Ambulatory Colorectal Surgery

Article Outline

• Copyright

The changing face of clinical practice in colorectal surgery in the 21st century is highlighted in many ways including the increasing role that outpatient surgery is playing in numerous disease states that previously mandated hospital stays for both workup and surgical treatment. Recognizing the evolving nature of colorectal surgical practice led the editors to develop this text to bring to its readership an update of various disease pathologies that can be evaluated in the clinic and then surgically treated either in the office or in the day surgery setting. It is in fact, more a modern-day proctology text that brings to its readers a relatively sophisticated presentation of various colorectal pathologies segregated as (1) functional disorders, including fissures, hemorrhoids, fecal incontinence, constipation, anal pain, and urogenital dysfunction; (2) septic disorders (abscess, fistuli, pilonidal disease, pruritis ani); (3) infectious disease (sexually transmitted diseases and anal intraepithelial neoplasia); and (4) perioperative care, including wound, ostomy, and pain management.

This textbook focuses on the more in-depth workup of the proctologic patient; thus, there are chapters and sections with thorough (and sometimes repetitive) reviews of anorectal manometry testing, endorectal ultrasound evaluation, pelvic floor testing including defecography, pudendal nerve testing, colonic transit testing, and pelvic floor electromyography. Pelvic floor dysfunction is a difficult subject and clearly the editors and their guest authors write from significant experience, even including a multidisciplinary section on urogynecologic disorders. The multiple contributors to this text present very thorough and erudite explanations of the many different subjects. The sections on biofeedback and Kegel training for fecal incontinence and constipation reflects an experience and first-hand understanding of such pathology and treatment. Similarly, there are excellent sections on evolving controversial topics such as the care and monitoring of patients with anal intraepithelial neoplasia, a subject of increasing importance since now HIV-infected patients live longer with effective antiviral therapy. There are excellent and very clinically relevant sections on anal pain management, pruritis ani, and fecal incontinence, including the Seca procedure. The chapter on stoma management is a thorough summary that any enterostomal therapist can use as a reference text with excellent pictures illustrating numerous enterostomal pathologies and their treatments.

However, there are some subject areas that receive scant or no attention that would have been very valuable contributions to such a text. Barely mentioned is the anticipated increasing role of sacral nerve stimulation for fecal incontinence and defecatory disorders (albeit most of this experience is from the UK and Europe). Similarly, the editors do not focus on the changing opinions regarding management of early rectal malignancy treated by either transanal resection or more often now, transanal endosopic microsurgery. Such subjects clearly fall into the “ambulatory colorectal surgery” definition; without them, this text has voids that will make it less useful to the practicing clinician.

The text uses illustrations and photos extensively to its advantage, especially in clarifying difficult subjects such as anorectal manometry and defecography. Some of the defecography figures with parallel highlighting of significant findings are excellent. But the relatively smaller size of this hard cover book combined with the exclusive black and white figures and photographs make them difficult to appreciate sometimes. Some figures also appear computer “pixelated,” which makes them even more indistinct. One figure alleges to show a Seton drain, but it is barely recognizable because of these factors. Thus, this book could have been a much more appealing text with better and higher quality figure reproduction, including a multicolor format.

Bottom Line: Although there are other texts of a similar type available, a unique aspect of this book is its broad subject material that will appeal to a wide array of readers. Beside colorectal surgeons, it provides topics relevant to gastroenterologists, gynecologists, enterostomal therapists, radiologists, pain and wound management staff, and even family practice professionals (eg, wanting knowledge of sexually transmitted diseases). The numerous topics this book covers provide for this broader approach to the proctologically afflicted outpatient and thus will be a useful contribution to any medical professional's library.