Hohenberger / Parker Lower Gastrointestinal Tract Surgery

Vol. 2, Open procedures
1. Auflage 2021
ISBN: 978-3-030-60827-9
Verlag: Springer International Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 625 Seiten

Reihe: Springer Surgery Atlas Series

This atlas, containing a wealth of clear operative images, is designed to enable trainee surgeons to visualise the surgical field for procedures specific to open colorectal surgery, thereby facilitating understanding and learning of surgical techniques and avoidance of intra- and postoperative complications. Step-by-step guidance is provided for a wide range of procedures to the colon, rectum, pelvic floor, anus and anal canal, in each case paying meticulous attention to surgical anatomy. The full range of potential indications for open surgery is considered, including benign and malignant tumours, inflammatory bowel disease, appendicitis, diverticulitis, hemorrhoids, anal fistulas and rectal prolapse among others. Whenever considered necessary, additional line drawings are included to aid comprehension of particular steps in the surgery. Readers seeking to improve their understanding of surgical anatomy and how to perform these operative procedures will find the atlas to be an unparalleled source of information and assistance. A complementary book from the same authors focuses on laparoscopic colorectal surgery.

Werner Hohenberger is Full Professor of Surgery, University of Erlangen-Nuremberg, Germany and Chair of the Surgical Department at the same university, where he had got his degree in 1973. Beside his long teaching career, during which he also worked as visiting professor in many universities abroad, such as the Cleveland Clinics, Ohio, USA and the Peking University People's Hospital, China, he has been dedicating great efforts within scientific societies in the field surgical oncology, which remains his chief clinical interest:  He was President of the German Cancer Society, the German Cancer Congress, and Member of the Executive Committee of the German Senologic Society. Michael Parker qualified from Westminster Hospital Medical School in 1973. He acquired the FRCS and FRCS(Ed) in 1980 and MS (London) in 1987. A consultant surgeon in a district general hospital for 20 years with a specialist interest in laparoscopic surgery, Professor Parker is a member of the Court of Examiners of the Royal College of Surgeons of England, past President of the Association of Coloproctology of Great Britain and Ireland, past President of the Surgical Section of the Royal Society of Medicine, past President of the Association of Laparoscopic Surgeons of Great Britain and Ireland and Trustee of the European Society of Coloproctology. In 2010 he initiated a programme of laparoscopic colorectal training in Denmark and in 2013 he was conferred with an Honorary Chair from the University of Århus. He spent ten years as a Council member of the Royal College of Surgeons of England until 2014. He is now retired from clinical practice but works as a Founder Director of a surgical innovations company called Sirius Genesis Ltd.

