Table of Contents

1. Anatomy and Embryology of the Colon, Rectum, and Anus
2. Colonic Physiology
3. Anorectal Physiology
4. Endoscopy
5. Endoscopic Management of Polyps and Endolumenal Surgery
6. Preoperative Evaluation in Colorectal Patients
7. Optimizing Outcomes with Enhanced Recovery
8. General Postoperative Complications
9. Anastomotic Construction
10. Anastomotic Complications
11. Hemorrhoids
12. Anal Fissure and Anal Stenosis
13. Cryptoglandular Abscess and Fistula
14. Rectourethral and Complex Fistulas: Evaluation and Management
15. Rectovaginal Fistula
16. Pilonidal Disease and Hidradenitis Suppurativa
17. Dermatology and Pruritus Ani
18. Sexually Transmitted Infections of the Colon and Rectum
19. Anal Intraepithelial Neoplasia
20. Anal Cancer
21. Presacral Tumors
22. Sporadic and Inherited Colorectal Cancer: How Epidemiology and Molecular Biology Guide Screening and Treatment
23. Management of Malignant Polyps
24. Colorectal Cancer: Preoperative Evaluation and Staging
25. Colon Cancer Surgical Treatment: Principles of Colectomy
26. Rectal Cancer: Neoadjuvant Therapy
27. Rectal Cancer: Local Excision
28. Rectal Cancer: Nonoperative Management
29. Proctectomy for Rectal Cancer
30. Colorectal Cancer: Postoperative Adjuvant Therapy and Surveillance
31. Colorectal Cancer: Management of Distant Metastases
32. Locally Recurrent Rectal Cancer
33. Appendiceal Neoplasms
34. Gastrointestinal Stromal Tumors, Neuroendocrine Tumors, and Lymphoma
35. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
36. Colorectal Cancer: Minimally Invasive Surgery
37. Minimally Invasive Complete Mesocolic Excision with Extended Lymphadenectomy for Colon Cancer
38. Colonic Diverticular Disease
39. Large Bowel Obstruction
40. Lower GI Hemorrhage
41. Endometriosis
42. Benign Colorectal Disease Trauma of the Colon and Rectum
43. Inflammatory Bowel Disease: Pathobiology
44. IBD Diagnosis and Evaluation
45. Medical Management of Ulcerative Colitis
46. Medical Therapy for Crohn’s Disease
47. Anorectal Crohn’s Disease
48. Crohn’s Disease: Surgical Management
49. Ulcerative Colitis: Surgical Management
50. Complications of the Pelvic Pouch
51. Infectious Colitis
52. Clostridium difficile Infection
53. Radiation, Microscopic, and Ischemic Colitis
54. Intestinal Stomas
55. Abdominal Wall Reconstruction and Parastomal Hernia Repair
56. Functional Disorders After Colorectal Surgery/IBS
57. Common Tests for the Pelvic Floor
58. Evaluation of Constipation and Treatment of Abdominal Component
59. Treatment of Difficult/Obstructive Defecation
60. Rectal Prolapse
61. Fecal Incontinence: Evaluation and Treatment
62. Low Anterior Resection Syndrome (LARS)
63. Sexual Function After Colorectal Surgery in Women
64. Male Genitourinary Dysfunction as a Consequence of Colorectal Surgery
65. Middle and Anterior Pelvic Compartment: Issues for the Colorectal Surgeon
66. Pediatric Colorectal Disorders
67. Considerations for Geriatric Patients Undergoing Colorectal Surgery
68. Healthcare Economics
69. Ethical Considerations (Conflict of Interest, Surgical Innovation, and End of Life)
70. Welcome to Litigation
71. Quality
72. Practice Management

Editors

Scott R. Steele, MD, MBA
Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA

Tracy L. Hull, MD
Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA

Neil Hyman, MD
University of Chicago Medical Center, Chicago, IL, USA

Justin A. Maykel, MD
Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA

Thomas E. Read, MD
Division of Gastrointestinal Surgery, University of Florida, Gainesville, FL, USA

Charles B. Whitlow, MD
Department of Colon and Rectal Surgery, Ochsner Clinic, New Orleans, LA, USA

Authors

Maher A. Abbas, MD
King’s College Hospital, Dubai, UAE

Karim Alavi, MD, MPH
University of Massachusetts Medical School, Department of Surgery, Division of Colon and Rectal Surgery, 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
University of Southern California – Keck School of Medicine, Department of Surgery, Division of Colorectal Surgery, Los Angeles, CA, USA

