The ASCRS Textbook of Colon and Rectal Surgery

Foreword
Preface
Contents
Contributors
	Editors
	Authors
Part I: Perioperative/Endoscopy
	1: Anatomy and Embryology of the Colon, Rectum, and Anus
		Anatomy of the Anal Canal and Pelvic Floor
			Anal Canal Epithelium
			Internal Anal Sphincter
			Conjoined Longitudinal Muscle
			External Anal Sphincter
			Hemorrhoids
			Perineal Body
			Pelvic Floor Muscles
				Puborectalis Muscle
				Iliococcygeus Muscle
				Pubococcygeus Muscle
		Anatomy of the Rectum
			Mesorectum
			Presacral Fascia
			Retrosacral Fascia
			Waldeyer’s Fascia
			Denonvilliers’ Fascia
			Lateral Ligaments
			Rectal Valves: The Spiral Valves of Houston and Kohlrausch’s Valve
		Anorectal Spaces
			Perianal Space
			Intersphincteric Space
			Submucous Space
			Ischioanal/Ischiorectal Space
			Supralevator Space
			Superficial and Deep Postanal Spaces
			Retrorectal Space
			Rectal Blood Supply
				Superior Rectal Artery
				Middle Rectal Artery
				Inferior Rectal Artery
			Venous and Lymphatic Drainage of the Rectum and Anus
			Innervation of the Rectum and Anus
		Anatomy of the Colon
			Cecum
			The Appendix
			Ascending Colon
			Transverse Colon
			Descending Colon
			Sigmoid Colon
			Rectosigmoid Junction
			Blood Supply
			Superior Mesenteric Artery
			Inferior Mesenteric Artery
			The Marginal Artery and Other Mesenteric Collaterals
			Venous Drainage
			Lymphatic Drainage
			Nervous Innervation
		Embryology
			Anus and Rectum
			Colon and Small Intestine
			Midgut Rotation
			Major Anomalies of Rotation
				Non-rotation
				Malrotation
				Reversed Rotation
				Omphalocele
				Internal Hernias
			Other Congenital Malformations of the Colon and Small Intestine
				Proximal Colon Duplication
				Meckel’s Diverticulum
				Atresia of the Colon
				Hirschsprung’s Disease
			Anorectal Malformations
				Anal Stenosis
				Membranous Atresia
				Anal Agenesis
				Anorectal Agenesis
				Rectal Atresia or “High Atresia”
				Persistent Cloaca
		References
	2: Colonic Physiology
		Embryology
		Colonic Anatomy
			Introduction
			Colonic Wall Anatomy
			Epithelial Types
			Secretory Role of Colonic Epithelium
				Sodium
				Potassium
				Aldosterone
			Mechanism for Water Absorption
				Short-Chain Fatty Acid Absorption
				Vitamin K Absorption
			Colonic Innervation
			Pain
			Colonic Motility
			Modulators of Colonic Motility
			Microbiome
		Conclusion
		References
	3: Anorectal Physiology
		Introduction
		Anatomy
		Physiology
			Innervation of the Anus and Pelvic Floor
			Normal Continence
				Rectal Sensation and Compliance
				Anorectal Reflexes
				Internal and External Anal Sphincters
				Puborectalis and the Pelvic Floor
			Normal Defecation
		Physiologic Testing
			Anal Manometry
			Pudendal Nerve Terminal Motor Latency
			Balloon Insufflation
			Defecography
		Functional Anorectal Disorders
			Fecal Incontinence
			Disorders of Defecation
			Anorectal Pain
		Urogynecological Considerations
		References
	4: Endoscopy
		Introduction
		Anorectal Examination
			Patient Positioning
			Inspection and Palpation
			Digital Rectal Examination
			Anoscopy
			Proctoscopy
		Endoanal/Endorectal Ultrasound
		Flexible Endoscopy Techniques
			Torque
			Tip Deflection
			Dithering/Jiggle
			Air Aspiration
			Slide-By
		Flexible Sigmoidoscopy
		Colonoscopy
			Bowel Preparation
			Special Considerations
				Poor/Difficult Prep
				Need for Antibiotics
				Anticoagulated Patient
			Sedation
			Instrumentation
			Colonoscopy Technique
			Alternative Techniques
				Carbon Dioxide Insufflation
				Water Insufflation
				Chromoendoscopy
				Narrow Band Imaging
				Full-Spectrum Endoscopy
			Difficult Exams
				Changing Patient Position
				Abdominal Pressure
				Rotating the Scope
			Incomplete Colonoscopy
			Complications
				Complications Due to Bowel Preparation
				Complications Due to Anesthesia/Sedation
				Procedural Complications
					Perforation
					Bleeding
					Post-polypectomy Syndrome
					Splenic Injury
					Infectious Complications
		The Endoscopy Unit
			Endoscope Processing
			Efficiency
			Quality Measures
				Withdrawal Time
				Adenoma Detection Rate
			Leasing vs Purchasing Endoscopy Equipment
		Training and Simulation
		Summary
		References
	5: Endoscopic Management of Polyps and Endolumenal Surgery
		Introduction
		Forceps
		Snare
			Tips for Optimal Snaring
		Lifting
		Endoscopic Mucosal Resection
			Clip
			Underwater EMR
		Endoscopic Submucosal Dissection
			ESD Complications
			Patient Selection for ESD
			ESD Technique
			Postoperative Care
			Controversies with ESD Versus EMR
		Endoscopic Suturing
		Stabilization Platforms
		Approach to Referral for Unresectable Polyp
		Colonic Stenting
			Stenting Technique
			Stenting Anastomotic Leaks
		Conclusion
		References
	6: Preoperative Evaluation in Colorectal Patients
		Evaluation of the Routine Colorectal Patients
			In Office by Surgeon
			Abdominal Surgery
			Anorectal Surgery
			Preoperative Testing
				Laboratory Studies
				Electrocardiogram
				Chest X-Ray
				Advanced Diagnostic Imaging
			Cardiac Evaluation
				Assessment of Cardiac Risk
				Initial Workup
				Additional Testing
				Preoperative Optimization and Medical Therapy
					Preoperative Anticoagulation
					Coronary Stent Management
				Bridging
				AICD/Management
			Pulmonary Assessment
				Perioperative Steroid Management
				Diabetes
				Obesity
				Malnutrition
				Solid Organ Transplant Recipients
				Substance Abuse
				Alcohol
				Tobacco
				Opioids
				Other Illicit Drugs
		Consideration of Specific Perioperative Medication Management
			Immunosuppressive Agents
			Preoperative Assessment in the Elderly
				Defining the Elderly
					Assessing Frailty
						Complete Geriatric Assessment
						Frailty Scores
			Cognitive Dysfunction and Delirium
			Prehabilitation
				Exercise
				Nutrition
				Psychosocial Therapy
		Outcomes
		Conclusion
		References
	7: Optimizing Outcomes with Enhanced Recovery
		Enhanced Recovery, Origins, and Overview
		Enhanced Recovery Models
		First Steps to Creating an Enhanced Recovery Program
			Enhanced Recovery Elements in Colorectal Surgery
				Preoperative Elements of ERAS in Elective Colorectal Surgery
					Education
					Preoperative Optimization
						Smoking Cessation
						Preoperative Nutrition
						Preoperative Anemia
						Perioperative Hyperglycemia
					Preoperative Fasting Period and Preoperative Carbohydrate Drink
					Bowel Preparation
				In-hospital Preoperative Enhanced Recovery Elements
					Prevention of Postoperative Nausea and Vomiting (PONV)
					Multimodal Analgesia (MMA)
					VTE Prophylaxis and Antibiotics
				Intraoperative Enhanced Recovery Elements
					Multimodal Analgesia
					Intentional Fluid Management
					Minimally Invasive Surgical Approaches
					Minimal Use for Drains, Tubes, and Lines
				Postoperative Enhanced Recovery
					Early Diet, Early Mobilization, and Early Oral Medications
					Multimodal Analgesia
					Standard Discharge Criteria
		Considerations in Special ERAS Populations
			Enhanced Recovery in Stoma Creation and Reversal
			ERAS in Emergency Surgery and Trauma
