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Re-Operative Surgery for Pilonidal Disease
Pilonidal disease is a condition of chronic inflammation and foreign body reaction of loose and abundant hair in the gluteal cleft leading to pits, sinuses and recurrent bouts of infection. Several management strategies have been used since initial description of the disease in 1833; however, all have been complicated by the potential of recurrence. Episodes of recurrence have been attributed to incomplete management of diseased tissue, either by unfinished excision or disruption of sinuses, as well as a persistence of a deep gluteal cleft after excision with or without primary closure. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 21, 2015 Category: Gastroenterology Authors: Greta V. Bernier, Eric K. Johnson, Justin A. Maykel, Scott R. Steele Source Type: research

Re-Operative Surgery for Genitourinary Fistulae to the Colorectum
Re-operative surgery for genitourinary fistulas to the colorectum is very distressing condition for the patients. These fistulas are extremely complex and at times may require a staged, multidisciplinary approach in order to correct them. Post operative and recurrent genitourinary fistula to the colorectum can occur as a consequence of pelvic disorders, including trauma, iatrogenic injury, inflammatory bowel disease, pelvic neoplasm, and infection. Basic surgical principles, such as gentle handling of the tissues, curetting of the fistula tract, adequate debridement of nonhealthy tissue, and adequate mobilization of tissue...
Source: Seminars in Colon and Rectal Surgery - September 21, 2015 Category: Gastroenterology Authors: Gokulakkrishna Subhas, Suraj Alva, Walter E. Longo Source Type: research

Reoperative surgery for diverticular disease and its complications
The need for reoperation for diverticulitis may become necessary for a range of conditions. Surgeons will most commonly encounter these conditions in an elective setting with planned cases for ostomy reversal, however, recurrence of acute disease after sigmoid resection also occurs with a degree of regularity. A suspected recurrence should prompt a workup for alternative conditions, such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Reoperation in the emergent setting may be necessary for both recurrent diverticulitis as well as complications from earlier procedures. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 20, 2015 Category: Gastroenterology Authors: Darcy Shaw, Jennifer S. Beaty, Alan G. Thorson Source Type: research

Reoperative Surgery for Complications of Hemorrhoidectomy
Hemorrhoids remain among the most common disorders treated by colorectal surgeons. A wide variety of medical, office-based, and surgical treatment options are currently available. The primary surgical procedures from which patients and surgeons may choose include excisional hemorrhoidectomy, stapled hemorrhoidopexy, and transanal hemorrhoidal dearterialization. Each of these operations is safe, however, like all operations, carry certain risks of complications. Some of these complications may require surgical management. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 20, 2015 Category: Gastroenterology Authors: Caroline Nally, Marc Singer Source Type: research

“Reoperative Surgery for Diverticular Disease and Its Complications”
The need for reoperation for diverticulitis may become necessary for a range of conditions. Surgeons will most commonly encounter these conditions in an elective setting with planned cases for ostomy reversal, however recurrence of acute disease after sigmoid resection also occurs with a degree of regularity. A suspected recurrence should prompt a workup for alternative conditions such as Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS). Reoperation in the emergent setting may be necessary for both recurrent diverticulitis as well as complications from earlier procedures. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 20, 2015 Category: Gastroenterology Authors: Darcy Shaw, Jennifer Beaty, Alan Thorson Source Type: research

Reoperative surgery for persistent anal fistulae
Failure of treatment of a primary anal fistula is rarely life threatening, but the cost to the patient in terms of pain, discomfort, and interruption of daily life is substantial. Complex or recurrent fistulas must be methodically evaluated so a successful treatment strategy can be developed, and therapy completed, ideally without compromising fecal continence. Advanced imaging can be useful in identifying complex tracts and accumulated sepsis but is rarely indicated in the setting of a primary fistula. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 19, 2015 Category: Gastroenterology Authors: Janice F. Rafferty, Jonathan R. Snyder Source Type: research

Reoperative Crohn׳s surgery: Lessons learned the hard way
Crohn׳s disease (CD) is a chronic inflammatory disease of the intestinal tract characterized by transmural inflammation, which can progress to intestinal perforation, intra-abdominal abscesses, intestinal strictures, and fistula development. Surgery is frequently required to correct these disease-related complications. Unfortunately, there is no medical or surgical cure for the disease, and the etiology remains undefined. Thus, many patients will undergo multiple operations over their lifetime when the disease process becomes medically refractory and complications ensue. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 19, 2015 Category: Gastroenterology Authors: Amy L. Lightner, Robert R. Cima Source Type: research

Introduction
The Specialty of Colon and Rectal Surgery has been within the armentarium of medicine for well over seventy years and has progressed dramatically since the 1980's when complex pelvic surgery, complicated anorectal procedures, challenging small intestinal disease, and recently, minimally invasive surgery of the colon, rectum and anus has become within the standard of care of almost all diseases of the midgut and hindgut now treated. As we have pushed the envelope for improved oncologic outcomes, the lessening need for intestinal stomas, improvement in continence and functional outcomes, there has been the tradeoff of the ne...
Source: Seminars in Colon and Rectal Surgery - September 19, 2015 Category: Gastroenterology Authors: Vikram Reddy, Walter E. Longo Source Type: research

