La teoría de juegos: Una breve introducción (El Libro De Bolsillo - Ciencias Sociales) (Spanish Edition)

Cover IFC Half Title Title Copyright Contributors Preface TOC Video Contents Section 1 - The American Board of Surgery Certifying (Oral) Examination The American Board of Surgery Certifying (Oral) Examination PRINCIPLE CONTENT PROCESS PREPARATION ASSESSMENT SUMMARY Suggested Readings Section 2 - Esophagus Subchapter 1 Esophageal Function Tests ESOPHAGEAL MANOMETRY ESOPHAGEAL pH MONITORING IMPEDANCE TESTING FUNCTIONAL LUMINAL IMAGING PROBE PANOMETRY CONCLUSION Subchapter 2 Surgical Management of Gastroesophageal Reflux Disease PRESENTATIONS OF GERD DIAGNOSIS AND PREOPERATIVE EVALUATION INITIAL MANAGEMENT AND INDICATIONS FOR SURGERY Indications for Surgical Management of GERD Contraindications to Antireflux Surgery SURGICAL TECHNIQUE Steps of the Procedure: Initial Setup, Hiatal Dissection, and Closure of the Crura Steps of the Procedure: Creating a 360-Degree Nissen Fundoplication Steps of the Procedure: Creating a 270-Degree Posterior Toupet Fundoplication POSTOPERATIVE CARE, SURGICAL COMPLICATIONS, AND OUTCOMES SPECIAL CONSIDERATIONS Subchapter 3 New Approaches to Gastroesophageal Reflux Disease (Linx) WHY A NEW SURGICAL ANTIREFLUX PROCEDURE? NEW SURGICAL APPROACH TO GERD LINX ANTIREFLUX DEVICE LINX IMPLANTATION PROCEDURE LONG-TERM CLINICAL OUTCOMES OF THE LINX MAGNETIC SPHINCTER AUGMENTATION DEVICE Subchapter 4 Management of Barrett’s Esophagus DEFINITION OF BARRETT’S ESOPHAGUS AND TREATMENT OBJECTIVES CLINICAL EFFECT AND FEATURES OF BARRETT’S ESOPHAGUS SCREENING AND EVALUATION OF BARRETT’S ESOPHAGUS Screening Evaluation SURVEILLANCE MANAGEMENT OF BARRETT’S ESOPHAGUS WITHOUT DYSPLASIA MANAGEMENT OF BARRETT’S ESOPHAGUS WITH LOW-GRADE DYSPLASIA MANAGEMENT OF BARRETT’S ESOPHAGUS WITH HIGH-GRADE DYSPLASIA Esophagectomy in High-Grade Dysplasia CONSIDERATIONS REGARDING ANTIREFLUX SURGERY IN BARRETT’S ESOPHAGUS CONCLUSION Subchapter 5 Endoscopic Treatment of Barrett’s Esophagus SURVEILLANCE AND MANAGEMENT ALGORITHM Screening Surveillance PRINCIPLES OF ENDOSCOPIC THERAPIES ENDOSCOPIC RESECTION TECHNIQUES Endoscopic Mucosal Resection Endoscopic Submucosal Dissection ENDOSCOPIC ABLATION TECHNIQUE Photodynamic Therapy Argon Plasma Coagulation Cryotherapy Radiofrequency Ablation CONCLUSION Subchapter 6 Management of Paraesophageal Hernia Repair SURGICAL INDICATIONS AND PREOPERATIVE EVALUATION SURGICAL TECHNIQUE Laparoscopic Repair of Paraesophageal Hernias Positioning of the Patient and Placement of Ports Dissection and Reduction of the Hernia Sac Esophageal Mobilization and Lengthening Closure of the Esophageal Hiatus Creation of the Fundoplication Open Repair of Large Paraesophageal Hernias Repair through an Upper Midline Laparotomy Repair through a Left Thoracotomy POSTOPERATIVE CARE OUTCOMES Acknowledgments Subchapter 7 Management of Zenker’s Diverticulum GENERAL CONSIDERATIONS PATHOPHYSIOLOGY DIAGNOSIS TREATMENT SURGICAL MANAGEMENT Surgical Anatomy and Access Dysmotility Treatment Diverticulum Treatment Outcome ENDOSCOPIC TREATMENT OF ZENKER’S DIVERTICULUM Rigid Endoscopic Technique Flexible Endoscopic Technique Endoscopic Septum Division Z-POEM Subchapter 8 Achalasia of the Esophagus TREATMENT Botulinum Toxin Pneumatic Dilation Myotomy: Laparoscopic Heller Myotomy and Peroral Endoscopic Myotomy Laparoscopic Heller Myotomy Peroral Endoscopic Myotomy TREATMENT FAILURE, ADVANCED DISEASE, AND FOLLOW-UP Robotic Heller Myotomy with Dor Fundoplication SUMMARY Subchapter 9 Management of Disorders of Esophageal Motility PRESENTATION Diagnostic Testing Classification of Disease Esophagogastric Outflow