Colorectal Disease and the Gut Microbiome: What a Surgeon Needs to Know
Surg Clin North Am. 2024 Jun;104(3):647-656. doi: 10.1016/j.suc.2023.12.004. Epub 2023 Dec 28.ABSTRACTThe gut microbiome is defined as the microorganisms that reside within the gastrointestinal tract and produce a variety of metabolites that impact human health. These microbes play an intricate role in human health, and an imbalance in the gut microbiome, termed gut dysbiosis, has been implicated in the development of varying diseases. The purpose of this review is to highlight what is known about the microbiome and its impact on colorectal cancer, inflammatory bowel disease, constipation, Clostridioides difficile infectio...
Source: The Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Shahrose Rahman Ethan Lu Ranish K Patel Vassiliki Liana Tsikitis Robert G Martindale Source Type: research
Colorectal Oncologic Emergencies: Recognition, Management, and Outcomes
Surg Clin North Am. 2024 Jun;104(3):631-646. doi: 10.1016/j.suc.2023.12.003. Epub 2023 Dec 18.ABSTRACTColorectal cancer is the third most frequent type of malignancy in the United States, and the age at diagnosis is decreasing. Although the goal of screening is focused on prevention and early detection, a subset of patients inevitably presents as oncologic emergencies. Approximately 15% of patients with colorectal cancer will present as surgical emergencies, with the majority being due to either colonic perforation or obstruction. Patients presenting with colorectal emergencies are a challenging cohort, as they often prese...
Source: The Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Joshua Sullivan Alec Donohue Shaun Brown Source Type: research
Management of Oligometastatic Colorectal Cancer
Surg Clin North Am. 2024 Jun;104(3):619-629. doi: 10.1016/j.suc.2023.11.011. Epub 2023 Dec 11.ABSTRACTThe management of oligometastatic colorectal cancer differs from the treatment of metastatic colorectal cancer, and it is essential that those who treat oligometastatic disease be familiar with the treatment options for these patients. Although definitive treatment is often surgical, there are situations where local therapies such as SBRT or ablative techniques may better serve the patient. Adjuvant therapy should be provided to all patients, and neoadjuvant chemotherapy should be considered as well. The role of immunother...
Source: The Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Camille R Suydam Andrew T Schlussel Source Type: research
Total Neoadjuvant Therapy for Rectal Cancer
Surg Clin North Am. 2024 Jun;104(3):609-617. doi: 10.1016/j.suc.2023.11.010. Epub 2024 Feb 12.ABSTRACTThe treatment of locally advanced rectal cancer has traditionally included sequenced multimodal therapy including radiation, chemotherapy, and surgery. The relative contribution of each and the order of treatments have evolved over the years. By the early twenty-first century, there was widespread use of the German Rectal Cancer Trial approach: preoperative chemoradiation, followed by standardized surgery including total mesorectal excision, and finally adjuvant chemotherapy. Recent advances have defined the superiority of...
Source: The Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Arthur G Affleck Daniel Herzig Source Type: research
Screening for Colorectal Cancer
Surg Clin North Am. 2024 Jun;104(3):595-607. doi: 10.1016/j.suc.2023.11.009. Epub 2023 Dec 14.ABSTRACTColorectal cancer remains the third leading cause of cancer death in the United States. Colorectal cancer screening allows for prevention and early detection of precancerous and cancerous lesions, and screening has been shown to be effective in preventing colorectal cancer deaths. Screening recommendations vary by patient risk profile. A variety of screening modalities exist.PMID:38677823 | DOI:10.1016/j.suc.2023.11.009 (Source: The Surgical Clinics of North America)
Source: The Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Matthew Jacobsson Vitas Wagner Shalini Kanneganti Source Type: research
Functional Constipation and Obstructed Defecation
Surg Clin North Am. 2024 Jun;104(3):565-578. doi: 10.1016/j.suc.2023.11.007. Epub 2023 Dec 14.ABSTRACTConstipation encompasses symptoms of decreased colonic motility or difficulty with the defecation process. As a broad definition, this can be inclusive of functional constipation (FC) or colonic inertia, obstructed defecation (OD), and irritable bowel syndrome-constipation type (IBS-CS). After excluding IBS-C, FC and OD diagnosis and management require a multidisciplinary approach often involving nutritionists, pelvic floor therapists, urogynecologists, and colon and rectal surgeons. Differentiating the presence or absence...
Source: The Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Mary T O'Donnell Sarah M Haviland Source Type: research
Management of the Difficult Stoma
Surg Clin North Am. 2024 Jun;104(3):579-593. doi: 10.1016/j.suc.2023.11.008. Epub 2024 Jan 29.ABSTRACTFecal ostomy creation is a commonly performed procedure with many indications. Better outcomes occur when preoperative patient education and stoma site marking are provided. Despite a seemingly simple operation, ostomy creation is often difficult and complications are common. Certain risk factors, particularly obesity, are strongly associated with stoma-related complications. The ability to optimize the ostomy and stoma in the operating room and to troubleshoot frequently encountered post-operative stoma-related issues are...
