Hamartomatous Polyps and Associated Syndromes
Clinics in Colon and Rectal Surgery 2016; 29: 330-335 DOI: 10.1055/s-0036-1582441Hamartomatous polyps of the gastrointestinal tract can occur sporadically, however, for several hereditary syndromes, their presence is one of the major clinical features. Peutz–Jeghers syndrome, juvenile polyposis syndrome, and the PTEN hamartoma syndromes are autosomal dominant inherited disorders that predispose to formation of such polyps, especially in the colon and rectum. These can lead to increased colorectal cancer risk and should be followed and managed appropriately. In this article, the three major hereditary hamartomatous sy...
Source: Clinics in Colon and Rectal Surgery - November 21, 2016 Category: Surgery Authors: Cone, Molly M. Tags: Review Article Source Type: research

Adenomatous Polyposis Syndromes: Diagnosis and Management
Clinics in Colon and Rectal Surgery 2016; 29: 321-329 DOI: 10.1055/s-0036-1584089Familial adenomatous polyposis (FAP) syndromes make up fewer than 1% of patients diagnosed with colorectal cancer each year. Patients with familial polyposis syndromes including FAP, attenuated FAP, and MYH-associated polyposis (MAP), are an important group often cared for by colorectal surgeons. Registry and screening programs have been shown to improve survival in patients with adenomatous polyposis, as it allows patients to undergo surgical intervention prior to the development of colorectal cancer. There are several surgical options for th...
Source: Clinics in Colon and Rectal Surgery - November 21, 2016 Category: Surgery Authors: Mitchem, Jonathan B. Hall, Jason F. Tags: Review Article Source Type: research

Management of Rectal Polyps
Clinics in Colon and Rectal Surgery 2016; 29: 315-320 DOI: 10.1055/s-0036-1582438Colorectal cancer is one of the most common causes of cancer and cancer morbidity in the United States. In comparison to colon polyps, rectal polyps pose a unique challenge. Advances in endoscopic techniques have allowed for more thorough rectal adenoma detection and removal; however, there remains a concern over piecemeal resection and negative resection margins. Advances in transanal excision techniques, such as transanal endoscopic microsurgery, have been proposed for the removal of benign polyps as well as some early stage rectal cancers, ...
Source: Clinics in Colon and Rectal Surgery - November 21, 2016 Category: Surgery Authors: Cowan, Michelle L. Silviera, Matthew L. Tags: Review Article Source Type: research

Colonic Polyps: Treatment
This article focuses on these modalities with contemporary recommendations for choice of modality based on the size and features of the polyp encountered upon endoscopy. In addition, the morphologically apparent risk factors for polyps harboring invasive malignancy are discussed along with implications for management. Current literature on the comparative risks and benefits of EMR, ESD, CELS, and surgical resection is reviewed, as well as recommendations regarding cancer risk and subsequent surveillance. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of conten...
Source: Clinics in Colon and Rectal Surgery - November 21, 2016 Category: Surgery Authors: Huang, Emily Sarin, Ankit Tags: Review Article Source Type: research

Colonic Polyps: Diagnosis and Surveillance
Clinics in Colon and Rectal Surgery 2016; 29: 296-305 DOI: 10.1055/s-0036-1584091Colorectal cancer begins as a polyp that is a benign growth on the mucosal surface of the colon or rectum. Over a period of 5 to 15 years, polyps can degenerate into a cancer, thus invading the colonic wall. Colorectal screening methods are designed to diagnose and remove polyps before they acquire invasive potential and develop into cancer. Screening for colorectal cancer can prevent and reduce mortality. Given the benefits and effectiveness of screening, guidelines exist from multiple organizations. These guidelines risk-stratify patients to...
Source: Clinics in Colon and Rectal Surgery - November 21, 2016 Category: Surgery Authors: Huck, Michael B. Bohl, Jaime L. Tags: Review Article Source Type: research

Polyp Genetics
Clinics in Colon and Rectal Surgery 2016; 29: 289-295 DOI: 10.1055/s-0036-1582442The genetic events involved in the transformation of normal colonic epithelium to neoplastic polyps to invasive carcinoma, as initially proposed by Fearon and Vogelstein, form the foundation of our understanding of colorectal cancer. The identification of the polyp as the precursor lesion to colorectal cancer is the basis of many of our current practices for screening, surveillance, and prevention. The last three decades have seen a veritable explosion in our understanding of the molecular events involved in the pathogenesis of colorectal canc...
Source: Clinics in Colon and Rectal Surgery - November 21, 2016 Category: Surgery Authors: Klos, Coen Laurens Dharmarajan, Sekhar Tags: Review Article Source Type: research

