The field of colorectal surgery has undergone tremendous developments in recent decades. Surgery has become less invasive, new perspectives and insights have improved perioperative management and novel outcome measures have been defined. At the same time, the limits of surgical technique and perioperative care are being challenged by more complex patients. In order to realize the immense potential for excellent outcomes in colorectal surgery, coordinated multifaceted care must be delivered within a context of limited resources. Accordingly, there is a pressing need to streamline processes and heighten clinical productivity. Excellent communication and collaboration are required, with constant attention to detail and precision within an environment of learning, research and innovation. This book discusses in depth the transdisciplinary integration of different components of care in colorectal surgery. Pertinent background information on the complexities of current management in colorectal surgery is first provided, followed by discussion of the role of design thinking in care integration. Subsequent chapters focus on a range of issues associated with surgical and perioperative care in patients undergoing colorectal surgery, with emphasis on how the multiple facets of care can be integrated through a transdisciplinary approach. Each chapter provides helpful take-home messages in bullet point form and numerous informative figures and tables are also included. The authors are surgeons, physicians, anesthetists, oncologists, nurses, and allied health professionals with extensive experience in the field.

Practical resource for all healthcare professionals involved in day-to-day management of operating rooms of all sizes and complexity.

Surgical site infections are caused by bacteria that get in through incisions made during surgery. They threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance. In low- and middle-income countries, 11% of patients who undergo surgery are infected in the process. In Africa, up to 20% of women who have a caesarean section contract a wound infection, compromising their own health and their ability to care for their babies. But surgical site infections are not just a problem for poor countries. In the United States, they contribute to patients spending more than 400 000 extra days in hospital at a cost of an additional US $10 billion per year. No international evidence-based guidelines had previously been available before WHO launched its global guidelines on the prevention of surgical site infection on 3 November 2016, and there are inconsistencies in the interpretation of evidence and recommendations in existing national guidelines. These new WHO guidelines are valid for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.

Enhanced recovery after surgery (ERAS), also referred to as an enhanced recovery program, fast-track rehabilitation, multimodal management, or similar descriptors, is a multidisciplinary approach to perioperative care. A protocol of components related to preadmission, preoperative, intraoperative, and postoperative care is implemented with the goal of improving patient recovery, facilitating earlier discharge from the hospital, and potentially reducing health care costs without increasing complications or hospital readmissions. The protocol components may contribute to minimizing, and/or improving the response to, physiological stress associated with surgery. Although guidelines for ERAS related to colorectal surgery exist, variation in the number and definition of protocol components contributes to difficulties in determining effectiveness. Little is known about implementation barriers and facilitators as well as components (or combinations of components) key for improved clinical outcomes. In addition, protocol compliance, when reported, may be measured by percentage of elements applied or completed without standardization across elements (timing, regimens, doses, etc). Preliminary literature searches conducted for topic refinement found several systematic reviews on enhanced recovery for colorectal surgery. However, none reported on subgroups based on surgical approach (open or laparoscopic surgery) or colorectal condition. While several noted the enhanced recovery protocol components from the included studies, the standard care protocols were not documented. None commented on barriers or facilitators to implementation of an enhanced recovery program. The defining components of an enhanced recovery program for colorectal surgery have been revised over time and new trials have been published since the search dates of the existing reviews. We provide an updated review of randomized controlled trials (RCTs) and controlled clinical trials (CCTs) looking at comparative effectiveness and harms overall and by type of surgery, colorectal condition, and fidelity to an enhanced recovery protocol. We also review barriers and facilitators to implementation and provide a contextual discussion of compliance and outcomes.

Complexities in Colorectal Surgery: Decision-Making and Management provides a unique, modern, practical guide that covers the strategic evaluation, specific approaches, and detailed management techniques utilized by expert Colorectal Surgeons caring for patients with complex problems—whether they result from underlying colorectal disease or from complications arising from previous surgical therapy. The text is formatted as both a “how-to” manual as well as an algorithm-based guide allowing the reader to understand the thought process behind the proposed treatment strategies. By making use of evidence-based recommendations, each chapter will include not only diagnostic and therapeutic guidelines, but also a narrative by the author on his/her operative technical details and perioperative “tips and tricks” that they utilize in the management of these complex surgical challenges. This test includes chapters on the assessment of risk and nutritional intervention methods utilized to minimize perioperative complications. In addition, sections on medical and surgical therapies for abdominal, pelvic and anorectal disease are incorporated. Moreover, the technical challenges of managing complications resulting from the original or subsequent operations is addressed. The underlying focus throughout the text is to provide pragmatic and understandable solutions that can be readily implemented by surgeons of varying experience to successfully treat complex colorectal problems. The text also goes beyond the technical aspects of Colorectal Surgery and includes special sections highlighting the essence of a surgeon. These include chapters describing the importance of the first encounter, building patient rapport, and demonstrating confidence and competence while showing humility and avoiding arrogance. Additionally, aspects involving the medical-legal, ethical, and economic challenges confronting surgeons are covered.

While there is evidence to suggest that mechanical bowel preparation should not be used in isolation, there is renewed interest in determining the value of adding oral antibiotics to the preoperative regimen for elective colorectal procedures. For instance, a recent retrospective database analysis has suggested that there may be an important role for the combination of mechanical bowel preparation and oral antibiotics in reducing postoperative surgical site infections in elective colorectal surgery. Thus, this report aims to review relevant evidence addressing the clinical effectiveness, cost-effectiveness, and evidence-based guidelines for the use of standard, parenteral antibiotic prophylaxis with or without mechanical bowel preparation versus intravenous plus oral antibiotic prophylaxis with or without mechanical bowel preparation for patients undergoing elective colorectal procedures.