Surgeon Burnout: Defining, Identifying, and Addressing the New Reality
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1692709Surgeon wellness is a multidimensional commitment that encompasses occupational, mental, physical, emotional, and social domains. Loss of professional control, autonomy, and flexibility; inefficient processes; disjointed workplace relationships and goals; excessive administrative burdens; poor work–life balance; and frustrations with medical record and order entry systems have all been associated with burnout. Described as a syndrome of emotional exhaustion, depersonalization, and loss of a sense of personal accomplishment, burnout can have myriad untowar...
Source: Clinics in Colon and Rectal Surgery - September 7, 2019 Category: Surgery Authors: Senturk, James Clark Melnitchouk, Nelya Tags: Review Article Source Type: research

Transitioning from Practice to Health Care Administration: The Later Years
This article will provide insight into such transitions and dual-career pathways and discuss important considerations when faced with this juncture in one's career. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - September 7, 2019 Category: Surgery Authors: Opelka, Frank G. Tags: Review Article Source Type: research

Perianal Crohn's Disease
This article provides an overview of the principles in the evaluation and management of perianal Crohn's disease (CD). Manifestation-specific treatment is addressed including abscess, fistula, skin tags, hemorrhoids, fissure, ulcers, strictures, ano-, and rectovaginal fistulas as well CD-associated hidradenitis suppurativa. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - September 6, 2019 Category: Surgery Authors: Pogacnik, Javier Salgado Salgado, Gervasio Tags: Review Article Source Type: research

Systemic and Autoimmune Diseases
This article reviews the clinical features of systemic and autoimmune diseases affecting the perianal region and its surrounding integumentary structures. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - September 6, 2019 Category: Surgery Authors: Delgadillo, Xavier Ortega, Adri án E. Greco, Alejandro Moreira Tags: Review Article Source Type: research

Parasitic Infections
This article discusses the perianal cutaneous findings caused by the parasitic illnesses, amebiasis, schistosomiasis, Enterobius vermicularis, strongyloidiasis, and cutaneous larva migrans, as well as their respective management. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - September 6, 2019 Category: Surgery Authors: Khubchandani, Indru T. Bub, David S. Tags: Review Article Source Type: research

Non-HPV Perianal and Anorectal Sexually Transmitted Viral Infections
This article reviews the epidemiology, diagnosis, and management of common viral infections of the perianal skin and anorectum including herpes simplex virus, human immune deficiency virus, and molluscum contagiosum. Human papilloma virus infection is reviewed in the subsequent article. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - September 6, 2019 Category: Surgery Authors: Murphy, Margarita Chedister, Gabriel Ryan George, Virgilio Tags: Review Article Source Type: research

Mycotic and Bacterial Infections
This article reviews the salient clinical features, evaluation, and treatment of mycotic and bacterial infections of the perianal and contiguous zones of the human body. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - September 6, 2019 Category: Surgery Authors: Duldulao, Phillip M. Ortega, Adri án E. Delgadillo, Xavier Tags: Review Article Source Type: research

Perianal Dermatology
Clinics in Colon and Rectal Surgery 2019; 32: 325-326 DOI: 10.1055/s-0039-1687826 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - September 6, 2019 Category: Surgery Authors: Ortega, Adri án E. Delgadillo, Xavier Tags: Preface Source Type: research

Human Papilloma Virus Infection and Anal Squamous Intraepithelial Lesions
This article addresses the natural history of the human papilloma virus (HPV) infection to anal squamous intraepithelial lesions, and onto squamous cell carcinoma of the anus. This article provides overviews of the virology, pathophysiology, nomenclature, classification, historical terms, risk factors, clinical evaluation, differential diagnosis, and treatment of HPV infection and its sequelae. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - August 22, 2019 Category: Surgery Authors: Svidler L ópez, Laura La Rosa, Luciana Tags: Review Article Source Type: research