			Enhanced Recovery in the Elderly
			Enhanced Recovery and Inflammatory Bowel Disease
		Economic Impact and Value of Enhanced Recovery to the Healthcare System
		Current Directions and the Future of ERAS
			Societies and Governments Assist Implementation Across Canada and the USA
			Future Directions
		Summary
		References
	8: General Postoperative Complications
		Introduction
		Risk Factors
			Non-modifiable Risk Factors
				Age
				Sex
				Morbidities
				Prior Surgeries and Adhesion Formation
			Modifiable Risk Factors
				Nutrition
				Smoking
				Preoperative Anemia
				Sarcopenia
				Obesity
				Functional Exercise Capacity
				Open Surgical Approach
		Assessing Risk Factors
		Addressing Risk Factors
		Postoperative Complications
			Gastrointestinal Complications (#1)
				Ileus (Functional Bowel Obstruction)
				Postoperative Small Bowel Obstruction (Mechanical Bowel Obstruction)
			Hematologic Complications (#2)
				Postoperative Bleeding and Transfusions
				Venous Thromboembolism
			Infectious Complications (#3)
				Surgical Site Infection (SSI)
				Anastomotic Leaks
				Wound Dehiscence
				Other Infectious Complications
				Clostridium difficile Colitis
			Pulmonary Complications (#4)
				Postoperative Respiratory Failure
				Pneumonia
				Pulmonary Aspiration
			Renal Complications (#5)
				Acute Kidney Injury
				Postoperative Urinary Retention
			Cardiac Complications (#6)
				Myocardial Infarction
				Dysrhythmias
			Neurological Complications (#7)
				Perioperative Cerebrovascular Accidents
				Sexual Dysfunction
				Postoperative Delirium
		Conclusion
		References
	9: Anastomotic Construction
		Introduction
		Physiology of Anastomotic Healing
		Fundamental Principles for Anastomotic Construction
			Operative Planning
			Mobilization
				Small Bowel Mobilization
				Colonic Mobilization
				Splenic Flexure Mobilization
				Special Mobilization Techniques
					Retroileal Anastomosis or Ileal Mesenteric Window
					Right Colon De-Rotation (Deloyer’s Procedure)
			Perfusion
			Anastomosis Configuration
			Low Pelvic Anastomosis
			Methods for Anastomotic Construction
				Sutured Anastomosis
				Stapled Anastomosis
					Types of Tissue Staplers
					Compression and Tissue Stapling
				Compression Ring Anastomosis
		The Conundrum of Best Practice and Continuing Challenge
		References
	10: Anastomotic Complications
		Anastomotic Leak
			Risk Factors
			Diagnosis
			Management of Anastomotic Leak
			Outcomes After Anastomotic Leak
		Anastomotic Fistula
		Blind Loop Syndrome
		Anastomotic Bleeding
		Anastomotic Stricture
		References
Part II: Anorectal Disease
	11: Hemorrhoids
		Epidemiology
		Anatomy
		Pathogenesis
		Clinical Presentation
		History
		Treatment
			Medical Management
				Stool Habits
				Stool Texture
				Hygiene
				Topical Therapies
				Oral Therapies
			Office-Based Procedures
				Internal Hemorrhoids
			Thrombosed Hemorrhoid Excision
			Operative Management of Hemorrhoids
				Excisional Hemorrhoidectomy Closed Technique (Ferguson Technique)
				Excisional Hemorrhoidectomy Open Technique (Milligan-Morgan)
				Use of Energy Devices in Excisional Hemorrhoidectomy
				Whitehead Hemorrhoidectomy
				Stapled Hemorrhoidopexy
				Doppler-Guided Hemorrhoidectomy
			Pain Management and Postoperative Care
				Topicals After Hemorrhoidectomy
				Routine Postoperative Care
			Complications of Hemorrhoidectomy
				Urinary Retention
				Postoperative Hemorrhage
				Fecal Incontinence
				Anal Stenosis
			Special Patient Populations
				Strangulated Hemorrhoids
				Hemorrhoids in Pregnancy
				Hemorrhoids, Varices, and Portal Hypertension
				Hemorrhoids in Crohn’s Disease
				Hemorrhoids in the Immunocompromised Patient
		Conclusion
		References
	12: Anal Fissure and Anal Stenosis
		Anal Fissure
			Definition, Clinical Presentation, and Etiology
			Medical/Pharmaceutical Treatment
				Topical Agents
				Botulinum Toxin Injection
			Operative Treatment
				Lateral Internal Sphincterotomy (LIS)
					Technique
					Outcomes
				Local Advancement Flaps
				Fissurotomy and Fissurectomy
			Atypical Fissures
			Anal Fissure, Conclusion
		Anal Stenosis
			Introduction, Definition, and Types
			Incidence and Causes
			Symptoms
			Evaluation
			Classification
			Treatment
				Nonoperative Treatment
				Surgical Treatment
					Transverse Closure Following Excision of Scar (With Possible Sphincterotomy)
					Rectal Advancement Flap
					Y-V Advancement Flap
					V-Y Advancement Flap
					Diamond (Rhomboid) Flap
					House Flap
					U Flap (Island Flap Anoplasty)
					Rotational S Flap
			Technical Aspects
			Flap Aftercare
			Choosing the Right Procedure
			Anal Stenosis in Crohn’s Disease
			Prevention
			Anal Stenosis, Conclusions
		References
	13: Cryptoglandular Abscess and Fistula
		Introduction
		Cryptoglandular Pathophysiology
			Cryptoglandular Abscess
		Diagnosis
		Treatment
		Acute Fistula Management
		Post-drainage Care
		Post-drainage Antibiotics
		Anal Fistula
			Presentation/Symptoms
			Classification
			Preoperative Imaging for Fistula Characterization
				Fistulography
				Computed Tomography (CT)
				Magnetic Resonance Imaging (MRI)
				Endoanal Ultrasound (EAUS)
			Treatment Strategies
				Intraoperative Fistula Identification
				Fistulotomy
				Setons
					Draining Seton
					Cutting Seton
					Loose Seton as Definitive Treatment and External Anal Sphincter-Sparing Seton
				Fibrin Glue
				Fistula Plug
				Endorectal Advancement Flap (ERAF)
				Ligation of Intersphincteric Fistula Tract (LIFT)
			Novel Surgical Therapies
				Fistula Tract Laser Closure (FiLaC™)
				Video-Assisted Anal Fistula Treatment (VAAFT)
				Fistulotomy with Primary Anal Sphincter Reconstruction
				Stem Cell Therapy
				Over the Scope Clip (OTSC® Proctology)
		Recommendation
		References
	14: Rectourethral and Complex Fistulas: Evaluation and Management
		Introduction
		Etiology
		Clinical Presentation
		Diagnostic Evaluation
		Classification
		Management of Rectourethral Fistula
			Transanal Approach
			Transperineal Approach
			Posterior Approach
			Transabdominal Approach
			Other Approaches
		Outcomes of RUF Repair
		Conclusion
		References
	15: Rectovaginal Fistula
		Etiology of Rectovaginal Fistula
			Obstetrical
			Crohn’s Disease
			Cryptoglandular
			Anastomotic and Other Surgical Complications
			Radiation Injury
		Evaluation of Patient with RVF
		Surgical Techniques
			Perineal Approach
				Episioproctotomy
				Transverse Perineal Repair
			Transrectal Approaches
				Rectal Sleeve Advancement
			Vaginal Approach
				Tissue Transposition Repairs
			Bioprosthetic Products
			Abdominal Approaches
		Conclusion
		References
	16: Pilonidal Disease and Hidradenitis Suppurativa
		Pilonidal Disease
			Introduction
			Epidemiology and Etiology
			Diagnosis
			Treatment
				Managing Patient Expectations
				Nonsurgical Treatment
				Antibiotics
				Phenol
				Fibrin Glue
			Surgical Treatments
				Incision and Drainage
				Lay Open Technique Versus Excision with Primary Closure
			Complex Surgical Treatment
				Karydakis Flap
				Rhomboid Flap (aka Limberg Flap)
