Cancer of the large bowel is the third most common cancer diagnosed in both men and women in the United States with the exclusion of skin cancers. Surgery represents the mainstay of therapy in early-stage rectal cancer and is frequently warranted in advanced cases for palliation. Complete resection and retention of gastrointestinal continuity with low recurrence rates are the ultimate goal in treating localized disease. Local recurrence in rectal cancer essentially represents a failure of surgical therapy and is avoidable in most cases. Radiation has been shown to reduce local recurrences. This review covers the surgical anatomy of the rectum, factors to consider when evaluating patients with rectal cancer, choosing a therapeutic protocol, obtaining patient consent, preoperative considerations, and surgical technique. Local (transanal local excision, transanal endoscopic microsurgery) and radical procedures (anterior resection technique, abdominoperineal resection) are described. Laparoscopic and robotic approaches, key intraoperative concepts in rectal cancer, perioperative care, adjuvant therapy, and follow-up regimens are also detailed. Tables describe general medical issues for surgeons to review, vital knowledge for the colorectal surgeon, American Joint Committee on Cancer TNM Clinical Classification of Colorectal Cancer, American Joint Committee on Cancer Staging System for Colon Cancer, the multidisciplinary team for treating rectal cancer, risk factors associated with high rectal cancer recurrence rate, National Comprehensive Cancer Network 2013 Guidelines for Transanal Excision, and total mesorectal excision score as categorized by Quirke. Figures show procedures for local, anterior, and abdominoperineal resection. This review contains 11 figures, 9 tables, and 64 references. Keywords: rectoscope, resection, excision, anastomosis, radiation, stapler, abdominoperineal resection
{"title":"Procedures for Rectal Cancer","authors":"B. Safar, J. Efron","doi":"10.2310/surg.2090","DOIUrl":"https://doi.org/10.2310/surg.2090","url":null,"abstract":"Cancer of the large bowel is the third most common cancer diagnosed in both men and women in the United States with the exclusion of skin cancers. Surgery represents the mainstay of therapy in early-stage rectal cancer and is frequently warranted in advanced cases for palliation. Complete resection and retention of gastrointestinal continuity with low recurrence rates are the ultimate goal in treating localized disease. Local recurrence in rectal cancer essentially represents a failure of surgical therapy and is avoidable in most cases. Radiation has been shown to reduce local recurrences. This review covers the surgical anatomy of the rectum, factors to consider when evaluating patients with rectal cancer, choosing a therapeutic protocol, obtaining patient consent, preoperative considerations, and surgical technique. Local (transanal local excision, transanal endoscopic microsurgery) and radical procedures (anterior resection technique, abdominoperineal resection) are described. Laparoscopic and robotic approaches, key intraoperative concepts in rectal cancer, perioperative care, adjuvant therapy, and follow-up regimens are also detailed. Tables describe general medical issues for surgeons to review, vital knowledge for the colorectal surgeon, American Joint Committee on Cancer TNM Clinical Classification of Colorectal Cancer, American Joint Committee on Cancer Staging System for Colon Cancer, the multidisciplinary team for treating rectal cancer, risk factors associated with high rectal cancer recurrence rate, National Comprehensive Cancer Network 2013 Guidelines for Transanal Excision, and total mesorectal excision score as categorized by Quirke. Figures show procedures for local, anterior, and abdominoperineal resection.\u0000This review contains 11 figures, 9 tables, and 64 references.\u0000Keywords: rectoscope, resection, excision, anastomosis, radiation, stapler, abdominoperineal resection","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82064221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The rationale for operating on patients with carotid artery disease is to prevent stroke. It has been estimated that in 50 to 80% of patients who experience an ischemic stroke, the underlying cause is a lesion in the distribution of the carotid artery, usually in the vicinity of the carotid bifurcation. Appropriate identification and intervention could significantly reduce the incidence of ischemic stroke. Carotid endarterectomy for both symptomatic and asymptomatic carotid artery stenosis has been extensively evaluated in prospective, randomized trials. Surgical reconstruction of the carotid artery yields the greatest benefits when done by surgeons who can keep complication rates to an absolute minimum. The majority of complications associated with carotid arterial procedures are either technical or judgmental; accordingly, this review emphasizes the procedural aspects of planning and operation considered to be particularly important for deriving the best short- and long-term results from surgical intervention. Specifically, this review covers preoperative evaluation, operative planning, operative technique, postoperative care, follow-up, and alternatives to direct carotid reconstruction. Figures show