Parastomal hernia (PSH) is a type of incisional hernia defined as a protrusion of abdominal contents through a weakness in the abdominal wall. PSH is the most common and significant complication following enterostomy construction, with an incidence of 30–50%. The risk is higher in colostomies than in ileostomies. Diagnosis of PSH is based on clinical examination or imaging. Most patients with PSH are usually asymptomatic. On the other hand, PSHs may affect an individual’s physical function and decrease their quality of life. Surgical repair is indicated in 10–30% of patients with PSH. For repair, no single technique is superior to another. Therefore, several surgical methods have been developed and attempted, including primary repair, stoma relocation, and repair with different types of mesh either via the open or laparoscopic approach. However, high recurrence rates have been reported after repair. Because this is a difficult and problematic entity, the prevention of PSH occurrence is clearly the most appropriate management approach.
Part of the book: Hernia
Diverticulosis is a common problem, especially in industrialized countries. The main risk factors for the development of diverticular disease are physical inactivity and consumption of a low-fiber diet. Among the population with diverticulosis, only 10–25% of the patients develop diverticulitis. Computed tomography (CT) scans are very helpful for diagnosis and deciding the treatment strategy. Patients with acute diverticulitis usually have a good response to conservative therapy. However, some of the patients present with complications such as perforation, fistula, abscess, stricture, and obstruction. Depending on disease severity, they commonly require surgical or radiologic intervention. Despite lots of contradictory results on treatment approaches, recent guidelines tend to be less invasive than the ones in the past. As a result, less invasive treatment protocols, including nonsurgical follow-up, percutaneous drainage, minimally invasive surgery and resection with primary anastomosis, are more commonly used than the more invasive Hartmann procedure. In this chapter, we discuss the clinical characteristics, diagnostic workup and different treatment approaches in the management of diverticular diseases.
Part of the book: Gastrointestinal Surgery
Colorectal cancers (CRCs) are commonly diagnosed malignancy in both men and women. Although it is a common disease, mortality rates decrease with widespread use of screening methods and novel developments in surgery. Physical examination, abdomen and pelvic computerized tomography, and chest imaging are necessary for preoperative staging and surgical planning of a newly diagnosed colon cancer. CRCs usually develop from adenomatous polyps. Although curative treatment of localized colon cancer is surgery, endoscopic polypectomy is sufficient when severe dysplasia or carcinoma in situ is detected on a polyp surface. Total mesorectal excision and neoadjuvant chemoradiotherapy in rectum cancers resulted in significant reductions in morbidity, mortality, and recurrence rates. Recently, complete mesocolic excision and central vascular ligation method has been described in the surgical treatment of colon cancer to achieve similar results. Unfortunately, metastatic colon cancer rate at presentation is approximately 20%. Surgery is a potentially curative option in selected patients with liver and lung metastasis. Pathologic stage of the tumor at presentation is the most important prognostic factor after resection. Therefore, early diagnosis of colon cancer by screening methods and new surgical techniques will lead to better results in survival rates.
Part of the book: Current Trends in Cancer Management