Ergonomics and Musculoskeletal Health of the Surgeon
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1693026Surgeons face hazardous working conditions due to ergonomic deficiencies found throughout the operating room. More than 80% of surgeons have succumbed to a work-related injury or illness as a consequence of sustaining awkward or static positions throughout lengthy operations over a career. While the focus of the procedure is directed to the patient, there is little concurrent regard for proper posture or spinal stability. Even when symptoms of discomfort are experienced, they are often ignored. This results in decreased production and may ultimately threaten su...
Source: Clinics in Colon and Rectal Surgery - August 22, 2019 Category: Surgery Authors: Schlussel, Andrew T. Maykel, Justin A. Tags: Review Article Source Type: research

Transition to Surgical Practice: The Early Years
This article will discuss aspects that are unique to the early career surgeon. Where possible, I will use the available literature to augment the discussion, whereas, in other areas, I will offer my thoughts from personal experience on the topic. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - August 22, 2019 Category: Surgery Authors: Paquette, Ian M. Tags: Review Article Source Type: research

Idiopathic Pruritus Ani and Acute Perianal Dermatitis
This article reviews the etiologies, pathophysiology, clinical evaluation, and treatment of idiopathic pruritus ani and perianal dermatitis. It underscores a practical approach to each of these common proctologic conditions. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - August 22, 2019 Category: Surgery Authors: Ortega, Adri án E. Delgadillo, Xavier Tags: Review Article Source Type: research

From Burnout to Well-Being: A Focus on Resilience
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1692710Burnout is a widespread problem in health care. Factors that contribute to enhancing engagement and building resiliency are widely discussed, but the data supporting these practices are not well understood. Interventions aimed at increasing engagement and promoting resiliency are targeted toward individual practitioners, health care institutions, and national organizations. Knowledge of the data supporting various kinds of interventions is vital to implementing change meaningfully. Prevention of burnout should start early in training with appropriate modeling a...
Source: Clinics in Colon and Rectal Surgery - August 22, 2019 Category: Surgery Authors: Mahmoud, Najjia N. Rothenberger, David Tags: Review Article Source Type: research

Workplace Exposures
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1693010Workplace exposure in colorectal surgery is unique compared with other surgical specialties and generally underreported. Although the most common device-associated exposure in surgery is suture needle injury, colorectal surgeons are increasingly exposed to gastrointestinal-related infectious agents, radiation, and other hazards in multiple different clinical settings. Highlighting the unique workplace exposures in colorectal surgery may help increase awareness, improve education, and identify possible targets for early intervention in order to minimize these ri...
Source: Clinics in Colon and Rectal Surgery - August 22, 2019 Category: Surgery Authors: Lee, Janet T. Gaertner, Wolfgang B. Tags: Review Article Source Type: research

The Pregnant Surgeon
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1693012The proportion of women entering medicine and surgery is increasing steadily. As more women surgeons have children during residency and practice, it is essential that we adopt a team approach to the pregnant surgeon, as a pregnancy undoubtedly impacts the team and not just the individual. Coauthored by a practicing surgeon mother of 2 (J. D.) and a postgraduate year 8 colorectal surgery fellow mother of 2 who is currently pregnant (C. H.), we aim to review the data while providing some practical advice for pregnant surgeons and those considering pregnancy, as w...
Source: Clinics in Colon and Rectal Surgery - August 22, 2019 Category: Surgery Authors: Harnsberger, Cristina R. Davids, Jennifer S. Tags: Review Article Source Type: research

Miscellaneous Perianal Afflictions
This article provides an overview of hidradenitis suppurativa, lichen planus, lichen sclerosis, calcinosis cuti, pyogenic granuloma, intertrigo, and seborrheic keratosis. This article also focuses on recognition and management of these pleomorphic afflictions of the perianal region. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - August 22, 2019 Category: Surgery Authors: Hagerman, Gonzalo F. Silva-Velazco, Jorge Molina-Lopez, Juan Francisco Tags: Review Article Source Type: research

