Principles and Practice of Surgery for the Colon, Rectum, and Anus, Third Edition

1354 Pages·2007·48.017 MB·English

by  Philip H. Gordon, Santhat Nivatvongs

Principles and Practice of
Surgery for the
Colon, Rectum,
and Anus
Third Edition
Philip H. Gordon
M.D., F.R.C.S. (C), F.A.C.S., F.A.S.C.R.S., Hon. F.R.S.M., Hon. F.A.C.G.B.I
Professor of Surgery and Oncology, McGill University
Director of Colon and Rectal Surgery
Sir Mortimer B. Davis-Jewish General Hospital and McGill University
Montreal, Quebec, Canada
Santhat Nivatvongs
M.D., F.A.C.S., F.A.S.C.R.S., Hon. F.R.C.S.T. (Thailand), Hon. F.R.A.C.S.
Consultant Surgeon and Professor of Surgery
Mayo Clinic College of Medicine
Rochester, Minnesota, U.S.A.
ILLUSTRATORS
Scott Thorn Barrows, C.M.I., F.A.M.I
Director and Clinical Assistant Professor, Biomedical Visualization
University of Illinois at Chicago Medical Center
with the assistance of
Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, and Kim Martens
New York London
Informa Healthcare USA, Inc.
270 Madison Avenue
New York, NY 10016
© 2007 by Informa Healthcare USA, Inc.
Informa Healthcare is an Informa business
No claim to original U.S. Government works
Printed in the United States of America on acid‑free paper
10 9 8 7 6 5 4 3 2 1
International Standard Book Number‑10: 0‑8247‑2961‑7 (Hardcover)
International Standard Book Number‑13: 978‑0‑8247‑2961‑5 (Hardcover)
This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. A
wide variety of references are listed. Reasonable efforts have been made to publish reliable data and information, but the author and the publisher cannot assume
responsibility for the validity of all materials or for the consequences of their use.
No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or here‑
after invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the
publishers.
For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copyright.com/) or contact the Copy‑
right Clearance Center, Inc. (CCC) 222 Rosewood Drive, Danvers, MA 01923, 978‑750‑8400. CCC is a not‑for‑profit organization that provides licenses and
registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent
to infringe.
Library of Congress Cataloging‑in‑Publication Data
Gordon, Philip H.
Principles and practice of surgery for the colon, rectum, and anus / by Philip H. Gordon, Santhat Nivatvongs. ‑‑ 3rd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN‑13: 978‑0‑8247‑2961‑5 (alk. paper)
ISBN‑10: 0‑8247‑2961‑7 (alk. paper)
1. Colon (Anatomy)‑‑Surgery. 2. Rectum‑‑Surgery. 3. Anus‑‑Surgery. I. Nivatvongs, Santhat. II. Title.
[DNLM: 1. Colonic Diseases‑‑surgery. 2. Anus Diseases‑‑surgery. 3. Colorectal Neoplasms‑‑surgery. 4. Rectal Diseases‑‑surgery. WI 520
G664p 2006]
RD544.G67 2006
617.5’547‑‑dc22 2006050379
Visit the Informa Web site at
www.informa.com
and the Informa Healthcare Web site at
www.informahealthcare.com
Contributors
&
Peter A. Cataldo Associate Professor of Surgery, University of
VermontCollegeofMedicine,FletcherAllenHealthCare,Burlington,Vermont,U.S.A.
&
Jean MacDonald E.T. Nurse Consultant, Sir Mortimer B. Davis–Jewish
General Hospital, Montreal, Quebec, Canada
&
W. Rudolf Schouten Department of Surgery, Division of Colon and
Rectal Surgery, University Hospital Dijkzigt, Rotterdam, The Netherlands
&
Lee E. Smith Clinical Professor of Surgery, George Washington University,
Director, Section of Colon and Rectal Surgery, Washington Hospital Center,
Washington, D.C.
iii

I am once again deeply indebted to my wife
Rosalie
for her constant patience and understanding through the burden of this third edition.
Her constant life-long support has made all my professional accomplishments possible.
To my wonderful children
Laurel and Elliot
of whom I am extremely proud.
My love and gratitude to all.
—PHG
To my two angels
Marisa and Nitara.
Thinking of them makes me smile;
talking to them recharges my energy.
—SN