Obstruction Disorders of Peristalsis Nonoperative Management Dietary and Behavioral Modifications Pharmacologic Therapy Endoscopic Therapy Surgical Management Peroral Endoscopic Myotomy Operative Technique Postoperative Care Complications CONCLUSION Acknowledgment Subchapter 10 Management of Esophageal Cancer EPIDEMIOLOGY CLINICAL PRESENTATION DIAGNOSIS/STAGING STAGE-BASED TREATMENT STRATEGIES/ALGORITHMS OPERATIVE APPROACHES TO ESOPHAGEAL CANCER Surgical Resection Ivor Lewis Esophagectomy McKeown Transhiatal COMPLICATIONS CONCLUSION Subchapter 11 Multimodality Therapy in Esophageal Cancer OVERVIEW DEFINITIONS OF MULTIMODAL THERAPY AND INDICATIONS IN ESOPHAGEAL CANCER Traditional Multimodal Treatment Esophageal Adenocarcinoma and Gastroesophageal Junction Adenocarcinoma Esophageal Squamous Cell Carcinoma Immunotherapy in Neoadjuvant and Adjuvant Settings Multimodal Therapy for Recurrent and Oligometastatic Disease: A New Frontier for Surgery? Additional Considerations to Multimodal Therapy CONCLUSIONS Subchapter 12 Use of Esophageal Stents STENTS THROUGH THE AGES STENT SELECTION PATIENT SELECTION INDICATIONS Malignant Esophageal Disease Malignant Esophageal Strictures Malignant Esophageal Fistulas Gastroesophageal Junction Tumors Bridge to Surgery Benign Esophageal Disease Benign Refractory Esophageal Strictures Benign Perforations, Anastomotic Leaks, and Fistulas Achalasia Refractory Esophageal Variceal Bleeding PROCEDURE COMPLICATIONS Tissue Erosion Vascular Erosion Aerodigestive Erosion Stent Migration CONCLUSION Subchapter 13 Management of Esophageal Perforation INTRODUCTION DIAGNOSIS Esophagram Computed Tomography Computed Tomography Esophagography Endoscopy Assessing Severity of Illness and Prognosis MANAGEMENT Nonoperative Management Endoscopic Stenting with Thoracoscopic Mediastinal and Pleural Drainage Endoscopic Techniques Open Repair Thoracic Perforations Cervical Perforations Abdominal Perforations Nutritional Management Following Repair Resection with Diversion Special Situations Malignancy Achalasia Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Section 3 - Stomach Benign Gastric Ulcer TYPES OF BENIGN GASTRIC ULCER SURGICAL OPTIONS FOR GASTRIC ULCER INDICATIONS FOR OPERATION PERFORATED GASTRIC ULCER BLEEDING GASTRIC ULCER OBSTRUCTING GASTRIC ULCER NONHEALING GASTRIC ULCER (INTRACTABILITY) MARGINAL AND RECURRENT ULCER Management of Duodenal Ulcers INTRODUCTION MEDICAL MANAGEMENT OF DUODENAL ULCER Perforated Duodenal Ulcer Omental Patching Special Considerations for Large Ulcer Perforations Definitive Ulcer Surgery Minimally Invasive Surgery Postoperative Management BLEEDING DUODENAL ULCER Risk Stratification Surgery for Bleeding Duodenal Ulcer Oversewing of a Bleeding Duodenal Ulcer Definitive Ulcer Surgery Postoperative Management GASTRIC OUTLET OBSTRUCTION Surgery for Obstructing Duodenal Ulcer Vagotomy and Antrectomy INTRACTABLE DUODENAL ULCER MANAGEMENT OF THE DIFFICULT DUODENAL STUMP CONCLUSION Management of Zollinger-Ellison Syndrome CLINICAL PRESENTATION CLINICAL PATHOLOGIC CORRELATION DIAGNOSIS TUMOR LOCALIZATION SURGICAL MANAGEMENT OF GASTRINOMA SURGERY FOR ZOLLINGER-ELLISON SYNDROME SURGICAL EXPLORATION AND RESECTION TECHNIQUES Postoperative Management Results of Treatment Recurrent Gastrinoma Management of Metastatic or Locally Advanced Disease SUMMARY Management of Mallory-Weiss Syndrome PATHOPHYSIOLOGY AND RISK FACTORS FOR MWT DIAGNOSIS TREATMENTS FOR MWT: ENDOSCOPY, ANGIOGRAPHY, AND SURGERY Endoscopic Treatment Angiography Surgical Treatment SUMMARY Management of Gastric Adenocarcinoma INTRODUCTION RISK FACTORS PATHOLOGY DIAGNOSIS AND STAGING SURGERY Proximal Gastrectomy