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Clinics in Colon and Rectal Surgery最新文献

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Achieving Health Equity: Advancing Colorectal Surgery among Racial and Ethnic Minorities in America 实现健康公平：促进美国少数种族和族裔的结直肠外科手术
IF 1.4 4区 医学
Clinics in Colon and Rectal Surgery Pub Date : 2024-05-13 DOI: 10.1055/s-0044-1786532
Demario S. Overstreet, Robert H. Hollis
{"title":"Achieving Health Equity: Advancing Colorectal Surgery among Racial and Ethnic Minorities in America","authors":"Demario S. Overstreet, Robert H. Hollis","doi":"10.1055/s-0044-1786532","DOIUrl":"https://doi.org/10.1055/s-0044-1786532","url":null,"abstract":"<p>Racial inequities in short and long-term outcomes following colorectal surgery continue to persist. Using inflammatory bowel disease and colorectal cancer as disease foci, we review existing racial inequities in surgical outcomes and complications, discuss how social determinants of health and biopsychosocial factors can contribute to these inequities, and highlight potential mechanisms for building interventions to achieve health equity following colorectal surgery for minority populations.</p> ","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"2014 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140929080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Crohn's-like Ileal Pouch Illness and Ileal Pouch Salvage Strategies 克罗恩病样回肠袋疾病和回肠袋挽救策略
IF 1.4 4区 医学
Clinics in Colon and Rectal Surgery Pub Date : 2024-05-10 DOI: 10.1055/s-0044-1786384
Alex L. Huang, Marnie Abeshouse, Katherine C. Lee, Emily Rinebold, Maia Kayal, Michael C. Plietz
{"title":"Crohn's-like Ileal Pouch Illness and Ileal Pouch Salvage Strategies","authors":"Alex L. Huang, Marnie Abeshouse, Katherine C. Lee, Emily Rinebold, Maia Kayal, Michael C. Plietz","doi":"10.1055/s-0044-1786384","DOIUrl":"https://doi.org/10.1055/s-0044-1786384","url":null,"abstract":"<p>De novo Crohn's disease (CD) of the pouch or Crohn's-like Ileal Pouch Illness (CLIPI) is an increasingly common occurrence in an ever-growing ileal pouch population. Although currently undetermined if a subset of classic CD or a completely new entity, it primarily affects the prepouch afferent limb, pouch, and rectal cuff. Symptoms can mimic other more common disorders, such as pouchitis, and requires a thorough workup, including pouchoscopy with biopsy and often cross-sectional imaging, for the diagnosis to be made. There is an increased risk of long-term pouch failure in this population. Treatment is typically dependent upon the disease phenotype with surgical management considered in a step-up fashion. Medical management is primarily performed with “biologics,” such as antitumor necrosis factor agents, although data are limited due to the lack of randomized controlled trials. Surgical management for CLIPI can include endoscopic, anorectal, and abdominal approaches to assist as “pouch-salvage strategies.” The performance of advanced pouch-salvage techniques in the CLIPI population requires careful patient selection and should preferably be performed at high-volume pouch centers.</p> ","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"126 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140929035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Serving Those Who Served: Enhancing Colorectal Surgery Care for Veterans 为退伍军人服务：加强对退伍军人的结直肠外科护理
IF 1.4 4区 医学
Clinics in Colon and Rectal Surgery Pub Date : 2024-05-10 DOI: 10.1055/s-0044-1786388
Austin Hewitt, Melanie Fritz, Cristina B. Sanger
{"title":"Serving Those Who Served: Enhancing Colorectal Surgery Care for Veterans","authors":"Austin Hewitt, Melanie Fritz, Cristina B. Sanger","doi":"10.1055/s-0044-1786388","DOIUrl":"https://doi.org/10.1055/s-0044-1786388","url":null,"abstract":"<p>The Department of Veterans Affairs (VA) is the largest provider of integrated health care services in the United States and its mission is to honor veterans by providing timely, effective, and high-quality health care that improves individuals' health and functionality. The VA provides comprehensive primary and specialty care, including colorectal surgery services, to eligible veterans who suffer from a disproportionately high burden of medical comorbidities and often belong to vulnerable populations, including individuals of low socioeconomic status, those who identify as lesbian, gay, bisexual, transgender, and questioning, racial minorities, and those suffering from severe mental health illness. There are many challenges to caring for a population of veterans with benign and malignant colorectal disease due to both patient and system level factors. Despite these challenges, the VA has demonstrated a commitment to ensuring culturally competent, equitable, and inclusive care and to conducting research that establishes evidence-based best practices in the management of colorectal diseases. These efforts have led to outcomes for patients undergoing care for colorectal diseases within the VA that are par with or better than civilian outcomes. The VA is uniquely positioned on a system level to provide nationwide efforts that improve care delivery and serve those who served.</p> ","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"22 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140928981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Surgical Management of the Mesentery in Crohn's Disease 克罗恩病肠系膜的手术治疗
