Pub Date : 2026-03-01Epub Date: 2025-12-17DOI: 10.1016/j.scrs.2025.101163
Hannah K. Holland MD , Timothy J. Ridolfi MD, MS
Post-operative venous thromboembolism is a significant source of morbidity, mortality, and healthcare cost in patients undergoing colon and rectal surgery. Patients with colorectal disease are particularly vulnerable to venous thromboembolism formation due to the proinflammatory nature of their conditions and subsequent operative trauma. Tailored thromboprophylaxis strategies according to individualized risk assessments as well as use of evidence-based guidelines for venous thromboembolism treatment are essential in minimizing ongoing complications and avoiding post-operative bleeding. This review summarizes current prevention and management guidelines as well as future directions for improving postoperative venous thromboembolism related outcomes in colorectal surgery patients.
{"title":"Postoperative venous thromboembolism after colon and rectal surgery","authors":"Hannah K. Holland MD , Timothy J. Ridolfi MD, MS","doi":"10.1016/j.scrs.2025.101163","DOIUrl":"10.1016/j.scrs.2025.101163","url":null,"abstract":"<div><div>Post-operative venous thromboembolism is a significant source of morbidity, mortality, and healthcare cost in patients undergoing colon and rectal surgery. Patients with colorectal disease are particularly vulnerable to venous thromboembolism formation due to the proinflammatory nature of their conditions and subsequent operative trauma. Tailored thromboprophylaxis strategies according to individualized risk assessments as well as use of evidence-based guidelines for venous thromboembolism treatment are essential in minimizing ongoing complications and avoiding post-operative bleeding. This review summarizes current prevention and management guidelines as well as future directions for improving postoperative venous thromboembolism related outcomes in colorectal surgery patients.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 1","pages":"Article 101163"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147408064","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}
Pub Date : 2026-03-01Epub Date: 2025-12-17DOI: 10.1016/j.scrs.2025.101161
Laura M. Nicolais MD , Gerald Gantt MD
Nonhealing perineal wounds remain a significant challenge following abdominoperineal resection (APR) for rectal cancer and other pelvic malignancies. Despite advancements in surgical techniques, wound complication rates remain high, particularly in the context of neoadjuvant chemoradiotherapy and extensive pelvic dissection. This review examines the natural history of perineal wound healing, evaluates closure strategies including primary closure, flap reconstruction, and adjuncts such as omental pedicle flaps, and explores advanced and emerging therapies including hyperbaric oxygen, negative pressure wound therapy, and regenerative medicine. By synthesizing the current literature and highlighting risk factors for poor healing, we provide an evidence-based guide to optimizing outcomes in this complex and often debilitating complication.
{"title":"Nonhealing perineal wounds: Current strategies and emerging therapies","authors":"Laura M. Nicolais MD , Gerald Gantt MD","doi":"10.1016/j.scrs.2025.101161","DOIUrl":"10.1016/j.scrs.2025.101161","url":null,"abstract":"<div><div>Nonhealing perineal wounds remain a significant challenge following abdominoperineal resection (APR) for rectal cancer and other pelvic malignancies. Despite advancements in surgical techniques, wound complication rates remain high, particularly in the context of neoadjuvant chemoradiotherapy and extensive pelvic dissection. This review examines the natural history of perineal wound healing, evaluates closure strategies including primary closure, flap reconstruction, and adjuncts such as omental pedicle flaps, and explores advanced and emerging therapies including hyperbaric oxygen, negative pressure wound therapy, and regenerative medicine. By synthesizing the current literature and highlighting risk factors for poor healing, we provide an evidence-based guide to optimizing outcomes in this complex and often debilitating complication.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 1","pages":"Article 101161"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147408069","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}
Pub Date : 2026-03-01Epub Date: 2025-12-17DOI: 10.1016/j.scrs.2025.101162
Ahad Azimuddin , Saieesh A. Rao , Mohammad Ali Abbass
Perineal hernias are an uncommon but clinically significant condition faced by the colorectal surgeon, commonly as a complication following abdominoperineal resection or pelvic exenteration. Clinical presentation varies based on hernia size and contents, often involving gastrointestinal or urinary symptoms. Diagnosis primarily relies on clinical examination and cross-sectional imaging, with computed tomography as the preferred modality in acute settings. Although rare, perineal hernias can result in serious complications, including enterocutaneous fistulas, bowel obstruction, and herniation of pelvic organs. Management requires an individualized surgical approach based on defect size, hernia contents, and patient factors. Abdominal approaches, particularly open approaches, tend to offer lower recurrence rates compared to perineal repairs but are associated with longer recovery times. Mesh reinforcement is generally preferred for large defects, while flap reconstruction remains crucial for radiated or complex surgical fields. Despite advances in technique, recurrence remains a challenge, particularly following primary suture repairs. Reconstructions with synthetic mesh via abdominal or perineal approaches, with or without flaps, may provide the best outcomes.