Kenneth S. Azarow, MD
Oregon Health Sciences University, Department of Surgery, Portland, OR, USA

Andrea Chao Bafford, MD
University of Maryland School of Medicine, Department of Surgery, 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
Amsterdam University Medical Centre, Location Meibergdreef, Department of Surgery, Amsterdam, Netherlands

Greta Bernier, MD
UW Medicine – Valley Medical Center, Department of Surgery, Renton, WA, USA

Anuradha R. Bhama, MD
Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, OH, USA

Elisa Birnbaum, MD
University of Colorado Anschutz Medical Center, Department of Surgery, Aurora, CO, USA

Joshua I. S. Bleier, MD
University of Pennsylvania, Perelman School of Medicine, Department of Surgery, 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
Jewish General Hospital, Division of Colorectal Surgery, Montreal, QC, Canada

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
University of Alabama Birmingham Medical Center, Department of Surgery/Gastrointestinal Section, Birmingham, AL, USA

Lisa M. Cannon, MD
University of Rochester Medical Center, Department of Surgery, Division of Colon and Rectal Surgery, Rochester, NY, USA

Evie H. Carchman, MD
University of Wisconsin, Department of General Surgery, 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
Larner College of Medicine at the University of Vermont, Department of Surgery, Burlington, VT, USA

Heidi Chua, MD
Mayo Clinic School of Medicine, Department of Colon and Rectal Surgery, Rochester, MN, USA

Daniel I. Chu, MD
University of Alabama at Birmingham, University Hospital, Department of General Surgery-Gastrointestinal Division, Birmingham, AL, USA

Jeffrey L. Cohen, MD, CPE
Hartford HealthCare, Hartford, CT, USA
University of Connecticut, Hartford, CT, USA

Michelle Cowan, MD
University of Washington, Department of Surgery, Seattle, WA, USA

Giovanna da Silva, MD
Cleveland Clinic Florida, Department of Colorectal Surgery, Weston, FL, USA

Jennifer S. Davids, MD
University of Massachusetts Memorial Medical Center, Department of Surgery, Worchester, MA, USA

Bradley R. Davis, MD, MBA
Department of Surgery, Atrium Health, Charlotte, NC, USA

Teresa deBeche-Adams, MD
Center for Colon & Rectal Surgery at Florida Hospital East, Orlando, FL, USA

David W. Dietz, MD
University Hospitals, Case Western Reserve University School of Medicine, Department of Surgery, Division of Colorectal Surgery, Cleveland, OH, USA

Eric J. Dozois, MD
Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, MN, USA

David A. Etzioni, MD, MSHS
Mayo Clinic, Department of Surgery, Phoenix, AZ, USA

Daniel L. Feingold, MD
Division of Colorectal Surgery, Rutgers University, Department of Surgery, New Brunswick, NJ, USA

Alessandro Fichera, MD
Colon and Rectal Surgery, Baylor University Medical Center, Department of Surgery, Dallas, TX, USA

Fergal J. Fleming, MD, MPH
University of Rochester Medical Center, Department of Surgery, Rochester, NY, USA

Phillip R. Fleshner, MD
Cedars Sinai Medical Center, Department of Surgery, 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
University of Virginia Medical Center, Department of Surgery, 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
Weill Cornell Medicine – New York Presbyterian Hospital, Department of General Surgery, Section of Colon and Rectal Surgery, New York, NY, USA

Susan L. Gearhart, MD, ME HP
Johns Hopkins Institutions, Department of Surgery, Baltimore, , MD, USA

Sean C. Glasgow, MD
Washington University School of Medicine, Department of Surgery, St. Louis, MO, USA

Emre Gorgun, MD
Cleveland Clinic, Department of Colorectal Surgery, Cleveland, OH, USA

Brooke H. Gurland, MD
Stanford Medical Center, Department of General Surgery, 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
University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA

Amanda V. Hayman, MD, MPH
Division of Gastrointestinal & 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
Spectrum Health, Department of Colon and Rectal Surgery, Grand Rapids, MI, USA

Stefan David Holubar, MD, MS
Cleveland Clinic, Department of Colon and Rectal Surgery, Cleveland, OH, USA

Steven R. Hunt, MD
Washington University School of Medicine, Department of Surgery, St. Louis, MO, USA

Mehraneh D. Jafari, MD
University of California – Irvine, Department of Surgery, Orange, CA, USA