Colorectal Polyps and Polyposis Syndromes
Clinics in Colon and Rectal Surgery 2016; 29: 287-288 DOI: 10.1055/s-0036-1582439 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 - November 21, 2016 Category: Surgery Authors: Wise, Paul E. Tags: Preface Source Type: research

Paul E. Wise, MD, FACS, FASCRS
Clinics in Colon and Rectal Surgery 2016; 29: 285-286 DOI: 10.1055/s-0036-1582440 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 - November 21, 2016 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to Guest Editor Source Type: research

Parastomal Hernia: Avoidance and Treatment in the 21st Century
Clinics in Colon and Rectal Surgery 2016; 29: 277-284 DOI: 10.1055/s-0036-1584506Despite medical and surgical advances leading to increased ability to restore or preserve gastrointestinal continuity, creation of stomas remains a common surgical procedure. Every ostomy results in a risk for subsequent parastomal herniation, which in turn may reduce quality of life and increase health care expenditures. Recent evidence-supported practices such as utilization of prophylactic reinforcement, attention to stoma placement, and laparoscopic-based stoma repairs with mesh provide opportunities to both prevent and successfully treat ...
Source: Clinics in Colon and Rectal Surgery - August 19, 2016 Category: Surgery Authors: Glasgow, Sean C. Dharmarajan, Sekhar Tags: Original Article Source Type: research

Optimizing Treatment for Rectal Prolapse
Clinics in Colon and Rectal Surgery 2016; 29: 271-276 DOI: 10.1055/s-0036-1584505Rectal prolapse is associated with debilitating symptoms and leads to both functional impairment and anatomic distortion. Symptoms include rectal bulge, mucous drainage, bleeding, incontinence, constipation, tenesmus, as well as discomfort, pressure, and pain. The only cure is surgical. The optimal surgical repair is not yet defined though laparoscopic rectopexy with mesh is emerging as a more durable approach. The chosen approach should be individually tailored, taking into account factors such as presence of pelvic floor defects and coexiste...
Source: Clinics in Colon and Rectal Surgery - August 19, 2016 Category: Surgery Authors: Hrabe, Jennifer Gurland, Brooke Tags: Original Article Source Type: research

Fecal Incontinence: Epidemiology, Impact, and Treatment
Clinics in Colon and Rectal Surgery 2016; 29: 264-270 DOI: 10.1055/s-0036-1584504Fecal incontinence (FI) is a chronic and debilitating condition that carries a significant health, economic, and social burden. FI has a considerable psychosocial and financial impact on patients and their families. A variety of treatment modalities are available for FI including behavioral and dietary modifications, pharmacotherapy, pelvic floor physical therapy, bulking agents, anal sphincteroplasty, sacral nerve stimulation, artificial sphincters, magnetic sphincters, posterior anal sling, and colostomy. [...] Thieme Medical Publishers 333 ...
Source: Clinics in Colon and Rectal Surgery - August 19, 2016 Category: Surgery Authors: Bochenska, Katarzyna Boller, Anne-Marie Tags: Original Article Source Type: research

Epidemiologic Analysis of Diverticulitis
Clinics in Colon and Rectal Surgery 2016; 29: 258-263 DOI: 10.1055/s-0036-1584503The aim of this article is to evaluate geographic variation in the incidence of diverticulitis and examine behavioral and environmental factors associated with high rates of diverticulitis across the United States. We used state hospital discharge data from 20 states to determine rates of inpatient diverticulitis from January 2002 to December 2004 at patient's county of residence. Next, we merged the county level data with behavioral and environmental survey data from the Behavioral Risk Factor Surveillance System (BRFSS). Finally, we determin...
Source: Clinics in Colon and Rectal Surgery - August 19, 2016 Category: Surgery Authors: Jena, Marie D. Marcello, Peter W. Roberts, Patricia L. Read, Thomas E. Schoetz, David J. Hall, Jason F. Francone, Todd Ricciardi, Rocco Tags: Original Article Source Type: research

