Foreword	6
	Preface	8
	Acknowledgments	9
	Contents	10
	Contributors	12
	Part I: Colon	15
	1: Surgical Anatomy and Embryology	16
	1.1 Introduction	16
	1.2 Embryology	16
	1.3 Fasciae	19
	1.4 Mesocolon	21
	1.5 Arterial Blood Supply	29
	1.6 Venous Drainage	32
	1.7 Lymphatic System	37
	1.8 Autonomic Nerves	40
	References	43
	2: Appendectomy	44
	2.1 Introduction	44
	2.2 Deciding Between Open Versus Laparoscopic Approach	44
	2.3 Surgical Anatomy	44
	2.4 Conventional Appendectomy	46
	References	57
	Suggested Readings	57
	3: Crohn’s Disease of the Large Bowel	58
	3.1 General Principles of Surgery for Crohn’s Disease of the Large Bowel	58
	3.2 Operative Options	58
	3.2.1 Segmental Colectomy	61
	3.2.2 Subtotal or Total Colectomy	64
	3.2.3 Proctectomy	65
	3.2.4 Proctocolectomy	65
	References	65
	4: Ulcerative Colitis	66
	4.1 Introduction	66
	4.2 Surgical Options for UC	66
	4.3 Total Proctocolectomy with Conventional End Ileostomy (TPC)	66
	4.4 Creation of Conventional End Ileostomy	67
	4.5 Restorative Proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA)	67
	4.6 Creation of Loop Ileostomy	93
	References	95
	5: Benign Tumours of the Colon	96
	5.1 Introduction	96
	5.2 Resection of Right-Sided Tumours	96
	5.3 Resection of Tumours of the Transverse and Left Colon	104
	5.4 Laparoscopic Sigmoid Colectomy	116
	5.5 Laparoscopic Total Colectomy	125
	5.6 Laparoscopic “Rendezvous” or Laparo-Endoscopic Resection	129
	References	131
	6: Volvulus of the Colon	132
	6.1 Caecal Volvulus	132
	6.1.1 Pathophysiology	132
	6.1.2 Clinical Presentation	132
	6.1.3 Diagnosis	132
	6.1.4 Management of Ileocaecal Volvulus	139
	6.1.5 Open Versus Laparoscopic Surgery	141
	6.2 Sigmoid Volvulus	141
	6.2.1 Pathophysiology	142
	6.2.2 Symptoms and Signs	143
	6.2.3 Diagnosis	144
	6.2.4 Imaging	144
	6.2.5 Treatment	147
	6.2.5.1 Conservative Treatment	147
	6.2.5.2 Surgical Management	151
	6.2.5.3 Elective Surgery	151
	6.2.5.4 Non-resectional Procedures	151
	6.2.5.5 Resectional Procedures	152
	6.2.5.6 Emergent Procedure	152
	6.2.6 Surgical Technique	156
	Suggested Readings	163
	7: Colon Cancer	164
	7.1 Introduction	164
	7.2 Embryological Planes and Mesocolic Excision	164
	7.3 Lymph Node Dissection	169
	7.4 Right Hemicolectomy	171
	7.5 Extended Right Hemicolectomy	182
	7.6 Carcinomas of the Splenic Flexure	190
	7.7 Anastomosis	192
	References	195
	Suggested Reading	195
	8: Ileostomies and Colostomies	196
	8.1 Introduction	196
	8.2 Loop Ileostomy	201
	8.3 Loop Colostomy	211
	References	219
	9: Surgery for Cancer of the Left Colon	220
	9.1 Introduction	220
	9.2 Mobilisation of the Left Colon	220
	9.3 Dissection of the Vessels, Bowel Resection and Reconstruction	227
	Suggested Readings	235
	Part II: Rectum	236
	10: Rectum: Surgical Anatomy and Embryology	237
	10.1 Introduction	237
	10.2 Embryological Development of the Anorectum	237
	10.3 Topographic Anatomy of the Rectum	240
	10.4 Perirectal Fasciae	246
	10.5 Arterial Blood Supply of the Anorectum	247
	10.6 Autonomic and Somatic Nerve Supply of the Anorectum and Male Pelvic Organs	249
	10.7 Dorsal, Lateral and Ventral Topography of the Rectum	250
	Suggested Readings	260
	11: Per Anal Excision of Benign Tumours	261
	11.1 Introduction	261