Preface to the Third Edition
Inthefirsteditionofthistextbookourgoalwastoproduce and in particular HNPCC. Extensive discussion of the indi-
a comprehensive book that would encompass the gamit of cations for and interpretation of genetic testing and the
colon and anorectal diseases. It was not intended to be invaluableroleofgeneticcounseling aredescribedindetail.
encyclopedic but to provide information for the busy sur- Thereisanupdateontheproprietyofadjuvanttherapywith
geon who needed to extract information as quickly as its limitations andcomplications andpossiblefinetuningof
possible. With this in mind, the contents were divided into indications for adjuvant therapy. There is updated informa-
fivemajorsectionsthatwehavebeentoldwerehelpfuland tion on the treatment of recurrent metastatic carcinoma
sowehavemaintainedthebasicformatthroughthesecond providing prognostic indicators for recurrence following
and third editions. therapy. A section on intra-luminal stenting for obstruction
In theeightyearsthathave elapsedsince ourlastedi- has been added. There is new information on the staging
tion, the proliferation of information published in the ofrectalcarcinoma.Thereisreviseddescriptionofsphincter
surgical literature makes it necessary to update and elabo- saving operations(pouch,coloplasty,coloanalanastomosis).
rate on these developments. Highlights in the revision Thereisadiscussionoftotalmesorectalexcisionwithresults
include a new discussion of fascial attachments of the rec- oftheuseofthistechnique.Thereareupdatedresultsonthe
tum and relationship to the lateral pelvic wall with treatment of carcinoma of the rectum with a discussion of
specificreferencetotheapplicationforoperationsonrectal theproprietyoftheuseoflocalexcisionofrectalcarcinoma.
carcinoma. Newer pharmacologic effects on the internal Thereisexpansion onthesectiononpalliativemanagement
sphincter and new investigative modalities for anorectal ofpatientswithrectalcarcinomaandthereisadiscussionon
physiology are described. The value and role of virtual the role of preoperative neoadjuvant treatment for rectal
colonoscopy is discussed as is the controversy regarding carcinoma. A new section on the management of presacral
the need for mechanical bowel preparation. There is a bleedinghasbeenincluded.Screening,surveillance,andfol-
detailed description of the newest modality of hemorrhoid low-upforlargebowelcarcinomacontinuetoevolverapidly
therapy, namely the stapler hemorrhoidopexy and its withbetterunderstanding.Thenewalgorithmforcolorectal
potential role in the armamentarium of hemorrhoid treat- carcinoma screening has been revised. The controversy in
ment. An extensive section on pharmacologic therapy for thesurveillanceaftersurgeryhasbeenlaidoutasguidelines
fissure-in-ano has been added and the efficacy of various from different major societies and institutions.
agents for chemical sphincterotomy are described. The The controversy on ileal pouch-anal anastomosis
value of intra-anal ultrasound and MRI in the diagnosis (IPAA) as primary treatment of chronic ulcercative colitis
of complicated recurrent fistula-in-ano have been high- hasbeenclarified.Abetterunderstandingoftheriskofcar-
lighted as has the efficacy of fibrin glue. A new section cinoma in the ileal pouch and the retained anal canal is
on the technique of the repair of rectourethral fistula has elucidated. The management of chronic pouchitis now
been added. Topical agents for condyloma accuminata includes immunosuppressive drugs. The long-term out-
and drugs and their dosage for various sexually trans- come of IPAA is now better understood. The Crohn’s
mitted diseases have been updated. An extensive review diseasechapterhasbeenextensivelyrevisedwithanelabo-
onthetherapyforfecalincontinenceincludingtheartificial rate discussion on the natural history and classification of
sphincter, hyperbaric oxygen, Secca procedure, implanta- the disease and an extensive discussion of the medical
tion of silicone biomaterial and detailed description of therapies with their limitations and the consideration of
sacral neuromodulation has been added. chemoprevention of colorectal carcinoma in inflammatory
The chapter on the etiology and management of peri- bowel disease. The changing paradigm regarding the indi-
anal neoplasms and anal carcinoma has been extensively cations for elective operation in diverticular disease has
revisedreflectingnewinformation,inparticularthediscus- been revisited along with the most recent data on results
sion on anal intraepithelial neoplsia (AIN). This included of the treatment of diverticulitis. The laparoscopy chapter
the new method of diagnosis and management of high has been totally revised and expanded. The indications
grade AIN of the perianal skin or Bowen’s disease. In the for laparoscopic colectomy have been revisited and
benign neoplasms chapter, the relatively new interest and expanded as newer technology has become available and
