Difficult Decisions in Colorectal Surgery 1st Edition by Neil Hyman, Konstantin Umanskiy ISBN 9783319402239 3319402234

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ISBN 10: 3319402234
ISBN 13: 9783319402239
Author: Neil Hyman, Konstantin Umanskiy

Difficult Decisions in Colorectal Surgery 1st Edition Table of contents:

Chapter 1: Introduction

Tell Me a Story. The Importance of an Anecdote

Information Literacy. Learning the New Language

Bringing It Together

Why This Book?

References

Chapter 2: Evaluating Evidence

Introduction

Initial Evaluation

Stratifying Evidence

Random Error and Systematic Error (Bias)

Methodological Limitations (Bias)

Confidence in Effect

Downgrading Evidence

Imprecision

Inconsistency

Indirectness

Publication Bias

Upgrading Evidence

Large Magnitude of Effect

Plausible Confounders

Dose Response Gradient

Overall Quality Rating

Conclusion

References

Part I: IBD

Chapter 3: IBD: Management of Symptomatic Anal Fistulas in Patients with Crohn’s Disease

Introduction

Search Strategy

Results

Scenario 1: The Patient with a Simple Fistula and No Macroscopic Rectal Disease

Scenario 2: The Patient with Either a Simple or a Complex Fistula and Macroscopic Rectal Disea

Scenario 3: The Patient with a Complex Fistula and No Macroscopic Rectal Disease

Recommendations Based on the Data

A Personal View of the Data

References

Chapter 4: IBD: Management of a Painful Anal Fissure and Skin Tags in Patients with Crohn’s Di

Introduction

Search Strategy

Data Review/Recommendations

Personal View of the Data

References

Chapter 5: IBD: Elective Surgical Management in Patients with Ulcerative Colitis-How Many Stages?

Introduction

Search Strategy

Results

Diverting Loop Ileostomy

Initial Colectomy Prior to IPAA

Recommendations Based on the Data

A Personal View of the Data

References

Chapter 6: Which Ulcerative Colitis Patients Should Not Have Ileal Pouch-Anal Anastomosis

Search Strategy

Results

Recommendations

Personal View

References

Chapter 7: Management of Pouch-Vaginal Fistulas

Introduction

Search Strategy (See Table 7.1)

Results

Perineal Approach

Biological Therapy

Transanal Ileal Advancement Flap

Transvaginal Repair

Gracilis Muscle Interposition Flap

Transanal Pouch Advancement

Abdominoperineal Approach

Diversion

Recommendations

Personal View of the Data

References

Chapter 8: Crohn’s Colitis and Ileal Pouch Anal Anastomosis

Introduction

Methods

Results

Recommendations Based on the Data

A Personal View of the Data

References

Chapter 9: Steroid Management in Patients Undergoing Surgery for IBD

Introduction

Search Strategy

Results

Recommendations Based on Data

Personal View of Data

References

Chapter 10: IBD: Management of Dysplasia in Patients with Ulcerative Colitis

Introduction

Search Strategy

Results

Incidences of Dysplasia and Colorectal Cancer (CRC)

Disease Defined Risk Factors: Disease Duration, Age of Onset, Disease Extent, PSC

Patient Defined Risk Factors: Family History of CRC, Medication Usage, Smoking, Patient Awareness

Classification of UC Dysplasia

Dysplasia Management

Neoplastic Progression

Flat LGD

High Grade Dysplasia

DALMS

ALMS

A Personal View of the Data

References

Chapter 11: Post-operative Prophylaxis in Patients with Crohn’s Disease

Introduction

Recurrence in Post-operative Crohn’s

Risk Factors for Relapse

Patient Factors

Crohn’s Disease Behavior

Surgical Factors

Assessment of Recurrence

Non-invasive Methods of Assessing Post-operative Recurrence

Symptoms After Surgery Are Not Necessarily due to Recurrence

Medical Prophylaxis Options

Minimal Benefit: Probiotics/5-ASA/Corticosteroids

Moderate Benefit: Antibiotics/Immunomodulators

High Benefit: Biological Therapy

Authors’ Approach to Post-operative Crohn’s Patients

References

Part II: Colon Cancer

Chapter 12: Follow-Up in Patient’s After Curative Resection for Colon Cancer Surveillance for C

