Improved Outcomes in Colon and Rectal Surgery Edited by Charles B Whitlow David E Beck David A Margolin Terry C Hicks Alan E Timmcke Improved Outcomes in Colon and Rectal Surgery Whitlow • Beck • Margolin Hicks • Timmcke www.informahealthcare.com Telephone House, 69-77 Paul Street, London EC2A 4LQ, UK 52 Vanderbilt Avenue, New York, NY 10017 Improved Outcomes in Colon and Rectal Surgery About the book Written by many of the world’s leading colorectal surgeons, this evidence-based text investigates the risks and benets of colorectal surgeries. By using clinical pathways, algorithms, and case discussions, the authors identify the best practices for patient safety and positive outcomes to ensure that physicians correctly recognize potential problems and carefully manage complications. Improved Outcomes in Colon and Rectal Surgery is an essential reference for all colorectal surgeons, fellows and residents, as well as those working in gastroenterology and the medico-legal profession. About the editors Charles B Whitlow MD, Program Director, Colon and Rectal Surgery Fellowship Program, Ochsner Medical Center, New Orleans, Louisiana, USA. David E Beck MD, Chairman, Department of Colon and Rectal Surgery, Ochsner Medical Center, New Orleans, Louisiana, USA. He is President-Elect of the American Society of Colon and Rectal Surgeons and Editor-in-Chief of Clinics in Colon and Rectal Surgery and the Ochsner Journal. David A Margolin MD, Colon and Rectal Research Director, Ochsner Medical Center, New Orleans, Louisiana, USA. He is an Associate Editor of Diseases of the Colon and Rectum. Terry C Hicks MD, Associate Chairman, Department of Colon & Rectal Surgery, Ochsner Medical Center, New Orleans, Louisiana, USA. He is President of the American Board of Colon and Rectal Surgeons Alan E Timmcke, Sta Colon and Rectal Surgeon, Ochsner Medical Center, New Orleans, Louisiana, USA. Also available Ambulatory Colorectal Surgery Edited by Laurence R Sands and Dana R Sands (ISBN: 9780824727925) Gastrointestinal Oncology: Evidence and Analysis Edited by Peter McCulloch, Martin S Karpeh, David J Kerr and Jaer Ajani (ISBN: 9780849398650) Neoplasms of the Colon, Rectum, and Anus, Second Edition Authored by Philip H Gordon and Santhat Nivatvongs (ISBN: 9780824729615) Improved Outcomes in Colon and Rectal Surgery Edited by Charles B Whitlow MD Program Director Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA David E Beck MD Chairman Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA David A Margolin MD Research Director Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA Terry C Hicks MD Associate Chairman Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA Alan E Timmcke MD Staff Surgeon Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA © 2010 Informa UK First published in 2010 by Informa Healthcare, Telephone House, 69-77 Paul Street, London EC2A 4LQ. Informa Healthcare is a trading division of Informa UK Ltd. Registered Office: 37/41 Mortimer Street, London W1T 3JH. Registered in England and Wales number 1072954. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. A CIP record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Data available on application ISBN-13: 9781920071528 Orders Informa Healthcare Sheepen Place Colchester Essex CO3 3LP UK Telephone: +44 (0)20 7017 5540 Email: CSDhealthcarebooks@informa.com Typeset by C&M Digitals (P) Ltd, Chennai, India Printed and bound in Great Britain by CPI, Antony Rowe, Chippenham, Wiltshire Contents List of Contributors v Preface ix Foreword xi 1 Preexisting conditions 1 Eric L Marderstein, Siyamek Neragi-Miandoab, and Conor P Delaney 2 Preoperative bowel preparation 14 David A Margolin and Sean Mayfield 3 Anesthesia and intraoperative positioning 19 Lebron Cooper and Larry R Hutson 4 Sepsis 27 Steven Mills and Michael J Stamos 5 Intraoperative anastomotic challenges 33 David E Beck 6 Other intraoperative challenges 44 James T McCormick and Sharon G Gregorcyk 7 Postoperative anastomotic complications 56 Daniel L Feingold 8 General postoperative complications 67 Scott R Steele and Clifford L Simmang 9 Care paths and optimal postop management 79 Surya P M Nalamati and Eric J Szilagy 10 Limitations of anorectal physiology testing 87 Thomas E Cataldo and Syed G Husain 