Sources

Landing page for wiki/sources/ — one page per ingested article or paper. Each source page includes the full citation, study design, key findings, limitations, and a relevance note.

Azhar 2021 - SCANDIV 5-Year Outcomes — SCANDIV trial, 5-year RCT follow-up: laparoscopic lavage vs. primary resection for perforated purulent diverticulitis. No difference in complications/mortality/QoL; lavage has lower stoma rate but higher recurrence and reoperation rate. Backs Diverticulitis and SCANDIV Trial.
Vennix 2015 - Ladies Trial LOLA — Ladies trial (LOLA group), stopped early for safety: lavage had significantly higher short-term morbidity/reintervention and recurrence than sigmoidectomy; no difference in 12-month composite outcome, mortality, or QoL. Backs Diverticulitis and Ladies Trial (LOLA).
Boublikova 2023 - TNT in Rectal Cancer Review — narrative review synthesizing 4 phase III TNT trials (POLISH II, RAPIDO, PRODIGE 23, STELLAR); efficacy, indications, regimens, NOM. Backs Total Neoadjuvant Therapy (TNT) and Rectal Cancer.
Hoehn 2021 - Appendiceal Neoplasms — review of all 5 appendiceal neoplasm histopathologic subtypes (MAN/PMP, NEN, GCA, colonic-type, signet ring), AJCC/PSOGI staging, and CRS/HIPEC controversies. Backs Appendiceal Neoplasms and Cytoreductive Surgery and HIPEC.
Lambrichts 2019 - LADIES DIVA Trial — LADIES DIVA arm: primary anastomosis strongly favored over Hartmann's procedure for Hinchey III/IV perforated diverticulitis (stoma-free survival 94.6% vs 71.7%). Backs Diverticulitis and Ladies Trial.
Sabiston Ch52 - Diverticular Disease, Obstruction & Pseudo-Obstruction — textbook reference chapter (chunk 1 of Sabiston's "Colon and Rectum" chapter). Uncomplicated diverticulitis, elective surgery timing, special populations, large bowel obstruction, Ogilvie syndrome. Backs Diverticulitis, Large Bowel Obstruction, and Colonic Pseudo-Obstruction (Ogilvie Syndrome). More chunks of this chapter to follow (IBD, neoplasia/rectal cancer surgery, pelvic floor).
Sabiston Ch52 - Inflammatory Bowel Disease — textbook reference chapter (chunk 2 of Sabiston's "Colon and Rectum" chapter). UC and Crohn's epidemiology, classification, diagnosis, medical treatment, surgical indications/options. Backs Inflammatory Bowel Disease, Ulcerative Colitis, Crohn Disease, and Ileal Pouch-Anal Anastomosis (IPAA). More chunks of this chapter to follow (infectious/ischemic colitis, neoplasia/rectal cancer surgery, pelvic floor).
Sabiston Ch52 - Infectious & Ischemic Colitis — textbook reference chapter (chunk 3 of Sabiston's "Colon and Rectum" chapter). C. difficile and other infectious colitis, ischemic colitis. Backs Infectious Colitis and Ischemic Colitis. More chunks of this chapter to follow (neoplasia/rectal cancer surgery, pelvic floor).
Sabiston Ch52 - Colorectal Neoplasia & Colon Cancer Surgery — textbook reference chapter (chunk 4 of Sabiston's "Colon and Rectum" chapter). CRC molecular pathways, polyps, hereditary CRC syndromes, TNM staging, colon cancer surgical technique, obstructing colon cancer. Backs Colorectal Cancer Molecular Pathways, Colorectal Polyps, Hereditary Colorectal Cancer Syndromes (and its three detail pages), Colorectal Cancer Staging (TNM), Colon Cancer Resection, and Obstructing Colon Cancer. More chunks of this chapter to follow (rectal cancer surgery, pelvic floor).
Sabiston Ch52 - Rectal Cancer Surgery — textbook reference chapter (chunk 5 of Sabiston's "Colon and Rectum" chapter). Rectal cancer preop evaluation/staging, TME history, LAR, sphincter- sparing surgery, taTME, APR, anastomotic complications, LARS, adjuvant chemotherapy by stage. Backs the expanded Rectal Cancer page, Local Excision of Rectal Neoplasms, Total Mesorectal Excision (TME) & Sphincter-Sparing Resection, Abdominoperineal Resection (APR), Colorectal Anastomotic Complications, and Low Anterior Resection Syndrome (LARS).
Sabiston Ch52 - Pelvic Floor Disorders & Constipation — textbook reference chapter (chunk 6, the final chunk, of Sabiston's "Colon and Rectum" chapter). Anorectal physiology testing, rectal prolapse, SRUS, rectocele, constipation. Backs Anorectal Physiology Testing, Rectal Prolapse (Procidentia), Rectal Prolapse Repair, Solitary Rectal Ulcer Syndrome (SRUS), Rectocele, and Constipation. This completes the entire "Colon and Rectum" chapter (82 pages across 6 chunks).
Sabiston Ch50 - Small Bowel Anatomy, Physiology, Obstruction & Crohn Disease — textbook reference chapter (chunk 1 of Sabiston's "Small Bowel" chapter). Embryology, anatomy, physiology, motility, endocrine/immune function; small bowel obstruction; Crohn disease (full small-bowel treatment: history, epidemiology, genetics, pathology, diagnosis, medical therapy, surgery incl. strictureplasty). Backs the new Small Intestine Anatomy & Physiology and Small Bowel Obstruction pages, and substantially expands Crohn Disease (previously built only from Sabiston Ch52 - Inflammatory Bowel Disease). More chunks of this chapter to follow (remaining inflammatory/infectious diseases, neoplasms, diverticular disease, miscellaneous problems).
Sabiston Ch50 - Infectious Enteritis & Small Bowel Neoplasms — textbook reference chapter (chunk 2 of Sabiston's "Small Bowel" chapter). Remainder of Crohn disease (colorectal/perianal/ duodenal disease, prognosis), typhoid enteritis, immunocompromised-host enteritis, and small bowel neoplasms (NETs, adenocarcinoma, GIST, lymphoma, benign tumors). Backs the expanded Crohn Disease page, and the new Typhoid Enteritis, Enteritis in the Immunocompromised Host, Small Bowel Neoplasms, Small Bowel Neuroendocrine Tumors (NETs), Small Bowel Adenocarcinoma, and Gastrointestinal Stromal Tumors (GIST) pages. More chunks of this chapter to follow (diverticular disease, miscellaneous problems).
Sabiston Ch50 - Diverticular Disease & Miscellaneous Problems — textbook reference chapter (chunk 3, the final chunk, of Sabiston's "Small Bowel" chapter). Additional GIST prognostic/ mutation-directed therapy detail, metastatic neoplasms to the small bowel, diverticular disease (duodenal, jejunoileal, Meckel), and miscellaneous problems (ulcerations, foreign bodies, enterocutaneous fistula, pneumatosis intestinalis, blind loop syndrome, radiation enteritis, short bowel syndrome, SMA syndrome). Backs the expanded Gastrointestinal Stromal Tumors (GIST) and Small Bowel Neoplasms pages, and the new Small Bowel Diverticular Disease, Duodenal Diverticula, Jejunal and Ileal Diverticula, Meckel Diverticulum, Small Bowel Ulcerations, Ingested Foreign Bodies, Enterocutaneous Fistula, Pneumatosis Intestinalis, Blind Loop Syndrome, Radiation Enteritis, Short Bowel Syndrome, and Vascular Compression of the Duodenum (SMA Syndrome) pages. This completes the entire "Small Bowel" chapter (61 pages across 3 chunks) and the wiki's original planned ingest list.
Bahadoer 2021 - RAPIDO Trial — RAPIDO phase 3 RCT: SCRT+chemo (TNT) vs standard CRT in high-risk LARC. Reduced disease-related treatment failure and distant metastases, but no OS benefit and a numerically (later reportedly significantly) higher locoregional failure rate with TNT. Backs Total Neoadjuvant Therapy (TNT) and Rectal Cancer.
Conroy 2024 - PRODIGE 23 Long-Term Results — PRODIGE 23 long-term (7-year) follow-up: chemotherapy-first TNT (mFOLFIRINOX) vs standard CRT in LARC. First rectal-cancer TNT trial to show a real OS benefit, with no locoregional trade-off. Backs Total Neoadjuvant Therapy (TNT) and Rectal Cancer.
Jin 2022 - STELLAR Trial — STELLAR phase 3 RCT: SCRT-based TNT (like RAPIDO) vs standard CRT in LARC. Noninferior DFS, numerically better OS (non-powered), and — unlike RAPIDO — no locoregional trade-off, at the cost of roughly double the acute grade ≥3 toxicity. Backs Total Neoadjuvant Therapy (TNT) and Rectal Cancer.
Schrag 2023 - PROSPECT Trial — PROSPECT phase 2/3 RCT: neoadjuvant FOLFOX with selective CRT vs routine CRT in lower-risk, sphincter-sparing-eligible LARC. A radiation-omission trial, distinct from the TNT-intensification trials above; noninferior DFS, 90% avoided radiation entirely. Backs Rectal Cancer. (Uploaded filename mislabeled this as RAPIDO — corrected in the source page.)
Caplin 2014 - CLARINET Trial — CLARINET phase 3 RCT: lanreotide vs placebo in nonfunctioning enteropancreatic NETs. Significantly prolonged PFS (median not reached vs 18.0 months). Backs Small Bowel Neuroendocrine Tumors (NETs).
Rinke 2009 - PROMID Trial — PROMID phase IIIB RCT: octreotide LAR vs placebo in treatment-naive midgut NETs. First placebo-controlled antiproliferative evidence for a somatostatin analogue (median TTP 14.3 vs 6.0 months); OS analysis underpowered/not confirmatory. Backs Small Bowel Neuroendocrine Tumors (NETs).
Strosberg 2017 - NETTER-1 Trial — NETTER-1 phase 3 RCT: 177Lu-Dotatate (PRRT) vs high-dose octreotide in SSA-progressive midgut NETs. 79% lower risk of progression/death; interim OS signal not yet mature. Backs Small Bowel Neuroendocrine Tumors (NETs).
Yao 2016 - RADIANT-4 Trial — RADIANT-4 phase 3 RCT: everolimus vs placebo in advanced non-functional lung/GI NETs (excludes pancreatic/functioning tumors). Median PFS 11.0 vs 3.9 months; interim OS trend not statistically significant. Backs Small Bowel Neuroendocrine Tumors (NETs).
Ciseł 2019 - POLISH II Long-Term Results — POLISH II long-term (7-year) follow-up: short-course RT + consolidation FOLFOX4 vs long-course chemoradiation in cT4/fixed-cT3 rectal cancer. A genuinely neutral trial — no difference in OS, DFS, local failure, or distant metastases in either direction; an early 3-year OS edge for the short-course/consolidation arm did not persist to 8 years. Backs Total Neoadjuvant Therapy (TNT) and Rectal Cancer.
Dijkstra 2023 - RAPIDO 5-Year Locoregional Failure — RAPIDO trial's 5.6-year extended follow-up, focused on locoregional recurrence. Confirms a statistically significant increase in locoregional recurrence with TNT (10.2% vs 6.1%, P=0.027) that was only a non-significant trend at 3 years — resolves this wiki's previously-flagged unresolved cross-trial disagreement as a RAPIDO-specific finding. Systemic-control benefit (DrTF, distant metastases) remains durable at 5 years; still no OS difference. Backs Total Neoadjuvant Therapy (TNT) and Rectal Cancer.
Quénet 2021 - PRODIGE 7 Trial — PRODIGE 7 phase 3 RCT: cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) vs CRS alone for colorectal peritoneal metastases. No OS or relapse-free-survival benefit from adding HIPEC; significantly more morbidity at 60 days with HIPEC. Backs Cytoreductive Surgery and HIPEC.
Brouquet 2020 - GRECCAR16 Trial Protocol — NORAD01-GRECCAR16 phase 3 trial protocol (no results yet): modified FOLFIRINOX replacing radiotherapy entirely vs standard chemoradiation in CRM-negative resectable LARC. Backs Total Neoadjuvant Therapy (TNT) and Rectal Cancer.
Alvarez 2024 - JANUS Trial Protocol — Alliance A022104/NRG-GI010 "Janus" phase II/III trial protocol (no results yet, still accruing): triplet (mFOLFIRINOX) vs doublet (mFOLFOX6/CAPOX) consolidation chemotherapy after long-course CRT, for clinical complete response and DFS/organ preservation. Backs Total Neoadjuvant Therapy (TNT).
