Full Description
A gem among surgical manuals, this comprehensive guide to Crohn's disease and ulcerative colitis is an excellent source for all surgeons looking specifically for technical details about the surgical management of these two diseases. Its authors - both involved in multi-center international trials, working parties and symposia - capture in print the improved techniques that have brought about revolutionary developments in the field. The extremely practical approach makes it easy for surgeons to review the indications for surgical interventions and the surgical options available for each clinical problem. Step-by-step operative instructions with practical tips born of long experience are given. The authors point out what results one should expect following the surgical intervention; these include zero mortality and minimal morbidity. They also list all the steps that should be taken to minimize the risk of late complications or recurrence. The clear instructions in this manual will also be of great value to non-surgical physicians who wish to know the indications for surgical treatment and what results they should expect from their surgical colleagues.
Contents
Section I.- 1 History.- The History of Crohn's Disease.- The History of Ulcerative Colitis.- 2 Aetiopathology and Natural History.- 3 Nutrition in Inflammatory Bowel Disease.- Specific Nutritional Problems in IBD.- Nutritional Support in the Treatment for IBD.- 4 Psychosis, Psychology, Stress and Counselling.- Relationship of Psychiatric and Psychological Disorders.- Stress.- The Effect of Diagnosis.- Psychological Counselling of Patients with Crohn's Disease.- The Role of Patient Societies and Clubs.- Assessment of the Quality of Life.- Longitudinal Surveillance (a Surgical Perspective).- Section II.- 5 Crohn's Disease: A Remaining Medical Enigma and Surgical Challenge.- Demography.- 6 Surgical Management.- The General Principles.- Overcoming the Complications of Crohn's Disease.- 7 Indications for Surgical Intervention.- Emergency Indications.- Elective Indications.- 8 Reducing the Risks of Operation.- Principles.- Minimise Blood Loss.- Preventing Damage to Adjacent Tissues and Organs.- Minimise Infection.- Avoid Unnecessary Sacrifice of Gut.- Avoiding Anastomotic Leakage.- Risk of Recrudescence and How to Minimise It.- 9 Assessment and Preparation.- Principles.- General and Nutrition.- Psychological Preparation.- Bowel Preparation.- 10 Resection of the Ileum or Ileocaecum.- Operative Position.- Skin Preparation and Draping.- The Incision.- Peritoneal Access.- Technique of Dissection.- Haemostasis.- Extent of Excision.- Opening and Occluding the Gut.- Suturing.- When to Avoid Anastomosis.- Creation of a Stoma.- Abdominal Wall Closure.- Management of Contaminated Wounds.- 11 Bypass, Diversion and Dilatation.- Indications and Principles of Bypass.- Ileo-transverse and Entero-enteric Bypass.- Dilatation with Balloon or Dilator.- Indications.- Technique.- Complications and Precautions.- Results.- 12 Strictureplasty.- Why Strictures Cause Problems.- Towards Conservative Operations.- The Concept of Strictureplasty.- Indications.- Technique.- Results.- Complications.- Strictureplasty Now and in the Future.- 13 The Management of Fistula.- Principles.- Defence Mechanisms and Repair.- The Natural History of an Intestinal Fistula.- Classification of Fistulas.- Causes of Fistula.- Peculiarities of Fistulas in Crohn's Disease.- Assessment.- Nutrition.- Surgical Intervention.- 14 Colonic Crohn's Disease (Including Rectal Disease).- Indications for Surgery.- Surgical Options.- 15 Technique of Total Colectomy and Ileo-rectal Anastomosis.- Pre-operative Check.- Bowel Preparation.- Patient Position and Skin Preparation.- Position of the Surgical Team.- Incision.- The Laparotomy.- Dissection of the Upper Rectum.- Colectomy.- The Anastomosis.- Closure of the Abdomen.- 16 Technique of Panproctocolectomy.- Preparation and Position of the Patient.- Rectal Dissection from Above.- Perineal Dissection.- Management of the Pelvic Space.- Creation of the Stoma.- Abdominal Closure.- Eversion of the Ileostomy.- 17 Post-operative Complication.- Early Complications.- Intermediate.- 18 Perianal Crohn's Disease.- Definition.- Classification.- Pathology.- Symptoms and Signs.- Differentiation from Common-or-Garden Anal Disease.- Natural History of the Disease.- Assessing the Extent and Anatomical Location.- The Management of Perianal Crohn's Disease.- Some Unanswered Questions.- The Way Ahead.- 19 Associated Diseases.- Extra-intestinal Manifestations.- Associated Diseases.- Section III.- 20 Ulcerative Colitis: Indications for Surgical Intervention.- Indications for Urgent Surgery.- Elective Surgery for Ulcerative Colitis.- 21 Surgical Options.- Total Colectomy and Mucus Fistula.- Panproctocolectomy and Permanent Ileostomy.- Ileo-rectal Anastomosis.- Continent Ileostomy (Kock Pouch).- Restorative Proctocolectomy.- 22 Pre-operative Assessment and Preparation.- Pre-operative Assessment.- Preparation of the Patient.- 23 The Operation.- Total Colectomy, Ileostomy and Mucus Fistula.- Panproctocolectomy and Ileostomy.- Ileo-rectal Anastomosis.- The Continent Ileostomy.- Restorative Proctocolectomy.- 24 Indeterminate Colitis.- 25 Management of Cancer and Dysplasia in Ulcerative Colitis.- The Role of Dysplasia in Ulcerative Colitis.- Surveillance of Patients at Risk.- Surgical Treatment of Cancer in Ulcerative Colitis.- 26 Pouch Function.- Clinical Determinants of Pouch Function.- Physiological Determinants of Pouch Function.- Pouch and Anal Canal Motility.- Ecology of Ileal Pouches.- 27 Complications of Restorative Proctocolectomy.- Early Complication.- Pouchitis.- Pouch-Anal or Pouch-Vaginal Fistulas.- Re-operation for Complications of Restorative Proctocolectomy.- Quality of Life after Ileal Pouch-Anal Anastomosis.- Section IV.- 28 Management of Stomas.- Stoma Siting.- Patient Counselling.- Operative Technique.- Ileostomy Effluent.- Complications of Stomas.- 29 Follow-Up in Inflammatory Bowel Disease.