carotid arterial procedures including recommended patient positioning, the commonly used vertical incision, the alternative transverse incision, mobilization of the sternocleidomastoid muscle to identify the jugular vein, palpation of the internal carotid artery, division of the structures between the internal and external carotid arteries to allow the carotid bifurcation to drop down, division of the posterior belly of the digastric muscle to yield additional exposure of the internal carotid artery, a graphic representation of the measurement of internal carotid artery back-pressure, a central infarct zone surrounded by an ischemic zone, shunt placement, open endarterectomy, eversion endarterectomy, repair of fibromuscular dysplasia, and repair of coiling or kinking of the internal carotid artery. This review contains 17 figures, and 25 references Key words: Carotid artery disease; Carotid endarterectomy; Carotid angioplasty with stenting; Eversion endarterectomy; Open endarterectomy; Carotid plaque; TCAR
{"title":"Surgical Treatment of Carotid Artery Disease","authors":"W. Moore","doi":"10.2310/surg.2104","DOIUrl":"https://doi.org/10.2310/surg.2104","url":null,"abstract":"The rationale for operating on patients with carotid artery disease is to prevent stroke. It has been estimated that in 50 to 80% of patients who experience an ischemic stroke, the underlying cause is a lesion in the distribution of the carotid artery, usually in the vicinity of the carotid bifurcation. Appropriate identification and intervention could significantly reduce the incidence of ischemic stroke. Carotid endarterectomy for both symptomatic and asymptomatic carotid artery stenosis has been extensively evaluated in prospective, randomized trials. Surgical reconstruction of the carotid artery yields the greatest benefits when done by surgeons who can keep complication rates to an absolute minimum. The majority of complications associated with carotid arterial procedures are either technical or judgmental; accordingly, this review emphasizes the procedural aspects of planning and operation considered to be particularly important for deriving the best short- and long-term results from surgical intervention. Specifically, this review covers preoperative evaluation, operative planning, operative technique, postoperative care, follow-up, and alternatives to direct carotid reconstruction. Figures show carotid arterial procedures including recommended patient positioning, the commonly used vertical incision, the alternative transverse incision, mobilization of the sternocleidomastoid muscle to identify the jugular vein, palpation of the internal carotid artery, division of the structures between the internal and external carotid arteries to allow the carotid bifurcation to drop down, division of the posterior belly of the digastric muscle to yield additional exposure of the internal carotid artery, a graphic representation of the measurement of internal carotid artery back-pressure, a central infarct zone surrounded by an ischemic zone, shunt placement, open endarterectomy, eversion endarterectomy, repair of fibromuscular dysplasia, and repair of coiling or kinking of the internal carotid artery.\u0000This review contains 17 figures, and 25 references\u0000Key words: Carotid artery disease; Carotid endarterectomy; Carotid angioplasty with stenting; Eversion endarterectomy; Open endarterectomy; Carotid plaque; TCAR ","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88770250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Coagulation Disorders","authors":"Eric M. Campion, Mitchell J. M. Cohen","doi":"10.2310/surg.2235","DOIUrl":"https://doi.org/10.2310/surg.2235","url":null,"abstract":"<jats:p />","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78992943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Currently approximately 10% of the 650,000 ESRD patients in the U.S. requiring renal replacement therapy are on peritoneal dialysis (PD). Although equally efficacious as hemodialysis (HD), advantages of PD may include a more flexible schedule allowing greater freedom to work or travel, better tolerability in patients with cardiovascular compromise, and decreased costs. PD requires an intact peritoneal membrane and abdominal wall and the ability to perform at home, either by the patient or by a caregiver. Although PD catheters can be inserted via open or laparoscopic techniques, laparoscopic insertion allows for direct visualization and placement of the tip of the catheter, as well as the ability to secure the tip of the dialysis catheter in the pelvis. Laparoscopic insertion improves catheter survival, reduces the incidence of mechanical complications, and allows for additional procedures, such as repair of umbilical hernias, lysis of adhesions, or omentopexy. Laparoscopy is also ideal for secondary procedures for catheter salvage. Infections remain the most frequent complication of peritoneal dialysis catheters and the most common reason for catheter removal or conversion from PD to HD. This review contains 16 figures, 6 tables, and 40 references. Key Words: Peritoneal dialysis; End-stage renal disease; renal replacement therapy; dialysis; laparoscopy; catheter-associated peritonitis; exit site infections; catheterpexy; omental wrapping; catheter outflow obstruction.
