| Jafari MD, Ault G, Bordeianou L, Cologne K, Friel C, Hawkins A, Maykel JA, McGee MF, Paquette I, Raman S (Editors) The ASCRS Textbook of Colon and Rectal Surgery All rights reserved
|
Mehraneh Dorna Jafari, MD
Editor-in-Chief
Department of Surgery, Weill Cornell Medicine, New York, NY, USA
Department of Colon and Rectal Surgery, New York Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
Glenn T. Ault, MD, MSEd
ASCRS U Dean
Department of Colorectal Surgery, Keck Medicine of University of Southern California, Los Angeles, CA, USA
Liliana Bordeianou, MD, MPH
Pelvic Floor and Colorectal Surgery Centers, Massachusetts General Hospital, Boston, MA, USA
Kyle Cologne, MD
Department of Colorectal Surgery, Keck Medicine of University of Southern California, Los Angeles, CA, USA
Charles Friel, MD
Department of Surgery, University of Virginia Medical Center, Charlottesville, VA, USA
Alexander Hawkins, MD, MPH
Division of Colorectal Surgery, Duke Surgery, Duke University School of Medicine, Durham, USA
Justin A. Maykel, MD
Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
Michael F. McGee, MD
Division of Colorectal Surgery, University of Michigan, Ann Arbor, MI, USA
Ian Paquette, MD
Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Shankar Raman, MD
Division of General Surgery/Colorectal Surgery, Mercy One Des Moines Surgical Care, Des Moines, IA, USA
Maher A. Abbas, MD
King’s College Hospital, Dubai, UAE
Karim Alavi, MD, MPH
Department of Surgery, Division of Colon and Rectal Surgery, University of Massachusetts Medical School, Worcester, MA, USA
Dennis K. Ames, JD
Medical Malpractice Trail Attorney, Santa Ana, CA, USA
Jean H. Ashburn, MD
Wake Forest Baptist Health, Department of Surgery, Winston-Salem, NC, USA
Reza Askari, MD
Division of Trauma, Burns, Surgical Critical Care and Acute Care Surgery, Brigham and Woman’s Hospital, Harvard Medical School, Boston, MA, USA
Glenn T. Ault, MD, MSEd
Department of Surgery, Division of Colorectal Surgery, University of Southern California – Keck School of Medicine, Los Angeles, CA, USA
Kenneth S. Azarow, MD
Department of Surgery, Oregon Health Sciences University, Portland, OR, USA
Andrea Chao Bafford, MD
Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
Jennifer S. Beaty, MD
Associate Dean for Graduate Medical Education, Des Moines University Medicine and Health Sciences, Des Moines, IA, USA
Willem A. Bemelman, MD, PhD
Department of Surgery, Amsterdam University Medical Centre, Location Meibergdreef, Amsterdam, Netherlands
Greta Bernier, MD
Department of Surgery, UW Medicine – Valley Medical Center, Renton, WA, USA
Anuradha R. Bhama, MD
Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, OH, USA
Elisa Birnbaum, MD
Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Joshua I. S. Bleier, MD
Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
Liliana Bordeianou, MD, MPH
Harvard Medical School, Colorectal Surgery Program at the Massachusetts General Hospital, Massachusetts General Hospital, Department of Surgery, Boston, MA, USA
Marylise Boutros, MD
Department of Colorectal Surgery, Cleveland Clinic in Florida, Research for the Digestive Disease Institute, Weston, FL, USA
Mantaj S. Brar, MD, MSc GradStat
Mount Sinai Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada
W. Donald Buie, MD, MSc
Foothills Medical Center, Departments of Surgery and Oncology, University of Calgary, Calgary, AB, Canada
Jamie A. Cannon, MD
Department of Surgery/Gastrointestinal Section, University of Alabama Birmingham Medical Center, Birmingham, AL, USA
Lisa M. Cannon, MD
Department of Surgery, Division of Colon and Rectal Surgery, University of Rochester Medical Center, Rochester, NY, USA
Evie H. Carchman, MD
Department of General Surgery, University of Wisconsin, Madison, WI, USA
Joseph C. Carmichael, MD
Division of Colon and Rectal Surgery, University of California, Irvine, Department of Surgery, Orange, CA, USA
Peter A. Cataldo, MD
Department of Surgery, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
Heidi Chua, MD
Department of Colon and Rectal Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA
Daniel I. Chu, MD
