Reconstructive Surgery of the Rectum, Anus and Perineum PDF
Preview Reconstructive Surgery of the Rectum, Anus and Perineum
Reconstructive Surgery of the Rectum, Anus and Perineum Andrew P. Zbar (cid:129) Robert D. Madoff Steven D. Wexner Editors Reconstructive Surgery of the Rectum, Anus and Perineum Editors Andrew P. Zbar , M.D. (Lond), M.B.B.S., FRCS Steven D. Wexner , M.D., Ph.D. (Hon), (Ed.), FRACS FACS, FRCS, FRCS (Ed.) Department of Surgery and Transplantation Professor & Chair, Department of C haim Sheba Medical Center, 52621 Ramat Gan Colorectal Surgery Israel Emeritus Chief of Staff Cleveland Clinic Associate Dean for Academic Affairs Sackler Medical School Florida Atlantic University College of Medicine Tel Aviv University Af fi liate Dean for Clinical Education Tel Aviv Florida International University College of Israel Medicine Florida Robert D. Madoff , M.D. USA Division of Colon and Rectal Surgery Department of Surgery University of Minnesota Medical School Minneapolis MN USA ISBN 978-1-84882-412-6 ISBN 978-1-84882-413-3 (eBook) DOI 10.1007/978-1-84882-413-3 Springer London Heidelberg New York Dordrecht Library of Congress Control Number: 2012954867 © Springer-Verlag London 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro fi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) This book is dedicated to my parents, whose unswerving love was tempered with a dedication to honesty and integrity in the acquisition of knowledge. It also is dedicated to my new friends and mentors Mordechai Gutman, Oded Zmora, Moshe Shabtai, and Abraham Czerniak who reinforced that sense of purpose and to Micha Rabau for his experience, warmth and guidance. Andrew P. Zbar For my fellows discipulus praeceptorem docet Robert D. Madoff My work in this book is dedicated to Nick and Joe Caporella whose generosity has made possible numerous signifi cant advances in surgical science and in medical practice. Their philanthropy and altruism have greatly improved the quality of life of countless patients around the world. I am indebted to them for their continuous support of innovations and advances in colorectal surgery. Steven D. Wexner Foreword Reconstructive Surgery of the Rectum, Anus and Perineum , edited by Andrew Zbar, Robert Madoff, and Steven Wexner is a major textbook containing about 600 pages divided into 54 chapters written by an internationally renowned panel of authors from fi ve continents. As the title implies, the emphasis is on the management of clinical conditions that have arisen as a result of the failure of previous treatment, whether because of benign or malignant disease or complications, for example, anastomotic leakage. Such problems are common in colorectal surgical practice and the book deals with them in detail. Included is an account of salvage treat- ment, usually surgery, for important conditions such as recurrent cancer and the failing pouch, but the book goes much further to cover the fi eld of colorectal disease with extraordinary thor- oughness. It is more advanced than usual textbooks on the subject since, uniquely, it is aimed at the surgeon in a tertiary unit or the trainee who aspires to become established in tertiary practice. There is no other book on colon and rectal surgery that sets out to achieve this. The book is divided into eight parts, including investigation, decision-making, re-operative strategies in in fl ammatory bowel disease, constipation and obstructive defecation, and fecal incontinence, anal reconstructive techniques, stomas, and special topics. Each part starts with an Introduction by one of the Editors. The text is clear and the chapters are presented in a very readable form. They are all up-to- date and contain excellent detail. The bibliography is comprehensive and will be a very useful resource. The references are easy to fi nd on the page, making it simple to check them with the minimum of disturbance to reading the text. In general, the fi gures are of the highest quality. This is especially true for the chapters on surgery for pelvic recurrence, where the colored diagrams are very informative. The line diagrams are clear and easily interpreted, there are excellent clinical photographs, and the tables are well set out and easy to read. The entire range of coloproctology is covered and uncommon conditions are given full treatment alongside those that are more frequent. There are chapters on newer technologies, such as laparoscopic and robotic surgery and STARR, describing the management of prob- lems, which can occur. Those on the methods of anal and perianal reconstruction are very useful. At the end there is a valuable chapter on the medicolegal aspects. This authoritative book fi lls a need for both trainee and established colorectal surgeon in the more advanced aspects of practice. It is a mine of information and will be of immense value. Emeritus Consultant Surgeon, John Nicholls St Mark’s Hospital, London MA (Cantab), M.Chir, FRCS (Eng), Professor of Colorectal Surgery, EBSQ (Coloproctology), hon FRCP (Lond), Imperial College, London hon FACS, hon FRCSE, hon FRCS (Glasg), hon ASCRS, hon ACPGBI, hon ESCP, hon BSG vii Preface Few texts address the management principles of reconstructive surgery of the rectum, anus, and perineum in both benign and malignant disease. Yet the coloproctologist often is faced with a patient who has undergone multiple failed procedures for complex problems such as a high fi stula-in-ano or recalcitrant perianal Crohn’s disease, where familiarity with the wide array of new operative procedures and ancillary techniques is essential. Although benign proc- tology has not developed into its own subspecialty within coloproctology, such