				Cleft Lift Flap (Bascom Procedure)
			Minimally Invasive Treatments
				Endoscopic/Video-Assisted Ablation of Pilonidal Sinus (VAAPS)
				Laser Ablation of Pilonidal Sinus
				Trephination
				Management of Recurrent Disease
				Wound Healing Adjuncts
		Hidradenitis Suppurativa
			Introduction
			Incidence and Etiology
			Clinical Presentation and Diagnosis
			Treatment
				Medical Therapy
					Topical Therapy
					Systemic Antibiotics
					Biologics
				Other Medical Therapies
					Laser Therapies
					Surgery
		Conclusions
		References
	17: Dermatology and Pruritus Ani
		Introduction
		Pathophysiology
		Etiology
			Fecal Soilage
			Dietary Factors and Medications
			Dermatologic Diseases
		Diagnostic Approach
			Laboratory Testing
		Treatment
			First Encounter
			Second Encounter (3–6 Weeks After First Encounter)
		Conclusions
		References
	18: Sexually Transmitted Infections of the Colon and Rectum
		Introduction
		Anorectal Immunology
		Screening and Prevention
		Diagnosis and Initial Evaluation and Treatment
			Asymptomatic
			Symptomatic
		Bacterial Sexually Transmitted Infections
			Chlamydia
				Epidemiology and Presentation
				Diagnosis
				Treatment
			Lymphogranuloma Venereum
				Epidemiology and Presentation
				Diagnosis
				Treatment
			Gonorrhea
				Epidemiology and Presentation
				Diagnosis
				Treatment
			Syphilis
				Epidemiology and Presentation
				Diagnosis
				Treatment
			Chancroid
				Epidemiology and Presentation
				Diagnosis
				Treatment
			Donovanosis
				Epidemiology and Presentation
				Diagnosis
				Treatment
		Herpes Simplex Virus
		Genital Warts
		Giant Condyloma
		Molluscum Contagiosum
		Human Immunodeficiency Virus
		Ectoparasitic Sexually Transmitted Diseases
		Conclusion
		References
	19: Anal Intraepithelial Neoplasia
		Introduction
		Incidence
		Epidemiology
		Screening and Surveillance
		Progression
		Diagnosis
		Treatment
			Expectant Management
			Topical Therapies
				Trichloroacetic Acid (TCA)
				5-Flurorouracil (5FU)
				Cidofovir
				Imiquimod
			Local Ablative Therapies
			Wide Local Excision
			Treatment Summary
		Surveillance/Prevention
		Conclusion
		References
Part III: Malignant Disease
	20: Anal Cancer
		Introduction and Epidemiology
		Evaluation and Staging
		Physical Examination
		Radiologic Evaluation
		Anal Anatomy
		Perianal Squamous Cell Carcinoma
		Anal Canal Squamous Cell Carcinoma
			Chemotherapy
			Radiation Therapy
			Inguinal Lymph Node Metastases
			Surgery
			Anal Cancer and HIV
			Surveillance
		Anal Adenocarcinoma
		Verrucous Carcinoma
		Melanoma
		Perianal Paget’s Disease (Intraepithelial Adenocarcinoma)
		Basal Cell Carcinoma
		Gastrointestinal Stromal Tumor (GIST)
		Conclusion
		References
	21: Presacral Tumors
		Introduction
		Anatomic Considerations
		Clinical Presentations
		Physical Examination
		Imaging Studies
		Preoperative Biopsy
		Classification
			Epidermoid and Dermoid Cysts
			Tailgut Cysts
			Enterogenous Cysts
			Teratomas
			Chordomas
			Meningoceles
			Neurogenic Tumors
			Osseous Tumors
			Miscellaneous Lesions
			Currarino Syndrome
		Management
			Multidisciplinary Team
			Neoadjuvant Therapy
			Preoperative Considerations
			Surgical Approach
			Posterior Approach
			Abdominal and Combined Anterior and Posterior Approach
			Minimally Invasive Approaches
		Outcomes
			Follow-Up and Observation-Only Patients
		Conclusions
		References
	22: Sporadic and Inherited Colorectal Cancer: How Epidemiology and Molecular Biology Guide Screening and Treatment
		Introduction
		Sporadic Versus Inherited Colorectal Cancer
			Sporadic Colorectal Cancer
				Epidemiology of Sporadic CRC
				Risk Factors for Sporadic Colorectal Cancer
				Molecular Biology of Sporadic Colorectal Cancer
					Adenoma to Carcinoma Pathway
					Mutations
					Chromosomal Alterations
					Epigenetic Alterations in Colorectal Cancer
					Molecular Subtypes of CRC
					Right vs. Left CRC
				Screening for Sporadic CRC
				Treatment for Sporadic CRC
			Young Onset CRC
				Epidemiology
				Management
				Genetics of YO-CRC
			Inherited CRC
				Lynch Syndrome (Hereditary Non-polyposis CRC)
					Genetic Mutation
					Diagnosis and Histology
					Lynch Syndrome Variants
						Turcot Syndrome
						Muir-Torre Syndrome
						Familial CRC X
					Screening Recommendations
					Surgical Treatment
					Medical Treatment
				POLE/POLD1-Related Hereditary Cancer
				Familial Adenomatous Polyposis
					Genetic Mutations
					Extracolonic Manifestations
					Screening Recommendations
					Variants of FAP
						Attenuated FAP
						Gardner Syndrome
					Surgical Treatment
				MUTYH-Associated Polyposis
				Serrated Polyposis Syndrome
					Diagnosis
					Treatment
				Hamartomatous Polyposis Syndromes
					Juvenile Polyposis
					Peutz-Jeghers Syndrome
					Cowden Syndrome
		Conclusion
		References
	23: Management of Malignant Polyps
		Overview
		Colorectal Cancer Precursor Lesions
			Adenomas
			Serrated Polyps
		Colorectal Cancer Carcinogenic Pathways
			Adenoma-Carcinoma Pathway
			Serrated Pathway
		Definition of Terms: Colorectal Cancer and the Malignant Polyp
		Lesion Assessment
			Polyp Morphology and Size
			Polyp Surface Pit and Vascular Pattern
		Depth of Invasion
			Haggitt Classification of Pedunculated Polyps
			Kudo and Kikuchi Classification of Sessile Polyps
			Depth of Invasion and Risk of Lymph Node Metastases
			Histopathological Factors Influence the Risk of Lymph Node Metastasis in Early Colorectal Cancer
		Endoscopic Resection of Malignant Polyps
			Endoscopic Mucosal Resection (EMR) Technique
			Outcomes of EMR of Colorectal Polyps
			Endoscopic Submucosal Dissection Technique
			Outcomes of ESD for Colorectal Polyps
			Endoscopic Approach to Malignant Polyps
			Predicting the Risk of Residual Mural Cancer or Lymph Node Metastasis Following Endoscopic Resection of Malignant Polyp
			Recurrence Following Endoscopic Resection
			Surveillance After Endoscopic Resection
		Conclusion
		References
	24: Colorectal Cancer: Preoperative Evaluation and Staging
		Diagnosis of Colorectal Cancer
			Screening and Diagnostic Modalities
			Fecal Sampling
			Flexible Sigmoidoscopy
			Computed Tomography (CT) Colonography
			Colonoscopy
		Delineating Colon Versus Rectum
		Staging and Workup of Colon and Rectal Cancer
			TNM Staging
				History
				Physical Examination
				Proctoscopy
				Colonoscopy
				Tumor Localization
				Blood Work
				Imaging
					Computed Tomography (CT) Scan
					PET-CT
				Rectal Cancer-Specific Staging Modalities
					Endorectal Ultrasound
					Rectal Cancer-Specific Pelvic MRI
		Preoperative Evaluation
		Prognostic Factors Associated with Overall and Disease-Free Survival
			Pathologic Features: Pre-Resection
				Lymphovascular Invasion (LVI)
				Perineural Invasion (PNI)
				Tumor Budding
				Mismatch Repair (MMR) Deficient or Microsatellite Instability-High (MSI) Status
				Tumor Grade
				Histologic Type
			Pathologic Factors: Post-Resection
				Lymph Node Positivity and Ratio
			Extranodal Tumor Deposits
				Mesorectal Grade
				Tumor Regression Score
		Clinical or Imaging-Based Factors