ASCRS Ch01 - Anatomy and Embryology — first chapter of the ASCRS Textbook of Colon and Rectal Surgery (4th ed.), being ingested sequentially (72 chapters total). Gross anatomy and embryology of the colon, rectum, and anus. Backs the new Colorectal Anatomy & Embryology page; flags a measurement discrepancy with Rectal Cancer and corroborates Meckel Diverticulum.
ASCRS Ch02 - Colonic Physiology — second chapter of the sequential ASCRS ingest. Colonic histology, secretory/absorptive physiology, innervation, motility, and microbiome. Backs the new Colonic Physiology page; adds mechanistic depth to Constipation and flags a microbiome discrepancy with Crohn Disease.
ASCRS Ch03 - Anorectal Physiology — third chapter. Normal continence/defecation physiology, physiologic testing, and functional anorectal disorders. Backs the new Anorectal Physiology and Fecal Incontinence pages; extends Anorectal Physiology Testing.
ASCRS Ch04 - Endoscopy — fourth chapter. Anorectal exam, flexible endoscopy technique, colonoscopy (bowel prep, sedation, technique, complications), quality measures, training. Backs the new Colonoscopy & Lower GI Endoscopy page.
ASCRS Ch05 - Endoscopic Management of Polyps and Endolumenal Surgery — fifth chapter. Polypectomy, EMR, ESD, endoscopic suturing, colonic stenting. Backs the new Endoscopic Polypectomy, EMR & ESD page; fills gaps on Large Bowel Obstruction and Obstructing Colon Cancer.
ASCRS Ch06 - Preoperative Evaluation in Colorectal Patients — sixth chapter. Cardiac risk, anticoagulation, pulmonary assessment, steroid management, diabetes, obesity, malnutrition, transplant recipients, substance abuse, immunosuppressive/biologic/chemotherapy anastomotic- healing risk, frailty, prehabilitation. Backs the new Preoperative Evaluation & Perioperative Risk Optimization page; flags a framing-confidence difference with Crohn Disease and quantifies existing content on Diverticulitis, Total Neoadjuvant Therapy (TNT), and Ileal Pouch-Anal Anastomosis (IPAA).
ASCRS Ch07 - Optimizing Outcomes with Enhanced Recovery — seventh chapter. ERAS origins/ history, five-phase model of care, preop/intraop/postop enhanced-recovery elements, special populations (stoma, emergency surgery, elderly, IBD), economic impact. Backs the new Enhanced Recovery After Surgery (ERAS) page — a genuinely new topic for the wiki; cross-links Ileal Pouch-Anal Anastomosis (IPAA), Crohn Disease, and Preoperative Evaluation & Perioperative Risk Optimization.
ASCRS Ch08 - General Postoperative Complications — eighth chapter. Complication epidemiology/ risk factors, risk calculators, and management by organ system (GI, hematologic, infectious, pulmonary, renal, cardiac, neurological); explicitly defers anastomotic leaks to ASCRS Ch10. Backs the new General Postoperative Complications page; quantifies existing content on Total Mesorectal Excision (TME) & Sphincter-Sparing Resection, Abdominoperineal Resection (APR), and Infectious Colitis.
ASCRS Ch09 - Anastomotic Construction — ninth chapter. Anastomotic healing physiology, mobilization technique, perfusion assessment, configuration (incl. Kono-S, low pelvic reservoir options), sutured vs. stapled vs. compression-ring methods, and conflicting stapled-vs-hand-sewn leak-rate evidence. Backs the new Anastomotic Construction page; cross-links Crohn Disease, Colon Cancer Resection, Low Anterior Resection Syndrome (LARS), Ileal Pouch-Anal Anastomosis (IPAA), Total Mesorectal Excision (TME) & Sphincter-Sparing Resection, and Colorectal Anastomotic Complications.
ASCRS Ch10 - Anastomotic Complications — tenth chapter, closing out Part I ("Perioperative/ Endoscopy"). Anastomotic leak (risk factors, CRP/procalcitonin diagnostic cutoffs, management algorithm, chronic presacral sinus tracts), outcomes after leak, anastomotic fistula, blind loop syndrome, anastomotic bleeding, and anastomotic stricture. Triggered a major in-place rewrite of Colorectal Anastomotic Complications rather than a new page — the clearest "reconcile, don't duplicate" example in the ingest so far. Cross-links Enhanced Recovery After Surgery (ERAS) and Low Anterior Resection Syndrome (LARS).
ASCRS Ch11 - Hemorrhoids — eleventh chapter, first of Part II ("Anorectal Disease"). Hemorrhoid anatomy/grading, pathogenesis, presentation, medical/office/operative management (excisional hemorrhoidectomy, stapled hemorrhoidopexy, Doppler-guided HAL/THD), complications, and special populations. Backs the new Hemorrhoids page — closes an open item flagged since ASCRS Ch01 - Anatomy and Embryology; cross-links Colorectal Anatomy & Embryology, Anorectal Physiology, Rectal Prolapse (Procidentia), and Fecal Incontinence.
ASCRS Ch12 - Anal Fissure and Anal Stenosis — twelfth chapter. Anal fissure (etiology, NOS-deficiency/ischemia pathophysiology, medical and operative treatment ladders, atypical/Crohn's fissures) and anal stenosis (types/causes, classification, nonoperative and reconstructive-flap treatment, Crohn's-specific outcomes, prevention). Backs two new pages, Anal Fissure and Anal Stenosis; flags an unresolved Crohn's-fissure pain-characterization discrepancy against Crohn Disease's existing Sabiston-sourced content; cross-links Hemorrhoids, Fecal Incontinence, and Colonoscopy & Lower GI Endoscopy.
ASCRS Ch13 - Cryptoglandular Abscess and Fistula — thirteenth chapter. Anorectal abscess (pathophysiology, classification by anatomic space, drainage technique, post-drainage care/ antibiotics) and anal fistula (Parks classification, Goodsall's rule, imaging, the full treatment ladder from fistulotomy through setons, fibrin glue, fistula plug, ERAF, LIFT and variants, and novel therapies). Backs two new pages, Anorectal Abscess and Anal Fistula — closes an open item flagged since ASCRS Ch01 - Anatomy and Embryology; cross-links Colorectal Anatomy & Embryology, Crohn Disease, and Fecal Incontinence.
ASCRS Ch14 - Rectourethral and Complex Fistulas — fourteenth chapter. Acquired rectourethral fistula (RUF): etiology (overwhelmingly iatrogenic — prostatectomy, radiation, salvage therapy), presentation, diagnosis, classification, and the transanal/transperineal/posterior/transabdominal repair-approach ladder. Backs the new Rectourethral Fistula page; cross-links Anal Fistula, Crohn Disease, Rectal Cancer, and Colorectal Anastomotic Complications.
ASCRS Ch15 - Rectovaginal Fistula — fifteenth chapter. Rectovaginal fistula (RVF): classification, etiology (obstetric injury, Crohn's disease, cryptoglandular, anastomotic/surgical complications, radiation), evaluation, and the full surgical technique ladder (perineal, transrectal, vaginal, tissue transposition, abdominal). Backs the new Rectovaginal Fistula page; cross-links Rectourethral Fistula, Crohn Disease, Colorectal Anatomy & Embryology, Rectal Cancer, Colorectal Anastomotic Complications, Hemorrhoids, Rectal Prolapse Repair, and Local Excision of Rectal Neoplasms.
ASCRS Ch16 - Pilonidal Disease and Hidradenitis Suppurativa — sixteenth chapter. Two distinct entities: pilonidal disease (epidemiology/etiology, diagnosis, nonsurgical and surgical treatment incl. Karydakis/Limberg/cleft lift flaps, minimally invasive treatment, recurrence management) and hidradenitis suppurativa (epidemiology/pathogenesis, severity classification, medical therapy incl. biologics, surgery). Backs two new pages, Pilonidal Disease and Hidradenitis Suppurativa; cross-links Anal Stenosis.
ASCRS Ch17 - Dermatology and Pruritus Ani — seventeenth chapter. Pruritus ani: pathophysiology (C-fiber "vicious cycle"), broad etiology (fecal soilage, diet, dermatologic disease, infections, systemic disease, anorectal disorders), diagnostic approach, and treatment ladder. Backs the new Pruritus Ani page; cross-links Anal Fissure, Hemorrhoids, Anorectal Abscess, Anal Fistula, Hidradenitis Suppurativa, Crohn Disease, and Anal Stenosis.
ASCRS Ch18 - Sexually Transmitted Infections of the Colon and Rectum — eighteenth chapter. Anorectal immunology, screening/prevention, bacterial STIs (chlamydia/LGV, gonorrhea, syphilis, chancroid, donovanosis), viral STIs (HSV, genital warts, giant condyloma, molluscum, HIV), and ectoparasitic STIs. Backs the new Anorectal Sexually Transmitted Infections page; cross-links Pruritus Ani, Anal Fissure, Hemorrhoids, Anorectal Abscess, Anal Fistula, Anal Stenosis, and Colorectal Anatomy & Embryology.
ASCRS Ch19 - Anal Intraepithelial Neoplasia — nineteenth chapter, last of Part II ("Anorectal Disease"). AIN nomenclature (LAST project), epidemiology, screening/surveillance (anal cytology, HRA, ANCHOR trial), progression biology, diagnosis, and treatment (expectant management, topical therapies, local ablation, wide local excision) by grade/immune status. Backs the new Anal Intraepithelial Neoplasia page; closes forward references in Colorectal Anatomy & Embryology, Anorectal Sexually Transmitted Infections, and Pruritus Ani.
ASCRS Ch20 - Anal Cancer — twentieth chapter, first of Part III ("Malignant Disease"). Epidemiology, AJCC 8th-edition TNM staging, perianal vs. anal canal SCC, chemoradiotherapy as anal canal SCC's primary treatment (Nigro protocol, ACT I, RTOG 98-11, ACT II), inguinal nodal disease, surgery's salvage role, HIV-specific guidance, plus anal adenocarcinoma, verrucous carcinoma (Buschke-Löwenstein tumor), melanoma, perianal Paget disease, basal cell carcinoma, and GIST. Backs the new Anal Cancer page; closes forward references in Colorectal Anatomy & Embryology, Anorectal Sexually Transmitted Infections (also reconciles that page's Giant Condyloma section with this chapter's Verrucous Carcinoma section — same entity), and Pruritus Ani; cross-links Anal Intraepithelial Neoplasia, Rectal Cancer, Gastrointestinal Stromal Tumors (GIST), and Anal Stenosis.
ASCRS Ch21 - Presacral Tumors — twenty-first chapter, second of Part III. The presacral (retrorectal) space's full tumor taxonomy: anatomic considerations, clinical presentation/imaging (MRI, scimitar sign), preoperative biopsy, Mayo classification (congenital/neurogenic/osseous/ miscellaneous), major entities (dermoid/tailgut/enterogenous cysts, teratomas, chordomas, meningoceles, neurogenic/osseous tumors, Currarino syndrome), function-sparing vs. en bloc management, surgical approach by sacral level (including the coccygectomy debate), minimally invasive approaches, and extensive chordoma-specific outcomes literature. Backs the new Presacral Tumors page; disambiguates against Colorectal Anastomotic Complications's distinct chronic-presacral-sinus-tract content; cross-links Colorectal Anatomy & Embryology, Gastrointestinal Stromal Tumors (GIST), Anal Cancer, and Rectal Cancer.
ASCRS Ch22 - Sporadic and Inherited Colorectal Cancer — twenty-second chapter, third of Part III. Sporadic CRC (epidemiology, risk factors, molecular biology, right-vs-left biology, screening/treatment), young-onset CRC, and inherited CRC (Lynch syndrome incl. variants/ immunotherapy, POLE/POLD1-related hereditary cancer, FAP, MUTYH-associated polyposis, serrated polyposis syndrome, hamartomatous polyposis syndromes incl. Cowden syndrome). Mainly a reconciliation chapter: substantially enriches Lynch Syndrome, Familial Adenomatous Polyposis (FAP), Hamartomatous Polyposis Syndromes, and Hereditary Colorectal Cancer Syndromes rather than duplicating them; backs the new Sporadic & Young-Onset Colorectal Cancer page and a new serrated-polyposis-syndrome subsection on Colorectal Polyps; extends Colorectal Cancer Molecular Pathways with RAS/BRAF treatment-response and CMS right-vs-left content.
ASCRS Ch23 - Management of Malignant Polyps — twenty-third chapter, fourth of Part III. Malignant-polyp-specific lesion assessment, depth-of-invasion/lymph-node-metastasis risk (quantitative SMI-depth data), histopathological risk factors, curative-resection criteria, the ACPGBI risk-stratification tool, and recurrence/surveillance after endoscopic resection. Reconciled into Colorectal Polyps's existing Malignant polyps section rather than duplicated; resolves Endoscopic Polypectomy, EMR & ESD's previously-flagged open item about cross-checking against that page; adds TES malignant-polyp outcome data to Local Excision of Rectal Neoplasms.