Eric K. Johnson, MD
Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, OH, USA

William Forrest Johnston, MD
Ochsner Clinic, Department of Colon and Rectal Surgery, 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
Ochsner Health, Department of Colon and Rectal Surgery, New Orleans, LA, USA

Deborah S. Keller MS, , MD
University of California Davis Medical Center, Division of Colorectal Surgery, Department of Surgery, Sacramento, CA, USA

Scott R. Kelley, MD
Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, MN, USA

Gregory D. Kennedy, MD, PhD
University of Alabama Medical Center, Department of Surgery, Birmingham, AL, USA

Cindy Kin, MD, MS
Stanford University, Department of Surgery, 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
Lahey Hospital and Medical Center, Department of Colon and Rectal Surgery, Burlington, MA, USA

Mukta K. Krane, MD
University of Washington, Department of Surgery, 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
Mount Sinai Hospital, Department of Surgery, New York, NY, USA

Ron G. Landmann, MD
Section of Colon and Rectal Surgery, Baptist , MD Anderson Medical Center, Department of Surgery, Jacksonville, FL, USA

David W. Larson, MD, MBA
Mayo Clinic, Department of Surgery, Rochester, MN, USA

Amy L. Lightner, MD
Cleveland Clinic, Department of Colorectal Surgery, Cleveland, OH, USA

Anthony R. MacLean, MD
Foothills Medical Center, Department of Surgery, University of Calgary, Calgary, AB, Canada

Helen MacRaeMA, , MD
Mount Sinai Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada

Najjia N. Mahmoud, MD
Division of Colon and Rectal Surgery, University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA

Nathalie Mantilla, MD
Rush University, Cook County Health, Department of Colon and Rectal Surgery, Chicago, IL, USA

Slawomir Marecik, MD
Advocate Lutheran General Hospital, Park Ridge, IL, USA
University of Illinois at Chicago, Chicago, IL, USA

David A. Margolin, MD
Ochsner Clinic Foundation, Ochsner Clinical School, University of Queensland, Department of Colon and Rectal Surgery, New Orleans, LA, USA

David J. Maron, MD, MBA
Cleveland Clinic Florida, Department of Colorectal Surgery, Weston, FL, USA

Matthew Martin, MD
Scripps Mercy Hospital, Uniformed Services University of the Health Sciences, San Diego, CA, USA

Michael F. McGee, MD
Northwestern University Feinberg School of Medicine, Department of Surgery, Division of Gastrointestinal Surgery, Chicago, IL, USA

Shane McNevin, MD
Providence Sacred Heart, Spokane, WA, USA

Anders Mellgren, MD, PhD
Division of Colon & Rectal Surgery, University of Illinois Chicago, Chicago, IL, USA

Evangelos Messaris, MD, PhD
Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Surgery, Boston, MA, USA

Craig A. Messick, MD
The University of Texas , MD Anderson Cancer Center, Department Surgical Oncology, Houston, TX, USA

John Migaly, MD
Division of Surgical Oncology, Section of Colorectal Surgery, Duke University School of Medicine, Durham, NC, USA

Steven Mills, MD
Division of Colon and Rectal Surgery, University of California, Irvine, Department of Surgery, Orange, CA, USA

John R. T. Monson, MD
Digestive Health and Surgery Institute, AdventHealth, Center for Colon and Rectal Surgery, Orlando, FL, USA

Brendan John Moran, MCh, FRCS, FRCSI (Gen)
Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Department of General and Colorectal Surgery, Basingstoke, UK

Nancy Morin, MD
S, MDB Jewish General Hospital, McGill University, Department of Surgery, Division of Colorectal Surgery, Montreal, QC, Canada

Margarita Murphy, MD
East Cooper Medical Center, Department of Surgery, Mount Pleasant, SC, USA

Matthew G. Mutch, MD
Washington University School of Medicine, Department of Surgery, St. Louis, MO, USA

James W. OgilvieJr, MD, MS
Spectrum Health, Michigan State University, Department of Colorectal Surgery, Grand Rapids, MI, USA

Lucia Camara Castro Oliveira, MD, PhD
Anorectal Physiology Department and Colorectal Surgery, Hospital Casa de Saude Sao Jose and CEPEMED, Department of Colorectal Surgery, Rio de Janeiro, Brazil

Ian M. Paquette, MD
University of Cincinnati College of Medicine, Department of Surgery – Colon and Rectal Surgery, Cincinnati, OH, USA