Department of General Surgery-Gastrointestinal Division, University of Alabama at Birmingham, University Hospital, Birmingham, AL, USA
Jeffrey L. Cohen, MD, CPE
Hartford HealthCare, Hartford, CT, USA
University of Connecticut, Hartford, CT, USA
Michelle Cowan, MD
Department of Surgery, University of Washington, Seattle, WA, USA
Giovanna da Silva, MD
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
Jennifer S. Davids, MD
Department of Surgery, University of Massachusetts Memorial Medical Center, Worchester, MA, USA
Bradley R. Davis, MD, MBA
Department of Surgery, Atrium Health, Charlotte, NC, USA
Teresa deBeche-Adams, MD
Center for Colon and Rectal Surgery at Florida Hospital East, Orlando, FL, USA
David W. Dietz, MD
Department of Surgery, Division of Colorectal Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
Eric J. Dozois, MD
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
David A. Etzioni, MD, MSHS
Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
Daniel L. Feingold, MD
Department of Surgery, Division of Colorectal Surgery, Rutgers University, New Brunswick, NJ, USA
Alessandro Fichera, MD
Department of Surgery, Colon and Rectal Surgery, Baylor University Medical Center, Dallas, TX, USA
Fergal J. Fleming, MD, MPH
Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
Phillip R. Fleshner, MD
Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
Todd D. Francone, MD, MPH
Department of Surgery, Division of Colon and Rectal Surgery, Massachusetts General Hospital, Boston, MA, USA
Charles M. Friel, MD
Department of Surgery, University of Virginia Medical Center, Charlottesville, VA, USA
Wolfgang B. Gaertner, MD, MSc
Division of Colon and Rectal Surgery, University of Minnesota – M Health, Minneapolis, MN, USA
Julio Garcia-Aguilar, MD, PhD
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Kelly A. Garrett, MD
Department of General Surgery, Section of Colon and Rectal Surgery, Weill Cornell Medicine – New York Presbyterian Hospital, New York, NY, USA
Susan L. Gearhart, MD, ME HP
Department of Surgery, Johns Hopkins Institutions, Baltimore, MD, USA
Sean C. Glasgow, MD
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
Emre Gorgun, MD
Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
Brooke H. Gurland, MD
Department of General Surgery, Stanford Medical Center, Stanford, CA, USA
Jason F. Hall, MD, MPH
Section of Colon and Rectal Surgery, Boston Medical Center, Department of Surgery, Boston, MA, USA
Karin M. Hardiman, MD, PhD
Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
Amanda V. Hayman, MD, MPH
Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, OR, USA
Traci L. Hedrick, MD, MSc
University of Virginia Health, Charlottesville, VA, USA
Rebecca Hoedema, MD, MS
Department of Colon and Rectal Surgery, Spectrum Health, Grand Rapids, MI, USA
Stefan David Holubar, MD, MS
Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, OH, USA
Steven R. Hunt, MD
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
Mehraneh D. Jafari, MD
Department of Surgery, Weill Cornell Medicine, New York, NY, USA
Department of Colon and Rectal Surgery, New York Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
Eric K. Johnson, MD
Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, OH, USA
William Forrest Johnston, MD
Department of Colon and Rectal Surgery, Ochsner Clinic, New Orleans, LA, USA
Matthew F. Kalady, MD
Department of Surgery, Division of Colon and Rectal Surgery, The Ohio State University, Columbus, OH, USA
Brian R. Kann, MD
Department of Colon and Rectal Surgery, Ochsner Health, New Orleans, LA, USA
Deborah S. Keller MS, MD
Division of Colorectal Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, USA
Scott R. Kelley, MD
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
Gregory D. Kennedy, MD, PhD
Department of Oncology, UnityPoint Health, Des Moines, IA, USA
Cindy Kin, MD, MS
Department of Surgery, Stanford University, Stanford, CA, USA
Pokala Ravi Kiran, MBBS, MS (Gen Surg), MSc (EBM)
Division of Colorectal Surgery, New Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
David A. Kleiman, MD, MSc
Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
Mukta K. Krane, MD
Department of Surgery, University of Washington, Seattle, WA, USA
Hiroko Kunitake, MD, MPH
Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, USA
Jenny Alex Ky-Miyasaka, MD, PhD
Department of Surgery, Mount Sinai Hospital, New York, NY, USA
Ron G. Landmann, MD
Department of Surgery, Section of Colon and Rectal Surgery, MD Anderson Medical Center, Jacksonville, FL, USA
David W. Larson, MD, MBA
Department of Surgery, Mayo Clinic, Rochester, MN, USA
Amy L. Lightner, MD
Department of Molecular and Cellular Biology, Scripps Research and Scripps Clinic, San Diego, CA, USA
Anthony R. MacLean, MD
Department of Surgery, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
Helen MacRae, MD, MA
Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
Najjia N. Mahmoud, MD
Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, PA, USA
Nathalie Mantilla, MD
Piedmont Physicians Colon and Rectal Surgery at Augusta, Georgia, USA
Slawomir Marecik, MD
Advocate Lutheran General Hospital, Park Ridge, IL, USA
University of Illinois at Chicago, Chicago, IL, USA
David A. Margolin, MD
Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, Ochsner Clinical School, University of Queensland, New Orleans, LA, USA
David J. Maron, MD, MBA
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
Matthew Martin, MD
Department of Colorectal Surgery, Keck Medicine of University of Southern California, Los Angeles, CA, USA
Michael F. McGee, MD
Division of Colorectal Surgery, University of Michigan, Ann Arbor, MI, USA
Shane McNevin, MD
Section of Colorectal Surgery at the University of Colorado School of Medicine, Anschutz, CO, USA
Anders Mellgren, MD, PhD
Division of Colon and Rectal Surgery, University of Illinois Chicago, Chicago, IL, USA
Evangelos Messaris, MD, PhD
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Craig A. Messick, MD
Department Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
John Migaly, MD
Division of Colorectal Surgery/Ravitch Division at Johns Hopkins Medicine, Baltimore, MD, USA
Steven Mills, MD
Department of Surgery, Division of Colon and Rectal Surgery, University of California, Irvine, Orange, CA, USA
John R. T. Monson, MD
Department of Surgery, Wake Forest University School of Medicine, Atrium Health, Winston-Salem, NC, USA
Brendan John Moran, MCh, FRCS, FRCSI (Gen)
Department of General and Colorectal Surgery, Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
Nancy Morin, MD
Department of Surgery, Division of Colorectal Surgery, MDB Jewish General Hospital, McGill University, Montreal, QC, Canada
Margarita Murphy, MD
East Cooper Medical Center, Department of Surgery, Mount Pleasant, SC, USA
Matthew G. Mutch, MD
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
James W. Ogilvie Jr., MD, MS
Department of Colorectal Surgery, Spectrum Health, Michigan State University, Grand Rapids, MI, USA
Lucia Camara Castro Oliveira, MD, PhD
Department of Colorectal Surgery, Anorectal Physiology Department and Colorectal Surgery, Hospital Casa de Saude Sao Jose and CEPEMED, Rio de Janeiro, Brazil
Ian M. Paquette, MD
Department of Surgery – Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Danielle Patterson, MD, SM
Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Baltimore, MD, USA
Rodrigo Oliva Perez, MD, PhD
Department of Surgical Oncology, Angelita and Joaquim Gama Institute, Beneficencia Portuguesa de Sao Paolo, Alemao Oswaldo Cruz, Sao Paulo, Brazil
W. Brian Perry, MD
Department of Surgery, Audie L. Murphy VA Medical Center, San Antonio, TX, USA
Walter R. Peters Jr, MD, MBA
Baylor Scott and White Health, Dallas, TX, USA
Clayton C. Petro, MD
Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
Ajita Prabhu, MD
Department of Surgery, Cleveland Clinic, Cleveland, OH, USA
Jan Rakinic, MD
Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
Jennifer D. Rea, MD
Department of Colorectal Surgery, Colorectal Surgical and Gastroenterology Associates, Lexington, KY, USA
Scott E. Regenbogen, MD, MPH
Division of Colorectal Surgery, Department of Surgery,University of Michigan, Ann Arbor, MI, USA
Craig A. Reickert, MD
