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ASCRS Annual Scientific Meeting Registration Program 2015
• 2015 Preliminary Program • The American Society of Colon and Rectal Surgeons Annual Scientific Meeting May 30 - June 3, 2015 Hynes Convention Center & Sheraton Boston Hotel fascrs.org Table of Contents General Information Monday Program HarryE.Bacon,MD,Lectureship ................................42 ePoster Presentations ..........................................42 ParvizKamangarHumanitiesinSurgeryLectureship............42 Lecture:TheMathInvolvedinaManuscript ....................43 Symposium: NewTechnologies.................................43 Saturday Program Tuesday Program MeettheProfessorBreakfasts ..................................44 Symposium: AnorectalDisorders:BalancingInnovation withConventionalWisdom.....................................45 Symposium: UpdateonInflammatoryBowelDisease............46 ErnestineHambrick,MD,Lectureship ...........................47 ePoster Presentations ..........................................47 Symposium: ControversiesinRectalCancerManagement ......48 Symposium: Ostomies:Location,Creation andComplications .............................................49 Abstract Session: GeneralSurgeryForum ........................50 MastersinColorectalSurgeryLectureship Honoring David Schoetz, Jr., MD .................................51 ePoster Presentations ..........................................51 WomeninColorectalSurgeryLuncheon........................51 Symposium: AnalCancer:Prevention,Diagnosis andTreatment .................................................52 Abstract Session: InflammatoryBowelDisease...................53 Abstract Session: ResearchForum ...............................54 Symposium: MedicalLegalSymposium: HowtoProtectYourself .......................................55 Symposium: AnalFistulas:Diagnosis,Imaging andTherapy–RationalApproaches ............................57 AfterHoursDebate ............................................58 Residents’Reception ...........................................58 Sunday Program CoreSubjectUpdate ...........................................21 Symposium: HealthcareEconomicsintheACAEra ..............22 Symposium: QualityInitiativesinClinicalPractice...............23 Symposium: LaparoscopicNuts&BoltsandRoboticRivets ......24 Symposium: Complications:PreventionandManagement ......26 Luncheon Symposium: CurrentAdvancesinthe ManagementofFecalIncontinence ............................27 Luncheon Symposium: TheGeneticsofColorectal CancerandCancerRelatedSyndromes .........................28 WelcomeandOpeningAnnouncements .......................29 Symposium: TechnicalPearls–HowIt’sReallyDone.............30 Abstract Session: NeoplasiaI ....................................31 ePoster Presentations ..........................................32 NormanD.Nigro,MD,ResearchLectureship ....................32 AfterHoursDebate ............................................33 WelcomeReception............................................33 T Reg ist O er Onlin e ............................ 3-5 TransanalEndoscopicSurgeryWorkshop ........................6 AINandHRA:WhattheColorectalSurgeon NeedstoKnowWorkshop .......................................8 LaparoscopicColectomySymposiumandWorkshop .............9 OptimalManagementofFecalIncontinence SymposiumandWorkshop .....................................11 RoboticColonandRectalSurgery: Tips,Tricks,andSimulationSymposiumandWorkshop .........15 Symposium: AdvancedEndoscopyandEndoluminalSurgery ...17 QuestionWritingWorkshop:HowtoWriteExamQuestions .....19 Symposium: ImprovingOutcomes-Identifying andManagingtheComplexSurgicalPatients ..................20 CLICK H ERE Wednesday Program MeettheProfessorBreakfasts ..................................59 Symposium: ColonCancer:Staging,Techniquesand theRoleofAdjuvantTherapy ..................................60 Abstract Session: Outcomes .....................................61 ASCRS/SSAT Symposium: ChallengesandControversies: SurgicalManagementofAdvancedDiseaseand RecurrentCancer ..............................................62 Abstract Session: BestVideos ...................................63 Symposium: OptimizingTreatmentforRectalProlapse, ConstipationandObstructedDefecationSyndrome ............64 Abstract Session: NeoplasiaII ...................................65 Symposium: EnhancedPerioperativeCarePathwaysand PostoperativePainManagement ...............................66 Symposium: IsthereaParadigmShiftinthe ManagementofDiverticularDisease? ..........................67 ASCRSAnnualBusinessMeetingandStateofthe SocietyAddress ................................................68 ASCRSAnnualReceptionandDinnerDance ....................68 Monday Program MeettheProfessorBreakfasts ..................................34 Residents’Breakfast ............................................34 Symposium: RoboticColorectalSurgery.........................35 Symposium: RectalCancer:OptimizingOutcomes throughTechniques ...........................................36 MemorialLectureshipHonoringJohn M. MacKeigan, MD ........37 PresidentialAddress ...........................................37 ePoster Presentations ..........................................37 Symposium: NavigatingaCareerPathinColonand RectalSurgery– OrchestratingandOptimizingCareer TransitionsatallLevels ........................................38 Abstract Session: BenignColonicDisease........................39 ePoster Presentations ..........................................39 Symposium: PastPresidents’Panel:ControversiesandCases ....40 Abstract Session: PelvicFloor/Anorectal .........................41 2 Return to Table of Contents Education Information Thisactivityissupportedbyeducationalgrantsfrom commercialinterests.Completeinformationwillbe providedtoparticipantspriortotheactivity. Target Audience David Margolin, MD ProgramChair Theprogramisintendedfortheeducationofcolonand rectalsurgeonsaswellasgeneralsurgeonsandothers involvedinthetreatmentofdiseasesaffectingthecolon, rectumandanus. H. David Vargas, MD ProgramVice-Chair Accreditation Annual Scientific Meeting Mission, Goal, Purpose and Learning Objectives TheAmericanSocietyofColonandRectal Surgeons(ASCRS)isaccreditedbythe AccreditationCouncilforContinuingMedical Education(ACCME)toprovidecontinuingmedical educationforphysicians.ASCRStakesresponsibilityforthe content,qualityandscientificintegrityofthisCMEactivity. ThegoaloftheAmericanSocietyofColonandRectal Surgeons’AnnualScientificMeetingistoimprovethe qualityofpatientcarebymaintaining,developingand enhancingtheknowledge,skills,professionalperformance andmultidisciplinaryrelationshipsnecessaryforthe prevention,diagnosisandtreatmentofpatientswith diseasesanddisordersaffectingthecolon,rectum andanus.TheAnnualProgramCommitteeisdedicatedto meetingthesegoals. Continuing Medical Education Credit TheAmericanSocietyofColonandRectalSurgeons (ASCRS)designatesthisliveactivityforamaximumof50.25 AMA PRA Category 1 Credits™.Physicians should claim only the credit commensurate with the extent of their participation in the activity. Attendeescanearn1CME Credithourforevery60minutesofeducationaltime. Thisscientificprogramisdesignedtoprovidesurgeons within-depthandup-to-dateknowledgerelativeto surgeryfordiseasesofthecolon,rectumandanuswith emphasisonpatientcare,teachingandresearch. Presentationformatsincludepodiumpresentations followedbyaudiencequestionsandcritiques,panel discussions,e-posterpresentations,videopresentations andsymposiafocusingonspecificstate-of-the-art diagnosticandtreatmentmodalities. Successful Completion: Participantsmustberegisteredfor theconferenceandattendthesession(s).Eachparticipant willreceiveausernameandpasswordforcompletionof theevaluationsfortheASCRS2015AnnualScientific Meeting;participantsmustcompleteanonlineevaluation formforeachsessiontheyattendtoreceivecredithours. Therearenoprerequisitesunlessotherwiseindicated. Thepurposeofallsessionsistoimprovethequalityofcare ofpatientswithdiseasesofthecolonandrectum. Self Assessment Credit Attheconclusionofthismeeting,participantsshouldbe ableto: Recognizenewinformationincolonandrectalbenign andmalignanttreatments,includingthelatestinbasic andclinicalresearch. Manyofthesessionsofferedwillbedesignatedasself assessmentCMEcredit,applicabletoPart2oftheABS MOCprogram.Inordertoclaimselfassessmentcredit, attendeesmusttakeapost-test.Information/instructions willbegiventoallmeetingregistrants. Describecurrentconceptsinthediagnosisand treatmentofdiseasesofthecolon,rectumandanus. Applyknowledgegainedinallareasofcolonandrectal surgery. Recognizetheneedformultidisciplinarytreatmentin patientswithdiseasesofthecolon,rectumandanus. 3 Return to Table of Contents Annual Scientific Meeting Information eitheronlineorontheregistrationform,andthenobtain theirseatingticketonsitepriortothedinnerdance.The costforothersis$75perticket. ASCRS Mission TheAmericanSocietyofColonandRectalSurgeonsisan associationofsurgeonsandotherprofessionalsdedicated toassuringhighqualitypatientcarebyadvancingthe sciencethroughresearchandeducationforpreventionand managementofdisordersofthecolon,rectumandanus. Free WiFi Available TherewillbecomplimentaryWiFiintheHynesConvention Centerforallmeetingattendees. Disclaimer Accommodations TheprimarypurposeoftheASCRSAnnualMeetingis educational.Information,aswellastechnologies,products and/orservicesdiscussed,areintendedtoinform participantsabouttheknowledge,techniquesand experiencesofspecialistswhoarewillingtosharesuch informationwithcolleagues.Adiversityofprofessional opinionsexistinthespecialtyandtheviewsofthe AmericanSocietyofColonandRectalSurgeonsdisclaims anyandallliabilityfordamagestoanyindividualattending thisconferenceandforallclaimswhichmayresultfromthe useofinformation,technologies,productsand/orservices discussedattheconference. ThemeetingwillbeheldattheHynesConventionCenter& SheratonBostonHotelinBoston,Massachusetts. TheHynesConventionCenterandnearbyhotelsare approximately15minutesfromBostonLogan InternationalAirport. Hotels & Room Rates: Sheraton Boston Hotel $258Single/Double(+14.45%tax) (Headquarters – connected to the Convention Center via mall) Hilton Boston Back Bay Hotel $250Single/Double(+14.45%tax) (Adjacent to the Convention Center & Sheraton) Disclosures and Conflict of Interest IncompliancewiththestandardsoftheAccreditation CouncilforContinuingMedicalEducationandtheASCRS, facultyhasbeenrequestedtocompleteaDisclosure of Financial Relationships.Disclosureswillbemadeatthetime ofpresentation,aswellasincludedintheProgramBook andmobileapp.Allperceivedconflictsofinterestwillbe resolvedpriortopresentation;and,ifnotresolved,the presentationwillbedenied. Internet: Forbestavailability,makeyourreservationonline. Sheraton Boston Hotel https://www.starwoodmeeting.com/Book/ASCRS15 Hilton Boston Back Bay http://www.hilton.com/en/hi/groups/personalized/B/ BOSBHHH-ASCRS-20150525/index.jhtml Phone: Ifmakingareservationbyphone,callthefollowingphone numbersandaskfortheASCRSroomblock. Sheraton Boston Hotel .....................(888)627-7054 Hilton Boston Back Bay.....................(617)236-1100 Social Events TheWelcome Reception willbeheldSunday,May31st from7:00–8:30pm(complimentarytoallregistered attendees)andwillfeaturehorsd’oeuvres,cocktailsand entertainment.TheWelcomeReceptionwillbeheldatthe SheratonBostonHotel.TheResearchFoundationwilljoin forceswithASCRStowelcomeallatthisreception. Hotelreservations/rateavailabilityarenotguaranteedafter theroomblockisfullorafterApril 27, 2015.Pleaseregister early–onlyalimitednumberofroomsareavailable. ThisyeartheWelcomeReceptionwillbeknownas“Jersey Night.”Makesuretowearyourteam’sfavoritejersey (collegiateorprofessional)toshowyourcolleagueswhich teamyourootfor! The deadline for hotel reservations is Monday, April 27, 2015. Special Needs TheAnnual Dinner Dance isscheduledforWednesday, June3rdwiththereceptionbeginningat7:00pmandthe dinnerat8:00pm.Thereisnoadditionalcostforaticketfor full–payingMembersandFellows.Members/Fellowsmust indicatewhethertheywanttoattendthedinnerdance IncompliancewiththeAmericanswithDisabilities Act,ASCRSrequeststhatparticipantsinneedof specialaccomodationssubmitawrittenrequesttoASCRS wellinadvance. 4 Return to Table of Contents Annual Scientific Meeting Information Official ASCRS Travel Agency Dining and Places to see in Boston SuggestedthingstodoinandaroundBoston,clickhere. Tobookyourreservation,callASCRS’sofficialtravelagency, UniglobePreferredTravel,at(800)626-0359andafterthe promptdial“0”(M-F8:30am–5:30pmCST).Ifyouprefer youmay: Bookyourtravelonlineatwww.uniglobepreferred.com. Clickthedownarrownextto“BusinessTravel”thenclick onRapid-Rezlink.Whenthebookingpagecomesup, clickon“CreateNewUser.”Enterpersonalinformation, click“done”;thenextpageisformoredetailedpersonal information–hereyoumust enteracreditcardnumber andbillingaddresstomakeareservation.Scrolldown andclick“Save.”Clickonthe“TravelPlanner”tabtomake areservationandselectASCRSforthe“TripReason.” PleaserecordyourUserIDandyourPasswordforfuture use.Bookingonthissitewillhaveareducedagency servicefeeof$15. Spouse/Guest Program Please review the following and indicate your choices online or on the registration form. Package #1 ($100)Includes: Welcome Reception, 7:00–8:30pm,Sunday, May31,SheratonBostonHotel Annual Reception, 7:00–8:00pm,Wednesday, June3,SheratonBostonHotel Annual Dinner Dance, 8:00–10:30pm, Wednesday,June3,SheratonBostonHotel Admission toscientificsessionsandthe exhibitarea Exhibit Hours Sunday, May 31, 3:00 – 5:00 pm PMrefreshmentbreak Package #2 ($55)Includes: Welcome Reception, 7:00–8:30pm,Sunday, May31,SheratonBostonHotel Admission toscientificsessionsandthe exhibitarea Monday, June 1, 9:00 am – 4:30 pm AMandPMrefreshmentbreaks Complimentaryboxlunch Tuesday, June 2, 9:00 am – 2:00 pm AMrefreshmentbreak Complimentaryboxlunch Temperature Please Note: Timesandspeakersaresubjecttochange. TheaveragetemperatureinMay/Junerangesfromalow of60°toahighof76°F. Child Care Services Pleasecontacttheconciergeatthehotelatwhichyouare stayingforalistofbondedindependentbabysittersand babysittingagencies. Join ASCRS Non-members,pleaseconsiderjoiningtheASCRSto receivethe“member”ratefortheAnnualMeeting. Pleaseclick here forbenefitsofjoiningASCRS. Click here forapplicationform. 5 Return to Table of Contents Saturday, May 30 Transanal Endoscopic Surgery Workshop 8.5 CME 7:00 am – 4:30 pm Fee: $495 • Limit: 48 participants • Lunch Included Registration Required • No refunds after May 11 Didactic Session: 7:00 – 8:25 am Transanalexcisionoftumorsoftherectumhasbeenlimitedbythetechnicaldifficultiesofoperatinginaconfinedspace withinadequateinstrumentation.Accesstolesionshigherthan6cmfromtheanalvergeisnotfeasiblewithstandard transanaltechniques.Transanalendoscopicmicrosurgery(TEM)wasdesignedtoovercometheselimitationsandhasproven tobeaninvaluableendoscopictoolintreatingrectallesionswhichmightotherwiserequireproctectomy.Overthelast severalyears,thearmamentariumoftransanalapproachhasincreasedwiththedevelopmentoftwonewplatforms, TransanalEndoscopicOperations(TEO)andTransanalMinimallyInvasiveSurgery(TAMIS).Theseplatformsofferother optionsforadvancedtransanalsurgery. Radicalresectionoftherectumforbenignandmalignantneoplasmsisassociatedwithratesofperioperativecomplications andfunctionaldisordersthatlargelyexceedthemorbidityassociatedwithothertypesofbowelresections.Thishasled surgeonstoattemptlessinvasivesurgicalalternativesincludingtransanalexcisionandtraditionalendoscopicapproaches. Standardtransanalexcisionaltechniquesarelimitedbyinstrumentationandanatomytothedistal6-12cmoftherectum andareassociatedwithsubstantialrecurrenceratesforbenignandmalignantdisease.Intheearly1980’s,transanal endoscopicmicrosurgery(TEM)wasdescribed.Inthepastdecade,itsacceptancehasincreasedandseveralauthorshave demonstrateddecreasedrecurrenceratesforbenignandearlystagemalignantneoplasmswhencomparedtostandard transanalexcision.MorbidityforTEMhasbeenlowandsimilartotransanalexcision.Withtherecentintroductionofnew devices(TEO,TAMIS)toperformtransanalendoscopicresections,surgeonsnowhavemoreflexibilityintermsofequipment andoperativesetup.Surgeonsexperiencedintransanalendoscopicsurgery(TES)havelearnedvaluablelessonsinpatient selection,operativesetup,technicalpearlsandtroubleshooting,andpostoperativemanagementthatcanaccelerate learningforthoseinterestedinadoptingthistechnique. Existing Gaps What Is: DespiteincreasedacceptanceofTESandreporteddecreasedratesofrecurrencecomparedtostandardtransanal excision,manycolorectalsurgeonshavenotadoptedTESintotheirpractices. What Should Be: Comprehensivereviewofindicationsfortransanalendoscopicmicrosurgeryandofalldevicescurrently available,andhands-onpracticeinaninanimatelabtrainingsessionundertheguidanceofexperts,willallowformore surgeonstoadoptTESandofferittopatientsasanalternativetoradicalresectionwhenclinicallyindicated. Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Recognizethesurgical indicationsandpreoperativepreparationforTES;b)Recalltheoperativesetup,transanaldevicesand equipmentcurrentlyusedtoperformTES;c)Demonstratehowtotroubleshoottechnicaldifficultiesduring TES;d)ExplainintraoperativecomplicationsandpostoperativemanagementofpatientsundergoingTES; e)DemonstratethetechnicalskillsnecessarytoperformTESandbecomefamiliarwithalltheavailabletransanal devices;f )CharthowtobillappropriatelyforthevariousTEStechniques;g)Describetherequirements necessarytostartaTESprogramattheirinstitution. Continued next page 6 Return to Table of Contents Saturday, May 30 Transanal Endoscopic Surgery Workshop (Continued) Co-Director: Peter Cataldo, MD, Burlington, VT Co-Director: Joshua Bleier, MD, Philadelphia, PA 7:00am Introduction to TES: Past and Present PeterCataldo,MD,Burlington,VT 7:05am 7:20am 7:35am 7:50am Indications for TES, Patient Selection DanaSands,MD,Weston,FL Excision and Suturing Techniques (all platforms) PeterCataldo,MD,Burlington,VT 8:05am Oncologic Results JoshuaBleier,MD,Philadelphia,PA Complications ScottSteele,MD,FortLewis,WA 8:25am Break into Groups Setup and Positioning (all platforms) TheodoreSaclarides,MD,Maywood,IL Group A – Hands-on Lab Group B – TES Panel Discussion with Videos 8:30 am – noon 8:30 am – noon Peter Cataldo, MD, Lab Director Joshua Bleier, MD, Workshop Director TEO SkandanShanmugan,MD,Philadelphia,PA; JaimeSanchez,Tampa,FL;PatriciaSylla,MD, Boston,MA;BrianValerian,MD,Albany,NY Panel: LilianaBordeianou,MD,Boston,MA;RodrigoPerez, MD,SaoPaulo,Brazil;TheodoreSaclarides,MD, Maywood,IL;MarkWhiteford,MD,Portland,OR Participantsarewelcometobringquestionsanddifficult casestothepanel. TEM EricHaas,MD,Houston,TX;TraciHedrick,MD, Charlottesville,VA;DanaSands,MD,Weston,FL; ElizabethRaskin,St.Paul,MN Noon Group B – Hands-on Lab TAMIS MatthewIsho,MD,SanDiego,CA;Sergio Larach,MD,Orlando,FL;ElisabethMcLemore, LosAngeles,CA;ScottSteele,MD,FortLewis, WA;TheodorosVoloyiannis,MD,Houston,TX Noon 1:00 – 4:30 pm Peter Cataldo, MD, Lab Director TEO ElisabethMcLemore,MD,LosAngeles,CA; JaimeSanchez,Tampa,FL;PatriciaSylla,MD, Boston,MA;BrianValerian,MD,Albany,NY Lunch (provided) Group A – TES Panel Discussion with Videos TEM EricHaas,MD,Houston,TX;TraciHedrick,MD, Charlottesville,VA;DanaSands,MD,Weston,FL; ElizabethRaskin,St.Paul,MN 1:00 – 4:30 pm Joshua Bleier, MD, Workshop Director Panel: CharlesFinne,MD,Minneapolis,MN;JorgeMarcet, MD,Tampa,FL;BruceOrkin,MD,Chicago,IL; TheodoreSaclarides,MD,Maywood,IL;Mark Whiteford,MD,Portland,OR TAMIS MatthewIsho,MD,SanDiego,CA;Sergio Larach,MD,Orlando,FL;ScottSteele,MD, FortLewis,WA;TheodorosVoloyiannis,MD, Houston,TX Participantsarewelcometobringquestionsanddifficult casestothepanel. 4:30pm Lunch (provided) 4:30pm Adjourn Adjourn 7 Return to Table of Contents Saturday, May 30 AIN and HRA: What the Colorectal Surgeon Needs to Know Workshop 5.25 CME 7:00 am – 12:30 pm Fee: $495 • Limit: 39 participants Registration Required • No refunds after May 11 Theincidenceofanalcancerisincreasingduetorisingratesofhumanpapillomavirus(HPV)infection.HPVinfectioncan leadtoanalintraepithelialneoplasia(AIN)thatcanbeidentifiedwithhigh-resolutionanoscopy(HRA).Whilecolonand rectalsurgeonsareveryfamiliarwiththeevaluationandtreatmentofanalcancer,manydonotknowhowtoidentifythe analcancerprecursor,AIN,withHRA. Throughadidacticandhands-oneducationalinitiative,wewillreviewHPVinfectionsandtheindicationsanduse ofHRAforAIN.Theparticipantswillbedividedintothreegroupsandwillhaverotationsbetweendidactic,hands-onand videosessions. Existing Gaps What Is: Whilecolonandrectalsurgeonsunderstandtheevaluationandtreatmentofanalcancer,manyarenotskilledat theevaluationandtreatmentofAINanduseofHRA. What Should Be: ColonandrectalsurgeonsshouldhaveathoroughunderstandingofAIN.Inaddition,colonandrectal surgeonsshouldhaveanunderstandingofhowtouseHRAtoevaluateandtreatAIN.Finally,surgeonsshouldknowallthe treatmentoptionsavailableforpatientswithAIN. Director: Stephen Goldstone, MD, New York, NY Assistant Director: Naomi Jay, NP, PhD, San Francisco, CA 7:00am Welcome StephenGoldstone,MD,NewYork,NY 7:05am Intro to HPV: Scope of the Problem JoelPalefsky,MD,SanFrancisco,CA 7:20am How to Diagnose AIN: Screening and Diagnostics J.MichaelBerry-Lawhorn,MD,SanFrancisco,CA NaomiJay,NP,PhD,SanFrancisco,CA 7:40am HRA Findings of AIN NaomiJay,NP,PhD,SanFrancisco,CA 8:00am HRA Guided Treatment Options StephenGoldstone,MD,NewYork,NY JoelPalefsky,MD,SanFrancisco,CA 8:40am Panel Discussion/Questions J.MichaelBerry-Lawhorn,MD,SanFrancisco,CA StephenGoldstone,MD,NewYork,NY NaomiJay,NP,PhD,SanFrancisco,CA JoelPalefsky,MD,SanFrancisco,CA 9:00am 9:30am Hands-on Workshop: HRA Including Use of the Colposcope and Biopsy Techniques J.MichaelBerry-Lawhorn,MD,SanFrancisco,CA StephenGoldstone,MD,NewYork,NY 10:00am HRA the Movie JoelPalefsky,MD,SanFrancisco,CA 10:30am Refreshment Break in Foyer 10:45am IRC and Hyfrecator Movie StephenGoldstone,MD,NewYork,NY 11:15am Hands-on Workshop: HRA Treatment NaomiJay,NP,PhD,SanFrancisco,CA JoelPalefsky,MD,SanFrancisco,CA 11:45am Cases: Identifying Lesions, Determining Sites for Biopsies J.MichaelBerry-Lawhorn,MD,SanFrancisco,CA 12:15pm Panel Discussion/Questions J.MichaelBerry-Lawhorn,MD,SanFrancisco,CA StephenGoldstone,MD,NewYork,NY NaomiJay,NP,PhD,SanFrancisco,CA JoelPalefsky,MD,SanFrancisco,CA Hands-on Workshop: Lesion Identification (understanding lesion patterns to differentiate LG from HG) NaomiJay,NP,PhD,SanFrancisco,CA 12:30pm Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Describetheprevalenceofanal HPVinfection;b)RecognizehowtobestdiagnoseAIN;c)Demonstratehowtoperformhighresolution anoscopy;d)IdentifytreatmentoptionsavailableforAIN. 8 Return to Table of Contents Saturday, May 30 Laparoscopic Colectomy Symposium and Workshop Didactic Session: 7:30 – 11:45 am • Didactic is open to all registrants (Complimentary) 4.25 CME Didactic Session: 7:30 – 11:45 am Theutilizationoflaparoscopictechniquestoperformcolonandrectalresectionshasbeenexpandingforyears, andwillcontinuetodosointhefaceofnewtechnologicaldevelopmentsandadvancementininstrumentation.Thought andopinionleaderscontinuetodevelopnewtechniquesthatsimplifylaparoscopiccolorectalproceduresandfoster adoptionofminimallyinvasiveapproaches.Intheefforttoensurethebestoutcomesforourpatients,itisessentialthat practicingcolorectalsurgeonshaveasolidgrasponkeyconceptsfortheperformanceoflaparoscopiccolorectalsurgery. Thissymposiumwilladdressissuesoftenencounteredwhenperformingminimallyinvasivecolonandrectalsurgery: • Review of Laparoscopic and Anatomic Principles • Port Placement Philosophy • Procedural Reviews - Rightcolectomy - Leftcolectomy - Proctectomy - Rectopexy - Hartmannreversal - Peristomalherniarepair • Technical Descriptions - Medialtolateralapproach - Lateraltomedialapproach - Stapling - SafeEnergyutilization - Handassistcolectomy • New Technologies - Singlesite - Florescenceimaging • New Techniques Thissymposiumwilladdresslaparoscopiccolectomytechniques,withanemphasisoncreativeandexcellenceinteaching followedbyaworkshopthatwillallowforhands-onexperience. Co-Director: Amir Bastawrous, MD, Seattle, WA Co-Director: Eric K. Johnson, MD, Fort Lewis, WA 7:30am Right Colectomy, the Laparoscopic Gateway Drug MarcSinger,MD,Chicago,IL 7:45am Video Presentation Inferior to Superior Right Colectomy ImranHassan,MD,IowaCity,IA 8:00am 8:15am 8:45am Laparoscopic Left Colectomy, the Next Challenge KonstantinUmanskiy,MD,Chicago,IL 9:00am 9:15am 9:45am Panel Discussion 10:15am Laparoscopic Proctectomy and TME, the Differentiator JosephCarmichael,MD,Orange,CA 10:30am Video Presentation TME SlawomirMarecik,MD,ParkRidge,IL Anastomotic Options AlanHarzman,MD,Columbus,OH Panel Discussion HALS-Role and Advantages DarrenPollock,MD,Seattle,WA 10:05am Refreshment Break in Foyer Video Presentation Medial to Lateral Right Colectomy NellMaloneyPatel,MD,NewBrunswick,NJ 8:30am 9:30am 10:45am Video Presentation Tips for the Difficult Pelvis DanielHerzig,MD,Portland,OR 11:00am Panel Discussion 11:15am Complications and Challenges EricK.Johnson,MD,FortLewis,WA Video Presentation Medial to Lateral Left Colectomy TalRaphaeli,MD,Humble,TX 11:45am Adjourn 11:45am Lunch Provided for Hands-on Lab Participants 12:30pm Bus Departs for Tufts Medical Center Video Presentation Splenic Flexure Approaches JohnGriffin,MD,SaltLakeCity,UT Continued next page 9 Return to Table of Contents Saturday, May 30 Laparoscopic Colectomy Symposium and Workshop (Continued) Hands-on Lab Session: 1:00 – 4:30 pm • Limit 20 • Fee: $595 Lunch Included for Hands-on Lab Registrants • Registration Required • No refunds after May 11 Location for Hands-on Lab: TuftsMedicalCenter Transportation will be provided 3.5 CME Existing Gaps What Is: Despitetheevidencesupportingimprovedoutcomeswiththeuseofminimallyinvasivetechniques,adoptionhas beenslow.Atleast50%ofcolectomiescontinuetobeperformedutilizingtraditionalopentechniques.Evenamong fellowshipoftrainedcolonandrectalsurgeons,mostdonotuselaparoscopyroutinelyintheirpractice.Whilesomecases requireanopenapproach,manymoredonot.Thesetechniquescannotbelearnedfromatextbook. What Should Be: Newandexperiencedcolorectalsurgeonsshouldhaveaccesstoqualityeducationalmaterialaswellas theopportunitytotakeahands-onapproachtolearningthemostup-to-dateminimallyinvasivetechniquesforcolorectal resection.Becauseofthenatureofmanyoftheproblemsencountered,expertsinseveralfieldsshouldbeableto personallypassonknowledgebuiltfromexperiencewiththeseissues.Abetterunderstandingofbasicandcomplex principleswillassistthesurgeoninprovidingqualitycare,optimizingoutcomesandensuringfuturepersonal,practice,and institutionalrevenueinacompetitivemarket. 1:00– 4:30pm(OffSite) Hands-on Session (Registration Required) Demonstratetheknowledgeyouaquiredduringthemorningsymposiumtostrengthenyourskills.Wewillbeginwith laparoscopicrightcolectomy,thenleftcolectomy,thenlowanteriorresection,handassist,andSILS. Faculty for hands-on session includes: AmirBastawrous,MD,Seattle,WA;JosephCarmichael,MD,Orange,CA;JohnGriffin,MD,SaltLakeCity,UT;AlanHarzman, MD,Columbus,OH;ImranHassan,MD,CedarRapids,IA;DanielHerzig,MD,Portland,OR;EricK.Johnson,MD,FortLewis, WA;NellMaloneyPatel,MD,NewBrunswick,NJ;SlawomirMarecik,MD,ParkRidge,IL;DarrenPollock,MD,Seattle,WA; TalRaphaeli,MD,Humble,TX;MarcSinger,MD,Chicago,IL;KonstantinUmanskiy,MD,Chicago,IL Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Discussthepotentialadvanced approachestocomplexsituationsencounteredduringlaparoscopiccolorectalresection;b)Describethe appropriateutilizationofavailablestaplingandenergytechnology;c)Reproducethebasicapproachestoright andleftcolectomy;d)Explaintipsandtricksoflaparoscopicrectalmobilizationande)Describepotential advantagestotheroboticapproachtopelvicdissection. 10 Return to Table of Contents Saturday, May 30 Optimal Management of Fecal Incontinence Symposium and Workshop 4.25 CME Didactic Session: 7:30 am – noon Didactic is open to all registrants (Complimentary) Didactic Session: 7:30 am – noon Theprevalenceoffecalincontinenceisdifficulttoestimateasitisfrequentlyunderreportedduetoembarrassment andreluctanceofpatientstodiscusssymptomswiththeirphysicians.Patientswithfecalincontinencecanbenefitfrom specializedassessmentwithultrasound,manometry,motilitytestinganddefecography. ThesurgicaltreatmentoffecalincontinenceintheUnitedStateshasbeenlimited.Sphincterrepairhasgoodshort-term results,butcontinencetendstodeteriorateovertime.Theplacementofanartificialbowelsphincterhasahighmorbidity andrevisionrate.Divertingcolostomyisgenerallyalastresort.Bothsacralnervestimulation(SNS)andtheinjectionof bulkingagentshavebeenusedformanyyearsintheurologicfield.Thesetreatmentmodalitieshaverecentlybecome recognizedinthefieldofcolorectalsurgeryforthetreatmentoffecalincontinence.Inadditiontothesenewprocedures, thereareadditionalproceduresbeinginvestigatedsuchasthepelvicslingandmagneticanalsphincter. Throughadidacticcourseandhands-onlaboratorysession,wewilladdresstheworkupandmanagementofpatientswith fecalincontinenceincludingthereviewofbothtraditionalaswellasemergingproceduresthatareusedtotreatthis condition.Thelectureportionwillbefollowedbyaworkshopthatwillallowforhands-onexperienceaswellasthe discussionofcases. Existing Gaps What Is: Anorectalandphysiologytestingplayanimportantroleintheassessmentofpatientswithanorectalandpelvic floordisorders.Theaccuracyoftheseexaminationsdependsupontheoperator’sabilitytoperformtheexamandproperly interprettheresults. Despitetheintroductionofnewtreatmentmodalitiesintothefieldofcolorectalsurgery,manycolorectalsurgeonshave notadoptedeitherprocedureintotheirpractice. What Should Be: Itisimportantthatcolorectalsurgeonsdevelophands-onexpertiseintheuseofanorectalultrasoundin ordertoeffectivelymanagepatientswithfecalincontinence. Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Explaintheinitialassessment andmanagementofpatientswithfecalincontinence;b)Demonstrateandinterpretendorectalultrasound; c)Identifywiththeinterpretationofanalmanometry;d)Describeandinterpretdefecography;e)Distinguishthe operativesetup,identificationoflandmarksandstepsforoptimalleadplacementintheperformanceofSNS; f )RecallthepostoperativemanagementofpatientswithanInterstimimplantincludingtroubleshooting difficulties;g)Recognizewhenandhowtoinjectbulkingagentsintotheanalcanal;h)Outlinetheclinical resultsofproceduresforfecalincontinence;i)Distinguishalternativestotheseprocedures. Continued next page 11 Return to Table of Contents Saturday, May 30 Optimal Management of Fecal Incontinence Symposium and Workshop (Continued) Co-Director: Anders Mellgren, MD, PhD, Chicago, IL Co-Director: Kelly Garrett, MD, New York, NY 7:30am Introductions AndersMellgren,MD,PhD,Chicago,IL KellyGarrett,MD,NewYork,NY 7:40am Initial Assessment of Patients with Fecal Incontinence JoshuaBleier,MD,Philadelphia,PA 7:50am Ultrasound Technique and Image Interpretation JohanNordenstam,MD,PhD,Chicago,IL 8:10am Normal Anorectal Ultrasound Anatomy AndreasKaiser,MD,LosAngeles,CA 8:20am Normal Pelvic Floor Ultrasound Anatomy GiulioSantoro,MD,PhD,Treviso,Italy 8:30am Ultrasound in the Assessment of Patients with Fecal Incontinence LilianaBordeianou,MD,Boston,MA 8:40am 8:50am 10:00am Injectable Bulking Agents: Clinical Results WilhelmGraf,MD,PhD,Uppsala,Sweden 10:10am Sacral Nerve Stimulation: Steps of the Procedure MargaritaMurphy,MD,Pleasant,SC 10:20am Sacral Nerve Stimulation: Postoperative Complications and Troubleshooting StevenSiegel,MD,St.Paul,MN 10:30am Sacral Nerve Stimulation: Clinical Results KlausMatzel,MD,Erlangen,Germany 10:40am Refreshment Break in Foyer 11:00am The Role of Secca in the Management of Fecal Incontinence MarianaBerho,MD,Hollywood,FL 11:20am Treat the Prolapse! The Role of Ventral Rectopexy AndreD’Hoore,MD,Leuven,Belgium Ultrasound in the Assessment of Pelvic Floor Disorders SthelaMurad-Regadas,MD,PhD,Fortaleza, Brazil 11:30am When to Consider an Artificial Bowel Sphincter ShaneMcNevin,MD,Spokane,WA 11:40am Emerging Therapies: Topas Sling Procedure and Initial Results MassaratZutshi,MD,Cleveland,OH Radiologic Evaluation of Pelvic Floor AmyThorsen,MD,Minneapolis,MN 9:00am Anorectal Manometry Technique and Interpretation SarahVogler,MD,Minneapolis,MN 9:30am Non-surgical Treatment of Fecal Incontinence KellyGarrett,MD,NewYork,NY 9:40am The Role of Overlapping Sphincteroplasty IanPaquette,MD,Cincinnati,OH 9:50am 11:50am Emerging Therapies: Magnetic Anal Sphincter and Initial Results Paul-AntoineLehur,MD,PhD,Nantes,France Noon Adjourn Noon Lunch Provided for Hands-on Lab Participants 12:30pm Bus Departs for Tufts Medical Center Injectable Bulking Agents: How I do It MitchellBernstein,MD,NewYork,NY Continued next page 12 Return to Table of Contents Saturday, May 30 Optimal Management of Fecal Incontinence Symposium and Workshop (Continued) Hands-on Lab Session: 1:00 – 4:30 pm • Limit 80 • Fee: $495 Lunch Included for Hands-on Lab Registrants • Registration Required • No refunds after May 11 Location for Hands-on Lab: TuftsMedicalCenter Transportation will be provided 3.0 CME Hands-on Training 1:00 – 2:30 pm Hands-on Sessions Groups 1-9 1:00 pm 1:15 pm 1:30 pm SNS Cadaver Model Dr.Siegel Group 1 SNS Inanimate Model Dr.Bordeianou Group 2 Manometry Dr.Graf Group 3 Ultrasound Dr.Santoro Group 4 SNS Cadaver Model Dr.Paquette SNS Inanimate Model Dr.Vogler Group 5 Manometry Dr.Bernstein Group 6 Ultrasound Dr.Murad-Regadas Group 7 SNS Cadaver Model Dr.Murphy SNS Inanimate Model Dr.McNevin Group 8 Manometry Dr.Zutshi Ultrasound Dr.Thorsen Group 9 1:45 pm Ultrasound Dr.Santoro SNS Cadaver Model Dr.Siegel SNS Inanimate Model Dr.Bordeianou Manometry Dr.Graf Ultrasound Dr.Murad-Regadas SNS Cadaver Model Dr.Paquette SNS Inanimate Model Dr.Vogler Manometry Dr.Bernstein Ultrasound Dr.Thorsen SNS Cadaver Model Dr.Murphy SNS Inanimate Model Dr.McNevin Manometry Dr.Zutshi 2:00 pm 2:15 pm SNS Inanimate Model Dr.Bordeianou Manometry Dr.Graf Ultrasound Dr.Santoro SNS Cadaver Model Dr.Siegel SNS Inanimate Model Dr.Vogler Manometry Dr.Bernstein Ultrasound Dr.Murad-Regadas SNS Cadaver Model Dr.Paquette SNS Inanimate Model Dr.McNevin Manometry Dr.Zutshi Ultrasound Dr.Thorsen SNS Cadaver Model Dr.Murphy Case Discussions Groups 10-18 2:30pm Drs.JoshuaBleier,KellyGarrett,Paul-AntoineLehur,KlausMatzel, AndersMellgren,StevenSiegel,AmyThorsen,StevenWexner Break Continued next page 13 Return to Table of Contents Saturday, May 30 Optimal Management of Fecal Incontinence Symposium and Workshop (Continued) Hands-on Training 3:00 – 4:30 pm Hands-on Sessions Groups 10-18 3:00 pm SNS Inanimate Model Dr.Bordeianou Manometry Dr.Graf Group 12 Ultrasound Dr.Santoro Group 13 SNS Cadaver Model Dr.Paquette Group 14 SNS Inanimate Model Dr.Vogler Manometry Dr.Bernstein Group 15 Ultrasound Dr.Murad-Regadas Group 16 SNS Cadaver Model Dr.Murphy Group 17 3:30 pm SNS Cadaver Model Dr.Siegel Group 10 Group 11 3:15 pm SNS Inanimate Model Dr.McNevin Manometry Dr.Zutshi Ultrasound Dr.Thorsen Group 18 3:45 pm Ultrasound Dr.Santoro SNS Cadaver Model Dr.Siegel SNS Inanimate Model Dr.Bordeianou Manometry Dr.Graf Ultrasound Dr.Murad-Regadas SNS Cadaver Model Dr.Paquette SNS Inanimate Model Dr.Vogler Manometry Dr.Bernstein Ultrasound Dr.Thorsen SNS Cadaver Model Dr.Murphy SNS Inanimate Model Dr.McNevin Manometry Dr.Zutshi 4:00 pm 4:15 pm SNS Inanimate Model Dr.Bordeianou Manometry Dr.Graf Ultrasound Dr.Santoro SNS Cadaver Model Dr.Siegel SNS Inanimate Model Dr.Vogler Manometry Dr.Bernstein Ultrasound Dr.Murad-Regadas SNS Cadaver Model Dr.Paquette SNS Inanimate Model Dr.McNevin Manometry Dr.Zutshi Ultrasound Dr.Thorsen SNS Cadaver Model Dr.Murphy Case Discussions Groups 1-9 4:30pm Drs.JoshuaBleier,KellyGarrett,Paul-AntoineLehur,KlausMatzel, AndersMellgren,StevenSiegel,AmyThorsen,StevenWexner Adjourn 14 Return to Table of Contents Saturday, May 30 Robotic Colon and Rectal Surgery: Tips, Tricks, and Simulation Symposium and Workshop 4.0 CME Didactic Session 8:00 am – noon or 12:30 – 4:30 pm Didactic is open to all meeting registrants (complimentary). Hands-on Lab Session: 8:00 am – noon or 12:30 – 4:30 pm • Limit 