{"title":"Perineal Hernias: Diagnosis and surgical management","authors":"Ahad Azimuddin , Saieesh A. Rao , Mohammad Ali Abbass","doi":"10.1016/j.scrs.2025.101162","DOIUrl":"10.1016/j.scrs.2025.101162","url":null,"abstract":"<div><div>Perineal hernias are an uncommon but clinically significant condition faced by the colorectal surgeon, commonly as a complication following abdominoperineal resection or pelvic exenteration. Clinical presentation varies based on hernia size and contents, often involving gastrointestinal or urinary symptoms. Diagnosis primarily relies on clinical examination and cross-sectional imaging, with computed tomography as the preferred modality in acute settings. Although rare, perineal hernias can result in serious complications, including enterocutaneous fistulas, bowel obstruction, and herniation of pelvic organs. Management requires an individualized surgical approach based on defect size, hernia contents, and patient factors. Abdominal approaches, particularly open approaches, tend to offer lower recurrence rates compared to perineal repairs but are associated with longer recovery times. Mesh reinforcement is generally preferred for large defects, while flap reconstruction remains crucial for radiated or complex surgical fields. Despite advances in technique, recurrence remains a challenge, particularly following primary suture repairs. Reconstructions with synthetic mesh via abdominal or perineal approaches, with or without flaps, may provide the best outcomes.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 1","pages":"Article 101162"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147408063","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}
Pub Date : 2026-03-01Epub Date: 2025-12-17DOI: 10.1016/j.scrs.2025.101159
Lucille Y. Yao, Lisa M. Cannon
Postoperative adrenal insufficiency (PAI) leading to refractory hypotension and resultant circulatory collapse is a rare but potentially devastating complication. In this review, we aim to describe the phenomenon of postoperative adrenal insufficiency, clarify approaches to management, and summarize current literature that informs management of perioperative steroids in the colorectal surgery patient population.
{"title":"Postoperative adrenal insufficiency and perioperative steroid management","authors":"Lucille Y. Yao, Lisa M. Cannon","doi":"10.1016/j.scrs.2025.101159","DOIUrl":"10.1016/j.scrs.2025.101159","url":null,"abstract":"<div><div>Postoperative adrenal insufficiency (PAI) leading to refractory hypotension and resultant circulatory collapse is a rare but potentially devastating complication. In this review, we aim to describe the phenomenon of postoperative adrenal insufficiency, clarify approaches to management, and summarize current literature that informs management of perioperative steroids in the colorectal surgery patient population.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 1","pages":"Article 101159"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147408067","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}
Pub Date : 2026-03-01Epub Date: 2025-12-17DOI: 10.1016/j.scrs.2025.101160
Carine Dornbush MD , Jennifer Hrabe MD FACS FACRS
Ileus is a prevalent and perplexing surgical phenomenon that adds to patient morbidity and hospital length of stay and cost. While many have studied this process, the underlying cause remains elusive, but risk factors have been identified. Additionally, enhanced recovery pathways have been developed to mitigate surgical risk in ileus development. This review will define ileus, and its impact as well discuss potential causes and treatment strategies that have been evaluated.
