2.2;Transsphincteric Fistula;260
5.4.5.2.3;Suprasphincteric Fistula (Extremely Rare);263
5.4.5.2.4;Extrasphincteric Fistula (Extremely Rare);263
5.4.5.2.5;Technical Hints for Performing Fistulotomy;264
5.4.6;POSTOPERATIVE CARE;264
5.4.7;COMPLICATIONS;264
5.4.8;REFERENCES;265
5.5;24 Lateral Internal Sphincterotomy for Chronic Anal Fissure;266
5.5.1;INDICATIONS;266
5.5.2;PREOPERATIVE PREPARATION;266
5.5.3;PITFALLS AND DANGER POINTS;266
5.5.4;OPERATIVE STRATEGY;266
5.5.5;OPERATIVE TECHNIQUE;266
5.5.5.1;Anesthesia;266
5.5.5.2;Closed Sphincterotomy;266
5.5.5.3;Open Sphincterotomy;267
5.5.5.4;Removal of the Sentinel Pile;267
5.5.6;POSTOPERATIVE CARE;267
5.5.7;COMPLICATIONS;267
5.5.8;REFERENCES;268
5.6;25 Anoplasty for Anal Stenosis;269
5.6.1;INDICATIONS;269
5.6.2;PREOPERATIVE PREPARATION;269
5.6.3;PITFALLS AND DANGER POINTS;269
5.6.4;OPERATIVE STRATEGY;269
5.6.5;OPERATIVE TECHNIQUE;269
5.6.5.1;Sliding Mucosal Flap;269
5.6.5.1.1;Incision;269
5.6.5.1.2;Internal Sphincterotomy;269
5.6.5.1.3;Advancing the Mucosa;269
5.6.5.2;Sliding Anoderm Flap;269
5.6.5.2.1;Incision;269
5.6.5.2.2;Internal Sphincterotomy;272
5.6.5.2.3;Advancing the Anoderm;272
5.6.6;POSTOPERATIVE CARE;274
5.6.7;COMPLICATIONS;274
5.6.8;REFERENCE;274
5.7;26 Thiersch Operation for Rectal Prolapse SURGICAL LEGACY TECHNIQUE;275
5.7.1;INDICATIONS;275
5.7.2;PREOPERATIVE PREPARATION;275
5.7.3;PITFALLS AND DANGER POINTS;275
5.7.4;OPERATIVE STRATEGY;275
5.7.4.1;Selecting Proper Suture or Banding Material;275
5.7.4.2;Achieving Proper Tension of the Encircling Band;275
5.7.5;OPERATIVE TECHNIQUE;275
5.7.5.1;Fabricating the Encircling Band of Mesh;275
5.7.5.2;Incision and Position;275
5.7.5.3;Inserting the Mesh Band;275
5.7.5.4;Adjusting Tension;276
5.7.5.5;Closure;276
5.7.6;POSTOPERATIVE CARE;278
5.7.7;COMPLICATIONS;278
5.7.8;REFERENCES;278
5.8;27 Operations for Pilonidal Disease;279
5.8.1;INDICATIONS;279
5.8.2;PITFALLS AND DANGER POINTS;279
5.8.3;OPERATIVE STRATEGY;279
5.8.3.1;Acute Pilonidal Abscess;279
5.8.3.2;Marsupialization;279
5.8.3.3;Excision with Primary Suture;279
5.8.4;OPERATIVE TECHNIQUE;279
5.8.4.1;Marsupialization;280
5.8.4.2;Pilonidal Excision with Primary Suture;281
5.8.4.3;Excision of Sinus Pits with Lateral Drainage;282
5.8.5;POSTOPERATIVE CARE;283
5.8.6;COMPLICATIONS;283
5.8.7;REFERENCES;284
6;Index;285