Gut Microbiota and Colorectal Surgery: Impact on Postoperative Complications
Clinics in Colon and Rectal Surgery 2016; 29: 253-257 DOI: 10.1055/s-0036-1584502Colorectal anastomotic leakage is a dreaded complication after colorectal surgery and causes high morbidity and mortality. The pathophysiology of anastomotic healing remains unclear despite numerous studies. In this article, our aim is to provide different perspectives on what is known about the role of the gastrointestinal tract microbiome and its relation to anastomotic integrity. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract &n...
Source: Clinics in Colon and Rectal Surgery - August 19, 2016 Category: Surgery Authors: Russ, Andrew J. Casillas, Mark A. Tags: Review Article Source Type: research

Postoperative Complications: Looking Forward to a Safer Future
Clinics in Colon and Rectal Surgery 2016; 29: 246-252 DOI: 10.1055/s-0036-1584501Colorectal surgery patients frequently suffer from postoperative complications. Patients with complications have been shown to be at higher risk for mortality, poor oncologic outcomes, additional complications, and worse quality of life. Complications are increasingly recognized as markers of quality of care with more use of risk-adjusted national surgical databases and increasing transparency in health care. Quality improvement work in colorectal surgery has identified methods to decrease complication rates and improve outcomes in this patien...
Source: Clinics in Colon and Rectal Surgery - August 19, 2016 Category: Surgery Authors: Tevis, Sarah E. Kennedy, Gregory D. Tags: Review Article Source Type: research

Low Anterior Resection Syndrome: Current Management and Future Directions
Clinics in Colon and Rectal Surgery 2016; 29: 239-245 DOI: 10.1055/s-0036-1584500Outcomes for rectal cancer surgery have improved significantly over the past 20 years with increasing rates of survival and recurrence, specifically local recurrence. These gains have been realized during a period of time in which there has been an increasing emphasis on sphincter preservation. As we have become increasingly aggressive in avoiding resection of the anus, we have begun accepting bowel dysfunction as a normal outcome. Low anterior resection syndrome, defined as a constellation of symptoms including incontinence, frequency, urgenc...
Source: Clinics in Colon and Rectal Surgery - August 19, 2016 Category: Surgery Authors: Ridolfi, Timothy J. Berger, Nicholas Ludwig, Kirk A. Tags: Review Article Source Type: research

The Multidisciplinary Management of Colorectal Cancer: Present and Future Paradigms
Clinics in Colon and Rectal Surgery 2016; 29: 232-238 DOI: 10.1055/s-0036-1584292As treatment strategies for patients with colorectal cancer advance, there has now become an ever-increasing need for multidisciplinary teams to care for these patients. Recent investigations into the timing and duration of perioperative therapy, as well as, the rise of molecular profiling have led to more systemic chemotherapeutic options. The most efficacious use, in terms of timing and patient selection, of these therapies in the setting of modern operative and radiotherapy techniques requires the generation of care teams discussing cases a...
Source: Clinics in Colon and Rectal Surgery - August 19, 2016 Category: Surgery Authors: Sievers, Chelsie K. Kratz, Jeremy D. Zurbriggen, Luke D. LoConte, Noelle K. Lubner, Sam J. Uboha, Natalya Mulkerin, Daniel Matkowskyj, Kristina A. Deming, Dustin A. Tags: Review Article Source Type: research

Future of Minimally Invasive Colorectal Surgery
This article will give an overview of the state of minimally invasive surgery and the many advances that have been made over the last two decades. Specifically, we discuss the introduction of the robotic platform and some of its benefits and limitations. We also describe some newer techniques related to robotics. [...] 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 19, 2016 Category: Surgery Authors: Whealon, Matthew Vinci, Alessio Pigazzi, Alessio Tags: Review Article Source Type: research

Endoluminal Therapy in Colorectal Cancer
This article will discuss these principle endoscopic techniques, their outcomes, and briefly highlight their influence on endoscopic interventions, including transanal endoscopic microsurgery and natural orifice transluminal endoscopic surgery. [...] 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 19, 2016 Category: Surgery Authors: Kelley, Katherine A. Tsikitis, V. Liana Tags: Review Article Source Type: research

