The Development of the Mesenteric Model of Abdominal Anatomy
Clin Colon Rectal Surg DOI: 10.1055/s-0042-1743585Recent advances in mesenteric anatomy have clarified the shape of the mesentery in adulthood. A key finding is the recognition of mesenteric continuity, which extends from the oesophagogastric junction to the mesorectal level. All abdominal digestive organs develop within, or on, the mesentery and in adulthood remain directly connected to the mesentery. Identification of mesenteric continuity has enabled division of the abdomen into two separate compartments. These are the mesenteric domain (upon which the abdominal digestive system is centered) and the non-mesenteric domai...
Source: Clinics in Colon and Rectal Surgery - April 19, 2022 Category: Surgery Authors: Byrnes, Kevin Gerard Cullivan, Orla Walsh, Dara Coffey, John Calvin Tags: Review Article Source Type: research

Intriguing Role of the Mesentery in Ileocolic Crohn's Disease
Clin Colon Rectal Surg DOI: 10.1055/s-0042-1743590Crohn's disease (CD) is a chronic relapsing inflammatory bowel disease with unknown etiology. Up to 80% of patients will eventually require surgery throughout their lifetime, and often repeated resections are required for disease recurrence. Observations of “creeping fat” surrounding the diseased intestine renewed interest in the mesentery, recently defined as an organ with endocrine and immune functions. According to the inside-out model, the mesentery may be primarily affected in CD and subsequent cause alterations in the mucosa. Recently, lower surgical recurrence ra...
Source: Clinics in Colon and Rectal Surgery - April 13, 2022 Category: Surgery Authors: Turri, Giulia Carvello, Michele Ben David, Nadav Spinelli, Antonino Tags: Review Article Source Type: research

Operating on the Mesentery in Robotic Colonic Surgery —General Techniques
Clin Colon Rectal Surg DOI: 10.1055/s-0042-1743586During colorectal surgery the mesentery is the organ on which the greatest amount of operating time is focused. It has recently gained increasing attention. This technical review focuses on the mesentery during robotic colonic procedures. Specifically, we focus upon how to access, dissect, and divide the mesentery using the robotic platform. We also touch on the management of bleeding and some specific disease etiologies. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Abstra...
Source: Clinics in Colon and Rectal Surgery - April 13, 2022 Category: Surgery Authors: Coulter, Jonathan Peirce, Colin Tags: Review Article Source Type: research

Anatomy of the Mesentery
Clin Colon Rectal Surg DOI: 10.1055/s-0042-1743587It is clear that despite the importance of multimodal therapy, the most impactful weapon in the arsenal of treatment in a patient with colorectal cancer is high-quality surgery. This has been shown time and time again and surgery remains the bedrock in the management of visceral, and particularly colorectal, cancer. The reason for this is an anatomical one, based upon embryological planes. One cannot truly understand and perform high-quality surgery without an appreciation of the fascial and mesenteric anatomy of the abdomen and pelvis.R. J. (“Bill”) Heald greatly advan...
Source: Clinics in Colon and Rectal Surgery - April 13, 2022 Category: Surgery Authors: Bunni, John Tags: Review Article Source Type: research

Professor J. Calvin Coffey, BSc, MB, PhD, FRCS
Clin Colon Rectal Surg DOI: 10.1055/s-0042-1743427 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 13, 2022 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to the Guest Editor Source Type: research

The Mesentery - Past, Present and Future
Clin Colon Rectal Surg DOI: 10.1055/s-0042-1743428 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 - March 8, 2022 Category: Surgery Authors: Coffey, John Calvin Tags: Preface Source Type: research

Management of Perineal Wounds Following Pelvic Surgery
This article details the methods of optimizing patient and operative factors to mitigate this risk, alongside strategies to deal with sequelae of wound failure. [...] 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 - March 7, 2022 Category: Surgery Authors: Mori, George A. Tiernan, Jim P. Tags: Review Article Source Type: research

Dealing with Complications of Colorectal Surgery Using the Transanal Approach —When and How?
Clin Colon Rectal Surg 2022; 35: 155-164 DOI: 10.1055/s-0041-1742117The transanal approach is a new and exciting addition to the surgeons' repertoire to deal with complications after colorectal surgery. Improved exposure, accessibility, and visibility greatly facilitate adequate dissection of the affected area with potential increase in effectiveness and reduced morbidity. An essential component in salvaging anastomotic leaks of low colorectal, coloanal, or ileoanal anastomoses is early diagnosis and early treatment, especially when starting with endoscopic vacuum therapy, followed by early surgical closure (endoscopic vac...
Source: Clinics in Colon and Rectal Surgery - February 28, 2022 Category: Surgery Authors: Talboom, K. Tanis, P. J. Bemelman, W. A. Hompes, R. Tags: Review Article Source Type: research

Functional Outcomes after Transanal Surgery
This article provides an overview of the different techniques currently available for the minimally invasive transanal treatment of rectal lesions, particularly focusing on functional outcomes. [...] 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 - February 28, 2022 Category: Surgery Authors: Foppa, Caterina Carrano, Francesco Maria Spinelli, Antonino Tags: Review Article Source Type: research