super-special- ization may occur as more colorectal surgeons gain signi fi cant reputations in this fi eld. The management and imaging of the patient with evacuatory dysfunction has moved in that direc- tion as knowledge of complex reparative techniques and sacral neuromodulation has created subspecialty division. At present, there is no accreditation facility for the coloproctology trainee of of fi ce imaging or of more extended radiological techniques such as magnetic reso- nance imaging or defecographic interpretation. Part I of this book addresses the role of different specialized forms of imaging for patients in whom reconstructive and reoperative surgery is required. This section delineates the indica- tions for and the selective use, interpretation, and limitations of conventional radiography, defecography, endoluminal sonography, magnetic resonance imaging, and endoscopy in clini- cal practice in these dif fi cult cases. This section also assesses the physiological principles of anorectal manometry, vector volumetry, impedance planimetry, barostat, and neurophysiologi- cal testing for reoperative cases. Part I I describes the technical recommendations for revising ultralow anastomoses where there is associated signi fi cant postoperative functional disturbance, especially after adjuvant radiation or anastomotic leakage. In this section, the alternatives to neorectal reservoir con- struction and revision are outlined along with speci fi c techniques for their use in the irradiated rectum. The operative details of patients undergoing extensive cancer resections and pelvic exenterations are de fi ned by two leading groups operating in different parts of the world, who outline their strategies for such extended R0 resections. The mechanistic principles of how to manage dif fi cult laparoscopic and robotic colorectal cases is discussed, as are the management principles of preneoplastic anal cancer syndromes, anal cancer itself, and the results of total anorectal reconstruction after radical rectal extirpation. Part I II outlines the surgical strategies for in fl ammatory bowel disease and discuss at length the clinical importance of dysplasia in the colitic patient, revisional surgery after ileal pouch anal anastomosis, reoperative principles, the results of colonic Crohn’s disease and ulcerative colitis, and the results of a range of approaches in the patient presenting with complicated and recurrent perianal Crohn’s disease. Part I V of the book explores reoperation in patients with disabling functional bowel disease and discusses the management of failed surgery for severe constipation, megarectum, failed rectocele repair, and how to manage patients when the results after stapled endoanal surgery are less than satisfactory. It concludes with the gynecologist’s perspective on patients present- ing with primary pelvic fl oor disorders and problems of the perineal soft tissues and pelvic compartments. Part V de fi nes the known data concerning patients presenting with recurrent fecal inconti- nence. It assesses the role of redo sphincteroplasty, failed graciloplasty, problematic arti fi cial ix x Preface sphincter implantation and sacral neuromodulation, and the results of sphincter augmentation procedures. Part V I analyzes surgical approaches and alternatives to anal canal and perineal resurfacing, with speci fi c attention given to the troublesome recurrent or persistent anal fi ssure, the man- agement of the complicated fi stula-in-ano, dif fi cult repeat surgeries for rectovaginal fi stulae, and the management of rectoprostatic fi stulae. Part VII discusses revisional stoma surgery, including stoma re-siting and local revision, the recent successes of laparoscopic repair of parastomal hernias, operative strategies in Hartmann’s reversal, and revision of the pediatric stoma. Part VIII outlines management alternatives for a range of miscellaneous colorectal and proctological conditions for which revisional surgery is likely to be required. This section includes a discussion of novel strategies in the anesthetic management of these patients, new approaches to the care of complicated diverticulitis, and management strategies for anasto- motic dehiscence. Presacral tumors and their operative approaches and investigation are revis- ited, and algorithms for the surgical management of failed rectal prolapse surgery are presented. The troublesome condition of recurrent pilonidal disease is evaluated, along with the reopera- tive approach in patients with colorectal endometriosis. Finally, a medicolegal strategy is pro- vided for cases requiring reoperative or reconstructive surgery, with an emphasis on those patients for whom functional outcomes after repeat surgery are particularly in jeopardy. Just as the multidisciplinary integration of cancer care requires specialized expertise, the successful surgical management of complicated problems of the rectum, anus, and perineum requires sophisticated expertise on a similar scale, ideally by those who are able to collaborate with experts from other disciplines and interested in documenting prospective functional out- come data. This new book provides a coordinated strategic basis for patient care in these com- plicated cases. The editors are particularly grateful to all of the chapter authors for their time, expertise, and creativity, which were essential to the production of this novel book. We further thank Melissa Morton of Springer for promoting the book concept within Springer-Verlag and Maureen Pierce, our tireless editor, who made this production possible. Andrew P. Zbar Robert D. Madoff Steven D. Wexner
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