11 Limitations of colorectal imaging studies 97 Travis J Blanchard, Wilson B Altmeyer, and Charles C Matthews 12 Transanal endoscopy 132 Terry C Hicks 13 Laparoscopic colorectal surgery 140 James W Fleshman and Jonathan S Chun 14 Medical legal issues 148 Charles F Gay Jr and Terry C Hicks 15 Miscellanous conditions 154 M Benjamin Hopkins and Alan E Timmcke 16 Quality and outcome measures 159 Janak A Parikh, Sushma Jain, Marcia L McGory, and Clifford Y Ko 17 Hemorrhoidal surgery 168 Dan R Metcalf and Anthony J Senagore 18 Nonoperative therapy for hemorrhoid disease 178 Kerry Hammond and Charles B Whitlow contents 19 Surgery and nonoperative therapy of perirectal abscesses and anal fistulas 183 Brian R Kann and Charles B Whitlow 20 Surgery and nonoperative therapy of anal fissure 199 Jaime L Bohl and Alan J Herline 21 Surgery for pilonidal disease and hidradenitis suppurativa 215 Paula I Denoya and Eric G Weiss 22 Surgical treatment of fecal incontinence 226 Ann C Lowry and Dimitrios Christoforidis 23 Surgery for rectal prolapse 239 Steven R Hunt 24 Operative and nonoperative therapy for diverticular disease 249 R Scott Nelson and Alan G Thorson 25 Abdominal surgery for colorectal cancer 263 Jason Hall and Rocco Ricciardi 26 Transanal approaches to rectal cancer 271 Sachin S Kukreja and Theodore J Saclarides 27 Abdominoperineal resection 278 W Brian Perry, Fia Yi, Clarence Clark, and Danny Kim 28 Indications and outcomes for treatment of recurrent rectal cancer and colorectal liver and lung metastasis 286 Harry L Reynolds Jr, Christopher T Siegel, and Jason Robke 29 Chemotherapy for colon and rectal cancer 300 Liliana Bordeianou and Judith L Trudel 30 Radiation therapy: Acute and late toxicity 306 Roland Hawkins 31 Surgery for ulcerative colitis 318 Patricia L Roberts 32 Surgery for Crohn’s disease 331 Jorge Canedo, Tolga Erim, and Steven D Wexner 33 Ostomies 349 Vance Y Sohn and Scott R Steele 34 Operative and nonoperative therapy for chronic constipation 361 Harry T Papaconstantinou 35 Colorectal trauma 375 S David Cho, Sharon L Wright, and Martin A Schreiber 36 Urologic complications of colorectal surgery 395 Scott Delacroix Jr and J Christian Winters Index 405 List of Contributors Wilson B Altmeyer MD Department of Radiology Ochsner Clinic Foundation New Orleans, Louisiana USA David E Beck MD Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA Travis J Blanchard MD Department of Radiology Ochsner Clinic Foundation New Orleans, Louisiana USA Jaime L Bohl MD Department of Surgery Vanderbilt University Nashville, Tennessee USA Liliana Bordeianou MD Department of Surgery Division of General and Gastrointestinal Surgery Massachusetts General Hospital Boston, Massachusetts USA Jorge Canedo MD Department of Colorectal Surgery Cleveland Clinic Florida Weston, Florida USA Thomas E Cataldo MD Warren Alpert Medical School of Brown University Brown Program in Colon and Rectal Surgery Rhode Island Hospital/Lifespan Health System Providence, Rhode Island USA S David Cho MD Department of Surgery Oregon Health and Science University Portland, Oregon USA Dimitrios Christoforidis MD Department of Visceral Surgery, CHUV-University of Lausanne Lausanne, Switzerland Jonathan S Chun MD Section of Colon and Rectal Surgery Washington University School of Medicine St Louis, Missouri USA Clarence Clark MD Department of General Surgery Wilford Hall Medical Center and the University of Texas Health Science Center, San Antonio Lackland AFB, Texas USA Lebron Cooper MD Department of Anesthiology Ochsner Clinic Foundation New Orleans, Louisiana USA Scott E Delacroix, Jr., MD Department of Urology Louisiana State University Health Sciences Center New Orleans, Louisiana University of Texas, MD Anderson Cancer Center Houston, Texas USA Conor P Delaney MD MCh PhD Department of Surgery Division of Colorectal Surgery University Hospitals Case Medical Center Cleveland, Ohio USA Paula I Denoya MD Department of Colorectal Surgery Cleveland Clinic Florida Weston, Florida USA Tolga Erim MD Department of Colorectal Surgery Cleveland Clinic Florida Weston, Florida USA lst of contrbutors Daniel L Feingold MD Section of Colorectal Surgery Columbia University New York, New York USA James W Fleshman MD Section of Colon and Rectal Surgery Washington