Pub Date : 2022-06-01DOI: 10.1016/j.scrs.2022.100884
Bruce W. Robb MD , Michael Guzman MD
Anastomotic leak can be a devastating complication. Early recognition is the most important step in avoiding mortality and significant morbidity. Once identified, the surgeon must decide how to best mitigate the problem. A variety of options are available and should be tailored to the unique characteristics of the patient. Choosing between operative and non-operative intervention will be guided by the presentation. Early presentation with septic complications will typically be treated with a more invasive approach, while a delayed or insidious presentation can often be managed with a non-operative approach.
{"title":"Anastomotic leak won't fix itself. What are the options for management of anastomotic leak?","authors":"Bruce W. Robb MD , Michael Guzman MD","doi":"10.1016/j.scrs.2022.100884","DOIUrl":"10.1016/j.scrs.2022.100884","url":null,"abstract":"<div><p>Anastomotic leak can be a devastating complication. Early recognition is the most important step in avoiding mortality and significant morbidity. Once identified, the surgeon must decide how to best mitigate the problem. A variety of options are available and should be tailored to the unique characteristics of the patient. Choosing between operative and non-operative intervention will be guided by the presentation. Early presentation with septic complications will typically be treated with a more invasive approach, while a delayed or insidious presentation can often be managed with a non-operative approach.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 2","pages":"Article 100884"},"PeriodicalIF":0.3,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43558476","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 : 2022-06-01DOI: 10.1016/j.scrs.2022.100882
Lucille Yao MD , Karen Zaghiyan MD
This chapter is focused on the timely diagnosis of anastomotic leak (AL). The general approach emphasizes the recognition of early symptoms of AL to expedite diagnosis and treatment. We will begin with a brief background on known risk factors for developing AL, followed by a review of common presenting symptoms and diagnostic tools. We will review clinical, laboratory, imaging, and endoscopic assessments that may be used to facilitate early diagnosis. We will discuss novel, evidence-based laboratory studies used to detect early AL. We will also discuss whether imaging studies are needed and the pros and cons of various imaging and endoscopic modalities for different types of AL. This chapter is intended to be a succinct reference to guide clinical practice.
{"title":"When you think something is wrong – something IS wrong: Timely diagnosis of anastomotic leak","authors":"Lucille Yao MD , Karen Zaghiyan MD","doi":"10.1016/j.scrs.2022.100882","DOIUrl":"10.1016/j.scrs.2022.100882","url":null,"abstract":"<div><p><span>This chapter is focused on the timely diagnosis of anastomotic leak (AL). The general approach emphasizes the recognition of early symptoms of AL to expedite diagnosis and </span>treatment. We will begin with a brief background on known risk factors for developing AL, followed by a review of common presenting symptoms and diagnostic tools. We will review clinical, laboratory, imaging, and endoscopic assessments that may be used to facilitate early diagnosis. We will discuss novel, evidence-based laboratory studies used to detect early AL. We will also discuss whether imaging studies are needed and the pros and cons of various imaging and endoscopic modalities for different types of AL. This chapter is intended to be a succinct reference to guide clinical practice.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 2","pages":"Article 100882"},"PeriodicalIF":0.3,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43156788","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 : 2022-06-01DOI: 10.1016/j.scrs.2022.100881
Meridith Ginesi MD, Emily Steinhagen MD
Many factors go into the decision to make an anastomosis in colorectal surgery. Emergency surgery is inherently higher risk than elective surgery, but patient factors, such as comorbidities and clinical status, and situational factors, such as contamination can increase the risk of anastomotic complications. Evidence has demonstrated the relative safety of anastomosis and diversion in the setting of feculent or purulent peritonitis, which is somewhat contradictory to previous surgical dictum. Anastomosis in the setting of large bowel obstruction has been extensively studied, and its safety varies widely depending on the cause of the obstruction, location of the obstruction and the type of anastomosis required. In traumatic injuries, data suggests that anastomosis is not necessarily riskier than diversion.