POSTOPERATIVE RECOVERY SYSTEMIC THERAPY TARGETED THERAPY SURVEILLANCE PALLIATION CONCLUSION Familial Gastric Cancer PATHOLOGY OF GASTRIC CANCER Hereditary Diffuse Gastric Cancer Hereditary Nonpolyposis Colorectal Cancer Li Fraumeni Syndrome Polyp-Associated Gastric Cancer Syndromes Familial Adenomatosis Polyposis and MUTYH-Associated Polyposis Syndromes Peutz-Jeghers Syndrome Gastric Adenocarcinoma and Proximal Polyposis of the Stomach PREOPERATIVE WORKUP AND SURGICAL INTERVENTION POSTSURGICAL CARE Management of Gastrointestinal Stromal Tumors CLINICAL PRESENTATION WORKUP RISK STRATIFICATION SURGERY FOR PRIMARY DISEASE Indications General Technical Principles Minimally Invasive Approach Site-Specific Considerations ENDOSCOPIC MANAGEMENT OF GIST NEOADJUVANT THERAPY ADJUVANT THERAPY RECURRENT, METASTATIC, AND RESISTANT DISEASE CONCLUSION Gastrointestinal Tubes for Feeding and Decompression INTRODUCTION NASOGASTRIC TUBE Indications for Nasogastric Tube Placement Contraindications Placement of Nasogastric Tubes Confirmation of Nasogastric Tube Placement Complications FEEDING TUBES Nasoenteric Tubes Percutaneous Endoscopic Gastrostomy or Jejunostomy Tubes Endoscopic Placement Technique Routine Care Complications Tube Deterioration and Replacement Gastrostomy or Jejunostomy Tube Removal Management of Morbid Obesity PATIENT SELECTION OPERATIVE PROCEDURES Laparoscopic Roux-en-Y Gastric Bypass Laparoscopic Vertical Sleeve Gastrectomy Laparoscopic Duodenal Switch with Biliopancreatic Diversion Laparoscopic Single Anastomosis Duodenal Switch Intragastric Balloon Endoscopic Sleeve Gastroplasty ENHANCED RECOVERY AFTER SURGERY OUTCOMES AND COMPLICATIONS Suggested Readings suggested readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings SUGGESTED READINGS Suggested Readings Suggested Readings Section 4 - Small Bowel Subchapter 23 Management of Small Bowel Obstruction INTRODUCTION CAUSES CLINICAL PRESENTATION DIAGNOSIS Laboratory Testing Imaging Plain Radiography Computed Tomography Magnetic Resonance Imaging CLASSIFICATION Partial Small Bowel Obstruction Complete Small Bowel Obstruction Complete Small Bowel Obstruction with Bowel Compromise MANAGEMENT Nonoperative Management Operative Management Laparoscopic Management SBO WITH CONFOUNDING CONDITIONS Closed-Loop SBO SBO with a Transition Point at the Site of a Hernia Geriatric Patients Pregnancy Obstruction Due to Inflammatory Bowel Disease Malignancy Virgin Abdomen Bariatric Surgery Early Postoperative Small Bowel Obstruction CONCLUSION Subchapter 24 Management of Crohn’s Disease of the Small Bowel MULTIDISCIPLINARY MANAGEMENT MEDICAL TREATMENT INDICATIONS FOR SURGERY Obstruction Perforation Failure of Medical Management PREOPERATIVE CONSIDERATIONS Timing Medications TECHNICAL CONSIDERATIONS FOR SURGICAL INTERVENTION Resection Ileostomy Disease of the Duodenum Strictureplasty Heineke-Mikulicz Strictureplasty Finney Strictureplasty Side-to-Side Isoperistaltic Strictureplasty (Michelassi Strictureplasty) POSTOPERATIVE CARE Subchapter 25 Use of Strictureplasty in Crohn’s Disease CLINICAL PRESENTATION INDICATIONS AND CONTRAINDICATIONS FOR STRICTUREPLASTY OPERATIVE PLANNING STRICTUREPLASTY TECHNIQUES Heineke-Mikulicz Strictureplasty Finney Strictureplasty (Fig. 5) Michelassi Strictureplasty or Side-to-Side Isoperistaltic Strictureplasty Results SUMMARY Subchapter 26 Management of Small Bowel Tumors PRESENTATION Predisposing Conditions Examination and Diagnostics for Patients Found to Have Small Bowel Tumors Imaging Endoscopy MANAGEMENT Benign Malignant Neuroendocrine Tumors Adenocarcinoma GIST Sarcoma Lymphoma Metastatic Disease SUMMARY Subchapter 27 