University School of Medicine St Louis, Missouri USA Charles F Gay Jr Adams and Reeds Attorneys and Counselors at Law New Orleans, Louisiana USA Sharon G Gregorcyk MD Texas Colon and Rectal Specialists Dallas, Texas USA Jason Hall MD Department of Colon and Rectal Surgery Lahey Clinic Tufts University Burlington, Massachusetts USA Roland Hawkins MD Radiation Oncology Ochsner Cancer Institute New Orleans, Louisiana USA Kerry Hammond MD Division of General Surgery Medical University of South Carolina Charleston, South Carolina USA Alan J Herline MD Department of Surgery Vanderbilt University Nashville, Tennessee USA Terry C Hicks MD Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA M Benjamin Hopkins MD Department of Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA Steven R Hunt MD Colon and Rectal Surgery Section Division of General Surgery Washington University St. Louis, Missouri USA Syed G Husain MD Brown Program in Colon and Rectal Surgery Warren Alpert Medical School of Brown University Rhode Island Hospital/Lifespan Health System Providence, Rhode Island USA Larry R Hutson MD Department of Anesthiology Ochsner Clinic Foundation New Orleans, Louisiana USA Sushma Jain MBBS MPH David Geffen School of Medicine at UCLA Department of Surgery Los Angeles, California USA Brian R Kann MD Cooper University Hospital UMDNJ-Robert Wood Johnson Medical School-Camden Department of Surgery Camden, New Jersey USA Danny Kim MD Department of General Surgery Wilford Hall Medical Center and the University of Texas Health Science Center, San Antonio Lackland AFB, Texas USA Clifford Y Ko MD MS MSHS David Geffen School of Medicine at UCLA Department of Surgery Los Angeles, California USA Sachin S Kukreja MD Section of Colon and Rectal Surgery Department of General Surgery Rush University Medical Center Chicago, Illinois USA Ann C Lowry MD Colon & Rectal Surgery Associates Ltd St Paul, Minnesota USA lst of contrbutors James T McCormick DO Department of Surgery Division of Colon and Rectal Surgery Western Pennsylvania Hospital and the Forbes Regional Campus Temple University School of Medicine Philadelphia, Pennsylvania USA Marcia L McGory MD PhD David Geffen School of Medicine at UCLA Department of Surgery Los Angeles, California USA Eric L Marderstein MD MPH Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio USA David A Margolin MD Colon and Rectal Surgery The Ochsner Clinic Foundation New Orleans, Louisiana USA Charles C Matthews MD Department of Radiology Ochsner Clinic Foundation New Orleans, Louisiana USA Sean Mayfield MD Colon and Rectal Surgery The Ochsner Clinic Foundation New Orleans, Louisiana USA Dan R Metcalf MD SMDC Health System Department of Surgery Duluth, Minnesota USA Steven Mills MD University of California Irvine, California USA Surya PM Nalamati Division of Colon and Rectal Surgery Henry Ford Health System Department of Surgery/Colon & Rectal Group Detroit, Michigan USA R Scott Nelson DO Colon & Rectal Surgery, Inc Omaha, Nebraska USA Siyamek Neragi-Miandoab MD Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio USA Harry T Papaconstantinou MD Department of Surgery Scott & White Hospital and Clinic Texas A&M University System Health Science Center Temple, Texas USA Janak A Parikh MD David Geffen School of Medicine at UCLA Department of Surgery Los Angeles, California USA W Brian Perry MD Department of General Surgery Wilford Hall Medical Center and the University of Texas Health Science Center, San Antonio Lackland AFB, Texas USA Harry L Reynolds Jr MD University Hospital of Cleveland Cleveland, Ohio USA Rocco Ricciardi MD MPH Department of Colon and Rectal Surgery Lahey Clinic Tufts University Burlington, Massachusetts USA Patricia L Roberts MD Department of Colon and Rectal Surgery Lahey Clinic Medical Center Burlington, and Tufts University School of Medicine Boston, Massachusetts USA J Robke MD University Hospital of Cleveland Cleveland, Ohio USA lst of contrbutors Theodore J Saclarides MD Section of Colon and Rectal Surgery Department of General Surgery Rush University Medical Center Chicago, Illinois USA Martin A Schreiber MD Division of Trauma and Critical Care Oregon Health and Science University Portland, Oregon USA Christopher T Siegel MD University Hospital of Cleveland