			Age
			Extramural Vascular Invasion (EMVI)
			Circumferential Radial Margin (CRM) Status
			Tumor Location
		Conclusion
		References
	25: Colon Cancer Surgical Treatment: Principles of Colectomy
		Introduction
		Preoperative Tumor Localization
		General Surgical Principles
			Extent of Resection
			No-Touch Technique
			Lymphadenectomy
			Mesocolic Excision
			Adjacent Tissue or Organ Invasion
		Surgical Procedures Based on Anatomic Location
			Cecum and Ascending Colon Cancer
				Technical Aspects
			Hepatic Flexure Colon Cancer
				Technical Aspects
			Transverse Colon Cancer
				Technical Aspects
			Splenic Flexure and Descending Colon Cancer
				Technical Aspects
			Sigmoid Colon Cancer
				Technical Aspects
		Special Circumstances
			Obstructing or Perforated Colon Cancer: Principles of Surgical Resection
			Surgical Resection for Colon Cancer in the Setting of Lynch Syndrome
		References
	26: Rectal Cancer: Neoadjuvant Therapy
		Introduction
		Rectal Cancer Staging
		History of (Neo)Adjuvant Therapy
		Adjuvant Radiation
		Neoadjuvant Radiation
		The Foundation Trials
		Short- vs Long-Course Radiation
		Total Neoadjuvant Chemoradiation Therapy (TNT)
			Rationale
		Utilization of Systemic Chemotherapy in the Neoadjuvant Setting
			Systemic Chemotherapy Alone
		Radiation Therapy with Systemic Chemo Therapy (Concurrent)
			Pathologic Complete Response
		Consolidation vs Induction Chemotherapy
			Short-Course Radiation Therapy with Systemic Chemotherapy
		Conclusion
		References
	27: Rectal Cancer: Local Excision
		Introduction
		Patient Selection
		T1N0
		Predicting Lymph Node Metastasis
		Depth of Invasion
		Lymphovascular Invasion and Poor Differentiation
		Tumor Budding
		T2
		Techniques
			Transanal Excision
				Transanal Endoscopic Microsurgery
				Transanal Minimally Invasive Surgery (TAMIS)
		Complications
		Oncologic Results
			T1 Cancer
			T2 Cancer
		Local Excision and Adjuvant Therapy
		Neoadjuvant Therapy and Local Excision
		Quality of Life
		Salvage Surgery
		Conclusion
		References
	28: Rectal Cancer: Nonoperative Management
		Introduction
		Terminology and Definitions
		Rationale
		Primary Tumor Assessment and Selection Criteria
			Accidental Versus Intentional WW
			Baseline Stage
			Tumor Location
			Endoscopic Features
		Assessment of Tumor Response
		Criteria for a Complete Clinical Response
		Endoscopic and Clinical Assessment
		Radiological Studies
		Surveillance/Follow-up Strategy
		Local Reassessment After Achievement of a cCR
		Surveillance for Metastatic and Metachronous Disease
		Local Regrowth
		Systemic Recurrences
		Oncologic Outcomes
		Functional Outcomes
		Prediction of Tumor Response
		References
	29: Proctectomy for Rectal Cancer
		Background
		Anatomy of the Rectum and Mesorectum
		Priorities in Proctectomy for Rectal Cancer
		Preoperative Preparation
		Operative Approaches
			Open Low Anterior Resection
			Straight Stapled Anastomosis
			Handsewn Coloanal Anastomosis
			Colonic J-Pouch Anastomosis
			End-to-Side Anastomoses
			Transverse Coloplasty
			Laparoscopic Low Anterior Resection
			Robotic Low Anterior Resection
			Transanal Total Mesorectal Excision
			Abdominoperineal Resection
			Reconstruction After APR
			Low Anterior Resection Syndrome
			Multivisceral or Extended Resections
		Oncologic Outcomes
		Multidisciplinary Rectal Cancer Care
		Conclusion
		References
	30: Colorectal Cancer: Postoperative Adjuvant Therapy and Surveillance
		Introduction
		Colon Cancer
			Stage III Colon Cancer
			Stage II Colon Cancer
			Radiation for Colon Cancer
			Neoadjuvant Chemotherapy and Radiation for Colon Cancer
		Rectal Cancer
			Adjuvant Chemotherapy Following Neoadjuvant Radiation
			Adjuvant Therapy Without Neoadjuvant Radiation
			Adjuvant Therapy Following Local Excision of Early-Stage Rectal Cancer
		Targeted Chemotherapy Options
		Molecular Profiling
		Surveillance After Curative-Intent Therapy
			Introduction
		Timing and Choice of Surveillance Modalities
			Historical Literature
			FACS Trial
			Modern Literature
			CEA Watch Trial
			GILDA
			COLOFOL Trial
			Alliance and CoC Collaboration
			PRODIGE
			Other Works
			Specific Tests and Recommendations
			Physical Examination
			Laboratory Testing
			Abdominal Imaging
			Colonoscopy
		Special Circumstances
			Stage I Colon Cancer
			Stage I Rectal Cancer
			Quality of Life
			Cost
		Conclusions
		References
	31: Colorectal Cancer: Management of Distant Metastases
		Introduction
		Multidisciplinary Evaluation
			Synchronous Metastases
			Management of Primary Tumor
			Unresectable Synchronous Metastases
			Resectable Synchronous Metastases
			Rectal Cancer
		Metachronous Metastases
		Liver Metastases
			Resection
			Locoregional Therapies
				Radiofrequency Ablation
				Microwave Ablation
				Transcatheter Intra-arterial Techniques
				Stereotactic Body Radiation Therapy
		Lung Metastases
		Other Sites of Metastases
			Ovarian Metastases
			Brain Metastases
			Adrenal Metastases
		Surveillance
		Conclusion
		References
	32: Locally Recurrent Rectal Cancer
		Introduction
		General Considerations
		Patterns of Local Recurrence and Anatomical Considerations
		Patient Selection and Treatment Planning
			Imaging
			Multidisciplinary Team Assessment
			Resectability
			Metastatic Disease
			Neoadjuvant and Intraoperative Treatment
		Technical Considerations
			Preparation
			Positioning
			Exploration and Preparing the Pelvis
			Central Recurrences
			Composite Pubic Bone Resection
			Lateral Neurovascular Resection
			Posterior Recurrences
			Reconstruction
			Postoperative Management
		Outcomes
		Conclusions
		References
	33: Appendiceal Neoplasms
		Introduction
		Epithelial Neoplasms
		Adenocarcinoma
		Other Mucinous Lesions
		Neuroendocrine Tumors
		Other Neoplasms
		References
	34: Gastrointestinal Stromal Tumors, Neuroendocrine Tumors, and Lymphoma
		Gastrointestinal Stromal Tumors (GISTs)
			Introduction
			Histology and Molecular Biology
			Incidence and Distribution
			Clinical Presentation
			Diagnosis
			Treatment
				Surgery
				Medical Therapy
		Neuroendocrine Tumors (NETs)
			Introduction
			Histology and Biomarkers
			Incidence and Distribution
			Clinical Presentation
			Carcinoid Syndrome
			Diagnostic Tests
				Endoscopy and Imaging
				Biochemical Workup
			Treatment
			Surveillance
			Prognosis
		Lymphoma
			Incidence and Distribution
			Clinical Presentation
			Histology
			Diagnostic Tests
			Treatment
		References
	35: Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
		Introduction
		Pseudomyxoma Peritonei (PMP): The Pathophysiology of Peritoneal Disease and the Re-distribution Phenomenon
		The Peritoneal Cavity
		Colorectal Cancer and the Concept of Resectable Peritoneal Metastases
		The Peritoneal Cancer Index (PCI)
		Cytoreductive Surgery: “Complete Cytoreductive (CC)” Scoring System
		Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
		Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC)
		Evidence Base for CRS and HIPEC for Colorectal Peritoneal Metastases (CPM)
		The Role of Systemic Chemotherapy: Before or After CRS and HIPEC?