Small Bowel Diverticulosis INTRODUCTION DETECTION AND MANAGEMENT OF ASYMPTOMATIC (INCIDENTALLY DISCOVERED) SMALL BOWEL DIVERTICULOSIS Duodenal Diverticula Jejunoileal Diverticula Meckel’s Diverticulum DETECTION AND MANAGEMENT OF SYMPTOMATIC SMALL BOWEL DIVERTICULOSIS Duodenal Diverticula Jejunoileal Diverticula Meckel’s Diverticula Subchapter 28 Diagnosis and Management of Motility Disorders of the Stomach and Small Bowel in the Current Era INTRODUCTION MOTILITY DISORDERS OF THE STOMACH Delayed Gastric Emptying/True Gastroparesis Clinical Presentation and Diagnosis Nonoperative Treatment Operative Treatment of Delayed Gastric Emptying GASTROPARESIS-LIKE SYNDROMES DIABETIC GASTROPARESIS RAPID GASTRIC EMPTYING Clinical Presentation and Diagnosis Treatment MOTILITY DISORDERS OF THE SMALL INTESTINE Adynamic Ileus Clinical Presentation and Diagnosis Treatment Postoperative Ileus Chronic Idiopathic Intestinal Pseudo-Obstruction Familial Visceral Myopathy Familial Visceral Neuropathy As Yet Undefined Neuromotor Dysmotility Clinical Presentation Diagnosis Treatment Scleroderma Postvagotomy Diarrhea Clinical Presentation Diagnosis and Treatment Subchapter 29 Management of Short Bowel Syndrome THERAPEUTIC GOALS Maintain Nutritional Status Maximize Enteral Nutrient Absorption Prevent Complications SURGICAL STRATEGIES Preserve the Intestinal Remnant Surgical Therapy for Short Bowel Syndrome Adequate Remnant Length with Dilated Bowel Moderate Remnant Length with Rapid Transit Patients with a Short Remnant and Dilated Bowel Short Remnant Length and Parenteral Nutrition–Related Complications MULTIDISCIPLINARY APPROACH Subchapter 30 Management of Enterocutaneous Fistulas OVERVIEW PRESENTATION CLASSIFICATION STABILIZATION AND SEPSIS CONTROL LONG-TERM MANAGEMENT Fluid and Electrolyte Repletion Nutritional Optimization Fistuloclysis Pharmacologic Management of Fistula Output Wound Care Define the Fistula Anatomy SPONTANEOUS CLOSURE OPERATIVE INTERVENTION SUMMARY Subchapter 31 Management of Radiation-Induced Injury to the Small and Large Bowel INTRODUCTION PATHOPHYSIOLOGY AND HISTOPATHOLOGY RISK FACTORS RADIATION THERAPY TOXICITY GRADING SYSTEMS CLINICAL FEATURES DIAGNOSIS MANAGEMENT STRATEGIES Medical Management Endoscopic Management Surgical Management PREVENTION Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Section 5 - Large Bowel Preoperative Bowel Preparation: Is It Necessary? TYPES OF BOWEL PREPARATION Mechanical Bowel Preparation Oral Antibiotics MECHANICAL BOWEL PREP VS ORAL ANTIBIOTICS VS NO BOWEL PREPARATION OUTCOMES OF SURGERY DEPENDENT ON TYPE OF SURGERY BOWEL PREPARATION IN ERAS CONCLUSION Management of Diverticular Disease of the Colon INTRODUCTION MANAGEMENT OF DIVERTICULITIS Clinical Presentation and Diagnosis Management of the Patient with Acute Diverticular Disease Uncomplicated Diverticular Disease Diverticular Disease with Pericolic Abscess Diverticular Disease with Perforation/Peritonitis Treatment of Sequelae of Complicated Diverticulitis Diverticular Stricture Diverticular Fistula Surgical Treatment Route of Access Common Surgical Themes Among All Routes of Access Most Common Surgical Errors MANAGEMENT OF DIVERTICULAR BLEEDING Clinical Presentation and Diagnosis Endoscopic Strategies for Diverticular Bleeding Radiologic Strategies for Diverticular Bleeding Surgical Strategies for Diverticular Bleeding CONCLUSION Management of Chronic Ulcerative Colitis INTRODUCTION EXTRACOLONIC MANIFESTATIONS OF UC RISK FACTORS DIAGNOSIS MEDICAL THERAPY SURGERY AND ULCERATIVE COLITIS Overview Total Abdominal Colectomy with End Ileostomy Completion Proctectomy/Total Proctocolectomy Creation of Ileal Pouch