Colorectal Surgery Review

Allen Kamrava, MD MBA FACS FASCRS
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An academic, sponsor-free audio review of core concepts in colon and rectal surgery. Using the power of A.I., created by Dr. Allen Kamrava, Associate Teaching Faculty at Cedars-Sinai Medical Center, this series is designed for residents, fellows, and practicing surgeons to stay current with concise, evidence-based updates. Covering textbook foundations, landmark trials, and evolving ASCRS guidelines, each episode delivers practical surgical education for the commute, workout, or even to wind down at night. Learn more at https://drkamrava.com/podcast

  1. 5d ago

    Enhanced Recovery After Colorectal Surgery (ERAS)

    Join us for a detailed clinical dissection of the updated American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Clinical Practice Guidelines for Enhanced Recovery After Surgery (ERAS). In this episode, we move past basic ERAS concepts to explore the precise physiological mechanisms, statistical realities, and trial data behind modern perioperative pathways. Whether you are updating hospital protocols, optimizing patient pathways, or prepping for recertification and board exams, this review delivers the evidence-based details you need. Preoperative Optimization & Stoma Education: Implementing structured ileostomies pathways to prevent dehydration and AKI—reducing readmission rates from 15.5% down to 0%. Fasting & Carbohydrate Loading: Ditching the "NPO after midnight" rule for clear liquids up to 2 hours pre-induction. Why complex carbohydrates (maltodextrin) prevent post-op insulin resistance and why simple sugars are avoided. Pre-op Nutrition vs. Immunonutrition: Weight-based protein supplementation (1.2–1.5 g/kg/day) for malnourished patients and why commercial immunonutrition shakes remain controversial in non-industry-funded trials. Bowel Prep & C. diff Reduction: The strong Grade 1B mandate for combining Mechanical Bowel Preparation (MBP) with oral antibiotics (Neomycin + Metronidazole/Erythromycin) to decimate mucosal biofilms and cut SSIs in half. Intraoperative SSI Bundles: Swiss-cheese risk management, including dedicated wound-closure trays, mandatory glove/gown changes before facial closure, normothermia, and tight glycemic control. Analgesia & The NSAID Leak Debate: Why Diclofenac dramatically increases anastomotic leak rates due to enterohepatic circulation, while Ketorolac and COX-2 inhibitors remain safe. Plus, why routine thoracic epidurals and gabapentinoids are falling out of favor in minimally invasive cases. Fluid Management & Hemodynamics: Moving away from "bone-dry" fluid restriction to preserve the endothelial glycocalyx. The chemistry of why Normal Saline causes hyperchloremic metabolic acidosis and renal vasoconstriction, and how Goal-Directed Hemodynamic Therapy (GDHT) prevents fluid overload. Hardware & Post-Op Care: Evidence against routine NG tubes and pelvic drains, accepting post-op oliguria down to 0.2 mL/kg/hr without fluid boluses, and accelerating bowel return with sham feeding (gum) and coffee. Early Discharge Pathways: Criteria from the RECOVER MI trial allowing selected low-risk patients to safely go home on Post-Op Day 1 before the return of bowel function.

  2. Aug 10

    ASCRS Guidelines: Anal Squamous Cell Cancer Management

    Join us for a detailed clinical breakdown of the 2018 American Society of Colon and Rectal Surgeons (ASCRS) Clinical Practice Guidelines for Anal Squamous Cell Cancer. In this episode, we dive into the virology, staging nuances, landmark trial data, and treatment paradigms every practicing surgeon, oncologist, and board candidate needs to master. Key Topics Covered in This Episode: Etiology & Risk Factors: The oncogenic role of HPV (serotypes 16 & 18), the field defect within the anal transitional zone (ATZ), and independent risk factors such as cigarette smoking and immunosuppression. Anatomic Classification: Distinguishing anal canal vs. perianal lesions using gluteal distraction and the strict 5 cm distance rule. Pathology & Biomarkers: Implementing the LAST two-tiered terminology (LSIL vs. HSIL), why the term "Bowen's disease" is obsolete, and using p16 and Ki-67 biomarkers to guide diagnosis. Screening & High-Resolution Anoscopy (HRA): Addressing the low specificity of anal cytology swabs, the mechanism of aceto-white staining during HRA, and when expectant management is acceptable. HPV Vaccination Rule: Why secondary HPV vaccination is not recommended for treating existing dysplasia (Grade 2A). Staging Pitfalls: Why anal SCC staging relies on maximum diameter rather than depth of wall invasion, and why sphincter muscle invasion does not upgrade a tumor to T4. Definitive Chemoradiation (The Nigro Protocol): The shift away from primary APRs, radiation dosing limits, and trial evidence (RTOG 9811 & ACT II) proving why 5-FU + Mitomycin C remains superior to Cisplatin. Surgical Exceptions & Survivorship: Narrow criteria for wide local excision alongside essential pre-treatment counseling for fertility preservation and post-radiation vaginal stenosis.