			Current Guidelines for Initial and Definitive Management of CPM
		Prophylactic CRS and HIPEC in Advanced Cancer
		Synchronous Colorectal Peritoneal and Other Site Oligo-Metastases
		Palliative CRS for CPM
		Conclusion
		References
	36: Colorectal Cancer: Minimally Invasive Surgery
		Introduction
		Minimally Invasive Rectal Cancer Surgery
			Laparoscopic Rectal Cancer Surgery
			Laparoscopic Proctectomy
				Indications
				Preoperative Considerations
				Surgical Technique
					Access to the Abdomen and Vessel Ligation
					Splenic Flexure and Left Colon Mobilization
					Mesorectal Mobilization Using TME Principles
				Intersphincteric Resection
			Laparoscopic Abdominoperineal Resection (APR)
			Preoperative Considerations
			Surgical Technique
				Abdominal Approach
				Laparoscopic Perineal Approach
		Robotic Rectal Cancer Surgery
			Robotic Proctectomy
				Preoperative Considerations
			Surgical Technique
				Abdominal Robotic Approach
				Robotic Proctectomy
			Robotic APR
		Transanal Total Mesorectal Excision (TaTME)
			Transanal TME
				Surgical Technique
					Abdominal Approach
					Transanal Approach
						Setup and Start
					Mesorectal Mobilization
						Specimen Extraction
						Anastomosis
		Hand-Assisted Rectal Cancer Surgery
			Hand-Assisted Laparoscopic Proctectomy
				Preoperative Considerations
				Surgical Technique
					Access to the Abdomen and Vessel Ligation
					Splenic Flexure and Left Colon Mobilization
					Mesorectal Mobilization
		References
	37: Minimally Invasive Complete Mesocolic Excision with Extended Lymphadenectomy for Colon Cancer
		Introduction
		CME and Extended Lymphadenectomy: Definitions
			Lymph Node Classification
			D1, D2, and D3 Lymphadenectomy
			Quality Indicators of CME Resections
		Rationale for Adoptions of CME for Colon Cancer
			Impact of CME on Mesocolic Dissection Grade
			The Impact of CME on Lymph Node Harvest, Central Node, Skip, and Occult Metastases
		Anatomical Considerations
		Variations in Configuration of the GCT/GPCT
			Variations in the Anatomy of SMV Tributaries
			Variations in Arterial Anatomy and Relationship to SMV
		Laparoscopic Approach for CME + D3 Dissection
		Techniques of MIS CME + D3 for Right-Sided and Transverse Colon Cancer
			Medial to Lateral Approach
			Lateral to Medial Approach
			Cranial to Caudal Approach
			MIS CME for Left Colon Cancer with D3 Dissection
		Short-Term Outcomes of CME
		Long-Term Outcomes of CME with D3 Dissection
		Conclusions
		References
Part IV: Benign Colorectal Disease
	38: Colonic Diverticular Disease
		Introduction
		Epidemiology
		Histology and Pathology
			Role of Fiber
		Pathophysiology
			Genetics
			Microbiome
		Risk Factors for Disease
			Age
			Sex
			Physical Activity
			Smoking
			Non-steroidal Anti-inflammatory Agents
			Obesity
			Clinical Manifestations and Physical Findings
				Differential Diagnosis
				History and Physical Examination
				Diagnostic Evaluation
				Endoscopic Evaluation
		Management of Diverticulitis
			Acute Uncomplicated Diverticulitis
			Antibiotics
			Ambulatory Management
			Dietary Changes
			Management of Acute Complicated Diverticulitis
			Diverticular Abscesses (Hinchey Stages Ib and II)
			Hinchey Stage III Diverticulitis
				Nonoperative Management
					Laparoscopic Lavage
						Technique: Diagnostic Laparoscopy and Laparoscopic Lavage
			Hinchey IV Diverticulitis
		Chronic Diverticular Disease
			Chronic Uncomplicated Disease
			The Young
			The Immunocompromised
			Fistula
			Obstruction
		Technical Aspects of Surgery
			Approach
			Transection Margins
			Inferior Mesenteric Artery Preservation
			Splenic Flexure Mobilization
			Ureteral Stents
			Anastomotic Leak Testing
		Right-Sided Diverticulitis
		Conclusion
		References
	39: Large Bowel Obstruction
		Introduction
		Pathophysiology
		Clinical Presentation
		Initial Management
		Imaging
		Malignant Large Bowel Obstruction
		Perforation
		Right-Sided Colonic Obstruction (Cecum to Distal Transverse Colon)
		Left-Sided Colonic Obstruction (Splenic Flexure to Rectosigmoid)
		Segmental Versus Total Colectomy
		Covered Versus Uncovered Stents
		Obstructing Rectal Cancer
		Unresectable Disease
			Volvulus
			Sigmoid Volvulus
				Nonoperative Methods for Devolvulizing a Sigmoid Volvulus
				Surgery for Sigmoid Volvulus
		Cecal Volvulus
			Ileosigmoid Knotting
			Acute Colonic Pseudo-obstruction
			Medical Therapy
			Pharmacotherapy
			Colonic Decompression
			Surgical Therapy
		Rare Causes of LBO
			Intussusception
			Hernia
			Infection
			Endometriosis
			Other Malignancies
		References
	40: Lower GI Hemorrhage
		Introduction
		Epidemiology
		Etiology
		Presentation
		Evaluation
		Risk Stratification
		Management
			Endoscopic Evaluation
			Endoscopic Intervention
			Radiologic Evaluation
				CT Angiography
				Catheter-Based Angiography
				Nuclear Medicine
		Recurrent LGIB
		Small Bowel GIB
			Enteroscopy
			Surgery
		Non-localized LGIB
		Conclusion
		References
	41: Endometriosis
		Introduction
		Epidemiology
		Etiology
		Clinical Manifestations
		Diagnosis
			Classification of Endometriosis
			Endometriosis and Cancer
		Treatment
			Medical Management
			Surgical Management
				Recurrence After Surgery
		Conclusion
		References
	42: Benign Colorectal Disease Trauma of the Colon and Rectum
		Introduction and Historical Perspective
		Colon Trauma
			Epidemiology
			Diagnosis
			Management
				Preoperative Consideration
			Timing of Injury and Operative Decisions
				Operative Management: When to Repair, Resect, or Divert
			Evidence and Practice Guidelines
			Technical Considerations
		Rectal Trauma
			Epidemiology
			Diagnosis
			Anatomic Considerations
			Management of Intraperitoneal Rectal Injuries
			Management of Extraperitoneal Rectum
			Guidelines
		Anal Trauma
			Epidemiology
			Diagnosis
			Management
		References
	43: Inflammatory Bowel Disease: Pathobiology
		Introduction
		Host Factors
			Genetics
			Immunity
			Intestinal Microbiome
			Antibiotics
		Environmental Factors
			Urbanization
			Smoking
			NSAIDs
			Diet
				Pouchitis Pathobiology
		References
	44: IBD Diagnosis and Evaluation
		Inflammatory Bowel Disease Epidemiology
		Clinical Presentation of IBD
		IBD Phenotypes
			Crohn’s Disease
			Ulcerative Colitis
			IBD-Unclassified (IBD-U) and Indeterminate Colitis
			PSC-IBD
		Extraintestinal Manifestations
		Diagnostic Evaluation of Suspected IBD
		Laboratory Investigations and Stool Tests
		Diagnostic Imaging
			Computed tomography
			Ultrasound
			Magnetic Resonance Imaging
		Endoscopy
		Histology
		Genetic Studies
		Classification and Grading of IBD