36 • Fee: $495 Lunch Included for Hands-on Lab Registrants • Registration Required • No refunds after May 11 4.0 CME Roboticcolonandrectalsurgeryhasslowlygainedinterestandtractionamongthemembership.Newinstruments, technology,andtechniquesareconstantlybeingaddedtothefield.Acombinationofvideoandlectureshighlightingthe newtechniquesandinstrumentswillprovideanopportunityforsurgeonstolearnabouttheadvancesinthefield. Existing Gaps What Is: Roboticsurgeryhasslowlygainedacceptanceforuseinrectalcancerandinpelvicsurgery,butmanycolonand rectalsurgeonshavenotadoptedroboticsintotheirpractices. What Should Be: Studieshavedemonstratedtheeffectivenessoftheuseofsimulationcombinedwithvideosandlectures tofacilitateadoptionofaneworadvancedtechnique.Thespeakerswillattempttobridgetheknowledgegapassociated withtheimplementation,use,andoutcomesofroboticstoeducatecolonandrectalsurgeonsonhowbesttouseand adoptroboticsintotheirpractice. Co-Director: Vincent Obias, MD, Washington, DC Co-Director: Elizabeth Raskin, MD, St. Paul, MN Lab Assistants: Jamie Cannon, MD, Birmingham, AL; Joseph Martz, MD, New York, NY and Nell Maloney Patel, MD, New Brunswick, NJ Group A Group B 8:00am– noonDidactic Lectures (complimentary) 8:00am– noonHands-on with Robotic Simulators 12:30– 4:30pmHands-on with Robotic Simulators 12:30– 4:30pmDidactic Lectures (complimentary) Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Describethebasictechniquesof roboticportplacementanddocking;b)Definetheanatomyofthecolon,itsvasculatureandretroperitoneum fromaroboticperspective;c)Explainthesequenceofstepsnecessarytoperformroboticproceduressafely;and d)Identifywhatnewtechnologythereisconcerningrobotics,andhowitcanhelptheirpatients. Continued next page 15 Return to Table of Contents Saturday, May 30 Robotic Colon and Rectal Surgery: Tips, Tricks, and Simulation Symposium and Workshop (Continued) Group A – Didactic Group B – Hands-on with Simulators 8:00 am – noon 8:00am Robotic Surgery – Starting Up: Academic and Private View JeffreyS.Cohen,MD,Marietta,GA 8:25am Tips in Docking the Robot and How to do Safe Robotic Surgery DeborahNagle,MD,Boston,MA 8:50am Robotic Low Anterior Resection JohnMarks,MD,Wynnewood,PA 9:15am Robotic Abdominoperineal Resection GeorgeChang,MD,Houston,TX 9:40am Panel Discussion 8:00 am – noon Noon – Complimentary Lunch Group B – Didactic 12:30 – 4:30 pm 12:30pm Robotic Surgery-Starting Up: Academic and Private View JeffreyS.Cohen,MD,Marietta,GA 12:55pm Tips in Docking the Robot and How to do Safe Robotic Surgery DeborahNagle,MD,Boston,MA 10:05am Refreshment Break in Foyer 10:15am Robotic Surgery for Pelvic Floor Diseases I.EmreGorgun,MD,Cleveland,OH 1:20pm 10:30am Robotic Multiport Right Hemicolectomy with Intracorporeal Anastamosis RobertCleary,MD,AnnArbor,MI Robotic Low Anterior Resection JohnMarks,MD,Wynnewood,PA 1:50pm Robotic Abdominoperineal Resection GeorgeChang,MD,Houston,TX 10:55am Novel New Techniques in Robotics – Single Incision, Parastomal Hernia Repair, J pouch, Transanal Surgery JorgeLagares-Garcia,MD,Charleston,SC 2:10pm Panel Discussion 2:20pm Refreshment Break in Foyer 2:30pm 11:20am Robotic New Instruments: Firefly, Stapler, Vessel Sealer, and Xi EduardoParra-Davila,MD,Celebration,FL Robotic Surgery for Pelvic Floor Diseases I.EmreGorgun,MD,Cleveland,OH 2:55pm Robotic Multiport Right Hemicolectomy with Intracorporeal Anastamosis RobertCleary,MD,AnnArbor,MI 3:20pm Novel New Techniques in Robotics – Single Incision, Parastomal Hernia Repair, J pouch, Transanal Surgery JorgeLagares-Garcia,MD,Charleston,SC Group A – Hands-on with Simulators 3:45pm Robotic New Instruments: Firefly, Stapler, Vessel Sealer, and Xi EduardoParra-Davila,MD,Celebration,FL Noon – Complimentary Lunch 12:30 – 4:30 pm 4:10pm Panel Discussion 4:30pm Adjourn 11:45am Panel Discussion 16 Return to Table of Contents Saturday, May 30 Symposium Advanced Endoscopy and Endoluminal Surgery 12:30 – 4:00 pm Therehasbeensignificantexpansionofnewtechniquesandinstrumentationsforadvancementofendoscopic procedures.Thesetechniquesbroadenourabilitytoperformmorecomplexproceduresinmuchlessinvasiveways. Ascolorectalsurgeons,weareuniquelypositionedtoadoptthesetechniquesandtoleadinthisfield. 3.5 CME Anumberofnew,advancedendoscopictechniqueshavebeendevelopedoverthepastfewyears.Thesetechniqueshave notonlybroadenedtheabilityoftheendoscopisttosuccessfullyscopeallpatientsbuttheyalsoallowidentificationand treatmentofcolonicpathologiessuchaspolyps,cancer,andinflammatoryboweldisease.Newendoscopictechniqueshave resultedinhighercecalintubationratesandlesionidentification.Enhancedimagingtechnologyincreasespolypdetection. Endoscopicclippingcancontrolbleedingandtreatcolonicperforation.Colonicstentingisanon-operativemeansof treatingcolonicobstructionandcanconvertatwo-stageoperationintoaone-stageprocedure.Extendedsubmucosal dissectionandtheuseofbothCO2andlaparoscopicassistancehaveallowedsurgeonstoresectmorecomplexcolonic lesionswithoutmajorsurgery. Existing Gaps What Is: Colorectalsurgeonsmaybeunfamiliarwithseveralnewtechniquestoimprovethesuccessrateofcolonoscopyas wellasimagingtechniquesforlesionidentification.Asignificantnumberofsurgeonsarenotperformingendoscopic submucosalresectionofcolorectalneoplasiaorcombinedlaparo-endoscopicresection.Withthecontinuedadvancesof technologyinendoluminaltherapy,surgeonswillneedtrainingtoincorporatethesemethodsintotheirpractice. What Should Be: Surgeonsneedtohaveacomprehensiveunderstandingofthenewervisualizationtechniquesaswellas theindicationsandusesforendoscopicsubmucosalresection,colonicstenting,andendoscopicclipping.Thisimportant learningsessionwillprovidethebasisforthemeaningfulimplementationofthesenewerendoluminaltechniquesand improvetheirpatients’colorectalcare. Co-Director: Peter Marcello, MD, Burlington, MA Co-Director: Sang Lee, MD, New York, NY 12:30pm Introductions PeterMarcello,MD,Burlington,MA SangLee,MD,NewYork,NY 1:10pm Endoscopic Submucosal Dissection: Another Perspective I.EmreGorgun,MD,Cleveland,OH 12:35pm Difficult Colonoscopy: Tricks and New Techniques for Getting to the Cecum DanielFeingold,MD,NewYork,NY 1:25pm The Future of ESD and Full Thickness Endoluminal Resection with Closure SergeyKantsevoy,MD,Baltimore,MD 12:45pm Advanced Endoscopic Imaging: Polyps and Dysplasia Detection DavidRivadeneira,MD,Woodbury,NY 1:50pm Panel Discussion/Questions 2:10pm Combine Endoscopic Laparoscopic Surgery (CELS) SangLee,MD,NewYork,NY 12:55pm Beyond Polypectomy: EMR and ESD RichardWhelan,MD,NewYork,NY Continued next page 17 Return to Table of Contents Saturday, May 30 Advanced Endoscopy and Endoluminal Surgery (Continued) 2:25pm Technical Tips for Endoluminal Stenting MaherAbbas,MD,AbuDhabi,United ArabEmirates 3:25pm Future Endoscopic Tool Box: New Tools, Changing Paradigms? JeffreyMilsom,MD,NewYork,NY 2:40pm Colonic Stenting JeffreyMarks,MD,Cleveland,OH 3:40pm Panel Discussion/Questions 4:00pm Adjourn 2:55pm Endoluminal Management of Anastomotic Complications GovindNandakumar,MD,NewYork,NY 3:10pm Other Advanced Endoluminal Procedures and Innovations: A Gastroenterologist Perspective ChristopherThompson,MD,Boston,MA Photo Credit: Greater Boston Convention & Visitors Bureau Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Demonstratemethodsto improvececalintubationratesandlesiondetection;b)Statetheavailableenhancedendoscopicvisualization techniques;c)Recognizetheindicationsandusesforendoscopicsubmucosalresectionforcolorectalneoplasia; d)Recognizetheindicationsandtechnicalaspectsofcombinedlaparoscopicandendoscopicresectionof colorectalneoplasia;e)Outlinetheindicationandutilityofcolonicstentplacementandf )Recallallavailable techniquesforendoscopicclosureofbowelwall. Hynes Convention Center 18 Return to Table of Contents Saturday, May 30 Question Writing Workshop: How to Write Exam Questions 2.75 CME 12:30 – 3:30 pm Limit 70 • Registration Required Therearemultipleareasofexaminationintherealmofcolonandrectalsurgerythatrequirewrittenquestionsto assessknowledge.Theseincludethecertifyingwrittenexam,therecertificationexam,CARSITE,andCARSEPamongothers. Despitelookingstraightforward,itisextremelydifficulttowriteagoodexamquestion.Manyconceptsarecontroversial andwhatisnotcontroversialcanbecometrivial.Therearebasicguidelinesthathelpthewriterandthisisaskillthatcanbe learnedandimprovewithpractice.Inrecentyearsemphasishasbeenplacedonhowtowriteanacceptableexamquestion andguidelineshavebeenpublishedbyorganizationssuchastheNationalBoardofMedicalExaminers. Existing Gaps What Is: Mostprofessionalssuchascolonandrectalsurgeonsfeelthatitiseasytowritehighqualityquestions.However themajorityofquestionsthataresubmittedforrevieweachyeararerejectedorhavefundamentalflawsthatrequire significantrevisionsbeforetheycanbeacceptedforuse. What Should Be: Thereshouldbemanyinterestedmembersthatareabletowritehighqualityquestionsthatcanbeused withminimaltonorevisions. Director: Tracy Hull, MD, Cleveland, OH 12:30pm Introduction TracyHull,MD,Cleveland,OH 1:45pm Fundamental Problems with Questions MarcusBurnstein,MD,Toronto,ON,Canada 12:45pm What Is a Key Concept? NajjiaMahmoud,MD,Philadelphia,PA 2:05pm Refreshment Break in Foyer 2:15pm Let's Write Questions 3:00pm Questions Review 3:15pm Conclusion 3:30pm Adjourn 1:05pm Formatting the Stem: Tips ShaneMcNevin,MD,Spokane,WA 1:25pm Formatting the Answers: Avoiding Common Errors GlennAult,MD,LosAngeles,CA Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Identifyfundamentalproblems withconstructionofwrittenquestions;b)Explainthesequentialthinkingprocessusedtowriteanacceptable questionandunderstandkeyconcepts;c)Demonstratehowtowriteastemforaquestion;d)Prepareatwostepquestionthatcombinesdiagnosisandmanagementandformattheanswersinanacceptableform;and e)Recallwhathappenstoaquestionafteritissubmittedbyawriterbeforeitisusedinatest. 19 Return to Table of Contents Saturday, May 30 Symposium Improving Outcomes-Identifying and Managing the Complex Surgical Patients 1.5 CME 4:00 – 5:30 pm Inthissymposium,bymakinguseofevidence-basedrecommendations,eachlecturewillincludenotonly diagnosticandtherapeuticguidelines,butwillalsoprovideanarrativebythepresenter(whereappropriate)on his/heroperativetechnicaldetailsandperioperative“tipsandtricks”thattheyutilizeinthemanagementofthesecomplex surgicalchallenges.Inothercases,theywilllendtheirpersonalinsightintosituationswheredatamaybemoresparse,but individualandcollectiveexperienceisparamounttomakingsounddecisionsandtherebyoptimizingpatientoutcomes. Furthermore,wewillfocusontheinitialassessmentofriskandinterventionmethodsutilizedtominimizeperioperative complications.Thepresenterswillfocusonexpandingtheaudience’sunderstandingofthedetailsthatmakethese situationschallenging,whileofferingevidenceandexperience-basedsolutionsforsurgeonsofalllevelstobettercarefor thesecomplexpatients.Theunderlyingfocuswillbeonprovidingpragmaticandunderstandablesolutionsthatcanbe readilyimplementedbysurgeonsofvaryingexperiencetosuccessfullytreatcomplexcolorectalproblems. Thismultidisciplinarysymposiumwillserveasacomprehensivediscussionofthetopicslistedabovewithemphasisonthe pathologicassessment,surgicaltechnique,adjuvanttherapy,andgenetictestingtoimproveoutcomes. Existing Gaps What Is: Surgeonsarefacedwithcomplexdecisionsindeterminingtheoptimalcareforpatientswithdifficultcolorectal surgerydisease.Multipleoptionsexistregardingtheassessment,optimization,surgicaltreatment,andpost-operative managementofthesepatients,whilelessisunderstoodaboutwhattheidealmethodis. What Should Be: Thissymposiumwillbeusefultocolorectal,generalandoncologicsurgeonswhoareincreasinglycalled upontocareforpatientswithcomplexcolorectaldiseases.Furthermore,thissymposiumwillbeofparticularinteresttothe surgeons-in-training,andthegeneralandcolorectalsurgeonwhoisoftencalledupontomanageavarietyofcomplications anddilemmasthatmaybeoutsideofhisorherspecialtyornichewithincolorectalsurgery. Director: Scott Steele, MD, Fort Lewis, WA Assistant Director: Sean Langenfeld, MD, Omaha, NE 4:00pm Introduction ScottSteele,MD,FortLewis,WA 4:03pm 4:15pm 4:27pm 4:39pm Perioperative Risk Assessment: Who, What, When and Why? W.DonaldBuie,MD,Calgary,AB,Canada Functional Problems After Colorectal Surgery: When the Surgery Goes “Great” but Problems Arise: Now What? LilianaBordeianou,MD,Boston,MA 4:51pm The Body’s Response to Surgical Stress: What Every Clinician Should Know AnjaliKumar,MD,Washington,DC Enhanced Recovery Pathways: Beyond the Basics ConorDelaney,MD,PhD,Cleveland,OH 5:03pm Cases/Panel Discussion 5:30pm Adjourn Intra-operative Nightmares: The Intraoperative Consult When Things Go Wrong BradleyDavis,MD,Cincinnati,OH Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Discusstheidealpreoperative riskassessmentandhowtoidentifyhigh-riskpatients,optimizepatientsandmaximizeoutcomes;b)Describe theimportanceofthebody’sresponsetosurgicalstressandhowtominimizethenegativeaspectsofthis naturalphenomenon;c)Describethemultimodalandsurgicalapproachtotechnicalfailuresandchallenging situationsthatariseintra-operativelyandmethodstominimizesecondarycomplications;d)Discussoptionsfor patientswithfunctionalproblemsfollowingcolorectalsurgeryinthepresenceandabsenceofcomplications; ande)Identifythecomponentsandimportanceofenhancedrecoverypathwaysandhowtheoutcomesextend beyondthebenefitsofindividualelementtothecollectivecareplan. 20 Return to Table of Contents Sunday, May 31 Core Subject Update 2.25 CME 7:15 – 9:30 am TheCoreSubjectUpdateisacontinuingmedicaleducationactivitywhichwasdevelopedtoassistinthe educationandrecertificationofcolonandrectalsurgeons.Twenty-fourcoresubjectshavebeenchosenandare presentedinafour-yearrotatingcycle.Presentersareexpertsontheirselectedtopicsandpresentevidence-basedreviews onthecurrentdiagnosis,treatmentandcontroversiesofthesediseases.Followingeach20-minutepresentation,abrief questionperiodismoderatedbythecoursedirector.AwrittensummaryofeachtalkisavailableontheASCRSwebsite,and questionsdevelopedfromeachpresentationareincludedintheAmericanBoardofColonandRectalSurgery’s recertificationquestionbank. Director: Justin Maykel, MD, Worcester, MA 7:15am Anatomy/Physiology/Complications ToddFrancone,MD,Burlington,MA 8:21am Crohn’s Disease KarimAlavi,MD,Worcester,MA 7:32am Discussion 8:38am Discussion 7:37am STD’s CindyKin,MD,Stanford,CA 8:43am Endoscopy/Polyps DonaldKim,MD,GrandRapids,MI 7:54am Discussion 9:00am Discussion 7:59am Constipation AmyThorsen,MD,Minneapolis,MN 9:05am Advanced Colon and Rectal Cancer GregoryKennedy,MD,PhD,Madison,WI 8:16am Discussion 9:22am Discussion 9:30am Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeabletoa)Recognizethecomplications commonlyassociatedwithcolorectalsurgicalproceduresandunderstandthemethodsofpreventionand treatment;b)Describethecommonsexuallytransmitteddiseasesoftheanorectumandbeabletoprovide comprehensivetreatmentplans;c)Explainthedifferenttypesofconstipationaswellastheevaluationprocessand medicalandsurgicaltreatmentoptions;d)DemonstrateanunderstandingofCrohn’sdiseaseincludingthe presentation,medicalmanagementandsurgicaloptionsforsmallintestine,colon,rectal,andanalinvolvement;e) Recognizetheindicationsforendoscopicevaluationofthecolonaswellasendoscopicoptionsforlesiondiagnosis andtreatment;andf )Describethepresentation,evaluation,surgicaltreatmentandoncologicmanagementof advancedcolonandrectalcancer. 21 Return to Table of Contents Sunday, May 31 Symposium Healthcare Economics in the ACA Era 8:00 – 9:45 am TheAffordableCareandAccountabilityActof2012(ACA)setinmotionchangestotheAmericanHealthcare system,thelikesofwhichhaveneverbeenseenbeforeintheUnitedStates. 1.75 CME Thesechangesaresignificantlyalteringthewaymedicineisdeliveredbyproviders,includinghospitalsandindividual physicians.WhiletheprimarythrustofthelegislationwastoincreaseaccesstohealthcareformillionsofAmericans, implementationoftheACAhasusheredinavarietyofothermeasuresthataredramaticallychanginghowmedicineis practiced. Existing Gaps What Is: TheAffordableCareActandcriticalelementsthatarerelatedtoitincludingvalue-basedpurchasing,ICD-10,valuebasedcareandtheAcountableCareorganization,meaningfuluse,andthetwomidnightrule. What Should Be: Surgeonsneedtohaveanunderstandingaboutkeyenvironmentalchangesimpactingtheirpractice. UnderstandingtheACAandcriticalinitiativesthatarecreatingsignificantchangeinthehealthcareenvironmentwillhelp tomakethemmuchmoresuccessful. Director: James Merlino, MD, Chicago, IL Assistant Director: David O’Brien, MD, Portland, OR 8:00am Affordable Care Act Overview; What it Means for Individual Physicians AnthonySenagore,MD,Parma,OH 8:10am The ACA Impact on Individual Physicians; How Can We Cope StephenSentovich,MD,Duarte,CA 8:20am 8:30am Moving from Volume to Value; How We will be Paid Differently FrankOpelka,MD,NewOrleans,LA 8:40am ICD-10; Delayed, but Not Forgotten DavidMaron,MD,Weston,FL 8:50am New Models of Care Delivery JeffreyL.Cohen,MD,Hartford,CT 9:00am Update on the Two Midnight Rule W.BrianPerry,MD,SanAntonio,TX 9:20am Discussion 9:45am Adjourn Meaningful Use and its Impact on the Physician Practice GuyOrangio,MD,NewOrleans,LA Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Discusstheimpactofthe AffordableCareActonproviders;b)Describeandunderstandtheimportanceofvalue-based-caredelivery; c)Recallhowcriticalelementsoftheaffordablecareactrelatetophysicianpractice;d)Describeandunderstand updatesonvalue-basedpurchasing,meaningfuluse,ICD-10,andthetwo-midnightrule. 