Clin Colon Rectal Surg 2019; 32(03): 147-148
DOI: 10.1055/s-0038-1677000
Preface
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Complications and Dilemmas in Colorectal Surgery

Skandan Shanmugan
1   Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
› Author Affiliations
Further Information

Publication History

Publication Date:
01 April 2019 (online)

Zoom Image
Skandan Shanmugan, MD

“No matter what measures are taken, doctors will sometimes falter, and it isn't reasonable to ask that we achieve perfection. What is reasonable is to ask that we never cease to aim for it.”

—Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

Complications in colon and rectal surgery are an unfortunate eventuality. Despite our best intentions and mastery of our craft, how we respond to these challenges is becoming increasingly scrutinized and even prompted national initiatives to curb these outcomes. While no “handbook” can possibly account for all the potential risks of colorectal surgery nor replace sound clinical judgment and expertise, my hope is that this edition of Clinics in Colon and Rectal Surgery will provide a useful roadmap to help surgeons navigate through the most commonly encountered hurdles in colon and rectal surgery.

We begin with Drs. Lee and Russ' evaluation of the current predictive models of postoperative risks in colorectal surgery and whether these tools can be practically implemented in our everyday practice. They also highlight modern strategies for patient optimization such as prehabilitation which has become increasingly popular with the aging of our patient population. Surgical site infections (SSI) continue to be scrutinized within our specialty, but few authors have been able to articulate the economic and clinical impact of SSI as well as our next authors, Drs. Turner and Migaly. They not only create a historical context for the growing level of national quality initiatives but also propose the trending solution for prevention bundles to globally minimize SSI in colorectal surgery. In addition to SSI, postoperative ileus is another common harbinger for increased morbidity, cost, and hospital length of stay among our patients, and Karim Alavi and his colleagues in Massachusetts provide an excellent outline of risk factors and how we may best sidestep this pitfall.

The creation and/or care of an ostomy is hardly elusive to colorectal surgeons and account for a significant proportion of related complications. Heidi Bahna and her colleagues tackle the decisional dilemmas of who, when, what, where, and why, while Drs. Murken and Bleier discuss the clinical impact of ostomy-related complications and strategies for prevention. Further scenarios and complications that may keep us awake at night include that of colonic perforation, anastomotic leaks, and urological injuries, each of which is superbly chronicled by the respective authors within the following articles. However, what is less often discussed is the understated yet significant bladder, sexual, and defecatory dysfunction that can occur after colorectal surgery as portrayed by Drs. Giglia and Stein in the penultimate article.

Finally, this edition concludes with an elegantly prosed article by Dr. Delaney and his colleagues who provide up-to-date commentary as to what is the “bigger picture” in colorectal surgery? The authors also outline the pros and cons to the potential future directives of cost containment, incentives, transparency, and centers for excellence.

I am immensely indebted to all the authors for all their time and efforts in producing top-notch contributions to this edition. These contributors have not only written excellent contemporary literature-guided articles but have also offered a wealth of practical knowledge and pearls that will prove to be invaluable to everyone's practice. I am thankful to Scott Steele for letting me borrow the keys as a “guest editor” of this influential and prestigious journal—his tireless commitment and dedication to our specialty is truly inspirational. I am also deeply grateful to my past mentors Drs. Delaney, Champagne, and Fry and to those colleagues and mentors in my present, Drs. Mahmoud and Bleier. Finally, I am thankful for all my patients for whom I work tirelessly to strive for perfection, for this profession which continues to be equally exciting and humbling and finally for my residents who keep me grounded but driven to a pursuit of excellence.