Introduction

Search Strategy

Results

Guidelines

MRI and PET Scans

Overall Utility

Personal Review of the Data

References

Chapter 13: Management of Patients with Acute Large Bowel Obstruction from Colon Cancer

Introduction

Methods: Search Strategy

Results

Self-Expanding Metal Stents (SEMS)

Stenting as Palliation

Stenting as a Bridge to Surgery

Conclusions

The Approach to the Patient with Obstructing Colon Cancer

References

Chapter 14: Utility of Primary Tumor Resection in Asymptomatic, Unresectable Metastatic Colon and

Introduction

Search Strategy

Results

Overall Survival

Chemotherapy and Survival

Metastatic Disease Burden and Survival

Further Considerations

Acute Surgery During Chemotherapy

Postoperative Complications: Elective Versus Acute Surgery

Systemic Inflammation and Primary Resection

Recommendations

Personal View of the Data

References

Chapter 15: Management of Large Sessile Cecal Polyps

Overview/Introduction

Treatment Options

EMR and Laparoscopic Inspection

ESD and Laparoscopic Inspection

Laparoscopic-Facilitated Colonoscopic Polypectomy Method

Laparoscopic “Wedge” Partial Circumference Full Thickness Resection

Standard Segmental Bowel Resection

Treatment Algorithm

Polyp Characteristics

Location

Algorithm (for Polyps That Do Not Fall into the Above Categories) (Table 15.2)

Conclusion

References

Chapter 16: Stage II Colon Cancer: Towards an Individualized Approach

Introduction

Search Strategy

Results

Non-risk Stratified Patients

Risk-Stratification-Clinical and Pathologic Factors

Risk-Stratification-Molecular Factors

Risk-Stratification-Gene Expression Profiling

Recommendations Based on the Data

A Personal View of the Data

References

Part III: Rectal Cancer

Chapter 17: Rectal Cancer: Management of T1 Rectal Cancer

Introduction

Search Strategy

Results

Oncologic Outcomes

Local Recurrence

Distant Metastasis

Overall Outcome

Quality of Life

Other Studies

Evidence Based Recommendations

A Personal View/Approach

References

Chapter 18: Management of T2 Rectal Cancer

Introduction

Search Strategy

Surgical Decision Making

Recommendations

Author’s Approach

Conclusions

References

Chapter 19: Clinical Complete Response after Neoadjuvant Chemoradiotherapy in Rectal Cancer: Operat

Introduction

Uncertainties about Tumor Response to Neoadjuvant Therapy

Treatment Options for Patients with a cCR after Neoadjuvant Therapy: Observation or Surgery?

Evidence Supporting NOM

Local Regrowth and Salvage Therapy vs. Stoma Rates and Operative Mortality

Functional Outcomes and Toxicity Associated with NOM

Non-Operative Management in the Elderly

Future Prospective Studies

Expert Opinion

References

Chapter 20: Management of the Patient with Rectal Cancer Presenting with Synchronous Liver Metas

Introduction

Search Strategy

Results

Evaluation of the Patient with Rectal Cancer and Synchronous Hepatic Metastasis

Treatment Options

Recommendations Based on the Data

Evaluation of the Rectal Cancer Patient with Synchronous Hepatic Metastasis

Treatment Options: Multimodality Treatment

Treatment Options: Surgical Approach

A Personal View of the Data

Summary of Recommendations

References

Chapter 21: Who Needs a Loop Ileostomy After Low Anterior Resection for Rectal Cancer?

Introduction

Methods

Why Not Divert?

Does Fecal Diversion Decrease Anastomotic Leak Rate?

Who Is at Highest Risk for Developing a Leak?

What Type of Diverting Ostomy Should We Use?