22 Return to Table of Contents Sunday, May 31 Symposium Quality Initiatives in Clinical Practice 2.0 CME 9:00 – 11:00 am Qualityimprovementisintegraltoclinicalpractice.Ongoingeffortstoimprovethequalityofsurgicalcarehave hadasignificantandpositiveimpactonpatientoutcomes.WhileparticipationinnationalinitiativessuchasSCIPand NSQIPisimportant,itiscrucialthatweactivelyusedatatochangequalityofcarewithinourowninstitutionsandpractices. Existing Gaps What Is: Althoughsurgeonsareawareofnationalqualityinitiatives,fewhavethetoolstoimplementqualityinitiatives withintheirowninstitution. What Should Be: Surgeonsshouldunderstandthequalityimprovementprocess,beabletoimplementqualityinitiatives andaccessdatatoevaluateeffectiveness. Co-Director: Arden Morris, MD, Ann Arbor, MI Co-Director: Larissa Temple, MD, New York, NY 9:00am Building the Systems and Culture of Prevention ElizabethWick,MD,Baltimore,MD 9:10am Six Sigma, Lean, Rapid Results: What Do They All Mean? NancyBaxter,MD,PhD,Toronto,ON,Canada 9:20am Steps to a Successful Quality Improvement Project RobertCima,MD,Rochester,NY 9:40am Measuring Success of Quality Improvement GenevieveMelton-Meaux,MD,Minneapolis,MN 9:50am Leveraging IT to Improve Outcomes AllisonMcCoy,PhD,NewOrleans,LA 10:00am Improving Outcomes: Decreasing Readmission DeborahNagle,MD,Boston,MA 10:08am Improving Outcomes: Decreasing Length of Stay JulieThacker,MD,Durham,NC 10:16am Improving Processes: Leveraging the Electronic Medical Record StefanHolubar,MD,Lebanon,NH 10:25am Panel Discussion 11:00am Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeabletounderstand:a)Identifythe principalsofacultureofsafetyandqualityimprovement;b)Recognizemethodsusedtodevelopquality improvementinitiatives;c)Describethepracticalstepstoimplementingandmaintainingaquality improvementproject;d)Definehowtoevaluatethesuccessofaqualityimprovementinitiative. 23 Return to Table of Contents Sunday, May 31 Symposium Laparoscopic Nuts & Bolts and Robotic Rivets 9:30 – 11:45 am Laparoscopicandroboticsurgicaltechniquesareanintegralpartofmoderncolorectalsurgicalpractice. 2.25 CME Theeducationofsurgeonsinthesetechniquesoccursinavarietyofsettingsincludingfellowshiptraining,industrysponsoredtrainingprograms,andprofessionalsocietycontinuingmedicaleducationprograms.Inthissymposium,stateof theartlaparoscopicandroboticapproachestocommoncolorectalconditionsarepresentedbyexpertsinthefield.The educationalformatwillbeshortvideosfollowedbyquestionandanswersessions.Theaimofthissymposiumistoexpand theknowledgebaseofsocietymembersandguestsintheareasoflaparoscopicandroboticcolorectalsurgery. Existing Gaps What Is: Laparoscopicandroboticcolorectalsurgicaltechniquesaredevelopingatarapidpace.Continuingmedical educationforsurgeonsinpracticetolearnthesetechniquesarelimited. What Should Be: Periodiceducationalprogramsthatallowpracticingsurgeonstolearnbasicandadvancedlaparoscopic androboticcolorectalsurgicaltechniques. Director: Mark Whiteford, MD, Portland, OR Assistant Director: Jon Vogel, MD, Aurora, CO 9:35am Lap Right Colectomy: Complete Mesocolic Excision HermannKessler,MD,PhD,Cleveland,OH 10:20am Splenic Flexure: The Inside Passage, IMV Gateway to the Lesser Sac ArmandoMelani,MD,Barretos,Brazil 9:40am Single Incision Colectomy: Steps to Success for the Right and Transverse Colon JamieMurphy,MD,London,UnitedKingdom 10:25am Splenic Flexure: Give Me a Hand (HALS) KellyGarrett,MD,NewYork,NY 9:45am Taking Control: Clip, Seal, or Staple the Large Vessels? KarinHardiman,MD,PhD,AnnArbor,MI 10:30am Splenic Flexure: A Robot in Your Corner MeaganCostedio,MD,Cleveland,OH 10:35am TME: A Hand for the Holy Planes (HALS) MatthewMutch,MD,St.Louis,MO 9:50am Laparoscopic Ileocolic Resection for Crohn’s Disease: What to Do When It’s Really Stuck SanghyunKim,MD,NewYork,NY 10:40am TME: Mr. Roboto DavidEtzioni,MD,Phoenix,AZ 9:55am Laparoscopic Hartmann’s Reversal ArmenAboulian,MD,Cleveland,OH 10:45am TME: Laparoscopic Cylindrical APR. Nothing to Waist Yi-QianNancyYou,MD,Houston,TX 10:00am Laparoscopic Parastomal Hernia Repair ScottSteele,MD,FortLewis,WA 10:50am Panel Discussion 10:05am Panel Discussion Continued next page 24 Return to Table of Contents Sunday, May 31 Laparoscopic Nuts & Bolts and Robotic Rivets (Continued) 11:00am Laparoscopic IPAA: Making the Pouch Reach Every Time DavidLarson,MD,Rochester,MN 11:15am Robotic Mishaps: Getting Into and Out of Trouble AlessioPigazzi,MD,PhD,Orange,CA 11:05am Laparoscopic Stapling of the Low Rectum: Maximizing the Odds of Using a Minimum of Staple Loads DavidMaron,MD,Weston,FL 11:20am Laparoscopic Rectopexy: Anterior or Posterior Approach? ChristopherCunningham,MBChB,Oxford, UnitedKingdom 11:10am Laparoscopic Colorectal Anastomosis: There’s an Air-Leak. Now What? JasonHall,MD,Burlington,MA 11:25am Panel Discussion 11:45am Adjourn Photo Credit: Greater Boston Convention & Visitors Bureau Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Performbasicandadvanced laparoscopicandroboticcolorectalsurgicaltechniqueswhileavoidingsurgicalcomplications;b)Identify complicationsthatcanoccurwhilerecognizingvariousapproachestocommonandextraordinarysurgical problems;c)Describetotheirpatientstheprosandconsoflaparoscopicandrobotictechniques. The USS Constitution was nicknamed "Old Ironsides," after the War of 1812, when shots from the British appeared to bounce off her thick oak hull as if it were made from iron. 25 Return to Table of Contents Sunday, May 31 Symposium Complications: Prevention and Management 2.0 CME 9:45 – 11:45 am Complicationpreventionandmanagementguideseveryaspectofourtreatmentparadigms.Althoughthe preoperativeassessmentisabroad,moreglobalpatientevaluation,itiscomprisedofmanydatapoints,including thepathology,aspectsoftheparticularplannedprocedure,thecurrentandpasthealthissuesofthepatientand postoperativecare.Thechallengetothesurgeonistotakethisdetailedevaluationanduseittooptimizeoperative outcomeswhileminimizingperioperativeandpostoperativemorbidity.Theincreasingcomplexityofourpatient’smedical andsurgicalissuesandtheexpectationforperfectoutcomesmakesmanagementevermoredaunting.Furthermore,the increasingoversightofsurgicaloutcomes,individualandinstitutionalcosts,andpatientsatisfactionmaketheprevention andmanagementofsurgicalcomplicationscrucialtothesuccessfulpracticeofsurgeryinthecurrentera. Existing Gaps What Is: Theincreasinglycomplexnatureofpatientcareandthelackofevidencedbasedtreatmentalgorithmsfor complicationsincolonandrectalsurgerymakemanagementofthevariedcomplicationschallenging. What Should Be: Treatmentalgorithmsforcolorectalsurgicalcomplicationsshouldbeevidenceandconsensusbasedto allowformanagementthatoptimizesoutcomes,limitscostsandimprovespatientsatisfaction. Co-Director: John Eggenberger, MD, Ypsilanti, MI Co-Director: Harry Reynolds, MD, Cleveland, OH 9:45am 9:57am Locally Advanced and Recurrent Rectal Cancers: Avoiding and Treating Complications in the Difficult Pelvis PhilipPaty,MD,NewYork,NY 10:45am Global Surgery Challenges in 2015 RudolphRustin,MD,Mt.Pleasant,SC 10:57am How Do We Prevent Perioperative Anastomotic Complications: Surgical Technique and/or Manipulation of the Microbiome? JohnAlverdy,MD,Chicago,IL The Problematic Low Rectal Anastomosis: Dealing with Stacking, Stenosis, Bleeding and Disruption KirkLudwig,MD,Milwaukee,WI 11:09am Optimization of Patient Satisfaction Despite Adversity: Complication Prevention and Management in the Era of Surgical Outcome Tracking JamesMerlino,MD,Chicago,IL 10:09am Management of the Stenotic, Bleeding, Leaking or Fistulizing Colonic Anastomosis MichaelMcGee,MD,Chicago,IL 10:21am Understanding Perioperative Anticoagulation with Emphasis on Novel Anticoagulants, Antiplatlet Agents, Drug Eluting Stents, and DVT TeresaCarman,MD,Cleveland,OH 11:22am Panel Discussion 11:45am Adjourn 10:33am C. Dificile Colitis: Resect, Divert, Antibiotics, or Transplant? MarkManwaring,MD,Greenville,NC Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Definestrategiestoavoidandmanage complicationsarisingduringresectionsoflocallyadvancedorrecurrentrectalcancers;b)Describestrategiestoavoidand treatcomplicationsofcoloanalanastomoses,includingstenosis,bleeding,anddisruptionwithpresacralabscessandchronic fistula;c)Discussmanagementstrategyinthepatientwithileocolic,colocolic,orcolorectalanastomoticbleeding,leak, obstructionandfistula;d)Manageandlimitcomplicationsintheurgentoperationofpatientsonnovelanticoagulation agents,antiplateletagentsanddrugelutingstents;e)Explainhowgutbacteriaandsubsequenthostpathogeninteractions mayinfluenceanastomotichealing;f )Describeoptimalpreventionandmanagementofparastomalandventralherniasin thecolorectalsurgicalpatient;g)Establishmedicalandsurgicaltreatmentalgorithmsforthemanagementofdifficile infection;andh)Developstrategiesofcomplicationpreventionandmanagementthatoptimizepatientoutcomes, expectationsandthe“patientexperience”inanerainwhich,increasingly,surgeonsarebeingmeasuredandcomparedwith theirpeersbyhospitals,thirdpartypayersandgovernmentalagencies. 26 Return to Table of Contents Sunday, May 31 Luncheon Symposium Parallel Session 1-A Current Advances in the Management of Fecal Incontinence 1.5 CME 11:45 am – 1:15 pm Controloffecalmaterialisacomplexprocessthatinvolvescoordinatedinteractionofthecolon,rectum,and anus.Also,therearemanyaspectsoffecalincontinencewhichincludevariousdegreesofcontrolforgas,liquid,and solidmaterial.Thisisfurthercomplicatedwhenthereisassociatedurgency.Campaignsdesignedtomakepatientsand caregiversawareofthedebilityassociatedwithfecalincontinencehaveledtomorepatientsseekinghelp.Manytimes patientshavesearchedtheinternetandcomewithmanyquestionsthatcaregiversmaynotbeabletoaddress. Existing Gaps What Is: Therearemanytreatmentsavailableandunclearrecommendationswhenatreatmentshouldbeconsideredfor apatient. What Should Be: Caregiversshouldbeawareofallcurrenttreatmentoptionsandwhatisprojectedtobeavailableinthe future.Theyalsoshouldbeabletoindividualizetreatmenttomeettheneedsandsymptomsofthespecificpatient. Director: Tracy L. Hull, MD, Cleveland, OH Assistant Director: Liliana Bordeianou, MD, Boston, MA 11:45am How Do We Assess Fecal Incontinence to Individualize Treatment Plans? IanPaquette,MD,Cincinnati,OH 12:25pm What are the Options when the Primary Surgical Options Fail (an Algorithm for Choices) AlexKy,MD,NewYork,NY 11:55am What About Sphincter Repair, Radiofrequency, and the Artificial Bowel Sphincter? AndersMellgren,MD,PhD,Chicago,IL 12:35pm Are Stem Cells Going to be Available Soon? MassaratZutshi,MD,Cleveland,OH 12:10pm What are the Newest Treatments (Injectables and Sacral Nerve Stimulation)? KlausMatzel,MD,Erlangen,Germany 12:45pm Panel and Case Presentations 1:15pm Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Nameacceptabletreatmentsfor fecalincontinence;b)Recallwhereinjectabletherapyandsacralnervestimulationfitintothetreatment options;c)Prepareanacceptablealgorithmfortreatmentoptionsforfecalincontinencewhentheprimary optionfails;d)Describethelimitationsofmultipletreatmentsandalternativetherapiesand;e)Definethe developmentofstemcellsforfecalincontinencetreatment 27 Return to Table of Contents Sunday, May 31 Luncheon Symposium Parallel Session 1-B The Genetics of Colorectal Cancer and Cancer Related Syndromes 1.5 CME 11:45 am – 1:15 pm Centraltoourunderstandingofcolorectalcancerbiologyarethecellulargeneticalterationsthatleadtothe developmentofcancer,whetherthesearerelatedtoahereditaryoracquiredgenemutation.Roughlyonethirdof colorectalcancershavesomehereditarycomponent,andapproximately10%arerelatedtoahereditarycolorectalcancer syndromesuchasnon-polyposis(Lynchsyndromeandhereditarynonpolyposiscolorectalcancer(HNPCC))orpolyposis syndromes(adenomatouspolyposes(likeFAPandMYH-associatedpolyposis),hamartomatouspolyposes,andserrated polyposis).Multiplestrategieshaveemergedtohelpidentifythesehereditarysyndromesthroughscreeningandother methods.Oncethediagnosisismade,timingandextentofsurgicaltreatmentaswellasthesubsequentsurveillanceofthe patientandtheirfamiliesisdependentonanunderstandingoftheimplicationsoftheoutcomesofgenetictesting.Itis essentialthattheASCRSmembershipbeup-to-dateregardingthegeneticsofcolorectalcancer,themeanstodiagnosethe mostcommonhereditarycancersyndromes,theapplicationofgeneticknowledgetopatientcare,andthelatestsurgical andsurveillancestrategiesforthemostcommonsyndromes. Existing Gaps What Is: Intheirroutinedailypractice,cliniciansdonotoftenappreciatetherelevanceofunderstandingcancergenetics anditsimpactoncancerdevelopment,andthuspatientsandfamilieswithhereditarycancersyndromesfrequentlygo unrecognized.Asaresult,thesepatientsandtheirfamiliesarenotdiagnosedandthereforedonotreceiveappropriate treatment,surveillance,and/orgeneticcounseling. What Should Be: Patientswithhereditarycancersyndromesarereadilyidentifiedandofferedappropriatecounselingand medicalandsurgicaltherapy.Surgicalstrategiesshouldalsoincludeunderstandingoftheappropriatetimingandextentof resectionaswellasappropriatepost-operativesurveillance. Director: Paul Wise, MD, St. Louis, MO Assistant Director: Matthew Kalady, MD, Cleveland, OH 11:45am Introduction PaulWise,St.Louis,MO 12:20pm Lynch Syndrome/HNPCC: When to Operate, How Much to Take, and Why MollyCone,MD,Nashville,TN 11:50am Colorectal Cancer Genetics: Making Sense of the Alphabet Soup JamesChurch,MD,Cleveland,OH Noon 12:30pm Hereditary Cancer Syndrome Surveillance: You’ve Done the Colectomy, So Now What? CraigMessick,MD,Houston,TX Recognizing the Red Flags: Does My Patient Have Hereditary Colorectal Cancer? HeatherHampel,MS,LGC,Columbus,OH 12:40pm Panel and Case Discussion 1:15pm Adjourn 12:10pm Polyposis Syndromes: When to Operate, How Much to Take, and Why TimothySadiq,MD,ChapelHill,NC Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Identifythegeneticsofcolorectal cancerandthegeneticsofthevarioushereditarycolorectalcancersyndromes;b)Describethemethodsby whichpatientswithhereditarycolorectalcancersyndromesmightbeidentifiedinasurgicalpractice,including screeningmethodstodiagnosethemostcommonsyndrome(s);c)Definetheappropriateoperationsforthe polyposisandnon-polyposissyndromes,thebesttimingforthoseoperations,whytheyshouldbeperformed, andtheevidencetosupportthesedecisions;d)Describethepost-colectomysurveillanceroutinesforthe hereditarycolorectalcancersyndromesaswellasanypracticalextracolonicsurveillanceroutinesandthe evidencetosupportthem. 28 Return to Table of Contents Sunday, May 31 Welcome and Opening Announcements 1:15 – 2:00 pm Terry Hicks, MD, New Orleans, LA President,ASCRS Paul Shellito, MD, Boston, MA Kelly Tyler, MD, Springfield, MA LocalArrangementsCo-Chairs David Margolin, MD,New Orleans, LA ProgramChair Steven Wexner, MD, Weston, FL President,ASCRSResearchFoundation H. David Vargas, MD, New Orleans, LA ProgramVice-Chair Roberta Muldoon, MD, Nashville, TN PublicRelationsChair Photo Credit: Greater Boston Convention & Visitors Bureau Jason Hall, MD, Burlington, MA AwardsChair Faneuil Hall Marketplace 29 Return to Table of Contents Sunday, May 31 Symposium Parallel Session 2-A Technical Pearls – How it’s Really Done 2.0 CME 2:00 – 4:00 pm Itisclearthatmastersurgeonsexist,andthatthesesurgeonsperformoperationswithtechniquestheyhave learnedfromexperience.Theselearned“tricks”oftenallowasurgeontoperformoperationsinawaythatmost cannot.Whenaskedtodescribewhattheydotocompletetheseprocedures,themastersurgeonoftencannotverbalizeit asthesetechniqueshavebecomeapartoftheirmusclememory.Inthissymposium,wewillaskthesesurgicalmasters todemonstratethesetechniquesinthisopenforum.Differentapproachestothesemaneuverswillthenbereviewed anddiscussed. Existing Gaps What Is: Surgicalskillvarieswidelyresultingindisparatepatientoutcomesforthetreatmentofmanycommon surgicaldiseases. What Should Be: Apatientundergoingsurgicaltreatmentofcommondiseaseshouldbeabletogettreatmentintheir communityandexpectthesamehighleveltreatmentasthepatienttreatedbythesurgicalmasterforthesame commondisease. Co-Director: Michael Stamos, MD, Orange, CA Co-Director: Gregory Kennedy, MD, PhD, Madison, WI 2:00pm Transabdominal Approaches to Rectal Prolapse – Cutting Edge vs Tried and True MarkArnold,MD,Columbus,OH 2:50pm Laparoscopy in the Super Obese – Tips to Get it Done ConorDelaney,MD,PhD,Cleveland,OH 2:10pm Approaches to Complex Fistula Disease: Outcomes and My Preferred Options SusanGearhart,MD,Baltimore,MD 3:00pm A Simple Operation that Needs More Work – the Perfect Ileostomy JohnPemberton,MD,Rochester,MN 2:20pm Bowel Preservation in Crohn’s Disease – Complex Decisions for Complex Procedures RobinMcLeod,MD,Toronto,ON,Canada 3:15pm Transanal Excision and Tumor Scatter – How to Achieve a Negative Margin TheodoreSaclarides,MD,Maywood,IL 2:30pm Parastomal Hernia Repair – Local Repair versus Stoma Resite KirkLudwig,MD,Milwaukee,WI 3:25pm Gracilis Interposition to Treat Complex Fistula Disease StevenWexner,MD,Weston,FL 2:40pm Finding the Ureter and Taking Down the Splenic Flexure in the Reoperative Abdomen CharlesFriel,MD,Charlottesville,VA 3:35pm Panel Discussion 4:00pm Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Identifytheapproachofa surgicalmastertorectalprolapse;b)Describeprinciplesofpreventionofinjurytothespleenwhenmobilizing thesplenicflexure;c)Statethepropertechniquetoperformingagracilisinterpositionprocedured)Namethe optionsavailabletoperformaloopileostomy;e)Describetheroleofnovelapproachestorectopexy;and f )Recognizethefactorsthatneedtobeconsideredinthemanagementofcolonicpolyps. 