Autoren/Hrsg.

Hohenberger, Werner

Parker, Michael

Inhaltsverzeichnis

1;Foreword;6
2;Preface;8
3;Acknowledgments;9
4;Contents;10
5;Contributors;12
6;Part I: Colon;15
6.1;1: Surgical Anatomy and Embryology;16
6.1.1;1.1 Introduction;16
6.1.2;1.2 Embryology;16
6.1.3;1.3 Fasciae;19
6.1.4;1.4 Mesocolon;21
6.1.5;1.5 Arterial Blood Supply;29
6.1.6;1.6 Venous Drainage;32
6.1.7;1.7 Lymphatic System;37
6.1.8;1.8 Autonomic Nerves;40
6.1.9;References;43
6.2;2: Appendectomy;44
6.2.1;2.1 Introduction;44
6.2.2;2.2 Deciding Between Open Versus Laparoscopic Approach;44
6.2.3;2.3 Surgical Anatomy;44
6.2.4;2.4 Conventional Appendectomy;46
6.2.5;References;57
6.2.5.1;Suggested Readings;57
6.3;3: Crohn’s Disease of the Large Bowel;58
6.3.1;3.1 General Principles of Surgery for Crohn’s Disease of the Large Bowel;58
6.3.2;3.2 Operative Options;58
6.3.2.1;3.2.1 Segmental Colectomy;61
6.3.2.2;3.2.2 Subtotal or Total Colectomy;64
6.3.2.3;3.2.3 Proctectomy;65
6.3.2.4;3.2.4 Proctocolectomy;65
6.3.3;References;65
6.4;4: Ulcerative Colitis;66
6.4.1;4.1 Introduction;66
6.4.2;4.2 Surgical Options for UC;66
6.4.3;4.3 Total Proctocolectomy with Conventional End Ileostomy (TPC);66
6.4.4;4.4 Creation of Conventional End Ileostomy;67
6.4.5;4.5 Restorative Proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA);67
6.4.6;4.6 Creation of Loop Ileostomy;93
6.4.7;References;95
6.5;5: Benign Tumours of the Colon;96
6.5.1;5.1 Introduction;96
6.5.2;5.2 Resection of Right-Sided Tumours;96
6.5.3;5.3 Resection of Tumours of the Transverse and Left Colon;104
6.5.4;5.4 Laparoscopic Sigmoid Colectomy;116
6.5.5;5.5 Laparoscopic Total Colectomy;125
6.5.6;5.6 Laparoscopic “Rendezvous” or Laparo-Endoscopic Resection;129
6.5.7;References;131
6.6;6: Volvulus of the Colon;132
6.6.1;6.1 Caecal Volvulus;132
6.6.1.1;6.1.1 Pathophysiology;132
6.6.1.2;6.1.2 Clinical Presentation;132
6.6.1.3;6.1.3 Diagnosis;132
6.6.1.4;6.1.4 Management of Ileocaecal Volvulus;139
6.6.1.5;6.1.5 Open Versus Laparoscopic Surgery;141
6.6.2;6.2 Sigmoid Volvulus;141
6.6.2.1;6.2.1 Pathophysiology;142
6.6.2.2;6.2.2 Symptoms and Signs;143
6.6.2.3;6.2.3 Diagnosis;144
6.6.2.4;6.2.4 Imaging;144
6.6.2.5;6.2.5 Treatment;147
6.6.2.5.1;6.2.5.1 Conservative Treatment;147
6.6.2.5.2;6.2.5.2 Surgical Management;151
6.6.2.5.3;6.2.5.3 Elective Surgery;151
6.6.2.5.4;6.2.5.4 Non-resectional Procedures;151
6.6.2.5.5;6.2.5.5 Resectional Procedures;152
6.6.2.5.6;6.2.5.6 Emergent Procedure;152
6.6.2.6;6.2.6 Surgical Technique;156
6.6.3;Suggested Readings;163
6.7;7: Colon Cancer;164
6.7.1;7.1 Introduction;164
6.7.2;7.2 Embryological Planes and Mesocolic Excision;164
6.7.3;7.3 Lymph Node Dissection;169
6.7.4;7.4 Right Hemicolectomy;171
6.7.5;7.5 Extended Right Hemicolectomy;182
6.7.6;7.6 Carcinomas of the Splenic Flexure;190
6.7.7;7.7 Anastomosis;192
6.7.8;References;195
6.7.8.1;Suggested Reading;195
