Ambulatory Colorectal Surgery - L. Sands, D. Sands (Informa, 2008) WW

2008·7.19 MB·English

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Gastroenterology and Hepatology
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about the book… u AmbulAtory
A great single-source reference encompassing all aspects of colorectal surgery, Ambulatory l
Colorectal Surgery covers topics: a
• patient evaluation
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• anorectal anatomy ColoreCtAl
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• anorectal ultrasound
• biofeedback techniques r
• fecal incontinence evaluation and management
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• wound management

• stoma management Surgery
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• pain management
• anal fissure o
• anorectal abscess
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• proctalgia fugax
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about the editors...
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LAURENCE R. SANDS is Associate Professor of Surgery and Chief of the Division of Colon and
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Rectal Surgery at the University of Miami Miller School of Medicine, Miami, Florida, USA. He
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received his M.D. from Northwestern University, Chicago, Illinois, USA. Subsequently, he
completed his general surgery residency at the Albert Einstein Medical Center in Philadelphia, t
Pennsylvania, USA. He then went on to do his colon and rectal surgery training at the Cleveland a
Clinic Florida, Weston, Florida, USA. He has worked at the University of Miami for 11 years and
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now serves as Chief of the Division of Colon and Rectal Surgery. Dr. Sands is a fellow of both the

American College of Surgeons and the American Society of Colon and Rectal Surgeons. In
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addition, he has served as President of the South Florida Chapter of the American College of
Surgeons and now serves as a Governor of the Chapter. u
DANA R. SANDS is a staff colorectal surgeon and Director of the Colorectal Physiology Center at r
edited by
the Cleveland Clinic Florida in the Department of Colon and Rectal Surgery in Weston, Florida, g
USA. Dr. Sands received her M.D. from Hahneman University, Philadelphia, Pennsylvania, USA.
e laurence r. Sands
She completed her general surgery residency at the University of Miami/Jackson Memorial
Hospital, Miami, Florida, USA. She completed her colon and rectal surgery training at the r
Dana r. Sands
Cleveland Clinic Florida, Weston, Florida, USA. Dr. Sands then joined the busy the Cleveland
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Clinic Florida practice and was appointed a staff surgeon. She assumed the role as Director of the
Colorectal Physiology Center and cares for patients with a broad spectrum of colorectal diseases
and complex pelvic floor pathology. She is a fellow of both the American College of Surgeons
and the American Society of Colon and Rectal Surgeons.
Sands
Printed in the United States of America
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AmbulAtory
ColoreCtAl
Surgery
Sands_978-0824727925_TP.indd 1 10/28/08 9:46:38 AM