Department of Colon and Rectal Surgery, Wayne State University, Detroit, MI, USA
Timothy J. Ridolfi, MD, MS
Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
Michael J. Rosen, MD
Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic, Cleveland, OH, USA
Leslie Roth, MD
Department of Surgery, Brown University, Rhode Island Hospital, Providence, RI, USA
Ali Salim, MD
Division of Trauma, Burns, Surgical Critical Care and Acute Care Surgery, Brigham and Woman’s Hospital, Harvard Medical School, Boston, MA, USA
Dana R. Sands, MD
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
Nicole M. Saur, MD
Division of Colon and Rectal Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
Andrew T. Schlussel, DO
HCA Florida Jacksonville Surgical Specialists, Jacksonville, FL, USA
Benjamin D. Shogan, MD
Department of Surgery, University of Chicago, Chicago, IL, USA
Radhika K. Smith, MD
Division of Surgery, AdventHealth, Orlando, FL, USA
Michael J. Snyder, MD
Department of Surgery, McGovern School of Medicine, Houston, TX, USA
Michael J. Solomon, MB BCH (Hons), BAO, MSc DMEDSC
Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Antonino Spinelli, MD, PhD
Department of Biomedical Sciences, Humanitas University, Milan, Italy
IRCCS Humanitas Research Hospital - Division of Colon and Rectal Surgery, Milan, Italy
Kyle Staller, MD, MPH
Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
Emily Steinhagen, MD
Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
David B. Stewart, MD
Department of Surgery, CIty of Hope Cancer Center, Chicago, IL, USA
Luca Stocchi, MD
Department of Surgery, Division of Colorectal Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
Scott A. Strong, MD
Department of Surgery, Northwestern University, Chicago, IL, USA
Pasithorn A. Suwanabol, MD, MS
Division of Colorectal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
Patricia Sylla, MD
Department of Surgery, Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
Sanda A. Tan, MD, PhD
West Florida Healthcare, Department of Surgery, University of Central Florida, Pensacola, FL, USA
Erin A. Teeple, MD
Nemours/AI Dupont Hospital for Children, Department of Surgery, Wilmington, DE, USA
Julie Thacker, MD
Department of Surgery, Duke University School of Medicine, Durham, NC, USA
Amy J. Thorsen, MD
Colon and Rectal Surgery Associates, Minneapolis, MN, USA
V. Liana Tsikitis, MD, MBA, MCR
Department of General Surgery, Division of Gastroenterology, Oregon Health and Science University, Portland, OR, USA
Konstantin Umanskiy, MD
Department of Surgery, University of Chicago, Chicago, IL, USA
Michael A. Valente DO
Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
H. David Vargas, MD
Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
Carol-Ann Vasilevsky, MD
Department of Surgery, Jewish General Hospital, Montreal, QC, Canada
Jon D. Vogel, MD
Section of Colorectal Surgery at the University of Colorado School of Medicine, Anschutz, CO, USA
Sarah A. Vogler, MD, MBA
Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
Eric G. Weiss, MD
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
Mark H. Whiteford, MD
Colon and Rectal Surgery, The Oregon Clinic, Providence Portland Medical Center, Providence Cancer Institute, Gastrointestinal and Minimally Invasive Surgery Division, Portland, OR, USA
Elizabeth C. Wick, MD
Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
Kirsten Bass Wilkins, MD
Associated Colon and Rectal Surgeons, Edison, NJ, USA
Dennis Yang, MD
Department of Gastroenterology, University of Florida, Gainesville, FL, USA
Karen N. Zaghiyan, MD
Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
Matthew D. Zelhart, MD
Department of Colon and Rectal Surgery, Ochsner Clinic, New Orleans, LA, USA
Massarat Zutshi, MD
Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
The ASCRS Textbook of Colon and Rectal Surgery has long served as a cornerstone of education and clinical reference in our specialty. Today, it has evolved into something more than a textbook—it is a living resource, continuously updated and refined to reflect the ever-changing landscape of colorectal surgery.