6.8;8: Ileostomies and Colostomies;196
6.8.1;8.1 Introduction;196
6.8.2;8.2 Loop Ileostomy;201
6.8.3;8.3 Loop Colostomy;211
6.8.4;References;219
6.9;9: Surgery for Cancer of the Left Colon;220
6.9.1;9.1 Introduction;220
6.9.2;9.2 Mobilisation of the Left Colon;220
6.9.3;9.3 Dissection of the Vessels, Bowel Resection and Reconstruction;227
6.9.4;Suggested Readings;235
7;Part II: Rectum;236
7.1;10: Rectum: Surgical Anatomy and Embryology;237
7.1.1;10.1 Introduction;237
7.1.2;10.2 Embryological Development of the Anorectum;237
7.1.3;10.3 Topographic Anatomy of the Rectum;240
7.1.4;10.4 Perirectal Fasciae;246
7.1.5;10.5 Arterial Blood Supply of the Anorectum;247
7.1.6;10.6 Autonomic and Somatic Nerve Supply of the Anorectum and Male Pelvic Organs;249
7.1.7;10.7 Dorsal, Lateral and Ventral Topography of the Rectum;250
7.1.8;Suggested Readings;260
7.2;11: Per Anal Excision of Benign Tumours;261
7.2.1;11.1 Introduction;261
7.2.2;11.2 Transanal Resection;261
7.2.3;11.3 Transanal Endoscopic Microsurgery;261
7.2.3.1;11.3.1 Pre-operative Assessment;264
7.2.3.2;11.3.2 Peri-operative Care and Positioning;265
7.2.3.3;11.3.3 Equipment;265
7.2.3.4;11.3.4 Procedure;266
7.2.3.5;11.3.5 Post-operative Care;271
7.2.4;11.4 Transanal Minimally Invasive Surgery;272
7.2.5;11.5 Endoscopic Mucosal Resection;273
7.2.6;11.6 Endoscopic Submucosal Dissection;279
7.2.7;References;282
7.3;12: Rectal Cancer: Anterior Resection and Low Anterior Resection with Total or Partial Mesorectal Excision;283
7.3.1;12.1 Introduction;283
7.3.2;12.2 Embryology;283
7.3.3;12.3 Left Colon and Splenic Flexure Mobilisation (Fig. 12.1);284
7.3.4;12.4 Ligation and Division of the Inferior Mesenteric Vessels;286
7.3.5;12.5 Mobilisation of the Mesorectum and Rectum;290
7.3.6;12.6 Posterior Dissection;290
7.3.7;12.7 Lateral Dissection;296
7.3.8;12.8 Anterior Dissection;299
7.3.9;12.9 Deep Posterior Dissection;300
7.3.10;12.10 Anterior Dissection in Low Rectal Cancer;304
7.3.11;12.11 Extended Resection for Cancer Adherence or Involvement Beyond the Mesorectal Fascia;304
7.3.12;12.12 Distal Washout and Anastomosis;305
7.3.13;12.13 Circular Stapled Anastomosis;308
7.3.14;12.14 Defunctioning a Low Anastomosis After TME;308
7.3.15;12.15 Partial Mesorectal Excision;309
7.3.16;12.16 Post-operative Assessment of the Specimen;309
7.3.17;References;310
7.4;13: Lateral Pelvic Lymph Node Dissection (Pelvic Sidewall Dissection);311
7.4.1;13.1 Introduction;311
7.4.2;13.2 Indications;311
7.4.3;13.3 Pelvic Sidewall Dissection;312
7.4.3.1;13.3.1 Taping of the Autonomic Nerves;313
7.4.3.2;13.3.2 Taping of the Ureters;313
7.4.3.3;13.3.3 Dissection of the Common Iliac Lymph Nodes;314
7.4.3.4;13.3.4 Dissection of the External Iliac Lymph Nodes;314
7.4.3.5;13.3.5 Dissection of the Obturator Lymph Nodes with Preservation of the Obturator Nerve;315
7.4.3.6;13.3.6 Dissection of the Internal Iliac Lymph Nodes Preserving the Superior Vesical Artery;316
7.4.3.7;13.3.7 Extraperitoneal Approach;320