Beyond Histologic Staging: Emerging Imaging Strategies in Colorectal Cancer with Special Focus on Magnetic Resonance Imaging
Clinics in Colon and Rectal Surgery 2016; 29: 205-215 DOI: 10.1055/s-0036-1584288Imaging plays an increasingly important role in the staging and management of colorectal cancer. In recent years, magnetic resonance imaging (MRI) has supplanted transrectal ultrasound as the preferred modality for the locoregional staging of rectal cancer. Furthermore, the advent of both diffusion-weighted imaging and hepatobiliary contrast agents has significantly enhanced the ability of MRI to detect colorectal liver metastases. In clinical practice, MRI routinely provides prognostic information, helps to guide surgical strategy, and determ...
Source: Clinics in Colon and Rectal Surgery - August 19, 2016 Category: Surgery Authors: Fraum, Tyler J. Owen, Joseph W. Fowler, Kathryn J. Tags: Review Article Source Type: research

Advances in Biomarkers: Going Beyond the Carcinoembryonic Antigen
Clinics in Colon and Rectal Surgery 2016; 29: 196-204 DOI: 10.1055/s-0036-1584289Using biologically available markers to guide treatment decisions in colorectal cancer care is becoming increasingly common, though our understanding of these biomarkers is in its infancy. In this article, we will discuss how this area is rapidly changing, review important biomarkers being used currently, and explain how the results influence clinical decision-making. We will also briefly discuss the possibility of a liquid biopsy and explore several exciting and new options. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 100...
Source: Clinics in Colon and Rectal Surgery - August 17, 2016 Category: Surgery Authors: Lopez, Nicole E. Peterson, Carrie Y. Tags: Review Article Source Type: research

Familial Colorectal Cancer: Understanding the Alphabet Soup
Clinics in Colon and Rectal Surgery 2016; 29: 185-195 DOI: 10.1055/s-0036-1584290While most colorectal cancers (CRCs) originate from nonhereditary spontaneous mutations, one-third of cases are familial or hereditary. Hereditary CRCs, which account for 
Source: Clinics in Colon and Rectal Surgery - August 17, 2016 Category: Surgery Authors: Giglia, Matthew D. Chu, Daniel I. Tags: Review Article Source Type: research

Hot Topics in Colorectal Surgery
Clinics in Colon and Rectal Surgery 2016; 29: 183-184 DOI: 10.1055/s-0036-1584291 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 17, 2016 Category: Surgery Authors: Kennedy, Gregory D. Tags: Preface Source Type: research

Gregory D. Kennedy, MD, PhD
Clinics in Colon and Rectal Surgery 2016; 29: 181-182 DOI: 10.1055/s-0036-1584286 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 17, 2016 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to Guest Editor Source Type: research

Role of Minimally Invasive Surgery in the Reoperative Abdomen or Pelvis
Clinics in Colon and Rectal Surgery 2016; 29: 168-180DOI: 10.1055/s-0036-1580637Laparoscopy has become widely accepted as the preferred surgical approach in the management of benign and malignant colorectal diseases. Once considered a relative contraindication in patients with prior abdominal surgery (PAS), as surgeons have continued to gain expertise in advanced laparoscopy, minimally invasive approaches have been increasingly incorporated in the reoperative abdomen and pelvis. Although earlier studies have described conversion rates, most contemporary series evaluating the impact of PAS in laparoscopic colorectal resecti...
Source: Clinics in Colon and Rectal Surgery - May 26, 2016 Category: Surgery Authors: Feigel, AmandaSylla, Patricia Source Type: research

Management of the Perineal Defect after Abdominoperineal Excision
Clinics in Colon and Rectal Surgery 2016; 29: 160-167DOI: 10.1055/s-0036-1580627The optimal management of the perineal defect following abdominoperineal excision for anorectal malignancy remains a source of debate. The repopularization of extralevator resection means colorectal surgeons are confronted with larger perineal wounds. There are several surgical options available—primary perineal closure and drainage, omentoplasty, biological or synthetic mesh placement, musculocutaneous flap repair, and negative wound pressure therapy. These options are discussed along with the potential benefits and complications of each...
Source: Clinics in Colon and Rectal Surgery - May 26, 2016 Category: Surgery Authors: Peirce, ColinMartin, Sean Source Type: research

