Zbar / Wexner / Nasseri Coloproctology

1. Auflage 2010
ISBN: 978-1-84882-756-1
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 221 Seiten

Reihe: Springer Specialist Surgery Series

Coloproctology is a surgical specialty which dynamically changes every few years. There is a profusion of colorectal textbooks but specialty series on particularly complex topics as well as on the specialized management approach for trainees and training colorectal surgeons are actually few. The aim of this text is a superior quality colorectal book written by world experts targeted at senior surgical and colorectal trainees and young consultant coloproctologists in current areas of subspecialty expertise. The structure of the chapters is current and is based on what does not appear and is not addressed in current colorectal textbooks. This series has proven useful in areas already represented, including Neurosurgery, Vascular Surgery, Transplantation Surgery, etc. The text is aimed at being relatively didactic with an algorithm approach to specialized areas within coloproctology which could potentially be updated every 3 years or so with new topics to create a set for didactic training in colorectal surgery. It is anticipated that these texts will become valuable teaching textbooks and part of every coloproctologist's armamentarium as well as appealing to all general surgeons and surgical trainees engaged in complex elective and emergency colorectal surgery.

Andrew P. Zbar, MB BS, FRCS (Ed.), FRCS (Gen.), FRACS, FCCS Professor of General and Colorectal Surgery Queen Elizabeth Hospital Barbados 2002-PRESENT. Trained in Australia in General Surgery 1978-1993. Postgraduate colorectal work in anorectal physiology and colorectal cancer immunology and immunotherapy London Hammersmith Hospital 1993-1999. Co-Director of Coloproctology at Kaplan Hospital Tel Aviv 2000-2002. Specialist areas of interest are in functional anorectal disorders, colorectal cancer immunology and imaging of complex anorectal disorders.Steven D Wexner, MD, FACS, FRCS, FRCSED, Chair, Advisory Council for Colon and Rectal Surgery (1998-2003), American College of Surgeons; Chair (2003), Intl Committee, Chair (2003), Intl Advisory Committee, Chair (2003), Membership Committee, Program Committee (2003), American Society for Colon and Rectal Surgeons; In 1993 helped establish the Young Surgeons Committee which offers an exchange program with the Association of Coloproctology of GB & Ireland; Ed Board of Diseases of the Colon & Rectum.John S.P. Lumley, MS, FRCS, DMCC, FMAA(Hon), FGA, Professor of Vascular Surgery, University of London, Civilian Consultant to the Royal Navy in Vascular Surgery; Honorary Consultant Surgeon, St. Bartholomew's Hospital, London, UK

Autoren/Hrsg.

Zbar, Andrew P.

Wexner, Steven D.