7.4.3.8;13.3.8 Completion of Pelvic Sidewall Dissection;321
7.4.3.9;13.3.9 Combined Resection of Distal Internal Iliac Artery;321
7.4.3.10;13.3.10 Completion of Therapeutic Pelvic Sidewall Resection;325
7.4.4;References;328
7.5;14: Intersphincteric Abdominoperineal Resection;329
7.5.1;14.1 Definition and Indications;329
7.5.2;14.2 Surgical Strategy;329
7.5.3;14.3 Evolution of Surgery;332
7.5.4;14.4 Surgical Technique;333
7.5.4.1;14.4.1 Abdominal Step;333
7.5.4.2;14.4.2 Anal Exposure;335
7.5.4.3;14.4.3 Anal Canal Incision;336
7.5.4.4;14.4.4 Posterior Intersphincteric Dissection;337
7.5.4.5;14.4.5 Lateral Dissection;338
7.5.4.6;14.4.6 Anterior Dissection;339
7.5.4.7;14.4.7 Connection with the Abdominal Dissection;342
7.5.4.8;14.4.8 Anal Repair;346
7.5.4.9;14.4.9 Rectal Reconstruction;346
7.5.5;14.5 Deciding Between ISR and APR;347
7.5.6;14.6 Summary of Good Surgical Practice;350
7.5.7;References;350
7.6;15: Colon Cancer: Multivisceral Resection;351
7.6.1;15.1 Introduction;351
7.6.2;15.2 Preoperative and Intraoperative Management;351
7.6.3;15.3 Operative Procedure;351
7.6.4;15.4 Case Presentation;353
7.6.5;15.5 Peritoneal Carcinomatosis;376
7.6.6;15.6 Reconstruction;377
7.6.7;15.7 Conclusion;378
7.6.8;References;378
7.7;16: Abdominoperineal Excision of the Rectum;379
7.7.1;16.1 Introduction;379
7.7.2;16.2 The Abdominal Part of APE;379
7.7.3;16.3 Omentoplasty;379
7.7.4;16.4 The Pelvic Part of APE;382
7.7.5;16.5 Inter-Sphincteric APE (Fig. 16.2);382
7.7.6;16.6 Stoma Formation;383
7.7.7;16.7 Extra-Levator APE (ELAPE) (Fig. 16.3);385
7.7.8;16.8 Ischio-Anal APE (Fig. 16.12);396
7.7.9;16.9 Minimally Invasive Approaches to APE;398
7.7.10;16.10 Reconstruction of the Pelvic Floor;399
7.7.11;References;402
7.8;17: Pelvic Exenteration with Composite Pelvic Bone Resection for Malignant Infiltration;403
7.8.1;17.1 Introduction;403
7.8.2;17.2 Pelvic Bone Compartments and Their Contents (Fig. 17.1);405
7.8.3;17.3 Surgical Technique of Pelvic Exenteration with En Bloc Composite Resection of the Anterior Pelvic Bone (Pubic Bone) (Fig. 17.2);407
7.8.3.1;17.3.1 Results of Pelvic Exenteration with En Bloc Composite Resection of the Anterior Pelvic Bone (Pubic Bone);416
7.8.4;17.4 Surgical Technique of Pelvic Exenteration with En Bloc Composite Resection of the Posterior Bone (Sacrectomy);418
7.8.4.1;17.4.1 Results of Pelvic Exenteration with En Bloc Composite Resection of the Posterior Pelvic Bone (Sacrectomy);428
7.8.5;17.5 Surgical Technique of Lateral Pelvic Exenteration with Composite Lateral Pelvic Bone Excision;430
7.8.5.1;17.5.1 Results of Lateral Composite Pelvic Bone Excision with Pelvic Exenteration;432
7.8.6;References;434
7.9;18: Flaps for Reconstruction: Vertical Rectus Abdominis Myocutaneous Flap;435
7.9.1;18.1 Introduction;435
7.9.2;18.2 Preoperative Considerations and Measures;435
7.9.3;18.3 Operative Procedure;439
7.9.4;References;450
8;Part III: Pelvic Floor, Anus and Anal Canal;451
8.1;19: Pelvic Floor/Anal Canal: Surgical Anatomy and Embryology;452
8.1.1;19.1 Introduction;452