			Endoscopic Scores
			Activity Scores
		Surveillance Endoscopy in IBD
		References
	45: Medical Management of Ulcerative Colitis
		Introduction
		Medications
			Homeopathic Agents
				Curcumin
				Probiotics
			5-Aminosalicylate Compounds
			Glucocorticoids
			Immunomodulators
				Thiopurines
				Methotrexate
				Calcineurin Inhibitors
				Janus Kinase Enzyme Inhibitors
			Biologic Agents/Biosimilars
				Antitumor Necrosis Factor (TNF) Agents
				Integrin Receptor Antagonist
				IL-12 and IL-23 Inhibitor
		Disease Severity
		Induction of Remission
			Mild-to-Moderate Disease
				5-ASA Compounds (Topical, Oral)
				Glucocorticoids (Topical, Oral)
			Moderate-to-Severe Disease
				5-ASA Compounds (Topical, Oral)
				Glucocorticoids
				Immunomodulators
				Biologic Agents/Biosimilars
			Severe/Fulminant Disease
				Glucocorticoids
				Immunomodulators (Calcineurin Inhibitors)
				Biologic Agents/Biosimilars
		Maintenance of Remission
			5-ASA Compounds (Topical, Oral)
			Glucocorticoids
			Immunomodulators
			Biologic Agents/Biosimilars
		Conclusion
		References
	46: Medical Therapy for Crohn’s Disease
		History
		Introduction
		Microbiome Therapies
			Antibiotics
			Probiotics
			Dietary Interventions
			Fecal Transplant
			Exclusive Enteral Nutrition
		5-ASA Therapy
			Isolated Colonic Crohn’s
			Crohn’s Proctitis
			Side-Effects and Perioperative Management
		Corticosteroids
			Topical Corticosteroids
				Side-Effects and Perioperative Management
			Systemic Corticosteroids
				Safety
				Stress-Dose Steroids and Tapering
		Immunomodulators
			Thiopurines
				TP Pharmacokinetics
				Monotherapy
				Side Effects and Perioperative Management
			Methotrexate
				Side-Effects and Perioperative Management
		Biologic Therapy
			Antitumor Necrosis Factor Agents
				Combination Therapy
			Leukocyte-Trafficking Agents
			Interleukin-12 and -23 Antagonist
			Biosimilars
		Induction and Maintenance of Remission
			Principles of Induction Therapy
				Mild Disease
				Moderate Disease
				Severe Disease
		Principles of Maintenance Therapy
			Target to Treat
				General Principles of Maintenance Therapy
			Therapeutic Drug Monitoring
			De-escalation
		Postoperative Prophylaxis
		Conclusions
		References
	47: Anorectal Crohn’s Disease
		Introduction
		Fistulizing Complications
			Epidemiology and Risk Factors
			Pathogenesis
			Clinical Presentation and Classification
				Abscess
					Management
				Anorectal Fistula
					Diagnosis
					Management
						Medical Management
							Antibiotics
							Thiopurines
							Calcineurin Inhibitors
							Biologics
						Surgical Management
							Fistulotomy
							Draining Seton
							Endorectal Advancement Flap
							Ligation of the Internal Fistula Tract (LIFT)
							Fibrin Glue and Fistula Plugs
							Mesenchymal Stem Cell Therapy
				Rectovaginal Fistula
		Non-fistulizing Complications
			Anal Fissures and Ulcers
			Skin Tags
			Hemorrhoids
			Anal Stricture
			Anal Cancer
		Diversion and Proctectomy for Perianal Crohn’s Disease
		Conclusions
		References
	48: Crohn’s Disease: Surgical Management
		Introduction
		Changing Trends in the Surgical Management of Crohn’s Disease
			Indications for Surgery
				Failed Medical Therapy
				Bowel Obstruction
				Perforation
				Penetrating Disease: Fistula and Abscess Formation
				Cancer and Dysplasia
				Toxic Colitis
				Bleeding
			Surgical Considerations
				Nutritional Support and Total Parenteral Nutrition
			Overview of Operative Considerations
				Minimally Invasive Surgery
				Enhanced Recovery Pathways
				Perioperative Medical Management
				Anastomotic Type
			Disease Recurrence Trends and Surveillance
		Operative Considerations for Specific Locations
			Gastroduodenal Disease
			Upper Small Bowel Disease
			Colonic and Rectal Disease
			Ileal Pouch-Anal Anastomosis in Crohn’s Disease
		Special Considerations
			Ileosigmoid Fistula
			Complex Perineal Wounds
		Conclusion
		References
	49: Ulcerative Colitis: Surgical Management
		Introduction
		Indications for Surgery
			Elective Surgery
			Emergent Surgery
		Surgical Options and Postoperative Outcomes
			Preoperative Planning
			Ileal Pouch-Anal Anastomosis
				Operative Technique
			Controversies
				One-, Two-, or Three-Stage IPAA
				Optimal Pouch Design
				Type of Anastomosis: Hand-Sewn or Stapled
				Transanal Pouch
		Ileorectal Anastomosis
		Continent Ileostomy
			Operative Technique
			Postoperative Complications
		References
	50: Complications of the Pelvic Pouch
		Introduction
		Risk Factors for Pouch Dysfunction
		Approach to the Patient with  a Dysfunctional Pouch
			Initial Evaluation
			Multidisciplinary Approach to Diagnosis
			The Case for the “Thoughtful” Ileostomy
		Etiology and Management of Pouch Complications
			Structural Complications of the Pouch
				Afferent Limb (AF) Complications
				Issues of the Pouch Body
					Pouch-Anal Anastomotic (PAA) Defect
					“Tip of J” Pouch Leak
					Failure of Pouch “Scaffolding”
					180°/360° Mesenteric Rotation
				Efferent Limb (EL) Problems
					Efferent Stricture
					Elongated S-Pouch Outlet/Elongated Rectal Cuff (Pouch-Rectal Anastomosis)
			Inflammatory Complications of the Pouch
				Pouchitis
				Cuffitis
				Crohn’s Disease of the Pouch
			Diagnosis with Exam Under Anesthesia
			Control of Sepsis
			Fecal Diversion
			Pouch Excision
				Pouch Revision in the Setting of CD
			Functional Complications of the Pouch
			Neoplasia of the Pouch
			Outcomes of Surgical Management of Pouch Complications
		Conclusion
		References
	51: Infectious Colitis
		Bacterial Colitidies
			Campylobacter
			Salmonella
			Shigella
			Escherichia coli
			Yersinia
			Vibrio
			Other Bacterial Colitidies
		Parasitic Colitidies
			Amebic Colitis
			Anisakidosis
			Ascaris
			Strongyloides
			Trichuris
			Enterobius
			Cryptosporidium
			Balantidium
			Giardia
			Schistosomiasis
			Tapeworms
			Trypanosoma
		Fungal Colidities
			Histoplasma
			Candida
			Other Fungal Colitidies
		Viral Colitidies
			Cytomegalovirus
			Other Viral Colitidies
		Infectious Colitis in Immunocompromised Patients
			Inflammatory Bowel Disease
			Human Immunodeficiency Virus
			Transplant Patients
		References
	52: Clostridium difficile Infection
		Introduction
		Epidemiology
		Clinical Risk Factors
			Advanced Age
			Antibiotic Treatment
			Contact with a Healthcare Facility
			Immunocompromised States
			Inflammatory Bowel Disease
			Perioperative Prophylactic Antibiotics and Mechanical Bowel Preparation
			Proton Pump Inhibitors
		Nomenclature and Genetics of C. difficile Infection
			Ribotype and Clinical Severity