{"title":"A brave new world: Colorectal anastomosis in trauma, diverticulitis, peritonitis, and colonic obstruction","authors":"Meridith Ginesi MD, Emily Steinhagen MD","doi":"10.1016/j.scrs.2022.100881","DOIUrl":"10.1016/j.scrs.2022.100881","url":null,"abstract":"<div><p>Many factors go into the decision to make an anastomosis<span><span> in colorectal surgery. Emergency surgery is inherently higher risk than </span>elective surgery<span><span>, but patient factors, such as comorbidities and clinical status, and situational factors, such as contamination can increase the risk of anastomotic complications. Evidence has demonstrated the relative safety of anastomosis and diversion in the setting of feculent or purulent peritonitis, which is somewhat contradictory to previous surgical dictum. Anastomosis in the setting of large </span>bowel obstruction has been extensively studied, and its safety varies widely depending on the cause of the obstruction, location of the obstruction and the type of anastomosis required. In traumatic injuries, data suggests that anastomosis is not necessarily riskier than diversion.</span></span></p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 2","pages":"Article 100881"},"PeriodicalIF":0.3,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43421076","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 : 2022-03-01DOI: 10.1016/j.scrs.2022.100868
Jean H Ashburn MD
For decades, surgery has been a dependable mainstay in the treatment of inflammatory bowel disease, particularly for ulcerative colitis. Surgical techniques and approaches have evolved over time, but the ultimate goals of surgery for ulcerative colitis have remained constant: that is, to alleviate symptoms and mitigate cancer risk while achieving the highest possible quality of life. A structured surgical approach to the patient with ulcerative colitis is required whereby the complexities of surgical decision-making and several commonly debated topics must be considered.
{"title":"Operative indications and options in ulcerative colitis","authors":"Jean H Ashburn MD","doi":"10.1016/j.scrs.2022.100868","DOIUrl":"10.1016/j.scrs.2022.100868","url":null,"abstract":"<div><p><span><span>For decades, surgery has been a dependable mainstay in the treatment of inflammatory bowel disease, particularly for </span>ulcerative colitis. Surgical techniques and approaches have evolved over time, but the ultimate goals of surgery for ulcerative colitis have remained constant: that is, to alleviate symptoms and mitigate cancer risk while achieving the highest possible </span>quality of life. A structured surgical approach to the patient with ulcerative colitis is required whereby the complexities of surgical decision-making and several commonly debated topics must be considered.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 1","pages":"Article 100868"},"PeriodicalIF":0.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46841207","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 : 2022-03-01DOI: 10.1016/j.scrs.2022.100861
Katherine Falloon MD , Ruthvik Padival MD , Satya Kurada MD , Sara El Ouali MD , Florian Rieder MD
Inflammatory bowel diseases are a group of chronic, relapsing disorders of the gastrointestinal tract. The initially limited therapy options were significantly expanded with the advent of biologics and small molecules. Biologics and small molecules can be divided into four categories based on their immunologic targets – anti-tumor necrosis factor, anti-interleukin, anti-integrin, and janus kinase pathway inhibitor. Each class of medication functions through a particular mechanism of action that dictates its indications for use, rate of efficacy, and safety profile.
{"title":"Biologic agents and small molecules – mechanism of action","authors":"Katherine Falloon MD , Ruthvik Padival MD , Satya Kurada MD , Sara El Ouali MD , Florian Rieder MD","doi":"10.1016/j.scrs.2022.100861","DOIUrl":"10.1016/j.scrs.2022.100861","url":null,"abstract":"<div><p>Inflammatory bowel diseases are a group of chronic, relapsing disorders of the gastrointestinal tract<span>. The initially limited therapy options were significantly expanded with the advent of biologics and small molecules. Biologics and small molecules can be divided into four categories based on their immunologic targets – anti-tumor necrosis factor, anti-interleukin, anti-integrin, and janus kinase pathway inhibitor. Each class of medication functions through a particular mechanism of action that dictates its indications for use, rate of efficacy, and safety profile.</span></p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 1","pages":"Article 100861"},"PeriodicalIF":0.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46480656","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 : 2022-03-01DOI: 10.1016/j.scrs.2022.100862
Eula Plana Tetangco MD, MPH , Adam C. Stein MD
Crohns disease (CD) is a chronic inflammatory condition that can affect any portion of the intestinal tract. The disease presents with myriad symptoms and signs and is best diagnosed and staged through a combination of laboratory tests, endoscopic procedures, and radiographic studies. Appropriate medical therapy is based upon the disease behavior, location, and severity and may require use of one or more classes of medications in an attempt to achieve endoscopic remission as well as histologic normalization. Several clinical scenarios require special consideration and it is important for the gastroenterologist to work with the patient, surgeon, and other healthcare providers to achieve optimal outcomes.
