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Vascular Closure Devices for Small Arteriotomies: How to Avoid and Deal With Complications

Introduction: Options for Achieving Hemostasis Arterial access was first described by Sven Ivar Seldinger in the 1950s and is increasingly being utilized as open surgeries are replaced by minimally invasive image-guided procedures. The common femoral artery (CFA) continues to be one of the preferred sites of access for both diagnostic angiography and percutaneous interventions ranging from coronary artery stenting to aortic aneurysm repair. Vascular closure devices…

Other Access

Introduction General Issues Anatomy While access sites such as the common femoral artery are easily accessible, sometimes alternative access may be needed as a result of the previous site being infected, scarred, or occluded. Preoperative planning by considering the patient’s anatomy, vessel to be accessed, location of intended treatment, positioning of the patient for comfort, and devices needed for treatment is paramount in making the procedure…

Access Complications

Introduction The common femoral artery (CFA) is considered the most frequently used percutaneous arterial access site. Multiple methods are used as a landmark for entry, including pulse palpation, fluoroscopic guidance, and ultrasound-guided puncture to achieve arterial access. Many access-related complications can occur, and some are life and limb threatening, such as retroperitoneal hemorrhage or arterial occlusion. Older studies have reported femoral access site complication rates ranging…

Minor anorectal conditions

Haemorrhoids Anatomy and physiology Haemorrhoids are vascular arteriovenous plexuses that form two sets of anal cushions in the normal rectal anatomy. These plexuses are located in the upper anal canal above the dentate line (internal haemorrhoidal plexus), and at the anal verge (external haemorrhoidal plexus). The internal haemorrhoidal plexus or internal haemorrhoids, also known as anal cushions , lie above the dentate line and are covered…

Anal fistula

Introduction Anorectal sepsis is common, presenting as either an acute abscess or a chronic anal fistula. Treatment in most involves only a small risk of minor complications, but a minority can present a major challenge to both sufferer and surgeon. Although fistula-in-ano may be found in association with a variety of specific conditions, the majority in the UK are idiopathic or cryptoglandular, their exact aetiology having…

Functional problems and their medical management

Introduction Symptoms related to functional gastrointestinal disorders (FGIDs) are highly prevalent. In community-based studies, up to 22% of ‘normal’ UK subjects can be diagnosed as having irritable bowel syndrome (IBS) and up to 28% have functional constipation. These disorders are constellations of symptoms – they are not diseases. As such, the emphasis of management of these patients is based on simple principles: the exclusion of organic…

Pelvic floor surgery for the colorectal surgeon

Acknowledegments We would like to thank Nicola S. Fearnhead and Alexis M. P. Schizas for their previous versions of the book chapters entitled ‘Functional Problems and their Surgical Management’ and ‘Anorectal Investigation’. Introduction Pelvic floor pathology is multifactorial and often multi-compartmental. Pelvic floor dysfunction includes pathology of the anterior, middle and posterior pelvic floor compartments. Posterior pelvic floor pathology includes defaecatory dysfunction with obstructed defaecation (evacuatory…

Faecal incontinence

Introduction Faecal incontinence (FI), the involuntary loss of solid or liquid stool, is a debilitating condition with potentially devastating consequences for both physical and psychosocial well-being. Although surveys of the adult population have estimated the prevalence of FI to be between 1% and 19%, the majority of sufferers do not seek medical help because of embarrassment and social stigmatisation. , As a result, the condition remains…

Intestinal failure

Introduction Intestinal failure (IF) is defined as the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or fluid and electrolytes, such that intravenous supplementation is required to maintain health and/or growth. , IF can be classified on the basis of onset, metabolic and expected outcome criteria: , Type 1: acute, short-term, without significant intestinal pathology and usually self-limiting. The vast majority…

Crohn’s disease

Acknowledgement This chapter in the sixth edition was written by Mark Thompson-Fawcett and we are grateful to him for those parts of the chapter, which we have kept in this edition. Introduction Crohn’s disease is a chronic, relapsing illness of unknown cause with a transmural inflammatory process that can affect the gastrointestinal tract anywhere from mouth to anus, and which may be associated with extra-intestinal manifestations.…