		Diagnosis of C. difficile Infection
			Diagnostic Tests for CDI
		Clinical Measures of Severity
		Antibiotic Therapy for CDI
		Surgery for CDI
		Fecal Microbiota Transplant (FMT)
		References
	53: Radiation, Microscopic, and Ischemic Colitis
		Radiation Colitis
			Definition and Manifestation
			Etiology and Risk Factors
			Prevention
			Diagnosis
			Management
				Medical
				Endoscopic
					Formalin
					Argon Beam Coagulation (ABC)
				Surgical
			Summary
		Microscopic Colitis
			Definition
			Etiology and Risk Factors
			Manifestations
			Diagnosis
				Laboratory Studies
				Imaging Studies
				Endoscopic
			Histology
			Management
				Medical
		Ischemic Colitis
			Definition
			Anatomy, Epidemiology, and Risk Factors
			Clinical Presentation
			Diagnosis
			Management
			Prognosis
		References
	54: Intestinal Stomas
		Introduction
		Colostomy
			Configuration
			Physiology
		Small Bowel Stomas
			Configuration
			Physiology
		Preoperative Considerations for the Ostomate
			Stoma Site Marking
			Preoperative Stoma Education
		Technical Considerations of Stoma Creation
			Small Bowel End Stoma
			Small Bowel Loop Stoma
			End Colostomy
			Loop Colostomy
		Postoperative Care for the Stoma
			Early Inpatient Postoperative Care
			Postoperative Outpatient Care
			Stoma Appliances
		Stoma Complications
			Stomal Ischemia: Necrosis, Retraction, and Stenosis
			Peristomal Skin Disorders
			Peristomal Pyoderma Gangrenosum
			Peristomal Varices
			Stoma Prolapse
			Peristomal Abscess
			High Output Small Bowel Stomas
		Stoma Reversal
			Preoperative Preparation
			Timing
			Technical Consideration of Loop Stoma Reversal
			Technical Considerations of End Stoma Reversal
			Stoma Reversal Complications
		Special Considerations
			The Difficult Stoma
			Temporary Fecal Diversion: Loop Ileostomy Versus Loop Colostomy
			Genitourinary Stomas
			The Turnbull Blowhole Colostomy
			Ileostomy and Foodstuff Bolus Obstruction
		References
	55: Abdominal Wall Reconstruction and Parastomal Hernia Repair
		Introduction
		Incidence, Risk Factors, and Diagnosis
		Classification
		Operative Indications
		Preoperative Optimization and Planning
		Repair Techniques and Associated Outcomes
			Primary Repair
			Onlay Mesh Repair
			Open Intraperitoneal Mesh Repair
			Laparoscopic Intraperitoneal Mesh Repair
			Open Retromuscular Repair and Abdominal Wall Reconstruction
			Algorithm
		Mesh Options
		Conclusion
		References
Part V: Pelvic Floor Disorders
	56: Functional Disorders After Colorectal Surgery/IBS
		Definitions
		Diagnosis and Clinical Workup
		IBS and the Relationship to Surgery
		IBS Treatment Approach
			Fiber
			Dietary Treatments
			IBS-D Treatments
			IBS-C Treatments
		Treating Abdominal Pain with Neuromodulation
		Chronic Pelvic Pain
		IBS and Pelvic Pain
		Functional Anorectal Pain
			Levator Ani Syndrome
			Proctalgia Fugax
		Coccygodynia
		Pudendal Neuralgia
			Pudendal Nerve Block
			Neuromodulation
			Nerve Ablation
			Operative Approaches
		Conclusion
		References
	57: Common Tests for the Pelvic Floor
		Introduction
		Manometry
			Equipment
			Indications
			Technique
			Resting Pressure
			Squeeze Pressure
			Cough Reflex
			Push/Simulated Evacuation
			Rectoanal Inhibitory Reflex (RAIR)
			Rectal Sensation
		Balloon Expulsion Test (BET)
		London Protocol and Criteria
		Authors Note Conventional Versus High-Definition 3D Manometry
		Neurophysiologic Testing
			EMG
			Pudendal Nerve Terminal Motor Latency (PNTML)
			Spinal Motor Latency
		Ultrasound and Dynamic Imaging
			Indication
			Equipment and Technique
			Interpretation
		MRI
		Dynamic Imaging of the Pelvic Floor
		Defecography
			Normal Evaluation
			Rectocele
			Intussusception/Prolapse
			Enterocele/Sigmoidocele
			Anismus
			Pelvic Floor Descent
		MR Defecography
		Dynamic Ultrasound
		Echodefecography
		Conclusion
		References
	58: Evaluation of Constipation and Treatment of Abdominal Component
		Introduction
		Definition
		Etiology and Pathophysiology
		History and Physical
		Diagnostic Testing
		Medical Management
		Surgical Options for Slow Transit Constipation
			Abdominal Colectomy
			Less Standard Approaches
			Less Invasive Surgical Alternatives
		Conclusion
		References
	59: Treatment of Difficult/Obstructive Defecation
		Introduction
		Physiology of Defecation
		Definition and Etiology
		Dyssynergic Defecation
			Rectocele
			Enterocele
			Internal Prolapse
			Rectal Prolapse
		Scoring Systems
		Testing for Obstructed Defecation Syndrome
		Treatment of Obstructed Defecation
			Treatment of Obstructed Defecation Syndrome Due to Puborectalis Pathology
			Treatment of ODS Due to Internal Prolapse/Rectal Intussusception
			Treatment of ODS Due to Overt Rectal Prolapse
			Treatment of ODS Due to Rectocele/Enterocele/Sigmoidocele
		Treatment of an Enterocele/Sigmoidocele
		Conclusions
		References
	60: Rectal Prolapse
		Introduction
		Multidisciplinary Approach
		Pathophysiology
		Solitary Rectal Ulcer Syndrome
		Evaluation of the Patient
			History and Physical Exam
			Patient Questionnaires
			Anorectal Physiology Testing
			Imaging
			Treatment
		Perineal Repairs
			Incarcerated Rectal Prolapse
		Abdominal Repairs
			Suture Rectopexy
			Suture Rectopexy with Sigmoid Resection
			Posterior Rectopexy with Mesh
			Ripstein Procedure
			Ventral Mesh Rectopexy
				Recurrent Rectal Prolapse
		Conclusion
		References
	61: Fecal Incontinence: Evaluation and Treatment
		Introduction
		Evaluation
			History and Physical Exam
			Anorectal Manometry
			Ultrasound
			Neurophysiology Testing
			Defecography
			Colonoscopy
		Treatment
			Conservative Treatment
			Pelvic Floor Exercises
			Anal Insertion Device
			Vaginal Bowel Control System
			Sacral Neuromodulation
			Bulking Agents
			Percutaneous Tibial Nerve Stimulation
			Radiofrequency Energy Delivery
			Stem Cell Therapy
			Anal Sling
			Surgical Sphincter Repair (Sphincteroplasty)
			Ventral Rectopexy
			Gracilis Muscle Transposition
			Magnetic Anal Sphincter Augmentation
			Artificial Bowel Sphincter
		Treatment Failure
		Conclusion
		References
	62: Low Anterior Resection Syndrome (LARS)
		Introduction
		Etiology
		Definition
		LARS: Scope of the Problem
		Risk Factors for LARS
		Prediction of LARS for Patient Counseling and Surgical Planning
		Prevention of LARS
		Diagnosis
		Treatment Options
		Nonsurgical Interventions
			Medical Therapy
			Topical Treatments
			Biofeedback
			Retrograde Colonic Irrigation (RCI)
			Surgical Interventions
				Sacral Nerve Neuromodulation (SNM)
				Antegrade Continence Enemas (ACE)
				Fecal Diversion
		Conclusion
		References