Anal Anastomosis PERIOPERATIVE AND POSTOPERATIVE CONSIDERATIONS Perioperative Management Ileal Pouch Complications SUMMARY Management of Toxic Megacolon CAUSE, INCIDENCE, AND PATHOGENESIS DIAGNOSIS THERAPY Medical Therapy Management of Patients with Inflammatory Bowel Disease Management of Patients with Clostridium difficile–Associated Disease Surgical Therapy OUTCOMES SUMMARY Surgical Management of Crohn’s Colitis INTRODUCTION MEDICAL MANAGEMENT INDICATION FOR SURGICAL INTERVENTION PREOPERATIVE OPTIMIZATION SURGICAL MANAGEMENT Total Abdominal Colectomy Total Proctocolectomy Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis Minimally Invasive Surgery Robotic Surgery SURGICAL PEARLS POSTOPERATIVE MANAGEMENT CONCLUSION Ischemic Colitis DEFINITION AND EPIDEMIOLOGY ETIOLOGY CLASSIFICATION PRESENTATION DIAGNOSIS SEVERITY SURGICAL APPROACH POSTOPERATIVE COURSE CONCLUSION Management of Clostridioides Difficile Colitis BACKGROUND Clinical Risk Factors for CDI CLINICAL PRESENTATION DIAGNOSIS Endoscopy Imaging MEDICAL TREATMENT SURGICAL MANAGEMENT Total Abdominal Colectomy with End Ileostomy Colonic Lavage and Diverting Loop Ileostomy SPECIAL POPULATION: PATIENTS WITH INFLAMMATORY BOWEL DISEASE CONCLUSION Acknowledgments Management of Large Bowel Obstruction ETIOLOGY CLINICAL PRESENTATION DIAGNOSIS History and Physical Examination Imaging TREATMENT Initial Management Surgical Management Emergent Surgical Management Nonemergent Surgical Management Colonic Lavage Endoscopic Stenting SPECIFIC SITUATIONS Sigmoid Volvulus Cecal Volvulus or Bascule Acute Colonic Pseudo-Obstruction SUMMARY Enteral Stents in the Treatment of Colonic Obstruction INTRODUCTION INITIAL EVALUATION INDICATIONS FOR STENT PLACEMENT Malignant Colonic Obstruction Bridge to Elective Surgery Palliative Stenting Extrinsic Malignancy Benign Colonic Disease CONTRAINDICATIONS TO COLONIC STENTS Technical Considerations Types of Colonic Stents Stent Dimensions Stent Material Covered versus Uncovered Stents Technical Aspects of Stent Deployment (Box 1) Pre-stent placement Stent Deployment Process FOLLOW-UP CARE OUTCOMES AND ADVERSE EVENTS Early Complications Perforation Stent Migration and Failure Abdominal/Rectal Pain and Incontinence Late Complications Occlusion by Fecal Impaction and/or Tumor Ingrowth CONCLUSION Management of Acute Colonic Pseudo-Obstruction (Ogilvie’s Syndrome) CLINICAL MANIFESTATIONS AND DIAGNOSIS MANAGEMENT COLONOSCOPIC DECOMPRESSION PERCUTANEOUS CECOSTOMY SURGICAL THERAPY SUMMARY Management of Colonic Volvulus INTRODUCTION SIGMOID VOLVULUS CECAL VOLVULUS Rare Types of Volvulus SUMMARY Management of Rectal Prolapse ETIOLOGY PRESENTATION EVALUATION MANAGEMENT/SURGICAL APPROACH PARTIAL THICKNESS PROLAPSE Mucosal Sleeve Resection FULL THICKNESS PROLAPSE Perineal Rectosigmoidectomy Abdominal Approaches Suture Rectopexy Ventral Mesh Rectopexy Recurrent Prolapse CONCLUSION Surgical Management of Constipation ANATOMY AND PHYSIOLOGY DIAGNOSIS Clinical Assessment Radiologic Testing Sitz Marker Study (Radiopaque Marker Study) Defecography Anorectal Physiology Testing MANAGEMENT Medical Management Noninvasive Techniques Surgical Management Colonic Slow-Transit Constipation Total Abdominal Colectomy with Ileorectal Anastomosis Preoperative Intraoperative Cecorectal Anastomosis Completion Proctectomy with Ileal Pouch–Anal Anastomosis (IPAA) Diverting Ileostomy Outlet Obstruction Constipation Rectocele Repair Preoperative Intraoperative Colostomy Creation Other Surgical Options Colonic Disimpaction Malone Antegrade Colonic Enema Sacral Nerve Stimulation ADULT HIRSCHSPRUNG’S DISEASE CONCLUSION Surgical Management of the Polyposis