30 Return to Table of Contents Sunday, May 31 Abstract Session Parallel Session 2-B Neoplasia I 1.5 CME 2:00 – 3:30 pm 2:00pm Impact of Hospital Volume on Quality Indices for Rectal Cancer Surgery in British Columbia, Canada S1 R.McColl*,M.J. Raval,T.P. Phang, A.A. Karimuddin,C.J. Brown,C. Mcgahan, E. Cai,Vancouver,BC,Canada 2:07pm Discussion 2:10pm Transanal Endoscopic Microsugery (TEM) Following Neoadjuvant Chemoradiation for Rectal Cancer – Is Salvaging Local Recurrences Too Little Too Late? R. Perez,A. Habr-Gama*,G.P. SãoJulião, I. Proscurshim,L.M. Fernandez,J. GamaRodrigues,SaoPaulo,Brazil S2 2:17pm Discussion 2:20pm S3 Transanal Total Mesorectal Excision: The Oxford Experience S3 N.C. Buchs*,G. Nicholson,T. Yeung, N. Mortensen,C. Cunningham,O. Jones, S. Ashraf,R. Guy,R. Hompes,Oxford,United Kingdom 2:27pm Discussion 2:30pm Determining the Optimal Timing for Initiation of Adjuvant Chemotherapy After Resection for Stage II/III Colon Cancer S4 Z. Sun*,M. AbdelgadirAdam,J. Kim, D. Nussbaum,E. Benrashid,C.R. Mantyh, J. Migaly,Durham,NC 2:37pm Discussion 2:40pm Observation Versus Surgical Resection in Patients with Rectal Cancer Who Achieved Complete Clinical Response after Neoadjuvant Chemoradiotherapy: Preliminary Results of a Randomized Trial (NCT02052921) S.C. Nahas,C.S. Nahas*,U. Ribeiro,Jr., C. SparapanMarques,G. C.Cotti,C. Ortega, R. Azambuja,A. Chen,P. Hoff,I. Cecconello, SaoPaulo,Brazil 2:47pm Discussion 2:50pm Surgical Resection of the Primary Tumor in Stage IV Colorectal Cancer without Metastasectomy is Associated with Improved Overall Survival Compared to Chemotherapy/Radiation Therapy Alone B.C. Gulack*,D. Nussbaum,J.E. Keenan, A.M. Ganapathi,Z. Sun,M. Worni,J. Migaly, C. Mantyh,Durham,NC S6 2:57pm Discussion 3:00pm Correlation Between Extramural Vascular Invasion (EMVI) and DNA S7 Hypermethylation in Rectal Cancer H.G. Jones*,R. Radwan,G. Jenkins,N. Williams, P. Griffiths,J. Beynon,D. Harris,Cardiff, UnitedKingdom 3:07pm Discussion 3:10pm Waist Hip Ratio Better Predicts Oncological Quality of Resection and Outcome after Colon Cancer Surgery than Body Mass Index S8 N. Hetsch,D. Leonard*,A. Kartheuser, A. vanMaanen,Brussels,Belgium;H. Paterson, Edinburgh,UnitedKingdom;F. Penninckx, Leuven,Belgium 3:17pm Discussion 3:20pm Q&A 3:30pm Adjourn S5 *PresentingAuthor 31 Return to Table of Contents Sunday, May 31 Refreshment Break in Exhibit Hall and ePoster Presentations 4:00 – 4:45 pm Norman D. Nigro, MD, Research Lectureship 4:45 – 5:15 pm The Evolution of Minimally Invasive Surgery for Colorectal Cancer: Past, Present, and Future .5 CME Professor Antonio Lacy, MD, PhD Barcelona, Spain Photo Credit: Greater Boston Convention & Visitors Bureau Introduction: Steven Wexner, MD The Boston Skyline, as seen from the HarborWalk. 32 Return to Table of Contents Sunday, May 31 After Hours Debate 1.25 CME 5:15 – 6:30 pm Allsurgicalspecialtieshavecertaintopics/diseasesthatcontaincontroversy.Understandingtheoptimal treatmentplanforpatientsoftendependsonaphysician’sabilitytoseeclarityintheselinesofgray.Debatesare excellenttoolstoshowdifferencesinperspectiveandopinionregardingthesetopics.Theyeffectivelychallengeandbreak downsurgicaldogmaandopenpeopletonewpointsofview.Theyoftenhelpaudiencememberscrystalizetheirown valuesandbeliefs.Speakerswithpassionateviewsaboutopposingtreatment,withclearguidelinesforthedebate,can effectivelycreateaneffectiveandnovellearningenvironment.Furthermore,anassertiveandexperiencedmoderatorcan challengethespeakersandengagetheaudiencetobothoptimizecriticalthinkingandillustratewhattreatmentplanmay bebestfordifferentscenarios. Existing Gaps What Is: Theroleofsurgicalskillstestingisanareaofevolvingdiscussion.Therearedifferentandoftenopposingviewson it’sappropriateness,indicationandit’sutilityinsurgicaleducationandcertification.Surgeonsareunsurewhateffectthis willhaveinthefuture.Whilelaparoscopicsurgeryhasbecomemoreandmoremainstream,thereisstillsomequestion abouttheefficacyandoutcomesoflaparoscopicnodepositiverectalcancersurgery. What Should Be: Surgeonsshouldhaveaclearervisionoftheroleofskilltestinginrelationtocertificationand recertification.Theyalsoneedabetterunderstandingoftheroleoflaparoscopicrectalcancersurgeryasopposedtocolon cancersurgery. Moderator: James Fleshman, MD, Dallas, TX 5:15pm Surgical Skills Testing HelenMacRae,MD,Toronto,ON,Canadavs CharlesWhitlow,MD,NewOrleans,LA 5:45pm Laparoscopic Surgery for Stage 3 Rectal Cancer RichardWhelan,MD,NewYork,NYvs ScottSteele,MD,FortLewis,WA 6:30pm Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Recognizetheroleofskilltesting inrelationtocertificationandrecertification;b)Describetheevidenceandpracticalimplicationsforperforming oravoidingmechanicalbowelpreparation;andc)Explaintheoutcomesinminimallyinvasivesurgeryforthe treatmentofnodepositiverectalcancer. Welcome Reception 7:00 – 8:30 pm Sheraton Boston Hotel • Jersey Night! • Wear your favorite team’s jersey to show your colleagues which team you support. TheWelcome Reception willbeheldattheSheratonBostonHotelandiscomplimentaryto allregisteredattendees.Theeventwillfeaturehorsd’oeuvres,cocktailsandentertainment. TheResearchFoundationwilljoinforceswithASCRStowelcomeallatthisreception. 33 Return to Table of Contents Monday, June 1 Meet the Professor Breakfasts 6:00 – 7:00 am Limit: 30 per breakfast • Fee $40 • Tickets Required • Continental Breakfast Registrants are encouraged to bring problems and questions to this informal discussion. Please register early and indicate your 1st and 2nd choice on the Registration Form. M-1 HNPCC and Polyposis: Knowing When to Operate CharlesTernent,MD,Omaha,NE MatthewKalady,MD,Cleveland,OH 1.0 CME M-4 The Management of T1 Rectal Cancer RobertMadoff,MD,Minneapolis,MN MaherAbbas,MD,AbuDhabi, UnitedArabEmirates M-2 Quality Metrics and Colorectal Surgery JuanNogueras,MD,Weston,FL RoccoRicciardi,MD,Burlington,MA M-5 How to Produce a High Quality Manuscript for Scientific Journals ThomasRead,MD,Burlington,MA W.DonaldBuie,MD,Calgary,AB,Canada M-3 Coding Pearls GuyOrangio,MD,NewOrleans,LA StephenSentovich,MD,Duarte,CA M-6 Rectal Prolapse StanleyGoldberg,MD,Minneapolis,MN BrookeGurland,MD,Cleveland,OH Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Describetheproceduresand approachesdiscussedinthissession. Residents’ Breakfast 6:00 – 7:00 am The Road Less Traveled or the High Road? Charting a Path to Success 1.0 CME Michael Stamos, MD Chair Department of Surgery University of California, Irvine Health Orange, CA Open to Residents Only Registration Required 34 Return to Table of Contents Monday, June 1 Symposium Parallel Session 3-A Robotic Colorectal Surgery 2.25 CME 7:00 – 9:15 am Whilethepracticeofsurgerycontinuestoevolvewithrespecttonewtechniquesandtechnology,itremains criticalthattheattentionofsurgeonsandsocietyasawholefocusonimprovingthequalityofpatientcare. Innovationsthereforemustbeassessedthroughscienceandexperienceinorderthatthesegoalsareachieved.Controversy overthecost,potentialcomplications,training,highlightedinboththelaypressandpublications,demonstratetheneed forthisdiscussion.Theseunansweredquestionsregardingtheuseofroboticsurgeryrepresentfertilegroundfromwhicha robustdiscussioncanensue.Therefore,acriticalneedexiststoreviewthecurrentstateoftheroboticsinorderthat surgeonsareinformedofongoingandfuturestudiespertainingtotheuseofroboticsurgery. Existing Gaps What Is: Theapproachanduseofroboticsurgeryremainsvariedanddiverse.Todate,fewinstitutionsexistwithlarge experiencesincolorectaldisease.Moreover,theappropriateapplicationofroboticsisoftenbasedonlocalprevailing customsandexpertiseduetolimiteddataandtraining. What Should Be: Surgeonsshouldunderstandtheappropriateapplicationofrobotictechnicsandabasisforliterature reportedoutcomesincolorectalsurgery.Inaddition,surgeonsshouldhaveabasicunderstandingofthepotentialpitfalls andcostsassociatedwiththisapproach. Director: David Larson, MD, Rochester, MN Assistant Director: Scott Kelley, MD, Cincinnati, OH 7:00am What's New with the Robot (Tools, Capabilities) and How Might it Improve My Practice HowardRoss,MD,Philadelphia,PA 7:15am The Evidence: Where are We? DavidJayne,MD,Leeds,UnitedKingdom 7:30am Role of Robotics in Colon Surgery? JulioGarcia-Aguilar,MD,PhD,NewYork,NY 7:45am The Costs of Robotics, Pitfalls and Economics RobertCleary,MD,AnnArbor,MI 8:00am Complex Pelvic Surgery, Techniques and Tricks AmirBastawrous,MD,Seattle,WA 8:15am Robotic Rectal Cancer Surgery and RoboticIntersphincteric Resection JinKim,MD,Seoul,SouthKorea 8:30am Economics of Robotics CraigRezac,MD,NewBrunswick,NJ 8:45am Questions and Panel Discussion 9:15am Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Identifythecapabilitiesandtools associatedwithdifferentrobotictechnologies;b)Describetheprinciplesderivedfromtheliteratureonthe benefitorlackofbenefitfromaroboticapproach;c)Recallthepropertechnicalissuesofbothabdominaland pelvicroboticsurgery;d)Describethecurrentandongoingtrialsofroboticsurgery;ande)Distinguishthe financialburdenassociatedwithroboticsurgeryandtheopportunitiesforcostsavings. 35 Return to Table of Contents Monday, June 1 Symposium Parallel Session 3-B Rectal Cancer: Optimizing Outcomes through Techniques 2.25 CME 7:00 – 9:15 am Withcontinuedtechnologicaladvancementsandtheirimplementationintosurgicalpractice,thenumberof surgicalapproachesforthemanagementofrectalcancercontinuestoexpand.Dependingonthestageandlocation oftherectalcancerandpatientco-morbiditiesandwishes,onesurgicalapproachmaybepreferredoveranother. Nevertheless,regardlessofsurgicalapproach,short-termandlong-termoncologicalandfunctionalresultsaregreatly dependentonsurgicaltechnique. Thepurposeofthissymposiumistopresentexpertcommentariesbyhigh-volumesurgeonsontheessentialtechnical componentsofabroadrangeofspecificopenandminimallyinvasivesurgicalapproachescommonlyusedforthe managementofrectalcancer. Existing Gaps What Is: Althoughcolorectalsurgeonsaretrainedinallthedifferentsurgicaloptionsforrectalcancermanagement,the scienceandartinaspecificsurgicaltechniquearemasteredafteryearsofpracticeandexperience. What Should Be: ThisSymposiumaimstohighlightanddisseminateoptimalsurgicaltechniquesusedbyexperthigh volumesurgeonsinthesurgicalmanagementofrectalcancer. Director: José Guillem, MD, New York, NY Assistant Director: Patricia Sylla, MD, Boston, MA 7:00am Introduction JoséGuillem,MD,NewYork,NY 7:05am Open Low Anterior Resection RobertMadoff,MD,Minneapolis,MN 7:15am Open Ultra-Low Resection with Coloanal Anastomosis: Mucosectomy vs Intersphincteric Resection ThomasRead,MD,Burlington,MA 7:25am 7:35am 7:45am Discussion and Cases 8:00am Robotic Rectal Cancer Resections SlawomirMarecik,MD,ParkRidge,IL 8:10am TEM/TAMIS SergioLarach,MD,Orlando,FL 8:20am Transanal Total Mesorectal Excision AntonioLacy,MD,PhD,Barcelona,Spain 8:30am Results of Robotic vs Laparoscopic Resection for Rectal Cancer: ROLARR Study AlessioPigazzi,MD,PhD,Orange,CA Abdominal Perineal Resection: Prone Position/Cylindrical Approach: When and How? TorbjörnHolm,MD,Stockholm,Sweden ALaCaRT: Australian Laparoscopic Cancer of the Rectum Trial AndrewStevenson,MD,Chermside,Australia 8:40am Discussion 9:15am Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Describethemostcommonly performedandevolvingopenandminimallyinvasivesurgicalapproachesforrectalcancerwithanemphasison properpatientselectionandoptimalsurgicaltechnique;andb)Identifyspecificpreferredtechniques,potential technicaldifficultiesandpitfallsinordertoassureoptimaloncologicalandfunctionaloutcome. 36 Return to Table of Contents Monday, June 1 Memorial Lectureship Honoring John M. MacKeigan, MD 9:15 – 9:45 am A Short Walk Through the History of the Quality Movement .5 CME Martin Luchtefeld, MD Chief, Div. of Colon and Rectal Surgery Clinical Asst. Professor, MSU College of Medicine Ferguson Clinic-Spectrum Health Medical Group Spectrum Health Grand Rapids, MI Introduction: Anthony Senagore, MD Presidential Address 9:45 – 10:15 am A Surgeon’s Puzzle: “The Missing Pieces” .5 CME Terry Hicks, MD Vice Chair, Dept. of Colon and Rectal Surgery Ochsner Clinic New Orleans, LA Introduction: Michael Stamos, MD Refreshment Break in Exhibit Hall and ePoster Presentations 10:15 – 11:00 am 37 Return to Table of Contents Monday, June 1 Symposium Parallel Session 4-A Navigating a Career Path in Colon and Rectal Surgery – Orchestrating and Optimizing Career Transitions at All Levels 1.5 CME 11:00 am – 12:30 pm Surgeonsatallphasesoftheircareerfacedifficultdecisionsaboutpotentialtransitionsintheirprofessionaland personallives.Theoptimalstrategicapproachtotheselifechangingeventscanbeelusiveandmayleadtoa“trialby error”experiencewithdramaticconsequences.Wemusttrytounderstandthatthesechangescomefromtheimpossibility toliveotherwisethanaccordingtothedemandsofourconscienceandnotfromourmentalresolutiontotryanewformof life.Furthermore,noteveryopportunityisgrowth,asallmovementisnotforward. Existing Gaps What Is: Graduatingcolorectalresidentsandattendingsurgeonslookingforacareerchangereceiveverylittlecounseling andpragmaticadvicetoassistthemintheirpotentialtransitiontoanewposition. What Should Be: Careertransitionsshouldbeapproachedandhandledbyanindividualwithateamofmentorsand advisors.Theabsenceofthis“team”canbebalancedbynationalcoursesandsymposiawithspeakerswelleducatedin thisarena. Director: Bradley Champagne, MD, Cleveland, OH Assistant Director: Andrew Russ, MD, Knoxville, TN 11:00am Life after Training – You are Now the Attending of Record! MarkManwaring,MD,Greenville,NC 11:36am A View from Above – How to Effectively Lead a Team! MichaelStamos,MD,Orange,CA 11:12am Mid-Life Crisis, Build your Own or Lead from the Center! GregoryKennedy,MD,PhD,Madison,WI 11:48am Emotional Intelligence – The Real Key to Success JamesFleshman,MD,Dallas,TX 11:24am From Private Practice to Hospital Acquisition – Lifestyle, Dollars and Sense! WayneAmbroze,MD,Atlanta,GA Noon Question and Answer 12:30pm Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Recognizetheimportanceofa thoughtfulandstrategicapproachtothefirstyearsinpracticeaftertraining;b)Describethekeycomponentsto thedecisionmakingprocesswhenasurgeonisdecidingbetweenmovingtoanotherpositionwithpotential leadershipopportunitiesvs.stayingintheircurrentrole;c)IdentifythecurrentchallengeswithPrivatePractice andwhyhospitalbasedpracticemaybeadvantageous;d)RecognizehowtoturnaVisionintorealityby effectiveimplementationofthestrategicplan;ande)Identifythatmentaltoughnessandemotionalintelligence aredifficulttomeasurebutarethecornerstoneofpersonalandprofessionalsuccess. 38 Return to Table of Contents Monday, June 1 Abstract Session Parallel Session 4-B Benign Colonic Disease 11:00 am – 12:30 pm 11:00am Surgical Site Infection Following Colorectal Surgery: In the Eye of the Beholder? S9 T.L. Hedrick*,A. Harrigan,B. Umapathi, R. Sawyer,C.M. Friel,Charlottesville,VA 1.5 CME 11:46am Discussion 11:49am Parastomal Hernia Prevention Through Laparoscopic Modified Sugarbaker Technique with Composite Mesh (Physiomesh™). A Multicenter S14 Randomized Controlled Trial. X. Serra-Aracil*,L. Mora,A. Serracant,M. LopezCano,S. Biondo,D. Fraccalvieri,E. Espin, J. Sanchez,Barcelona,Spain 11:07am Discussion 11:09am Diverticulitis In The United States: A Decade Analysis Of Changing Trends S10 M.H. Hanna*,Z. Moghadamyeghaneh, G. Hwang,L. Malellari,S.D. Mills,J.C. Carmichael, M.J. Stamos,A. Pigazzi,Orange,CA 11:56am Discussion 11:16am Discussion 11:59am Killingback Award High vs low Urine Output Targets in Elective Surgical Patients: A Randomized Clinical Trial S15 J. Puckett*,J. DeZoysa,M. Kluger,Auckland, NewZealand;S. Palmer,.JPickering,Z. Endre, Christchurch,NewZealand;M. Soop,Auckland, NewZealand 11:19am Sigmoid Colectomy for Acute Diverticulitis in Immunosuppressed vs. Immunocompetent Patients: Outcomes from the ACS-NSQIP Database S11 A. Al-Khamis*,J. AbouKhalil,C. Vasilevsky, N. Morin,G. Ghitulescu,P. Gordon,M. Demian, J. Faria,M. Boutros,Montreal,QC,Canada 12:06pm Discussion 11:26am Discussion 12:09pm The Current State of Colorectal Surgery Training: A Survey of Program Directors, Current Colorectal Residents, and Recent Colorectal Graduates. S16 M.B. Bailey*,P.E. Miller,S. Pawlak,M. Thomas, H. Vargas,T. Hicks,C. Whitlow,D. Beck, D. Margolin,NewOrleans,LA 11:29am The Readmission After Acute Diverticulitis (RAD) Score – A Nomogram for Determining 60-day Readmission Risk for Diverticulitis Patients Using 145,325 Admissions from the State Inpatient Database (SID) (2006-2011). S12 V. Chakravorty*,K. Mahendraraj, R.S. Chamberlain,Livingston,NJ 12:16pm Discussion 11:36am Discussion 12:19pm Q&A 11:39am Conservatively Treated Diverticular Abscess Associated with High Risk of Recurrence and Disease Complications B. Devaraj*,K. Cologne,A.M. Kaiser, LosAngeles,CA 12:30pm Adjourn S13 Complimentary Box Lunch in Exhibit Hall and ePoster Presentations 12:30 – 1:30 pm *PresentingAuthor 39 Return to Table of Contents Monday, June 1 Symposium Parallel Session 5-A Past Presidents’ Panel: Controversies and Cases 1.5 CME 1:30 – 3:00 pm Themanagementofcomplicatedcolorectaldisordersiswhatdifferentiatesthisspecialtyfromgeneralsurgery. Colorectalsurgeonsareoftencalledupontomanagecomplexmedicalandsurgicalconditions,especiallyreoperative surgery.Thissessionwillhighlightthestrategiesofseniorcolorectalsurgeons’managementofthemostcomplicated reoperativeconditionsaddressedbyourspecialty. • Recurrent Anal Fissures • Recurrent Rectal Cancer • Hemorrhoid Disease • Inflammatory Bowel Disease • Complex Fistula Existing Gaps What Is: Manysurgeonsarecomfortablewiththestraightforwardmanagementofcommoncolorectalconditions.Complex cases,reoperativesurgeryandthosewithcomplicationsareoftenreferredtoatertiarycarecenter. What Should Be: Surgeonsshouldbefamiliarwiththemanagementoptionsforcomplicatedcolorectaldiseasesandthe potentialinterventionsnecessarytoprovidesatisfactoryoutcomes. Director: Steven Wexner, MD, Weston, FL 1:30pm Recurrent Anal Fissures RichardBillingham,MD,Seattle,WA 2:15pm Inflammatory Bowel Disease MichaelStamos,MD,Orange,CA 1:45pm Recurrent Rectal Cancer H.RandolphBailey,MD,Houston,TX 2:30pm Complex Fistula AnnLowry,MD,St.Paul,MN 2:00pm Hemorrhoid Disease LesterRosen,MD,WestPalmBeach,FL 2:45pm Roundtable Discussion 3:00pm Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Recognizethemanagement optionsofrecurrentanalfissures,complexanalfistula,hemorrhoiddisease,rectalcancerandIBD;and b)Identifythetechniqueofcolonoscopyandhowtomanagepotentialcomplicatedlesionsendoscopically. 