better understanding of ‘‘serrated’’ adenoma has been increasedexperiencehasbeengained.Thenewinstrumen-
added. The hot topic on the management of malignant tation of equipment that is available has been outlined
polyps of the low rectum has been updated. Information including subjects such as handports and robotic surgery.
on uncommon benign polyps has been expanded. Techniques of laparoscopic colectomy have been added.
New data regarding the incidence, prevalence, and The results of laparoscopic colectomy, conversion rates,
trends in colorectal carcinoma are included. There is an detailed morbidity, and mortality by disease process
update on the genetics of colorectal carcinoma in general have been updated. Difficult situations such as obesity,
vii
viii & PREFACETOTHETHIRDEDITION
inflammatory masses, and fistulas have been described. We hope we have accomplished our goal of summar-
Qualityof lifeandcost issueshave beenincluded. Amajor izing the enormous body of knowledge published in the
expansion of the complications, including incidence and literature and share our personal experience and prefer-
prevention of complications with laparoscopic colectomy ences with our readers. We strove for a book that strikes
have been described. In the miscellaneous chapter, an abalanceofbeingauthoritativeanddetailedwithoutbeing
entire new section on colon interposition has been added. soinclusivethatsomewhatirrelevantmaterialandminutia
The book is replete with color illustrations and photo- areincluded.Wesincerelyhopeoureffortswillprovidethe
graphs adjacent to the text material rather than grouped at practicingsurgeonandsurgeonintraining,theappropriate
thebeginning,middle,orendofthebook.Newillustrations informationtopermitthemtoprovidearationalandup-to-
have been added and others redrawn to conform to better datecourse ofactiontotheultimatebenefit ofeachoftheir
understanding and improvement in operative technique. patients.
Color has been added to many previous black and white
illustrations to enhance the visual image and better display Philip H. Gordon
the anatomic details. Each chapter is heavily referenced. Santhat Nivatvongs
Preface from the Second Edition
Sevenyearshaveelapsedsincethefirsteditionofthisbook In our quest to present a balanced view throughout
waspublishedandwehavebeenamazedatthenewdevel- this book, this endeavor has become almost encyclopedic.
opments relevant to diseases affecting the colon, rectum, As a result, this textbook has even grown beyond its origi-
and anus that have occurred in that relatively short span nal intimidating size. Despite the size, we have tried to
of time. Some of these developments have been an out- make this information readily accessible to our readers
growth of the increased knowledge of the disease process while maintaining the author’s personal imprint. There-
and the underlying genetic factors that influence it. Others fore, we have preserved our prerogative to state our
are a reflection of more sophisticated modalities of investi- preferences when applicable and to reflect our individual
gation such as intrarectal ultrasonographic assessment of perspectives. The basic organization of the subject matter
rectal carcinoma and positron emission tomography has also been maintained to permit ready access to infor-
(PET) scanningforrecurrentcarcinomaor improvedthera- mation which we have attempted to present in a
peutic options such as sphincter-saving operations and systematic format. New illustrations have been added
newer procedures for fecal incontinence. Added to this is and others have been redrawn to better clarify procedures
the yet undefined and still controversial role of laparo- or disease processes and to further enhance the learning
scopic operations to manage a host of colon and rectal process. A comprehensive bibliography also accompanies
disorders. This proliferation of knowledge has prompted each chapter.
a major revision of the last edition of this book. Parts have We hope we have accomplished our goal of summar-
beenentirelyrewritten(perianalandanalcanalneoplasms, izing the staggering body of current knowledge and
early detection and follow-up of large bowel carcinoma, sharing our own personal experience and preferences with
andischemiccolitis),othershavebeenextensivelyupdated ourreaders.Ourultimateobjectivehasbeentoaddressthe
(anal incontinence and adjuvant therapy for colorectal car- needs of practicing surgeons, gastroenterologists, other
cinoma), whereas still others have been greatly expanded physicians, residents in training, and medical students so
(fissures and Crohn’s disease). An entirely new chapter that they can develop a rational course of action for each
onlaparoscopyhasbeenaddedinviewofthecurrentinter- individual patient.
estinthistechnique.Theexcitingnewdevelopmentsinthe
geneticsofcolorectalcarcinomahavereceivedthein-depth Philip H. Gordon
coverage they deserve. Santhat Nivatvongs
ix