AmbulAtory
ColoreCtAl
Surgery
edited by
laurence r. Sands
University of Miami Medical Center
Miami, Florida, USA
Dana r. Sands
Cleveland Clinic Florida
Weston, Florida, USA
Sands_978-0824727925_TP.indd 2 10/28/08 9:46:39 AM
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Ambulatorycolorectalsurgery/editedbyLaurenceR.Sands,DanaR.Sands.
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Includesbibliographicalreferencesandindex.
ISBN-13:978-0-8247-2792-5(hardcover:alk.paper)
ISBN-10:0-8247-2792-4(hardcover:alk.paper)
1. Colon(Anatomy)–Surgery. 2. Rectum–Surgery. 3.Ambulatorysurgery. I.Sands,
LaurenceR. II.Sands,DanaR.
[DNLM:1.Colon–surgery. 2.AmbulatorySurgicalProcedures–methods. 3.Digestive
SystemSurgicalProcedures–methods. 4.Rectum–surgery.WI520A4972008]
RD544.A5332008
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Foreword
The Editors are to be congratulated on their collaborative effort to provide colon and rectal
surgeons and their trainees with an excellent resource for the management of anorectal and
outpatient problems in colon and rectaldiseases.The table of contents is comprehensive and
contemporary. The chapters have been authored by young colon and rectal surgeons with
experiencedseniorsurgeonsascoauthorsincertaincircumstances.Theapproachtoeachtopic
iswellorganizedwithadequatehistoricalcommenttoprovidebackgroundtomoderntherapy.
This is a rapidly changing field and the authors have provided evidence for the use of each
physiologictest,imaginingtechnique,andtherapeuticmaneuver(medicalorsurgical).Thisis
aconcise,detailed,andpracticaltreatise,whichwillbeeasilyusedasareferenceintheclinic,
physiologylab,andoutpatientoperatingroom.
JamesW.Fleshman,M.D.
WashingtonUniversitySchoolofMedicine,
St.Louis,Missouri,U.S.A.
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Preface
The face of medicine has changed significantly in the 21st century. Emphasis is placed on
minimallyinvasivetechniquesandshorterhospitalization.Thismedicalclimatehaschallenged
physicianstoprovideexcellentcareofincreasinglycomplexproblemsoftenintheoutpatient
settingandfrequentlyusingmultidisciplinaryapproaches.
Assuch,wehavebeenmotivatedtowriteanewcolonandrectalsurgerytextbookcapital-
izingontheshiftingpracticesofmedicineinthe21stcentury.Thisbookrepresentsacompilation
ofoffice-baseddiagnoses,conditions,andtreatmentsthatarecommonlyencounteredingeneral
and colon and rectal surgical practices. Attention is paid to all facets of outpatient colorectal
surgeryincludingtheevaluationandtreatmentofcomplexpelvicfloorpathology.
Manyoffice-basedoutpatientconditionsandanorectaldiseasesingeneralareoftenpoorly
understood. This disease spectrum is frequently glossed over in surgical training programs.
Most surgical trainees today have limited access to the outpatient office setting, especially
within the confines of the restricted working hours of residents. Conditions such as the ones
reviewedinthisbookmakeupthecoreofmanysurgicalpractices.Therefore,webelievethat
this book will be useful to all practicing colon and rectal surgeons, general surgeons with
an interest in anorectal disease, and particularly those young surgeons just completing their
surgicaltrainingandstartinginpractice.
Thechaptersarelistedbyconditionandincludeacomprehensivereviewofthedisease
entityfollowedbytheavailablediagnosticmodalitiesandtreatmentoptions.Theperioperative
careisalsoincludedinordertoprovidethereaderwithaguidetothecompletemanagement
ofthesepatients.Areviewoftheliterature,bothclassicandnew,willhelpthereadertogain
a thorough understanding of each disease process. Prominent authors who have expertise in
theseareashavebeenbroughttogetherinthisefforttobringsomesimplicitytothetreatment
ofagroupofcommonconditions,whichareoftenineffectivelymanagedbyphysicians.
Our hope is that this book will give surgeons the ability to manage the spectrum of
diseasesencounteredintheoutpatientsettingandmakeastrongcontributiontothewelfareof
allpatients.
The editors are especially thankful to the contributors who have taken time from their
busyclinicalpracticestohelpinthisendeavorandtoElektraMcDermott,withoutwhom,this
projectwouldnothavebeenpossible.Wealsowishtoacknowledgeanddedicatethisbookto
ourdearchildren,RyanandCory,fromwhomwehavetakenmuchtimeinthepreparationof
thisproject.
LaurenceR.Sands
DanaR.Sands
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Contents
Foreword JamesW.Fleshman .... iii
Preface .... v
Contributors .... ix
SectionI: EvaluationTools
1. PatientEvaluation 1
SanjayJobanputra,T.CristinaSardinha,andMarcE.Sher
2. AnatomyoftheRectumandAnus 7
Jose´MarcioNevesJorgeandNewtonLuizT.Gasparetti,Jr.
3. AnorectalPhysiology 21
SheriefShawkiandDanaR.Sands
4. AnorectalUltrasound 45
TracyHullandMassaratZutshi
5. BiofeedbackTreatmentforFunctionalAnorectalDisorders 55
DawnVickers
SectionII: FunctionalDisorders
6. Hemorrhoids:Office-BasedManagement 79
DeanC.KohandMartinA.Luchtefeld
7. Hemorrhoids:SurgicalTreatment 87
DavidJ.MaronandStevenD.Wexner
8. AnalFissure 103
MigueldelMazoandLaurenceR.Sands
9. FecalIncontinence:Evaluation 109
JaimeL.BohlandRobertaL.Muldoon
10. FecalIncontinence:Office-BasedManagement 121
TishaLunsfordandJonathanEfron
11. FecalIncontinence:SurgicalManagement 135
JuanJ.NoguerasandAnneY.Lin
12. Constipation:EvaluationandManagement 141
BadmaBashankaev,MaratKhaikin,andEricG.Weiss