Nonviral Sexually Transmitted Diseases
This article provides a practical overview for the management of nonviral sexually transmitted diseases affecting the perianal and anorectal regions. Clinical manifestations, diagnosis, and treatment of syphilis, gonorrhea, chancroid, donovanosis, and lymphogranuloma venereum are individually addressed. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - August 22, 2019 Category: Surgery Authors: Cologne, Kyle G. Hsieh, Christine Tags: Review Article Source Type: research

Premalignant and Malignant Perianal Lesions
This article examines the various types of perianal cancers and their precursor lesions and will explore treatment options as well as outcomes and prognosis. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - August 22, 2019 Category: Surgery Authors: Abbass, Mohammad Ali Valente, Michael A. Tags: Review Article Source Type: research

Adri án E. Ortega, MD, FASCRS, and Xavier Delgadillo, MD, EBSQ-C
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1687825 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - August 22, 2019 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to the Guest Editors Source Type: research

Jennifer Suzanne Davids, MD, FACS, FASCRS
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1692707 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - August 22, 2019 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to the Guest Editor Source Type: research

Strictureplasty in Complex Crohn's Disease: Beyond the Basics
Clinics in Colon and Rectal Surgery 2019; 32: 243-248 DOI: 10.1055/s-0039-1683905The strictureplasty operation was originally adopted for use in selected patients with Crohn's disease to allow for bowel conservation. The procedure and its usage have evolved over time as experience and confidence with the technique has grown. The short- and long-term outcomes of strictureplasty compared with resection attest to its safety and durable efficacy. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Ful...
Source: Clinics in Colon and Rectal Surgery - July 12, 2019 Category: Surgery Authors: Strong, Scott A. Tags: Review Article Source Type: research

Crohn's Disease and the Risk of Cancer
This article reviews the current literature regarding Crohn's disease and subsequent risk of cancer formation. Recognition of risk factors (both modifiable and unmodifiable) is essential for prevention and appropriate screening. Future investigations into the molecular mechanisms associated with Crohn-related malignancy will provide additional insight into carcinogenesis, potential for early intervention, and identification of at-risk patients. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  F...
Source: Clinics in Colon and Rectal Surgery - July 2, 2019 Category: Surgery Authors: Carchman, Evie Tags: Review Article Source Type: research

Minimally Invasive Surgery in Complex Crohn's Disease
Clinics in Colon and Rectal Surgery 2019; 32: 300-304 DOI: 10.1055/s-0039-1683922Minimally invasive approaches are safe, feasible, and often recommended as the initial choice in the surgical management of Crohn's disease. However, a consensus has not been reached as the ideal approach in the surgical treatment of complex and recurrent Crohn's disease. Laparoscopy may provide advantages such as shorter length of stay and decreased postoperative pain and result in less adhesion formation in patients with complex disease. Robotic techniques may be beneficial in selected patients for completion proctectomy, providing better vi...
Source: Clinics in Colon and Rectal Surgery - July 2, 2019 Category: Surgery Authors: Sapci, Ipek Gorgun, Emre Tags: Review Article Source Type: research

Reoperative Surgery in Complex Crohn's Disease
This article provides a structured approach to the technical aspects of reoperative surgery for Crohn's disease. Specific indications for surgery including repeat ileocolic resection, Crohn's complications of ileal pouch anal anastomosis and continent ileostomy, completion proctectomy, and the role of small bowel transplant will be discussed. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - July 2, 2019 Category: Surgery Authors: Leinicke, Jennifer A. Dietz, David W. Tags: Review Article Source Type: research

Role of Fecal Diversion in Complex Crohn's Disease
Clinics in Colon and Rectal Surgery 2019; 32: 273-279 DOI: 10.1055/s-0039-1683916Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in progressive tissue damage, which can result in strictures, fistulae, and abscesses formation. The triggering mechanism is thought to be in the fecal stream, and diversion of this fecal stream is sometimes required to control disease when all other avenues of medical and surgical management have been exhausted. Fecal diversion can be temporary or permanent with the indications being defunctioning a high-risk anastomosis, as a result of a surgical...
Source: Clinics in Colon and Rectal Surgery - July 2, 2019 Category: Surgery Authors: Burke, John P. Tags: Review Article Source Type: research