{"title":"Medical treatment of intestinal Crohn's disease","authors":"Eula Plana Tetangco MD, MPH , Adam C. Stein MD","doi":"10.1016/j.scrs.2022.100862","DOIUrl":"10.1016/j.scrs.2022.100862","url":null,"abstract":"<div><p>Crohns disease (CD) is a chronic inflammatory condition that can affect any portion of the intestinal tract. The disease presents with myriad symptoms and signs and is best diagnosed and staged through a combination of laboratory tests, endoscopic procedures, and radiographic studies. Appropriate medical therapy is based upon the disease behavior, location, and severity and may require use of one or more classes of medications in an attempt to achieve endoscopic remission as well as histologic normalization. Several clinical scenarios require special consideration and it is important for the gastroenterologist to work with the patient, surgeon, and other healthcare providers to achieve optimal outcomes.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 1","pages":"Article 100862"},"PeriodicalIF":0.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49472256","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 : 2022-03-01DOI: 10.1016/j.scrs.2022.100866
Amy L. Lightner MD , Phillip R. Fleshner MD
As biologics have become the cornerstone of medical management for ulcerative colitis, an increasing number of surgical candidates have been recently exposed to biologic therapy. Evidence regarding the impact of biologic therapy on postoperative outcomes remains controversial. Data comes largely from retrospective single-center databases which are limited by significant interstudy heterogeneity. Although some debate remains, it is imperative that surgeons have an understanding of how to best manage biologic therapy in the perioperative period, and potentially adjust their surgical approach in order to optimize postoperative outcomes.
{"title":"Perioperative management of biologic agents in ulcerative colitis","authors":"Amy L. Lightner MD , Phillip R. Fleshner MD","doi":"10.1016/j.scrs.2022.100866","DOIUrl":"10.1016/j.scrs.2022.100866","url":null,"abstract":"<div><p>As biologics have become the cornerstone of medical management for ulcerative colitis<span>, an increasing number of surgical candidates have been recently exposed to biologic therapy. Evidence regarding the impact of biologic therapy on postoperative outcomes remains controversial. Data comes largely from retrospective single-center databases which are limited by significant interstudy heterogeneity. Although some debate remains, it is imperative that surgeons have an understanding of how to best manage biologic therapy in the perioperative period, and potentially adjust their surgical approach in order to optimize postoperative outcomes.</span></p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 1","pages":"Article 100866"},"PeriodicalIF":0.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45132179","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 : 2022-03-01DOI: 10.1016/j.scrs.2022.100865
Valery Vilchez MD, Amy L. Lightner MD
The medical management of inflammatory bowel disease has shifted towards more frequent use of biologics in the current era. This has led to an increasing number of patients exposed to various classes of biologics in the perioperative period. Evidence regarding the impact of preoperative exposure to this therapy on surgical outcomes remains controversial and difficult to completely assess given different confounding factors associated with the disease process. Regardless, it is imperative that surgeons have an improved understanding of the perioperative optimization of biologics in order to more closely work with both their patients and gastroenterologists to achieve optimal outcomes.