IF 1.4 4区 医学
Clinics in Colon and Rectal Surgery Pub Date : 2024-05-10 DOI: 10.1055/s-0044-1786197
J.C. Coffey, M.L. Devine
{"title":"The Surgical Management of the Mesentery in Crohn's Disease","authors":"J.C. Coffey, M.L. Devine","doi":"10.1055/s-0044-1786197","DOIUrl":"https://doi.org/10.1055/s-0044-1786197","url":null,"abstract":"<p>Increasing evidence suggests that Crohn's disease is a primary mesenteropathy and that resection of the mesentery, or its exclusion from an anastomosis, may alter disease progression. If borne out in clinical trials, this observation would be welcome, as current pharmacotherapeutic approaches to Crohn's disease appear to have limited effect on disease progression. This article explores arguments for and against the alteration of mesenteric inputs by surgical means, in Crohn's disease.</p> ","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"16 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140929183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How to Approach the Difficult Perineum in Crohn's Disease 如何解决克罗恩病患者会阴部的难题
IF 1.4 4区 医学
Clinics in Colon and Rectal Surgery Pub Date : 2024-05-07 DOI: 10.1055/s-0044-1786377
Emily Rinebold, Alex L. Huang, Sue J. Hahn
{"title":"How to Approach the Difficult Perineum in Crohn's Disease","authors":"Emily Rinebold, Alex L. Huang, Sue J. Hahn","doi":"10.1055/s-0044-1786377","DOIUrl":"https://doi.org/10.1055/s-0044-1786377","url":null,"abstract":"<p>Crohn's disease (CD) is a chronic, inflammatory bowel disease with a wide range of presentations, including perianal disease. Presentation is variable, ranging from skin tags to complex fistulas, strictures, and nonhealing wounds. Symptoms of perianal CD can be devastating and may impact quality of life. Optimal management requires coordinated medical and surgical therapy. When possible, conservative treatment of perianal disease should be attempted. However, surgical treatment is often required, and some patients may ultimately require total proctocolectomy with permanent diversion due to the severity of disease. Even with close attention and treatment, disease can be recurrent, and complications of treatment are sometimes worse than the initial presentation. Novel treatments, including use of mesenchymal stem cells and autologous fat grafting, hold some promise, but are not yet widely available. Thorough knowledge of treatment options, careful patient selection, coordination between medical and surgical providers, and setting realistic expectations are important in the successful treatment of difficult perineal CD.</p> ","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"65 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140886322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Addressing Low Health Literacy in Surgical Populations 解决手术人群健康素养低的问题
IF 1.4 4区 医学
Clinics in Colon and Rectal Surgery Pub Date : 2024-05-02 DOI: 10.1055/s-0044-1786389
{"title":"Addressing Low Health Literacy in Surgical Populations","authors":"","doi":"10.1055/s-0044-1786389","DOIUrl":"https://doi.org/10.1055/s-0044-1786389","url":null,"abstract":"Health literacy is defined as the ability to obtain, engage, understand, and act upon health information to make decisions about health care. Health literacy is a key determinant of health outcomes and disparities including those in surgery. Over one-third of surgical patients suffer from low health literacy, with disproportionately higher rates among older, rural, and black patients. Low health literacy has been associated with poor adherence to preoperative and discharge instructions, longer lengths-of-stay, higher readmission rates, and higher health care costs. However, health literacy is modifiable, and therefore it is uniquely positioned for meaningful interventions at the patient, provider, and system level. These interventions include using more visual aids with patients and families (patient level), communicating in more understandable ways (provider level), and improving the organizational health literacy of hospitals (system level). Through high-quality research and multilevel interventions, significant opportunities exist to address low health literacy and improve outcomes, eliminate disparities, and reduce costs for this disparity population.","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"18 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140838592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Addressing Colorectal Cancer Disparities in Unhoused Populations: A Call for Equitable Access and Compassionate Care 应对无住房人群中的结直肠癌差异：呼吁公平就医和体恤关怀
IF 1.4 4区 医学
Clinics in Colon and Rectal Surgery Pub Date : 2024-05-02 DOI: 10.1055/s-0044-1786531