Surgical Management of Complex Enteric Fistulas in Crohn's Disease
Clinics in Colon and Rectal Surgery 2019; 32: 268-272 DOI: 10.1055/s-0039-1683909Crohn's disease is a chronic, inflammatory bowel condition that can affect the entire digestive tract and in many cases lead to enteric fistula formation. The management of enteric fistulas can be challenging and often requires a multidisciplinary approach. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - July 2, 2019 Category: Surgery Authors: de Campos-Lobato, Luiz Felipe Kiran, Ravi P. Tags: Review Article Source Type: research

Treatment Strategies in Crohn's-Associated Rectovaginal Fistula
Clinics in Colon and Rectal Surgery 2019; 32: 261-267 DOI: 10.1055/s-0039-1683908Rectovaginal fistula (RVF) is a rare, but dreaded complication of Crohn's disease (CD) that is exceedingly difficult to manage. Treatment algorithms range from observation and medical therapy to local surgical repair and proctectomy. The multitude of surgical options and lack of consensus between experts speak to the complexity and shortcomings encountered to correct this disease process surgically. The key to successful management of these fistulae therefore rests on a multidisciplinary approach between the patient, gastroenterologists, and s...
Source: Clinics in Colon and Rectal Surgery - July 2, 2019 Category: Surgery Authors: DeLeon, Michelle F. Hull, Tracy L. Tags: Review Article Source Type: research

Management of Complex Anorectal and Perianal Crohn's Disease
Clinics in Colon and Rectal Surgery 2019; 32: 255-260 DOI: 10.1055/s-0039-1683907Perianal symptoms occur in up to 50% of patients with Crohn's disease in other parts of the gastrointestinal tract, and in 5% of patients it is the first manifestation of the disease. The perianal area is often under stress in patients with Crohn's disease, because of the diarrhea, and the fecal urgency, frequency, and incontinence caused by proximal disease. Symptomatic perianal disease can therefore be due to the effects of the stress on an otherwise normal anus, or the result of Crohn's disease in the low rectum and/or perianal tissues them...
Source: Clinics in Colon and Rectal Surgery - July 2, 2019 Category: Surgery Authors: Bolshinsky, Vladimir Church, James Tags: Review Article Source Type: research

Current Status of Segmental Colectomy in Select Crohn's Disease Patients
Clinics in Colon and Rectal Surgery 2019; 32: 249-254 DOI: 10.1055/s-0039-1683906Crohn's disease is a complex disease with a varying clinical and anatomical spectrum. One-third of patients with Crohn's will have disease confined to the colon. In this article, the authors review the surgical treatment options for colonic Crohn's disease including the current status of performing segmental colectomy in colonic Crohn's, the pros and cons of segmental versus subtotal colectomy, and the influence of biologics on recurrence rates following segmental colectomy. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 1000...
Source: Clinics in Colon and Rectal Surgery - July 2, 2019 Category: Surgery Authors: Heriot, Alexander Smart, Philip Tags: Review Article Source Type: research

Tailored Medical Management of the Complex Postoperative Crohn's Disease Patient
Clinics in Colon and Rectal Surgery 2019; 32: 225-230 DOI: 10.1055/s-0039-1683853Despite advancements in medical therapy, many patients with Crohn's disease continue to require surgery for intestinal resection and/or management of perianal disease at some point in their disease course. Unfortunately, in this complex group of patients, postoperative disease recurrence rates are high. Medical prophylaxis can be used to prevent Crohn's disease recurrence or manage residual disease after surgery, but the ideal timing to start medications after surgery varies based on patient risk factors and patient preference for medication u...
Source: Clinics in Colon and Rectal Surgery - July 2, 2019 Category: Surgery Authors: Achkar, Jean-Paul Tags: Review Article Source Type: research

