Principles and Practice of Surgery for the Colon, Rectum, and Anus PDF

Preface

In the first edition of this textbook our goal was to produce a comprehensive book that would encompass the gamit of colon and anorectal diseases. It was not intended to be encyclopedic but to provide information for the busy surgeon who needed to extract information as quickly as possible. With this in mind, the contents were divided into five major sections that we have been told were helpful and so we have maintained the basic format through the second and third editions.

In the eight years that have elapsed since our last edition, the proliferation of information published in the surgical literature makes it necessary to update and elaborate on these developments. Highlights in the revision include a new discussion of fascial attachments of the rectum and relationship to the lateral pelvic wall with specific reference to the application for operations on rectal carcinoma. Newer pharmacologic effects on the internal sphincter and new investigative modalities for anorectal physiology are described. The value and role of virtual colonoscopy is discussed as is the controversy regarding the need for mechanical bowel preparation. There is a detailed description of the newest modality of hemorrhoid therapy, namely the stapler hemorrhoidopexy and its potential role in the armamentarium of hemorrhoid treatment. An extensive section on pharmacologic therapy for fissure-in-ano has been added and the efficacy of various agents for chemical sphincterotomy are described. The value of intra-anal ultrasound and MRI in the diagnosis of complicated recurrent fistula-in-ano have been highlighted as has the efficacy of fibrin glue. A new section on the technique of the repair of rectourethral fistula has been added. Topical agents for condyloma accuminata and drugs and their dosage for various sexually transmitted diseases have been updated. An extensive review on the therapy for fecal incontinence including the artificial sphincter, hyperbaric oxygen, Secca procedure, implantation of silicone biomaterial and detailed description of sacral neuromodulation has been added.

The chapter on the etiology and management of perianal neoplasms and anal carcinoma has been extensively revised reflecting new information, in particular the discussion on anal intraepithelial neoplsia (AIN). This included the new method of diagnosis and management of high grade AIN of the perianal skin or Bowen's disease. In the benign neoplasms chapter, the relatively new interest and better understanding of ‘‘serrated'' adenoma has been added. The hot topic on the management of malignant polyps of the low rectum has been updated. Information on uncommon benign polyps has been expanded.

New data regarding the incidence, prevalence, and trends in colorectal carcinoma are included. There is an update on the genetics of colorectal carcinoma in general and in particular HNPCC. Extensive discussion of the indications for and interpretation of genetic testing and the invaluable role of genetic counseling are described in detail. There is an update on the propriety of adjuvant therapy with its limitations and complications and possible fine tuning of indications for adjuvant therapy. There is updated information on the treatment of recurrent metastatic carcinoma providing prognostic indicators for recurrence following therapy. A section on intra-luminal stenting for obstruction has been added. There is new information on the staging of rectal carcinoma. There is revised description of sphincter saving operations (pouch, coloplasty, coloanal anastomosis). There is a discussion of total mesorectal excision with results of the use of this technique. There are updated results on the treatment of carcinoma of the rectum with a discussion of the propriety of the use of local excision of rectal carcinoma. There is expansion on the section on palliative management of patients with rectal carcinoma and there is a discussion on the role of preoperative neoadjuvant treatment for rectal carcinoma. A new section on the management of presacral bleeding has been included. Screening, surveillance, and follow- up for large bowel carcinoma continue to evolve rapidly with better understanding. The new algorithm for colorectal carcinoma screening has been revised. The controversy in the surveillance after surgery has been laid out as guidelines from different major societies and institutions.

The controversy on ileal pouch-anal anastomosis (IPAA) as primary treatment of chronic ulcercative colitis has been clarified. A better understanding of the risk of carcinoma in the ileal pouch and the retained anal canal is elucidated. The management of chronic pouchitis now includes immunosuppressive drugs. The long-term outcome of IPAA is now better understood. The Crohn's disease chapter has been extensively revised with an elaborate discussion on the natural history and classification of the disease and an extensive discussion of the medical therapies with their limitations and the consideration of chemoprevention of colorectal carcinoma in inflammatory bowel disease. The changing paradigm regarding the indications for elective operation in diverticular disease has been revisited along with the most recent data on results of the treatment of diverticulitis. The laparoscopy chapter has been totally revised and expanded. The indications for laparoscopic colectomy have been revisited and expanded as newer technology has become available and increased experience has been gained. The new instrumentation of equipment that is available has been outlined including subjects such as handports and robotic surgery. Techniques of laparoscopic colectomy have been added. The results of laparoscopic colectomy, conversion rates, detailed morbidity, and mortality by disease process have been updated. Difficult situations such as obesity, inflammatory masses, and fistulas have been described. Quality of life and cost issues have been included. A major expansion of the complications, including incidence and prevention of complications with laparoscopic colectomy have been described. In the miscellaneous chapter, an entire new section on colon interposition has been added.

The book is replete with color illustrations and photographs adjacent to the text material rather than grouped at the beginning, middle, or end of the book. New illustrations have been added and others redrawn to conform to better understanding and improvement in operative technique. Color has been added to many previous black and white illustrations to enhance the visual image and better display the anatomic details. Each chapter is heavily referenced.

We hope we have accomplished our goal of summarizing the enormous body of knowledge published in the literature and share our personal experience and preferences with our readers. We strove for a book that strikes a balance of being authoritative and detailed without being so inclusive that somewhat irrelevant material and minutia are included. We sincerely hope our efforts will provide the practicing surgeon and surgeon in training, the appropriate information to permit them to provide a rational and up-todate course of action to the ultimate benefit of each of their patients.