{"title":"Addressing Colorectal Cancer Disparities in Unhoused Populations: A Call for Equitable Access and Compassionate Care","authors":"","doi":"10.1055/s-0044-1786531","DOIUrl":"https://doi.org/10.1055/s-0044-1786531","url":null,"abstract":"Housing is essential for health. Unhoused individuals have markedly worse health status than the general population culminating in higher rates of premature mortality. Cancer is a leading cause of death in older unhoused adults. Caring for unhoused patients at risk for or with colorectal cancer poses challenges at every stage of oncologic care: prevention, screening, diagnosis, treatment, and follow-up. These challenges result in later stages at diagnosis and worse overall survival. Health systems can work to advance health equity in colorectal cancer in unhoused patients by improving access to care, transitions of care, health care quality, and focusing on socioeconomic/environmental impact.","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"48 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140838314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anastomosis after Bowel Resection for Crohn's Disease: State of the Art Review 克罗恩病肠道切除术后的吻合术：最新技术回顾
IF 1.4 4区 医学
Clinics in Colon and Rectal Surgery Pub Date : 2024-05-02 DOI: 10.1055/s-0044-1786534
{"title":"Anastomosis after Bowel Resection for Crohn's Disease: State of the Art Review","authors":"","doi":"10.1055/s-0044-1786534","DOIUrl":"https://doi.org/10.1055/s-0044-1786534","url":null,"abstract":"Recurrence after surgically induced remission in Crohn's disease remains a topic of research and debate with significant clinical implications for overall quality of life and intestinal and defecatory functions. While the surgeon continues to play a critical role in surgical prophylaxis of recurrence, optimal results will only be obtained in the setting of a true multidisciplinary team approach, following the principles of “the right surgery, on the right patient, at the right time, performed by the right surgeon, supported by the right team.” The centerpiece of surgical prophylaxis is the intestinal anastomosis. The ideal anastomosis after resection for Crohn's disease should be safe and reliable, as postoperative septic complications have been shown to increase the risk of recurrence; result in a wide lumen and a configuration that would not impede enteric flow; exclude or excise the mesentery, a known culprit in primary and recurrent disease; and preserve vascularization and innervation. This article will review the evidence supporting the above-mentioned surgical principles and the long-term results of the different anastomotic configurations.","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"24 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140838595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Difficulties and Disparities in Colorectal Cancer End-of-Life Care: A Patient's Story 结直肠癌临终关怀的困难与差距：一位患者的故事
IF 1.4 4区 医学
Clinics in Colon and Rectal Surgery Pub Date : 2024-04-29 DOI: 10.1055/s-0044-1786393
Stacy Ranson, Danielle Noreika, Emily B. Rivet
{"title":"Difficulties and Disparities in Colorectal Cancer End-of-Life Care: A Patient's Story","authors":"Stacy Ranson, Danielle Noreika, Emily B. Rivet","doi":"10.1055/s-0044-1786393","DOIUrl":"https://doi.org/10.1055/s-0044-1786393","url":null,"abstract":"<p>Patients with advanced colorectal cancer nearing the end of life require a multidisciplinary approach to address the unique challenges they face. Using a case vignette, we outline the various stages of a patient's journey with advanced rectal cancer and the common obstacles to their care as they interface with the medical system. We highlight how Black persons might be vulnerable to differences in screening, treatment, procedural interventions, end-of-life care, and health care decision-making. The article also addresses how health inequities and barriers relating to concordant treatment goals can impact the relationship between patient and surgeon. This vignette illustrates the importance of ensuring a team approach to treatment and the value of early involvement of palliative medicine for patients with advanced colorectal cancer.</p> ","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"50 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140838312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Minimally Invasive Management of Complicated and Re-operative Crohn's Disease 微创治疗并发症和再手术克罗恩病
IF 1.4 4区 医学
Clinics in Colon and Rectal Surgery Pub Date : 2024-04-29 DOI: 10.1055/s-0044-1786515
Conor Kinford, Vitaliy Poylin
{"title":"Minimally Invasive Management of Complicated and Re-operative Crohn's Disease","authors":"Conor Kinford, Vitaliy Poylin","doi":"10.1055/s-0044-1786515","DOIUrl":"https://doi.org/10.1055/s-0044-1786515","url":null,"abstract":"<p>Minimally invasive techniques for the surgical management of Crohn's disease have become the recommended approach for initial surgical intervention in noncomplicated patients as there is lower morbidity for patients without compromising treatment outcomes. There has been a push to expand minimally invasive approaches to complex and recurrent diseases, trying to benefit these difficult patients. However, until recently there have been little data to support the adoption of minimally invasive surgery (MIS) in these scenarios. This article aims to build on the 2019 Clinics in Colon and Rectal Surgery article on complex Crohn's and MIS by introducing new data in support of these approaches. Decisions for technique should be based on patient characteristics, but minimally invasive techniques have emerged as valid and possibly superior for complex and recurrent disease.</p> ","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"155 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140838313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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