ASCRS Ch24 - Colorectal Cancer Preoperative Evaluation and Staging — twenty-fourth chapter, fifth of Part III. CRC screening modalities, colon-vs-rectum delineation, full AJCC T/N/M/stage tables, diagnostic workup (history, exam, proctoscopy, tumor localization/tattooing, CEA), imaging (CT, PET-CT), rectal-cancer-specific ERUS/MRI staging (CRM, EMVI, T3 subclassification, MRI "Good/Bad/Ugly" risk stratification, restaging/tumor regression grading), the ASCRS preoperative checklist, and pre-/post-resection prognostic factors. Substantially expands Colorectal Cancer Staging (TNM) (resolving its own previously-flagged missing-AJCC-table open item) and resolves Rectal Cancer's previously-flagged CRM/EMVI open item; backs the new Colorectal Cancer Screening page; flags a third rectal-thirds measurement convention (an intra-textbook discrepancy against ASCRS Ch01 - Anatomy and Embryology) and an ERUS T-stage-accuracy figure discrepancy against ASCRS Ch04 - Endoscopy.
ASCRS Ch25 - Colon Cancer Surgical Treatment — twenty-fifth chapter, sixth of Part III. Preoperative tumor localization/tattooing, general surgical principles (margins, no-touch technique, lymphadenectomy, complete mesocolic excision/central vascular ligation, adjacent-organ invasion), procedures by anatomic location (cecum/ascending, hepatic flexure, transverse, splenic flexure, descending, sigmoid), obstructing/perforated colon cancer, Lynch-syndrome-associated colon cancer surgery, and neoadjuvant therapy for locally advanced colon cancer (FOxTROT). Mainly a reconciliation chapter: substantially enriches Colon Cancer Resection (resolving its own previously-flagged "no CME detail" open item) rather than duplicating it; lightly cross-links Obstructing Colon Cancer and Lynch Syndrome with genuinely new procedural detail rather than duplicating their existing, more detailed coverage.
ASCRS Ch26 - Rectal Cancer Neoadjuvant Therapy — twenty-sixth chapter, seventh of Part III. History and foundational preoperative-radiotherapy trials (Swedish Rectal Cancer Trial, Dutch Colorectal Cancer Group/TME trial, original Polish trial, TROG, Stockholm III, FOWARC), concurrent chemoradiation regimen trials (Lyon R0-04, CALGB 89901, ECOG 3204, STAR-01, NSABP R-04, German CAO/ARO/AIO-04), pathologic complete response as an imperfect surrogate endpoint, and induction-vs-consolidation chemotherapy sequencing within TNT (Habr-Gama's regimens, KONCLUDE, Spanish GCR-3, MSKCC TNT cohort, Rectal Cancer Consortium trial, German CAO/ARO/AIO-12). Substantially expands Total Neoadjuvant Therapy (TNT); flags an unresolved cross-trial inconsistency (STAR-01/NSABP R-04 vs. AIO-04 on oxaliplatin addition to CRT); lightly cross-linked into Rectal Cancer's Evolution of treatment section.
ASCRS Ch27 - Rectal Cancer Local Excision — twenty-seventh chapter, eighth of Part III. Predicting lymph node metastasis (Chang et al.'s LVI/differentiation-combination data, Hogan et al.'s locoregional-vs-systemic-recurrence data, the ITBCC 2016 tumor-budding consensus), the T2 local-excision question, complications, oncologic results (T1 and T2), local excision combined with adjuvant/neoadjuvant therapy, quality of life, and salvage surgery. Substantially expands Local Excision of Rectal Neoplasms (resolving its own previously-flagged open item) and Colorectal Polyps; flags two unresolved cross-source LVI/differentiation effect-size discrepancies.
ASCRS Ch28 - Rectal Cancer Nonoperative Management — twenty-eighth chapter, ninth of Part III. Watch and Wait terminology and definitions, rationale, primary tumor assessment/selection criteria, tumor location considerations, response-assessment methodology (three-tier classification, mrTRG), surveillance/follow-up strategy, local regrowth and systemic recurrence, oncologic and functional outcomes, and tumor-response-prediction research. Backs a substantial new page, Watch and Wait (Nonoperative Management) — the wiki's first dedicated treatment of this topic; cross-linked into (not duplicating) Total Neoadjuvant Therapy (TNT)'s and Rectal Cancer's existing brief mentions, resolving the latter's previously-flagged open item.
ASCRS Ch29 - Proctectomy for Rectal Cancer — twenty-ninth chapter, tenth of Part III. Rectal/ mesorectal anatomy (blood supply, holy plane, Denonvilliers'/Waldeyer's fascia, autonomic nerves), priorities of proctectomy, bowel-prep evidence, open/laparoscopic/robotic/transanal (taTME) LAR technique, low-pelvic anastomosis/reservoir options, APR technique/ELAPE outcome data/ reconstruction, LARS (Delphi consensus definition, LARS score, treatment ladder), multivisceral/ extended resections, oncologic outcomes, multidisciplinary care. Substantially expands Total Mesorectal Excision (TME) & Sphincter-Sparing Resection (primary target), Abdominoperineal Resection (APR), and Low Anterior Resection Syndrome (LARS) (resolving its own previously-flagged open item); adds technique specifics to Anastomotic Construction's reservoir-option content.
ASCRS Ch30 - Colorectal Cancer Postoperative Adjuvant Therapy and Surveillance — thirtieth chapter. Colon cancer adjuvant chemotherapy (Stage III MOSAIC/NSABP C-07/IDEA-collaboration, Stage II high-risk features/MSI-MMR-BRAF/Oncotype DX), radiation for colon cancer, rectal cancer's three-scenario adjuvant complexity (following neoadjuvant radiation, without neoadjuvant radiation, following local excision — Table 30.2 + ACOSOG Z6041 corroboration), targeted-therapy trials (AVANT, PETACC-8, N0147, all negative), molecular profiling, and a full surveillance-strategy review (national-guideline comparison Table 30.3, historical/modern trial evidence Table 30.4 — FACS, GILDA, COLOFOL, CEA Watch — largely showing no survival benefit from intensive surveillance). Backs two substantial new pages, Adjuvant Chemotherapy for Colorectal Cancer and Colorectal Cancer Surveillance After Curative Treatment; cross-linked into (not duplicating) Rectal Cancer's existing adjuvant/surveillance section, Colon Cancer Resection (light corroboration), Local Excision of Rectal Neoplasms (Table 30.2 + ACOSOG Z6041 DFS figure), and Total Neoadjuvant Therapy (TNT)'s Adjuvant therapy after TNT section.
ASCRS Ch31 - Colorectal Cancer Management of Distant Metastases — thirty-first chapter. Epidemiology of metastatic CRC; synchronous metastases (Fig. 31.1 algorithm, primary-tumor bleeding/ obstruction/perforation management, unresectable-disease chemo-first philosophy and ongoing resection-efficacy trials JCOG1007/CAIRO4/GRECCAR 8, resectable-disease NCCN sequencing vignettes, rectal-cancer-specific radiotherapy-sequencing complexity); metachronous metastases (site distribution, hazard-ratio predictors); liver metastases (resection — FLR/PVE/ALPPS/LIGRO trial, laparoscopic OSLO-COMET trial; locoregional therapies — Table 31.1, RFA/MWA/TACE/TARE-SIRT/SBRT, the FOXFIRE/SIRFLOX/FOXFIRE-Global pooled analysis, Martin et al.'s FOLFOX-DEBIRI RCT); lung metastases (STS Expert Consensus, PulMiCC trial); ovarian/brain/adrenal metastases; surveillance. Backs a substantial new page, Management of Colorectal Cancer Distant Metastases — the wiki's first dedicated treatment of metastatic-CRC surgical/procedural management; cross-linked into (not duplicating) Rectal Cancer's existing systemic-chemotherapy-regimen framework for metastatic disease.
ASCRS Ch32 - Locally Recurrent Rectal Cancer — thirty-second chapter. Pelvic exenteration for LRRC, framed as fundamentally distinct from exenteration for advanced primary rectal cancer (extra-mesorectal recurrence planes vs. primary-tumor mesorectal-fascia breach); five-compartment anatomical classification (Fig. 32.1); imaging/MDT/resectability assessment (evolving lateral- compartment resectability, R0 rates 21%→69%); three-phase (dissection/resection/reconstruction) technique with the "6 C philosophy"; compartment-specific technique (central — interlabial radical vaginectomy, perineal urethrectomy; composite pubic bone resection; lateral — en bloc iliac vascular/sciatic nerve resection; posterior — sacrectomy by level, abdomino-lithotomy vs. prone jackknife approach); urinary conduit reconstruction (Fig. 32.14); PelvEx Collaborative outcomes data. Backs a substantial new page, Pelvic Exenteration for Locally Recurrent Rectal Cancer — the wiki's first dedicated treatment of LRRC-specific exenteration; cross-linked into (not duplicating) Total Mesorectal Excision (TME) & Sphincter-Sparing Resection's existing brief primary-tumor- exenteration mention.
ASCRS Ch33 - Appendiceal Neoplasms — thirty-third chapter, closing out Part III ("Malignant Disease"). Appendiceal adenocarcinoma (subtypes, staging, right hemicolectomy vs. appendectomy- alone, perforated-tumor management, NCDB adjuvant-chemotherapy data, surveillance); other mucinous lesions per the full PSOGI spectrum (serrated polyp, simple mucocele, LAMN, HAMN, mucinous adenocarcinoma; the "volcano sign" colonoscopic finding; acellular-vs-cellular mucin surveillance stratification; "preemptive" CRS/HIPEC); appendiceal NETs (mesoappendiceal invasion as an added risk feature, AJCC TNM Table 33.1, right hemicolectomy indications, CgA surveillance). Mainly a reconciliation chapter: enriches the existing Appendiceal Neoplasms page (previously sourced from Hoehn 2021 - Appendiceal Neoplasms) with HAMN/serrated-polyp/simple-mucocele classification detail, the volcano sign, adjuvant/surveillance detail, and mesoappendiceal-invasion risk, rather than duplicating it.
ASCRS Ch34 - GIST, Neuroendocrine Tumors, and Lymphoma — thirty-fourth chapter, closing Part III. GISTs (whole-GI-tract epidemiology, SDH-deficient/Carney triad/Carney-Stratakis/NF1-associated wild-type molecular subgroup, rectal-GIST transanal-platform technique, neoadjuvant imatinib per Cavnar et al., named adjuvant trials ACOSOG Z9001/EORTC 62024/SSG VIII/PERSIST-5, RFA for hepatic metastases); neuroendocrine tumors of the midgut and hindgut, explicitly excluding appendiceal NETs (deferred to Ch33) — general biology corroborates Small Bowel Neuroendocrine Tumors (NETs) — while the colon/rectum-specific staging (Tables 34.1–34.2) and size-driven endoscopic/TES/radical- resection treatment algorithm (Table 34.4, Fig. 34.4) is genuinely new; lymphoma (incidence/ distribution, WHO histologic subtypes Table 34.5, Dawson criteria, modified Ann Arbor staging Table 34.6, treatment by stage/lineage). Enriches Gastrointestinal Stromal Tumors (GIST) and Small Bowel Neuroendocrine Tumors (NETs) in place rather than duplicating them; backs two substantial new pages, Colonic and Rectal Neuroendocrine Tumors and Colorectal Lymphoma — the latter the wiki's first dedicated treatment of colorectal lymphoma, closing a long-flagged open item on Small Bowel Neoplasms.
ASCRS Ch35 - Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy — thirty-fifth chapter, opening Part IV. Peritoneal disease pathophysiology (PMP, the "redistribution phenomenon," CPM terminology preferred over "carcinomatosis," dissemination risk factors); the Peritoneal Cancer Index (PCI, incl. radiological/laparoscopic PCI, PCI-survival correlation, why PCI shouldn't gate PMP candidacy) and Completeness of Cytoreduction (CC) score (Table 35.1 peritonectomy/organ-resection detail); HIPEC technique (open/semi-open/closed, mitomycin-C vs. oxaliplatin regimens) and PIPAC; the foundational CPM evidence base (Verwaal 2003/2008 RCT, Elias 2009 retrospective, corroborating PRODIGE 7); systemic chemotherapy timing (adjuvant vs. neoadjuvant, Passot et al.'s response-based prognostic data); prophylactic/proactive CRS-HIPEC strategies (Promenade, HIPECT4, COLOPEC, ProphyloChip/Elias 2011 second-look series); synchronous liver/lung oligometastases combined with CRS/HIPEC; palliative CRS and the "obstruction-free survival" concept. Mainly a reconciliation chapter: substantially broadens the existing Cytoreductive Surgery and HIPEC page from an appendiceal-specific framing to a CPM-centered one, resolving that page's own previously-flagged open item about needing broader-than-appendiceal framing.