{"title":"Postoperative ileus","authors":"Carine Dornbush MD , Jennifer Hrabe MD FACS FACRS","doi":"10.1016/j.scrs.2025.101160","DOIUrl":"10.1016/j.scrs.2025.101160","url":null,"abstract":"<div><div>Ileus is a prevalent and perplexing surgical phenomenon that adds to patient morbidity and hospital length of stay and cost. While many have studied this process, the underlying cause remains elusive, but risk factors have been identified. Additionally, enhanced recovery pathways have been developed to mitigate surgical risk in ileus development. This review will define ileus, and its impact as well discuss potential causes and treatment strategies that have been evaluated.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"37 1","pages":"Article 101160"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147408068","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}
Pub Date : 2025-12-01Epub Date: 2025-09-17DOI: 10.1016/j.scrs.2025.101133
Kelly M. Tyler M.D. (Guest Editor)
{"title":"Colorectal Billing, Coding, and Reimbursement: Understanding the Basics and Navigating Complexity","authors":"Kelly M. Tyler M.D. (Guest Editor)","doi":"10.1016/j.scrs.2025.101133","DOIUrl":"10.1016/j.scrs.2025.101133","url":null,"abstract":"","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"36 4","pages":"Article 101133"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658891","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}
Pub Date : 2025-12-01Epub Date: 2025-09-15DOI: 10.1016/j.scrs.2025.101137
Lynn M. O’Connor , Joshua A. Waters
The use of unlisted procedural codes in surgical billing poses risks of under-reimbursement or denial, especially in innovative fields like minimally invasive surgery. These codes are required when procedures lack specific CPT codes, often for new, experimental, or discontinued services. Proper documentation and preparation are crucial to secure reimbursement and reduce risks.
Unlisted codes should be compared to reference CPT codes to aid pricing and justification. Detailed documentation must include a description of the procedure, its complexity, necessity, and outcomes. This supports claims and ensures payer collaboration.
Reimbursement and RVU negotiations benefit from transparency regarding costs, resource demands, and historical data. Highlighting advanced technologies, specialized teams, or prolonged hospital stays can justify higher rates. For RVU-based models like Medicare, comparing complexity and resource use to reference codes is essential.
Preauthorization, appeals, and adherence to payer guidelines remain critical for success, ensuring fair compensation while reflecting the procedure’s true effort and value.
{"title":"Coding and reimbursement for unlisted anorectal and abdominal surgical procedures seminars in colon and rectal surgery","authors":"Lynn M. O’Connor , Joshua A. Waters","doi":"10.1016/j.scrs.2025.101137","DOIUrl":"10.1016/j.scrs.2025.101137","url":null,"abstract":"<div><div>The use of unlisted procedural codes in surgical billing poses risks of under-reimbursement or denial, especially in innovative fields like minimally invasive surgery. These codes are required when procedures lack specific CPT codes, often for new, experimental, or discontinued services. Proper documentation and preparation are crucial to secure reimbursement and reduce risks.</div><div>Unlisted codes should be compared to reference CPT codes to aid pricing and justification. Detailed documentation must include a description of the procedure, its complexity, necessity, and outcomes. This supports claims and ensures payer collaboration.</div><div>Reimbursement and RVU negotiations benefit from transparency regarding costs, resource demands, and historical data. Highlighting advanced technologies, specialized teams, or prolonged hospital stays can justify higher rates. For RVU-based models like Medicare, comparing complexity and resource use to reference codes is essential.</div><div>Preauthorization, appeals, and adherence to payer guidelines remain critical for success, ensuring fair compensation while reflecting the procedure’s true effort and value.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"36 4","pages":"Article 101137"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658895","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}
Pub Date : 2025-12-01Epub Date: 2025-08-20DOI: 10.1016/j.scrs.2025.101132
Kelly M. Tyler MD