Syndromes INTRODUCTION ADENOMATOUS POLYPOSIS SYNDROMES Familial Adenomatous Polyposis Extracolonic Intestinal Disease Extraintestinal Manifestations Desmoid Tumors Attenuated Familial Adenomatous Polyposis Mutation Y-Homolog Associated Polyposis CHEMOPREVENTION SURGERY Proctocolectomy with End Ileostomy Proctocolectomy with Continent Ileostomy Total Abdominal Colectomy with Ileorectal Anastomosis Restorative Proctocolectomy/Ileal Pouch Anal Anastomosis Double-Stapled Technique Handsewn Technique Postoperative Surveillance OTHER POLYPOSIS SYNDROMES Peutz-Jeghers Syndrome Juvenile Polyposis Syndrome Cowden’s Syndrome Bannayan-Riley-Ruvalcaba Syndrome Cronkhite-Canada Syndrome Hereditary Mixed Polyposis Syndrome Serrated Polyposis Syndrome Surgical Management of Colon Cancer CLINICAL PRESENTATION AND SCREENING PREOPERATIVE EVALUATION AND STAGING SURGICAL MANAGEMENT Preoperative Preparation Operative Approach Colon Resection SPECIAL SCENARIOS Malignant Polyp Locally Advanced Cancer Stage IV Cancer TUMOR-RELATED EMERGENCIES Perforation Bowel Obstruction ADJUVANT THERAPY SURVEILLANCE CONCLUSION PET Scanning in the Management of Colorectal Cancer INTRODUCTION POSITRON EMISSION TOMOGRAPHY CONCEPTS AND DEFINITIONS INITIAL DIAGNOSIS, WORKUP, AND STAGING OF COLORECTAL CANCER THE ROLE OF PREOPERATIVE FDG-PET CT IN COLORECTAL MALIGNANCY POSTTREATMENT EVALUATION OF COLORECTAL MALIGNANCY COLORECTAL CANCER SURVEILLANCE THE ROLE OF PET CT IN COLORECTAL LIVER METASTASES FDG-PET MRI CONCLUSION Neoadjuvant and Adjuvant Therapy for Colorectal Cancer STAGING Colon Cancer Stage II Colon Cancer Stage III Colon Cancer RECTAL CANCER Adjuvant Therapy for Rectal Cancer Neoadjuvant Therapy for Rectal Cancer SURVEILLANCE Management of Colorectal Polyps OVERVIEW HISTOPATHOLOGY OF POLYPS Adenomas Serrated Polyps Hamartomas TECHNIQUES FOR EXCISING POLYPS Colonoscopic Approach Endoscopic Mucosal Resection Endoscopic Submucosal Dissection Combined Endo-Laparoscopic Surgery Surgical Approach Conventional Transanal Excision Transanal Endoscopic Microsurgery Transanal Minimally Invasive Surgery APPROACH TO THE MALIGNANT POLYP Management of Peritoneal Surface Malignancies EPIDEMIOLOGY AND CLASSIFICATION Appendiceal Neoplasm CLINICAL MANIFESTATION PREOPERATIVE WORKUP PATIENT SELECTION COLORECTAL CANCERS Epidemiology Clinical Manifestations Preoperative Workup Patient Selection for Surgery GASTRIC CANCER Epidemiology and Clinical Manifestation Preoperative Workup Patient Selection for Surgery PERITONEAL MESOTHELIOMA Epidemiology and Clinical Manifestation Perioperative Workup Patient Selection for Surgery OVARIAN CANCER Epidemiology and Clinical Manifestation Preoperative Workup Patient Selection for Surgery Intraoperative Management and Technique Postoperative Management Management of Lower Gastrointestinal Bleeding INTRODUCTION Etiology Epidemiology History and Physical Examination MANAGEMENT Resuscitation and Transfusion Special Hematologic Considerations Localization Nasogastric Lavage Anoscopy/Rigid Sigmoidoscopy Colonoscopy Computed Tomographic Angiography Nuclear Scintigraphy with Technetium-99m Angiography Capsule Endoscopy Double Balloon Enteroscopy Management Algorithm for LGIB SURGICAL CONSIDERATIONS Indications Operative Technique CONCLUSION Appendicitis: Diagnosis and Management ANATOMY OF THE APPENDIX PATHOLOGY OF ACUTE APPENDICITIS CLINICAL PRESENTATION AND DIAGNOSTIC WORKUP History and Physical Examination Laboratory Examination Diagnostic Imaging MANAGEMENT OF ACUTE APPENDICITIS Timing of Surgery Laparoscopic Appendectomy Open Appendectomy Management of Perforated (Complicated) Appendicitis CURRENT CONTROVERIES Nonoperative