The Difficult Stoma: Challenges and Strategies
Clinics in Colon and Rectal Surgery 2016; 29: 152-159DOI: 10.1055/s-0036-1580628The problems that a patient experiences after the creation of a temporary or permanent stoma can result from many factors, but a carefully constructed stoma located in an ideal location is typically associated with appropriate function and an acceptable quality of life. The construction of the stoma can be confounded by many concomitant conditions that increase the distance that the bowel must traverse or shorten the bowel's capacity to reach. Stomas can be further troubled by a variety of problems that potentially arise early in the recovery p...
Source: Clinics in Colon and Rectal Surgery - May 26, 2016 Category: Surgery Authors: Strong, Scott A. Source Type: research

Genitourinary Considerations in Reoperative and Complex Colorectal Surgery
Clinics in Colon and Rectal Surgery 2016; 29: 145-151DOI: 10.1055/s-0036-1580629Genitourinary structures are at risk of injury during colorectal surgery. The incidence of injury is low; however, the risk is higher in cases involving severe inflammatory or infectious processes, locally advanced or recurrent cancer, previous radiation, and reoperation. Consideration of the anatomical relationship between the genitourinary system, and the colon and rectum is crucial to avoid injuries. Intraoperative diagnostic techniques such as intravenous pyelogram (IVP), fluoroscopic cystogram, or retrograde urethrogram can aid in identify...
Source: Clinics in Colon and Rectal Surgery - May 26, 2016 Category: Surgery Authors: Althumairi, Azah A.Efron, Jonathan E. Source Type: research

Management of Colorectal Anastomotic Leak
Clinics in Colon and Rectal Surgery 2016; 29: 138-144DOI: 10.1055/s-0036-1580630The aim of this article is to present strategies for preventing and managing the failure of the surgical restoration of intestinal continuity. Despite improvements in surgical technique and perioperative care, anastomotic leaks still occur, and with them occur increased morbidity, mortality, length of stay, and costs. Due to the devastating consequences for patients with failed anastomoses, there have been a myriad of materials and techniques used by surgeons to create better intestinal anastomoses. We will also discuss the management strategie...
Source: Clinics in Colon and Rectal Surgery - May 26, 2016 Category: Surgery Authors: Thomas, Michael S.Margolin, David A. Source Type: research

Enterocutaneous Fistula: Proven Strategies and Updates
This article summarizes the current classification systems and successful management protocols, provides an in-depth review of fluid resuscitation, sepsis control, nutrition management, medication management of output quantity, wound care, nonoperative intervention measures, operative timeline, and considerations, and discusses special considerations such as inflammatory bowel disease and enteroatmospheric fistula.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Clinics in Colo...
Source: Clinics in Colon and Rectal Surgery - May 26, 2016 Category: Surgery Authors: Gribovskaja-Rupp, IrenaMelton, Genevieve B. Source Type: research

The Failed J Pouch
Clinics in Colon and Rectal Surgery 2016; 29: 123-129DOI: 10.1055/s-0036-1580724The development and refinement of proctectomy with ileal pouch-anal anastomosis (IPAA) since its introduction in the 1970s has made it the optimal procedure of choice in patients with chronic ulcerative colitis and patients with familial adenomatous polyposis. However, it is a procedure that can be associated with significant morbidity. Pouch failure due to infection, mechanical, or functional disability represents a challenge to both surgeon and patient. Practicing surgeons who deal with revisional pouch surgery face a variety of intraoperativ...
Source: Clinics in Colon and Rectal Surgery - May 26, 2016 Category: Surgery Authors: Pappou, Emmanouil P.Kiran, Ravi P. Source Type: research

Surgery for Locally Recurrent Rectal Cancer: Tips, Tricks, and Pitfalls
Clinics in Colon and Rectal Surgery 2016; 29: 114-122DOI: 10.1055/s-0036-1580723Rectal cancer can recur locally in up to 10% of the patients who undergo definitive resection for their primary cancer. Surgical salvage is considered appropriate in the curative setting as well as select cases with palliative intent. Disease-free survival following salvage resection is dependent upon achieving an R0 resection margin. A clear understanding of applied surgical anatomy, appropriate preoperative planning, and a multidisciplinary approach to aggressive soft tissue, bony, and vascular resection with appropriate reconstruction is nec...
Source: Clinics in Colon and Rectal Surgery - May 26, 2016 Category: Surgery Authors: Warrier, Satish K.Heriot, Alexander G.Lynch, Andrew Craig Source Type: research