8.1.2;19.2 Pelvic and Urogenital Diaphragm;452
8.1.3;19.3 Pelvic Floor and Anal Sphincter Muscles;457
8.1.4;19.4 Nerve and Vascular Supply of the Pelvic Floor;461
8.1.5;19.5 Topography of Pelvic Spaces;464
8.1.6;19.6 Anal Canal;467
8.1.7;Suggested Readings;473
8.2;20: Haemorrhoids;474
8.2.1;20.1 Introduction;474
8.2.2;20.2 Clinical Presentation;474
8.2.3;20.3 Treatment Algorithm;474
8.2.3.1;20.3.1 General Measures;474
8.2.3.2;20.3.2 Sclerotherapy;475
8.2.3.3;20.3.3 Rubber Band Ligation;475
8.2.4;20.4 Surgery;475
8.2.4.1;20.4.1 Indication for Surgery;475
8.2.5;20.5 Surgical Techniques;476
8.2.5.1;20.5.1 Milligan-Morgan’s Open Haemorrhoidectomy (Fig. 20.1a–g);476
8.2.5.2;20.5.2 Segmental Haemorrhoid Resections with Tissue Sealing (Fig. 20.2a–j);476
8.2.5.3;20.5.3 Supra-Anodermal Haemorrhoidopexy with the Stapler (Fig. 20.3a–j);483
8.2.5.4;20.5.4 Haemorrhoidal Artery Ligation with/Without Anal Repair (Fig. 20.4a–d);483
8.2.5.5;20.5.5 Submucosal Tissue Destruction;483
8.2.6;20.6 Individualised Therapy and Indication;484
8.2.7;20.7 Results (for Detailed Information See the Respective Literature);484
8.2.8;20.8 Conclusion for Practical Work in Daily Routine;484
8.2.9;Suggested Readings;491
8.3;21: Anal Fistulas;492
8.3.1;21.1 Introduction;492
8.3.2;21.2 Diagnostic Imaging;492
8.3.3;21.3 Surgical Treatments;492
8.3.3.1;21.3.1 General Surgical Procedures;495
8.3.3.1.1;21.3.1.1 Fistulotomy;495
8.3.3.1.2;21.3.1.2 Core-Out Fistulectomy;496
8.3.3.1.3;21.3.1.3 Seton (Cutting, Loose, Chemical);499
8.3.3.1.3.1;Seton (Cutting Technique);499
8.3.3.1.3.2;Seton (Loose or Draining Technique);500
8.3.3.1.4;21.3.1.4 Mucosal/Skin Advancement Flaps (Fig. 21.6);501
8.3.3.2;21.3.2 Sphincter-Saving Procedures;502
8.3.3.2.1;21.3.2.1 Ligation of Intersphincteric Fistula Tract;503
8.3.3.2.2;21.3.2.2 Closure of Internal Opening with Over-the-Scope Clip (OTSC) Fistula Clip;505
8.3.3.2.3;21.3.2.3 Fistula Tract Filling (Glue, Paste, Plugs);506
8.3.3.2.3.1;Glue;506
8.3.3.2.3.2;Collagen Paste;507
8.3.3.2.3.3;Plugs;507
8.3.3.2.4;21.3.2.4 Fistula Tract Ablation;508
8.3.3.2.4.1;FiLaC;508
8.3.3.2.4.2;VAAFT (Video-Assisted Anal Fistula Treatment);509
8.3.3.2.5;21.3.2.5 Stem-Cell Therapy;509
8.3.4;21.4 Conclusions;511
8.3.5;References;511
8.4;22: Entero- and Rectocele, Rectal Prolapse;512
8.4.1;22.1 Introduction;512
8.4.2;22.2 Surgical and Functional Anatomy;512
8.4.3;22.3 Epidemiology, Aetiology and Pathogenesis;512
8.4.4;22.4 Treatment Objectives;513
8.4.5;22.5 Treatment Principles;514
8.4.6;22.6 Surgical Treatment;514
8.4.6.1;22.6.1 Transanal Approach;514
8.4.6.1.1;22.6.1.1 Mucosal Resection According to Rehn-Delorme;514
8.4.6.1.2;22.6.1.2 Rectosigmoidectomy According to Altemeier;521
8.4.6.1.3;22.6.1.3 Stapled Transanal Resection of the Rectum (STARR);522
8.4.6.1.4;22.6.1.4 Perineal Stapled Prolapse Resection (PSP);527
8.4.7;22.7 Transabdominal Surgical Approaches;528
8.4.8;References;533
8.5;23: Sacral Nerve Stimulation for Faecal Incontinence;534