	63: Sexual Function After Colorectal Surgery in Women
		Background
		The Scope of the Problem
			Sexual Dysfunction After Surgery for Colorectal Cancer
			Sexual Dysfunction After Surgery for Benign Colorectal Disease
		Etiology of Sexual Dysfunction
			Radiation
			Chemotherapy
			Surgery
			Sexual Dysfunction After Surgery for Benign Colorectal Disease
		The Impact of Sexual Dysfunction on Fertility
		Defining the Problem for Effective Treatment
			Desire
			Arousal and Orgasm
			Sexual Pain
		Measuring Sexual Dysfunction
		Moving Forward
			Initiating the Conversation
			Developing Options for Diverse Patients
			Creating Multidisciplinary Treatment Teams
		Conclusions
		References
	64: Male Genitourinary Dysfunction as a Consequence of Colorectal Surgery
		Introduction
		Neuroanatomy and Physiology of the Male Genitourinary Tract
		Sympathetic Pelvic Anatomy and Physiology
		Parasympathetic Pelvic Anatomy and Physiology
		Male Genitourinary Functional Metrics
		Male Sexual Dysfunction Metrics
			The International Index of Erectile Function (IIEF-15)
			Sexual Health Inventory for Men (SHIM or IIEF-5)
			Expanded Prostate Cancer Index Composite (EPIC)
		Male Urinary Dysfunction Metrics
			Urogenital Distress Inventory/Urogenital Distress Inventory-6
			King’s Health Questionnaire
			Danish Prostatic Symptom Score
			International Continence Society Male/International Continence Society Male Short-Form Questionnaires
		Colorectal Procedures Resulting in Genitourinary Dysfunction
			Anterior Resection vs Low Anterior Resection vs Complete Proctectomy
			Minimally Invasive vs Open Techniques
		Genitourinary Dysfunction Related to Pelvic Radiotherapy
			Psychological Impact and Counseling
			Management of Male Genitourinary Dysfunction
				Vacuum Constriction Device (VCD)
				Intracorporeal (IC) Injections
				Intraurethral Alprostadil
				Oral Medications
				Penile Prosthesis
		Retrograde Ejaculation/Anejaculation
		Chronic Intermittent Catheterization vs Indwelling Urinary Catheter
		LGBTQ Populations
			Male Sexual Dysfunction Metrics in the Gay Population
				Gay Sexual Functioning Inventory
		Genitourinary Dysfunction Related to Fecal Diversion
		Conclusions
		References
	65: Middle and Anterior Pelvic Compartment: Issues for the Colorectal Surgeon
		Definition, Etiology, and Epidemiology
		Evaluation of the Anterior and Middle Compartments
		Indications and Outcomes for Common Nonoperative and Operative Approaches for Anterior and Middle Compartment Prolapse
			Multidisciplinary Approach to Pelvic Floor Prolapse
		Conclusion
		References
Part VI: Miscellaneous
	66: Pediatric Colorectal Disorders
		Hirschsprung’s Disease (HD)
		Colonic Duplications
		Constipation
		Prolapse
		Perianal Abscess and Fistula-in-Ano
		Fissures
		Cecostomy
		Transitional Care in the Pediatric Colorectal Patient: Anorectal Malformation, HD
		References
	67: Considerations for Geriatric Patients Undergoing Colorectal Surgery
		Introduction
		Frailty Screening
			Domains of Geriatric Assessment (GA)
				Functional Assessment
				Cognitive Function
				Polypharmacy
				Nutritional Assessment
				Social Support
				Patient’s Wishes
		Prehabilitation
		Surgical Considerations
		Postoperative Management
		Functional Recovery and Patient-Reported Outcomes
		Personalized Treatment of Rectal Cancer
		Conclusions
		References
	68: Healthcare Economics
		Healthcare Economics: A Global Perspective
		US Healthcare Finance
			Medicare
			Medicaid
			Employer-Sponsored Insurance
			Individual (Non-group) Insurance
		Healthcare and Politics
			The Future of the ACA
			Underinsurance
			Surprise Medical Billing
			Rural Hospital Closures
		Physician Reimbursement: The Quality Payment Program
			Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015 (MACRA)
			Merit-Based Incentive Payment System (MIPS)
			Advanced Alternative Payment Model (A-APM)
		Coding Systems
			ICD-10
			CPT®
			DRG
			Codes Become Payments
		References
	69: Ethical Considerations (Conflict of Interest, Surgical Innovation, and End of Life)
		Conflict of Interest in Surgical Research
			Classification
			Financial COI
			Non-financial
			Determining Conflict of Interest
			Reporting COI and the Effect on Study Outcomes
			Management Strategies for Primary and Secondary Research
				Disclosure
				Elimination
				Balance
				Exclusion
			COI and the Peer Review Process
			Conclusions
		Introduction of Surgical Innovation
			Incorporating New Techniques and New Technologies
			Oversight
			Informed Consent
			Outcomes
			Industry Involvement
			Conclusions
		End-of-Life and Surgical Care
			Communication
			Prognostication
			Decision-Making
				Respect for Autonomy
				Beneficence
				Non-maleficence
				Justice
			Conclusions
		References
	70: Welcome to Litigation
		Preparation: Key to Success
		Stages of the Litigation Process
			Initiation of the Litigation Process
				Notice of an Occurrence Likely to Lead to Litigation
		Teaching Points
		Teaching Points
		Caveat
		Teaching Points
			Notice of Events Which Suggest that Litigation Is Imminent: Handling Requests for Medical Records
		Teaching Points
			Service of the Summons and Complaint: Initial Meeting with Counsel
		Teaching Points
		Teaching Points
			The Discovery of the Process
				Written Discovery
		Teaching Points
			Your Deposition
		Teaching Points
			The Trial
		Teaching Points
		Concluding Remarks
		References
	71: Quality
		Introduction: What Is Quality?
		Measuring Quality
			Outcomes
			Process
			Structure
		Quality Measurement: Making the Right Choices
			Process Versus Outcome Measures
			Registry Versus Administrative Data
				Administrative Data
				Registry Data
				Which Is Better, Administrative or Registry Data?
			Evaluative Versus Transactional Data
			Composite Versus Single Outcomes
			Unadjusted Versus Risk-Adjusted Outcomes
			Final Words on Quality Measurement
		Quality Improvement
			Organizational Culture and Quality and Safety
			Alternative Payment Models
			National Accreditation Program for Rectal Cancer
			National Surgical Quality Improvement Program
		Conclusion
		References
	72: Practice Management
		Introduction
		Practice Models
			Independent Practices
				Single Specialty
				Multispecialty
				External Investment (Private Equity, Venture Capitalists)
				Employed Models
				Acquisition of an Independent Practice
		Finance
		Compensation
		Developing a Referral Base
		Marketing
		Setting Up Your Office
		Office-Based Procedures
		Ancillary Services
			Ambulatory Surgery Centers
		Other Ancillary Services
		Leadership Roles
		Conclusions
		References
Index