Management of Nonperforated Appendicitis Interval Appendectomy SUMMARY Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Reading Suggested Readings Suggested Readings Suggested Readings Section 6 - Anorectal Subchapter 53 Management of Hemorrhoids INTRODUCTION ETIOLOGY AND SYMPTOMS TREATMENT Dietary and Lifestyle Modifications Office-Based Procedures Rubber Band Ligation Sclerotherapy Other Office-Based Procedures Operative Treatment Acute Hemorrhoidal Crisis Ferguson Hemorrhoidectomy Milligan-Morgan Hemorrhoidectomy Stapled Hemorrhoidopexy Doppler-Guided Hemorrhoid Artery Ligation and Mucopexy Open Transanal Hemorrhoidopexy Postoperative Considerations SPECIAL SITUATIONS AND COMPOUNDING CONDITIONS Pregnancy Portal Hypertension Immunocompromised Patients Crohn’s Disease SUMMARY Subchapter 54 Management of Fissure-In-Ano INTRODUCTION NONOPERATIVE MANAGEMENT Dietary and Lifestyle Modifications Topical Sphincter Relaxants Chemical Denervation OPERATIVE MANAGEMENT Lateral Internal Sphincterotomy Advancement Flaps SPECIAL CONSIDERATIONS Subchapter 55 Management of Anorectal Abscess and Fistula ANORECTAL ABSCESS Etiology and Classification Presentation and Diagnosis Operative Evaluation and Drainage Primary Fistulotomy Antibiotics and the Immunocompromised Patient Necrotizing Perianal Skin Infection FISTULA-IN-ANO Etiology and Classification Presentation and Diagnosis Surgical Treatment Define Fistula Anatomy Ensure the Resolution of Sepsis Assess and Preserve Anal Sphincter Function Minimize Recurrence Risk Fistulotomy Seton LIFT Endorectal Advancement Flap Other Continence Preserving Procedures Subchapter 56 Anal Stenosis BACKGROUND DIAGNOSIS MANAGEMENT Nonoperative Management Operative Management Stricturoplasty Mucosal Advancement Flaps Y-V Advancement Flap V-Y Advancement Flap House Flap Diamond-Shaped and U-Shaped Flap Rotational S Flap POSTOPERATIVE CARE AND COMPLICATIONS SELECTION OF SURGICAL TECHNIQUE Subchapter 57 Management of Pruritus Ani DEFINITION ETIOLOGY Primary/Idiopathic Pruritus Ani Secondary Pruritus Ani Infectious Dermatologic Anorectal Diseases Miscellaneous EVALUATION AND DIAGNOSIS History Physical MANAGEMENT Education and Lifestyle Modifications Medical Subchapter 58 Surgical Management of Fecal Incontinence INTRODUCTION DIAGNOSTIC EVALUATION NONOPERATIVE MANAGEMENT Medical Management Biofeedback SURGICAL MANAGEMENT Sacral Nerve Stimulation Overlapping Anterior Sphincteroplasty Fecal Diversion Additional Surgical Interventions CONCLUSIONS Subchapter 59 Rectovaginal Fistula ETIOLOGY AND CLASSIFICATION EVALUATION ABDOMINAL APPROACHES PERINEAL APPROACHES Transanal Fistulotomy Endorectal Advancement Flap Fibrin Glue Fistula Plug TRANSVAGINAL REPAIRS Transvaginal Approach Vaginal Advancement Flap Transperineal Repairs Transperineal Ligation with a LIFT Procedure Overlapping Anterior Sphincteroplasty Episioproctotomy Transperineal Stapled Repair Interposition Flaps Gracilis Muscle Transposition Bulbocavernosus (Martius) Flap Subchapter 60 Anal Condyloma OVERVIEW INCIDENCE RISK FACTORS PATHOGENESIS, PRESENTATION, AND DETECTION MANAGEMENT OF ANAL CONDYLOMA GIANT CONDYLOMA ACUMINATA ANAL SQUAMOUS INTRAEPITHELIAL LESION HUMAN PAPILLOMAVIRUS VACCINE Subchapter 61 Management of Pilonidal Disease INTRODUCTION TREATMENT Nonoperative Treatment Operative Management Principles of Treatment Control Sepsis Do the Least Amount of Work Possible Avoid Too Much Excision Unroof All Disease, Debride Granulation Tissue, and Remove Hair Use Off-Midline Excision and Closure Minimize Tension if the Wound Is Closed Change the Anatomy/Flatten the Natal Cleft Never Underestimate the Impact of Postoperative