{"title":"Corrigendum to “Advanced practice providers: An evolution of the scope of practice and clinical integration across the surgical healthcare landscape” [Seminars in Colon and Rectal Surgery Volume 35, issue 3 (2024) 101039]","authors":"Kelly M. Tyler MD","doi":"10.1016/j.scrs.2025.101132","DOIUrl":"10.1016/j.scrs.2025.101132","url":null,"abstract":"","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"36 4","pages":"Article 101132"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658898","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}
Pub Date : 2025-12-01Epub Date: 2025-09-15DOI: 10.1016/j.scrs.2025.101138
By Nicholas A. Davis , David E. Stein MD, MHCM
Physician compensation models have evolved significantly over the past decades, with Relative Value Units (RVUs) becoming a central benchmark for productivity and remuneration. This paper explores the origins of RVUs, their application in physician compensation, and the consequences of productivity-driven pay structures. While RVU-based compensation can standardize productivity measurements, it can also incentivize volume over quality, potentially leading to physician burnout and unnecessary procedures. Alternative models from leading healthcare organizations such as Mayo Clinic, Cleveland Clinic, Geisinger, and Intermountain Health demonstrate more balanced approaches that prioritize quality outcomes and physician satisfaction. Finally, we propose a structured framework for designing physician compensation models that integrate productivity with meaningful quality incentives. Through thoughtful implementation, healthcare systems can align physician compensation with both organizational goals and patient-centered care.
{"title":"Benchmarking physician productivity: The modern reality of physician compensation","authors":"By Nicholas A. Davis , David E. Stein MD, MHCM","doi":"10.1016/j.scrs.2025.101138","DOIUrl":"10.1016/j.scrs.2025.101138","url":null,"abstract":"<div><div>Physician compensation models have evolved significantly over the past decades, with Relative Value Units (RVUs) becoming a central benchmark for productivity and remuneration. This paper explores the origins of RVUs, their application in physician compensation, and the consequences of productivity-driven pay structures. While RVU-based compensation can standardize productivity measurements, it can also incentivize volume over quality, potentially leading to physician burnout and unnecessary procedures. Alternative models from leading healthcare organizations such as Mayo Clinic, Cleveland Clinic, Geisinger, and Intermountain Health demonstrate more balanced approaches that prioritize quality outcomes and physician satisfaction. Finally, we propose a structured framework for designing physician compensation models that integrate productivity with meaningful quality incentives. Through thoughtful implementation, healthcare systems can align physician compensation with both organizational goals and patient-centered care.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"36 4","pages":"Article 101138"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658896","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}
Pub Date : 2025-12-01Epub Date: 2025-09-15DOI: 10.1016/j.scrs.2025.101134
Eric G. Weiss , Brett P. Weiss
American healthcare policy requires a standard nomenclature(CPT) and valuation process(RUC). We review the makeup of both the CPT panel and advisory panel as well as the processes to create new CPT codes and edit current CPT codes as medical care and technology changes. We describe the RUC panel composition and the processes for determining the valuation of these new or edited CPT codes.
{"title":"The American medical association current procedural technology and relative value update committee process: How surgical work is defined and valued","authors":"Eric G. Weiss , Brett P. Weiss","doi":"10.1016/j.scrs.2025.101134","DOIUrl":"10.1016/j.scrs.2025.101134","url":null,"abstract":"<div><div>American healthcare policy requires a standard nomenclature(CPT) and valuation process(RUC). We review the makeup of both the CPT panel and advisory panel as well as the processes to create new CPT codes and edit current CPT codes as medical care and technology changes. We describe the RUC panel composition and the processes for determining the valuation of these new or edited CPT codes.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"36 4","pages":"Article 101134"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658892","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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