Complex Crohn's Disease: Primum non nocere
Clinics in Colon and Rectal Surgery 2019; 32: 223-224 DOI: 10.1055/s-0039-1683852 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - July 2, 2019 Category: Surgery Authors: Valente, Michael A. Tags: Preface Source Type: research

Crohn's Disease of the Esophagus, Duodenum, and Stomach
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1683850Upper gastrointestinal Crohn's is an under-reported, under-recognized phenotype of Crohn's disease. Routine screening in the pediatric population has shown a higher prevalence compared with adults; however, most adult patients remain asymptomatic with respect to upper gastrointestinal Crohn's disease. For the patients who are symptomatic, medical treatment is the first line of management, except for cases of obstruction, perforation, or bleeding. Though most patients respond to medical therapy, mainly steroids, with the addition of immunomodulators and more rec...
Source: Clinics in Colon and Rectal Surgery - June 17, 2019 Category: Surgery Authors: Schwartzberg, David M. Brandstetter, Stephen Grucela, Alexis L. Tags: Review Article Source Type: research

Is There a Role for Ileal Pouch Anal Anastomosis in Crohn's Disease?
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1683917Traditionally, surgical interventions for colonic Crohn's disease (CD) have been limited to total abdominal colectomy and ileorectal anastomosis, or total proctocolectomy with end ileostomy if there is rectal involvement. However, improved understandings of the biology of CD, as well as the development of biologic therapies, have enabled more limited resections. Here, we review the indications for, and limitations of, specific procedures aiming to preserve intestinal continuity in colonic CD. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 1000...
Source: Clinics in Colon and Rectal Surgery - June 17, 2019 Category: Surgery Authors: Lopez, Nicole E. Zaghyian, Karen Fleshner, Phillip Tags: Review Article Source Type: research

Ostomy Complications in Crohn's Disease
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1683924Ostomy creation is a routine surgical procedure that has earned its place high in the surgeon's armamentarium in dealing with challenging situations. However, it is not without its complications. In this article, we review the common complications including parastomal hernia, prolapse, mucocutaneous junction separation with ischemia and stenosis, peristomal skin conditions, and infections. Additionally, we review conditions that arise in association with underlying Crohn's disease, such as peristomal inflammation, fistula formation, and pyoderma gangrenosum. [....
Source: Clinics in Colon and Rectal Surgery - June 17, 2019 Category: Surgery Authors: Aboulian, Armen Tags: Review Article Source Type: research

Michael A. Valente, DO, FACS, FASCRS
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1683851 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - June 17, 2019 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to Guest Editor Source Type: research

Surgical Site Infection: The Clinical and Economic Impact
This article discusses the clinical and economic impact of SSI and strategies for mitigating the risk of SSI through bundled prevention practices. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - April 2, 2019 Category: Surgery Authors: Turner, Megan C. Migaly, John Tags: Review Article Source Type: research

Recognition and Management of Colonic Perforation following Endoscopy
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0038-1677024Although rare, perforation can be a devastating complication of colonoscopy. Incidence ranges from 0.012 to 0.65% during diagnostic procedures and is higher in therapeutic procedures. Early diagnosis and management are of paramount importance to decrease morbidity. Diagnostic imaging after colonoscopy can reveal extraintestinal air, but overall clinical status including leukocytosis, fever, pain, and peritonitis is equally important to determine management. With the expanding availability of complex endoscopic interventions, an increasing number of perforations...
Source: Clinics in Colon and Rectal Surgery - April 2, 2019 Category: Surgery Authors: Thompson, Earl V. Snyder, Jonathan R. Tags: Review Article Source Type: research