	11.2 Transanal Resection	261
	11.3 Transanal Endoscopic Microsurgery	261
	11.3.1 Pre-operative Assessment	264
	11.3.2 Peri-operative Care and Positioning	265
	11.3.3 Equipment	265
	11.3.4 Procedure	266
	11.3.5 Post-operative Care	271
	11.4 Transanal Minimally Invasive Surgery	272
	11.5 Endoscopic Mucosal Resection	273
	11.6 Endoscopic Submucosal Dissection	279
	References	282
	12: Rectal Cancer: Anterior Resection and Low Anterior Resection with Total or Partial Mesorectal Excision	283
	12.1 Introduction	283
	12.2 Embryology	283
	12.3 Left Colon and Splenic Flexure Mobilisation (Fig. 12.1)	284
	12.4 Ligation and Division of the Inferior Mesenteric Vessels	286
	12.5 Mobilisation of the Mesorectum and Rectum	290
	12.6 Posterior Dissection	290
	12.7 Lateral Dissection	296
	12.8 Anterior Dissection	299
	12.9 Deep Posterior Dissection	300
	12.10 Anterior Dissection in Low Rectal Cancer	304
	12.11 Extended Resection for Cancer Adherence or Involvement Beyond the Mesorectal Fascia	304
	12.12 Distal Washout and Anastomosis	305
	12.13 Circular Stapled Anastomosis	308
	12.14 Defunctioning a Low Anastomosis After TME	308
	12.15 Partial Mesorectal Excision	309
	12.16 Post-operative Assessment of the Specimen	309
	References	310
	13: Lateral Pelvic Lymph Node Dissection (Pelvic Sidewall Dissection)	311
	13.1 Introduction	311
	13.2 Indications	311
	13.3 Pelvic Sidewall Dissection	312
	13.3.1 Taping of the Autonomic Nerves	313
	13.3.2 Taping of the Ureters	313
	13.3.3 Dissection of the Common Iliac Lymph Nodes	314
	13.3.4 Dissection of the External Iliac Lymph Nodes	314
	13.3.5 Dissection of the Obturator Lymph Nodes with Preservation of the Obturator Nerve	315
	13.3.6 Dissection of the Internal Iliac Lymph Nodes Preserving the Superior Vesical Artery	316
	13.3.7 Extraperitoneal Approach	320
	13.3.8 Completion of Pelvic Sidewall Dissection	321
	13.3.9 Combined Resection of Distal Internal Iliac Artery	321
	13.3.10 Completion of Therapeutic Pelvic Sidewall Resection	325
	References	328
	14: Intersphincteric Abdominoperineal Resection	329
	14.1 Definition and Indications	329
	14.2 Surgical Strategy	329
	14.3 Evolution of Surgery	332
	14.4 Surgical Technique	333
	14.4.1 Abdominal Step	333
	14.4.2 Anal Exposure	335
	14.4.3 Anal Canal Incision	336
	14.4.4 Posterior Intersphincteric Dissection	337
	14.4.5 Lateral Dissection	338
	14.4.6 Anterior Dissection	339
	14.4.7 Connection with the Abdominal Dissection	342
	14.4.8 Anal Repair	346
	14.4.9 Rectal Reconstruction	346
	14.5 Deciding Between ISR and APR	347
	14.6 Summary of Good Surgical Practice	350
	References	350
	15: Colon Cancer: Multivisceral Resection	351
	15.1 Introduction	351
	15.2 Preoperative and Intraoperative Management	351
	15.3 Operative Procedure	351
	15.4 Case Presentation	353
	15.5 Peritoneal Carcinomatosis	376
	15.6 Reconstruction	377
	15.7 Conclusion	378
	References	378
	16: Abdominoperineal Excision of the Rectum	379
	16.1 Introduction	379
	16.2 The Abdominal Part of APE	379
	16.3 Omentoplasty	379
	16.4 The Pelvic Part of APE	382
	16.5 Inter-Sphincteric APE (Fig. 16.2)	382
	16.6 Stoma Formation	383
	16.7 Extra-Levator APE (ELAPE) (Fig. 16.3)	385
	16.8 Ischio-Anal APE (Fig. 16.12)	396
	16.9 Minimally Invasive Approaches to APE	398
