Complex and Reoperative Colorectal Surgery

Cindy Kin, MD, MS, FACS

Clinically active surgeons will find themselves facing cases of great complexity due to the inherent nature of the pathology or due to the sequelae of prior operations. Undertaking an operation for a difficult colorectal diagnosis, sometimes in a reoperative field, is not only challenging but also often humbling. We have all found ourselves in the midst of a particularly difficult case, wondering why we agreed to take on such an endeavor, and wishing instead that we were doing a straightforward laparoscopic right colectomy in a young, thin, healthy person with textbook anatomy.

The operative and nonoperative management of these cases requires mental fortitude, physical stamina, patience, and wisdom. It also requires knowledge of techniques and strategies that one can employ to increase the chances for success and reduce the risks for complication. To this end, we have compiled a volume addressing some of the most difficult problems in colorectal surgery—from the management of enterocutaneous fistulas and recurrent rectal cancer to the management of complications such as iatrogenic injuries of the genitourinary tract and anastomotic leaks.

The contributors are experts in their field and offer invaluable advice, tips, and surgical techniques borne out of years of experience. These authors have impressively covered the literature on their rather broad topics and have also offered a wealth of practical knowledge that can be employed in the operating room. I am deeply grateful to them for their expertise and for taking time out of their very busy lives to write outstanding manuscripts, and they make me proud to be in the same profession as them. I also thank Dr. Scott Steele for giving me the opportunity to be the guest editor of this volume—through my experiences working with him, I am continually inspired by his mantra to “Dominate the Day!” as he does, undoubtedly, each and every day of his life.

A difficult case often represents a Hail Mary pass for the patient who has already sought help from multiple surgeons and has started to doubt that someone would be willing to help. For this reason, these complex and reoperative cases may be especially rewarding. The goal of this volume is to provide useful strategies for the management of such endeavors. At the very least, these authors will remind you that you are in good company, when you find yourself face-to-face with your next operative challenge.