Colorectal Surgery Consultation: Tips and Tricks for the Management of Operative Challenges

Description:

This book provides clear surgical options when the cases are not “routine”.  It follows both a “how to” manual as well as an algorithm-based guide to allow the reader to understand the thought process behind the proposed treatment strategy. In each chapter, international experts address how to avoid being in tough surgical situations through preoperative planning, how to better deal with commonly encountered intra-operative findings, how to deal with difficult laparoscopic, open, endoscopic, and anorectal cases, and how to avoid medico-legal issues. Colorectal Surgery Consultation is simple and succinct and provides pragmatic advice and reproducible techniques that can be readily implemented by surgeons of varying experience to successfully treat complex colorectal problems through endoscopic and endoluminal approaches that may make the difference in patient outcomes.

Table of Contents:

Part I. Introduction

1. How to Avoid Getting into Difficult Operative Situations

2. Principles in Approaching Difficult Operative Situations

Part II. How to Deal with Commonly Encountered Intra-operative Findings/Complications

3. Extensive Intra-abdominal Adhesions

4. Intraoperative Injury to Small or Large Bowel

5. Injury to the Rectum During Pelvic Surgery

6. Appendectomy Pathology Report Returns Adenocarcinoma, Carcinoid, or Appendiceal Mucinous Neoplasm

7. Unexpected Findings: Normal Appendix During Appendectomy

8. During Sigmoid Resection for Diverticulitis, the Patient Is Found to Have Diffuse Diverticulosis

9. Intraoperatively the Patient Is Found Incidentally to Have Colon or Small Bowel Inflammation

10. Unexpected Findings: Intraoperatively Suspected Colon Cancer Turns Out to Be Rectal Cancer

11. Unexpected Findings: Can’t Find the Colon Lesion

12. Unexpected Findings: The “Malignant Polyp”

13. Unexpected Findings: Positive Air Leak

14. Unexpected Findings: Anastomotic “Donut” Problems – Incomplete or Missing Donuts with a Negative Leak Test

15. Unexpected Findings: Locally Advanced Colon Cancer

Part III. Technical Tips and Tricks for Difficult Abdominal Cases

16. Difficult to Close Abdomen

17. The Difficult Splenic Flexure

18. Hartmann Takedown: Managing the Hard to Reach or Devascularized Left Colon

19. Cannot Find the Rectal Stump During Hartmann Reversal

20. Rectal Stump Perforation Stump While Passing an End-to-End Anastomotic Stapler

21. Inability to Pass End-to-End Anastomotic Stapler

22. The J Pouch Does Not Reach

23. Intraoperative Management of Bleeding at Stapled Side-to-Side Anastomosis

24. Postoperative End-to-End Anastomotic Bleeding

25. Postoperative Anastomotic Leak After Low Anterior Resection

26. Colon Does Not Reach for a Coloanal Anastomosis

27. Cannot Find Internal Opening of Fistula-in-Ano

28. How to Deal with Crohn’s Friable and Fragile Mesentery

29. Ulcerative Colitis with Severe Inflammation and Friable Tissues: How to Avoid Intraoperative Perforation and Manage the Colorectal Stump

30. Patient Develops Anastomotic Stricture After Low Anastomosis with Diverting Ileostomy

31. Presacral Bleeding

32. Cannot Extract the Circular Stapler

Part IV. Technical Tips and Tricks for Difficult Laparoscopic Cases

33. General Technical Recommendations for Difficult Laparoscopic Cases

34. Dislodged Laparoscopic Cannulas

35. How to Keep the Small Bowel from Getting in the Way of a Laparoscopic Operation

36. Laparoscopic Suturing

37. Re-look After Laparoscopic Resection

38. Retraction of a “Floppy Uterus” Encountered During Minimally Invasive Rectal Resection

39. Bleeding During Colectomy

40. Cannot Find the Ureter

41. Ileum Becomes Ischemic Due to Torsion During J-Pouch Creation

42. Difficult Laparoscopic Rectal Dissection

43. Techniques for Laparoscopic Distal Rectal Stapled Transection

44. How to Avoid “Twisting” an Ileocolic or Ileorectal Anastomosis

45. How to Deal with Splenic Injury During Laparoscopic Flexure Mobilization

46. Entering the Reoperative Hostile Abdomen Laparoscopically

47. Manage Inferior Epigastric Bleeding

Part V. Technical Tips and Tricks for Difficult Colostomy/Ileostomy

48. Hard to Reach Colostomy/Ileostomy

49. Stoma Prolapse

50. Ileostomy Retracts Below the Skin

Part VI. Technical Tips and Tricks for Difficult Anorectal Cases

51. Difficulties with the Stapled Hemorrhoidectomy Procedure

52. Symptomatic Long Residual Rectal Cuff Status Post J-Pouch

53. Difficult Anterior Perineal Dissection During Abdominoperineal Resection

54. Anastomotic Sinus After Low Anterior Resection and Diverting Loop Ileostomy

Part VII. Tips and Tricks for Difficult Colonoscopic Cases

55. Cannot Pass the Scope into the Cecum

56. Difficult to Remove Polyp

57. Bleeding After Colonoscopic Polypectomy

58. The Thin Colon After Endoscopic Mucosal Resection

59. Cannot Remove the Snare During Colonoscopy

60. How to Address a Polyp Involving the Appendiceal Orifice

Part VIII. Medico-Legal Issues

61. Medico-Legal Issues in Minimally Invasive Colon and Rectal Surgery: A Primer

Back Matter

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