“Reoperative Surgery For Persistent Anal Fistulae”
Failure of treatment of a primary anal fistula is rarely life threatening, but the cost to the patient in terms of pain, discomfort, and interruption of daily life is substantial. Complex or recurrent fistulas must be methodically evaluated so a successful treatment strategy can be developed, and therapy completed, ideally without compromising fecal continence. Advanced imaging can be useful in identifying complex tracts and accumulated sepsis but is rarely indicated in the setting of a primary fistula. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 19, 2015 Category: Gastroenterology Authors: Janice F. Rafferty, Jonathan R. Snyder Source Type: research

Reoperative surgery for recurrent rectal prolapse
Up to thirty percent of patients who undergo surgical treatment for rectal prolapse will experience a recurrence. The presentation and evaluation of recurrent rectal prolapse is similar to that of primary rectal prolapse. The options for surgical treatment are the same as those for primary disease, and similarly, there is no widely accepted gold standard. Several factors are considered when choosing an approach, such as the patient's previous surgical history, age, functional status, and comorbid pelvic floor disorders such as fecal incontinence and constipation. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 19, 2015 Category: Gastroenterology Authors: Jessica N. Cohan, Madhulika G. Varma Source Type: research

Reoperative Surgery for the Failed Low Pelvic Anastomosis
The most serious complication of rectal cancer surgery is an anastomotic catastrophe that can lead to worse oncologic outcomes, decreased ability to maintain the anastomosis and retain good functional outcome. Redo surgery for failed colorectal and coloanal anastomoses is a surgical challenge, with technical difficulties and high morbidity, but may be the only option to improve a patient's quality of life. The aim of this manuscript is to summarize the approaches to salvage the anastomosis that is beset by late complications including leakage, stenosis, sinus tract, chronic presacral chronic sepsis, fistula or disunion. (S...
Source: Seminars in Colon and Rectal Surgery - September 19, 2015 Category: Gastroenterology Authors: Vikram B. Reddy, Hulda Einarsdottir Source Type: research

Re-Operative Surgery for Intestinal Stoma Complications
Intestinal stomas remain a vital tool for the surgeon caring for patients with bowel disease. This chapter reviews stoma complications that may result in re-operative surgery to revise the stoma. It includes a comprehensive review of early and late stoma complications as well as an extensive review of the treatment and prevention of parastomal hernia. Surgical techniques, adherence to basic surgical principles, proper preoperative patient counseling, and pre-operative stoma marking, all of which may prevent many of these complications and enable the surgeon to create the perfect stoma, are also reviewed. (Source: Seminars ...
Source: Seminars in Colon and Rectal Surgery - September 19, 2015 Category: Gastroenterology Authors: Laurence R. Sands, Carlos Sam Morales Source Type: research

Reoperative Surgery Following Colorectal Anastomotic Leaks
Intestinal anastomotic leak (AL) is one of the most dreaded and challenging complications encountered after bowel surgery. Despite advances in surgical technique and innovation, anastomotic leak rates remain relatively unchanged over the past several decades. Management of an anastomotic leak typically necessitates a lengthy hospitalization often associated with considerable morbidity, suffering as well as overwhelming cost and resource utilization. The aim of this manuscript is to provide evidence based and experience driven advice to a practicing surgeon on the management and reoperative strategies following an anastomot...
Source: Seminars in Colon and Rectal Surgery - September 19, 2015 Category: Gastroenterology Authors: Monika A. Krezalek, Konstantin Umanskiy, Neil H. Hyman Source Type: research

Reoperative Crohn's Surgery: Lessons Learned the Hard Way
Crohn's disease (CD) is a chronic inflammatory disease of the intestinal tract characterized by transmural inflammation, which can progress to intestinal perforation, intraabdominal abscesses, intestinal strictures and fistula development. Surgery is frequently required to correct these disease related complications. Unfortunately, there is no medical or surgical cure for the disease, and the etiology remains undefined. Thus, many patients will undergo multiple operations over their lifetime when the disease process becomes medically refractory and complications ensue. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 19, 2015 Category: Gastroenterology Authors: Amy L. Lightner, Robert R. Cima Source Type: research

Assessing technical competency during colon and rectal surgery training
Competence in colon and rectal surgery requires a unique set of technical skills, in addition to sound judgment and devoted patient care. Assessment of technical competence is central to defining and maintaining standards and, to providing constructive trainee feedback. This review aims to appraise the instruments that are available to assess technical competence in colon and rectal surgery and discuss how these can be best utilized in assessing technical competence. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 3, 2015 Category: Gastroenterology Authors: Jonathan Hong, Sandra L. de Montbrun, Patricia L. Roberts, Helen MacRae Source Type: research