Uncommon Colorectal Challenges

Vladimir Bolshinsky, MBBS, MS, FRACS, FASCRS

Surgeons are physicians who can operate. As colorectal surgeons, we have extensive training in the physiological basis of gastrointestinal disorders and augment this core knowledge with a technical skillset. Some of us are fortunate to have formidable mentors who inspire us with their balance of surgical wisdom, finesse and flair that they refined over decades of practice. We are taught to consider outcomes ahead of the present and to do so independently, because when we are faced with a complex patient, it is simply too late to start thinking in the operating room.

In this volume of Clinics in Colon and Rectal Surgery we explore a series of uncommon colorectal challenges that are not popular enough for book chapters or review articles – until now. Our aim in exploring these topics is to combine the available literature with the practical tips from experts in the field.

I am indebted to all the authors who have invested their time and kindly shared their wealth of knowledge and experience. Each team has strived to make a point of difference in their respective articles that will not only leave the reader with an up-to-date synopsis, but also technical tips of how to successfully navigate such clinical scenarios.

Drs. Megan Lundy and Jean H. Ashburn from Wake Forest University Baptist Health in Winston-Salem North Carolina start off the edition by tackling the Hostile Abdomen. The concept of facing a hostile abdomen fills most abdominal surgeons with fearful sorrow and likely explains the paucity of publications on the topic. Several technical pearls are provided to help deal with difficult tissues and hostile adhesions.

Drs. Nitin Sajankila, Anthony DeRoss, and Jeremy Lipman from Cleveland Clinic in Cleveland, Ohio provide a detailed review of the Approach to the Adult Colorectal Patient with a History of Pediatric Abdominal Surgery. When faced with an adult patient requiring timely intervention, pediatric surgical records are often unavailable, and surgeons are left to piece together the preoperative anatomy based on a combination of limited patient history and radiological findings. This synopsis can be of benefit in such scenarios.

Dr. Kenneth Buxey from Melbourne, Australia addresses hernia and abdominal wall reconstruction for a colorectal surgeon. Incisional and parastomal hernias are a frequent issue faced by all colorectal surgeons. Our understanding and approach to both the prevention and treatment of such hernia is evolving. This article provides an update on new techniques, a summary of equipment and provides several complex case scenarios.

Dr. David M. Schwartzberg from Mather Hospital-Northwell health in Port Jefferson New York and Dr. Michael A Valente from Cleveland Clinic in Cleveland Ohio discuss Surgical Dilemmas associated with malignant large bowel obstructions. Surgeons faced with such emergent scenarios, are challenged both cognitively and technically. It is hoped that these scenarios may stimulate the readers to formulate the plan tailored to their skillset, which can be adapted to the anatomy of the specific patient.

Dr. Tarik Sammour from the Royal Adelaide Hospital and Dr. Arman Kahokehr from Lyell McEwin Hospital in Adelaide, Australia discuss pelvic radiation disease. This article describes short and long-term complications of pelvic radiation, focusing on both the genitourinary and gastrointestinal systems.

Drs. George A. Mori and Jim P. Tiernan from the John Goligher Colorectal Unit in Leeds, United Kingdom have written an excellent treatise on the Management of Perineal Wounds Following Pelvic Surgery. They provide an in-depth review of their extensive experience supported by the current literature.

Drs. Thomas Arthur and Adele Burgess from the Austin Hospital in Melbourne, Australia provide an in-depth review of the Acute Colonic Pseudo-Obstruction. Of particular interest is their attention to the recurrent pseudo-obstruction and underling colonic dysmotility, an important point of difference.

Drs. Rebecca J. Lendzion, Gert Frahm-Jensen, and James Keck from Melbourne and Canberra, Australia explore the challenges faced by colorectal and vascular surgeons when treating patients with acute mesenteric ischemia. The breadth of minimally invasive vascular interventions, hybrid management, and on-table modalities to confirm enteric perfusion may be of particular interest to the readership.

Drs. Bryan P. Kline and Nimalan A. Jeganathan from the Pennsylvania State University in Hershey, Pennsylvania discuss the morbid topic of Necrotizing Soft Tissue Infections of the Perineum. In their review they stress that early and aggressive debridement is critical. Further, they provide a healthy dose of clinical adaptability when exploring treatments adjuvant to the efficacy of timely surgical debridement.

Dr. Ashwin Subramaniam and the team from Melbourne, Australia provide a synopsis of colorectal surgery in critically unwell patients specifically exploring the physiological challenges faced by anesthesiologists and intensive care physicians. They offer several practical scenarios to illustrate their points.

On a personal level, it has been an absolute privilege to contribute to this volume of the journal and I wish to express my sincere gratitude to the Editor-in-Chief, Dr. Scott R. Steele. Behind the unparalleled energy and determination is a friend who I am incredibly fortunate to have as a mentor. To my wife Edwina (mother and surgeon) and my children Frederick, Adele, and Florence, I am proud, humbled, and grateful.

Publikationsverlauf

Artikel online veröffentlicht:
16. Februar 2022