  3. Aug 3

    Ambulatory Anorectal Surgery Explained

    Join us for a comprehensive clinical review of the 2015 American Society of Colon and Rectal Surgeons (ASCRS) Clinical Practice Guidelines for Ambulatory Anorectal Surgery. In this episode, we break down the most relevant surgical directives and statistical realities to help you optimize patient care from the moment of selection to the final post-discharge follow-up. If you are looking to update your clinical practice, reduce unnecessary testing, or prep for your board exams, this evidence-based dissection will help you streamline your ambulatory cases. Key Topics Covered in This Episode: Patient Selection & Pre-op Testing: Why routine preoperative testing (like CBCs and ECGs) is discouraged for healthy patients, and how to properly stratify risk using ASA physical status classifications. Anesthesia & Positioning: The clinical benefits of local anesthesia with IV sedation, and the specific physiological contraindications (such as obesity, late pregnancy, and severe COPD) for the prone jackknife position. VTE Prophylaxis: Unpacking the extremely low baseline risk (0.15%) of venous thromboembolism in anorectal procedures and identifying when mechanical prophylaxis is genuinely warranted. Pain Management: A look into multimodal pain control strategies, the prolonged efficacy of Liposomal Bupivacaine, the debate over topical GTN ointments for sphincter spasms, and why routine systemic antibiotics are actively discouraged. Postoperative Urinary Retention (POUR): The neurological mechanics behind urinary retention following pelvic surgery and the crucial importance of perioperative IV fluid restriction (under 1 liter). Discharge Protocols: Navigating standardized discharge criteria (like the Modified Aldrete or PADSS scores) to avoid premature discharges and dangerous post-op complications.

  4. Jun 9

    Rectal Prolapse

    Reviews the Broden and Snellman theory of rectal prolapse as a progressive internal intussusception. The episode clarifies the misnomer of solitary rectal ulcer syndrome—where true ulcers only appear in 23% of cases—and outlines its precise operative indications. Crucially, it highlights registry data showing that perineal approaches (Altemeier, Delorme) carry a four-times greater relative mortality risk in frail elderly patients compared to minimally invasive abdominal rectopexy, upending decades of surgical dogma.

  5. Jun 4

    Treatment of Difficult-Obstructive Defecation

    Unpacks Obstructive Defecation Syndrome (ODS), starting with the absolute necessity of pelvic floor biofeedback over surgical intervention for dyssynergic defecation. It details the strict millimeter-based grading systems for structural defects like rectoceles and enteroceles. The operative discussion highlights the abandonment of the STARR procedure due to a 40% long-term recurrence rate, instead favoring laparoscopic ventral mesh rectopexy for internal prolapse and transvaginal native tissue repairs for rectoceles.

  6. Jun 2

    Evaluation of Constipation and Treatment of Abdominal Component

    Explores the diagnostic and surgical algorithms for chronic refractory constipation. It clearly differentiates slow transit constipation (colonic inertia) from IBS-C utilizing the 5-day radiopaque marker study rule (retention of >20% markers). The episode breaks down the latest pharmacotherapy, including secretagogues and PAMORAs for opioid-induced constipation, and thoroughly dissects the significant morbidity, incontinence risks, and patient selection criteria for a total abdominal colectomy with ileorectal anastomosis (TAC-IRA).

  7. May 28

    Common Tests for the Pelvic Floor

    A deep dive into the physiological and mechanical evaluation of pelvic floor disorders. The episode examines the hardware evolution of manometry from water-perfused catheters to high-resolution systems, and the standardization of dyssynergic defecation phenotypes via the London Protocol. It also reviews the diagnostic utility of the balloon expulsion test and compares the true physiological advantages of sitting fluoroscopic defecography against the anatomical clarity of supine MRI defecography.

  8. May 26

    Functional Disorders After Colorectal Surgery - IBS

    Focuses on distinguishing and managing Irritable Bowel Syndrome using the rigid Rome IV criteria. It issues a stark warning against operating on functional visceral hypersensitivity, detailing how elective resections for symptomatic uncomplicated diverticular disease frequently fail to relieve pain. The episode reviews targeted pharmacotherapy based on IBS subtypes (e.g., eluxadoline for IBS-D and lubiprostone for IBS-C), and addresses pelvic floor pain syndromes like proctalgia fugax, which surprisingly responds to inhaled albuterol.

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About

An academic, sponsor-free audio review of core concepts in colon and rectal surgery. Using the power of A.I., created by Dr. Allen Kamrava, Associate Teaching Faculty at Cedars-Sinai Medical Center, this series is designed for residents, fellows, and practicing surgeons to stay current with concise, evidence-based updates. Covering textbook foundations, landmark trials, and evolving ASCRS guidelines, each episode delivers practical surgical education for the commute, workout, or even to wind down at night. Learn more at https://drkamrava.com/podcast

Information

  • Creator
    Allen Kamrava, MD MBA FACS FASCRS
  • Years Active
    2025 - 2026
  • Episodes
    58
  • Rating
    Explicit
  • Copyright
    © Allen Kamrava, MD MBA FACS FASCRS
  • Show Website
    Colorectal Surgery Review

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