40 Return to Table of Contents Monday, June 1 Abstract Session Parallel Session 5-B Pelvic Floor/Anorectal 1.5 CME 1:30 – 3:00 pm 1:30pm Treatment of Fecal Incontinence with Gatekeeper (™) Implantation S18 A. Heydari*,E. Merolla,S. Giuratrabocchetta, M. Piccoli,G. Melotti,Modena,Italy; R. Fazlalizadeh,Orange,CA 2:19pm Percutaneous Tibial Nerve Stimulation has Sustained Benefit in the Treatment of Fecal Incontinence at 12 Months S23 J.B. Cowley*,P.W. Waudby,H. O'Grady, G.S. Duthie,Beverley,UnitedKingdom 1:37pm Discussion 2:26pm Discussion 1:39pm The Impact of a Novel Vaginal Bowel S19 Control System on Bowel Function M.G. Varma*,SanFrancisco,CA;C.A. Matthews, ChapelHill,NC;H. Richter,Birmingham,AL 2:29pm 1:46pm Discussion 1:49pm The Effect of Coexisting Pelvic Floor Disorders on Fecal Incontinence Quality of Life Scores: A Prospective Survey-Based Study S20 L. Bordeianou,C.W. Hicks*,A. Olariu,L.R. Savitt, S.J. Pulliam,M. Weinstein,P. Sylla, M.M. Wakamatsu,Boston,MA;T. Rockwood, Minneapolis,MN;J. Kuo,Waltham,MA Outcomes of Re-Implantation of Sacral Neurostimulation for Fecal Incontinence are Similar to Those of S24 First Time Implants A. Cracco*,A. Chadi,S. Wexner,F. Rodrigues, G. DaSilva,Weston,FL;M. Zutshi,B. Gurlanb, Cleveland,OH 2:36pm Discussion 2:39pm Use of Biofeedback Combined with Diet for Treatment of Obstructed Defecation Associated with Paradoxical Contraction of Puborectalis Muscles (Anismus). Predictive Factors and Short-term Outcome S25 S.M. Murad-Regadas*,F.S. Regadas,C. Bezerra, M.C. Oliveira,F. RegadasFilho,R. Vasconcelos, S. Almeida,G. Fernandes,Ceara,Brazil 2:46pm Discussion 2:49pm Ligation of Intersphincteric Fistula Tract (LIFT) Versus LIFT-Plug Procedure in Patients with Transsphincteric Anal Fistula: A Multicenter Prospective Randomized Trial. S26 Z. Wang*,J. Han,Y. Zheng,J. Cui,C. Chen, Beijing,China;X. Wang,X. Che,Shan'xi,China; W. Song,Tianjin,China 2:56pm Discussion 3:00pm Adjourn 1:56pm Discussion 1:59pm The TOPAS™ Treatment for Fecal Incontinence: A Close Look at Complications S21 M. Zutshi*,Cleveland,OH;A. Mellgren, Chicago,IL;D.E. Fenner,AnnArbor,MI; V. Lucente,Allentown,PA;P. Culligan,Summit, NJ;M. Nihira,OklahomaCity,OK 2:06pm Discussion 2:09pm Long Term Efficacy of Sacral Nerve Stiumlation for Fecal Incontinence – A Single Center Experience J.B. Cowley*,P.W. Waudby,H. O'Grady, G.S. Duthie,Beverley,UnitedKingdom 2:16pm S22 Discussion *PresentingAuthor 41 Return to Table of Contents Monday, June 1 Harry E. Bacon, MD, Lectureship 3:00 – 3:30 pm Changes in Student and Residency Education in Surgery: Unanticipated Consequences and Challenges .5 CME Hiram C. Polk, Jr., MD Ben A. Reid, Sr. Professor of Surgery, Emeritus Former Chair, Department of Surgery, School of Medicine University of Louisville Louisville, KY Introduction: Terry Hicks, MD Ice Cream & Refreshment Break in Exhibit Hall and ePoster Presentations 3:30 – 4:15 pm Parviz Kamangar Humanities in Surgery Lectureship 4:15 – 4:45 pm Spirituality and Faith in Serious Illness .5 CME Robert Fine, MD, FACP, FAAHPM Clinical Director Office of Clinical Ethics and Palliative Care Baylor Scott and White Health Dallas, TX Introduction: Ira Kodner, MD 42 Return to Table of Contents Monday, June 1 Special Lecture 4:45 – 5:15 pm The Trials and Tribulations of Clinical Research: Why Johnny Can’t Add .5 CME Thomas Read, MD Lahey Clinic Medical Center Dept. of Colon and Rectal Surgery Burlington, MA No CME Credit Awarded New Technologies Symposium 5:15 – 6:45 pm TheNewTechnologiesSessionisdedicatedtotheprinciplethatthroughimaginationandinnovationmanyof themostchallengingproblemsinthefieldofcolonandrectalsurgerycanbesolved.Impactfulnewinnovationsin theareaofcolorectalsurgery;pharma,devices,prototypes,techniquesandapproacheswillbethefocusofthissession. Thissessionwillfeaturepresentationsonthelatestadvancesincolorectalsurgery. Existing Gaps What Is: Noplatformforemergingtechnologiesexistsforcolorectalsurgerytoday. What Should Be: TheASCRSannualmeetingwillserveasmajorconduitthroughwhichnewandemergingtechnologiesfor colorectalsurgerywillbeshowcased.Thissessionwillalsoserveasaneducationalplatformtolearnaboutdruganddevice developmentandprocessforFDAapproval. Co-Director: Sonia Ramamoorthy, MD, La Jolla, CA Co-Director: Eric Haas, MD, Houston, TX Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Identifyandemployemerging technologiesrelatingtocolorectalsurgicalissues;b)Recognizepersonalgapsinknowledgewhichwillleadto furtherindependentstudy;andc)Recognizesafeandeffectivestrategiestocorrectcommoncolorectal diseaseprocesses. 43 Return to Table of Contents Tuesday, June 2 Meet the Professor Breakfasts 6:30 – 7:30 am Limit: 30 per breakfast • Fee $40 • Tickets Required • Continental Breakfast Registrants are encouraged to bring problems and questions to this informal discussion. Please register early and indicate your 1st and 2nd choice on the Registration Form. T-1 Enterocutaneous Fistulas, Anastomotic Leaks and other Catastophes DavidBeck,MD,NewOrleans,LA JosephCarmichael,MD,Orange,CA T-2 T-3 T-4 T-5 Modern Management of Fecal Incontinence KellyGarrett,MD,NewYork,NY AmyHalverson,MD,Chicago,IL Pouch Problems and Solutions FezaRemzi,MD,Cleveland,OH DavidLarson,MD,Rochester,MN BonnieAlvey,APRN,WOCN,ACNS-BC, NewOrleans,LA T-6 Nonhealing Perineal Wounds MartinLuchtefeld,MD,GrandRapids,MI JonHourigan,MD,Lexington,KY Rectal Cancer: Difficult Cases and Controversies JamesFleshman,MD,Dallas,TX KirkLudwig,MD,Milwaukee,WI T-7 Colitis and Dysplasia Surveillance and Management DavidEtzioni,MD,Phoenix,AZ RandolphSteinhagen,MD,NewYork,NY Controversies the Management of Intestinal Crohn's Disease SandraBeck,MD,Pittsburgh,PA PhillipFleshner,MD,LosAngeles,CA Photo Credit: Greater Boston Convention & Visitors Bureau Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Describetheproceduresand approachesdiscussedinthissession. Situated on the waterfront, the JFK Library & Musuem offers glorious unobstructed views of the city and the ocean. 44 Return to Table of Contents Tuesday, June 2 Symposium Parallel Session 6-A Anorectal Disorders: Balancing Innovation with Conventional Wisdom 1.5 CME 7:30 – 9:00 am BillionsofdollarsarespentannuallyintheU.S.bypatientsontheirownandasprescribedbyaphysicianto managethesymptomsofawiderangeofano-rectalconditions.Surgicaltreatmentsincludestateoftheart technologiesandmethodsthathaveremainedunchangedsincethetimeofShakespeareandeventhePharaohs.Dothe newerapproachestotheseconditionsprovidebetteroutcomesatreasonablecost,orjustnoveltyandanopportunityto advanceone’spracticebybeingthe“firstkidontheblocktohavethenewesttoy?” Thissymposiumseekstojuxtaposethenewestadvancesagainstthetriedandtrue.Weplantoreviewtheemerging technologieswithregardtooutcomesandefficacyandalso“bangforthebuck”lookattheimprovementsandinnovation vscost.Therewillbeanin-depthdiscussionofhowtointegratenewtechnologyintoyourano-rectalpracticeandwhento stickwithwhatyouweretaughtinfellowship. Existing Gaps What Is: Avarietyofemergingtechniquesandtechnologiesthatspanthepracticeofano-rectalsurgery.Theadoptionand supportforthesechangesinpracticeisoftenindustrydriven.Thedistinctbenefitatpossiblyincreasedcostisnotalways knownbythepatientorthepractitioner.Manydifferentapproaches,newandold,arecurrentlyappliedacrosspractices. What Should Be: Surgeonsadoptingthenewestinnovativetreatmentsandtechnologiesshouldknowthebenefitsand costsofthesenewerapproachesincomparisontoprovenmethods.Thepractitionersshouldbeawareofpotentialrisksor benefitsofadoptingnewmethods.Evolvingchangesinsurgicaltechniquesneedtobecomparedtoestablishedstandards usinganevidencebasedapproach,freefromcommercialbias. Director: Thomas Cataldo, MD, Boston, MA Assistant Director: Vitaliy Poylin, MD, Boston, MA 7:30am Latest Advances in Guided Hemorrhoid Ligation VincentObias,MD,Washington,DC 8:10am Management of Fistula-in-Ano: From Shakespeare to the Space Shuttle BrianKann,MD,Philadelphia,PA 7:40am Hemorrhoidectomy – Do We Need to Reinvent the Wheel? SyedHusain,MD,Columbus,OH 8:20am Ventral Rectopexy for Obstructed Defecation P.RonanO'Connell,MD,Dublin,Ireland 8:30am Discussion 7:50am Management of Chronic Anal Fissures, to Rub on, Inject in, or Cut Through ElizabethRaskin,MD,St.Paul,MN 9:00am Adjourn 8:00am Injectable and Implantable Treatments for Fecal Incontinence NishitShah,MD,Providence,RI Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Identifythenewesttechniques formanagementofsymptomatichemorrhoids,fistula-in-ano,analfissure,rectalprolapseandincontinence; b)Reviewthenewestinnovationswithrespecttocost,risk,complicationsandsuccesscomparedtowell establishedtechniquesandtechnologies;andc)Planforincorporationofinnovativemethodsformanagement ofanorectalconditionsintheexistingpracticeofcolorectalsurgery. 45 Return to Table of Contents Tuesday, June 2 Symposium Parallel Session 6-B Update on Inflammatory Bowel Disease 7:30 – 9:00 am 1.5 CME ThemanagementofCrohn’sdiseaseandulcerativecolitiscontinuestoevolveaswelearnmoreaboutthe geneticsofthesediseases.Additionally,ourmanagementofpatientswithIBDhaschangedgreatlywithnewdrug development,whichthenhasdownstreamimpactontheirsurgicaltherapy.Therefore,itiscrucialtohaveacomprehensive understandingoftheseaspectsofCrohn’sdiseaseandulcerativecolitisinordertoprovidethemostcomprehensivecare forthesepatients. OurunderstandingofthegeneticsofCrohn’sdiseaseandtoalesserextent,ulcerativecolitis,hasgrowngreatlyinthepast decade.TheadvanceshavetodowiththediscoveryoftheNOD2geneandadvancesintechnologysuchasthehigh throughputgenetics.Thisunderstandinghasledtoimprovementinidentifyinghigh-riskpatients,anddefiningdisease phenotypes.Theintroductionandexpansionofbiologicagentsinthetreatmentofinflammatoryboweldisease(IBD)has providedaneffectivealternativetolong-termsteroidtherapy.Immunomodulatortherapyissowidespreadthatitis uncommonforanypatientwithCrohn’sorulcerativecolitistonotbetreatedwithoneoftheseagents.Dataclearly supportsitsuseintheacuteandmaintenancesettings,butthelong-termimpactofthedrugsonthesepatientsregarding theneedforsurgeryandqualityofliferemainscontroversial.Pouchitisisthemostcommoncomplicationassociatedwith restorativeproctocolectomies.Themajorityofcasesareeasilytreatedwithantibioticsbutasubsetofthesepatients developschronicpouchitisthatisantibioticdependentorrequiresimmunomodulatorstotreat.Wearegainingan increasingunderstandingofthepathophysiologyofpouchitisanditstreatments.PerianalCrohn’sdiseasepresentssomeof thegreatestchallengestothepatientandsurgeon.Themaingoalfortreatingpatientswithperianaldiseaseisfocused controlofsymptomsandrarelyoncureoreradication.Itremainsunclearhowthewidespreaduseofbiologictherapyhas impactedthesurgicalmanagementofthesepatients.Restorativeproctocolectomywithanilealanalpouchhasbecomethe surgicalstandardofcareforpatientswithulcerativecolitis.Thisprocedurecanbedoneinone,twoorthreestages,andthe bestapproachremainscontroversial. Existing Gaps What Is: Ourunderstandingofthegenetics,pathophysiology,medicaltherapyandsurgicaltherapyofIBDisconstantly changing. What Should Be: Surgeonsshouldunderstandthegeneticbasis,theindicationsandoutcomesassociatedwithmedical management,andthesurgicalprinciplesforthetreatmentofIBDintoday’sworldofmedicine. Director: Matthew Mutch, MD, St. Louis, MO Assistant Director: Marc Singer, MD, Chicago, IL 7:30am Introduction MatthewMutch,MD,St.Louis,MO 7:36am 7:49am 8:02am 8:19am Genetics of IBD – What Have We Learned? DavidStewart,Sr.,MD,Hershey,PA Perianal Crohn’s Disease – Has Biologic Therapy Changed our Surgical Principles? JustinMaykel,MD,Worcester,MA 8:28am Immunomodulators and Biologic Agents for Intestinal Disease – Surgery vs Drugs SekharDharmarajan,MD,St.Louis,MO Restorative Proctocolectomy – 3 Stage vs 2 Stage vs 1 Stage TimothyGeiger,MD,Nashville,TN 8:41am Panel Discussion/Questions 9:00am Adjourn Chronic Pouchitis – What Is it and How Do I Treat it? DavidDietz,MD,Cleveland,OH Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)RecognizethegeneticsofIBD; b)IdentifytheimpactofmedicaltherapyonthetreatmentofCrohn’sdisease;c)Recognizethepathophysiology andtreatmentofchronicpouchitis;d)DescribetheprincipleofmanagingperianalCrohn’sdisease;and e)Evaluatetheindicationsfor3stage,2stage,and1stagerestorativeproctocolectomy 46 Return to Table of Contents Tuesday, June 2 Ernestine Hambrick, MD, Lectureship 9:00 – 9:30 am Diverticulitis: What’s New .5 CME Lisa Strate, MD, MPH Associate Professor of Medicine Department of Medicine Division of Gastroenterology University of Washington Harborview Medical Center Seattle, WA Introduction: Ann Lowry, MD Refreshment Break in Exhibit Hall and ePoster Presentations Photo Credit: Greater Boston Convention & Visitors Bureau 9:30 – 10:15 am 47 Return to Table of Contents Tuesday, June 2 Symposium Parallel Session 7-A Controversies in Rectal Cancer Management 1.5 CME 10:15 – 11:45 am Rectalcancermanagementischangingasnewevidenceemergesregardingthebenefitsofmultidisciplinary treatmentandtechniquesforoptimizingsurgicaloutcomes.Specifically,theneedofroutinepreoperative radiotherapy,theroleforlong-coursechemoradiotherapyversusshortcourseradiotherapyalone,themanagementof patientswithcompleteclinicalresponsefollowingchemoradiation,andtheroleofadjuvanttherapyfollowingneoadjuvant chemoradiation,areallunsolvedclinicaldilemmas.Someofthisdebatehasbeeninformedbyimprovementsinsurgical outcomesandourimprovedunderstandingoftheimpactofcircumferentialmarginsatresection,forbothproximaland distalrectalcancers. Existing Gaps What Is: Currenttreatmentguidelinesforpatientswithrectalcancerdonotaccountfortheunderlyingheterogeneityof rectalcancerswithrespecttotreatmentresponseorriskforrecurrence. What Should Be: Surgeonsshouldhaveanunderstandingaboutthedeterminantsofoutcomesfollowingmultidisciplinary treatmentforrectalcancerandhowtreatmentmaybetailoredtomaximizeoncologicoutcomewhileminimizingtherisk forunnecessarytoxicity. Director: George Chang, MD, Houston, TX Assistant Director: Fergal Fleming, MD, Rochester, NY 10:15am The CRM is Widely Clear: Is Routine Preoperative Radiotherapy Still Necessary? PeterSagar,MD,Leeds,UnitedKingdom 11:15am Adjuvant Chemotherapy Following Neoadjuvant CXRT for Rectal Cancer: Does Anybody Benefit? Yi-QianNancyYou,MD,Houston,TX 10:30am Preoperative Radiotherapy for Rectal Cancer: When to Go Short and When to Go Long. AlexanderHeriot,MD,Melbourne,VIC,Australia 11:30am Discussion 11:45am Adjourn 10:45am I Don’t See Residual Tumor, What Should I Do? JulioGarcia-Aguilar,MD,PhD,NewYork,NY 11:00am Managing Minimally Invasive TME: Top Down or Bottom Up? JohnR.T.Monson,MD,Rochester,NY Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Discusstreatmentheterogeneity amongpatientswithrectalcancer;b)Describeissuesinthemanagementofrectalcancerpatientswitha clinicalcompleteresponsetoneoadjuvantchemoradiationtherapy;c)Discusstheevidenceregardingadjuvant chemotherapyforrectalcancerpatientsfollowingneoadjuvantchemoradiationtherapy;d)Discusscritical issuesrelatedtocircumferentialresectionmarginsduringrectalcancersurgery;ande)Discussthecriticalissues withintheevolvingareaoftransanalTME. 48 Return to Table of Contents Tuesday, June 2 Symposium Parallel Session 7-B Ostomies: Location, Creation and Complications 1.5 CME 10:15 – 11:45 am Despiteimprovementsinsurgicaltechniqueandenterostomaltherapycare,complicationsfollowingstoma creationareverycommon.Therateofstoma-specificcomplicationsintheliteraturevariesbetween10%and70%, andisdependentonthelengthoffollow-upandthedefinitionof“complication.”Complicationsincludeperistomalskin irritation,leakage,highoutput,dehydration,ischemia,retraction,stenosis,andrecurrenceofthediseaseforwhichastoma wascreated,suchasCrohn’sdisease. Surgeonswillbeupdatedonhowtoconstructintestinalstomasaswellashowtopreventandtreatstoma-related complications.Thissymposiumwilldiscussthetechniquesofstomasitingandmarking,stomaconstruction,prevention andmanagementofcomplicationsincludingparastomalhernia,andmanagementofpatientswithhigh-volumeoutputs. Technicaltipstoavoidcomplicationsandfacilitateconstructionwillbeemphasized.Qualityoflifeforpatientswithstomas willalsobediscussed. Existing Gaps What Is: Constructionandmanagementofstomasremainschallengingandstoma-relatedcomplicationsremainhigh.Often thesurgeonistheprimaryproviderinthemanagementofthesecomplications,andmanysurgeonslacktheexperience necessarytoadequatelytreatthem. What Should Be: Surgeonsshouldknowmultipleoptionsforstomacreation.Additionally,physiciansshouldhavean understandingofhowtopreventandtreatstoma-relatedcomplications. Co-Director: Deborah Nagle, MD, Boston, MA Co-Director: Joseph Carmichael, MD, Orange, CA 10:15am Patient Education and Stoma Site Selection A.MurrayCorliss,RN,CWOCN,BostonMA 11:00am Other Stoma Complications Other Than Hernia WalterPeters,Jr.,MD,Columbia,MO 10:30am Ostomy Selection, Construction and Technical Challenges NeilHyman,MD,Chicago,IL 11:15am Complicated Cases/Panel Discussion 10:45am 11:45am Adjourn Parastomal Hernias: The Controversy Continues MichaelRosen,MD,Cleveland,OH Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Discussthepreoperative optimizationofpatienttopreventstoma-relatedcomplications;b)Describemethodstomedicallymanage commonperistomalproblems;c)Describetechniquestopreventandrepairparastomalhernias;d)Discuss methodsofmanagingpatientswithstomaretraction,stenosis,prolapse,andperistomalskinproblems;and e)Describemethodsofmanagingpatientswithhigh-volumeoutputstomas. 