ASCRS Ch36 - Colorectal Cancer Minimally Invasive Surgery — thirty-sixth chapter, focused specifically on MIS technique for rectal cancer (colectomy MIS noted as well-accepted/less controversial). History/controversy (port-site recurrence resolution, CLASICC/COREAN/ACOSOG Z6051/ALaCaRT trials); laparoscopic proctectomy technique (ICG for real-time ureteral visualization, "three critical points" for colorectal vascular supply, distal rectal transection limitations, dog-ear-reduction techniques, the IntAct RCT for anastomotic perfusion, air leak testing); laparoscopic APR (Ng et al. RCT, CRM-reporting inconsistency across 19 studies incl. the Dutch TME trial's 30% CRM+ APR subset); robotic rectal surgery (ROLARR RCT — no conversion-rate or outcome benefit, higher cost); robotic APR/ELAPE; taTME (COLOR III trial, CO2 embolism, multifocal- recurrence controversy, detailed step-by-step technique); hand-assisted laparoscopic surgery (HALS/HALAR, 11-study summary). Entirely a reconciliation chapter: enriches Total Mesorectal Excision (TME) & Sphincter-Sparing Resection, Abdominoperineal Resection (APR), and Anastomotic Construction in place — no new pages created, since the procedures were already covered and this chapter mainly deepens trial/technical detail.
ASCRS Ch37 - Minimally Invasive Complete Mesocolic Excision with Extended Lymphadenectomy for Colon Cancer — thirty-seventh chapter, a deep single-topic dive into complete mesocolic excision (CME) with central vascular ligation (CVL) and Japanese-style D1/D2/D3(/D4) lymphadenectomy for colon cancer. CME/CVL-to-D3 terminology alignment (Table 37.1); anatomical variants relevant to safe D3 dissection (gastrocolic/gastro-pancreatico-colic trunk, SMV tributaries, arterial anatomy); five distinct MIS techniques for right-sided D3 dissection (incl. a detailed 9-step retrofascial uncinate-first protocol) plus the left-sided approach; quality indicators (mesocolic-plane grading, specimen morphometry); T-stage-based D2-vs-D3 decision-making; short- and long-term oncologic outcomes by registry/trial (JCOG0404, Danish DCCG, ERCRC registry, RELARC/SLRC/LCME/COLD trials); central lymph node metastasis implications (Halsted vs. Fisher models). Backs a new dedicated page, Complete Mesocolic Excision with D3 Lymphadenectomy — the wiki's most comprehensive single-topic procedure page to date — given the depth involved, rather than simply expanding Colon Cancer Resection's existing brief CME section (which now cross-links to it and has its "no RCT data" open item resolved).
ASCRS Ch38 - Colonic Diverticular Disease — thirty-eighth chapter, opening (per its own framing) or continuing (per the unresolved Ch35/Ch37 Part-boundary discrepancy — see Ch37's entry above) the textbook's benign/miscellaneous-conditions material. A comprehensive treatment of diverticular disease: diagnostic evaluation (CRP/procalcitonin, CT imaging incl. the modified CT-based Hinchey reclassification grades 0/1a/1b/2/3/4, endoscopic evaluation/malignancy yield); management across the Hinchey spectrum (antibiotics controversy per DIABOLO/AVOD, ambulatory management, diverticular abscess management, Hinchey III nonoperative management, the DILALA lavage-vs-resection trial, Hartmann's-vs-primary-anastomosis cohort data); chronic disease (elective surgery timing per the DIRECT trial, the young, the immunocompromised, right-sided diverticulitis); fistula (colovesical/colovaginal/colocutaneous); obstruction; technical aspects of surgery (laparoscopic approach, transection margins, IMA preservation vs. ligation, splenic flexure mobilization outcomes, ureteral stents, RCT-validated anastomotic leak testing). Mainly a reconciliation chapter: substantially deepens the existing Diverticulitis page (adding a new Diagnostic evaluation section, a new Complicated diverticulitis section, DILALA trial detail, a new Fistula section resolving a long-flagged open item, a new Obstruction section resolving a cross-link open item on Large Bowel Obstruction, and a new Technical aspects of surgery section) and enriches Anastomotic Construction with diverticular-disease-specific technical detail; no new pages created.
ASCRS Ch39 - Large Bowel Obstruction — thirty-ninth chapter. Pathophysiology/clinical presentation/imaging; malignant LBO (perforation management by tumor location; left-sided obstruction staging history incl. a Cochrane-endorsed RCT, the Lim on-table-lavage RCT, the SCOTIA segmental-vs-subtotal-colectomy trial, and the ACPGBI audit; right-sided obstruction incl. the Mege audit; SEMS as bridge-to-surgery incl. the Stent-In 2/Pirlet/Alcantara/CREST RCTs and the Arezzo/Mashar meta-analyses; obstructing rectal cancer; unresectable disease); volvulus (sigmoid, cecal, cecal bascule, mobile cecum syndrome, ileosigmoid knotting); acute colonic pseudo-obstruction (pharmacotherapy, colonic decompression, surgical therapy, National Inpatient Sample escalation-mortality data); rare LBO causes (intussusception, hernia, infection, endometriosis, other malignancies). Backs a new dedicated page, Volvulus — the wiki's first focused treatment of this topic, previously covered only in passing — and substantially enriches Large Bowel Obstruction, Colonic Pseudo-Obstruction (Ogilvie Syndrome) (flagging two diagnostic-threshold/perforation-rate nuances rather than silently reconciling them with the existing Sabiston-sourced figures), and Endoscopic Polypectomy, EMR & ESD's colonic stenting section with named-trial detail for its previously-anonymous "two RCTs closed early" reference.
ASCRS Ch40 - Lower GI Hemorrhage — fortieth chapter. Genuinely new topic for the wiki: epidemiology/etiology (diverticulosis and anorectal disease as leading causes; full Table 40.1 breakdown); presentation/evaluation; risk stratification (shock index, the Oakland score and other named risk models); resuscitation and anticoagulation-reversal management; endoscopic evaluation/ intervention by etiology (diverticular bleeding, angioectasia incl. Heyde syndrome, post-polypectomy bleeding); radiologic evaluation (CT angiography, catheter-based angiography, nuclear scintigraphy); recurrent LGIB; small bowel/obscure GI bleeding workup (capsule endoscopy, double/single balloon enteroscopy); surgery (segmental vs. subtotal colectomy for non-localized bleeding). Backs a new dedicated page, Lower Gastrointestinal Hemorrhage — no prior wiki page addressed LGIB as a distinct entity, though Diverticulitis now cross-links to it for the bleeding-specific presentation of diverticular disease.
ASCRS Ch41 - Endometriosis — forty-first chapter. Primarily a gynecologic-disease chapter (epidemiology, etiology theories, r-ASRM/ENZIAN/EFI staging, medical management, ovarian cancer association) — ingested here as a lighter-touch structural summary rather than full reconciliation, given the chapter's center of gravity sits outside this wiki's colorectal-surgery core. Only the colorectal-relevant subset (diagnosis modalities relevant to bowel-involving disease, and surgical management — shaving vs. disc excision vs. segmental resection, complication rates, anastomotic stenosis management, recurrence) backs a new narrow page, Colorectal Endometriosis, cross-linked from Large Bowel Obstruction (endometriosis as a rare LBO cause) and Anastomotic Construction (segmental-resection anastomotic technique).
ASCRS Ch42 - Colorectal Trauma — forty-second chapter. Genuinely new topic for the wiki: colon trauma (AAST grading, the historical mandatory-diversion dogma and the RCT evidence base — Stone 1979, Chappuis, Sasaki, Gonzalez, AAST 2001 — that reversed it, damage control laparotomy evolution, single-vs-double-layer closure technique); rectal trauma (AAST grading, intraperitoneal vs. extraperitoneal anatomic/management divide, the "4 Ds" and the AAST 2017 758-patient study and EAST guidelines narrowing them); anal trauma (diagnosis, minor-injury primary repair, massive blast-injury staged management, manometry-guided colostomy reversal). Backs a new dedicated page, Colorectal Trauma — no prior wiki page addressed traumatic colorectal injury as a distinct entity.
ASCRS Ch43 - Inflammatory Bowel Disease Pathobiology — forty-third chapter. Host factors (genetics incl. NOD2/IRGM/ATG16L1/IL23R/PTPN2 and epigenetics; immunity incl. Th1/Th17/Th2/Th3/ Th9/Treg balance and named cytokine roles); intestinal microbiome (dysbiosis pattern, Table 43.1 candidate organisms, virome/mycobiome, antibiotic-exposure risk); environmental factors (urbanization, smoking incl. CYP2A6/GSTP1 modulation, NSAIDs, diet); pouchitis pathobiology (UC-vs-FAP incidence gap, IL-1 SNP, NOD2, TLR2/4, defensin expression, microbiome shift). Mainly a reconciliation chapter: substantially deepens Inflammatory Bowel Disease's Epidemiology and etiology section and resolves a long-flagged open item on Ileal Pouch-Anal Anastomosis (IPAA) by supplying its first Pouchitis section; extends (without resolving) the existing Crohn Disease-vs-Colonic Physiology Bacteroidetes-direction discrepancy; no new pages created.
ASCRS Ch44 - IBD Diagnosis and Evaluation — forty-fourth chapter. Another mainly- reconciliation chapter: IBD Phenotypes/Crohn's-vs-UC distinguishing features; IBD-U/indeterminate colitis reclassification rates; extended PSC-IBD detail; diagnostic labs (pANCA+ASCA combo, fecal calprotectin pooled stats), imaging (CTE/MRE/ultrasound), endoscopy practicalities, and histology (Table 44.3/44.4, incl. the 64–74% pathologist UC-vs-CD accuracy caveat); genetic studies (NUDT15 alongside TPMT); Montreal/Paris classification detail for both diseases. Two genuinely new additions: a full endoscopic/clinical activity-scoring suite (Mayo endoscopic subscore, MMES, SES-CD, CDEIS, Rutgeerts score, Mayo score, CDAI, Harvey-Bradshaw Index) and a risk-stratified colorectal cancer surveillance framework (SCENIC terminology, chromoendoscopy RCT evidence, biopsy protocol) — both added to Inflammatory Bowel Disease. Deepens Crohn Disease (Paris classification, Rutgeerts score, SES-CD, pANCA+ASCA, NUDT15) and Ulcerative Colitis (Mayo endoscopic subscore grading, surveillance cross-link); no new pages created.
ASCRS Ch45 - Medical Management of Ulcerative Colitis — forty-fifth chapter. Heavily overlapping with Ulcerative Colitis's existing ACG 2025/AGA 2024-guideline-sourced medical management (including an independent third citation of VARSITY's exact numbers). Genuinely new additions: curcumin as an adjunct therapy (meta-analysis stats); 5-ASA mechanism (PPAR-γ) and sulfasalazine-vs-mesalamine side-effect detail; budesonide MMX formulation/dosing detail; concrete pivotal induction/maintenance trial dosing and response-rate tables (Tables 45.4–45.5); a dedicated maintenance-of-remission framework (who needs it, drug-by-drug maintenance evidence incl. MERIT-UC's negative methotrexate result); Truelove and Witts/Mayo score table detail; and CONSTRUCT-trial/CT-P13-biosimilar-rescue detail for ASUC. No new pages created.
ASCRS Ch46 - Medical Therapy for Crohn's Disease — forty-sixth chapter. Substantial overlap with Crohn Disease's existing BSG 2025-guideline-sourced advanced-therapy section, but adds real primary-trial-level detail that section lacked: named combination-therapy trials (SONIC positive for infliximab, DIAMOND equivocal for adalimumab), a treat-to-target framework (STRIDE, CALM), three TDM trials with genuinely conflicting results (TAXIT/PAILOT positive, TAILORIX negative), biosimilar non-inferiority data, and postoperative-recurrence risk factors (histologic margin status, plexitis). Also adds microbiome-directed therapy coverage (antibiotics, diet, fecal transplant — including a 2020 FDA fecal-transplant safety alert) essentially absent from the wiki before now, TPMT genotype-distribution numbers, and a new safety flag (EBV-positive young men's hepatocellular T-cell lymphoma risk on thiopurine therapy). No new pages created.
