Colorectal Surgery in Critically Unwell Patients: A Multidisciplinary Approach
Clin Colon Rectal Surg DOI: 10.1055/s-0041-1740045A proportion of patients require critical care support following elective or urgent colorectal procedures. Similarly, critically ill patients in intensive care units may also need colorectal surgery on occasions. This patient population is increasing in some jurisdictions given an aging population and increasing societal expectations. As such, this population often includes elderly, frail patients or patients with significant comorbidities. Careful stratification of operative risks including the need for prolonged intensive care support should be part of the consenting proc...
Source: Clinics in Colon and Rectal Surgery - February 9, 2022 Category: Surgery Authors: Subramaniam, Ashwin Wengritzky, Robert Skinner, Stewart Shekar, Kiran Tags: Review Article Source Type: research

Necrotizing Soft Tissue Infections of the Perineum
Clin Colon Rectal Surg DOI: 10.1055/s-0041-1740102Necrotizing soft tissue infections of the perineum are rapidly progressing infections associated with significant morbidity and mortality. Prompt diagnosis and management with early surgical debridement is necessary to improve survival from this deadly disease. Repeat debridements are not uncommon. Important adjuncts to surgery include broad-spectrum antibiotics and management in an intensive care unit, as patients frequently develop multisystem organ failure. Once the acute phase is managed, fecal diversion with either an ostomy or fecal management catheter can be consider...
Source: Clinics in Colon and Rectal Surgery - February 9, 2022 Category: Surgery Authors: Kline, Bryan P. Jeganathan, Nimalan A. Tags: Review Article Source Type: research

Hernia and Abdominal Wall Reconstruction for the Colorectal Surgeon
Clin Colon Rectal Surg DOI: 10.1055/s-0041-1740040Hernia remains a challenge for the colorectal surgeon both in regard to prevention of hernia, that is a common entity following colorectal surgery and in managing hernia which is often made more challenging by the co-existence of a significant colorectal-specific problem. This review outlines the extent of hernia as a problem for the colorectal surgeon and highlights contemporary approaches to dealing with patients who require both colorectal and complex hernia surgery. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in T...
Source: Clinics in Colon and Rectal Surgery - February 9, 2022 Category: Surgery Authors: Buxey, Kenneth Tags: Review Article Source Type: research

Therapeutic Endoscopy in Postoperative Pouch Complications
Clin Colon Rectal Surg 2022; 35: 078-088 DOI: 10.1055/s-0041-1740032Ileal pouch-anal anastomosis (IPAA) or “J”-pouch as it is commonly referred to, is the treatment of choice in patients with medically refractory ulcerative colitis. IPAA can have infectious, inflammatory, and mechanical complications. Currently, there are no Food and Drug Administration-approved medical therapies for these complications. Surgery that may be eventually required can have significant morbidities due to the complexity of IPAA. Endoscopy is fast emerging as a leading modality of treatment for some of these pouch complications. Endoscopy in ...
Source: Clinics in Colon and Rectal Surgery - January 17, 2022 Category: Surgery Authors: Chandan, Saurabh Shen, Bo Kochhar, Gursimran S. Tags: Review Article Source Type: research

Surgery versus Medical Therapy in Luminal Ileocecal Crohn's Disease
Clin Colon Rectal Surg 2022; 35: 072-077 DOI: 10.1055/s-0041-1740031The deeper understanding of the inflammatory process which gradually evolves into irreversible fibrosis and tissue damage has provided a precise picture of the disease course of luminal ileocecal Crohn's disease. According to the model of progressive structural damage, ideal time windows for medical and surgical treatment have been identified. While complicated disease clearly profits from surgical treatment, uncomplicated disease has become, in the last years, the most debatable setting in terms of different approaches including early surgery. On one hand...
Source: Clinics in Colon and Rectal Surgery - January 17, 2022 Category: Surgery Authors: Carvello, Michele Danese, Silvio Spinelli, Antonino Tags: Review Article Source Type: research

Acute Severe Colitis: The Need for Joint Management between Gastroenterologists and Surgeons
Clin Colon Rectal Surg 2022; 35: 066-071 DOI: 10.1055/s-0041-1740030The management of hospitalized patients with acute, severe ulcerative colitis involves close coordination among a multidisciplinary team. For patients not improving on intravenous corticosteroids, surgical consultation should be sought. The remaining hospital course requires frequent communications between the gastroenterologist managing the medical aspects of care, and the colorectal surgeon involved in planning for potential surgery, to optimize patient outcomes. This comanagement includes joint decision-making around the timing of surgery, minimizing me...
Source: Clinics in Colon and Rectal Surgery - January 17, 2022 Category: Surgery Authors: Fleshner, Phillip Melmed, Gil Y. Tags: Review Article Source Type: research

Staging Pouch Surgery in Ulcerative Colitis in the Biological Era
Clin Colon Rectal Surg 2022; 35: 058-065 DOI: 10.1055/s-0041-1740039Restorative proctocolectomy, or ileal pouch anal anastomosis, is considered the standard treatment for intractable ulcerative colitis. When the pelvic pouch was first introduced in 1978, a two-stage procedure with proctocolectomy, construction of the pelvic pouch, and a diverting loop with subsequent closure were suggested. Over the decades that the pelvic pouch has been around, some principal technical issues have been addressed to improve the method. In more recent days the laparoscopic approach has been additionally introduced. During the same time-peri...
Source: Clinics in Colon and Rectal Surgery - January 17, 2022 Category: Surgery Authors: Risto, Anton Abdalla, Maie Myrelid, P är Tags: Review Article Source Type: research