49 Return to Table of Contents Tuesday, June 2 Abstract Session Parallel Session 7-C General Surgery Forum 10:15 – 11:45 am 11:05am Discussant 10:15am Bariatric Surgery Modulates IBDAssociated Microbiome Patterns in a Murine Model GS1 A. Vinci*,S. Li,M.J. Stamos,A. Pigazzi,Orange, CA;S. Jellbauer,M. Raffatellu,Irvine,CA 11:08am Discussion 11:10am Colonoscopy After Left-Sided Diverticulitis: Utility or Futility? GS6 A.S. Walker*,J. Bingham,K. Janssen, E.K. Johnson,S.R. Steele,Tacoma,WA; J.A. Maykel,Worcester,MA;O. Ocampo,West Fairview,QuezonCity,Philippines;J.P. Gonzalez, Cebu,Philippines 10:21am Discussant 10:24am Discussion 10:26am Combining Old with New: Bowel Rest and Biologic Therapy Aid in the Surgical and Medical Management of Penetrating GS2 Ileocolic Crohn’s Disease M.D. Wagner*,M. McNally,J. Duncan, Bethesda,MD,|N. Jaqua,M. Ally,J. Betteridge, Bethesda,MD 11:16am Discussant 11:19am Discussion 11:21am Robotic versus Open Total Mesorectal Excision: A Comparison of Clinical and Pathologic GS7 Outcomes J.L. Agnew*F.M. Chory,P.D. Strombom, G. Bonomo,NewYork,NY;K.A. Melstrom, W.E. Enker,J.E. Martz,NewYork,NY 10:32am Discussant 10:35am Discussion 10:37am Laparoscopic Radical Resection after Transanal Endoscopic Microsurgery: Is it Feasible and Safe? M. Masse*,A. Bouchard,A. Laliberté, A. Lebrun,S. Drolet,Quebec,QC,Canada 1.5 CME 11:27am Discussant GS3 11:30am Discussion 11:32am Relative Benefits and Risks of Alternative Modes of Bowel Preparation to Prevent SSI Following Elective Colorectal Resection GS8 N. Esnaola,FoxChaseCancerCenter, Philadelphia,PA;S. Koller*,R. Smith, S. Jayarajan,M. Philp,H.M. Ross,H. Pitt, Philadelphia,PA 10:43am Discussant 10:46am Discussion 10:45am Adjuvant Chemoradiation in the Management of T2N0 Rectal Cancer: A Population Based Clinical Outcomes Study Involving 4,054 Patients from the Surveillance Epidemiology and End Result (SEER) Database (1973–2010) GS4 K. Mahendraraj*,V. Chakravorty,N. Ghalyaie, R.S. Chamberlain,WestOrange,NJ 11:38am Discussant 11:41am Discussion 11:45am Adjourn 10:54am Discussant 10:57am Discussion 10:59am Does Cyanoacrylate Glue Reinforcement Reduce Anastomotic Failure? Results of an GS5 Experimental Comparative Study W. Gaertner,Minneapolis,MN; E. Nunez-Garcia,I. Baley-Spindel,J. MedinaLeon,R. Sordo-Mejia*,MexicoCity,DF,Mexico 50 Return to Table of Contents Tuesday, June 2 Masters in Colorectal Surgery Lectureship Honoring David Schoetz, Jr., MD 11:45 am – 12:15 pm The Value of Mentorship .5 CME Patricia L. Roberts, MD Chair, Division of Surgery Lahey Hospital and Medical Center Burlington, MA Professor of Surgery Tufts University School of Medicine Boston, MA Introduction: Thomas Read, MD Complimentary Box Lunch in the Exhibit Hall and ePoster Presentations 12:15 – 1:30 pm Women in Colorectal Surgery Luncheon 12:15 – 1:30 pm • Complimentary • Registration Required TheWomen’sLuncheonoffersanopportunityforwomentorenew friendshipsandmakenewcontacts.Femalesurgeons,residentsand medicalstudentsattendingtheAnnualMeetingarewelcome. TraineesareparticularlyencouragedtoattendastheWomen’s Luncheonprovidesanopportunitytomeetexperiencedcolonand rectalsurgeonsfromavarietyofsettings. 51 Return to Table of Contents Tuesday, June 2 Symposium Parallel Session 8-A Anal Cancer: Prevention, Diagnosis and Treatment 1.5 CME 1:30 – 3:00 pm Analcancer,unlikecolorectalcancer,hasbeenincreasinginprevalenceoverthelast20years.Whilethe treatmentofanalcancerhaslargelyremainedunchanged,thedefinitionsofwhatconstitutesananalcancerhave changed.Further,theterminologyfortheanalcancerprecursorlesion,high-gradesquamousintraepitheliallesion(HSIL) hasbeenstandardized.Finally,studieshaveshownthatuntreatedprecursorlesionsmayprogresstoanalcancer substantiatingtheproposalthattreatmentofprecursorlesionsmaydecreaseanalcancerrates.Thissessionwillreview thecurrentunderstandingofprevention,diagnosisandtreatmentofpremalignantandmalignantlesionsoftheanus andperianus. Existing Gaps What Is: Thereisconfusionabouthowtodefinelesionsintheperianusasanalorperianal;alongwithconfusionabout efficacyandtheneedfortreatmentofpremalignantlesionsoftheperianus.Thereismixedusageofoldterminologyfor analandperianallesions. What Should Be: Therewillbeacommonunderstandingofwhatconstitutesanalandperianal.Therewillbeacommon ofstandardterminologythatappliestotheloweranogenitaltractandhasbeenpromulgatedbytheAmericanCollege ofPathology. Director: Mark Welton, MD, Stanford, CA Assistant Director: Janice Rafferty, MD, Cincinnati, OH 1:30pm Introductions MarkWelton,MD,Stanford,CA JaniceRafferty,MD,Cincinnati,OH 1:35pm Anatomic and Histologic Definitions GenevieveMelton-Meaux,MD,Minneapolis,MN 1:50pm Who Should be Screened for Anal Cancer? RoccoRicciardi,MD,Burlington,MA 2:05pm How to Do the Screening and Who Should Do It? BruceRobb,MD,Indianapolis,IN 2:20pm How Do We Manage Pre-Cancerous Lesions? NatalieKirilcuk,MD,Stanford,CA 2:35pm What Is the Treatment and Expected Outcomes of Patients with Anal Cancer Both Immuncompetent and Immunocompromised? LarissaTemple,MD,NewYork,NY 2:50pm Panel Discussion 3:00pm Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Explainthecurrentterminology surroundinghistologicfindingsofsquamouslesionsoftheanusandperianus;b)Explainthecurrent terminologyusedtodefinelesionsoftheanusandperianusaseitheranalorperianal;andc)Describethe currenttreatmentrecommendationsforanalandperianalcancer. 52 Return to Table of Contents Tuesday, June 2 Abstract Session Parallel Session 8-B Inflammatory Bowel Disease 1.5 CME 1:30 – 3:00 pm 1:30pm IBD: A Growing and Vulnerable Cohort of Hospitalized Patients with Clostridium Difficile Infection S27 A. Mabardy*,J. Coury,L. Ozcan,J. McCarty, A. Merchant,C. Armstrong,A. Hackford,H. Dao, Boston,MA 1:37pm Discussion 1:40pm Clostridium Difficile Infection in Ulcerative Colitis: Can Alteration of the Gut-Associated Microbiome Contribute to S28 Pouch Failure? K. Skowron*,M. Rubin,R.D. Hurst,N. Hyman, K. Umanskiy,Chicago,IL;B. Lapin,Evanston,IL 1:47pm Discussion 1:50pm Does Stool Leakage Increase in Aging Ileal Pouches? H. Kim*,L. Sun,B. Gurlanb,T.L. Hull, M. Zutshi,Cleveland,OH Discussion 2:00pm Proctocolectomy: Impact on Relationship Quality in Ulcerative Colitis Patients and their Partners S30 J.N. Cohan*,J. Rhee,E. Finlayson,M.G. Varma, SanFrancisco,CA Discussion 2:10pm Rates of Colectomy for Ulcerative Colitis in the Era of Biologic Therapy C. Kin*,M.L. Welton,C. Woo,Stanford,CA; A.L. Lightner,LosAngeles,CA 2:17pm Discussion 2:20pm ESCP Best Paper 2:27pm Discussion 2:30pm Kono-S Anastomosis Devised for Aurgical Prophylaxis of Anastomotic Recurrence in Crohn’s Disease: A Multicenter Study in S33 Japan and the United States T. Kono*,Sapporo,Japan;A. Fichera,M. Krane, Seattle,WA;K. Maeda,Nagoya,Japan;Y. Sakai, Kyoto,Japan;H. Ohge,Hiroshima,Japan; M. Shimada,Tokushima,Japan;D. Rubin, Chicago,IL;A. Maemoto,Sapporo,Japan; F. Michelassi,NewYork,NY 2:37pm Discussion 2:40pm Ileostomy Closure Site Fascial Reinforcement with Cross Linked Acellular Porcine Dermis Biologic Mesh Yields No Incisional Hernias at 1 Year of Follow-Up M. Brozovich*,Wexford,PA S29 1:57pm 2:07pm The Healing Effect of Mesenchymal Adipose-Tissue-Derived Stem Cells on Colonic Anastomosis Under Ischaemic Condition S32 TonyW.C. Mak*,DonW.C. Chin,JanetF.Y. Lee, PaulB.S. Lai,AnthonyW.I. Lo,PingKuenLam, SimonS.M. Ng,Shatin,HongKong S31 2:47pm Discussion 2:50pm Q&A 3:00pm Adjourn S34 *PresentingAuthor 53 Return to Table of Contents Tuesday, June 2 Abstract Session Parallel Session 8-C Research Forum 1.5 CME 1:30 – 3:00 pm 1:30pm Lymph Node Stromal Cell Microvesicles Mediate Colon Cancer Metastasis RF1 D. Margolin*,P.E. Miller,H. Green-Matrana, E. Flemington,X. Zhang,L. Li,NewOrleans,LA 2:25pm 1:36pm Discussant 2:31pm Discussant 1:39pm Discussion 2:34pm Discussion 1:41pm Diverticulitis and Crohn’s Disease Have Distinct But Overlapping Tumor Necrosis RF2 Superfamily 15 (TNFSF15) Haplotypes T.M. Connelly*,Dublin,Ireland;C.S. Choi, W. Koltun,A. Berg,J. Coble,Hershey,PA 2:36pm Mesna and Hydroxypropyl Methylcellulose Assists in Delayed Submucosal dDssection RF7 in a Rabbit Cecal Model G. Subhas*,M. Patel,J.S. Bhullar,V. Mittal, Southfield,MI 1:47pm Discussant 2:42pm Discussant 1:50pm Discussion 2:45pm Discussion 1:52pm Combination Therapy for Colorectal Cancer Metastasis using an Orthotopic Xenograft Model RF3 D. Margolin,B.A. Reuter*,L. Li,X. Zhang,New Orleans,LA 2:47pm 1:58pm Discussant Genetic Heterogeneity in Rectal Cancer Identification of Subpopulations of Tumor Cells Resistant to Neoadjuvant CRT RF8 R. Perez,F. Bettoni*,A. Camargo, E. Donnard,B. Correia,F. Koyama,P. Galante, A. Habr-Gama,J. Gama-Rodrigues, SaoPaulo,Brazil 2:01pm Discussion 2:53pm Discussant 2:03pm Depletion of let-7 microRNAs in the Intestinal Epithelium Promotes Upregulation of Oncofetal mRNAs and Intestinal Carcinogenesis RF4 A.N. Jeganathan*,R. Mizuno,A.K. Rustgi, Philadelphia,PA;B.B. Madison,St. Louis,MO 2:56pm Discussion 3:00pm Adjourn 2:09pm Discussant 2:12pm Discussion 2:14pm Mesenchymal Stem Cells following Local Electrical Stimulation Improves Function in a Rat Anal Sphincter Injury Model at a Time Remote from Injury RF5 L. Sun*,Z. Xie,M. Zutshi,M. Damaser, Cleveland,OH 2:20pm Discussant 2:33pm Discussion 54 Antitumor Activity of Dietary Phytochemicals in Colorectal Cancer B. Megna*,P. Carney,M. Nukaya, G.D. Kennedy,C. Diaz-Diaz,Madison,WI RF6 Return to Table of Contents Tuesday, June 2 Symposium Parallel Session 9-A Medical Legal Symposium: How to Protect Yourself 1.5 CME 3:00 – 4:30 pm Althoughtraditionallyphysicianshavefocusedonprofessionalliabilityrelatedtomedicalcaredelivery,theworld hasbecomemorecomplexandnowlegalexposureextendstomanyotherinteractions.Physiciansmustunderstand theimportancetomaintainaprofessionalandconstructiverelationshipwiththeirpatients,whileaccuratelyand contemporaneouslydocumentingthefactsoftheencounter.Anaccurateandcompletemedicalrecordisessentialto confirmboththethoughtprocessatthetimebutalsotheimmediatelyavailablefacts.However,allsurgeonswillface complicationsandmanagingboththediscussionaroundtheoccurrenceandthemanagementofthecomplicationare importantcomponentsforreducingtheriskoflitigation.Thereisacurrenttrendattheinstitutionallevelto“apologize”; however,thisprocessmustbemanagedwelltoavoidconfusingadverseoutcomefromactualerrorinthemindsofthe patientandhis/herfamily. Thecomplexityofthemedicalbillingprocessisanotherareaofincreasingrisktothecolorectalsurgeon.Onceagain accuratedocumentationisessentialtosupportaclaimsubmission.Thesurgeonshouldalsounderstandtheprocessfor correctcodeselection,useoftrackingcodes,andmodifierusetosupportaccuratereimbursement. Existing Gaps What Is: Communicationisanimportantcomponentwhichreducestheriskofhavingamedicalmalpracticeclaimfiled againstyou.However,giventhecurrentclimateevenrecognizedtreatmentcomplicationsareapotentialriskofsuch action.Currently,manycolorectalsurgeonsareunfamiliarwiththevalueofappropriate,timely,andaccurate documentationofclinicalencounterstoreduceexposureshouldamalpracticeclaimbefiled.Theentireprocessfrom discoverythroughtrialissomethinggenerallyunfamiliartomanycolorectalsurgeonsandthesetopicsarerarelytaught duringtraining.Inaddition,mostcolorectalsurgeonsareunfamiliarwiththevariousrulesandregulationsrelatedtoboth documentationofclinicalencountersandclaimssubmissions.ThesegapsincludeknowledgeofcriteriaforE/Mcode selection,modifieruse,andimplementationofcorrectcodinginitiativerulestoallowaccurateandcompleteclaims submission.Similarly,themajorityofcolorectalsurgeonshavelittleknowledgeorunderstandingofemploymentcontract lawandtheinteractionsoftheserequirementswithStarkprovisionsandothercomplexissuesrelatedtomovingfrom privatepracticetocorporateemployment.Finally,directcontractingwithlargepayorsisamajorchallengeforcolorectal surgeons.Itisimportanttofullyunderstandthecomplexlanguagesurroundingpatientvolumes,qualityindicatorsand reporting,preauthorizationrules,claimsdenialsandclaimsadjudication. What Should Be: Thecolorectalsurgeonshouldunderstandhis/herroleandthespecificcomponentsofclinical documentationandclaimsubmissionforpatientencounters.Equallyso,thecolorectalsurgeonconsideringsellinghis/her practiceordirectlyenteringcorporateemploymentaftertrainingshouldbeabletodiscussthekeycomponentsofa contractforsuchemployment.Colorectalsurgeonsshouldfullyunderstandtheirrightsandprivilegesundercontractual relationshipswithinsurerstoassurefullandcompletereimbursementwhilelimitingunnecessaryadministrativeoverhead. Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Formulatetheroleoftimelyand accurateclinicaldocumentationinreducingexposureinamedicalliabilityactionagainstacolorectalsurgeon; b)Explaintheprocessofamedicalliabilityactionagainstacolorectalsurgeon;c)Implementappropriate clinicaldocumentation,codeselection,andmodifieruseforaccurateclaimsubmissiontoinsurancepayors; d)Reviewthecomponentsofemploymentcontractsandtherightsandprivilegesexpectedbyacolorectal surgeontransitioningfromeitherprivatepracticeorresidencytrainingintofulltimecorporateemployment; ande)Definethecomponentsofcontractualrelationshipswithpayorstoassurefullandprompt reimbursementwhileavoidinglegalexposures(ieStarkregulationsetc). Continued next page 55 Return to Table of Contents Tuesday, June 2 Medical Legal Symposium: How to Protect Yourself (Continued) Director: Anthony Senagore, MD, Parma, OH Assistant Director: Kyle Cologne, MD, Los Angeles, CA Professional Liability MichaelStamos,MD,Orange,CA 4:00pm Insurance Contracting FrankOpelka,MD,NewOrleans,LA 3:20pm Medical Documentation Billing GuyOrangio,MD,NewOrleans,LA 4:20pm Panel Discussion 4:30pm Adjourn 3:40pm Employment Contracting MartinLuchtefeld,MD,GrandRapids,MI Photo Credit: Greater Boston Convention & Visitors Bureau 3:00pm 56 Return to Table of Contents Tuesday, June 2 Symposium Parallel Session 9-B Anal Fistulas: Diagnosis, Imaging and Therapy – Rational Approaches 1.5 CME 3:00 – 4:30 pm Analfistularepresentsoneofthemostcommonandchallenginganorectaldiseasesencounteredbysurgeons. Theprinciplesofsuccessfultreatmentincludeappropriatediagnosis,destructionoftheinternalopeningwith preservationofsphincterfunction.Primarylay-openfistulotomyhasahighsuccessrateintreatingfistulas;however,most surgeonsarereluctanttoperformthisprocedureininstanceswheresubstantialimpairmentofcontinencemayresult.Asa result,severalalternativetreatmentshavebeenpursuedwhichdonotinvolveanalsphincterdivision.Rectalmucosal advancementflap,lateralintersphinctericfistulatransaction(LIFT),andcollagenplughaveallbeendescribedassphincter sparingfistulatreatmentswithvaryingdegreesofsuccess.Understandingtheindications,limitations,andsuccessratesof thevarioustreatmentmodalitieswouldallowformoreeffectiveandefficienttreatmentoffistulainano. Existing Gaps What Is: Therearemanytreatmentoptionsforthetreatmentofanalfistulas.Thegoalsoffistularesolutionandsphincter preservationappeartobeatoddsgivencurrenttreatments.Multipleoptionsareavailableinthemanagementofchronic analfissures. What Should Be: Surgeonswillunderstandtheappropriatediagnosisindications,successrates,andcomplicationsofthe treatmentsavailableforanalfistulas. Director: Charles Whitlow, MD, New Orleans, LA Assistant Director: Jennifer Beaty, MD, Omaha, NE 3:00pm Fistulotomy – Does it Still Have a Place? M.BenjaminHopkins,MD,Raleigh,NC 3:52pm LIFT SeanLangenfeld,MD,Omaha,NE 3:13pm Setons – How and When JasonHall,MD,Burlington,MA 4:05pm New Innnovations for Fistulas JamesMcCormick,DO,Pittsburgh,PA 3:26pm Advancement Flaps – 90% Success! Really?? RebeccaHoedema,MD,GrandRapids,MI 4:18pm Discussion 4:30pm Adjourn 3:39pm Fistula Plugs and Glue MichaelSnyder,MD,Houston,TX Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Definethedifferenttreatment modalitiesavailableforanalfistula;andb)Developanalgorithmforthemanagementofdifferenttypesof analfistula. Refreshment Break in Foyer 4:30 – 5:00 pm 57 Return to Table of Contents Tuesday, June 2 After Hours Debate 1.25 CME 5:00 – 6:15 pm Allsurgicalspecialtieshavecertaintopics/diseasesthatcontaincontroversy.Understandingtheoptimal treatmentplanforpatientsoftendependsonaphysician’sabilitytoseeclarityintheselinesofgray.Debatesare excellenttoolstoshowdifferencesinperspectiveandopinionregardingthesetopics.Theyeffectivelychallengeandbreak downsurgicaldogmaandopenpeopletonewpointsofview.Theyoftenhelpaudiencememberscrystalizetheirown valuesandbeliefs.Speakerswithpassionateviewsaboutopposingtreatment,withclearguidelinesforthedebate,can effectivelycreateaneffectiveandnovellearningenvironment.Furthermore,anassertiveandexperiencedmoderatorcan challengethespeakersandengagetheaudiencetobothoptimizecriticalthinkingandillustratewhattreatmentplanmay bebestfordifferentscenarios. Existing Gaps What Is: Treatmentofchronicanalfissurehasevolvedtothepointthatsurgeryisstudiouslyavoidedinfavorofdifferent medicalregimens.Rectalprolapsesurgeryintheformoftransabdominalrectopexyhasbecomeaminimallyinvasive procedure–includingincreasinguseoftherobot. What Should Be: Treatmentofanalfissuresshouldbeappropriatelybalancedbetweenoperativeandnon-operative approaches.Operationswiththerobotshouldbejustifiablewithrespecttooutcomesandcost. Moderator: David Schoetz, Jr., MD, Burlington, MA 5:00pm Anal Fissure – Is It a Surgical Disease? Debating: PhillipFleshner,MD,LosAngeles,CA vsNeilHyman,MD,Chicago,IL 5:30pm Rectal Prolapse in the Robotic Age Debating: BradleyChampagne,MD,Cleveland,OH vsToddFrancone,MD,Burlington,MA 6:15pm Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Developasensibleapproachto thecureofchronicanalfissure;andb)Evaluatetheappropriateoperativetechniquesforperformanceof transabdominalrectopexy. Residents’ Reception 6:30 – 8:00 pm GeneralSurgeryresidentswillhaveanopportunityto networkandinteractwithcolorectalprogramdirectors. Open to general surgery residents and colorectal program directors only. 58 Return to Table of Contents Wednesday, June 3 Meet the Professor Breakfasts 6:30 – 7:30 am Limit: 30 per breakfast • Fee $40 • Tickets Required • Continental Breakfast Registrants are encouraged to bring problems and questions to this informal discussion. Please register early and indicate your 1st and 2nd choice on the Registration Form. W-1 Complex Fistula AnnLowry,MD,St.Paul,MN ScottStrong,MD,Cleveland,OH W-2 Stage 4 Cancer (What to Do) EricSzilagy,MD,Detroit,MI JulioGarcia-Aguilar,MD,PhD,NewYork,NY W-3 Pilonidal Disease: Options and Outcomes RichardBillingham,MD,Seattle,WA EricJohnson,MD,FortLewis,WA W-4 Enhanced Recovery Pathways CraigReickertMD,Detroit,MI ConorDelaney,MD,PhD,Cleveland,OH 1.0 CME W-5 Non-Operative Management of Rectal Cancerthe Right Patient RodrigioPerez,MD,PhD,SaoPaulo,Brazil PhilipPaty,MD,NewYork,NY W-6 Parastomal Hernia and Stoma Complications W.BrianPerry,MD,SanAntonio,TX WalterPeters,Jr.,MD,Columbia,MO Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Describetheproceduresand approachesdiscussedinthissession. 