ASCRS Ch47 - Anorectal Crohn's Disease — forty-seventh chapter. Supplies the full perianal- Crohn's treatment that Anal Fistula (ASCRS Ch13) had explicitly deferred as "still-pending" — pathogenesis, Parks/AGA fistula classification, diagnosis (EUA/MRI/ERUS accuracy comparison), medical management (concrete RCT-level biologic data: ACCENT II, CHARM, PRECiSE, GEMINI 2), surgical management (fistulotomy, seton, endorectal advancement flap, LIFT, fibrin glue/plugs, and a much stronger mesenchymal-stem-cell-therapy trial than previously in the wiki), rectovaginal fistula, and non-fistulizing complications (fissures/ulcers, skin tags, hemorrhoids, anal stricture, anal cancer). Substantially expands Crohn Disease with a new dedicated section; resolves three other pages' pending cross-links (Anal Fistula, Anal Stenosis, Hemorrhoids); extends the Crohn's-fissure pain-characterization discrepancy with Anal Fissure (now 2-against-1); flags a new unresolved stem-cell-trial discrepancy against existing BSG-sourced content. No new pages created.
ASCRS Ch48 - Crohn's Disease Surgical Management — forty-eighth chapter. A general surgical- management chapter with heavy overlap against Crohn Disease's existing Sabiston-sourced "Surgical treatment" and "Specific problems" content, reconciled throughout rather than added as a standalone section. New trial-level/epidemiologic detail: declining surgery-rate trend by era; CT/MR enterography fibrosis-vs-inflammation imaging and balloon-dilation outcome data for obstruction; Hirten's fistula-location frequency and detailed abscess/PCD/psoas-abscess management; expanded cancer/dysplasia epidemiology (age at diagnosis, cumulative risk by duration, stricture- associated-cancer cohorts); expanded GI bleeding localization detail; new nutritional-support/TPN and perioperative steroid/biologic-management subsections (incl. Table 48.2 risk factors); substantially expanded anastomotic-type trial evidence (Muñoz-Juárez, CAST, multiple meta-analyses, Kono's own follow-up studies, Shimada, the first Kono-S RCT — added primarily to Anastomotic Construction); postoperative recurrence-prevention trial evidence (Regueiro, PREVENT, De Cruz); expanded MIS/robotic/SILS and ERP evidence-quality detail; expanded strictureplasty technique/outcome data; Table 48.3 recurrence/stoma rates by colonic procedure; IPAA-in-Crohn's outcome data; ileosigmoid fistula management detail; and a full gastroduodenal- disease picture plus a new upper-small-bowel-disease bullet. No new discrepancies identified — all new content was consistent with what the wiki already had. No new condition/procedure pages created (content folded into Crohn Disease and Anastomotic Construction).
ASCRS Ch49 - Ulcerative Colitis Surgical Management — forty-ninth chapter. A detailed UC surgical decision-making/operative-technique chapter, reconciled into Ulcerative Colitis and substantially expanding Ileal Pouch-Anal Anastomosis (IPAA). New content on Ulcerative Colitis: elective/emergent surgery split; ASUC colectomy risk-scoring; SCENIC visible/invisible-dysplasia detail and UC-specific CRC cumulative-risk-by-duration figures (cross-compared with Crohn Disease's Ch48-added CD figures); preoperative planning; a fully fleshed-out IRA option (failure rates, cancer risk by procedure type, selective-candidate criteria) with one flagged internal inconsistency in the chapter's own IRA-failure-predictor discussion (preserved rather than silently resolved); and full continent-ileostomy (Kock pouch) operative/complication detail. New content on Ileal Pouch-Anal Anastomosis (IPAA): full laparoscopic operative-technique walkthrough; the one-/two-/three-stage and modified-two-stage staging controversy (incl. the PUCCINI preoperative-biologic-safety trial); pouch-design (J/S/W) outcome comparisons; hand-sewn-vs-stapled trial evidence; and the transanal-pouch (ta-J-pouch) approach. No new condition/procedure pages created.
ASCRS Ch50 - Complications of the Pelvic Pouch — fiftieth chapter. An entirely new complications framework folded into Ileal Pouch-Anal Anastomosis (IPAA) (previously brief on this topic): the structured approach to a dysfunctional pouch; full structural-complication detail (afferent-limb syndrome, PAA-defect/leak management, anastomotic sinus, "tip of J" leak, floppy-pouch scaffolding failure, mesenteric rotation, efferent-limb problems); a clinical categories/treatment algorithm for pouchitis (complementing, not replacing, the existing ASCRS Ch43 genetic/microbiome pathobiology); a new cuffitis section; Crohn's disease of the pouch, including the important finding that up to three-quarters of "CD of the pouch" diagnoses were reclassified as afferent-limb syndrome after specialty re-evaluation — correcting this wiki's prior "late Crohn's diagnosis" framing rather than just adding to it; irritable pouch syndrome and dyssynergic defecation; neoplasia-of-the-pouch incidence data; and pouch-excision-vs-revision outcome data. Also lightly cross-referenced on Ulcerative Colitis (continent ileostomy as a pouch-salvage option). No new condition/procedure pages created.
ASCRS Ch51 - Infectious Colitis — fifty-first chapter. A broad survey chapter substantially expanding Infectious Colitis: much fuller bacterial detail (STEC/EHEC pathotypes, Vibrio, TB, Aeromonas, Bacteroides, Listeria, deeper Campylobacter/Salmonella/Shigella/Yersinia treatment specifics); an entirely new "Parasitic colitidities" section (amebic colitis in depth, incl. a 112-case Mexico City perforation series, plus eleven other parasites); an entirely new "Fungal colitidities" section (Histoplasma/PDH, Candida, Aspergillus, Cryptococcus); a substantially deepened CMV writeup (epidemiology, "owl's eye" diagnostic detail, treatment, perforation-mortality data); and a new "Infectious colitis in immunocompromised patients" section (IBD — including the clinical warning that infectious colitis in IBD is often mistreated as an IBD exacerbation, with an illustrative amebic-colitis-mistaken-for-UC case; HIV; and transplant patients, incl. a 422-patient diarrhea-etiology review). Cross-referenced into Enteritis in the Immunocompromised Host (CMV and fungal sections) and Inflammatory Bowel Disease (CMV/C. difficile superinfection bullet). C. difficile itself is explicitly deferred to Ch52. No new condition/procedure pages created; no Research Priorities.md entries added (breadth-over-depth survey chapter, no single load-bearing trial identified).
ASCRS Ch52 - Clostridium difficile Infection — fifty-second chapter. A dedicated, much more granular CDI chapter than the wiki's existing Sabiston-sourced content — deepens nearly every existing subsection on Infectious Colitis (epidemiology incl. new economic-burden data; quantified risk factors incl. a TNFRSF14 genetic risk factor and IBD-specific colectomy risk; PPI-mechanism and hospital-level-variation data; a second severity schema alongside IDSA; the GDH→EIA→NAAT diagnostic algorithm; trial-level antibiotic evidence incl. the Zar 2007 RCT, EXTEND trial, and a Cochrane review; and trial-level surgical evidence incl. Neal 2011, the EAST 2017 multicenter study, and a 2019 NIS study) and adds two entirely new sections (nomenclature/genetics — PaLoc, toxins A/B, binary toxin; ribotype and clinical severity — ribotype 027/078). Also cross-referenced into Inflammatory Bowel Disease (CMV/C. difficile superinfection bullet) and Enteritis in the Immunocompromised Host (HIV-specific CDI risk figure). Five named studies flagged in Research Priorities.md (Zar 2007, Neal 2011, EAST 2017, EXTEND, the Cochrane review).
ASCRS Ch53 - Radiation, Microscopic, and Ischemic Colitis — fifty-third chapter. A three- condition survey chapter, unusually trial-rich throughout for the survey format. Two new condition pages: Radiation Colitis (Proctitis) (kept deliberately separate from the existing, Sabiston- sourced Radiation Enteritis — same underlying radiation-vasculopathy mechanism, but a distinct colorectal-specific presentation and largely endoscopic treatment armamentarium: topical formalin as first-line therapy for hemorrhagic radiation proctitis, argon beam coagulation as a near-equivalent alternative, surgery as a last resort given historically very high morbidity/ mortality) and Microscopic Colitis (no prior wiki page existed — collagenous vs. lymphocytic subtypes, epidemiology and autoimmune/smoking/medication risk factors, Spanish Microscopic Colitis Group diagnostic criteria, and a budesonide-anchored treatment ladder incl. two named induction/ maintenance RCTs). Substantial reconciliation of the existing Ischemic Colitis page: a formal mesenteric-ischemia-vs-ischemic-colitis comparison table, subgroup-specific epidemiology (COPD rates up to 100/100,000; 0–4.6% elective vs. up to 21% emergency-AAA-repair incidence), LGIB- etiology proportion data (Newman, Hreinsson), the pathognomonic "ghost cells" histologic finding, a CT-diagnostic-accuracy study (Iacobellis: 100% CT-positive in the acute phase, >70% mortality when pneumatosis and necrosis coexist), and a corroborating surgical-mortality figure (Scharff, up to 40%). Six named studies flagged in Research Priorities.md (Miehlke, Münch, the Spanish Microscopic Colitis Group/Fernandez-Banares, Higgins, Iacobellis, Scharff); two new pages.
ASCRS Ch54 - Intestinal Stomas — fifty-fourth chapter, by far the longest ingested to date (40 PDF pages, 38 figures) — created an entirely new procedure page, Intestinal Stomas, since no prior wiki page existed for stomas at all despite their centrality to colorectal practice. Covers configuration/indications and physiology for colostomy, ileostomy, and jejunostomy (end vs. loop); preoperative siting (the "stoma triangle") and education (Chaudhri, Younis preoperative-education outcome data); full technical creation detail including ICG near-infrared perfusion assessment; postoperative care and appliance selection; the full complications spectrum (ischemic necrosis/retraction/stenosis with the bedside "test tube" exam, peristomal skin disorders and fungal infection, peristomal pyoderma gangrenosum, peristomal varices incl. TIPS/PSC-specific detail, stoma prolapse, peristomal abscess, and high output stomas with a full dietary/ pharmacologic management ladder); stoma reversal (preoperative preparation, contentious timing evidence for both loop and end stomas, stapled-vs-handsewn loop-closure technique, and reversal-specific complication rates); and special considerations (the difficult/obese-patient stoma incl. the loop-end configuration and "pie crusting," genitourinary stomas incl. ileal conduit/Indiana pouch/Mitrofanoff/Monti, the Turnbull blowhole colostomy, and ileostomy/foodstuff bolus obstruction management). Cross-referenced into Diverticulitis, Crohn Disease, Ulcerative Colitis, Ileal Pouch-Anal Anastomosis (IPAA), Radiation Colitis (Proctitis), Infectious Colitis, and Short Bowel Syndrome. Unlike Ch52/Ch53, not particularly trial-rich for its most consequential claims — no Research Priorities.md entries added, though a Scandinavian early-vs-late loop ileostomy closure RCT and a stoma-rod meta-analysis (finding increased complications with rod use) are noted as worth independent verification if stoma-specific questions arise. One new page. Parastomal hernia repair itself is explicitly deferred by the source textbook to Ch55, next in the sequential ingest.
ASCRS Ch55 - Abdominal Wall Reconstruction and Parastomal Hernia Repair — fifty-fifth chapter. Despite its title, almost entirely about parastomal hernia repair specifically — the "abdominal wall reconstruction" techniques described (retromuscular repair, transversus abdominis release/ TAR) appear only in the parastomal-defect-repair context, not as standalone general AWR content. Created an entirely new procedure page, Parastomal Hernia Repair (previously only a bare incidence figure on Intestinal Stomas's complications table): incidence by stoma type (highest for end colostomy, lowest for loop ileostomy), risk factors (BMI/waist circumference as the strongest evidence-supported association), diagnosis (self-reported symptoms correlating with need for repair better than CT imaging, which can both over- and under-detect), the EHS 2014 classification, evidence for a selective operative approach (up to 70% of patients with a PSH never pursue repair, recurrence >50% even with mesh reinforcement), preoperative optimization targets, and the full repair-technique armamentarium with outcome tables — primary repair (largely abandoned, ~80% recurrence), onlay mesh (pooled 19% recurrence), open and laparoscopic intraperitoneal mesh in keyhole vs. Sugarbaker orientation (a DeAsis meta-analysis found laparoscopic Sugarbaker's 10% recurrence clearly superior to keyhole's 28%, the direct evidentiary basis for the chapter's "Sugarbaker is the procedure of choice" key concept), and open retromuscular repair/TAR (incl. the chapter authors' own less-favorable, unpublished-elsewhere experience with a promising-looking technique — preserved as a methodological caution rather than smoothed over). Also covers mesh selection (synthetic vs. biologic/biosynthetic trade-offs) and the chapter's own decision algorithm. No RCTs exist comparing PSH repair techniques — an explicit field-wide evidence gap. One new page.