Now published as part of ASCRS U, the ASCRS dynamic online educational platform, this textbook benefits from the collective expertise and dedication of ASCRS members. Through their ongoing contributions, the textbook authors and editors regularly revise the content to incorporate the latest literature, innovations in technique, and shifts in clinical practice. This format ensures that learners and practitioners have access to the most current, evidence-based guidance—delivered in real time and tailored to the needs of a modern surgical community.
Colorectal surgery is a field defined by progress. From advances in minimally invasive approaches and enhanced recovery protocols to the integration of precision medicine and global health perspectives, our specialty continues to evolve at a remarkable pace. This living textbook reflects that momentum, offering not only foundational knowledge but also a forward-looking view of where we are headed.
We are deeply grateful to the surgeons, educators, and researchers whose hard work and insight make this resource possible. Their commitment to excellence and education ensures that this textbook remains a trusted, relevant, and inspiring tool for all who seek to improve the care of patients with colorectal disease. We thank them for writing and revising, when needed, the chapters in this textbook.
Finally, we would like to thank Elizabeth Moran, the ASCRS Editorial Manager, for her extraordinary efforts and thoroughness in overseeing and ensuring the timely completion of the textbook.
We are deeply indebted to our teachers and mentors, who have been our heroes and generously shared their knowledge, experience, and enthusiasm over the years. We devote this edition to our trainees, whose energy, intellectual curiosity, and commitment to excellence drive us every day to be better. Pass it forward!
– The Editors
American Society of Colon and Rectal Surgeons
The ASCRS Textbook of Colon and Rectal Surgery (the "Content") is a publication of the American Society of Colon and Rectal Surgeons ("PUBLISHER"), and copyright © 2026, by PUBLISHER.
The Unbound™ software platform is copyright © 2000–2026 Unbound Medicine, Inc. All rights reserved.
The user is receiving only a limited right to use the Content and Unbound Platform (jointly referred to as the "Service") for user’s own internal or personal use. The user may not reproduce, forward, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the Service or in any way commingle the Service with other third party content, without PUBLISHER’s or Unbound Medicine’s consent.
THE SERVICE IS PROVIDED ON AN "AS IS" BASIS. NEITHER PUBLISHER, UNBOUND MEDICINE NOR ITS LICENSORS MAKE ANY GUARANTEES OR WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR USE AS TO THE SERVICE OR THE INFORMATION THEREIN OR ANY WARRANTIES AS TO THE ACCURACY, COMPLETENESS, CURRENTNESS, OR RESULTS TO BE OBTAINED FROM, ACCESSING OR USING THE SERVICE, OR ANY MATERIAL REFERENCED IN SUCH SERVICE OR ANY INFORMATION ENTERED INTO THE SERVICE BY USERS OR OTHER PERSONS AND/OR ANY MATERIAL AVAILABLE ON OR THAT CAN BE ACCESSED THROUGH THE SERVICE (INCLUDING VIA ANY HYPERLINK OR OTHERWISE) OR AS TO NON-INFRINGEMENT OF THIRD PARTY RIGHTS. ANY WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, ARE DISCLAIMED. ANY MATERIAL OR DATA OBTAINED THROUGH USE OF THE SERVICE IS AT YOUR OWN DISCRETION AND RISK AND USER UNDERSTANDS THAT IT WILL BE SOLELY RESPONSIBLE FOR ANY RESULTING DAMAGE TO ITS COMPUTER SYSTEM OR LOSS OF DATA.