Surgery for Locally Advanced T4 Rectal Cancer: Strategies and Techniques
Clinics in Colon and Rectal Surgery 2016; 29: 106-113DOI: 10.1055/s-0036-1580722Locally advanced T4 rectal cancer represents a complex clinical condition that requires a well thought-out treatment plan and expertise from multiple specialists. Paramount in the management of patients with locally advanced rectal cancer are accurate preoperative staging, appropriate application of neoadjuvant and adjuvant treatments, and, above all, the provision of high-quality, complete surgical resection in potentially curable cases. Despite the advanced nature of this disease, extended and multivisceral resections with clear margins have ...
Source: Clinics in Colon and Rectal Surgery - May 26, 2016 Category: Surgery Authors: Helewa, Ramzi M.Park, Jason Source Type: research

Multidisciplinary Approach to the Treatment of Concomitant Rectal and Vaginal Prolapse
Clinics in Colon and Rectal Surgery 2016; 29: 101-105DOI: 10.1055/s-0036-1580721Rectal prolapse and vaginal prolapse have traditionally been treated as separate entities despite sharing a common pathophysiology. This compartmentalized approach often leads to frustration and suboptimal outcomes. In recent years, there has been a shift to a more patient-centered, multidisciplinary approach. Procedures to repair pelvic organ prolapse are divided into three categories: abdominal, perineal, and a combination of both. Most commonly, a combined minimally invasive abdominal sacral colpopexy and ventral rectopexy is performed to tr...
Source: Clinics in Colon and Rectal Surgery - May 26, 2016 Category: Surgery Authors: Jallad, KarlGurland, Brooke Source Type: research

Management of Complex Perineal Fistula Disease
Clinics in Colon and Rectal Surgery 2016; 29: 092-100DOI: 10.1055/s-0036-1580631Management of complex perineal fistulas such as high perianal, rectovaginal, pouch-vaginal, rectourethral, or pouch-urethral fistulas requires a systematic approach. The first step is to control any sepsis with drainage of abscess and/or seton placement. Patients with large, recurrent, irradiated fistulas benefit from stoma diversion. In patients with Crohn's disease, it is essential to induce remission prior to any repair. There are different approaches to repair complex fistulas, from local repairs to transperineal and transabdominal approach...
Source: Clinics in Colon and Rectal Surgery - May 26, 2016 Category: Surgery Authors: Akiba, Ricardo TadayoshiRodrigues, Fabio Gontijoda Silva, Giovanna Source Type: research

Radiation-Induced Problems in Colorectal Surgery
Clinics in Colon and Rectal Surgery 2016; 29: 085-091DOI: 10.1055/s-0036-1580632Radiotherapy not only plays a pivotal role in the cancer care pathways of many patients with pelvic malignancies, but can also lead to significant injury of normal tissue in the radiation field (pelvic radiation disease) that is sometimes as challenging to treat as the neoplasms themselves. Acute symptoms are usually self-limited and respond to medical therapy. Chronic symptoms often require operative intervention that is made hazardous by hostile surgical planes and unforgiving tissues. Management of these challenging patients is best guided b...
Source: Clinics in Colon and Rectal Surgery - May 26, 2016 Category: Surgery Authors: Ashburn, Jean H.Kalady, Matthew F. Source Type: research

Perioperative Considerations in Crohn Disease and Ulcerative Colitis
Clinics in Colon and Rectal Surgery 2016; 29: 080-084DOI: 10.1055/s-0036-1580633The management of inflammatory bowel disease (IBD) is medically and surgically complex. Numerous patient- and disease-oriented factors must be considered in treating patients with IBD, including nutritional replenishment/support, effect of immunosuppressive medications, extent of resection, and use of proximal diversion. Perioperative planning and optimization of the patient is imperative to ensuring favorable outcomes and limiting morbidity. These perioperative considerations in Crohn disease and ulcerative colitis are reviewed here.[...]Thiem...
Source: Clinics in Colon and Rectal Surgery - May 26, 2016 Category: Surgery Authors: Nickerson, T. PaulMerchea, Amit Source Type: research