Limitations and Concerns with Transanal Total Mesorectal Excision for Rectal Cancer
Clin Colon Rectal Surg 2022; 35: 141-145 DOI: 10.1055/s-0041-1742115Transanal total mesorectal excision (TaTME) was developed to overcome the technical challenges of a minimally invasive (ultra-) low anterior resection. This new technique has recently come under careful scrutiny as technical pitfalls were reported, in specific relation to the transanal approach. Patients are at risk for urologic lesions. Moreover, carbon dioxide embolism is a rare but potentially life-threatening complication. The benefit of TaTME from an oncological point of view has neither been clarified. Hypothetically, better visualization of the lowe...
Source: Clinics in Colon and Rectal Surgery - February 28, 2022 Category: Surgery Authors: Vannijvel, M. Wolthuis, Albert M. Tags: Review Article Source Type: research

Indications and Surgical Technique for Transanal Proctectomy and Ileal Pouch –Anal Anastomosis for Inflammatory Bowel Disease
Clin Colon Rectal Surg 2022; 35: 135-140 DOI: 10.1055/s-0041-1742114Surgical management of inflammatory bowel disease has advanced significantly over the years. One particular focus of its evolution has been to minimize invasiveness. Transanal surgery has given the contemporary surgeon an alternate approach to access the low rectum situated in the confines of the deep pelvis. In benign disease, combining transanal surgery with laparoscopy has allowed for the development of novel techniques to create ileal pouch–anal anastomoses, perform intersphincteric Crohn's proctectomies, manage complications from pelvic surgery, and...
Source: Clinics in Colon and Rectal Surgery - February 28, 2022 Category: Surgery Authors: Yuen, Andrew Brar, Mantaj S. de Buck van Overstraeten, Anthony Tags: Review Article Source Type: research

Complex Procedures in Transanal Endoscopic Microsurgery: Intraperitoneal Entry, Ultra Large Rectal Tumors, High Lesions, and Resection in the Anal Canal
This article summarizes complex procedures in TEM. [...] 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 - February 28, 2022 Category: Surgery Authors: Serra-Aracil, Xavier Lucas-Guerrero, Victoria Mora-L ópez, Laura Tags: Review Article Source Type: research

Transanal Local Excision of Rectal Cancer after Neoadjuvant Chemoradiation: Is There a Place for It or Should Be Avoided at All Costs?
Clin Colon Rectal Surg 2022; 35: 122-128 DOI: 10.1055/s-0041-1742112Tumor response to neoadjuvant chemoradiation (nCRT) with tumor downsizing and downstaging has significantly impacted the number of patients considered to be appropriate candidates for transanal local excision (TLE). Some patients may harbor small residual lesions, restricted to the bowel wall. These patients, who exhibit major response (“near-complete”) by digital rectal examination, endoscopic assessment, and radiological assessment may be considered for this approach. Although TLE is associated with minimal postoperative morbidity, a few clinical con...
Source: Clinics in Colon and Rectal Surgery - February 28, 2022 Category: Surgery Authors: Perez, Rodrigo Oliva Juli ão, Guilherme Pagin São Vailati, Bruna Borba Tags: Review Article Source Type: research

The Role of Transanal Endoscopic Surgery for Early Rectal Cancer
Clin Colon Rectal Surg 2022; 35: 113-121 DOI: 10.1055/s-0041-1742111Transanal endoscopic surgery (TES), which is performed through a variety of transanal endoluminal multitasking surgical platforms, was developed to facilitate endoscopic en bloc excision of rectal lesions as a minimally invasive alternative to radical proctectomy. Although the oncologic safety of TES in the treatment of malignant rectal tumors has been an area of vigorous controversy over the past two decades, TES is currently accepted as an oncologically safe approach for the treatment of carefully selected early and superficial rectal cancers. TES can al...
Source: Clinics in Colon and Rectal Surgery - February 28, 2022 Category: Surgery Authors: Berger, Natalie F. Sylla, Patricia Tags: Review Article Source Type: research

Transanal Local Excision or Endoscopic Dissection for Benign and Large Lesions of the Rectum
Clin Colon Rectal Surg 2022; 35: 106-112 DOI: 10.1055/s-0042-1744356Since the introduction of transanal endoscopic microsurgery, local excision of “early” rectal lesions has offered the possibility to reduce the invasiveness of treatment for the limited disease. Flexible endoscopy techniques allow today different alternatives consisting of endoscopic mucosal resection or endoscopic submucosal dissection. The first is a straightforward and relatively easy technique, but it prevents a correct pathological staging of the lesion due to fragmentation and the verification of disease-free margins. The second relies on operato...
Source: Clinics in Colon and Rectal Surgery - February 28, 2022 Category: Surgery Authors: Morino, Mario Arezzo, Alberto Tags: Review Article Source Type: research