59 Return to Table of Contents Wednesday, June 3 Symposium Parallel Session 10-A Colon Cancer: Staging, Techniques and the Role of Adjuvant Therapy 1.5 CME 7:30 – 9:00 am Thepast50yearshasseensubstantialprogressinourunderstandingandinthemanagementofcolonandrectal cancer(CRC).Surveillancecolonoscopywithresectionofpremalignantpolypshasledtoadecreasedincidenceof CRCeventhoughcompliancewiththerecommendationsissuboptimal.Epidemiologicandgeneticinformationallowusto identifyindividualsatriskforcancerandshouldallowustopreventthediseaseinmanyindividuals.Patientsdiagnosed withadvancedCRClivemuchlongerthaninthepast,andmanyarecured.Thisisattributedtomanyfactors,including cross-sectionalimagingthatproperlystagespatientandidentifiesmetastasesearlier,newsurgicalapproachesand numerousnewchemotherapies.Higherresolutionimagingmodalitieshaveimprovedtheabilitytoproperlystage patients;surgicaladvancesincludeminimallyinvasiveproceduresandlaparoscopic-assistedproceduresandsaferand moreextensivelymphaticclearance.Biologictherapieshavenotyetbeenmaximized,butwearelearningwhenandwhere someshouldbeused.Soonweexpecttobestagingpatientsbybiologicandgeneticcharacteristicsratherthanbygross pathology-treatingpatientsbasedonbiologicfeaturesbutpreferablyidentifyingpeopleatriskandpreventing CRCaltogether. Existing Gaps What Is: Coloncancersurgeryisperformedbyalargenumberofgeneralandcolorectalsurgeonsinthecountry.Evenin theelectivesettingalargenumberofcasesareperformedthroughalaparotomy,withincompletepreoperativestaging andlimitedlymphaticclearance.Furthermoretheuseofadjuvantchemotherapyvariesextensivelyacrossspecialties, practicetypesandpatientpopulations. What Should Be: Surgeonsshouldunderstandproperstagingandsurgicaltechniques,indicationsforadjuvanttherapyand theneedforamultidisciplinaryevaluationandmanagementofcoloncancerpatients. Director: Alessandro Fichera, MD, Seattle, WA Assistant Director: Martin Weiser, MD, New York, NY 7:30am Introduction MartinWeiser,MD,NewYork,NY 7:35am 7:50am 8:05am 8:20am Preoperative Staging. What Does the Surgeon Needs to Know? LawrenceSchwartz,MD,NewYork,NY Stage II Colon Cancer. Who Needs Adjuvant Chemo and Why? BlasePolite,MD,Chicago,IL 8:35am Going Beyond MIS in Colon Cancer Surgery. Less is More. PeterMarcello,MD,Burlington,MA Molecular Classification of Colorectal Cancer: Current Status. DavidShibata,MD,Tampa,FL 8:50am Panel Discussion 9:00am Adjourn Total Mesocolic Resection for Colon Cancer. Magic Bullet? HermannKessler,MD,PhD,Cleveland,OH Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Describetheuseofimagingfor preoperativestaging;b)IdentifywhentorecommendMISinthemanagementofcoloncancer;c)Definebasic theoriesoflymphaticclearance;andd)Recognizenewcriteriaandprognosticfactorsasindicationfor adjuvanttherapy. 60 Return to Table of Contents Wednesday, June 3 Abstract Session Parallel Session 10-B Outcomes 1.5 CME 7:30 – 9:00 am 7:30am Frailty Predicts Dath, Disability and Institutionalization in Patients Undergoing Elective Colectomy S35 Z. Torgersen,R.A. Forse,D. Mukkai Krishnamurty*,A. Kallam,S.J. Langenfeld, J. Johanning,Omaha,NE 7:37am Discussion 7:39am Decreased Narcotic Consumption with the Addition of IV-Acetaminophen in Colorectal Patients: A Prospective, Randomized, Double-Blinded, PlaceboS36 Controlled Study C. Juergens,C. Ogg,W. Sergent,J. Ying, A.H. Aryaie*,S. Lalezari,T. Husted,C. Ratermann, Cincinnati,OH 7:46am Discussion 7:49am Patients Prefer Propofol for Conscious Sedation at Colonoscopy When Compared to Midazolam and Fentanyl S37 C. Schroeder*,R. Tocco-Bradley,J. Obear, C. Kaoutzanis,R.K. Cleary,K. Welch, AnnArbor,MI 7:56am Discussion 7:59am The Temporary Cessation of Clopidogrel and the Risk of Thrombotic or Bleeding Events in Patients Undergoing Colonoscopy S38 P.E. Miller*,M. Bailey,M. Thomas,S. Pawlak, D. Beck,T. Hicks,H. Vargas,C. Whitlow, D. Margolin,NewOrleans,LA 8:06am Discussion 8:09am Extending the Mandate for ExtendedDuration Thromboprophylaxis: Risk Factors for Post-Discharge Venothromboembolism in Colorectal Resections S39 J.C. Iannuzzi*,C.T. Aquina,A.S. Rickles, B.J. Hensley,K. Noyes,J. Monson,F. Fleming, Rochester,NY 8:16am Discussion 8:19am A Model of Cost Reduction and Standardization: Improved Cost Savings S40 While Maintaning the Quatlity of Care M. Guzman*,K. Umanskiy,Chicago,IL;M. Gitelis, J.G. Linn,M.B. Ujiki,J.P. Muldoon,Evanston,IL 8:26am Discussion 8:29am Failing to Prepare is Preparing to Fail: A Single Blinded Randomized Controlled Trial to Determine the Impact of a Preoperative Instructional Video on Resident's Ability to Perform Laparoscopic S41 Colectomy B. Crawshaw*,C.P. Delaney,W.C. Mustain, A.J. Russ,S. Shanmugan,B.J. Champagne, Cleveland,OH;S.R. Steele,Tacoma,WA;D. Lee, Albany,NY 8:36am Discussion 8:39am Surgical Specialization Increases Lymph Node Yield: Evidence From a National Database A.N. Jeganathan*,S. Shanmugan,J. Bleier, G.M. Hall,E.C. Paulson,Philadelphia,PA 8:46am Discussion 8:56am Q&A 9:00am Adjourn S42 *PresentingAuthor 61 Return to Table of Contents Wednesday, June 3 ASCRS/SSAT Symposium Parallel Session 11-A Challenges and Controversies: Surgical Management of Advanced Disease and Recurrent Cancer 1.5 CME 9:00 – 10:30 am Thesurgicalandmedicaltreatmentofearlystagecolonandrectalcancerisfairlystraightforwardandanumber ofguidelinesexist(NCCN,AmericanCancerSociety,ASCRS)tohelpcliniciansmanagetheirpatientswithcancer. However,therearemanycomplexsituationsthataredifficulttomanageandstrategiesfordealingwithlocallyadvanced disease,variouspatternsofdistantmetastaticdiseaseandrecurrentdiseasearenotcoveredinguidelines.Inaddition, advancesinchemotherapymeanthatpatientswithadvanceddiseasearesurvivingforlongerperiodsoftimeandduring theseextendedsurvivalperiods,surgeonsarenotinfrequentlyaskedtointerveneinwaysthatinthepastmayhavenot beenconsideredevenremotelyreasonable.Inthissetting,cliniciansfaceissuesthatrequirediscussionanddirection.The aimofthissessionwillbetoofferevidencebasedguidancetocliniciansfacedwithdifficultissuescenteredontreating advancedandrecurrentcolonandrectalcancer. Existing Gaps What Is: Therearemanycomplexsituationsthataredifficulttomanage,andstrategiesfordealingwithlocallyadvanced disease,variouspatternsofdistantmetastaticdiseaseandrecurrentdiseasearenotcoveredinguidelines.That,with advancesinchemotherapyallowingpatientstolivelonger,meanssurgeonsareaskedtointerveneinwaysthatinthepast mayhavenotbeenreasonable. What Should Be: Surgeonsshouldbeabletouseevidence-basedguidancewhenfacedwithdifficultissuescenteredon treatingadvancedandrecurrentcolonandrectalcancer. Director: Kirk Ludwig, MD, Milwaukee, WI Assistant Director: Julio Garcia-Aguilar, MD, PhD, New York, NY 9:00am New Chemotherapy Paradigms for Stage 4 Disease: Can the Surgeon Help by Reducing Tumor Burden and Does this Make Sense? CathyEng,MD,Houston,TX 9:36am Contemporary Management of Carcinomatosis from Colon or Rectal Cancer: What Is Reasonable and Possible? KiranTuraga,MD,Milwaukee,WI 9:12am Epithelial-Mesenchymal Transition and Somatic Alteration in Colorectal Cancer with and without Peritoneal Carcinomatosis YuryShelygin,MD,Moscow,Russia 9:48am Chasing Advanced Lymph Node Disease: When and Why? AlessandroFichera,MD,Seattle,WA 9:24am Managing Liver Metastases: Staged Resection, Combined Resection, or Liver First? MichaelD'Angelica,MD,NewYork,NY 10:00am Case Discussion and Questions 10:30am Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Explainnewchemotherapeutic regimensfortreatingStage4colorectalcancerandtheroleofthesurgeonintreatingStage4disease;b) Describecontemporarymanagementofcarcinomatosisfromcolorectalcancer;andc)Explainwhenandwhyit mightbereasonabletodoextendeddissectionsandlymphnodedissectionsforcolorectalcancer. 62 Return to Table of Contents Wednesday, June 3 Abstract Session Parallel Session 11-B Best Videos 1.5 CME 9:00 – 10:30 am 9:00am Martius Flap For Rectovaginal Fistulas K. Kniery*,S. Steele,Tacoma,WA WV1 9:07am Discussion 9:10am Robotic-Assisted Repair of WV2 Rectal Prolapse J. Mino*,M. Zutshi,B. Gurland,Cleveland,OH 9:17am Discussion 9:20am Transperineal Minimally Invasive WV3 Approach in Miles Operation S. Hasegawa*,R. Takahashi,K. Hida,K. Kawada, Y. Sakai,Kyoto,Japan;S. Kato,Y. Kadokawa, Y. Asao,Tenri,Japan 9:27am Discussion 9:30am Laparoscopic Repair of Perineal Hernia S. Brathwaite*,S. Husain,A. Harzman, Columbus,OH 9:37am Discussion 9:40am Full Thickness Excision for Benign Colon Polyps Using Combined Endoscopic Laparoscopic Surgery WV5 P.R. O'Mahoney*,J.W. Milsom,J.D. Smith, S.W. Lee,NewYork,NY 9:57am Discussion 10:00am Transanal Minimally Invasive Surgery with Inadvertent Rectal Injury and Repair M. Harfouche*,M. Philp,H.M. Ross, Philadelphia,PA WV7 10:07am Discussion 10:10am Laparoscopic Low Anterior Resection, Transanal Total Mesorectal Endoscopic WV8 Resection for Low Rectal Cancer M.H. Hanna*,G. Hwang,L. Malellari,A. Pigazzi, Orange,CA 10:17am Discussion 9:47am Discussion 9:50am Robotic-Assisted Low Anterior Resection with Transanal Extraction: Single Stapling Technique and Fluorescence Evaluation of Bowel Perfusion M.D. Jafari*,J.C. Carmichael,A. Pigazzi, Orange,CA 10:20am Wide Local Excision of Perianal Paget’s Disease with Gluteal Flap Reconstruction WV9 G. Melich*,K. Kochar,J. Calata,A. Pai,J. Park, L. Prasad,S. Marecik,ParkRidge,IL WV4 10:27am Discussion 10:30am Adjourn WV6 Refreshment Break in Foyer 10:30 – 11:00 am *PresentingAuthor 63 Return to Table of Contents Wednesday, June 3 Symposium Parallel Session 12-A Optimizing Treatment for Rectal Prolapse, Constipation and Obstructed Defecation Syndrome 1.5 CME 11:00 am – 12:30 pm Themanagementofrectalprolaspehasbeenthedebatefor100yearssinceMoschowitzfirstdescribedits pathogenesis.Sincethattime,over100operationshavebeendescribedforthecorrectionofprolapseoftherectum. Theoperativeapproachescanberoughlydividedintoabdominalandperinealcategories.Theevaluationprocessand decisionmakingwithrespecttothechoiceofsurgicalprocedureandspecifictechniqueswillbereviewed.Thesurgical managementofconstipationrequiresathoroughunderstandingofbothcolonicfunctionandtheevacuatorymechanism. Theevaluationofpatientswiththesedisordersandtheirsurgicaltreatmentoptionswillbepresented. Existing Gaps What Is: Manysurgeonsareunfamiliarwithallofthenewapproachestorepairrectalprolapse.Theydonothave experiencewithdifferentfixationandminimallyinvasivetechniquesavailable.Surgeonsfrequentlyarenotfamiliar withthephysiologictestingavailablefortheevaluationofconstipationandtheirsignificanceandimpactonsurgical decisionmaking. What Should Be: Surgeonsshouldbecomfortablewithseveralfixationtechniquestorepairprolapse.Theyshould haveanunderstandingofthedifferentrepairsavailableandtheirutilityintreatingdifferentpatientpopulations.Surgeons shouldbefamiliarwiththephysiologicevaluationtoolsavailableforconstipatedpatientsandhaveastrategyfor surgicalmanagement. Director: Dana Sands, MD, Weston, FL Assistant Director: Virginia Shaffer, MD, Atlanta, GA 11:00am Functional Disorders: What Tests are Necessary? HeidiBahna,MD,Miami,FL 11:45am Constipation: Surgical Indications and Outcomes MassaratZutshi,MD,Cleveland,OH 11:15am Rectal Prolapse Abdominal Repairs: Fixation and Resection Techniques BrookeGurland,MD,Cleveland,OH Noon 11:30am Rectal Prolapse Perineal Repairs: Still Relevant in the Era of Laparoscopy? JosephCarmichael,MD,Orange,CA 12:15pm Discussion Obstructed Defecation: Is it Surgically Correctable? LilianaBordeianou,MD,Boston,MA 12:30pm Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Describetheabdominal approachesanddifferentfixationtechniquesavailablefortreatmentofrectalprolapse;b)Explaintheperineal approachesanddifferentresectiontechniquesforthetreatmentofrectalprolapse;c)Describethevalueof laparoscopyinthemanagementofprolapse;d)Identifythetoolsavailabletoevaluateconstipationand evacuatorydysfunction;ande)Planatreatmentalgorithmforthemanagementofconstipationindifferent clinicalsettings. 64 Return to Table of Contents Wednesday, June 3 Abstract Session Parallel Session 12-B Neoplasia II 1.5 CME 11:00 am – 12:30 pm 11:00am Colorectal Specialization Improves Survival in Colorectal Cancer G.M. Hall,E.C. Paulson*,J. Bleier, A.N. Jeganathan,S. Shanmugan, Philadelphia,PA 11:51am Relative Value of Restaging MRI, CT and PET after Preoperative Chemoradiation for Rectal Cancer S49 D. Schneider*,A.C. Lynch,S. Warrier,A.G. Heriot, T. Akhurst,M. Michael,S. Ngan,EastMelbourne, VIC,Australia S44 11:07am Discussion 11:11am Enhanced Recovery Protocols in Colorectal Scheduled Surgery: Could We Do Better By Doing Less? J. Ramirez*,E. Redondo,P. Royo,J. Gracia, B. Calvo,P. Carrera,Zaragoza,Spain 11:58am Discussion 12:01pm Predictors of Outcome for Endoscopic S50 Colorectal Stenting M.A. Abbas*,G. Kharabadze,AbuDhabi,United ArabEmirates S45 11:18am Discussion 12:08pm Discussion 11:21am Does CD10 Expression Predict Lymph Node Metastasis in Colorectal Cancer? S46 I. Bernescu*,A. Reichstein,M. Luchtefeld, J. Ogilvie,A. Davis,W. Chopp,GrandRapids,MI 12:11pm British Traveling Fellow TBD S51 12:17pm Discussion 12:20pm Surgical Site Infection Rates Following Implementation of A Colorectal Closure Bundle In Elective Colorectal Surgeries A. Ghuman*,C.J. Brown,A.A. Karimuddin, M.J. Raval,T.P. Phang,Vancouver,British Columbia,Canada 11:28am Discussion 11:31am Robotic Colorectal Surgery: How Honest are the Authors’ Conclusions? An Assessment of Reporting and Interpretation of the Primary Outcomes S47 B. Howe,J. VanKoughnett,London,ON,Canada; S.V. Patel,NewYork,NY;S. Wexner,Weston,FL S52 12:27pm Discussion 12:30pm Adjourn 11:38am Discussion 11:41am Features Associated with Metastases Among Well-Differentiated Neuroendocrine (Carcinoid) Tumors of the Appendix: The Significance of Small Vessel Invasion In Addition to Size S48 D.A. Kleiman*,B.M. Finnerty,T. Beninato, R. Zarnegar,G. Nandakumar,T.J. Fahey,III, S.W. Lee,NewYork,NY 11:48am Discussion Lunch on your own 12:30 – 1:30 pm *PresentingAuthor 65 Return to Table of Contents Wednesday, June 3 Symposium Enhanced Perioperative Care Pathways and Postoperative Pain Management 1.5 CME 1:30 – 3:00 pm Enhancedrecoveryperioperativecareprinciplesarewidelyreportedtodecreasecomplicationsandtoimprove outcomessuchaslengthofstayandcost.Manyprotocolexamplesarereported,andsignificantprotocoldifferences exist.Unlessinvolvedincreatingaprotocolbeforenow,onewillfindthecurrentliteratureandrecommendations intimidating,andinsomeaspects,conflicting.Theimpactreputedlyreportedandtheimportanceofimplementationof evidencebasedpractices,however,requirethatwecriticallyconsidertheseprinciplesinourpractices. Inthissymposium,thebasicandcontroversialelementsdefinedintheenhancedrecoveryliterature,including postoperativepainmanagement,willbediscussed.Systematicimplementationstrategieswillbeshared,andcaseexamples willbeusedtocriticallydiscusscareelements. Existing Gaps What Is: Theliteratureofenhancedrecoveryaboundswithvariedexamplesratherthanpracticeparametersor practicalguides. What Should Be: Asystematicguidetoimplementingenhancedrecoverywouldallowbroadadoptionofessentialevidence basedbestcareelementsandwouldimproveoutcomes,decreasevariability,andlowercostsofcolorectalsurgery. Director: Julie Thacker, MD, Durham, NC Assistant Director: David Beck, MD, New Orleans, LA 1:30pm Essential Elements TBD 2:15pm Critical Review of Published Protocols TBD 1:45pm Head of the Table – The Role of the Anesthesiologist in Achieving Success RobertThiele,MD,Charlottesville,VA 2:30pm Details and Outcomes ConorDelaney,MD,PhD,Cleveland,OH 2:45pm Debate and Discussion 2:00pm Multimodality Postoperative Pain Management EricHaas,MD,Houston,TX 3:00pm Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Explainthecurrentevidenceof enhancedrecoveryprinciples;b)Definefortheirpractices,theelementsmostessentialtoimplement;c)Define fortheirhealthcaresystemsthebestimplementationstrategy;d)Describeavailablemethodstomanage postoperativepain;ande)Recognizetheoutcomestheyaremostlikelytoimpactwithenhancedrecovery implementationandhowtomonitortheseoutcomes. 66 Return to Table of Contents Wednesday, June 3 Symposium Is there a Paradigm Shift in the Management of Diverticular Disease? 1.5 CME 3:00 – 4:30 pm Themanagementofdiverticulardiseasehassignificantlychangedinthepast10years.Morepatientsare managedwithantibioticsanddrainageforacutecomplicateddiverticulitis,andavoidingemergenttripstothe operatingroom.Evenamongthosewhoaretakentotheoperatingroom,thetraditionalresectionwithHartmann’sclosure oftherectumisbeingreplacedbywashoutanddrainplacement,orevenresectionwithprimaryanastomosis.Eventheuse ofantibioticsinuncomplicateddiseaseischanging,withdatashowingnobenefitofthetreatmenttothediseaseprocess. Thosewhoareconservativelymanaged,undergowashout,orhaverecurrenceswillthenpresentforconsiderationof electiveresection.Thishascreatedashiftintheoutpatientmanagementasmorepatientspresentafterhospitalizationfor complexdisease.Decidingwhowillbenefitfromsurgeryhasbecomemorecomplexovertime. Existing Gaps What Is: Whoneedsanoperation,whocanbemedicallymanaged,andwhataretherisksofeachapproach? What Should Be: Aclearedapproachtobothemergentandelectivediseasemanagement. Director: Timothy Geiger, MD, Nashville, TN Assistant Director: Mukta Krane, MD, Seattle, WA 3:00pm Learning from History – The Evolution of the Management of Diverticulitis PatriciaRoberts,MD,Burlington,MA 3:15pm Epidemiology and Etiology of Diverticular Disease – More than Nuts and Seeds CaryAarons,MD,Philadelphia,PA 3:30pm Emergent Management of Acute Diverticulitis ScottStrong,MD,Cleveland,OH 3:45pm Elective Management of Diverticular Disease – Who Needs Surgery? DavidFlum,MD,Seattle,WA 4:00pm Right-Sided Disease, Postoperative Recurrences, Diverticular Disease in Younger Patients and Other Unusual Presentations JamesYoo,MD,Boston,MA 4:15pm Discussion 4:30pm Adjourn Objectives: Attheconclusionofthissession,participantsshouldbeableto:a)Recognizethecurrentliterature ontheetiologyofdiverticulosisandrisksofrecurrentdisease;b)Distinguishthemanagementofacute diverticulitisbothinthehospitalizedpatientandintheoutpatientsettings;c)Recognizethecurrentsurgical approachesforacutediverticulitis,andtheliteraturesupportingeachprocedure;andd)Assemblealogical approachformanagementofrecurrentdisease. 67 Return to Table of Contents Wednesday, June 3 ASCRS Annual Business Meeting and State of the Society Address 4:30 – 5:30 pm ASCRS Annual Reception and Dinner Dance Reception 7:00 – 8:00 pm Dinner Dance 8:00 – 10:30 pm Tickets Required R021815 68 Return to Table of Contents