Complex and Reoperative Colorectal Surgery: Setting Expectations and Learning from Experience
Clinics in Colon and Rectal Surgery 2016; 29: 075-079DOI: 10.1055/s-0036-1580634A range of topics are covered in this issue dedicated to complex and reoperative colorectal surgery, from radiation-induced surgical problems, to enterocutaneous fistulas and locally advanced or recurrent rectal cancer. Common themes include the importance of operative planning and patient counseling on the expected functional outcomes. Experts in the field offer their technical tips and clinical lessons to maximize outcomes and minimize complications in these challenging cases.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 100...
Source: Clinics in Colon and Rectal Surgery - May 26, 2016 Category: Surgery Authors: Kin, Cindy Source Type: research

Complex and Reoperative Colorectal Surgery
Clinics in Colon and Rectal Surgery 2016; 29: 073-074DOI: 10.1055/s-0036-1580635Thieme 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 - May 26, 2016 Category: Surgery Authors: Kin, Cindy Tags: Preface Source Type: research

Cindy Kin, MD, MS, FACS
Clinics in Colon and Rectal Surgery 2016; 29: 071-072DOI: 10.1055/s-0036-1580636Thieme 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 - May 26, 2016 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to Guest Editor Source Type: research

Transanal Approach to Rectal Polyps and Cancer
Clinics in Colon and Rectal Surgery 2016; 29: 065-070DOI: 10.1055/s-0035-1570395A transanal approach to rectal polyp and cancer excision is often an appropriate alternative to conventional rectal resection, and has a lower associated morbidity. There has been a steady evolution in the techniques of transanal surgery over the past 30 years. It started with traditional transanal excision and was revolutionized by introduction of transanal endoscopic microsurgery in early 1980s. Introduction of transanal minimally invasive surgery made it more accessible to surgeons around the world. Now robotic platforms are being tried in c...
Source: Clinics in Colon and Rectal Surgery - February 16, 2016 Category: Surgery Authors: Rai, VinayMishra, Nitin Tags: Review Article Source Type: research

Screening, Surveillance, and Treatment of Anal Intraepithelial Neoplasia
Clinics in Colon and Rectal Surgery 2016; 29: 057-064DOI: 10.1055/s-0035-1570394The prevalence of anal intraepithelial neoplasia has been increasing, especially in high-risk patients, including men who have sex with men, human immunodeficiency virus positive patients, and those who are immunosuppressed. Several studies with long-term follow-up have suggested that rate of progression from high-grade squamous intraepithelial lesions to invasive anal cancer is ∼ 5%. This number is considerably higher for those at high risk. Anal cytology has been used to attempt to screen high-risk patients for disease; however, it has be...
Source: Clinics in Colon and Rectal Surgery - February 16, 2016 Category: Surgery Authors: Long, Kevin C.Menon, RamanBastawrous, AmirBillingham, Richard Tags: Review Article Source Type: research

Rectovaginal Fistulae
Clinics in Colon and Rectal Surgery 2016; 29: 050-056DOI: 10.1055/s-0035-1570393Rectovaginal fistulae are abnormal epithelialized connections between the rectum and vagina. Fistulae from the anorectal region to the posterior vagina are truly best characterized as anovaginal or very low rectovaginal fistulae. True rectovaginal fistulae are less common and result from inflammatory bowel disease, trauma, or iatrogenic injury. A very few patients are asymptomatic, but the symptoms of rectovaginal fistula are incredibly distressing and unacceptable. Diagnostic approach, timing, and choice of surgical intervention, including sph...
Source: Clinics in Colon and Rectal Surgery - February 16, 2016 Category: Surgery Authors: Das, BidhanSnyder, Michael Tags: Review Article Source Type: research

Management of Complex Anal Fistulas
Clinics in Colon and Rectal Surgery 2016; 29: 043-049DOI: 10.1055/s-0035-1570392Complex anal fistulas require careful evaluation. Prior to any attempts at definitive repair, the anatomy must be well defined and the sepsis resolved. Several muscle-sparing approaches to anal fistula are appropriate, and are often catered to the patient based on their presentation and previous repairs. Emerging technologies show promise for fistula repair, but lack long-term data.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents  |  Abstract  ...
Source: Clinics in Colon and Rectal Surgery - February 16, 2016 Category: Surgery Authors: Bubbers, Emily J.Cologne, Kyle G. Tags: Review Article Source Type: research