A Multi-Disciplinary Approach to Perianal Fistulizing Crohn's Disease
Clin Colon Rectal Surg 2022; 35: 051-057 DOI: 10.1055/s-0041-1740038Perianal fistulizing Crohn's disease represents a severe phenotype associated with significant morbidity. Patients with perianal fistulizing disease are more likely to have a severe disease course and have significant reductions in quality of life. Moreover, these patients are at risk for the development of distal rectal and anal cancers. Given the complexity and severity of this patient group, the management of perianal Crohn's disease must be undertaken by a multidisciplinary team. The gastroenterologist and colorectal surgeon play a critical role in the...
Source: Clinics in Colon and Rectal Surgery - January 17, 2022 Category: Surgery Authors: Wiseman, Jacob Chawla, Tanya Morin, Frederic de Buck van Overstraeten, Anthony Weizman, Adam V. Tags: Review Article Source Type: research

Anorectal Strictures in Complex Perianal CD: How to Approach?
Clin Colon Rectal Surg 2022; 35: 044-050 DOI: 10.1055/s-0041-1740037Anorectal strictures are a notoriously difficult to treat phenotype of perianal Crohn's disease. Quality of life is diminished due to ongoing pain, incontinence, difficulty with stool evacuation, and recurrent medical and surgical treatments. Medical therapy is aimed at treating luminal disease and mucosal ulceration to prevent worsening of fibrosis. Clinical examination and endoscopic intervention can be used for serial dilations of strictures. Unfortunately, despite optimal medical therapy and endoscopic intervention with serial anal dilations, surgery w...
Source: Clinics in Colon and Rectal Surgery - January 17, 2022 Category: Surgery Authors: Lightner, Amy L. Regueiro, Miguel Tags: Review Article Source Type: research

Medical Therapy in Chronic Refractory Ulcerative Colitis: When Enough Is Enough
Clin Colon Rectal Surg 2022; 35: 032-043 DOI: 10.1055/s-0041-1740036Despite significant improvements in the management of ulcerative colitis (UC) in parallel with the evolution of therapeutic targets and novel biologics and small molecules, a subset of medically refractory patients still requires colectomy. Recent population-based studies demonstrate a trend toward a decrease in the rates of surgery for UC patients in the biological era, although the potential of disease modification with these agents is still debated. As the concept of irreversible bowel damage is underexplored in UC, refractory patients can be exposed to...
Source: Clinics in Colon and Rectal Surgery - January 17, 2022 Category: Surgery Authors: Dami ão, Aderson Omar Mourão Cintra Queiroz, Nat ália Sousa Freitas Tags: Review Article Source Type: research

The Essential Role of a Multidisciplinary Approach in Inflammatory Bowel Diseases: Combined Medical-Surgical Treatment in Complex Perianal Fistulas in CD
Clin Colon Rectal Surg 2022; 35: 021-031 DOI: 10.1055/s-0041-1740035Perianal fistulizing Crohn's disease (PFCD) represents a challenging and complex disease phenotype. Patients typically suffer a more severe disease course than those without perianal complications and are often managing debilitating symptoms. Etiology is understood to be multifactorial, with genetic predisposition, microbiological insult, aberrant immunity, and mechanical factors all implicated. As a result, multimodal treatment strategies must be employed to achieve disease control and fistula closure. This requires the complimentary involvement of medica...
Source: Clinics in Colon and Rectal Surgery - January 17, 2022 Category: Surgery Authors: Geldof, Jeroen Iqbal, Nusrat Warusavitarne, Janindra Hart, Ailsa Tags: Review Article Source Type: research

Rectovaginal Fistula in Crohn's Disease: When and How to Operate?
The objective of surgical repair is to close the fistula tract with minimal recurrence and functional disturbance. Several therapeutic strategies exist and the approach should be tailored to the anatomy of the RVF and the quality of the local supporting tissues. Herein, we review the medical and surgical management of CD-related RVF. [...] 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 - January 17, 2022 Category: Surgery Authors: Meyer, Jeremy Ris, Fr édéric Parkes, Miles Davies, Justin Tags: Review Article Source Type: research

Fecal Diversion in Complex Perianal Fistulizing Crohn's Disease
Clin Colon Rectal Surg 2022; 35: 005-009 DOI: 10.1055/s-0041-1740028Complex perianal Crohn's disease (CD) remains a challenging problem. Fecal stream is thought to be a trigger of disease progression in patients with CD. In patients with refractory perianal CD, diversion of fecal stream is sometimes required to alleviate clinical symptoms when medical and local surgical management are unsuccessful. Several studies evaluated the outcomes of fecal diversion for complex perianal CD. After fecal diversion, the majority of patients achieved early clinical response, but the prospect of restoring bowel continuity was low (approxi...
Source: Clinics in Colon and Rectal Surgery - January 17, 2022 Category: Surgery Authors: Yamamoto, Takayuki Shimoyama, Takahiro Tags: Review Article Source Type: research

The Essential Role of a Multidisciplinary Approach in Inflammatory Bowel Diseases
Clin Colon Rectal Surg 2022; 35: 003-004 DOI: 10.1055/s-0041-1740034 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 - January 17, 2022 Category: Surgery Authors: Kotze, Paulo Gustavo Tags: Preface Source Type: research

Paulo Gustavo Kotze, MD, MSc, PhD
Clin Colon Rectal Surg 2022; 35: 001-002 DOI: 10.1055/s-0041-1740033 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 - January 17, 2022 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to the Guest Editor Source Type: research