Nasseri, Yosef

Inhaltsverzeichnis

1;Foreword;6
2;Preface;7
3;Contents;8
4;Contributors;10
5;Genetic Approaches to Colorectal Cancer;12
5.1;Colorectal Cancer Epidemiology;12
5.2;Molecular Biology of Colorectal Cancer;13
5.2.1;Chromosomal Instability (CIN) or Tumor Suppressor Pathway;13
5.2.2;Microsatellite-Instability Pathway or Mutator Pathway;13
5.2.3;Aberrant Methylation Pathway;13
5.3;Hereditary Genetic Syndromes;14
5.3.1;Hereditary Non-Polyposis Colon Cancer;14
5.3.1.1;Molecular Genetics of HNPCC;15
5.3.1.2;Diagnosis of HNPCC;15
5.3.1.3;Genetic Counseling for HNPCC;17
5.3.2;Familial Adenomatous Polyposis;17
5.3.2.1;Molecular Genetics in FAP;18
5.3.2.2;Diagnosis of FAP;19
5.3.2.3;Genetic Counseling for FAP;20
6;Multivisceral Resection in Rectal Cancer;24
6.1;.Introduction;24
6.2;Preoperative Procedures;24
6.2.1;Staging and Imaging;24
6.2.1.1;Physical Examination;25
6.2.1.2;Radiologic Imaging;25
6.2.2;Neo-Adjuvant Therapy;26
6.3;Intraoperative Procedures;27
6.3.1;Surgical Treatment;27
6.3.1.1;Lateral Invasion;27
6.3.1.2;Posterior Invasion;27
6.3.1.3;Anterior Invasion;28
6.3.1.4;Pelvic Reconstruction;28
6.3.2;Intraoperative Decisions;29
6.3.3;Intraoperative Radiation Therapy (IORT);29
6.4;Morbidity of Multivisceral Resection;29
7;Colonic Stenting;32
7.1;.Introduction;32
7.2;.SEMS: Types;33
7.3;Placement;33
7.3.1;Radiological Placement;33
7.3.2;Endoscopic/Fluoroscopic Placement;34
7.4;Efficacy;34
7.5;Safety;34
7.6;Covered Vs. Uncovered Stents;35
7.7;Costs;35
7.8;Discussion;35
8;Chemotherapy Trials for Colorectal Cancer in Advanced Disease: What’s the Current Hypothesis?;37
8.1;Introduction;37
8.2;5-Fluorouracil;38
8.3;Capecitabine;38
8.4;Irinotecan;39
8.5;Oxaliplatin;40
8.6;What Is the Optimal Sequence of Cytotoxics?;40
8.7;Is Response Rate Important?;41
8.8;Continuous vs. Intermittent Therapy;44
8.9;Bevacizumab;46
8.10;The CONcePT Trial (Grothey et al. .2008b., ASCO 4010);50
8.11;Cetuximab;50
8.12;Results of First-Line Trials;51
8.13;Second-Line Trials;52
8.14;Panitumumab;54
8.15;Studies with Two Targeted Agents Combined;55
8.16;Neo-Adjuvant (Metastatic);56
8.17;Third-Line Studies;58
8.18;Conclusion;59
9;Current Clinical Trials in Radiotherapy for Rectal Cancer;65
9.1;.Work-Up of Patients with Rectal Cancer;65
9.2;.Staging;66
9.3;.Prognosis;66
9.4;.Adjuvant Therapy;66
9.4.1;Adjuvant Postoperative Radiotherapy Without Chemotherapy;68
9.4.2;Intensive Short Course Preoperative Radiotherapy Without Chemotherapy;69
9.4.3;Preoperative (Neoadjuvant) Chemoradiotherapy;69
9.4.4;Postoperative Chemoradiotherapy;70
9.4.5;Postoperative Adjuvant Chemotherapy Without Radiation;70
9.5;Treatment of Locally Advanced Unresectable Rectal Cancer;71
9.6;Radiation Therapy Simulation and Field Arrangement;71
9.7;Current Dose and Fractionation at Kaiser Permanente, Southern California;72
9.8;Acute Side Effects and Complications of Combined Modality Treatment;73
9.9;Chronic Effects of Radiotherapy on Anal and Bowel Functions;73
9.10;Long-Term Follow-Up;74
10;Quality of Life Issues and Rectal Cancer;78
10.1;Introduction;78
10.2;Effect of Surgery and Radiation on Function;78
10.3;Health-Related Quality of Life (HRQOL);80
10.4;Quality of Life and Surgery;82
10.5;Quality of Life and Radiotherapy;84
10.6;Quality of Life and Long-Term Follow-Up and Recurrence of Rectal Cancer;85
10.7;Conclusion;85
11;Managing Presacral Tumors;89
11.1;Presacral Tumors: General Considerations;89
11.2;Specific Presacral Tumors;90
11.2.1;Sacral Chordomas;90
11.2.1.1;Tailgut Cysts;92
11.2.1.2;Dermoid and Epidermoid Cysts;94
11.2.1.3;Rectal Duplication Cysts;94
11.2.2;Anterior Sacral Meningocele;95
11.2.2.1;Schwannomas;95
11.2.2.2;Teratomas;96
11.2.2.3;Miscellaneous Tumors;96
11.3;Conclusion;96
12;Revisional Pouch Surgery;100
12.1;Sepsis;101
12.1.1;Early Sepsis;101
12.1.1.1;Management;101
12.1.2;Delayed Sepsis;102
12.1.2.1;Management;102
12.1.3;Summary;103
12.2;Fistulation into the Vagina;104
12.2.1;Management;104
12.2.2;Summary;107
12.3;Poor Function;107
12.3.1;Differential Diagnosis;107
12.3.2;Mechanical Outlet Obstruction;108
12.3.2.1;Long Efferent Limb;108
12.3.2.2;Stricture of the Ileoanal Anastomosis;109
12.3.2.3;Retained Rectum After Ileorectal Anastomosis;110
12.3.2.4;Summary;111
12.3.3;Small-Volume Reservoir;111
12.3.4;Sphincter Dysfunction;111
12.4;Pouchitis;112