Ulcerative colitis

Introduction Ulcerative colitis (UC) is an idiopathic relapsing inflammatory bowel disease (IBD) involving the mucosa and lamina propria of the rectum and variable extent of the proximal colon. Characterised by remissions and exacerbations, the clinical spectrum of disease can range from inactive to fulminant. Medical management is generally effective in controlling UC, but ultimately 30–40% of patients will require surgical intervention. Criteria for the management of…

Diverticular disease

Historical perspectives Colonic diverticulosis is a common anatomical disorder characterised by acquired, sac-like mucosal protrusions (diverticula) through the muscle wall. They are false diverticula because they do not involve all colonic layers. The term ‘ diverticulum’ (‘divertikel’ in German) was originally used to describe what was an anatomical curiosity in the early 1800s and was not in widespread use until the recognition of ‘perisigmoiditis’ and related…

Anal neoplasia

Acknowledgement With thanks to the authors of the sixth edition, Pasquale Giordano, David J. Humes and John H. Scholefield. Introduction Anal cancer is predominantly (90%) squamous cell in origin, and 90% of anal squamous cell carcinoma (ASCC) is caused by the human papillomavirus (HPV). This chapter will outline what the surgeon needs to know about HPV infection, anal low- and high-grade intra-epithelial lesions (LSIL and HSIL)…

Advanced and recurrent colorectal cancer

Introduction The treatment of advanced and recurrent colorectal cancer represents a significant challenge to oncologists and surgeons, requiring a multimodality treatment approach. As a result, the National Institute for Health and Care Excellence (NICE; 2020) colorectal cancer guideline recommends these patients are best managed in specialist centres by an advanced colorectal cancer multi-disciplinary team (MDT). For the purposes of this chapter, advanced primary colon and rectal…

Chemotherapy and radiotherapy for colorectal cancer

Acknowledgement This chapter in the sixth edition was written by Simon Gollins and David Sebag-Montefiore and we are grateful to them for those parts of the chapter, which we have kept in this edition. Introduction Colorectal cancer is the fourth most common cancer in the UK, with around 42 000 cases diagnosed each year. About two-thirds arise in the colon and one-third in the rectum. Between…

Surgery for rectal cancer

Introduction Rectal cancer is defined as adenocarcinoma within 15 cm of the anal verge, and accounts for around 30% of colorectal cancers. There were 14 555 cases of rectal cancer in 2017 in the UK. Surgical excision remains the primary treatment modality for rectal cancer, with selected application of neoadjuvant therapy with radiotherapy, chemoradiotherapy or chemotherapy for advanced cases. Surgery is technically challenging as a result…

Surgery for colon cancer

Acknowledgement The authors and editors would like to thank Jordan Fletcher for developing and providing the illustrations for this chapter. Introduction The principles of surgery for colon cancer have been unchallenged for decades, and include a sufficient longitudinal resection margin, excision of the draining lymphatic territory and avoidance of unnecessary manipulation of the tumour before transection of the vascular pedicle (‘no-touch technique’). Although these principles remain…

Colorectal cancer and genetics

Introduction Individuals develop colorectal cancer (CRC) as a result of interaction between their genotype and the environment to which they are exposed. The lifetime risk of CRC in the UK population is about 5%. As it is common, many people by chance alone have at least one affected relative; as the number of affected relatives increases, so does the risk of developing the disease. As far…

Colorectal cancer

Acknowledgement This chapter in the sixth edition was written by Robert Steele and I am grateful to him for those parts of the chapter, which we have kept in this edition. Introduction Colorectal cancer is a significant healthcare issue in terms of prevention, timely diagnosis, treatment and survivorship. Improving outcomes remains a key healthcare challenge in the UK, where bowel cancer is the second most common…

Lower gastrointestinal endoscopy

Introduction Since flexible endoscopy of the colon was introduced in 1963, it has become the gold-standard diagnostic test for evaluation of colonic disease. Improvements in technique and technology have also led to advances in therapeutic procedures, and the boundary between endoscopic and surgical procedures is becoming increasingly blurred. A good understanding of both the technique and technology is essential for an endoscopist to perform high-quality, safe…