{"title":"Peritoneal Dialysis Access","authors":"David W. Shaffer, R. Forbes","doi":"10.2310/surg.2124","DOIUrl":"https://doi.org/10.2310/surg.2124","url":null,"abstract":"Currently approximately 10% of the 650,000 ESRD patients in the U.S. requiring renal replacement therapy are on peritoneal dialysis (PD). Although equally efficacious as hemodialysis (HD), advantages of PD may include a more flexible schedule allowing greater freedom to work or travel, better tolerability in patients with cardiovascular compromise, and decreased costs. PD requires an intact peritoneal membrane and abdominal wall and the ability to perform at home, either by the patient or by a caregiver. Although PD catheters can be inserted via open or laparoscopic techniques, laparoscopic insertion allows for direct visualization and placement of the tip of the catheter, as well as the ability to secure the tip of the dialysis catheter in the pelvis. Laparoscopic insertion improves catheter survival, reduces the incidence of mechanical complications, and allows for additional procedures, such as repair of umbilical hernias, lysis of adhesions, or omentopexy. Laparoscopy is also ideal for secondary procedures for catheter salvage. Infections remain the most frequent complication of peritoneal dialysis catheters and the most common reason for catheter removal or conversion from PD to HD. \u0000This review contains 16 figures, 6 tables, and 40 references.\u0000Key Words: Peritoneal dialysis; End-stage renal disease; renal replacement therapy; dialysis; laparoscopy; catheter-associated peritonitis; exit site infections; catheterpexy; omental wrapping; catheter outflow obstruction.","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77266052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Compression neuropathies result from entrapment at specific anatomic locations. They are a common clinical problem, particularly in the upper extremity, where a patient’s underlying medical conditions can affect the likelihood of symptoms. Early recognition from the clinical history and a detailed examination, including provocative maneuvers, combined with electrodiagnostic testing or imaging modalities is imperative to guide treatment and prevent permanent dysfunction. This review contains 7 figures, 2 tables, and 45 references. Keywords: carpal tunnel syndrome, cubital tunnel syndrome, radial tunnel syndrome, ulnar tunnel syndrome, pronator syndrome, anterior interosseous syndrome, entrapment neuropathy, electrodiagnostic studies
{"title":"Compression Neuropathies","authors":"T. Theman, K. Azari","doi":"10.2310/ps.10079","DOIUrl":"https://doi.org/10.2310/ps.10079","url":null,"abstract":"Compression neuropathies result from entrapment at specific anatomic locations. They are a common clinical problem, particularly in the upper extremity, where a patient’s underlying medical conditions can affect the likelihood of symptoms. Early recognition from the clinical history and a detailed examination, including provocative maneuvers, combined with electrodiagnostic testing or imaging modalities is imperative to guide treatment and prevent permanent dysfunction.\u0000 \u0000This review contains 7 figures, 2 tables, and 45 references.\u0000Keywords: carpal tunnel syndrome, cubital tunnel syndrome, radial tunnel syndrome, ulnar tunnel syndrome, pronator syndrome, anterior interosseous syndrome, entrapment neuropathy, electrodiagnostic studies\u0000 ","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"10 5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77591017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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