MEDICINE IS AN EVER-CHANGING SCIENCE. AS NEW RESEARCH AND CLINICAL EXPERIENCE BROADEN OUT KNOWLEDGE, CHANGES IN TREATMENT AND DRUG THERAPY ARE REQUIRED. IN VIEW OF THE POSSIBILITY OF HUMAN ERROR OR CHANGES IN MEDICAL SCIENCES, NEITHER PUBLISHER, UNBOUND MEDICINE NOR ITS LICENSORS WARRANTS THAT THE INFORMATION CONTAINED IN THE SERVICE IS IN EVERY RESPECT ACCURATE OR COMPLETE, AND THEY ARE NOT RESPONSIBLE FOR ANY ERRORS OR OMISSIONS OR THE RESULTS OBTAINED FROM THE USE OF SUCH INFORMATION. USERS ARE ENCOURAGED TO CONFIRM THE INFORMATION CONTAINED IN THE SERVICE WITH OTHER SOURCES. FOR EXAMPLE, AND IN PARTICULAR, USERS ARE ADVISED TO CHECK THE PRODUCT INFORMATION SHEET INCLUDED IN THE PACKAGE OF EACH DRUG THEY PLAN TO ADMINISTER TO BE CERTAIN THAT THE INFORMATION CONTAINED IN THE PUBLISHER CONTENT IS ACCURATE AND THAT CHANGES HAVE NOT BEEN MADE IN THE RECOMMENDED DOSE OR IN THE CONTRAINDICATIONS FOR ADMINISTRATION. THIS RECOMMENDATION IS PARTICULARLY IMPORTANT IN CONNECTION WITH NEW OR INFREQUENTLY USED DRUGS. NEITHER PUBLISHER NOR ITS LICENSORS SHALL BE LIABLE TO SUBSCRIBER OR TO ANY USER OR ANYONE ELSE FOR ANY INACCURACY, DELAY, INTERRUPTION IN SERVICE, ERROR OR OMISSION, REGARDLESS OF CAUSE, OR FOR ANY DAMAGES RESULTING THEREFROM.
IN NO EVENT WILL PUBLISHER, UNBOUND MEDICINE OR ITS LICENSORS, BE LIABLE FOR ANY INDIRECT, SPECIAL OR CONSEQUENTIAL DAMAGES, INCLUDING BUT NOT LIMITED TO, LOST TIME, LOST MONEY, LOST PROFITS OR GOOD WILL, WHETHER IN CONTRACT, TORT, STRICT LIABILITY OR OTHERWISE, AND WHETHER OR NOT SUCH DAMAGES ARE FORESEEN OR UNFORESEEN ARISING FROM OR RELATING TO: (i) YOUR USE OF THE SERVICE OR USE OF THE SERVICE THROUGH YOUR ACCOUNT BY ANYONE ELSE; (ii) THE COST OF PROCUREMENT OF SUBSTITUTE DATA, INFORMATION OR SERVICES; (iii) UNAUTHORIZED ACCESS TO OR ALTERATION OF YOUR TRANSMISSIONS OR DATA; OR (iv) ANY OTHER MATTER RELATING TO THE SERVICE. UNBOUND’S TOTAL CUMULATIVE LIABILITY TO YOU AND ANYONE WHO USES THE SERVICE THROUGH YOUR ACCOUNT, FOR ANY AND ALL CLAIMS UNDER ANY THEORY OF LAW, WILL NOT EXCEED THE UNUSED PORTION OF FEES PAID FOR THE SERVICE. IF, NOTWITHSTANDING THE OTHER TERMS OF THIS AGREEMENT, UNBOUND SHOULD HAVE ANY LIABILITY TO YOU OR ANY THIRD PARTY FOR ANY LOSS, HARM OR DAMAGE, YOU AND UNBOUND AGREE THAT SUCH LIABILITY SHALL UNDER NO CIRCUMSTANCES EXCEED THE LESSER OF $1,000 OR THE FEES YOU PAID US DURING THE THREE (3) MONTHS IMMEDIATELY PRECEDING THE DAY THE ACT OR OMISSION OCCURRED THAT GAVE RISE TO YOUR CLAIM. YOU AND UNBOUND AGREE THAT THE FOREGOING LIMITATION OF LIABILITY IS AN AGREED ALLOCATION OF RISK BETWEEN YOU AND US AND REFLECTS THE FEES, IF ANY, UNBOUND CHARGE YOU TO USE THE SITE AND THE SERVICES. YOU ACKNOWLEDGE THAT ABSENT YOUR AGREEMENT TO THIS LIMITATION OF LIABILITY, UNBOUND WOULD NOT PROVIDE THE SITE OR SERVICES TO YOU.