ASCRS Ch56 - Functional Disorders After Colorectal Surgery-IBS — fifty-sixth chapter, opening "Part V: Pelvic Floor Disorders." A broad functional-disorders survey with two halves: irritable bowel syndrome, and chronic pelvic pain syndromes relevant to colorectal practice. Created three entirely new condition pages. Irritable Bowel Syndrome (IBS): Rome IV definition/subtyping (IBS-D/C/M by Bristol stool form), diagnostic workup by subtype (incl. bile acid diarrhea and microscopic colitis as underrecognized IBS-D mimics), the surgery-avoidance message (misdiagnosis- driven cholecystectomy/hysterectomy/appendectomy), a newly identified diverticulitis/SUDD overlap cross-referenced into Diverticulitis for the first time, and the full graduated treatment ladder (dietary/FODMAP, pharmacotherapy by subtype incl. secretagogues and 5-HT₃ antagonists, neuromodulation by bowel habit, psychological treatment). Functional Anorectal Pain & Coccygodynia: supersedes and substantially expands the brief "Anorectal pain" section previously on Fecal Incontinence — the three Rome IV functional anorectal pain subtypes (levator ani syndrome, unspecified functional anorectal pain, proctalgia fugax) each with a full treatment ladder (digital massage, biofeedback — superior to EGS/massage per a 157-patient RCT — Botox, sphincterotomy for familial proctalgia fugax), plus coccygodynia (subtypes, workup, ganglion impar blockade, coccygectomy outcomes). Pudendal Neuralgia: entrapment anatomy (four possible levels), Nantes diagnostic criteria, and an unusually procedural treatment ladder for a "functional disorders" chapter — nerve block, neuromodulation (pudendal and conus medullaris stimulation), ablation, fat grafting, and several named operative decompression techniques (Istanbul technique, operative pudendoscopy, Hibner repeat decompression) with outcome data. Five studies flagged in Research Priorities.md (Ford 2018 ACG monograph, Black 2020 secretagogue meta-analysis, Chiarioni 2010 biofeedback trial, Robert 2005 pudendal decompression RCT, Kleimeyer 2017 coccygectomy cohort); three new pages. One page-offset note: confirmed via the copyright-line cross-check that the PDF/book offset jumped +2 (from Ch55's +10 to +12) at this Part-V boundary — see log.md's dedicated offset-correction entry, which also documents that Ch54 and Ch55's own offsets had been mislogged as unchanged at +9 when they were actually +10.
ASCRS Ch57 - Common Tests for the Pelvic Floor — fifty-seventh chapter, a dedicated technical survey of the pelvic floor testing battery. No new pages — instead a substantial rewrite of Anorectal Physiology Testing, which had previously carried only brief technique descriptions from Sabiston Ch52 - Pelvic Floor Disorders & Constipation and ASCRS Ch03 - Anorectal Physiology. New content: manometry catheter technology (water-perfused, solid-state, air-charged, HRAM/HDAM, incl. the chapter authors' own stated preference for conventional air-charged systems in their own labs despite HRAM/HDAM's availability), full manometry technique, the four-type dyssynergic defecation classification (Types I–IV by push adequacy × sphincter response) with its major caveat (up to 90% of asymptomatic controls/ non-constipated proctalgia patients show a "dyssynergic" pattern on this testing), the 2014–2018 London Protocol/classification (major vs. minor/inconclusive anorectal physiology findings), quantified endoanal-ultrasound sphincter anatomy (internal sphincter thickness by age, external sphincter anterior-vs-posterior thickness, perineal body length cutoffs), Oxford intussusception grading (correlating with worsening fecal incontinence but not constipation), and echodefecography — an entirely new imaging modality not previously in the wiki. Also expanded neurophysiologic testing detail (surface vs. needle EMG, PNTML's substantial methodologic limitations, spinal motor latency/MEPs found more tolerable and more often abnormal than PNTML in fecal incontinence). Confirmed via the copyright-line cross-check that the offset is unchanged at +12 from Ch56 — this chapter-to-chapter transition shows no jump, confirming the earlier +2 jump at Ch56 was specific to the Part V divider page rather than an ongoing drift. Not a trial-rich, comparative-outcomes chapter — no Research Priorities.md entries added.
ASCRS Ch58 - Evaluation of Constipation and Treatment of Abdominal Component — fifty-eighth chapter. Substantially expanded Constipation (previously built only from Sabiston Ch52 - Pelvic Floor Disorders & Constipation's brief technique/medication mentions). New content: full Rome IV subtyping table (functional constipation, IBS-C, opioid-induced constipation, functional defecation disorders), a secondary-causes etiology table, transit-testing technique detail (radiopaque markers, scintigraphy, wireless pH-pressure capsule, colonic manometry), and a much deeper medical management ladder that resolves the page's prior "no primary trial data" gap — named RCTs are now cited for lubiprostone, linaclotide, plecanatide, tenapanor, and prucalopride (the last via a 6-trial, 2,484-patient integrated analysis), plus a 27-RCT meta-analysis for PAMORAs in opioid-induced constipation. The chapter's real center of gravity is its surgical section: patient-selection factors for abdominal colectomy with IRA (transit-study and pelvic-floor-testing caveats, gastric/small bowel dysmotility, psychiatric factors), the Staller et al. 2018 multidisciplinary algorithm, the 2016 ASCRS CPG's (low-quality-evidence) recommendation for colectomy with IRA, long-term outcome data (77%/median-11-year and high-satisfaction/median-16-year cohorts, each with meaningful small bowel obstruction and incontinence rates), anastomotic variants (antiperistaltic cecorectal, Jinling procedure), the megarectum caveat (colectomy performs worse; Ileal Pouch-Anal Anastomosis (IPAA) as a small-series alternative the ASCRS CPG explicitly cautions against outside last-resort use), and less-invasive/less-standard alternatives (transanal irrigation, antegrade continence enemas, sacral neuromodulation, ileostomy). Five studies flagged in Research Priorities.md (Johanson 2008 lubiprostone RCT, Lembo 2011 linaclotide trials, Miner 2017 plecanatide RCT, Camilleri 2016 prucalopride integrated analysis, Luthra 2018 PAMORA meta-analysis). Confirmed via the copyright-line cross-check that the offset remains unchanged at +12 from Ch57. Zero new condition pages (one page substantially reconciled), one new source page.
ASCRS Ch59 - Treatment of Difficult-Obstructive Defecation — fifty-ninth chapter (Zutshi M, Oliveira LCC). Obstructed defecation syndrome (ODS) as an umbrella entity within Constipation's pelvic-constipation subtype: physiology of defecation, dyssynergic defecation definition/etiology (4.6% incidence in non-IBS patients), structural causes (rectocele, enterocele/sigmoidocele grading, internal prolapse/intussusception, overt rectal prolapse), scoring systems (CSI, ODS score, CRQOL, PFDI/CRADI), a diagnostic testing table, and etiology-specific treatment (puborectalis pathology via physical therapy/biofeedback/botulinum toxin A/EGS/myomectomy/diversion; internal prolapse via STARR/ventral rectopexy; rectocele/enterocele/sigmoidocele via transanal/transperineal/transvaginal repair and sacrocolpopexy; overt prolapse deferred to the not-yet-ingested rectal prolapse chapter). New umbrella page Obstructed Defecation Syndrome (ODS); substantially expanded Rectocele (repair-technique recurrence rates, resolving its prior open gap) and Constipation (new dyssynergic-defecation treatment ladder, resolving its prior "anismus treatment" gap); light cross-reference updates to Rectal Prolapse (Procidentia) and Rectal Prolapse Repair. Five studies flagged in Research Priorities.md (Rao 2018 home-vs-office biofeedback RCT, Faried 2010 surgical-vs-nonsurgical anismus RCT, Van Geluwe 2014 STARR meta-analysis, Nugent 2020 botulinum toxin A vs. EGS trial, Grimes 2019 posterior-compartment-prolapse systematic review). Confirmed via the copyright-line cross-check that the offset is unchanged at +12 for this chapter, but discovered a +1 jump to +13 at the Ch59/Ch60 boundary: book page 1017 (last page of Ch59, PDF page 1005) is immediately followed by book page 1019 (first page of Ch60, PDF page 1006) — book page 1018 has no corresponding PDF page, most likely a blank page present in print (conventionally inserted so a new chapter starts on a recto page) but dropped when the PDF was created. One new condition page, one new source page; two pages substantially reconciled, two pages lightly touched.
ASCRS Ch60 - Rectal Prolapse — sixtieth chapter (Murphy M, Vogler SA). Full-thickness rectal prolapse: pathophysiology (mid-rectal intussusception theory, connective tissue disorders, multicompartment POP as a contributing factor), the mucosal-prolapse/internal-intussusception/ overt-prolapse distinction, the Oxford rectal prolapse grading system (I–IV internal, V overt), evaluation (patient questionnaires — the 2019 Pelvic Floor Disorders Consortium's IMPACT instrument; prolapse-specific physiology-testing caveats; fluoroscopic defecography vs. dMRD, the latter shown less sensitive by meta-analysis), incarcerated rectal prolapse management, perineal procedures (Thiersch anal encirclement, Delorme, Altemeier — each with recurrence/mortality data by study), abdominal procedures (suture rectopexy/Cutait, resection rectopexy/Frykman-Goldberg, posterior mesh rectopexy/Wells, Ripstein anterior sling rectopexy, and ventral mesh rectopexy/ D'Hoore with extensive mesh/suture-type erosion and outcome data), approach-selection guidance, and recurrent-prolapse management. A dedicated SRUS section adds colitis cystica profunda, updated ulcer/polyp prevalence figures, argon plasma coagulation, and a mechanism-based (weakness vs. straining) surgical-vs-nonsurgical treatment split. Near-total rewrite of Rectal Prolapse Repair (correcting a Wells/Ripstein procedure conflation along the way); substantially expanded Rectal Prolapse (Procidentia) and Solitary Rectal Ulcer Syndrome (SRUS); resolved Obstructed Defecation Syndrome (ODS)'s deferred internal/overt-prolapse sections. Five studies flagged in Research Priorities.md (Hidaka et al. suture-rectopexy-vs-VMR RCT, Evans et al. 2,203-patient mesh-erosion series, Fang et al. NSQIP mortality analysis, Gurland et al. recurrent-prolapse VMR outcomes, Altomare et al. VMR-vs- STARR comparison). Confirmed via the copyright-line cross-check that the offset is unchanged at +13 for this chapter, but discovered another +1 jump to +14 at the Ch60/Ch61 boundary — the same "chapter starts on an odd/recto book page, forcing a blank page dropped from the PDF" pattern found at the Ch59/Ch60 boundary, confirmed against two independent pages early in Ch61. One new source page; three condition/procedure pages substantially reconciled (one near-total rewrite).
ASCRS Ch61 - Fecal Incontinence Evaluation and Treatment — sixty-first chapter (da Silva G, Mellgren A). The dedicated FI chapter that ASCRS Ch03 - Anorectal Physiology had explicitly deferred evaluation/treatment content to. FI epidemiology (1–19% prevalence, systematic review of 4,840 articles) and a four-category etiology framework; evaluation (CCF-FIS scoring, manometry correlations by sphincter/sensation finding, ultrasound, neurophysiology testing's declining role, defecography's negative predictive value for SNM, colonoscopy); and a full treatment ladder — conservative measures, biofeedback, anal insertion devices, the vaginal bowel control system, sacral neuromodulation (two-stage procedure, FDA-trial outcome data, reoperation rates), bulking agents (NASHA Dx RCT data), PTNS, SECCA radiofrequency, investigational stem cell therapy, the TOPAS anal sling, overlapping sphincteroplasty (full technique), ventral mesh rectopexy for prolapse-associated FI, dynamic graciloplasty, magnetic anal sphincter augmentation, the artificial bowel sphincter, and last-resort diversion/MACE (several devices flagged as not currently available in the USA). Substantially expanded Fecal Incontinence with new Evaluation and Treatment sections — the single largest resolution of a previously-flagged deferred-content gap in the wiki's pelvic floor arc. Light cross-reference addition to Anorectal Physiology Testing's PNTML discussion. Five studies flagged in Research Priorities.md (the SNM FDA-approval trial, the NASHA Dx sham-controlled RCT, the PTNS sham RCT, the SECCA sham-controlled RCT, and the Samaranayake et al. VMR-for-prolapse systematic review). Confirmed via the copyright-line cross-check that the offset is unchanged at +14 for this chapter, with no further jump at the Ch61/Ch62 boundary — Ch61 ends on an even book page, so no forced blank page, confirming the jump pattern tracks odd/even chapter-ending pages rather than being a constant per-chapter drift. One new source page; one condition page substantially expanded, one concept page lightly touched.