Operative Management of Anastomotic Leaks after Colorectal Surgery
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0038-1677025Anastomotic leak is associated with increased morbidity and mortality after colorectal surgery. Although surgical techniques have improved over time, anastomotic leak is still a reality in colorectal surgery with rates ranging from as low as 1% for low-risk anastomoses, such as enteroenteric or ileocolic, to 19% for high-risk coloanal anastomoses. There are many varied risk factors for anastomotic leak. However, many of the risk factors have not been definitively proven in high-quality studies. Presumably, risk factors are cumulative and every effort should be ...
Source: Clinics in Colon and Rectal Surgery - April 2, 2019 Category: Surgery Authors: Saur, Nicole M. Paulson, E. Carter Tags: Review Article Source Type: research

Diverting Ostomy: For Whom, When, What, Where, and Why
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0038-1677004Fecal diversion is an important tool in the surgical armamentarium. There is much controversy regarding which clinical scenarios warrant diversion. Throughout this article, we have analyzed the most recent literature and discussed the most common applications for the use of a diverting stoma. These include construction of diverting ileostomy or colostomy, ostomy for low colorectal/coloanal anastomosis, inflammatory bowel disease, diverticular disease, and obstructing colorectal cancer. We conclude the following: diverting loop ileostomy is preferred to loop col...
Source: Clinics in Colon and Rectal Surgery - April 2, 2019 Category: Surgery Authors: Plasencia, Alexis Bahna, Heidi Tags: Review Article Source Type: research

Ostomy-Related Complications
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0038-1676995Ileostomy or colostomy formation is an important component of many surgical procedures performed for a wide range of disorders of the gastrointestinal tract. Despite the frequency with which intestinal stomas are created, stoma-related complications remain common and are associated with significant morbidity as well as cost. Some of the most prevalent complications of stoma formation which will be detailed in this article include peristomal skin complications, retraction, stomal necrosis, stomal stenosis, prolapse, bleeding, dehydration from high ostomy output,...
Source: Clinics in Colon and Rectal Surgery - April 2, 2019 Category: Surgery Authors: Murken, Douglas R. Bleier, Joshua I. S. Tags: Review Article Source Type: research

Predicting and Preventing Postoperative Outcomes
This article aims to provide ways to predict and prevent postoperative complications in colorectal surgery. Here, we review the predictive models, American College of Surgeons National Surgery Quality Improvement Program risk calculator and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity on their practicality and usefulness. Additionally, this review summarizes nonmodifiable and modifiable risk factors in colorectal surgery, which are important for surgeons to understand to minimize and attempt to avoid postoperative complications as well as providing ways to optimize patients preo...
Source: Clinics in Colon and Rectal Surgery - April 2, 2019 Category: Surgery Authors: Lee, Sung Gon Russ, Andrew Tags: Review Article Source Type: research

Postoperative Ileus
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0038-1677003Postoperative ileus (POI) is a common complication following colon and rectal surgery, with reported incidence ranging from 10 to 30%. It can lead to increased morbidity, cost, and length of stay. Although definitions vary considerably in the literature, in its pathologic form, it can be characterized by a temporary inhibition of gastrointestinal motility after surgical intervention due to nonmechanical causes that prevents sufficient oral intake. Various risk factors for development of POI have been identified including increasing age, American Society of Anes...
Source: Clinics in Colon and Rectal Surgery - April 2, 2019 Category: Surgery Authors: Harnsberger, Cristina R. Maykel, Justin A. Alavi, Karim Tags: Review Article Source Type: research

Overlooked Long-Term Complications of Colorectal Surgery
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0038-1677027While colorectal surgery has been documented to have some of the highest complication rates in the surgical field, some of the more common, functional complications are often overlooked in the literature and in discussion with patients. Urinary, sexual, and defecatory dysfunction are common after colorectal surgery, especially after pelvic dissections, and may severely impact the postoperative quality of life for patients. These complications include urinary retention, erectile dysfunction, retrograde ejaculation, dyspareunia, infertility, and low anterior rese...
Source: Clinics in Colon and Rectal Surgery - April 2, 2019 Category: Surgery Authors: Giglia, Matthew D. Stein, Sharon L. Tags: Review Article Source Type: research