	16.10 Reconstruction of the Pelvic Floor	399
	References	402
	17: Pelvic Exenteration with Composite Pelvic Bone Resection for Malignant Infiltration	403
	17.1 Introduction	403
	17.2 Pelvic Bone Compartments and Their Contents (Fig. 17.1)	405
	17.3 Surgical Technique of Pelvic Exenteration with En Bloc Composite Resection of the Anterior Pelvic Bone (Pubic Bone) (Fig. 17.2)	407
	17.3.1 Results of Pelvic Exenteration with En Bloc Composite Resection of the Anterior Pelvic Bone (Pubic Bone)	416
	17.4 Surgical Technique of Pelvic Exenteration with En Bloc Composite Resection of the Posterior Bone (Sacrectomy)	418
	17.4.1 Results of Pelvic Exenteration with En Bloc Composite Resection of the Posterior Pelvic Bone (Sacrectomy)	428
	17.5 Surgical Technique of Lateral Pelvic Exenteration with Composite Lateral Pelvic Bone Excision	430
	17.5.1 Results of Lateral Composite Pelvic Bone Excision with Pelvic Exenteration	432
	References	434
	18: Flaps for Reconstruction: Vertical Rectus Abdominis Myocutaneous Flap	435
	18.1 Introduction	435
	18.2 Preoperative Considerations and Measures	435
	18.3 Operative Procedure	439
	References	450
	Part III: Pelvic Floor, Anus and Anal Canal	451
	19: Pelvic Floor/Anal Canal: Surgical Anatomy and Embryology	452
	19.1 Introduction	452
	19.2 Pelvic and Urogenital Diaphragm	452
	19.3 Pelvic Floor and Anal Sphincter Muscles	457
	19.4 Nerve and Vascular Supply of the Pelvic Floor	461
	19.5 Topography of Pelvic Spaces	464
	19.6 Anal Canal	467
	Suggested Readings	473
	20: Haemorrhoids	474
	20.1 Introduction	474
	20.2 Clinical Presentation	474
	20.3 Treatment Algorithm	474
	20.3.1 General Measures	474
	20.3.2 Sclerotherapy	475
	20.3.3 Rubber Band Ligation	475
	20.4 Surgery	475
	20.4.1 Indication for Surgery	475
	20.5 Surgical Techniques	476
	20.5.1 Milligan-Morgan’s Open Haemorrhoidectomy (Fig. 20.1a–g)	476
	20.5.2 Segmental Haemorrhoid Resections with Tissue Sealing (Fig. 20.2a–j)	476
	20.5.3 Supra-Anodermal Haemorrhoidopexy with the Stapler (Fig. 20.3a–j)	483
	20.5.4 Haemorrhoidal Artery Ligation with/Without Anal Repair (Fig. 20.4a–d)	483
	20.5.5 Submucosal Tissue Destruction	483
	20.6 Individualised Therapy and Indication	484
	20.7 Results (for Detailed Information See the Respective Literature)	484
	20.8 Conclusion for Practical Work in Daily Routine	484
	Suggested Readings	491
	21: Anal Fistulas	492
	21.1 Introduction	492
	21.2 Diagnostic Imaging	492
	21.3 Surgical Treatments	492
	21.3.1 General Surgical Procedures	495
	21.3.1.1 Fistulotomy	495
	21.3.1.2 Core-Out Fistulectomy	496
	21.3.1.3 Seton (Cutting, Loose, Chemical)	499
	Seton (Cutting Technique)	499
	Seton (Loose or Draining Technique)	500
	21.3.1.4 Mucosal/Skin Advancement Flaps (Fig. 21.6)	501
	21.3.2 Sphincter-Saving Procedures	502
	21.3.2.1 Ligation of Intersphincteric Fistula Tract	503
	21.3.2.2 Closure of Internal Opening with Over-the-Scope Clip (OTSC) Fistula Clip	505
	21.3.2.3 Fistula Tract Filling (Glue, Paste, Plugs)	506
	Glue	506
	Collagen Paste	507
	Plugs	507
	21.3.2.4 Fistula Tract Ablation	508
	FiLaC	508
	VAAFT (Video-Assisted Anal Fistula Treatment)	509
	21.3.2.5 Stem-Cell Therapy	509
	21.4 Conclusions	511
	References	511