12.5;Conclusion;112
13;Surgery for Fecal Incontinence;116
13.1;Introduction;116
13.2;Diagnostics and Treatment Considerations;116
13.3;Functional Rehabilitation;117
13.3.1;Biofeedback;117
13.3.2;Sacral Nerve Stimulation;118
13.4;Reconstructive Techniques;119
13.4.1;Bioinjectables;119
13.4.2;Sphincter Repair;120
13.4.2.1;Sphincter Replacement;121
13.4.2.2;Dynamic Graciloplasty;121
13.4.2.3;Artificial Bowel Sphincter;121
13.4.2.4;Antegrade Continence Enema (ACE);123
13.4.2.5;Stoma Creation;123
13.5;Summary;123
14;Recurrent Rectal Cancer;127
14.1;Introduction;127
14.2;Incidence;127
14.3;Surveillance Following Primary Therapy;128
14.4;Diagnosis of Recurrence;128
14.5;Radiographic Studies;129
14.6;Patterns of Recurrence;131
14.7;Surgical Management;132
14.7.1;Determination of Resectability;132
14.7.2;Pelvic Exenteration;133
14.7.3;Combined Sacrectomy with Exenteration;134
14.7.4;Laparoscopic Surgery;137
14.7.5;Palliative Surgery;137
14.8;Use of Intraoperative Radiation Therapy;138
14.9;Perineal Reconstruction;139
14.10;Nonoperative Management;142
14.11;Summary;142
15;The Surgical Management of Evacutory Dysfunction;145
15.1;Introduction;145
15.2;Patient Evaluation;145
15.3;Physical Examination;146
15.4;Diagnostic Testing;146
15.4.1;Rectocele;147
15.4.2;Enterocele;148
15.4.3;Sigmoidocele;148
15.4.4;Rectal Anal Intussusceptions and Rectal Prolapse;149
15.4.5;Puborectalis syndrome;150
15.4.6;Megarectum;150
15.5;Sacral Nerve Stimulation for Constipation;151
15.6;Antegrade Colonic Enema;151
15.7;Fecal Diversion;152
16;New Approaches in Perineal Crohn’s Disease;155
16.1;Introduction;155
16.2;Classification;155
16.3;Diagnosis;157
16.4;Medical Management;157
16.5;Surgical Management;158
16.6;Conclusion;163
17;Complex Anal Fistula;167
17.1;Introduction;167
17.2;Definitions and Classifications;167
17.3;Intersphincteric Fistula (Fig. .13.1a.);168
17.4;Trans-sphincteric Fistula (Fig. .13.1b.);168
17.5;Suprasphincteric Fistula (Fig. .13.1c.);169
17.6;Extrasphincteric Fistula (Fig. .13.1d.);169
17.6.1;Prevalence;169
17.6.2;Etiology;169
17.6.3;Clinical Presentation and Evaluation;169
17.6.3.1;Procedure Options;171
17.6.3.2;Fistulotomy;171
17.6.3.3;Fistulectomy;171
17.6.3.4;Setons;171
17.7;Advancement Rectal Flaps;172
17.8;Fibrin Glue Injection and Fistula Plug;173
17.9;Colostomy;173
17.10;Crohn’s Disease;173
17.11;Summary;174
18;Rectovaginal and Rectourethral Fistula;175
18.1;Introduction;175
18.2;Rectovaginal Fistula;175
18.3;Presentation and Investigation;175
18.4;Classification;176
18.5;Etiology;176
18.5.1;Trauma;176
18.5.2;Inflammatory Bowel Disease;177
18.5.3;Malignant Fistulas;177
18.5.4;Pelvic Radiation;177
18.6;Management;178
18.6.1;Local Repairs;178
18.6.1.1;Simple Fistulas;178
18.6.1.2;Crohn’s Disease;180
18.6.2;Trans-Abdominal Approaches;181
18.6.2.1;Radiation-Induced Fistula;181
18.6.2.2;Malignant Fistula;182
18.6.3;Bulbocavernosus (Martius) Graft;182
18.6.4;Diverting Stoma;183
18.6.5;Recurrent Fistulas;183
18.6.5.1;Rectourethral Fistula;184
18.7;Presentation and Investigation;184
18.8;Management;184
18.8.1;Local Techniques;185
18.8.2;Abdominal Approaches;185
18.8.3;Omental and Muscle Interposition;185
18.9;Conclusion;186
19;Surgeon-Performed Ultrasound in Proctologic Practice;191
19.1;Introduction;191
19.1.1;Complex Perirectal Sepsis;192
19.1.2;Fecal Incontinence;194
19.1.3;Evacuatory Dysfunction and Other Functional Problems;196
19.1.4;Miscellaneous including Anal and Rectal Tumors;199
20;Changing Paradigms in the Treatment of Sigmoid Diverticulitis;208
20.1;Background/Historical Perspective;208
20.2;Diagnosis and Initial Treatment of Uncomplicated Diverticulitis;209
20.2.1;Risk of Subsequent Attacks of Diverticulitis After Recovery from Uncomplicated Diverticulitis;211
20.2.2;Risk of Developing Complications After Recovery from an Attack of Uncomplicated Diverticulitis;211
20.2.3;Severity of Disease;212
20.3;Young Patients and Diverticulitis;212
20.4;Complicated Diverticulitis;212
20.4.1;Diverticular Abscess;213
20.4.2;Perforated Diverticulitis;214
20.4.3;Diverticular Fistulas;214
20.4.4;Obstruction;215
20.4.5;Immunocompromised Patients;215
20.5;Technical Aspects of Surgery for Diverticular Disease;216
20.5.1;Determination of 1 or 2 Stage Procedures;216
20.5.2;Laparoscopic Surgery;217
20.6;Conclusion;218
21;Index;221