Personal View of the Data

References

Chapter 22: Selection Factors for Reoperative Surgery for Local Recurrent Rectal Cancer

Introduction

Search Strategy

Results

Recommendations Based on the Data

A Personal View of the Data

Abstracted Recommendations

References

Part IV: Anal Dysplasia/Cancer

Chapter 23: Anal Dysplasia/Cancer: Management of Patients with AIN 3

Introduction

Search Strategy

Results

Prevention

Treatment

Expectant Management

Recommendations Based on the Data

Personal View of the Data

References

Chapter 24: Management of the Abnormal Pap Smear in HIV Positive Patients

Introduction

Methods

Results

Recommendations Based on the Data

A Personal View of the Data

References

Part V: Benign Colon Disease

Chapter 25: Indications for Surgery in Patients with Severe Clostridium Difficile Colitis

Introduction

Search Strategy

Results

Recommendations Based on the Data

Personal View of the Data

References

Chapter 26: Do We Need to Operate on Patients After Successful Percutaneous Drainage of a Diver

Introduction

Search Strategy

Results

Recommendations Based on the Data

A Personal View of the Data

References

Chapter 27: The Role of Laparoscopic Peritoneal Lavage in the Operative Management of Hinchey II

Introduction

Search Strategy

Results

Results of Low and Very-Low Quality Studies

Results of Randomized-Controlled Trials

Recommendations Based on the Data

Personal View of the Data

References

Chapter 28: Surgery for Acute Complicated Diverticulitis: Hartmann vs. Primary Anastomosis

Introduction

Methods/Search Strategy

Results

Randomized Control Trials (RCTs)

Meta-analyses

Database Studies

Retrospective/Prospective Cohort Studies

Focus on Mortality

Focus on Anastomotic Leak

Recommendations Based on Data

Personal View of Data

References

Chapter 29: Who Needs Elective Surgery for Recurrent Diverticulitis?

Introduction

Search Strategy

Results

Uncomplicated Diverticulitis

Complicated Diverticulitis

Special Populations

Recommendations Based on the Data

Personal View of the Data

References

Chapter 30: Deciding on an IRA vs. IPAA for FAP

Setting the Stage

Aims of Surgery in Patients with FAP

The Surgical Options

How Are the Outcomes of Surgery to Be Judged?

Quality of Surgery

What Do the Data Say?

Recommendation

References

Chapter 31: Rectal Prolapse: What Is the Best Approach for Repair?

Introduction

Search Strategy

Results

Abdominal Verses Perineal Approach

Recurrence Rates

Function and Quality of Life

Morbidity and Mortality

Altemeier Verses Delorme’s Procedure

Recurrence Rates

Function and Quality of Life

Morbidity and Mortality

Posterior Rectopexy Without or With Resection

Recurrence Rates

Function and Quality of Life

Morbidity and Mortality

Laparoscopic Verses Open Rectopexy

Ventral Rectopexy

Recommendations

Personal View

References

Part VI: Benign Anal Disease

Chapter 32: Optimal Management of the Transsphincteric Anal Fistula

Introduction

Search Strategy

Results

Fistulotomy

Setons

Advancement Flaps

Biologic Products

LIFT Procedure

Conclusion and Personal View

References

Chapter 33: Benign Anal Disease: Management of the Recurrent Anovaginal/Rectovaginal Fistula

Introduction

Search Strategy

Results

Recommendations Based on the Data

A Personal View of the Data

References

Chapter 34: Benign Anal Disease: When to Operate on the Patient with an Anal Fissure

Introduction and Problem

Search Methods

Results

Recommendations

A Personal View of the Problem and the Data

References

Chapter 35: Anal Fissure: Recurrence After Lateral Internal Sphincterotomy

Introduction

Treatment Options

Search Strategy

Results

Recommendations Based on Current Data

A Personal View of the Data

Conclusion

References

Chapter 36: Benign Anal Disease: Third Degree Hemorrhoids – Who Really Needs Surgery?

Introduction

Search Strategy/Methods

Results

Control of Symptoms

Post-Treatment Pain and Complications

Lifestyle (Return to Work and Patient Satisfaction)

Cost

Recommendations

Expert Opinion

References

Chapter 37: Which Patients with Fecal Incontinence Require Physiologic Workup?

Introduction

Search Strategy

Results

Recommendations Based on the Data

Summary of Recommendation Options

A Personal View of the Data

References

Chapter 38: Benign Anal Disease: Who Are the Right Candidates for Sacral Nerve Stimulation?