Pruritus Ani
Clinics in Colon and Rectal Surgery 2016; 29: 038-042DOI: 10.1055/s-0035-1570391Pruritus ani is a common condition with many different potential causes. Because of this, it can be difficult to treat. It is important to identify and eliminate any inciting factors, which are often unintentional consequences of the patient's attempts to alleviate symptoms. If no reversible cause is found, simple measures with diet modification and perianal hygiene are tried before using topical medications or procedures.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents&nbs...
Source: Clinics in Colon and Rectal Surgery - February 16, 2016 Category: Surgery Authors: Ansari, Parswa Tags: Review Article Source Type: research

Anal Fissure
Clinics in Colon and Rectal Surgery 2016; 29: 030-037DOI: 10.1055/s-0035-1570390Anal fissure (fissure-in-ano) is a very common anorectal condition. The exact etiology of this condition is debated; however, there is a clear association with elevated internal anal sphincter pressures. Though hard bowel movements are implicated in fissure etiology, they are not universally present in patients with anal fissures. Half of all patients with fissures heal with nonoperative management such as high fiber diet, sitz baths, and pharmacological agents. When nonoperative management fails, surgical treatment with lateral internal sphinc...
Source: Clinics in Colon and Rectal Surgery - February 16, 2016 Category: Surgery Authors: Beaty, Jennifer SamShashidharan, M. Tags: Review Article Source Type: research

Review of Hemorrhoid Disease: Presentation and Management
Clinics in Colon and Rectal Surgery 2016; 29: 022-029DOI: 10.1055/s-0035-1568144Symptomatic hemorrhoid disease is one of the most prevalent ailments associated with significant impact on quality of life. Management options for hemorrhoid disease are diverse, ranging from conservative measures to a variety of office and operating-room procedures. In this review, the authors will discuss the anatomy, pathophysiology, clinical presentation, and management of hemorrhoid disease.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents  |  Abstra...
Source: Clinics in Colon and Rectal Surgery - February 16, 2016 Category: Surgery Authors: Sun, ZhifeiMigaly, John Tags: Review Article Source Type: research

Complications Following Anorectal Surgery
Clinics in Colon and Rectal Surgery 2016; 29: 014-021DOI: 10.1055/s-0035-1568145Anorectal surgery is well tolerated. Rates of minor complications are relatively high, but major postoperative complications are uncommon. Prompt identification of postoperative complications is necessary to avoid significant patient morbidity. The most common acute complications include bleeding, infection, and urinary retention. Pelvic sepsis, while may result in dramatic morbidity and even mortality, is relatively rare. The most feared long-term complications include fecal incontinence, anal stenosis, and chronic pelvic pain.[...]Thieme Medi...
Source: Clinics in Colon and Rectal Surgery - February 16, 2016 Category: Surgery Authors: Kunitake, HirokoPoylin, Vitaliy Tags: Review Article Source Type: research

Perioperative Management of the Ambulatory Anorectal Surgery Patient
Clinics in Colon and Rectal Surgery 2016; 29: 007-013DOI: 10.1055/s-0035-1570023Ambulatory surgery is appropriate for most anorectal pathology. Ambulatory anorectal surgery can be performed at reduced cost compared with inpatient procedures with excellent safety, improved efficiency, and high levels of patient satisfaction. Several perioperative strategies are employed to control pain and avoid urinary retention, including the use of a multimodal pain regimen and restriction of intravenous fluids. Ambulatory anorectal surgery often utilizes standardized order sets and discharge instructions.[...]Thieme Medical Publishers 3...
Source: Clinics in Colon and Rectal Surgery - February 16, 2016 Category: Surgery Authors: Shaw, DarcyTernent, Charles A. Tags: Review Article Source Type: research

Evidence-based Evaluation and Management of Anorectal Disease
Clinics in Colon and Rectal Surgery 2016; 29: 005-006DOI: 10.1055/s-0035-1568142Thieme 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 16, 2016 Category: Surgery Authors: Langenfeld, Sean J. Tags: Preface Source Type: research

Approaches to Anorectal Disease
Clinics in Colon and Rectal Surgery 2016; 29: 003-004DOI: 10.1055/s-0035-1568141Thieme 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 16, 2016 Category: Surgery Authors: Bailey, H. Randolph Tags: Foreword Source Type: research