8.5.1;23.1 Introduction;534
8.5.2;23.2 Concept;534
8.5.3;23.3 Anatomy;534
8.5.4;23.4 Indications and Contraindications;535
8.5.5;23.5 Surgical Technique;537
8.5.5.1;23.5.1 Patient Positioning;537
8.5.5.2;23.5.2 Use of Fluoroscopy/X-Ray;538
8.5.5.3;23.5.3 Foramen Needle Electrode Placement (Acute Percutaneous Evaluation);541
8.5.5.4;23.5.4 Temporary Electrode Placement;545
8.5.5.5;23.5.5 Tined Lead Electrode Placement;547
8.5.5.6;23.5.6 The Pocket in the Buttock/Pulse Generator Placement;561
8.5.5.7;23.5.7 Postoperative Management;563
8.5.6;References;563
8.6;24: Sphincteroplasty;564
8.6.1;24.1 Introduction;564
8.6.2;24.2 Operative Technique;564
8.6.2.1;24.2.1 Preoperative Considerations;564
8.6.2.2;24.2.2 Positioning;564
8.6.2.3;24.2.3 Surgical Steps;564
8.6.3;24.3 Post-Operative Management;583
8.6.4;24.4 Outcomes;584
8.6.5;References;585
8.7;25: Transanal Total Mesorectal Excision (ta-TME);586
8.7.1;25.1 Introduction;586
8.7.2;25.2 Technical Description of ta-TME;587
8.7.2.1;25.2.1 Laparoscopic Abdominal Phase;587
8.7.2.2;25.2.2 Endoscopic Transitional Phase;588
8.7.2.2.1;25.2.2.1 Position of the Patient;588
8.7.2.2.2;25.2.2.2 Placement of the Transanal Port Device;588
8.7.2.2.3;25.2.2.3 Purse-String Suture Below the Tumour Under Endoscopic Vision;593
8.7.2.2.4;25.2.2.4 Complete Transection of the Rectal Wall;594
8.7.2.2.5;25.2.2.5 Posterior Mesorectal Dissection;595
8.7.2.2.6;25.2.2.6 Anterior Mesorectal Dissection to the Peritoneal Reflection;596
8.7.2.2.7;25.2.2.7 Lateral Mesorectal Dissection;597
8.7.2.2.8;25.2.2.8 Extraction of the Surgical Specimen;599
8.7.2.2.8.1;Extraction of the Specimen by Transanal Route;599
8.7.2.2.8.2;Transabdominal Extraction;600
8.7.2.2.9;25.2.2.9 Preparation of the Colon to Anastomose the Bowel;601
8.7.3;25.3 Types of Anastomosis;602
8.7.3.1;25.3.1 Mechanical Anastomosis;602
8.7.3.2;25.3.2 Hand-Sewn Colo-Anal Anastomosis;603
8.7.3.3;25.3.3 Pull-Through Type Delayed Anastomosis;604
8.7.4;Suggested Readings;607
8.8;26: Multivisceral Resection for Rectal Cancer;608
8.8.1;26.1 Introduction;608
8.8.2;26.2 Preoperative Assessment;609
8.8.3;26.3 Total Pelvic Exenteration: The Surgical Steps;610
8.8.3.1;26.3.1 Mobilisation of the Colon and Posterior Dissection of the Rectum;610
8.8.3.2;26.3.2 Anterior Mobilisation of the Bladder;611
8.8.3.3;26.3.3 Lateral Pelvic Dissection of the Bladder’s Vascular Pedicles, the Autonomic Nerves, and Ureters;612
8.8.3.4;26.3.4 Perineal Dissection;614
8.8.3.5;26.3.5 Special Considerations;617
8.8.3.5.1;26.3.5.1 Extended Urethral Resection to the Base of the Penis;617
8.8.3.5.2;26.3.5.2 Rectal Resection with Prostatectomy, Sparing of the Bladder and Sphincter Preservation;617
8.8.4;26.4 Exenteration in Female Patients;619
8.8.4.1;26.4.1 Posterior Exenteration;620
8.8.4.2;26.4.2 Special Considerations;622
8.8.4.2.1;26.4.2.1 Total Vaginectomy;622
8.8.5;26.5 Lateral Pelvic Dissections;622
8.8.6;26.6 Extended Resections of the Pelvic Floor;625
8.8.7;References;625
8.8.7.1;Suggested Reading;625