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Overcoming Geographic Barriers: Surgical Care in Rural Populations
Clin Colon Rectal Surg DOI: 10.1055/s-0044-1786390This chapter examines the challenges rural Americans face in accessing surgical care, which is characterized by geographical barriers, a decreasing surgical workforce, and unique patient factors. The widening health care disparity between rural and urban residents highlights the need for comprehensive strategies to improve surgical care delivery to rural areas. Focusing on colorectal care delivery, encompassing the spectrum of common and complex care, exemplifies opportunities to optimize care delivery for rural populations. Here, we discuss the complex and unique interplay...
Source: Clinics in Colon and Rectal Surgery - April 25, 2024 Category: Surgery Authors: Schaefer, Sara L. Ibrahim, Andrew M. Tags: Review Article Source Type: research

Navigating the Surgical Pathway for Frail, Older Adults Undergoing Colorectal Surgery
Clin Colon Rectal Surg DOI: 10.1055/s-0044-1786392Adults ≥ 65 years of age comprise nearly 20% of the U.S. population and over half of surgical patients. Older adults, particularly when frail, may require additional preoperative evaluation and counseling, specialized hospital care, and may experience more noticeable physical and cognitive changes than younger or healthier patients. Surgeons can assess frailty and risk using several frailty measures, as data exist demonstrating worse perioperative outcomes among patients undergoing colorectal surgery. Prehabilitation programs have not been shown to improve surgical outcom...
Source: Clinics in Colon and Rectal Surgery - April 25, 2024 Category: Surgery Authors: Roo, Ana C. De Ivatury, Srinivas J. Tags: Review Article Source Type: research

Considerations for the Treatment of Sexual and Gender Minority Individuals in Colon and Rectal Surgery
Clin Colon Rectal Surg DOI: 10.1055/s-0044-1786375Sexual and gender minorities (SGMs) experience critical barriers to health care access and have unique health care needs that are often overlooked. Given the rise in individuals identifying as lesbian, gay, bisexual, transgender, and queer, colorectal surgeons are likely to care for increasing numbers of such individuals. Here, we discuss key barriers to health care access and research among SGM populations and outline approaches to address these barriers in clinical practice. We also highlight two specific topics relevant to SGM populations that colorectal surgeons should ...
Source: Clinics in Colon and Rectal Surgery - April 25, 2024 Category: Surgery Authors: Roblee, Cole V. Jacobson, Clare Lane, Megan Morrison, Shane D. Tags: Review Article Source Type: research

Preoperative Optimization of Crohn's Patients before Abdominopelvic Surgery
Clin Colon Rectal Surg DOI: 10.1055/s-0044-1786380In this article, we review and identify modifiable risk factors associated with postoperative complications of Crohn's disease. We highlight the importance of factors such as nutrition, corticosteroids, immunomodulators, abscesses, ideal timing of surgery, and biologic and small-molecule therapy on surgical outcomes. Herein, we discuss the strategies for attenuating these risk factors. Special consideration is given to venous thromboembolism prophylaxis in this patient population. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAA...
Source: Clinics in Colon and Rectal Surgery - April 25, 2024 Category: Surgery Authors: Moussally, Moustafa Paski, Shirley C. Cohen, Benjamin Holubar, Stefan D. Tags: Review Article Source Type: research

Challenges and Strategies in Colorectal Surgery among Patients with Morbid Obesity
Clin Colon Rectal Surg DOI: 10.1055/s-0044-1786391This chapter explores the interplay between morbid obesity and the challenges encountered in colorectal surgery. Understanding the unique considerations in preoperative and intraoperative management along with weight optimization tools such as bariatric surgery emerges as potential mitigators, demonstrating benefits in reducing colorectal cancer risk and improving perioperative outcomes. Furthermore, the pervasive stigma associated with morbid obesity further complicates patient care, emphasizing the need for empathetic and nuanced approaches. Recommendations for minimizing...
Source: Clinics in Colon and Rectal Surgery - April 25, 2024 Category: Surgery Authors: Dualeh, Shukri H.A. Howard, Ryan Tags: Review Article Source Type: research

Bowel Resection Margins in Crohn's Disease: Do They Matter?
Clin Colon Rectal Surg DOI: 10.1055/s-0044-1786376Many patients with Crohn's disease (CD) will ultimately require surgical intervention for refractory disease despite recognizing that surgery does not cure CD. The initial operation, primarily for ileocolic disease, is focused on resecting the offending pathology and ideally providing a reduced likelihood for subsequent operations and additional bowel loss through surgical techniques. The appropriate margin, macro- vs. microscopic, lays in balance to provide an adequate resection that minimizes bowel loss, compared to an extensive resection which ensures a thorough resectio...
Source: Clinics in Colon and Rectal Surgery - April 25, 2024 Category: Surgery Authors: Choi, Beatrix Cohen, David Schwartzberg, David M. Tags: Review Article Source Type: research