ASCRS Ch62 - Low Anterior Resection Syndrome — sixty-second chapter (Messick CA). The dedicated LARS chapter. Chronicity data (58%/46%/41% major-symptom rates at 3/12/54 months), the 85%-continent-yet-42%-still-LARS finding, and LARS-like symptoms in preserved-rectum patients after pelvic chemoradiotherapy; the Delphi consensus described in this chapter's own text as "eight symptoms and five consequences," conflicting with ASCRS Ch29 - Proctectomy for Rectal Cancer's "eight symptoms and eight consequences" — flagged as a likely transcription inconsistency rather than silently resolved. Causes framed as genuinely poorly understood/unvalidated, plus a dedicated risk-factor list; the POLARS preoperative-prediction nomogram; prevention caveats (J-pouch advantage possibly not durable to 18 months; no intervention definitively proven preventive); a new diagnosis/exclusion-of-mimics section (pancreatic malabsorption, SIBO, lactose intolerance, radiation enteritis, strictures, ischemic conduits, recurrence); and a substantially expanded treatment ladder — chronic-disease/"Listen, Educate, Treat" framing, medical therapy (incl. topical skin care), biofeedback (tempered by a newer RCT localizing benefit to the FI component), an entirely new retrograde colonic irrigation subsection (three cited studies), sacral neuromodulation (systematic review: 94 screened, 79.8% implanted, 67.0% median LARS-score improvement — reconciled alongside rather than merged with the pre-existing Ch29-sourced SNS figures), PTNS (not available in the USA; CONFIDeNT sham-RCT), antegrade continence enemas (2016 meta-analysis, 83.6% pooled success), and fecal diversion. Near-total expansion of Low Anterior Resection Syndrome (LARS). Five studies flagged in Research Priorities.md (Battersby et al. POLARS nomogram validation, van der Heijden et al. postoperative screening/treatment protocol study, Andreyev et al. algorithmic-care RCT, Huang & Koh SNM-for-LARS systematic review, and an RCI-vs-PTNS RCT). Confirmed via the copyright-line cross-check that the offset is unchanged at +14 for this chapter, with no jump at the Ch62/Ch63 boundary — Ch62 ends on an even book page, so no forced blank page; confirmed against Ch63's first page. One new source page; one condition page near-totally expanded.
ASCRS Ch63 - Sexual Function After Colorectal Surgery in Women — sixty-third chapter (Keller DS, Ky-Miyasaka JA). The first of a paired set of chapters on sexual/genitourinary dysfunction after colorectal surgery (Ch64 covers male patients). Scope of the problem (19-62% postoperative sexual dysfunction prevalence in women, the QoLiRECT study, resection-extent/stoma effects, 40-60% dysfunction rates after IBD pelvic pouch surgery); etiology across radiation (detailed pelvic autonomic nerve anatomy — superior/inferior hypogastric plexus — the Dutch TME trial's 14-year follow-up data, Bregendahl et al., Thyø et al.'s OR 1.80 finding), chemotherapy (ovarian estrogen loss), and surgery (TME's nerve-preserving-dissection rationale); fertility impact (IPAA fertility reduction of 44-82%, fertility-preservation options); the four-phase female sexual response model (desire, arousal, orgasm, resolution) with phase-specific treatment (Table 63.2); the Pelvic Floor Disorders Consortium's 2020 measurement recommendations (FSFI-9, PISQ-IR); patient/provider communication barriers; cultural-competency considerations; and multidisciplinary treatment team composition. New concept page Sexual Function After Colorectal Surgery created (deliberately structured to also receive Ch64's male-specific content once ingested, rather than splitting into two pages, given the shared nerve anatomy and conceptual framework). Light cross-reference additions to Total Mesorectal Excision (TME) & Sphincter-Sparing Resection and General Postoperative Complications — the latter's previously-flagged "female sexual dysfunction covered only briefly, with conflicting infertility-risk data" open item is now marked resolved (the two different infertility-risk figures — threefold increase vs. 44-82% — are explicitly retained as a genuine range across different cited studies, not merged). No studies flagged in Research Priorities.md for this chapter — content is comprehensive secondary-summary material rather than built around a small number of individually load-bearing primary trials. Confirmed via the copyright-line cross-check that the offset is unchanged at +14 for this chapter, with no jump at the Ch63/Ch64 boundary — Ch63 ends on an even book page, so no forced blank page; confirmed against Ch64's first page. Two new pages (one concept, one source); two pages lightly cross-referenced.
ASCRS Ch64 - Male Genitourinary Dysfunction as a Consequence of Colorectal Surgery — sixty-fourth chapter (Mantilla N, McNevin S). The second of the paired sexual/genitourinary dysfunction chapters (Ch63 covers females). Introduction (20-80% prevalence estimate, contributors beyond nerve injury); detailed sympathetic (T12-L2, superior hypogastric plexus/hypogastric nerves, ejaculation) and parasympathetic (S2-S4, pelvic splanchnic nerves/nervi erigentes, inferior hypogastric plexus, erection) neuroanatomy; male sexual/urinary functional metrics (IIEF-15, IIEF-5/SHIM, EPIC, UDI/UDI-6, King's Health Questionnaire, Danish Prostatic Symptom Score, ICS male questionnaires); procedure-specific genitourinary dysfunction risk (anterior resection lowest, APR highest and multifactorial, MIS-vs-open TME's limited/controversial data, pelvic radiotherapy's contribution); psychological impact and counseling guidance; a full management ladder (vacuum constriction device, intracorporeal injections — alprostadil/Bimix/Trimix, intraurethral alprostadil, oral PDE5 inhibitors, penile prosthesis — inflatable vs. semirigid, retrograde- ejaculation/anejaculation fertility workaround via urine-harvested semen, urinary retention management); an extended LGBTQ section (gay/bisexual men's mental health burden, role-change dynamics, the clinically-defined anodyspareunia syndrome, the Gay Sexual Functioning Inventory from the Restore Study); and fecal-diversion-specific sexual/QOL impact (80% lifestyle change, 40% impaired sexuality, elevated ostomate suicide risk). Merged into Sexual Function After Colorectal Surgery as a new "Male genitourinary dysfunction" section organized in parallel to the existing female section. Light cross-reference addition to Abdominoperineal Resection (APR). No studies flagged in Research Priorities.md. Confirmed via the copyright-line cross-check that the offset is unchanged at +14 for this chapter, but Ch64 ends on book page 1075 (odd), so per the established mechanism the offset jumps +1 to +15 at the Ch64/Ch65 boundary — confirmed against Ch65's first page ("© Springer Nature Switzerland AG 2022 1077"). The fourth chapter-boundary offset jump found across this ingest arc, after Ch59/Ch60 and Ch60/Ch61. One new source page; one concept page expanded with a new parallel section; one procedure page lightly cross-referenced.
ASCRS Ch65 - Middle and Anterior Pelvic Compartment Issues for the Colorectal Surgeon — sixty-fifth chapter (Patterson D, Gearhart SL, Birnbaum E — a urogynecology-authored chapter for colorectal surgeons). Definition/etiology/epidemiology of pelvic organ prolapse (three-compartment model, 3-50% prevalence range, 12.6% lifetime surgical risk by age 80, vaginal-parity risk-factor data); evaluation (symptom domains, PFDI-20/PFIQ-7/PISQ-12, the full POP-Q staging exam, urodynamics, imaging indications); anterior/middle compartment operative options (nonoperative management and pessary use, obliterative-vs-reconstructive and transvaginal-vs-transabdominal decision points, SSLF/USLS apical suspension, anterior/posterior colporrhaphy, midurethral slings for SUI, sacrocolpopexy technique/candidacy, the FDA mesh-warning history and CARE trial mesh-erosion data, Chughtai et al.'s mesh-infection risk-combination finding); and a multidisciplinary approach section (shared pelvic support anatomy, the rectocele-as-consequence- not-cause argument, combined sacrocolpopexy+rectopexy technique/sequencing and TAPE-score outcome data). New concept page Pelvic Organ Prolapse (Anterior & Middle Compartment) created — resolving a gap explicitly flagged and deferred by Obstructed Defecation Syndrome (ODS) ("no dedicated page yet exists for enterocele/sigmoidocele... revisit if a urogynecology-focused source is ever ingested"), Rectocele, and Rectal Prolapse Repair. Light cross-reference additions to those three pages plus Rectal Prolapse (Procidentia). Five studies flagged in Research Priorities.md (Wu et al. lifetime-risk projection, the CARE trial, the OPTIMAL trial, Chughtai et al.'s mesh-infection combination study, and Watadani et al.'s combined sacrocolpopexy+rectopexy outcome study). Confirmed via the copyright-line cross-check that the offset is +15 for this chapter (a jump from +14, predicted at the end of the Ch64 entry since Ch64 ended on an odd book page, and now confirmed). A second, differently-caused jump was then found at the Ch65/Ch66 boundary: Ch65 itself ends on an even book page (1086), which would ordinarily predict no further jump, but PDF page 1072 is a Part divider page ("Part VI: Miscellaneous") with no chapter content of its own — the divider is printed on its own recto page with a blank verso dropped from the PDF, the same recto-forcing convention normally seen at chapter boundaries, applied here to a Part transition instead. Net effect: offset jumps again to +16 at Ch66's first page (confirmed via copyright line). The fifth chapter/section-boundary offset jump found across this ingest arc, and the first attributable to a Part divider rather than a plain chapter boundary. One new concept page, one new source page; four condition/procedure pages lightly cross-referenced.
ASCRS Ch66 - Pediatric Colorectal Disorders — sixty-sixth chapter (Teeple EA, Azarow KS), opening Part VI: Miscellaneous. A broad survey chapter: Hirschsprung's disease (three presentation windows; calretinin diagnosis; the pediatric-specific caveat that anorectal manometry is unreliable under 12 months of age; the three classic operations — Swenson, Soave with the Boley modification, Duhamel — and their equivalent success rates; HAEC epidemiology; adult/long-term outcomes); colonic duplications (epidemiology, embryologic theories, the Currarino triad, excision- vs-fenestration decision-making); pediatric constipation (natural history, HD-exclusion workup, sitz marker studies/colonic manometry, surgical options, constipation-associated volvulus/perforation); pediatric rectal prolapse (90% conservative resolution under age 4, cystic fibrosis screening, a 2018 APSA sclerotherapy survey with agent-specific cure rates, Thiersch/linear cauterization, operative options); perianal abscess/fistula-in-ano (distinct pediatric epidemiology, a genuinely unsettled operative-vs-nonoperative literature, IBD/immunosuppression red flags); anal fissure (anterior-midline female predominance, three GTN RCTs with mixed results, Botox-vs-myectomy data); cecostomy/ACE (MACE technique history, percutaneous alternatives, success prediction, adjunctive SNS); and ARM/HD transitional care to adult colorectal surgery (severity spectrum, fistula-level outcome correlation, a structured age-12-to-21 transition process). New umbrella condition page Pediatric Colorectal Disorders created, consolidating all of the above (on the same organizing logic as Obstructed Defecation Syndrome (ODS) and General Postoperative Complications) rather than fragmenting into many thin pediatric-specific pages. Light cross-reference additions to Constipation, Anal Fissure, and Anorectal Abscess. Four studies flagged in Research Priorities.md (Hintz et al.'s pediatric rectal prolapse sclerotherapy systematic review, the Kenny et al. GTN RCT whose null result conflicts with two other cited GTN trials, Afsarlar et al.'s pediatric perianal abscess/fistula outcomes study, and Christison-Lagay et al.'s nonoperative- management-reduces-fistula-risk study). Confirmed via the copyright-line cross-check that the offset is unchanged at +16 for this chapter, with a further +1 jump to +17 at the Ch66/Ch67 boundary — Ch66 ends on an odd book page (1103), the standard mechanism, confirmed against Ch67's first page. The sixth chapter-boundary offset jump found across this ingest arc. One new condition page, one new source page; three condition pages lightly cross-referenced.