Care Basic/Simple Procedures Abscess Drainage Non-Excisional Procedures Pit-Picking/Simple Bascom Procedure Excision With or Without Primary Wound Closure Intermediate Procedures Karydakis Flap Cleft Lift Procedure Complex Procedures Rhomboid Flap Special Situations Endoscopic Procedures Subchapter 62 Pneumatosis Intestinalis and the Importance for the Surgeon INTRODUCTION BENIGN CAUSES OF PNEUMATOSIS INTESTINALIS PNEUMATOSIS INTESTINALIS RESULTING FROM AN INTRAABDOMINAL EMERGENCY IMAGING FINDINGS X-ray Computed Tomography Ultrasound Magnetic Resonance Imaging Laboratory Findings Endoscopic Findings Distinguishing Benign from Pathologic Pneumatosis Intestinalis Medical Management of Benign Pneumatosis Intestinalis SURGICAL MANAGEMENT OF PATHOLOGIC PNEUMATOSIS INTESTINALIS Constant Communication with the Anesthesiologist Resuscitation to Euvolemia How Much to Resect Avoiding or Delaying an Anastomosis Subchapter 63 Management of Rectal Cancer BACKGROUND CLINICAL EVALUATION AND CLINICAL STAGING NEOADJUVANT THERAPY MANAGEMENT OF TUMOR-RELATED COMPLICATIONS RADICAL RESECTION LOCAL EXCISION NONOPERATIVE MANAGEMENT MANAGEMENT OF METASTATIC DISEASE POSTOPERATIVE MANAGEMENT/SURVEILLANCE Subchapter 64 Management of Tumors of the Anal Region OVERVIEW AND ANATOMY SQUAMOUS NEOPLASMS Human Papilloma Virus and Anal Squamous Neoplasia Condyloma Acuminatum (Anal Warts) Buschke-Lowenstein Tumor (Verrucous Carcinoma) Anal Intraepithelial Neoplasia Diagnosis Management Squamous Cell Carcinoma Diagnosis Staging Treatment Posttreatment Surveillance Treatment of Recurrent or Persistent Disease Metastatic Disease COLUMNAR NEOPLASMS Adenocarcinoma Paget’s Disease MELANOMA NEUROENDOCRINE AND MESENCHYMAL TUMORS MALIGNANT LYMPHOMA Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Suggested Readings Section 7 - Liver 65 Cystic Disease of the Liver Lucas W. Thornblade, MD, MPH, and Yuman Fong, MD INTRODUCTION Imaging Characteristics Types of Cystic Liver Lesions Mucinous Cystic Neoplasm and Mucinous Cystadenocarcinoma Intraductal Papillary Mucinous Neoplasm of the Bile Duct Ciliated Hepatic Foregut Cyst Cystic Malignancy Hepatic Pseudocysts and Traumatic Cysts Polycystic Liver Disease Special Considerations Biliary Cysts Extrahepatic Cysts Cystic Lesions Associated With Infection or Parasites Treatment Considerations CONCLUSION 66 Management of Echinococcal Cyst Disease of the Liver PATHOLOGY AND CLASSIFICATION PRESENTATION AND DIAGNOSIS Laboratory Tests Imaging TREATMENT Medical Management Percutaneous Therapy Operative Therapy Scolecoidal Agents Open Cyst Evacuation Minimally Invasive Cyst Evacuation Pericystectomy Liver Resection/Transplantation SUMMARY Uncomplicated Disease Complicated Disease RESULTS Morbidity and Mortality Long-Term Outcomes 67 Management of Liver Hemangioma Victor M. Zaydfudim, MD, MPH, and Reid B. Adams, MD OVERVIEW Pathogenesis and Clinical Presentation Diagnosis Treatment RUPTURED HEMANGIOMATA, KASABACH-MERRITT SYNDROME, AND BUDD-CHIARI SYNDROME MASQUERADING LESIONS 68 Management of Benign Liver Tumors RADIOGRAPHIC EVALUATION OF LIVER LESIONS BENIGN LIVER CYSTS Pathogenesis Presentation Imaging Management MUCINOUS CYSTIC NEOPLASM Pathogenesis Presentation Imaging Management HEPATIC HEMANGIOMA Pathogenesis Presentation Imaging Management HEPATIC ADENOMA Pathogenesis Presentation Imaging Management FOCAL NODULAR HYPERPLASIA Pathogenesis Presentation Imaging Management SUMMARY 69 Management of Malignant Liver Tumors PRIMARY LIVER TUMORS Hepatocellular Carcinoma Intrahepatic Cholangiocarcinoma METASTATIC LIVER TUMORS Colorectal Liver Metastasis PREOPERATIVE EVALUATION TECHNICAL CONSIDERATIONS Pos