Urological Injuries during Colorectal Surgery
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0038-1677026The proximity of the colon and rectum to the organs of the urologic system virtually ensures that iatrogenic urologic injuries become a distinct possibility during complex colorectal surgical procedures. An intimate knowledge of urogenital anatomy as well as strategies for identification and repair of potential injuries is of paramount importance. Attention is mandated when operating within the narrow confines of the pelvis, as this is where these structures are most at risk. The ureters are at highest risk of injury, followed by the bladder and urethra. The na...
Source: Clinics in Colon and Rectal Surgery - April 2, 2019 Category: Surgery Authors: Ferrara, Marco Kann, Brian R. Tags: Review Article Source Type: research

Health Care Policy and Outcomes after Colon and Rectal Surgery: What Is the Bigger Picture? —Cost Containment, Incentivizing Value, Transparency, and Centers of Excellence
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0038-1677028Early in the 21st century, the costs of health care in the United States have spiraled out of control, where the per capita spending is $9,237 per person—the highest in the world. By 2020, an estimated 20% of GDP will be spent on health care. The issue of cost and quality is now becoming a national crisis, with ∼50% of hospitals losing money on clinical operations, forcing closure of essential critical access hospitals, and forcing health care workers to relocate or change professions. This crisis will only worsen with the graying of America, as an es...
Source: Clinics in Colon and Rectal Surgery - April 2, 2019 Category: Surgery Authors: Bhama, Anuradha R. Holubar, Stefan D. Delaney, Conor P. Tags: Review Article Source Type: research

Complications and Dilemmas in Colorectal Surgery
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0038-1677000 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - April 1, 2019 Category: Surgery Authors: Shanmugan, Skandan Tags: Preface Source Type: research

Skandan Shanmugan, MD
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0038-1676999 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - April 1, 2019 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to the Guest Editor Source Type: research

Erratum to: Enhanced Recovery After Surgery Interactive Audit System: 10 Years' Experience with an International Web-Based Clinical and Research Perioperative Care Database
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1678573 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - February 28, 2019 Category: Surgery Authors: Currie, Andrew Soop, Mattias Demartines, Nicolas Fearon, Kenneth Kennedy, Robin Ljungqvist, Olle Tags: Erratum Source Type: research

Patient Satisfaction and Quality of Life with Enhanced Recovery Protocols
Clinics in Colon and Rectal Surgery 2019; 32: 138-144 DOI: 10.1055/s-0038-1676480While studies have demonstrated the benefits of Enhanced Recovery after Surgery (ERAS) programs in reducing length of stay and costs without increasing complications, fewer studies have evaluated patient satisfaction and quality of life (QOL) with enhanced recovery protocols. The aim of this project was to summarize the literature comparing satisfaction and quality of life after colorectal surgery following treatment within an ERAS protocol to standard postoperative care. The available evidence suggests patients suffer no detriment to satisfac...
Source: Clinics in Colon and Rectal Surgery - February 28, 2019 Category: Surgery Authors: Li, Debbie Jensen, Christine C. Tags: Review Article Source Type: research

Applying Enhanced Recovery Pathways to Unique Patient Populations
Clinics in Colon and Rectal Surgery 2019; 32: 134-137 DOI: 10.1055/s-0038-1676479Enhanced Recovery after Surgery (ERAS) pathways have become popular in colorectal surgery due to their associated decrease in length of stay (LOS), complications, and readmission rate. However, it is unclear if these pathways are safe, feasible, or effective in unique patient populations such as elderly patients, urgent/emergent surgeries, patients with specific comorbidities, inflammatory bowel disease, or pediatric patients. Enhanced recovery pathways appear safe in elderly patients, associated with decreased complications, though with sligh...
Source: Clinics in Colon and Rectal Surgery - February 28, 2019 Category: Surgery Authors: Lee, Grace C. Hodin, Richard A. Tags: Review Article Source Type: research