Introduction

Search Strategy

Results

Recommendations Based on the Data

Recommendations

A Personal View of the Data

References

Chapter 39: When Is an Anal Sphincter Repair Indicated?

Introduction

Surgical Approaches to Fecal Incontinence

Anal Sphincter Repair

Predicting Outcome After Anal Sphincter Repair

Relationship of Short and Long Term Outcomes

Repeat Sphincteroplasty Outcomes

Reporting and Comparing Outcomes

Sacral Nerve Stimulation

Discussion

Conclusions

References

Part VII: Quality Improvement

Chapter 40: Checklists in Surgery

Introduction

Methods and Search Strategy

Results

Recommendations from the Data

Personal View of the Data

References

Chapter 41: Quality Improvement: Where Are We with Bowel Preps for Patients Undergoing Colon Rese

Introduction

Search Strategy

Results

Recommendations Based on Data

A Personal View of the Literature

References

Chapter 42: Quality Improvement: Are Fast Track Pathways for Laparoscopic Surgery Needed?

Introduction

Search Strategy

Results

Recommendations Based on the Data

Recommendations Based on the Data

A Personal View of the Data

References

Chapter 43: Quality Improvement: Enhanced Recovery Pathways for Open Surgery

Introduction

Methods

Search Strategy

Results

Complications

Readmission

Length of Stay

Cost

Quality of Life

Recommendations Based on the Data

A Personal View of the Data

How We Do It

References

Chapter 44: Quality Improvement: Preventing Readmission After Ileostomy Formation

Introduction

Search Strategy

Results

Recommendations Based on the Data

Personal Recommendations Based on the Data

References

Part VIII: Technique

Chapter 45: Trans-anal Endoscopic Surgery vs. Conventional Transanal Surgery

Results

Author’s View of the Data

References

Chapter 46: Laparoscopic Versus Robotic Versus Open Surgery for Rectal Cancer

Results: (A): Laparoscopic Surgery Versus Open Surgery for Rectal Cancer

Short Term Outcomes

Oncologic Outcomes

Results: Robotic Surgery Versus Laparoscopic Surgery for Rectal Cancer

Short Term Outcomes

Oncologic Outcomes

Recommendations

References

Chapter 47: Reservoir Construction After Low Anterior Resection: Who and What?

Introduction

Search Strategy

Results

Perioperative Outcomes

Straight CAA Versus Colonic J Pouch

Colonic J Pouch Versus Transverse Coloplasty

Side-to-End Versus Colonic J Pouch

Functional Outcomes

Straight CAA Versus Colonic J Pouch

Colonic J Pouch Versus Tranverse Coloplasty

Side-to-End Versus Colonic J Pouch

Summary of Comparisons

Recommendations Based on the Data

Personal View of the Data

Abstract of Recommendation

References

Chapter 48: Conventional vs Single Port Approaches to Laparoscopic Colectomy

Introduction

Search Strategy

Results

Perioperative Outcomes

Cost

Pain

Cosmetic Outcomes

Hernia Formation

Oncologic Outcomes

Recommendations

Personal View of the Data

Recommendations

References

Chapter 49: Anastomotic Leak Management Following Low Anterior Resections

Introduction

Search Strategy

Recommendations Based on the Data

Surgical Management of Anastomotic Leakage Following LAR in Patients with Generalized Peritonit

Reestablishing Intestinal Continuity in Patients with Symptomatic Anastomotic Leakage Following 

A Personal View of the Data

References

Chapter 50: Management of the Unhealed Perineal Wound After Proctectomy

Introduction

Literature Search Strategy

Non-operative Strategies

Debridement

Local Antibiotic Agents

Negative Pressure Wound Therapy

Endoscopic Approaches: Sinusoscopy

Hyperbaric Oxygen Therapy

Operative Strategies

Omental Pedicle Grafts

Wide Excision and Split Thickness Skin Grafts

Gracilis Muscle Flap

Rectus Abdominus Myocutaneous Flap

Pudendal Flaps

Gluteus Maximus Flap

Meshes and Biological Implants

Conclusions

References

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