{"title":"Perioperative management of biologic agents in Crohn's disease","authors":"Valery Vilchez MD, Amy L. Lightner MD","doi":"10.1016/j.scrs.2022.100865","DOIUrl":"10.1016/j.scrs.2022.100865","url":null,"abstract":"<div><p>The medical management of inflammatory bowel disease has shifted towards more frequent use of biologics in the current era. This has led to an increasing number of patients exposed to various classes of biologics in the perioperative period. Evidence regarding the impact of preoperative exposure to this therapy on surgical outcomes remains controversial and difficult to completely assess given different confounding factors associated with the disease process. Regardless, it is imperative that surgeons have an improved understanding of the perioperative optimization of biologics in order to more closely work with both their patients and gastroenterologists to achieve optimal outcomes.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 1","pages":"Article 100865"},"PeriodicalIF":0.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44111750","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 : 2022-03-01DOI: 10.1016/j.scrs.2022.100864
Dominic Vitello MD, Michael F. McGee MD
Despite dramatic advances in medical treatment of inflammatory colitis, a substantial proportion of patients with ulcerative colitis (UC) and isolated Crohn's disease (CD) colitis will acutely develop severe disease requiring hospitalization and surgery. It is imperative that surgeons understand the multidisciplinary nuances at the intersection between medical and surgical management. It is important that the surgeon be able to evaluate and stratify the severity of inflammatory bowel disease (IBD) colitis, understand medical treatment options, monitor responses to medical therapy, and ultimately execute timely and appropriate surgery for these often-ill patients.
{"title":"Treatment of severe and fulminant inflammatory bowel disease colitis","authors":"Dominic Vitello MD, Michael F. McGee MD","doi":"10.1016/j.scrs.2022.100864","DOIUrl":"10.1016/j.scrs.2022.100864","url":null,"abstract":"<div><p><span>Despite dramatic advances in medical treatment of inflammatory colitis, a substantial proportion of patients with ulcerative colitis (UC) and isolated </span>Crohn's disease (CD) colitis will acutely develop severe disease requiring hospitalization and surgery. It is imperative that surgeons understand the multidisciplinary nuances at the intersection between medical and surgical management. It is important that the surgeon be able to evaluate and stratify the severity of inflammatory bowel disease (IBD) colitis, understand medical treatment options, monitor responses to medical therapy, and ultimately execute timely and appropriate surgery for these often-ill patients.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 1","pages":"Article 100864"},"PeriodicalIF":0.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47955703","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 : 2022-03-01DOI: 10.1016/j.scrs.2022.100863
Sumona Bhattacharya MD , Raymond K. Cross MD, MS
Ulcerative colitis is a chronic inflammatory condition characterized by abdominal pain and diarrhea usually with hematochezia. Optimal medical management of ulcerative colitis is aimed at resolving clinical symptoms as well as achieving mucosal healing. Treatments are selected based on several variables including severity of symptoms, overall inflammatory burden, and whether risk factors for poor prognosis are present. Various medications currently approved for use in ulcerative colitis include 5-aminosalicylates, corticosteroids, thiopurines, anti-tumor necrosis factor antagonists, ustekinumab, vedolizumab, and tofacitinib. While the appropriate use of these as solitary drugs or in combination is often straightforward, therapy for particularly complex patients such as those requiring a rapid onset of action, those who are elderly or have significant medical co-morbidities, those with history of or active malignancy, those who are pregnant or breastfeeding, as well as those with extra-intestinal manifestations requires special consideration.
{"title":"Medical treatment of ulcerative colitis","authors":"Sumona Bhattacharya MD , Raymond K. Cross MD, MS","doi":"10.1016/j.scrs.2022.100863","DOIUrl":"https://doi.org/10.1016/j.scrs.2022.100863","url":null,"abstract":"<div><p>Ulcerative colitis<span><span><span><span> is a chronic inflammatory condition characterized by abdominal pain and diarrhea usually with hematochezia<span>. Optimal medical management of ulcerative colitis is aimed at resolving clinical symptoms as well as achieving mucosal healing. Treatments are selected based on several variables including severity of symptoms, overall inflammatory burden, and whether risk factors for poor prognosis are present. Various medications currently approved for use in ulcerative colitis include 5-aminosalicylates, corticosteroids, </span></span>thiopurines<span>, anti-tumor necrosis factor antagonists, ustekinumab<span>, vedolizumab, and </span></span></span>tofacitinib. While the appropriate use of these as solitary </span>drugs<span> or in combination is often straightforward, therapy for particularly complex patients such as those requiring a rapid onset of action, those who are elderly or have significant medical co-morbidities, those with history of or active malignancy, those who are pregnant or breastfeeding, as well as those with extra-intestinal manifestations requires special consideration.</span></span></p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"33 1","pages":"Article 100863"},"PeriodicalIF":0.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138393422","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}