Updates in the Management of Crohn's Disease
Clin Colon Rectal Surg DOI: 10.1055/s-0044-1786382 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - April 25, 2024 Category: Surgery Authors: Khaitov, Sergey Tags: Preface Source Type: research

Sergey Khaitov, MD, FACS, FASCRS
Clin Colon Rectal Surg DOI: 10.1055/s-0044-1786533 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - April 25, 2024 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to Guest Editor Source Type: research

Nonfistulizing Perianal Crohn's Disease
Clin Colon Rectal Surg DOI: 10.1055/s-0044-1786198Perianal Crohn's disease (CD) includes a wide range of nonfistulizing sequela, including fissures and ulcers, skin tags, anal stricture, and anal cancer. Symptoms related to perianal manifestations of CD are often disabling and have a significant impact on patients' quality of life. They include pain, drainage, bleeding, difficulty with hygiene and may cause secondary difficulties with sexual and defecatory dysfunction. The care of patients with perianal CD requires a thoughtful approach, including detailed history taking, physical examination, and often multidisciplinary c...
Source: Clinics in Colon and Rectal Surgery - April 19, 2024 Category: Surgery Authors: Simon, Emily Steinhagen, Emily Tags: Review Article Source Type: research

Pasithorn A. Suwanabol, MD, MS, FACS, FASCRS
Clin Colon Rectal Surg DOI: 10.1055/s-0044-1786192 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - April 16, 2024 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to the Guest Editor Source Type: research

Management of Severe Colitis and Toxic Megacolon
Clin Colon Rectal Surg DOI: 10.1055/s-0043-1777665Severe colitis is a well-defined condition encompassing several etiologies but is most often caused by severe ulcerative colitis or Clostridioides difficile infection. Severe colitis can evolve into toxic colitis, or toxic megacolon when associated with bowel dilation and systemic manifestations, resulting in a life-threatening scenario where multidisciplinary management is often required. Medical management continues to play an important role in the initial treatment of toxic megacolon. However, timely surgical intervention can be lifesaving. [...] Thieme Medical Publisher...
Source: Clinics in Colon and Rectal Surgery - December 29, 2023 Category: Surgery Authors: Liggett, Marjorie R. Alam, Hasan B. Tags: Review Article Source Type: research

Large Bowel Obstruction: Etiologies, Diagnosis, and Management
Clin Colon Rectal Surg DOI: 10.1055/s-0043-1777452Large bowel obstructions (LBOs) often require urgent surgical intervention. Diagnosis relies on astute history and physical examination, as well as imaging with computed tomography (CT) scan for stable patients. Because of the high mortality associated with colonic perforation in patients with LBOs, decisive surgical decision-making is needed for optimal outcomes. This review seeks to provide an overview of the etiologies of LBO, diagnosis, and general management principles, as well as specific management for the most common etiologies, including colorectal cancer and stric...
Source: Clinics in Colon and Rectal Surgery - December 29, 2023 Category: Surgery Authors: Chen, Kevin A. Kapadia, Muneera R. Tags: Review Article Source Type: research

Colonic Volvulus
Clin Colon Rectal Surg DOI: 10.1055/s-0043-1777664Colonic volvulus represents 10 to 15% of all large bowel obstructions in the United States. It most commonly occurs in the sigmoid colon or cecum. Morbidity and mortality from colonic volvulus are high. It is therefore essential to have a high level of suspicion based on presentation and expedient diagnosis and management to prevent progression to ischemia or perforation. Broad goals of management include evaluation of colon viability, relief of obstruction, and prevention of recurrence. Endoscopic and surgical approaches vary based on the site of volvulus, presence of isch...
Source: Clinics in Colon and Rectal Surgery - December 28, 2023 Category: Surgery Authors: Savitch, Samantha L. Harbaugh, Calista M. Tags: Review Article Source Type: research

Management of Acute Hemorrhoidal Crisis: Evaluation, Treatment, and Special Considerations
Clin Colon Rectal Surg DOI: 10.1055/s-0043-1777663Hemorrhoidal disease is one of most common pathologies seen by colorectal and general surgeons. Although hemorrhoids themselves are a normal anatomic occurrence, development of symptomatic disease, usually due to bleeding, prolapse, or thrombosis, can cause significant patient distress. Acute presentation related to significant thrombosis or bleeding is referred to as acute hemorrhoidal crisis. Management of this pathology varies from nonoperative intervention for symptom control to definitive incisional or excisional hemorrhoidectomy. Here we will explore the approach to e...
Source: Clinics in Colon and Rectal Surgery - December 28, 2023 Category: Surgery Authors: Khan, Ayman Kanters, Arielle E. Tags: Review Article Source Type: research

Evaluation and Management of Traumatic Rectal Injury
This article reviews the literature regarding the evaluation and management of traumatic rectal injuries. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - December 21, 2023 Category: Surgery Authors: Clark, Nina M. Maine, Rebecca G. Tags: Review Article Source Type: research