ASCRS Ch67 - Considerations for Geriatric Patients Undergoing Colorectal Surgery — sixty-seventh chapter (Saur NM, Wilkins KB). A dedicated geriatric-surgery chapter: frailty screening (CGA as gold standard; Table 67.1's eight screening tools — ECOG PS, ADLs, Mini-Cog, fTRST, TUG, G8, NRS, ASA, CACI); domains of geriatric assessment (functional/TUG, cognitive/Mini-Cog, polypharmacy, nutrition, social support, patient's wishes); prehabilitation (Minnella et al.'s poor-baseline-walking-capacity-benefits-most finding, the ~30% non-responder rate, Gillis et al.'s nutritional-prehabilitation systematic review); surgical considerations (ERAS elements, MIS appropriateness, emergency surgery outcomes and the fTRST's ED-setting validation via Zattoni et al., explicit guidance against age-based bias toward palliative lesser operations); postoperative management (Shahrokni et al.'s geriatric-comanagement mortality comparison, delirium risk factors/prevention with OR 0.47 for multifactorial nonpharmacologic intervention, rehabilitation); functional recovery and patient-reported outcomes (the GOSAFE study's Clavien-Dindo-to-functional- decline correlation, ICHOM PROM domains via Doolin et al., the LARS score and Cleveland Clinic Fecal Incontinence Score as validated instruments, colostomy-vs-coloanal-anastomosis decision-making for poor baseline sphincter tone); and Personalized Treatment of Rectal Cancer — a 29-member interdisciplinary task force's (Montroni et al.) expert consensus recommendations (general principles, frailty-based MDT stratification, patient optimization, surgical treatment including TME approach selection and local excision restrictions, treatment of locally advanced disease including watch and wait and no-adjuvant-chemotherapy guidance, treatment of synchronous liver metastases, outcomes/ERAS/PROMs/healthcare cost recommendations, a fit-vs-frail treatment algorithm, and life-expectancy data showing modern surgical outcomes approach that of peers without rectal cancer). New concept page Geriatric Considerations in Colorectal Surgery created rather than folding into the existing, more general Preoperative Evaluation & Perioperative Risk Optimization or Enhanced Recovery After Surgery (ERAS) pages, given this chapter's substantially greater depth and its unique rectal-cancer-specific treatment algorithm. Light cross-reference additions to those two pages plus Rectal Cancer and Low Anterior Resection Syndrome (LARS). Six studies flagged in Research Priorities.md (Minnella et al., the GOSAFE study, Shahrokni et al., Zattoni et al., Hshieh et al.'s delirium-prevention meta-analysis, and Montroni et al.'s task-force recommendations — the single most load-bearing citation in the chapter). Confirmed via the copyright-line cross-check that the offset is unchanged at +17 for this chapter, with no jump at the Ch67/Ch68 boundary (Ch67 ends on an even book page, 1116; Ch68, "Healthcare Economics," confirmed starting at book page 1117). One new concept page, one new source page; four concept/condition pages lightly cross-referenced.
ASCRS Ch68 - Healthcare Economics — sixty-eighth chapter (Peters WR, deBeche-Adams T), a genuine outlier in scope relative to the rest of this clinical wiki — the first practice-management/ health-policy chapter in the sequential ingest. US healthcare spending in global (OECD) perspective (price vs. utilization drivers of the US spending gap, outcome-metric comparisons); US healthcare finance (Medicare Parts A-D, Medicaid federal-state financing structure, employer-sponsored insurance history and cost-shifting trends, individual/ACA-exchange insurance); healthcare policy debates (the ACA's contested legal status post-NFIB v. Sebelius, underinsurance/high-deductible-plan growth, surprise medical billing, rural hospital closures and their Medicaid-expansion correlation); physician reimbursement (MACRA's repeal of the SGR, the MIPS scoring system, the Advanced APM pathway); and coding systems (ICD-10-CM/PCS, CPT® Category I/II/III codes and the RUC valuation process, modifiers, add-on codes, unlisted codes, DRG, and the claims-to-payment pipeline). New standalone concept page Healthcare Economics & Surgical Coding created — no existing wiki page covered this material, and minimal cross-linking to clinical pages was attempted given the topical distance. No studies flagged in Research Priorities.md (health-policy/health-services-research citations, not clinical trials). Confirmed via the copyright-line cross-check that the offset is unchanged at +17 for this chapter, with no jump at the Ch68/Ch69 boundary (Ch68 ends on an even book page, 1126; Ch69, "Ethical Considerations," confirmed starting at book page 1127). One new concept page, one new source page; no other pages cross-referenced.
ASCRS Ch69 - Ethical Considerations (Conflict of Interest, Surgical Innovation, and End of Life) — sixty-ninth chapter (Buie WD, MacLean AR), the second consecutive non-clinical Part VI chapter. Conflict of interest in surgical research (financial vs. nonfinancial/intellectual/professional classification; Fineberg's reasonable-person COI standard; industry-sponsorship bias evidence including the Vioxx selective-interpretation case study; Cherla et al.'s 70.3% surgeon-vs-OPD COI discordance finding and its associated industry-favorable-conclusion bias; systematic-review COI underreporting rates of 17-65%; the four management strategies — disclosure, elimination, balance, exclusion — and their respective limitations; COI safeguards through the peer review process); introduction of surgical innovation (the laparoscopic cholecystectomy and taTME cautionary case studies — the latter's urethral-injury registry signal and the Norway moratorium/Netherlands recurrence reports; the Society of University Surgeons' 2008 position statement and the IDEAL Collaboration's five-stage evaluation framework; Jaffe et al.'s and Ahmed et al.'s surveys on gaps between actual and ideal new-skill-acquisition practices; innovation-specific informed consent requirements; the ethical obligation to track and publish outcomes even absent feasible RCTs; industry's dual enabling/COI-creating role); and end-of-life surgical care (communication principles incl. the SUPPORT trial and "clinical momentum"; prognostication incl. time-limited trials, advance directive rarity, and surrogate decision-maker miscalibration data; decision-making via the four ethical principles — autonomy/beneficence/non-maleficence/justice — shared decision-making and the best case/worst case framework, the double-effect doctrine, "no longer medically indicated" withdrawal-of-care criteria, and cultural variation in decision-making authority; elderly-specific end-of-life surgical considerations). New standalone concept page Surgical Ethics (Conflict of Interest, Innovation & End-of-Life Care) created — no existing wiki page covered any of these three ethics domains. Light cross-reference addition to Total Mesorectal Excision (TME) & Sphincter-Sparing Resection given the chapter's explicit use of taTME as its innovation-ethics case study, already covered clinically on that page. No studies flagged in Research Priorities.md (ethics/health-services-research citations, not clinical trials). Confirmed via the copyright-line cross-check that the offset is unchanged at +17 for this chapter, with no jump at the Ch69/Ch70 boundary (Ch69 ends on an even book page, 1138; Ch70, "Welcome to Litigation," confirmed starting at book page 1139). One new concept page, one new source page; one procedure page lightly cross-referenced.
ASCRS Ch70 - Welcome to Litigation — seventieth chapter (Ames DK, a practicing medical malpractice trial attorney rather than a physician), the third consecutive non-clinical Part VI chapter. Malpractice risk epidemiology (2011 NEJM data — 15.3% annual claim probability for general surgeons, 80%/99% career-claim probability by ages 45/65) and the chapter's "what when, not what if" framing; the three stages of civil litigation — Initiation (notice of an occurrence, quality- assurance/work-product privilege mechanics and their waiver conditions, medical records request handling including EMR-specific metadata issues, causes of action including the negligence-vs- informed-consent-vs-battery distinction and its insurance-coverage implications, damages classification including general/special and punitive categories), Discovery (written discovery via interrogatories/admissions/document requests, and an extensive deposition-technique section covering percipient-vs-expert testimony scope, refreshed-memory-vs-document-dependent testimony, ambiguous- term handling with the "emergency" worked example, the estimate-vs-guess distinction, transcript review/correction rights, and videotaped-deposition considerations), and Trial (physician role transition from passive to central asset, jury selection/voir dire, testimony conduct standards, the legal standard for surgical negligence via illustrative California civil jury instructions, the three verdict-form questions, burden of proof, and post-trial procedure). New standalone concept page Medical Malpractice Litigation created — no existing wiki page covered litigation procedure or deposition/trial technique. Light cross-reference addition to Surgical Ethics (Conflict of Interest, Innovation & End-of-Life Care) given the shared informed-consent-vs-battery distinction. No studies flagged in Research Priorities.md (the chapter's sole substantive citation is the NEJM epidemiology study; the remainder are California Civil Jury Instructions and case law, not independently verifiable clinical claims). Confirmed via the copyright-line cross-check that the offset is unchanged at +17 for this chapter, with no jump at the Ch70/Ch71 boundary (Ch70 ends on an even book page, 1160; Ch71, "Quality," confirmed starting at book page 1161). One new concept page, one new source page; one concept page lightly cross-referenced.
ASCRS Ch71 - Quality — seventy-first chapter (Wick EC, Etzioni DA), the fourth consecutive non-clinical Part VI chapter but the first to tie directly into existing clinical content. The National Academy of Medicine's quality definition and the six Crossing the Quality Chasm domains; the Donabedian structure/process/outcomes framework (the SCIP case study for process measurement, including its 2014 retirement after failing to show a direct link to complication rates); quality- measurement tradeoffs (registry vs. administrative data including ACS-NSQIP's origin in the National Veterans Administration Risk Study, evaluative vs. transactional data, composite vs. single outcomes via the CLABSI and PSI-90 worked examples, unadjusted vs. risk-adjusted outcomes); organizational safety culture and its tension with traditional surgical hierarchy; alternative payment models including the Bundle Care Program Initiative and a bundled-payment model for major bowel surgery then in development; the National Accreditation Program for Rectal Cancer (NAPRC — 22 standards, OSTRiCh origin, 12 verified hospitals as of ~2020, modeled on the bariatric-surgery MBSAQIP precedent, with CMS's 2013 discontinuation of mandatory bariatric accreditation cited as a caution about accreditation's uncertain outcome impact); and ACS-NSQIP's fuller history/structure (VA origins, 2001 expansion to non-VA hospitals, the Johns Hopkins Armstrong Institute-partnered Improving Surgical Care and Recovery Program driving ERAS adoption across 300+ hospitals). New standalone concept page Surgical Quality Measurement & Improvement created. Unlike Ch68-70, this chapter extends existing clinical content rather than standing apart from it: light cross-reference additions to Total Mesorectal Excision (TME) & Sphincter-Sparing Resection (extending its brief NAPRC mention with the full accreditation structure) and General Postoperative Complications (which cites NSQIP data extensively without describing the registry itself). No studies flagged in Research Priorities.md. Confirmed via the copyright-line cross-check that the offset is unchanged at +17 for this chapter, with a jump to +18 at the Ch71/Ch72 boundary (Ch71 ends on an odd book page, 1169 — the standard mechanism, the seventh offset jump found across this ingest arc). Ch72, "Practice Management," confirmed starting at book page 1171. One new concept page, one new source page; two pages (one procedure, one concept) lightly cross-referenced.
ASCRS Ch72 - Practice Management — seventy-second and final chapter (Rea JD, Cohen JL) of the ASCRS Textbook of Colon and Rectal Surgery, 4th edition; the book's Index follows immediately with no further chapters. Practice models (independent single/multispecialty, private-equity/MSO investment with EBITDA-multiple valuation, employed models now exceeding 47% of physicians, practice-acquisition considerations); finance/coding basics; RVU-based compensation (work/practice- expense/malpractice-expense components, academic vs. private structures); developing a referral base (the "four A's" — availability, affability, ability, accountability); marketing (digital/social media, SEO, online reputation management via Healthgrades/Vitals); office setup and staffing efficiency; office-based procedures (Table 72.1's CPT/reimbursement detail, Table 72.2's supply list); ancillary services and Stark Law/Anti-Kickback constraints (12 designated health services categories, in-office ancillary services exception, fair-market-value standards); ambulatory surgery centers (CON laws, JCHO accreditation, CLIA); leadership-role development; and closing reflections via the "quadruple aim." New standalone concept page Practice Management for Colorectal Surgeons created — no existing wiki page covered practice-operations/business content. Light cross-reference additions to Healthcare Economics & Surgical Coding (shared CPT®/coding foundation) and Surgical Quality Measurement & Improvement (the "quadruple aim" concept), plus a pointer to Anorectal Abscess, Anal Fistula, and Hemorrhoids for the clinical conditions treated by the tabulated office-based procedures. No studies flagged in Research Priorities.md (business/ practice-survey sources, not clinical trials). Confirmed via the copyright-line cross-check that the offset is unchanged at +18 for this chapter (book pages 1171-1188, PDF pages 1153-1170). One new concept page, one new source page; two concept pages lightly cross-referenced. This chapter concludes the sequential full-textbook ingest project — all 72 chapters of the ASCRS Textbook of Colon and Rectal Surgery, 4th edition, have now been ingested.

Colorectal LLM Wiki

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