MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Seminars in Colon and Rectal Surgery' source. Sun, 29 Jan 2012 16:28:10 +0100 http://www.medworm.com/index.php?rid=5401286&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000650%2Fabstract%3Frss%3Dyes Physicians who care for patients of childbearing potential of both genders who require pelvic surgery must have a clear understanding of the best-available evidence with regards to infertility as an outcome in this cohort. More specifically, colorectal surgeons must clearly understand the ramifications of altered anatomy on fertility and be able to adequately counsel patients. In this article we provide definitions associated with fertility and review the best-available literature regarding the impact of medical therapy for inflammatory bowel disease on fertility and both female and male infertility after proctectomy for chronic ulcerative colitis and rectal cancer. Finally, we review techniques for optimization of fertility as well as available options and treatments for those who have di... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5401286 Sun, 13 Nov 2011 09:16:52 +0100 5401286 http://www.medworm.com/index.php?rid=5401285&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000649%2Fabstract%3Frss%3Dyes Rectal resection may impact the sexual function of both men and women. Postoperative sexual dysfunction occurs in as many as 60% of patients, depending upon the specific symptom studied. Studying the issue is complex because the underlying disease process, surgical technique, need for a stoma, adjuvant therapy, and preoperative sexual function all affect postoperative sexual function. The quality of the literature is limited by the lack of studies in which the authors use validated instruments. Even in that context, information on female patients is more limited than data on male patients. Improvements in surgical technique may help reduce postoperative sexual dysfunction while more complete information would improve patient counseling. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5401285 Sun, 13 Nov 2011 09:16:52 +0100 5401285 http://www.medworm.com/index.php?rid=5401284&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000637%2Fabstract%3Frss%3Dyes The objective of this article was to review and summarize existing studies in the literature on bowel function after rectal cancer surgery. The major contributing factors to bowel function are reconstructive techniques and radiation therapy. Colonic J-pouch has been thoroughly studied and provides the best functional outcome, particularly with regard to bowel frequency. This technique may be impossible in obese patients with a narrow pelvis. Radiation therapy has an adverse effect on bowel outcomes, in particular, incontinence and bowel frequency, despite proven benefits in decreasing the risk of local recurrence. There is limited information on preoperative chemoradiation, but information to date suggests it is no different from short-course radiation. It is unclear whether a colonic J-po... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5401284 Sun, 13 Nov 2011 09:16:52 +0100 5401284 http://www.medworm.com/index.php?rid=5401283&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000625%2Fabstract%3Frss%3Dyes Recent efforts in improving health care quality have focused on patient satisfaction. The use of patient-reported outcomes is becoming increasingly common and gaining in importance as a measure of quality of care. Patient satisfaction, the best illustration of the patient-reported outcomes, is a complex concept. The advantages of measuring patient satisfaction are clear, and there are ongoing efforts to measure it in a standardized fashion. Several health care organizations have adopted measures to accomplish this goal, both in the United States and abroad. Despite the increasing number of instruments, the concept of patient satisfaction is still poorly understood and therefore frequently incorrectly measured. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5401283 Sun, 13 Nov 2011 09:16:52 +0100 5401283 http://www.medworm.com/index.php?rid=5401282&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000613%2Fabstract%3Frss%3Dyes Health-related quality of life is increasingly recognized as an important factor in evaluating the impact of a disease on an individual or assessing the risks and benefits of a treatment. Investigators have developed numerous instruments that aim to assess global quality of life and disease-specific quality of life. Colorectal cancer, inflammatory bowel disease, and Hirschsprung's disease are 3 colorectal conditions that have been the subject of much quality of life-related investigation. In addition to symptomatology, patients' social support structures, expectations, and level of communication with caregivers are all factors that impact an individual's perceived quality of life in colorectal disease. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5401282 Sun, 13 Nov 2011 09:16:51 +0100 5401282 http://www.medworm.com/index.php?rid=5401281&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000601%2Fabstract%3Frss%3Dyes The treatment of patients with colon and rectal cancer frequently involves multiple disciplines of medicine, including surgery, radiation, and chemotherapy. Timely treatment is widely accepted as a cornerstone of quality of care, with the goal of arresting progression of disease and alleviating patient anxiety. Existing research, however, has had difficulties with characterizing the relationship between delays in treatment and short- or long-term outcomes. In this review we examine reasons for this and propose that, despite these difficulties, timely treatment is an appropriate target for efforts in quality assessment and quality improvement. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5401281 Sun, 13 Nov 2011 09:16:51 +0100 5401281 http://www.medworm.com/index.php?rid=5401280&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000595%2Fabstract%3Frss%3Dyes The list of ambulatory procedures has grown considerably in the last half century. Colorectal procedures are particularly amenable to the ambulatory setting because of the volume of cases, minimally invasive techniques employed, and relatively quick recovery. Although we know that colon and rectal surgeons perform an increasing number of anorectal and endoscopic procedures in ambulatory surgery centers, useful metrics for outcomes assessment are lacking in this arena. In this review, we have summarized the data regarding outcomes assessment in ambulatory colorectal surgery, delineated the complexities of outcomes measurement, and suggested strategies for future assessment. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5401280 Sun, 13 Nov 2011 09:16:51 +0100 5401280 http://www.medworm.com/index.php?rid=5401279&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000662%2Fabstract%3Frss%3Dyes Colorectal resections account for a disproportionate burden of morbidity within general surgery, and most major complications probably originate in the operating room. A number of intraoperative factors are known to contribute to outcomes in colorectal surgery and yet no generally accepted metrics exist to evaluate the safety and quality of intraoperative care. Some composite performance scores have been described but are not commonly in use. Experiences from other surgical specialties can inform future efforts to develop, validate, and implement intraoperative quality indicators for colorectal surgery. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5401279 Sun, 13 Nov 2011 09:16:51 +0100 5401279 http://www.medworm.com/index.php?rid=5401278&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000583%2Fabstract%3Frss%3Dyes This article reviews the common types of nonfatal adverse events after colorectal resection, the monetary and long-term patient costs of these events, as well as some of the technical difficulties with valid measurement and comparison of complication rates. We review evidence suggesting that risk-adjusted complication rates vary by hospital, and may be improved by quality improvement initiatives. Promising strategies for decreasing nonfatal adverse events following colorectal operations include: the National Surgical Quality Improvement Program and regional collaborative programs, such as the Keystone Collaboratives and the Michigan Surgical Quality Collaborative. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5401278 Sun, 13 Nov 2011 09:16:51 +0100 5401278 http://www.medworm.com/index.php?rid=5401277&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000571%2Fabstract%3Frss%3Dyes In recent years the public, politicians, and physicians themselves have increasingly become aware of the importance and relevance of quality and value in health care. It is important for colon and rectal surgeons to understand cost-based comparative effectiveness studies pertaining to their specialty. These studies provide evidence to assist health care policymakers as well as clinicians and their patients in making well-informed decisions. The aim of this review is to familiarize colorectal surgeons with such research by providing definitions and examples from the colorectal literature. As this type of research gains greater attention among research funding agencies and health care policymakers, it is becoming increasingly important for colon and rectal surgeons to understand these method... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5401277 Sun, 13 Nov 2011 09:16:51 +0100 5401277 http://www.medworm.com/index.php?rid=5401276&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS104314891100056X%2Fabstract%3Frss%3Dyes This article describes the origins, mission, and methodology of the organizations and programs that have been established to standardize performance and improve quality. The role of these programs in health care, and the way they affect individual surgeons in practice, is then discussed. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5401276 Sun, 13 Nov 2011 09:16:51 +0100 5401276 http://www.medworm.com/index.php?rid=5401275&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000558%2Fabstract%3Frss%3Dyes More than 20 years have passed since the publication of Avedis Donabedian's classic article describing a framework for understanding quality of care in 3 domains: structure, process, and outcomes. In Donabedian's conceptual framework, structure corresponded to attributes of the setting of care; process measures defined actions in giving and receiving care; and outcomes were the effects of care on the health status of patients and populations. While the domains of quality are clearly interlinked, each has its own implications. For example, changing structure may be cumbersome, but measuring structural elements, such as case volume, has been used to optimize referral patterns in rectal cancer care. Identifying and measuring the most effective processes of care, such as guideline-concordant c... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5401275 Sun, 13 Nov 2011 09:16:51 +0100 5401275 http://www.medworm.com/index.php?rid=5132870&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000546%2Fabstract%3Frss%3Dyes Guidelines for the treatment of diverticular disease remain nebulous. More recent data question previous recommendations for aggressive surgical resection in recurrent uncomplicated diverticulitis. These data also question the link between worsening diverticular disease and recurrence or young age. In fact, recent data suggest a less virulent disease in patients (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5132870 Tue, 16 Aug 2011 22:58:48 +0100 5132870 http://www.medworm.com/index.php?rid=5132869&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000534%2Fabstract%3Frss%3Dyes This article critically reviews the laparoscopic lavage literature and offers a recommendation regarding the use of lavage in the management of patients with diverticulitis. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5132869 Tue, 16 Aug 2011 22:58:48 +0100 5132869 http://www.medworm.com/index.php?rid=5132868&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000479%2Fabstract%3Frss%3Dyes The role of laparoscopy in diverticular disease continues to evolve. Minimally invasive surgery for diverticular disease has been shown to reduce complications, hospital stay, and time to return of bowel function. Multiple techniques have been used, each with their own advantages. Complicated and emergency treatment of diverticular disease has been successfully treated using laparoscopic techniques. A variety of approaches and the current literature on risks and benefits will be reviewed. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5132868 Tue, 16 Aug 2011 22:58:48 +0100 5132868 http://www.medworm.com/index.php?rid=5132867&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000510%2Fabstract%3Frss%3Dyes Diverticular disease is more prevalent than suspected because majority of patients are asymptomatic. Symptoms develop due to an alteration in the bacterial milieu, fecal stasis, impaired mucosal barrier function, and release of pro-inflammatory cytokines. Complications include free perforation, abscess, fistula and obstruction. Uncomplicated diverticular disease presents with less severe symptoms. Treatment modalities continue to evolve as the etiology of the disease has become clearer. The use of probiotics, rifaximin and mesalamine appear favorable but still lack adequate data. High fiber diet has uniformly been accepted to be beneficial and antibiotics still remain as the mainstay of therapy in uncomplicated disease. New studies on the natural history of recurrent diverticulitis suggest... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5132867 Tue, 16 Aug 2011 22:58:47 +0100 5132867 http://www.medworm.com/index.php?rid=5132866&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000522%2Fabstract%3Frss%3Dyes This article attempts to address the following questions: (1) what defines “complicated diverticulitis”; (2) when is an intervention beyond medical management indicated; and (3) what currently (based on the type of complication) appears to be the optimal intervention? (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5132866 Tue, 16 Aug 2011 22:58:47 +0100 5132866 http://www.medworm.com/index.php?rid=5132865&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000509%2Fabstract%3Frss%3Dyes Diverticulitis is an increasingly common problem within the Western population. For the vast majority of patients with diverticulitis, nonoperative management is the preferred treatment method. In this review, we examine the current evidence related to the evaluation and treatment acute diverticulitis to further clarify its nonoperative management strategies. Our review finds little high-level evidence to guide management decisions. Given this absence of evidence, physicians need to exercise judgment and avoidance of unnecessary risk in the treatment of diverticulitis. There also appears to be evidence that inpatient management is overused, but the extent to which this is the case is difficult to quantify. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5132865 Tue, 16 Aug 2011 22:58:47 +0100 5132865 http://www.medworm.com/index.php?rid=5132864&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000492%2Fabstract%3Frss%3Dyes Genetic, geographic, and environmental factors are likely to have a significant impact on the presentation and characteristics of diverticular disease. Genetic predispositions to diverticular disease fall into 3 categories: conditions that alter colonic wall integrity, conditions that cause visceral neurological dysfunction, and those that result in change of stool consistency. These different mechanisms play a role, but the pathophysiology of diverticula formation is likely multifactorial. The influence of a westernized diet is substantiated by the fact that diverticulosis is exceptionally uncommon in the developing world. Many authors believe the protective effect of a high-fiber diet is the primary cause for these differences, citing studies that confirm an association between dietary f... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5132864 Tue, 16 Aug 2011 22:58:47 +0100 5132864 http://www.medworm.com/index.php?rid=5132863&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148911000480%2Fabstract%3Frss%3Dyes During the past two decades diverticular disease has become more prevalent in industrialized settings. Although it is difficult to accurately estimate the increased surgical burden, it is clear that surgeons have a critical role in evaluating, treating, and developing management strategies for this common disease. Old dogma, such as elective resection after 2 episodes of uncomplicated disease, have been questioned, if not discarded, and there are emerging medical therapies that have yet to be fully examined. The advent of minimally invasive techniques has ignited new debates and algorithms in all stages of diverticular disease. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=5132863 Tue, 16 Aug 2011 22:58:46 +0100 5132863 http://www.medworm.com/index.php?rid=4843380&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001314%2Fabstract%3Frss%3Dyes Hereditary colorectal cancer (CRC) affects a younger patient population than sporadic CRC. Sexual function is of great importance in this age group, and fertility is at its peak. Surgical extirpative procedures for hereditary CRC may affect reproductive function. Additional adjuvant or neoadjuvant chemoradiation, when required, may impair fertility as well. Most discussions with patients with hereditary CRC focus on major surgical complications, standard adjuvant therapy complications, cancer survival, and tumor recurrence. Physicians participating in the care of these patients need to provide information regarding effects of treatment on reproductive function and fertility preservation options. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843380 Fri, 20 May 2011 16:42:11 +0100 4843380 http://www.medworm.com/index.php?rid=4843379&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001302%2Fabstract%3Frss%3Dyes The management of rectal cancer is complex enough in itself but even more complicated in the setting of a hereditary cancer syndrome. Although the cancer treatment as such is similar to the one in sporadic cancer and based on cancer stage, tumor location, the patient's overall presentation and condition, the presence of an underlying disease raises additional concerns about functional aspects and the risk of metachronous lesions. We reviewed the role of multimodality treatment and the timing and extent of the planned surgeries. Rectal cancer in the setting of hereditary cancer syndromes (eg, hereditary nonpolyposis colorectal cancer, familial adenomatous polyposis) is not genuinely handled with a different approach, except when an ileal pouch anal anastomosis is planned as the neo-adjuvant... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843379 Fri, 20 May 2011 16:42:11 +0100 4843379 http://www.medworm.com/index.php?rid=4843378&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001296%2Fabstract%3Frss%3Dyes In this report, we will review the role of adjuvant chemotherapy in early and locally advanced colon cancer and the role of clinical and molecular prognostic and predictive factors with a particular focus on hereditary colorectal cancer. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843378 Fri, 20 May 2011 16:42:10 +0100 4843378 http://www.medworm.com/index.php?rid=4843377&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001284%2Fabstract%3Frss%3Dyes Colorectal cancer affects a significant number of patients younger than the age of 50, and the incidence may be increasing. Most of these cancers are caused by genetic mutations, some of which are well known, whereas others have yet to be identified. The mutations lead to an accelerated transformation from normal mucosa towards a cancer. Guidelines for the management of these marker-and/or family history positive patients are increasingly well defined. However, many young patients do not have a positive family history (Amsterdam negative), and/or they either had no genetic testing done or were found to be genetic marker-negative. There is no consensus in the literature about defining the best management for these patients. Approaches vary from a segmental resection to a (sub-) total colect... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843377 Fri, 20 May 2011 16:42:10 +0100 4843377 http://www.medworm.com/index.php?rid=4843376&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001272%2Fabstract%3Frss%3Dyes Hereditary nonpolyposis colon cancer is the most common cause of hereditary colon cancer and results from defects in mismatch repair genes that create the phenomenon of microsatellite instability. Apart from the high risk of colon cancer, these patients are at increased risk of multiple malignancies, including endometrial cancer, ovarian cancer, small bowel tumors, gastric cancer, pancreatic cancer, and multiple other extraintestinal tumors. Routine colonoscopy for patients with hereditary nonpolyposis colon cancer has become standard and is widely accepted, but screening regimens for other organs remain matters of debate. Inadequacies detected in attempted surveillance methods have led some authors to call for prophylactic surgery as an alternative strategy in cancer prevention. (Source: ... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843376 Fri, 20 May 2011 16:42:10 +0100 4843376 http://www.medworm.com/index.php?rid=4843375&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001260%2Fabstract%3Frss%3Dyes This article reviews the literature to date regarding the extent of surgical resection, and addresses the approach to prophylactic measures to both colonic and gynecologic aspects of malignancy in hereditary nonpolyposis colorectal cancer. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843375 Fri, 20 May 2011 16:42:10 +0100 4843375 http://www.medworm.com/index.php?rid=4843374&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001259%2Fabstract%3Frss%3Dyes Familial adenomatous polyposis (FAP) is a hereditary multisystem disease dominantly characterized by diffuse colorectal adenomas and near 100% colorectal cancer risk. In addition to colorectal cancer, multiple extracolonic sites are affected by malignant and benign changes. Other leading causes of death for FAP patients include desmoid disease and duodenal adenocarcinoma. Benign lesions, such as lipomas, fibromas, sebaceous and epidermoid cysts, osteomas, and congenital hypertrophy of the retinal pigment epithelium, are also common. Cancers of the thyroid, pancreas, liver, and adrenal gland all occur but are much less frequent. As the lifespan of FAP patients has increased because of improved guidelines for surveillance and surgical prevention and treatment of colorectal cancer, the preval... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843374 Fri, 20 May 2011 16:42:10 +0100 4843374 http://www.medworm.com/index.php?rid=4843373&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001247%2Fabstract%3Frss%3Dyes Familial adenomatous polyposis is an autosomal-dominant disease caused by a germline mutation of the adenomatous polyposis coli (APC) gene. It is characterized by the progressive development of hundreds to thousands of polyps in the colorectum. There are also associated extracolonic manifestations. The average age of colorectal carcinoma in these patients is 39 years. Surgery is the only effective treatment available to prevent the development of colorectal carcinoma. In the era of ileoanal pouch surgery, there are several surgical options available to patients. We review the current literature's support for the various surgical options available at this time and the respective postoperative follow-up. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843373 Fri, 20 May 2011 16:42:10 +0100 4843373 http://www.medworm.com/index.php?rid=4843372&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001235%2Fabstract%3Frss%3Dyes Family registries for hereditary colorectal cancer syndromes continue to play an important role even in modern age. With rapid advances in genetic technology likely to continue, and with the increasing availability of genetic testing, the need for such registries is likely to increase, not decrease. They not only support the education of patients, families, and physicians but allow deepening the research by linking genetic mutations to specific phenotypes and clinical courses. However, most notably, registries have been associated with prevention of cancer deaths. The setup of a family registry is recommended, but needs a systematic planning for a successful implementation [Guest Editor]. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843372 Fri, 20 May 2011 16:42:10 +0100 4843372 http://www.medworm.com/index.php?rid=4843371&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001223%2Fabstract%3Frss%3Dyes Hereditary colorectal cancer syndromes can be associated with a lifetime risk of colorectal cancer of >70% in the absence of specialized surveillance. Diagnosing a genetic predisposition to cancer allows clinicians to tailor cancer prevention strategies for patients and families at highest risk. Once a genetic syndrome has been identified in a family, communication with family members, timely implementation of screening tests and/or surgeries, and psychosocial support are all instrumental for effective cancer prevention. Molecular screening of tumors, computerized risk assessment models, and genetic testing can help clinicians identify individuals at risk for hereditary cancer syndromes. This review discusses some of the complexities involved in the diagnosis and management of families wit... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843371 Fri, 20 May 2011 16:42:10 +0100 4843371 http://www.medworm.com/index.php?rid=4843370&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001211%2Fabstract%3Frss%3Dyes Genetic counseling and testing for hereditary colon cancers is rapidly evolving and offers valuable management information for the clinician, the patient, and the entire family. The added genetic testing options have also increased the complexity of the process and underline the necessity of pre- and posttest genetic counseling and accurate ordering and result interpretation. Board-certified genetic counselors can assist gastroenterologists and colorectal surgeons in the genetic testing process to improve the likelihood that the correct test is ordered, reduce wasted health care dollars, and accurately interpret test results. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843370 Fri, 20 May 2011 16:42:09 +0100 4843370 http://www.medworm.com/index.php?rid=4843369&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS104314891000120X%2Fabstract%3Frss%3Dyes This article reviews the guidelines and analyzes the cost-effectiveness and possible obstacles for the 2 most common cancer syndromes, hereditary nonpolyposis colorectal cancer and familial adenomatous polyposis. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843369 Fri, 20 May 2011 16:42:09 +0100 4843369 http://www.medworm.com/index.php?rid=4843368&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001193%2Fabstract%3Frss%3Dyes Lynch syndrome and familial adenomatous polyposis represent the large majority of hereditary colorectal cancers; however, several additional less common syndromes are also associated with increased risk for developing malignancy. Identification of these syndromes requires an understanding of the phenotype to recognize the disease. Proper management of individuals and families affected by these syndromes provides an opportunity for cancer prevention. The purpose of this article is to provide a concise overview of the hereditary polyposis and colorectal cancer syndromes, exclusive of familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843368 Fri, 20 May 2011 16:42:09 +0100 4843368 http://www.medworm.com/index.php?rid=4843367&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001181%2Fabstract%3Frss%3Dyes Inherited colorectal cancer (CRC) represents 15-30% of all CRC cases. Hereditary nonpolyposis colorectal cancer and familial adenomatous polyposis are the 2 main syndromes that comprise this category, and both have a well-defined genetic defect. The introduction of immunohistochemistry and genetic testing has resulted in earlier and more sensitive diagnosis of these hereditary syndromes. The incidence of hereditary nonpolyposis colorectal cancer is estimated at 2-5% of all CRC cases and is due to a mutation of the DNA mismatch repair genes. Familial adenomatous polyposis comprises 1% of all CRC cases and is caused by a mutation in the APC tumor suppressor gene. Familial X CRC syndrome contains the remainder of the inherited CRC cases (10-25% of all CRC cases) and encompasses patients who c... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843367 Fri, 20 May 2011 16:42:09 +0100 4843367 http://www.medworm.com/index.php?rid=4843366&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS104314891000117X%2Fabstract%3Frss%3Dyes Hereditary colorectal adenocarcinomas only represent a small proportion of all colorectal cancers and, of those, only a fraction have distinct clinical or pathologic features and a mutation of a gene associated with a hereditary syndrome. These hereditary conditions include hereditary nonpolyposis colorectal cancer, familial adenomatous polyposis, MUTYH-associated polyposis, Peutz–Jeghers syndrome, and juvenile polyposis syndrome. Histopathologic features in patients with colorectal lesions (polyps, adenocarcinoma) that suggest the presence of a hereditary condition include the number and type of polyps, the morphologic features of the colorectal carcinoma, and the presence of extracolonic lesions or tumors. In addition, immunohistochemical stains can assist in identifying patients with ... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843366 Fri, 20 May 2011 16:42:09 +0100 4843366 http://www.medworm.com/index.php?rid=4843365&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001168%2Fabstract%3Frss%3Dyes Advances in molecular biology have defined the molecular basis for colorectal cancer (CRC). Although only a fraction of CRC has been determined to have a hereditary component, the discovery of genetic alterations in these clinical syndromes has permitted definition of similar discoveries in sporadic CRC. Here we delineate the molecular basis for the most common of these defined syndromes, including familial adenomatous polyposis, hereditary nonpolyposis colon cancer, MUTYH-associated polyposis, juvenile polyposis, Peutz–Jeghers syndrome, and Cowden's syndrome. The newest paradigm with implications for the pathogenesis of sporadic CRC is called the cancer stem cell hypothesis. As this paradigm also implicates aberrations in molecular pathways, a brief discussion of this hypothesis is incl... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843365 Fri, 20 May 2011 16:42:09 +0100 4843365 http://www.medworm.com/index.php?rid=4843364&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001156%2Fabstract%3Frss%3Dyes Hereditary colorectal cancer has become one of the poster scenarios to test our intellectual fitness and to demand sophistication-not because it would represent a large fraction of an average colorectal surgeon's practice, but because it has such a huge potential for negligence and inadequate care. In many regards, its management goes far beyond what we have learned as basic principles for prevention and management of sporadic colorectal cancer and the technicality of a surgical resection. Key differences are numerous: With the evolution of molecular techniques and sophisticated genetic analyses, our understanding of genetic diseases has changed dramatically. Nevertheless, the extensive amount of information has not necessarily made our lives as clinicians easier. Although Amsterdam criter... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4843364 Fri, 20 May 2011 16:42:09 +0100 4843364 http://www.medworm.com/index.php?rid=4596435&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000904%2Fabstract%3Frss%3Dyes This article reviews the current trends in biofeedback therapy for constipation and fecal incontinence. Pelvic muscle dysfunction biofeedback therapy is a group of therapies, including electromagnetic and manometric retraining, muscle stimulation therapy, and manual therapy, which can be used alone or in combination with medical management to improve patient outcomes for these conditions. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4596435 Tue, 01 Mar 2011 00:00:00 +0100 4596435 http://www.medworm.com/index.php?rid=4596434&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000898%2Fabstract%3Frss%3Dyes Rectal prolapse is a disabling and socially isolating surgical disease that frequently strikes elderly individuals with multiple risk factors for surgical intervention. Numerous operations have been designed to correct prolapse. In choosing an approach, the surgeon must balance the medical condition of his patient against the likelihood of an effective and durable repair. Operations for rectal prolapse are divided into abdominal and perineal approaches, with the former being traditionally perceived as more morbid but more enduring, and the latter as less invasive but more prone to recurrence. These perceptions are based on observational studies and there continues to be a lack of randomized data comparing the 2 approaches in terms of morbidity, efficacy, and functional outcome. Furthermore... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4596434 Tue, 01 Mar 2011 00:00:00 +0100 4596434 http://www.medworm.com/index.php?rid=4596433&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000886%2Fabstract%3Frss%3Dyes Obstructed defecation can be a significant problem for a large number of patients and treatment options are limited. Most patients can be helped by nonsurgical treatment options. Surgical intervention is successful in some patients, but preoperative selection of appropriate surgical candidates remains a problem. New abdominal surgical techniques for the treatment of patients with rectal intussusception have recently been introduced with promising results at short-term follow-up. Long-term follow-up in additional centers are warranted to establish the efficacy and durability of these methods. The efficacy and safety of the STARR procedure is still controversial and the technique has varying penetration in different parts of the world. Early experience indicates that sacral nerve stimulation... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4596433 Tue, 01 Mar 2011 00:00:00 +0100 4596433 http://www.medworm.com/index.php?rid=4596432&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000874%2Fabstract%3Frss%3Dyes Rectovaginal and rectourethral fistulas occur infrequently but result in devastating complications to patients. They also pose unique challenges to the surgeons treating these fistulas. A thorough evaluation should be performed to determine the location, size, and etiology of the fistula that may include trauma, infection, inflammatory bowel diseases, radiation, postoperative complications, and malignancy. Some fistulas may close spontaneously but most require surgical treatment. The options for repair include transrectal, transvaginal, or transperineal approaches and transabdominal approaches. Successful management of these fistulas involves recognizing the etiology, location, local tissue quality, and overall medical health of patients. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4596432 Tue, 01 Mar 2011 00:00:00 +0100 4596432 http://www.medworm.com/index.php?rid=4596431&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910001120%2Fabstract%3Frss%3Dyes Fecal incontinence (FI) is a distressing condition affecting a great number of patients. Its etiology is often multifactorial and cannot always be determined despite anorectal physiology testing or anal sphincter imaging. Severity scores combined with quality-of-life scores are useful to evaluate and compare treatment outcomes. Medical treatment to regulate bowel transit is helpful but other medications, such as topical perianal agents or antidepressants, have failed to demonstrate any efficacy. Biofeedback is widely used even if its superiority over simple conservative treatment is not apparent in systematic reviews. A variety of injectable sphincter bulking agents have been proposed with modest results. The major advance in the treatment of FI is the advent of sacral nerve stimulation (s... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4596431 Tue, 01 Mar 2011 00:00:00 +0100 4596431 http://www.medworm.com/index.php?rid=4596430&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000850%2Fabstract%3Frss%3Dyes Anal human papilloma virus (HPV) infection causes significant pathology, including condylomata as well as low- and high-grade anal intraepithelial lesions, the precursors of invasive cancer. Men who have sex with men, women with concomitant high-grade cervical/vulvar disease, and immunocompromised patients are particularly vulnerable. The incidence of anal cancer is increasing in men and women, but human immunodeficiency virus-infected patients regardless of immune reconstitution are at greatest risk. A critical review of the literature and evidence-based, comparative analysis and discussion of treatment modalities for anal HPV related diseases was undertaken. Anal cytology screening for high-grade dysplasia has been shown to be sensitive and cost-effective in men who have sex with men; an... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4596430 Tue, 01 Mar 2011 00:00:00 +0100 4596430 http://www.medworm.com/index.php?rid=4596429&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000849%2Fabstract%3Frss%3Dyes This article discusses the contributions to the colorectal literature because the publication of practice standards in 2005 and treatment approaches, including excisional hemorhoidectomy with energy devices, Doppler-guided arterial ligation and stapled hemorrhoidectomy. New data on pain treatments, including flavonoids and sphincter relaxation, are also reviewed. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4596429 Tue, 01 Mar 2011 00:00:00 +0100 4596429 http://www.medworm.com/index.php?rid=4596428&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000837%2Fabstract%3Frss%3Dyes The management of complex cryptoglandular fistula has concerned surgeons for millennia. The need to control infection and extirpate the fistula while maintaining the continence mechanism has yielded the development of multiple approaches to fistula management. Seton placement is perhaps the oldest approach to initial control of sepsis and long-term fistula management. Fistulotomy is a time-honored, highly successful approach to fistula, but it can be associated with a varying and significant impact on continence. The advancement flap was developed as a sphincter-sparing method of definitive closure of the internal opening, but this approach is technically difficult and associated with varying degrees of success and impact on continence. The anal fistula plug was introduced as a safe, easy ... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4596428 Tue, 01 Mar 2011 00:00:00 +0100 4596428 http://www.medworm.com/index.php?rid=4596427&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000825%2Fabstract%3Frss%3Dyes Anal fissure is a common problem, with several different modalities of treatment. Although the diagnosis and evaluation of fissure is not complicated, there are many different accepted treatments. Initial conservative measures focus on normalizing stool bulk and avoiding constipation. Medical treatment with nitroglycerine, calcium channel blockers, and topical anesthetics/steroids have proven efficacy, as does botulinum injection. The current evidence is not sufficient to label one of these options as the preferred treatment for anal fissure. Surgical sphincterotomy and anoplasty should be reserved for refractory cases. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4596427 Tue, 01 Mar 2011 00:00:00 +0100 4596427 http://www.medworm.com/index.php?rid=4596426&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000813%2Fabstract%3Frss%3Dyes Anorectal disorders may not be life-threatening, but they cause significant discomfort and misery. This issue of Seminars in Colon and Rectal Surgery, entitled “Advances in Anorectal Surgery,” provides an in-depth review of the most common anorectal conditions we face as colon and rectal surgeons, focusing on the most recent advances in the field. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4596426 Tue, 01 Mar 2011 00:00:00 +0100 4596426 http://www.medworm.com/index.php?rid=4204153&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000795%2Fabstract%3Frss%3Dyes Ultrasonography, including 2D, 3D, and 4D and endovaginal, endoanal, and translabial techniques, is relatively easy to perform, cost-effective, and a widely available technique for pelvic floor imaging. In this article, the methodology of the different sonographic modalities and their role in decision making in treating patients with outlet obstruction and pelvic floor disorders of the posterior compartment are presented and critically discussed. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4204153 Sat, 27 Nov 2010 05:14:37 +0100 4204153 http://www.medworm.com/index.php?rid=4204152&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000783%2Fabstract%3Frss%3Dyes Endoanal ultrasound is essential in the assessment of patients suffering from fecal incontinence. The procedure can assist in selecting patients for the appropriate treatment modality and the procedure is also used in the evaluation of outcomes after treatment. Endoanal ultrasound can identify patients that may benefit from surgical sphincter repair with overlapping sphincteroplasty and the technique also plays an important role in selecting patients for other treatment options, including the artificial anal sphincter, sacral nerve stimulation, and injectable biomaterials. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4204152 Sat, 27 Nov 2010 05:14:36 +0100 4204152 http://www.medworm.com/index.php?rid=4204151&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000771%2Fabstract%3Frss%3Dyes Fistula-in-ano and perianal abscess is a very common pathology encountered in a colorectal surgery practice. Surgical therapy is the main form of treatment. The goal is to eliminate the formation of abscess and achieve healing while preserving anal sphincter function. However, recurrence rates are significant, and postoperative stool incontinence can be present. To maximize operative results and minimize recurrence and complications, accurate preoperative assessment of the fistula is necessary. It is now increasingly recognized that preoperative imaging can help identify infection that would have otherwise gone unidentified. Magnetic resonance imaging and endoanal ultrasound findings preoperatively, especially in patients with complex or recurrent fistulas or persistent abscess, have been ... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4204151 Sat, 27 Nov 2010 05:14:36 +0100 4204151 http://www.medworm.com/index.php?rid=4204150&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS104314891000076X%2Fabstract%3Frss%3Dyes Squamous cell carcinoma is the most common malignancy of the anal canal. Accurate staging is important, both in selecting among treatment modalities and in predicting a patient's response, local recurrence, and survival. The traditional anal cancer tumor-nodes-metastases staging system is defined solely by tumor diameter, as determined via digital and anoscopic examination. As a result, a movement has emerged toward the use of endoanal ultrasound (EAUS). The data to suggest the advantages of anal canal cancer staging via the use of depth of penetration are fairly robust. Many studies, including a large multicenter prospective clinical trial, have shown ultrasound staging to be a more accurate predictor of complete response, local recurrence, and survival. EAUS is a better tool for evaluati... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4204150 Sat, 27 Nov 2010 05:14:36 +0100 4204150 http://www.medworm.com/index.php?rid=4204149&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000758%2Fabstract%3Frss%3Dyes Local recurrence of rectal cancer after treatment is a significant problem despite recent advances in surgery and adjuvant therapy. Appropriate follow-up is a cornerstone of early detection of local recurrence in hopes of timely treatment. Endorectal ultrasound is a readily available technique that can be performed in the outpatient's setting during regular follow-up and allows the detection of early and asymptomatic local recurrences. Endorectal ultrasound can also be used to obtain tissue diagnosis on the lesion in question. Other imaging modalities, including magnetic resonance imaging and positron emission tomography scanning, have been shown to be beneficial in both preoperative as well as postoperative settings. Although additional research is needed, successful detection of early re... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4204149 Sat, 27 Nov 2010 05:14:36 +0100 4204149 http://www.medworm.com/index.php?rid=4204148&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000722%2Fabstract%3Frss%3Dyes Preoperative staging of rectal cancer is important in tailoring the most optimal treatment for the patient. Early tumors T0 to T1 may be suitable for local excision therapy. More advanced lesions, such as T3 to T4, should be treated with neoadjuvant chemoirradiation before surgery because it has been shown to reduce local recurrence and improve outcomes. Endorectal ultrasound has been shown to be reliably accurate in helping the physician to assess the depth of penetration of tumor (uT staging) and acceptable in evaluating nodal involvement (uN staging). It is superior to computed tomography scan but inferior to magnetic resonance imaging. Large stenotic tumors that preclude intubation and complete assessment of the tumor are more suitably staged by magnetic resonance imaging, which is sup... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4204148 Sat, 27 Nov 2010 05:14:36 +0100 4204148 http://www.medworm.com/index.php?rid=4204147&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000746%2Fabstract%3Frss%3Dyes The performance of endoanal and endorectal ultrasound requires a solid understanding of basic anorectal and pelvic anatomy. It also requires comfort with the techniques involved. Neither of the aforementioned modalities is easily mastered. However, as with any operator-dependent technology, a solid understanding of the basics coupled with practice can allow the practitioner to eventually add this tool to his or her armamentarium. In this review, the basics of endoanal and endorectal ultrasound anatomy and technique will be reviewed with a focus on rigid ultrasound via the use of a 360° rotating crystal. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4204147 Sat, 27 Nov 2010 05:14:35 +0100 4204147 http://www.medworm.com/index.php?rid=4204146&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000734%2Fabstract%3Frss%3Dyes This article describes the evolution of ultrasound as a discipline of medical radiology, and details the basic physics that are required to obtain and interpret accurate images. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4204146 Sat, 27 Nov 2010 05:14:35 +0100 4204146 http://www.medworm.com/index.php?rid=4204145&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000801%2Fabstract%3Frss%3Dyes Upon considering my career in medical school, I was often told that surgeons were doers, not thinkers. A meticulous physical examination would tell the surgeon what the problem was, and a trip to the operating room would fix it. However, I believe that surgeons are the ultimate engineers in treating the human body; we gather as much information as possible, carefully plan our strategy, and then use our most advanced techniques to treat our patients. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=4204145 Sat, 27 Nov 2010 05:14:35 +0100 4204145 http://www.medworm.com/index.php?rid=3829230&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000497%2Fabstract%3Frss%3Dyes Although significant evidence exists detailing the benefits of enhanced recovery pathways, adoption rates have been slow for most surgeons and hospitals. Creating and implementing an enhanced recovery pathway is a significant undertaking with notable obstacles. Copious and sometimes conflicting data make determining which elements to incorporate into a care pathway difficult. The assessment of preimplementation complication and readmission rates is important to evaluate potential benefits or risks of the program to a patient population. A multidisciplinary team must be educated and committed to ensure the success of the program. Finally, both practitioners and patients must be reeducated, and preconceptions about postoperative recovery must be overcome to create a successful program. (Sour... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3829230 Sat, 07 Aug 2010 05:55:54 +0100 3829230 http://www.medworm.com/index.php?rid=3829229&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000485%2Fabstract%3Frss%3Dyes The fundamental impact of a colectomy enhanced recovery pathway is the increased efficiency provided by guidelines defining the sequencing and timing of interventions. The applicability of the pathway across a broad range of disease pathology and diverse patient populations must be considered and its value assessed across the entire episode of care. The major hurdle that limits the value proposition of an enhanced recovery pathway is successful implementation and maintenance of such pathways across all members participating in patient care. Increasing understanding of the surgical stress response will help us continue to create components within enhanced recovery pathways that will reduce morbidity and effectively reduce cost in management of colorectal patients. (Source: Seminars in Colon... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3829229 Sat, 07 Aug 2010 05:55:54 +0100 3829229 http://www.medworm.com/index.php?rid=3829228&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000473%2Fabstract%3Frss%3Dyes Perioperative outcomes after colorectal surgery can be significantly improved with fast-track recovery techniques by attenuating surgical stress responses and reducing postoperative organ dysfunction. Significant improvements in postoperative ileus and hospital length of stay can be achieved when fast-track programs are compared with traditional care for open surgery. However, whether the fast-track protocol is conducted with laparoscopic methods or open surgery, these protocols require multidisciplinary cooperation and continuous quality assurance to achieve optimal results. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3829228 Sat, 07 Aug 2010 05:55:54 +0100 3829228 http://www.medworm.com/index.php?rid=3829227&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000461%2Fabstract%3Frss%3Dyes Effective anesthesia and postoperative pain management are key elements for both optimal perioperative patient care and satisfaction and an accelerated recovery after ambulatory or inpatient colorectal surgery. A major concern for patients undergoing surgery continues to be pain control both during and after the operation. Although recent advances have been made in the development of new analgesics, treatment strategies, and delivery systems, providing effective pain control can still be a challenge. This is especially true in the setting of accelerated recovery programs that aim for early ambulation, earlier hospital discharge, and a more rapid return to the activities of daily living. We review the common methods of anesthesia and pain management for both ambulatory and major abdominal s... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3829227 Sat, 07 Aug 2010 05:55:54 +0100 3829227 http://www.medworm.com/index.php?rid=3829226&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS104314891000045X%2Fabstract%3Frss%3Dyes With the introduction of enhanced surgical recovery programs there has been a rekindled interest over recent years in the optimal surgical fluid regimen. The historical debate between liberal vs restrictive fluid regimens has been re-evaluated and the idea of individualized goal-directed therapy has been introduced and subjected to a number of randomized controlled trials. While untreated hypovolemia can be detrimental to patients, fluid overload can be just as (if not more) hazardous. By tailoring fluid administration to an individual patient's needs using a treatment algorithm based on closely monitored flow variables, postoperative recovery can be improved with reduced morbidity, less gastrointestinal dysfunction, and reduced hospital stay. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3829226 Sat, 07 Aug 2010 05:55:53 +0100 3829226 http://www.medworm.com/index.php?rid=3829225&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000448%2Fabstract%3Frss%3Dyes This article outlines the different pharmacologic options that exist for POI, with emphasis on the research during the past decade and future perspectives. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3829225 Sat, 07 Aug 2010 05:55:53 +0100 3829225 http://www.medworm.com/index.php?rid=3829224&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000436%2Fabstract%3Frss%3Dyes The National Surgical Quality Improvement Program is a validated, outcomes-based program that strives to improve the quality of surgical care nationwide. One approach to improve surgical outcomes is by reduction of adverse events, such as venous thromboembolism and surgical site infections. In this article, preventative measures with thromboprophylaxis and antibiotics are reviewed. Routine thromboprophylaxis for the hospitalized patient is recommended based on risk stratification. Mechanical, pharmacologic, or alternative interventions may be required. In addition, there are published guidelines for judicious use of antibiotics in the surgical setting. We discuss the optimal choice, administration, and duration of antibiotics with recommendations specific to colorectal patients. In the Nat... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3829224 Sat, 07 Aug 2010 05:55:53 +0100 3829224 http://www.medworm.com/index.php?rid=3829223&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000424%2Fabstract%3Frss%3Dyes Mechanical and antibiotic bowel preparation is a time tested procedure that when done appropriately, significantly reduces the risk of infectious complications of colorectal surgical procedures, surgical site infections, and anastomotic dehiscence. Currently, a 3-tier regimen, which includes preoperative mechanical cleansing to reduce the fecal load, preoperative nonabsorbed oral antimicrobials effective against both aerobic and anaerobic bacteria, and perioperative parenteral antibiotics is most commonly used in the US. The vast majority of surgeons in the US today consider this approach as the cornerstone of elective colorectal surgery. However, randomized clinical trials from several countries have concluded that the role of mechanical and antibiotic bowel preparation should be re-evalu... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3829223 Sat, 07 Aug 2010 05:55:53 +0100 3829223 http://www.medworm.com/index.php?rid=3829222&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000412%2Fabstract%3Frss%3Dyes Laparoscopic surgery has become a widely accepted standard of care for various intra-abdominal procedures, particularly colectomy. The creation of pneumoperitoneum has the potential to alter normal homeostatic mechanisms, but in general alters physiology to a lesser degree than open surgery, which translates into improvements in postoperative recovery. In addition, there are important variations in the immunologic response to laparoscopic surgery in comparison with open surgery. While all the innumerable interactions that occur both at the local site of surgery and systemically are still being elucidated, it does seem that these differences may have implications in terms of oncologic outcomes. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3829222 Sat, 07 Aug 2010 05:55:53 +0100 3829222 http://www.medworm.com/index.php?rid=3829221&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000400%2Fabstract%3Frss%3Dyes The primary goal of fast track protocols is to enhance postoperative recovery by decreasing morbidity, mortality, length of stay, and return to full function. An important component of limiting postoperative morbidity and mortality is evaluating and assessing preoperative risk. The underlying medical conditions of patients as well as their functional status form a big component of preoperative risk, which in turn is a determinant of postoperative outcomes. The preoperative history and physical examination form the backbone of preoperative risk assessment. This will direct which further tests are necessary to complete the preoperative evaluation. The underlying conditions that pose the greatest risk include cardiovascular disease, pulmonary disease, diabetes mellitus, underlying immunosuppr... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3829221 Sat, 07 Aug 2010 05:55:53 +0100 3829221 http://www.medworm.com/index.php?rid=3829220&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000394%2Fabstract%3Frss%3Dyes This edition of Seminars in Colorectal Surgery is devoted to understanding the evolution, evidence, and implementation of enhanced recovery or “fast track” pathways. I hope this overview is comprehensive and provides trainees, surgeons, and additional support staff with a fundamental understanding of why improved recovery programs have gained momentum at institutions around the globe. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3829220 Sat, 07 Aug 2010 05:55:53 +0100 3829220 http://www.medworm.com/index.php?rid=3571258&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000187%2Fabstract%3Frss%3Dyes The liver is the most common site of distant metastases in patients with colorectal cancer, and liver metastases are a frequent cause of death in this patient population. Chemotherapy is the standard treatment, with an expected median survival reaching approximately 2 years. Resection of metastases can achieve long-term cure in a small proportion of these patients. For unresectable or inoperable patients, several options for local ablative therapy exist, including radiofrequency ablation, chemoembolization, and cryotherapy. This review will discuss 2 radiotherapeutic approaches that are of growing interest due to the prospect of reducing treatment-related morbidity: external beam/stereotactic body radiation therapy, and yttrium-90 radio embolization. (Source: Seminars in Colon and Rectal S... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3571258 Tue, 18 May 2010 13:20:14 +0100 3571258 http://www.medworm.com/index.php?rid=3571257&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000175%2Fabstract%3Frss%3Dyes A decades long challenge for clinicians caring for patients with adenocarcinoma of the rectum has been to optimize oncologic outcomes while minimizing both disease- and treatment-associated morbidities. This review summarizes the landmark trials that have defined the current standard of adjuvant care for rectal cancer and ongoing/planned trials that may help shape future standards. The 1980s and 1990s witnessed validation of total mesorectal excision (TME) and 5-fluorouracil (%-FU)-based adjuvant chemoradiation therapy (CRT) as feasible and effective pillars of care for adenocarcinoma of the rectum. The parallel advancements in preoperative staging, colorectal surgery, radiation, and medical oncology during this time culminated in a trial reported by Sauer and colleagues in 2004. Not only ... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3571257 Tue, 18 May 2010 13:20:14 +0100 3571257 http://www.medworm.com/index.php?rid=3571256&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000163%2Fabstract%3Frss%3Dyes Over the past three decades, local-regional tumor control in rectal surgery has dramatically changed with the recognition of the importance of achieving tumor-free circumferential resection margins. This has led to the use of standardized total mesorectal excision (TME), with significant improvement in local control. Preoperative external beam radiation therapy (EBRT) has further increased the success of TME by reducing the rate of local relapse by half. However, the significant long term complication associated with EBRT is the price attached to this additional benefit. High Dose Rate Endocavitary Brachytherapy (HDREBT) appears to carries similar local control benefit but with minimal acute and long term complication rates. HDREBT technology was originally developed at McGill University. ... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3571256 Tue, 18 May 2010 13:20:13 +0100 3571256 http://www.medworm.com/index.php?rid=3571255&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000151%2Fabstract%3Frss%3Dyes The introduction of colorectal cancer screening is expected to lead to a dramatic increase in detection of early rectal cancer. Local excision for these early cancers spares patients a major operation, such as total mesorectal excision or abdominoperineal resection. The concern about local excision is whether it can be offered to patients with confidence that treatment results are equivalent to radical transabdominal resection. Recent publications have documented a variable risk of tumor recurrence after trananal excision with unsatisfactory oncologic results. Despite definition of histologic risk criteria for proper patient selection, local excision does not remove regional lymph nodes and thus inevitably carries the risk of unresected regional disease and imcomplete pathologic staging. I... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3571255 Tue, 18 May 2010 13:20:13 +0100 3571255 http://www.medworm.com/index.php?rid=3571254&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS104314891000014X%2Fabstract%3Frss%3Dyes Much has changed in the surgical management of rectal cancer since 1910 when Balfour first introduced the technique of anterior resection with primary end-to-end anastomosis, the first operation for rectal cancer avoiding a permanent stoma. Claude Dixon subsequently helped establish the safety and oncologic efficacy of sphincter-preserving operations for middle to upper rectal malignancies with his 1948 report of 400 patients who underwent anterior resection with a 2.6% mortality rate and 64% 5-year survival rate. The subsequent work of Black, Pollett, and Williams and coworkers improved our understanding of the biological behavior of rectal cancer, prompting surgeons to reevaluate and curtail the then standard 5-cm distal margin of resection to 2 cm. In 1972, Park described the low anteri... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3571254 Tue, 18 May 2010 13:20:13 +0100 3571254 http://www.medworm.com/index.php?rid=3571253&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000138%2Fabstract%3Frss%3Dyes To decrease local recurrence and avoid autonomic nerve injury, mobilization of the rectum is performed by anatomical dissection along the fascial planes. Anterior to the rectum, Denonvilliers' fascia divides into several laminae at both sides and separates the mesorectum from the autonomic nerves. This fascia is better preserved when the tumor is not located on the anterior wall of the rectum. Posterior to the rectum, the prehypogastric nerve fascia covering the hypogastric nerves is evident between the fascia propria of the rectum and the parietal pelvic fascia. The prehypogastric nerve fascia connects to 1 of the lateral laminae of Denonvilliers' fascia. The dissection plane posterior to the rectum is between the fascia propria of the rectum and the prehypogastric nerve fascia. After dis... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3571253 Tue, 18 May 2010 13:20:13 +0100 3571253 http://www.medworm.com/index.php?rid=3571252&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000126%2Fabstract%3Frss%3Dyes In light of the improved prognosis of rectal cancer, the quality of functional outcome has become increasingly important. Despite the good functional results achieved by expert surgeons, larger studies have shown a high incidence of pelvic organ dysfunction after rectal cancer treatment: more than half of patients experience deterioration of sexual functioning, one-third of patients report urinary dysfunction, and about half of patients suffer from fecal incontinence. Poor functional outcome, especially fecal incontinence, has a major effect on a patient's overall well-being. Therefore, construction of a permanent colostomy instead of sphincter preservation might be preferable in selective cases. Patients should be informed preoperatively about functional outcome, and different treatment o... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3571252 Tue, 18 May 2010 13:20:13 +0100 3571252 http://www.medworm.com/index.php?rid=3571251&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000114%2Fabstract%3Frss%3Dyes Treatment of patients with distal and locally advanced rectal cancer is challenging. In many series, abdominoperineal resection for distal rectal cancer is related to a high percentage of local recurrences. Some authors relate this high percentage of local recurrence to the abdominoperineal resection itself, considering it to be a poor operation for distal rectal cancer, while other authors relate it to technically inadequate resections: a high incidence of positive circumferential resection margins is seen because of coning of the specimen when the mesorectal fascia is followed or because of inadvertent perforation of the rectal wall. In many other series an acceptable low percentage of local recurrence after abdominoperineal resection is reported. These authors have consistently advocate... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3571251 Tue, 18 May 2010 13:20:12 +0100 3571251 http://www.medworm.com/index.php?rid=3571250&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000102%2Fabstract%3Frss%3Dyes Laparoscopic colectomy for cancer has been shown to be equivalent to open colectomy. Laparoscopic total mesorectal excision is feasible but remains investigational. Improvement in equipment and training for rectal dissection should result in similar outcomes to open operation for cancer in the future. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3571250 Tue, 18 May 2010 13:20:12 +0100 3571250 http://www.medworm.com/index.php?rid=3571249&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000096%2Fabstract%3Frss%3Dyes While major changes in technology have brought significant advances in treating rectal cancer, the fundamental advances in this disease, over the past 100 years, has been based on an understanding of its natural history. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3571249 Tue, 18 May 2010 13:20:12 +0100 3571249 http://www.medworm.com/index.php?rid=3571248&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000084%2Fabstract%3Frss%3Dyes Beginning with the introduction of total mesorectal excision, or TME, the past 30 years have witnessed remarkable changes in the diagnosis, evaluation, and treatment of rectal cancer. Starting in 1908, with the development of an oncologically sound operation, the field of rectal cancer has benefited from the work of physicians who were devoted to understanding the natural history of the disease and its pathophysiology, its pretreatment staging using the arts of endoscopy and of body imaging, the surgical treatment, neoadjuvant or adjuvant therapy, and follow-up. At the center of everyone's thinking, the combined goals of curative treatment and of organ and function preservation, or patient outcomes, have guided the most productive efforts, be they contributions by dedicated individuals, by... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3571248 Tue, 18 May 2010 13:20:12 +0100 3571248 http://www.medworm.com/index.php?rid=3571247&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148910000199%2Fabstract%3Frss%3Dyes The current issue of Seminars in Colon and Rectal Surgery is devoted to reducing the morbidity and the toxicities associated with treating rectal cancer. With that in mind, this issue is dedicated to Dr W. Douglas Wong, FACS, FRCS(C), whose career has been devoted to these same goals. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3571247 Tue, 18 May 2010 13:20:12 +0100 3571247 http://www.medworm.com/index.php?rid=3285432&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000669%2Fabstract%3Frss%3Dyes For many individuals, emptying their bowels is an automatic event but for some, particularly women, the process of evacuating stool may be difficult. Pelvic evacuation dysfunction refers to a constellation of symptoms such as prolonged repeated straining at bowel movements, sensation of incomplete evacuation, the need for digital manipulation, and different postures to initiate or complete bowel movements. Evacuation disorders are a result of multiple factors that include anatomical (rectocele, enterocele, and sigmoidocele), physiological (impaired rectal sensation) and functional components (nonrelaxing puborectalis). A systematic and complete pelvic floor history and physical examination should be elicited on all patients with complaints consistent with pelvic evacuation dysfunction. Ano... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285432 Fri, 19 Feb 2010 14:25:21 +0100 3285432 http://www.medworm.com/index.php?rid=3285431&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000657%2Fabstract%3Frss%3Dyes Surgical options for the management of rectal prolapse are extensive. Choosing the correct modality to suit patients needs requires an understanding of the principles of each approach and their benefits in correcting the underlying anatomical and functional defects. The abdominal approach has a lower recurrence rate and when performed laparoscopically, offers all the benefits of minimally invasive surgery including early return of bowel function, reduced analgesic requirements, and reduced time to discharge. The addition of resection to the rectopexy depends on the degree of constipation and redundancy of the sigmoid colon. It carries the risk of anastomostic leakage. The coexistence of slow-transit constipation or obstructed defecation will alter the management pathway. Patients with inco... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285431 Fri, 19 Feb 2010 14:25:21 +0100 3285431 http://www.medworm.com/index.php?rid=3285430&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000645%2Fabstract%3Frss%3Dyes Fecal incontinence is a devastating condition for patients and a challenge for physicians. There are many underlying causes that contribute to this major problem of which, a disrupted anal sphincter muscle is the only theoretically surgically treatable cause. Injury may be due to defects in the external anal sphincter and/or internal anal sphincter or a defect or a weakening of only the internal anal sphincter. A mere 20 years ago, the only available surgical methods were defect repair, levator muscle plication, or creation of a stoma. The internal anal sphincter is not amenable for surgical repair and despite initially promising short-term results of sphincteroplasty, the long-term outcomes have been very disappointing. The lack of reliable robust treatment prompted the development of new... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285430 Fri, 19 Feb 2010 14:25:20 +0100 3285430 http://www.medworm.com/index.php?rid=3285429&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000633%2Fabstract%3Frss%3Dyes The most common surgical treatment for fecal incontinence is sphincteroplasty, but this treatment option requires a localized anatomic sphincter injury and outcomes vary and tend to deteriorate with time. Other surgical techniques have therefore been developed. Postanal repair was designed to restore the anorectal angle with muscle plication of the posterior aspect of the anal canal. Initial improvement rates are acceptable, but only a small proportion of patients reports complete alleviation of symptoms and outcomes deteriorate with time. Suboptimal long-term outcome has lead to decreased use of the procedure. Electrostimulation of a transposed gracilis muscle around the anal canal can yield excellent results in selected patients. Complication rates are high when performed in nonspecialis... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285429 Fri, 19 Feb 2010 14:25:20 +0100 3285429 http://www.medworm.com/index.php?rid=3285428&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000621%2Fabstract%3Frss%3Dyes Fecal incontinence and constipation are benign conditions that can have a significant effect on the lifestyles of those affected. In order for clinicians to better understand a patient's baseline symptoms and, more importantly, to have a measure that can evaluate and compare different treatments and their outcomes, patient-validated self-report tools that assess symptoms and quality of life are essential. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285428 Fri, 19 Feb 2010 14:25:20 +0100 3285428 http://www.medworm.com/index.php?rid=3285427&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS104314890900061X%2Fabstract%3Frss%3Dyes The evaluation and testing of conditions attributed to the posterior compartment of the pelvic floor is an important component in the management of patients presenting with fecal incontinence, constipation, and anal pain. In recent years, numerous advances in radiological and physiological investigatory techniques have become available to the clinician. This can enable the underlying pathogenesis of the condition to be determined, which in turn can aid diagnosis and guide medical, behavioral, and surgical treatment. This review looks at current concepts and advances in the evaluation and testing of posterior pelvic floor disorders. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285427 Fri, 19 Feb 2010 14:25:20 +0100 3285427 http://www.medworm.com/index.php?rid=3285426&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000608%2Fabstract%3Frss%3Dyes Pelvic floor disorders encompass symptoms, including urinary incontinence, pelvic organ prolapse, and fecal incontinence. Challenges to treating individuals with pelvic floor disorders include under-reporting of symptoms and inconsistent diagnostic criterion. Nearly 1 in 4 individuals in the United States has experienced a pelvic floor disorder. Incontinence disorders are more frequent in women and the prevalence increases with age. Obstetrical trauma is a common factor in the development of pelvic floor dysfunction. Morbidly obese individuals have a higher prevalence of pelvic floor disorders and weight loss may lead to improvement of symptoms. Evaluation and treatment should address the individual's productivity and quality of life in addition to anatomic and functional limitations. Pelv... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285426 Fri, 19 Feb 2010 14:25:20 +0100 3285426 http://www.medworm.com/index.php?rid=3285425&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000591%2Fabstract%3Frss%3Dyes For health care providers, patients with pelvic floor problems can be one of the most complex and frustrating groups of patients we treat. There are many factors that must function in harmony for acceptable evacuation to occur at the correct moment. Minute changes in 1 aspect of the pelvis can lead to life altering results. Both ends of the spectrum can make patients miserable. I cannot imagine being afraid to leave my home and do daily activities for fear of having an uncontrolled spontaneous evacuation of stool. Likewise, sitting on the commode for hours daily, attempting to evacuate, and getting up only to feel you need to return to empty your rectum must be extremely frustrating. The degree patients go to alter their diet, activities, and schedule in an attempt to gain some control ove... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285425 Fri, 19 Feb 2010 14:25:20 +0100 3285425 http://www.medworm.com/index.php?rid=3098123&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000396%2Fabstract%3Frss%3Dyes As robotic technology becomes more commonplace, the demand for structured training programs in robotic surgery will increase. Every new technology has its learning curve and robotic surgery is no exception. The ideal training program in robotic surgery should progress from laboratory exercises to a mentored clinical experience in patients. This review presents the reported experience on teaching robotic surgery, suggests protocols for training colorectal surgeons as well as elaborates on the tools to objectively measure technical proficiency. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098123 Tue, 01 Dec 2009 00:00:00 +0100 3098123 http://www.medworm.com/index.php?rid=3098122&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000499%2Fabstract%3Frss%3Dyes This article reviews the technical issues that are commonplace in colorectal robotic procedures and describes available solutions. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098122 Tue, 01 Dec 2009 00:00:00 +0100 3098122 http://www.medworm.com/index.php?rid=3098121&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000451%2Fabstract%3Frss%3Dyes Since the concept of minimally invasive surgery was introduced, advances in technology have broadened laparoscopic approaches to the gastrointestinal tract. In particular, the development of robotic surgery has provided surgeons with greater comfort and the ergonomic tools necessary to overcome some of the limitations associated with conventional laparoscopic surgery. The da Vinci robotic system has been widely used in urological and gynecologic surgery and has now expanded into gastrointestinal procedures, including colorectal surgery. However, the robotic approach carries its own potential set of complications. This review will summarize the complications associated with robotic-assisted colorectal surgery in the current published report as well as robotic surgical failures seen when usi... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098121 Tue, 01 Dec 2009 00:00:00 +0100 3098121 http://www.medworm.com/index.php?rid=3098120&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000670%2Fabstract%3Frss%3Dyes The intended application of robotics in surgery was in the field of cardiac surgery. The addition of robot was thought to improve surgeon dexterity in a small field with the added advantage of a minimal invasive approach. Shortly thereafter, urologists recognized that this modality could be used in the deep pelvis and brought the robot to its current most widely used application, the robotic prostatectomy. In the subsequent years, the use of this technology for other “pelvic organs” such as the uterus, rectum, and bladder evolved. Similarly, during this time period, minimally invasive surgical techniques were being studied in colorectal surgery. The results of the Clinical Outcomes of Surgical Therapy trial in 2004 concluded that laparoscopic approaches to colon cancer could be perform... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098120 Tue, 01 Dec 2009 00:00:00 +0100 3098120 http://www.medworm.com/index.php?rid=3098119&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS104314890900044X%2Fabstract%3Frss%3Dyes Robotic surgery has many features that make it superior to traditional laparoscopic surgery. However, the use of the robot is limited by the need to reposition the robot during colon and rectal operations encompassing more than one abdominal quadrant. A “hybrid” technique has been developed which combines traditional laparoscopy with a robotic pelvic dissection. With this combined approach, the benefits of the 2 techniques can be maximized, while minimizing their limitations. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098119 Tue, 01 Dec 2009 00:00:00 +0100 3098119 http://www.medworm.com/index.php?rid=3098118&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000438%2Fabstract%3Frss%3Dyes Various surgical options exist for patients with pelvic organ prolapse. Conventionally, open procedures have been performed laparoscopically with similar results and fewer morbidity. However, widespread use of laparoscopy to treat rectal and vaginal vault prolapse has been limited by the technical challenges of performing these surgeries with a minimally invasive approach. Robotic surgery allows for improved visualization and ergonomics, enabling the surgeon to perform complicated procedures more easily. Robotically assisted laparoscopic rectopexies and sacrocolpopexies have been shown to have excellent results but they increase operative time and cost. Further investigation is needed to demonstrate clear advantages to using this approach over conventional laparoscopy. (Source: Seminars in... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098118 Tue, 01 Dec 2009 00:00:00 +0100 3098118 http://www.medworm.com/index.php?rid=3098117&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000463%2Fabstract%3Frss%3Dyes There are many potential advantages of using robotics for resection of the left colon and the sigmoid colon. These include stable traction of the vascular pedicles, preservation of the aortic and the hypogastric nerve plexus, improved accessibility for take-down of the splenic flexure, and easily applicable intracorporeal colorectal or colocolic anastomosis. This chapter provides a detailed description of the technique used in a robotic dissection for a left colectomy or sigmoidectomy. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098117 Tue, 01 Dec 2009 00:00:00 +0100 3098117 http://www.medworm.com/index.php?rid=3098116&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000426%2Fabstract%3Frss%3Dyes Robotic colectomy has been shown to be a feasible and safe procedure. Although left-sided colectomy and proctectomy have received the most attention in robotics application, the advantages of robotic technology apply equally to resection of the right colon. A description of a technique for robotic right hemicolectomy with intracorporeal anastomosis is presented, and it addresses some of the inherent limitations of current robotic systems. The potential advantages and disadvantages of robotics for right colon surgery are also discussed. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098116 Tue, 01 Dec 2009 00:00:00 +0100 3098116 http://www.medworm.com/index.php?rid=3098115&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000414%2Fabstract%3Frss%3Dyes Robotic surgery is a growing field that has introduced a new range of instruments, procedures, and protocols into the standard OR suite. The safety and efficiency of robotic assistance in surgical practice depend significantly on the presence of a consistent, trained, and experienced nursing staff and OR team. Establishing a robotic coordinator position goes a long way in optimal OR scheduling, timely procurement of instruments, training of nursing staff, and in collaborating between surgeons across multiple services. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098115 Tue, 01 Dec 2009 00:00:00 +0100 3098115 http://www.medworm.com/index.php?rid=3098114&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000402%2Fabstract%3Frss%3Dyes Surgical robots, although relatively new, have developed quickly. The development of surgical robots is reviewed in this article. The surgical robots have applications in many surgical specialties. The most widely used surgical robotic system is the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) that is based on an immersive, “master-slave” paradigm which enhances the surgeon's abilities. Surgical robotics is changing rapidly, and any development in surgical robots in future will allow greater application of robotic devices to increasingly more difficult procedures and hard to access anatomical sites, with significant improvement in patient outcomes. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098114 Tue, 01 Dec 2009 00:00:00 +0100 3098114 http://www.medworm.com/index.php?rid=3098113&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000384%2Fabstract%3Frss%3Dyes The relevance of this issue of Seminars in Colon and Rectal Surgery on “Robotics in Colorectal Surgery” cannot be overemphasized. With the use of robotic assistance in prostatic surgery rapidly emerging as a standard of care, the application of robotic technology in other surgical disciplines is gaining increasing importance. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098113 Tue, 01 Dec 2009 00:00:00 +0100 3098113 http://www.medworm.com/index.php?rid=2884269&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000190%2Fabstract%3Frss%3Dyes Perineal hernia is an uncommon complication following major pelvic surgery. The estimated incidence of herniation is 0.2%-3.5% following abdominoperineal resection. Symptomatic patients may undergo repair by a transabdominal, transperineal, combined abdominoperineal, or laparoscopic approach. Controversy continues with regard to the method of repair with many surgeons employing the use of mesh or local muscular flaps to buttress the pelvic floor. Recurrence rates are moderate but are also limited by small number of cases reported in the literature. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884269 Mon, 31 Aug 2009 23:00:00 +0100 2884269 http://www.medworm.com/index.php?rid=2884268&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000487%2Fabstract%3Frss%3Dyes We present here a review of these procedures with and without graft reinforcement as well as the current report supporting their use. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884268 Mon, 31 Aug 2009 23:00:00 +0100 2884268 http://www.medworm.com/index.php?rid=2884267&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000189%2Fabstract%3Frss%3Dyes The literature regarding mesh-related complications especially in the posterior vaginal compartment is incomplete and often it remains unclear whether the surgical technique or the employed mesh caused the complication. As the industry pushes and surgical training of conventional techniques diminishes, the use of synthetic mesh is tempting and anatomical results are promising. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884267 Mon, 31 Aug 2009 23:00:00 +0100 2884267 http://www.medworm.com/index.php?rid=2884266&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000177%2Fabstract%3Frss%3Dyes Parastomal herniation is an often encountered consequence of stoma formation. Most parastomal hernias never require surgical intervention. Of the numerous procedures for the repair of parastomal hernias, the best outcomes have been obtained with the application of synthetic mesh. The potential for serious complications arising from synthetic mesh has prompted investigations of biological implants as an alternative. These grafts provide an acellular collagen scaffold into which host cells migrate, producing the appropriate native tissue. The experience with the biomaterials AlloDerm, Permacol, Surgisis Gold, and Veritas for parastomal hernia repair has yielded satisfactory results in small, nonrandomized, short-term studies and case reports. Similarly, limited audits suggest the promise of ... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884266 Mon, 31 Aug 2009 23:00:00 +0100 2884266 http://www.medworm.com/index.php?rid=2884265&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000165%2Fabstract%3Frss%3Dyes Complications after open or laparoscopic approaches to ventral or incisional hernia repair with mesh span a wide range of severity. Intraoperative injuries to the bowel are rare but may necessitate a change in the operative plan. Postoperative complications are comprised of those common to all general surgery, for example, thromboembolism and superficial surgical site infection, and are typically managed no differently. Unique to recovery from hernia surgery however can be increased pain after mesh placement, seroma related to large dissection planes, infections of the mesh, as well as pulmonary insufficiency due to changes or loss in abdominal domain. Laparoscopic approaches to ventral or incisional hernia have dramatically affected the morbidity of surgery but may introduce complications... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884265 Mon, 31 Aug 2009 23:00:00 +0100 2884265 http://www.medworm.com/index.php?rid=2884264&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000153%2Fabstract%3Frss%3Dyes Laparoscopic ventral hernia repair (LVHR) offers a minimally invasive option for the repair of congenital or incisional abdominal wall hernias. A key component of LVHR is the placement of a prosthetic or biological mesh intraperitoneally to cover the defect without reapproximating the fascial edges with a primary suture repair. The optimum mesh provides high tensile strength, reducing the risk of recurrence, stimulates host tissue ingrowth without promoting adhesion or fistula formation, resists secondary infection and seroma formation, and is affordable. Numerous mesh materials are available on the market, each with specific advantages and disadvantages. However, no single mesh possesses all the qualities of the ideal mesh and relatively few studies have been performed comparing meshes of... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884264 Mon, 31 Aug 2009 23:00:00 +0100 2884264 http://www.medworm.com/index.php?rid=2884263&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000141%2Fabstract%3Frss%3Dyes The objective of this review is to describe the biomechanical properties of commonly used mesh materials and the available evidence regarding their effects on wound healing. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884263 Mon, 31 Aug 2009 23:00:00 +0100 2884263 http://www.medworm.com/index.php?rid=2884262&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS104314890900013X%2Fabstract%3Frss%3Dyes The concept of using a reinforcing material in the repair of hernias is ancient, as Dr Northington and Dr Asfaw point out in this issue. The practice has, at various times and points in recent history, fallen in and out of favor as new uses, and new complications, have arrived. It is evident from most data that the use of mesh in the repair of large ventral and inguinal hernias has clear benefit in reduction of recurrence rates over primary repair alone. Clearly, this comes at the price of mesh-related complications, as Drs Resnick and Bleier point out. The main problem using mesh in these circumstances seems to be determining which mesh to use. So little data exist favoring one type of mesh over another that empiricism seems to be the rule at times. Even so, detailed retrospective reviews... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884262 Mon, 31 Aug 2009 23:00:00 +0100 2884262 http://www.medworm.com/index.php?rid=2693336&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000104%2Fabstract%3Frss%3Dyes Abdominal salvage surgery is a major undertaking for patients with imminent ileal pouch failure. The success of abdominal salvage surgery for sepsis is less than for a nonseptic indication. Although functional outcomes following abdominal revisional surgery can improve significantly, pouch failure after abdominal salvage continues steadily over time. Complications may occur and the duration of treatment, including in-hospital stay, may have a serious impact on a patient who has already suffered disappointment and ill health owing to the threatened failure after primary restorative proctocolectomy. The chance of success is an essential part of the consultation process and must be discussed fully. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693336 Sun, 31 May 2009 23:00:00 +0100 2693336 http://www.medworm.com/index.php?rid=2693335&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000116%2Fabstract%3Frss%3Dyes An extended resection of the colon and rectum may be required in a variety of diseases, including neoplastic, inflammatory, and functional conditions. Restorative procedures after an extended resection are meant to avoid a permanent stoma, achieve good function and quality of life (QoL), and reduce complication rates to a minimum. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693335 Sun, 31 May 2009 23:00:00 +0100 2693335 http://www.medworm.com/index.php?rid=2693334&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000128%2Fabstract%3Frss%3Dyes Ileal pouch anal anastomosis is the procedure of choice for most patients undergoing proctocolectomy for ulcerative colitis and a proportion of patients with familial adenomatous polyposis. Since its first description in 1978, there has been evolution and refinement in the technical aspects of ileoanal pouch construction. This has been facilitated by advancements in stapler technology, and an increased focus on functional outcome. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693334 Sun, 31 May 2009 23:00:00 +0100 2693334 http://www.medworm.com/index.php?rid=2693333&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000050%2Fabstract%3Frss%3Dyes Restorative proctocolectomy and ileal pouch anal anastomosis (RP/IPAA) have been the procedures of choice for patients with ulcerative colitis, or familial adenomatous polyposis, and those with other diagnoses who require surgery. The options for this procedure are J, S, or W ileal pelvic pouch anastomosed by either stapled or hand-sewn technique. J-pouch is the preferred technique of most surgeons. The stapled IPAA is quicker, more secure, and safer, with better function, while the hand-sewn IPAA allows removal of the diseased anal transitional zone. Recently, in most of the centers, the use of a hand-sewn IPAA has been limited to those with dysplasia or lower rectum cancer and to when a stapled IPAA has failed. Although leaving intact rectal mucosa after stapled IPAA could be a potential... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693333 Sun, 31 May 2009 23:00:00 +0100 2693333 http://www.medworm.com/index.php?rid=2693332&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000098%2Fabstract%3Frss%3Dyes Ileorectal anastomosis (IRA) or ileorectostomy refers to the connection of terminal ileum to rectum following extirpation of the colon by total abdominal colectomy. This procedure is of great historical interest having been initially championed by Stanley Aylett from the UK, and used for over 50 years, as an alternative to proctocolectomy and permanent ileostomy for patients with ulcerative colitis. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693332 Sun, 31 May 2009 23:00:00 +0100 2693332 http://www.medworm.com/index.php?rid=2693331&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000062%2Fabstract%3Frss%3Dyes This article presents current indications, technical aspects and outcomes of this historical procedure, the Turnbull-Cutait abdominoperineal pull-through anastomosis, and reviews the relevant literature. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693331 Sun, 31 May 2009 23:00:00 +0100 2693331 http://www.medworm.com/index.php?rid=2693330&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000074%2Fabstract%3Frss%3Dyes Preservation of rectal function after low anterior resection or proctectomy with formation of a neorectum has improved the quality of life of many patients with rectal cancers. This would mean preserving the anal sphincters and avoiding a permanent stoma while reconstructing a neorectum to improve the bowel function of patients. Following proctectomy, the traditional anastomosis will be a straight coloanal end-to-end anastomosis to restore bowel continuity. However, this is associated with very poor bowel function. The construction of a colonic J-pouch anastomosis is introduced to reduce this problem. While colonic J-pouch anastomosis is able to obviate some of the functional problems of straight coloanal anastomosis, it comes with an additional problem of pouch evacuation. Therefore, alte... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693330 Sun, 31 May 2009 23:00:00 +0100 2693330 http://www.medworm.com/index.php?rid=2693329&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000086%2Fabstract%3Frss%3Dyes Following a resection of a rectal cancer with a total mesorectum excision, bowel continuity can be restored by different types of coloanal anastomosis: straight anastomosis, J-pouch, coloplasty, or side-to-end. A J-pouch is made after resection of the rectum. Two 6-cm colon limbs are folded up and a colotomy is made at the apex of the J. A side-to-side anastomosis is then performed on the antimesenteric side for 7 cm. For coloplasty, an 8- to 10-cm longitudinal incision is made along the antimesenteric side, starting 4 cm above the distal cut edge and the incision is closed transversely. A side-to-end anastomosis can be made using a stapler device introduced through the anus or through the distal end of the colon or hand-sewn via a perineal approach. Every coloanal anastomosis should be dr... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693329 Sun, 31 May 2009 23:00:00 +0100 2693329 http://www.medworm.com/index.php?rid=2693328&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000049%2Fabstract%3Frss%3Dyes This edition of Seminars in Colon and Rectal Surgery includes articles that describe the techniques to construct a new rectal reservoir and outcomes after these reconstructive procedures. The first article, by Jeremie H. Lefevre and Yann Parc from Paris, France, describes the techniques of colonic J-pouch, coloplasty, and side-to-end anastomosis. Meta-analysis and comparison of outcomes of colonic J-pouch, coloplasty, and side-to-end anastomosis are covered by Boon-Swee Ooi and Jiunn-Herng Lai from Singapore. Indications and outcomes of rectal reconstruction using the Turnbull-Cutait abdominoperineal pullthrough anastomosis is reviewed by I. Emre Gorgun and Jeffrey W. Milsom from New York. Peter Siaperas and John Hartley from Cottingham, UK, provide indications and outcomes of ileorectal a... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693328 Sun, 31 May 2009 23:00:00 +0100 2693328 http://www.medworm.com/index.php?rid=2478580&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000730%2Fabstract%3Frss%3Dyes Rectovaginal fistulas are a common type of anal fistulous disease that presents a distressing problem for the patient and a challenge for the treating physician. The symptoms can be minimal but frequently are disabling and associated with significant psychosocial and sexual dysfunction. Successful management must consider the etiology of the fistula and the health of both the rectum and the patient. It is important to completely evaluate the patient before any consideration is given to surgical correction. This includes evaluation of the function of the anal sphincter and the involvement of any other organ systems. The surgical management of fistulas between the anorectum and the vagina depends on the size, location, and cause of the fistula; anal sphincter function and overall health stat... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478580 Sun, 01 Mar 2009 05:00:00 +0100 2478580 http://www.medworm.com/index.php?rid=2478579&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000729%2Fabstract%3Frss%3Dyes Complex fistulas are difficult to treat. The options available are advancement flaps, fibrin glue, and, of late, anal fistula plug (AFP). A sizable proportion of the published studies are from the US and Europe. The results from these studies were analyzed and compared to the results of the published literature from the east (Asia and Australia). The overall success rate ranges from 46% to 100% for advancement flaps, 14% to 78% for fibrin glue, and 24% to 87% for AFP technique. However, the present data is insufficient to conclude the superiority of either (ie, fibrin glue or AFP procedure) over the other. So, depending on the surgeon's preference, either of the two procedures may be recommended as the first line of approach to tackle complex fistulas. Advancement flap procedure is associa... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478579 Sun, 01 Mar 2009 05:00:00 +0100 2478579 http://www.medworm.com/index.php?rid=2478578&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000717%2Fabstract%3Frss%3Dyes Impressed by the initial success rates (80%) of the Cook Surgisis AFP anal fistula plug for the closure of both cryptoglandular and Crohn's associated anorectal fistulas, the preliminary results from Europe showed healing rates of 41% and 61%, respectively. However, no impairment of continence was documented. Analyzing the current experiences of the plug procedure from a German perspective, a variety of issues are under debate including the role of bowel preparation, treatment of fistula tract, closure of the internal opening, postoperative management, and, finally, financial reimbursement. Furthermore, the “ideal” indication has to be defined. In general, the introduction of the plug has accelerated a “new” discussion on the optimal treatment of high anorectal fistulas. Further an... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478578 Sun, 01 Mar 2009 05:00:00 +0100 2478578 http://www.medworm.com/index.php?rid=2478577&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000705%2Fabstract%3Frss%3Dyes Anorectal fistulae are a heterogeneous group of disorders that can cause significant pain, social impairment, hygienic problems, and, rarely, sepsis. Surgery is the mainstay of treatment for anorectal fistulae, yet no one procedure is universally efficacious and safe. Simple fistulae can often be treated by simple fistulotomy, but complex fistulae present a more complicated scenario—effective surgical treatment options are compromised by increased risk of incontinence. Likewise, safe treatment alternatives have low risk of postoperative incontinence but low success rates. The Surgisis AFP appears to be an effective and safe treatment alternative for complex fistula, including Crohn's fistula, based on initial reports. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478577 Sun, 01 Mar 2009 05:00:00 +0100 2478577 http://www.medworm.com/index.php?rid=2478576&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000699%2Fabstract%3Frss%3Dyes This article explains the mode of action of fibrin glue, reviews the current literature, and highlights the varied opinions and potential reasons for its lower long-term success rates. It also introduces the fistula plug, which has demonstrated fistula healing in recent reports. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478576 Sun, 01 Mar 2009 05:00:00 +0100 2478576 http://www.medworm.com/index.php?rid=2478575&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000687%2Fabstract%3Frss%3Dyes Medical devices fabricated from the tissues of animals have been used for decades to repair failing human tissues and organs. Only recently, however, the notion that these tissues can be processed in ways that retain the natural structure and composition of the extracellular matrix (ECM) and then implanted without inciting adverse immune system reactions has become reality. Because natural ECM contains a complex composition of biologically active molecules able to assist in the restoration of a functional ECM when the patient's ECM is characterized by abnormal levels of pro-inflammatory factors and matrix-degrading enzymes, naturally occurring ECM can be used as a strategy to induce healing in both chronic skin ulcers and in chronic, complex fistulas. In this article, we compare the functi... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478575 Sun, 01 Mar 2009 05:00:00 +0100 2478575 http://www.medworm.com/index.php?rid=2478574&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000675%2Fabstract%3Frss%3Dyes Complex perianal fistulas are a significant cause of morbidity with detrimental effects on patient's quality of life. Affected individuals often require repeated anorectal surgeries with the potential for fecal incontinence and the need for a permanent stoma. Endoanal advancement flaps which use the basic premise of covering the fistulous opening with healthy tissue are an important surgical option. The rectal advancement flap is the most commonly used. The sleeve advancement flap is reserved for patients with severe fistulous disease in particular perianal Crohn's. If an abdominal approach is required, then one may consider a Turnbull-Cutait. Other options include the use of anocutaneous flaps and their variants. For a rectovaginal fistula with a thin perineum and coexisting sphincter inj... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478574 Sun, 01 Mar 2009 05:00:00 +0100 2478574 http://www.medworm.com/index.php?rid=2478573&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000663%2Fabstract%3Frss%3Dyes Anal fistulotomy, the unroofing of the entire tract from the external to the internal opening, is the most effective and simple treatment for most patients with anal fistula. However, anal fistulotomy carries a risk of fecal incontinence that is related to the loss of sphincter function and the deformity of the anal canal that results from dividing the tissue encircled by the fistula. The main treatment challenge is how to select patients who will be cured of their fistula without developing postoperative fecal incontinence. The decision should be individualized according to the proportion of the muscle involved, the location of the tract, the patient's sex, history of previous anal surgery, continence, and finally, but not less importantly, the surgeon's experience. (Source: Seminars in C... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478573 Sun, 01 Mar 2009 05:00:00 +0100 2478573 http://www.medworm.com/index.php?rid=2478572&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000651%2Fabstract%3Frss%3Dyes Setons in the treatment of fistula-in-ano have been used for thousands of years. Although there are few high-quality prospective trials, there are numerous retrospective series documenting high cure rates of more than 90% with cutting setons or two stage seton fistulotomy. Both techniques, however, result in a variable rate of incontinence, higher with two stage seton fistulotomy where the internal anal sphincter is routinely divided. Incontinence rates for slow cutting setons are 10%-20% for minor incontinence with rates of 0%-10% for major incontinence; compared to rates of more than 35% and as high as 70% with the two-stage technique. Loose draining setons have an important role the management of Crohn's disease and can result in good palliation with minimal risk of deterioration of bow... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478572 Sun, 01 Mar 2009 05:00:00 +0100 2478572 http://www.medworm.com/index.php?rid=2478571&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS104314890800064X%2Fabstract%3Frss%3Dyes This article aims to discuss the rationale for imaging and to review the options available. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478571 Sun, 01 Mar 2009 05:00:00 +0100 2478571 http://www.medworm.com/index.php?rid=2478570&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000638%2Fabstract%3Frss%3Dyes Complex anorectal fistula is probably the most frustrating and challenging pathology in colorectal surgery. It has plagued mankind since the sun came up and continues to baffle and frustrate us even in the 21st century. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478570 Sun, 01 Mar 2009 05:00:00 +0100 2478570