	22: Entero- and Rectocele, Rectal Prolapse	512
	22.1 Introduction	512
	22.2 Surgical and Functional Anatomy	512
	22.3 Epidemiology, Aetiology and Pathogenesis	512
	22.4 Treatment Objectives	513
	22.5 Treatment Principles	514
	22.6 Surgical Treatment	514
	22.6.1 Transanal Approach	514
	22.6.1.1 Mucosal Resection According to Rehn-Delorme	514
	22.6.1.2 Rectosigmoidectomy According to Altemeier	521
	22.6.1.3 Stapled Transanal Resection of the Rectum (STARR)	522
	22.6.1.4 Perineal Stapled Prolapse Resection (PSP)	527
	22.7 Transabdominal Surgical Approaches	528
	References	533
	23: Sacral Nerve Stimulation for Faecal Incontinence	534
	23.1 Introduction	534
	23.2 Concept	534
	23.3 Anatomy	534
	23.4 Indications and Contraindications	535
	23.5 Surgical Technique	537
	23.5.1 Patient Positioning	537
	23.5.2 Use of Fluoroscopy/X-Ray	538
	23.5.3 Foramen Needle Electrode Placement (Acute Percutaneous Evaluation)	541
	23.5.4 Temporary Electrode Placement	545
	23.5.5 Tined Lead Electrode Placement	547
	23.5.6 The Pocket in the Buttock/Pulse Generator Placement	561
	23.5.7 Postoperative Management	563
	References	563
	24: Sphincteroplasty	564
	24.1 Introduction	564
	24.2 Operative Technique	564
	24.2.1 Preoperative Considerations	564
	24.2.2 Positioning	564
	24.2.3 Surgical Steps	564
	24.3 Post-Operative Management	583
	24.4 Outcomes	584
	References	585
	25: Transanal Total Mesorectal Excision (ta-TME)	586
	25.1 Introduction	586
	25.2 Technical Description of ta-TME	587
	25.2.1 Laparoscopic Abdominal Phase	587
	25.2.2 Endoscopic Transitional Phase	588
	25.2.2.1 Position of the Patient	588
	25.2.2.2 Placement of the Transanal Port Device	588
	25.2.2.3 Purse-String Suture Below the Tumour Under Endoscopic Vision	593
	25.2.2.4 Complete Transection of the Rectal Wall	594
	25.2.2.5 Posterior Mesorectal Dissection	595
	25.2.2.6 Anterior Mesorectal Dissection to the Peritoneal Reflection	596
	25.2.2.7 Lateral Mesorectal Dissection	597
	25.2.2.8 Extraction of the Surgical Specimen	599
	Extraction of the Specimen by Transanal Route	599
	Transabdominal Extraction	600
	25.2.2.9 Preparation of the Colon to Anastomose the Bowel	601
	25.3 Types of Anastomosis	602
	25.3.1 Mechanical Anastomosis	602
	25.3.2 Hand-Sewn Colo-Anal Anastomosis	603
	25.3.3 Pull-Through Type Delayed Anastomosis	604
	Suggested Readings	607
	26: Multivisceral Resection for Rectal Cancer	608
	26.1 Introduction	608
	26.2 Preoperative Assessment	609
	26.3 Total Pelvic Exenteration: The Surgical Steps	610
	26.3.1 Mobilisation of the Colon and Posterior Dissection of the Rectum	610
	26.3.2 Anterior Mobilisation of the Bladder	611
	26.3.3 Lateral Pelvic Dissection of the Bladder’s Vascular Pedicles, the Autonomic Nerves, and Ureters	612
	26.3.4 Perineal Dissection	614
	26.3.5 Special Considerations	617
	26.3.5.1 Extended Urethral Resection to the Base of the Penis	617
	26.3.5.2 Rectal Resection with Prostatectomy, Sparing of the Bladder and Sphincter Preservation	617
	26.4 Exenteration in Female Patients	619
	26.4.1 Posterior Exenteration	620
	26.4.2 Special Considerations	622
	26.4.2.1 Total Vaginectomy	622
	26.5 Lateral Pelvic Dissections	622
	26.6 Extended Resections of the Pelvic Floor	625
	References	625
	Suggested Reading	625