Source: The Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Clay Merritt Paola Maldonado Source Type: research
Evaluation and Management of Rectal Prolapse
Surg Clin North Am. 2024 Jun;104(3):557-564. doi: 10.1016/j.suc.2023.12.002. Epub 2024 Jan 29.ABSTRACTRectal prolapse, or procidentia, is a common pathology for the practicing colorectal surgeon. It is associated with lifestyle limiting symptoms for the patient and frequently co-exists with other types of pelvic prolapse making multidisciplinary management key. It is primarily managed with surgical reconstruction. A number of operative approaches exist, and the optimum procedure is varied dependent upon patient characteristics.PMID:38677820 | DOI:10.1016/j.suc.2023.12.002 (Source: The Surgical Clinics of North America)
Source: The Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Michael Shane McNevin Source Type: research
Clostridioides difficile Colitis
Surg Clin North Am. 2024 Jun;104(3):545-556. doi: 10.1016/j.suc.2023.11.005. Epub 2023 Dec 26.ABSTRACTClostridioides difficile colitis is an important source of hospital-acquired diarrhea associated with antibiotic use. Symptoms are profuse watery diarrhea, typically following a course of antibiotics; however, some cases of fulminant disease may manifest with shock, ileus, or megacolon. Nonfulminant colitis is treated with oral fidaxomicin. C difficile colitis has a high potential for recurrence, and recurrent episodes are also treated with fidaxomicin. Bezlotoxumab is another medication that may be used in populations at ...
Source: The Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Luke Pumiglia Lexi Wilson Laila Rashidi Source Type: research
Condyloma and Anal Dysplasia
Surg Clin North Am. 2024 Jun;104(3):517-527. doi: 10.1016/j.suc.2023.11.004. Epub 2023 Dec 14.ABSTRACTAnal intraepithelial neoplasia (AIN) are precancerous lesions and are sequela of human papilloma virus (HPV) infection. AIN is classified as low-grade squamous intraepithelial lesion or high-grade squamous intraepithelial lesion. Screening with anal cytology and anoscopy should be considered for high-risk populations. Diagnosis is made through high resolution anaoscopy and biopsy. Options for treatment include ablation and several topical therapies; however, recurrence rates are high for all treatment options, and an ongoi...
Source: The Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Sarah M Haviland Mary T O'Donnell Source Type: research
Current Management of Diverticulitis
Surg Clin North Am. 2024 Jun;104(3):529-543. doi: 10.1016/j.suc.2023.12.001. Epub 2023 Dec 22.ABSTRACTDiverticulosis and diverticulitis remain common diagnoses in western countries, and the incidence continues to rise. Diverticulitis accounts for roughly one-third of admissions to acute care hospitals annually, with even more patients being treated as outpatients due to improved understanding of risk stratification and the natural history of disease progression. Thus, having a thorough understanding of the etiology of the disease in conjunction with computed tomography findings and patient presentation can help dictate the...
Source: The Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Erik Domas Kiefer Starks Shalini Kanneganti Source Type: research
Anal Cryptoglandular Suppuration: Evidence-Based Management
Surg Clin North Am. 2024 Jun;104(3):491-501. doi: 10.1016/j.suc.2023.11.002. Epub 2023 Dec 11.ABSTRACTAnal suppurative processes are commonly encountered in surgical practice. While the initial therapeutic intervention is philosophically straightforward (incision and drainage), drainage of the appropriate space and treatment of the subsequent fistula in ano require a thorough understanding of perianal anatomy and nuanced decision making. Balancing the risk of fecal incontinence with simple fistulotomy versus the higher risk of fistula recurrence with all sphincter-sparing fistula treatments can be a challenge for surgeons ...
Source: The Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Oladapo Akinmoladun Quinton M Hatch Source Type: research
Management of Pilonidal Disease and Hidradenitis Suppurativa
Surg Clin North Am. 2024 Jun;104(3):503-515. doi: 10.1016/j.suc.2023.11.003. Epub 2023 Dec 13.ABSTRACTPilonidal disease and hidradenitis suppurativa affect healthy young adults, causing discomfort and pain that leads to loss of work productivity and should be approached in a personalized manner. Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered. Hidradenitis suppurativa can be a morbid and challenging disease process. Medical management with topical agents, antibiotics, and biologics should be used initially but wide local excision should be considere...
Source: The Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Sneha Singh Kaushal Desai Suzanne Gillern Source Type: research
Management of Hemorrhoids and Anal Fissures
Surg Clin North Am. 2024 Jun;104(3):473-490. doi: 10.1016/j.suc.2023.11.001. Epub 2023 Dec 9.ABSTRACTHemorrhoids and anal fissures are two of the most common benign anorectal diseases. Despite their high prevalence, diagnostic accuracy of benign anorectal disease is suboptimal at 70% for surgeons, especially for hemorrhoidal diseases. Once the diagnosis is correctly made, numerous medical and surgical treatment options are available, each with different rates of success and complications. In this article, the authors review each step of patient management, with emphasis on evidence-based treatment options for hemorrhoids a...
Source: The Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Oladapo Akinmoladun William Oh Source Type: research
Evaluating Clinical Reasoning in Undergraduate Medical Education: The Value of a Virtual Oral Assessment
CONCLUSIONS: Virtual oral assessments of clinical reasoning can be incorporated in undergraduate medical education to identify students struggling with components of clinical reasoning, while also allowing maximum flexibility for the clinician educator workforce as examiners. Longitudinal use of these exams would be valuable to track the development of clinical reasoning across the medical school curriculum.PMID:38676698 | DOI:10.1177/00031348241250049 (Source: The American Surgeon)
Source: The American Surgeon - April 27, 2024 Category: Surgery Authors: Michelle Jeffery A Reema Kar Archana Pradhan Samantha Brannigan Carol Terregino Hanin Rashid Rick Salisbury Conrad Johnson Sugeet Jagpal Source Type: research