Cleveland, Ohio USA Anthony J Senagore MD MS MBA Spectrum Health System Grand Rapids, Michigan USA Clifford L Simmang MD Texas Colon and Rectal Surgeons Dallas, Texas USA Vance Y Sohn MD Department of Surgery Madigan Army Medical Center Tacoma, Washington USA Michael J Stamos MD University of California Irvine, California USA Scott R Steele MD Department of Surgery Madigan Army Medical Center Tacoma, Washington USA Eric J Szilagy MD Department of Surgery/Colon & Rectal Group Division of Colon and Rectal Surgery Henry Ford Health System Detroit, Michigan USA Alan G Thorson MD Colon & Rectal Surgery, Inc Omaha, Nebraska USA Alan E Timmcke MD Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA Judith L Trudel MD, MSc, MHPE University of Minnesota St Paul, Minnesota USA Eric G Weiss MD Department of Colorectal Surgery Cleveland Clinic Florida Weston, Florida USA Steven D Wexner MD Department of Colorectal Surgery Ohio State University and Department of Surgery, Division of General Surgery University of South Florida College of Medicine Cleveland Clinic Florida Weston, Florida USA Charles B Whitlow MD Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana USA J Christian Winters MD FACS Department of Urology Female Pelvic Medicine and Reconstructive Surgery Louisiana State University Health Sciences Center New Orleans, Louisiana USA Sharon L Wright MD Department of Surgery Oregon Health and Science University Portland, Oregon USA Fia Yi MD Department of General Surgery Wilford Hall Medical Center and the University of Texas Health Science Center, San Antonio Lackland AFB, Texas USA Preface Quality measures and outcomes are receiving greater attention by the lay and medical communities. The occurrence or mis- management of complications often results in poor outcomes, increased cost, and significant morbidity. Answering the call for transparency and improvement requires action by all involved in the care of patients. Collection of objective data and quality measures allows documentation of optimal care and desired out- comes while identifying areas for improvement. The goal of this text is to present the current knowledge of outcomes, as well as the techniques for minimizing and managing complications from the common diseases and procedures of this specialty. This information will aid providers in optimizing care and encourage research in outcome and quality measurement. Improved Outcomes of Colon and Rectal Surgery represents the collaborative efforts of many individuals. The contributing authors were selected for their knowledge of colorectal surgery and ability to present their surgical judgment and experience in written form. They represent a spectrum of experienced providers who have made significant contributions to younger individuals who will shape the future of their specialty. In addition to reviewing the available literature, they have described their personal approach to complications in colorectal surgery. Numerous technical descriptions and highlights from multiple discussions held in surgical locker rooms, morbidity and mortality conferences, and the hallways of conferences and symposiums have been included. Using this approach, we hope this text will provide initial guidance to the less experienced provider and stimulate additional thought and research to the more experienced provider. The editors gratefully acknowledge the efforts of the many individuals who made this book possible. This text carries on the vision of previous editors and contributors to the first two editions of Complications in Colon and Rectal Surgery. Charles B Whitlow, MD David E Beck, MD David A Margolin, MD Terry C Hicks, MD Alan E Timmcke, MD . the American Society of Colon and Rectal Surgeons and Editor -in- Chief of Clinics in Colon and Rectal Surgery and the Ochsner Journal. David A Margolin MD, Colon and Rectal Research Director,. Improved Outcomes in Colon and Rectal Surgery Edited by Charles B Whitlow David E Beck David A Margolin Terry C Hicks Alan E Timmcke Improved Outcomes in Colon and Rectal Surgery Whitlow. Margolin Hicks • Timmcke www.informahealthcare.com Telephone House, 69-77 Paul Street, London EC2A 4LQ, UK 52 Vanderbilt Avenue, New York, NY 10 017 Improved Outcomes in Colon and Rectal Surgery About