Danielle Patterson, MD, SM
Johns Hopkins Medical Institutions, Department of Gynecology and Obstetrics, Baltimore, , MD, USA

Rodrigo Oliva Perez, MD, PhD
Angelita and Joaquim Gama Institute, Beneficencia Portuguesa de Sao Paolo, Alemao Oswaldo Cruz, Department of Surgical Oncology, Sao Paulo, Brazil

W. Brian Perry, MD
Audie L. Murphy VA Medical Center, Department of Surgery, San Antonio, TX, USA

Walter R. Peters Jr, MD, MBA
Baylor Scott and White Health, Dallas, TX, USA

Clayton C. Petro, MD
Cleveland Clinic, Department of General Surgery, Cleveland, OH, USA

Ajita Prabhu, MD
Cleveland Clinic, Department of Surgery, Cleveland, OH, USA

Jan Rakinic, MD
Southern Illinois University School of Medicine, Department of Surgery, Springfield, IL, USA

Jennifer D. Rea, MD
Colorectal Surgical and Gastroenterology Associates, Department of Colorectal Surgery, Lexington, KY, USA

Scott E. Regenbogen, MD, MPH
University of Michigan, Division of Colorectal Surgery, Department of Surgery, Ann Arbor, MI, USA

Craig A. Reickert, MD
Wayne State University, Department of Colon and Rectal Surgery, Detroit, MI, USA

Timothy J. Ridolfi, MD, MS
Medical College of Wisconsin, Division of Colorectal Surgery, Department of Surgery, Milwaukee, WI, USA

Michael J. Rosen, MD
Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic, Department of Surgery, Cleveland, OH, USA

Leslie Roth, MD
Brown University, Rhode Island Hospital, Department of Surgery, Providence, RI, USA

Ali Salim, MD
Division of Trauma, Burns, Surgical Critical Care and Acute Care Surgery, Brigham and Woman’s Hospital, Harvard Medical Schoo, Boston, MA, USA

Dana R. Sands, MD
Cleveland Clinic Florida, Department of Colorectal Surgery, Weston, FL, USA

Nicole M. Saur, MD
University of Pennsylvania, Division of Colon and Rectal Surgery, Department of Surgery, Philadelphia, PA, USA

Andrew T. Schlusse, lDO
Madigan Army Medical Center, Department of Surgery, Tacoma, WA, USA

Benjamin D. Shogan, MD
University of Chicago, Department of Surgery, Chicago, IL, USA

Radhika K. Smith, MD
Washington University in St. Louis, Department of Surgery, St. Louis, MO, USA

Michael J. Snyder, MD
McGovern School of Medicine, Department of Surgery, Houston, TX, USA

Michael J. Solomon, MB BCH (Hons), BAO, MSc DMEDSC
Royal Prince Alfred Hospital, Department of Colorectal Surgery, 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
University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Department of Surgery, Cleveland, OH, USA

David B. Stewart, MD
Southern Illinois University School of Medicine, Department of Surgery, Springfield, IL, USA

Luca Stocchi, MD
Mayo Clinic Florida, Department of Surgery, Division of Colorectal Surgery, Jacksonville, FL, USA

Scott A. Strong, MD
Northwestern University, Department of Surgery, Chicago, IL, USA

Pasithorn A. Suwanabol, MD, MS
University of Michigan, Division of Colorectal Surgery, Department of Surgery, 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
Oregon Health and Science University, Department of General Surgery, Division of Gastroenterology, Portland, OR, USA

Konstantin Umanskiy, MD
University of Chicago, Department of Surgery, Chicago, IL, USA

Michael A. Valente DO
Cleveland Clinic, Department of Colorectal Surgery, Cleveland, OH, USA

H. David Vargas, MD
Ochsner Clinic Foundation, Department of Colon and Rectal Surgery, New Orleans, LA, USA

Carol-Ann Vasilevsky, MD
Jewish General Hospital, Department of Surgery, Montreal, QC, Canada

Jon D. Vogel, MD
University of Colorado, Aurora, CO, USA

Sarah A. Vogler, MD, MBA
Cleveland Clinic, Department of Colorectal Surgery, Cleveland, OH, USA

Eric G. Weiss, MD
Cleveland Clinic Florida, Department of Colorectal Surgery, 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
University of California, San Francisco, Department of Surgery, San Francisco, CA, USA

Kirsten Bass Wilkins, MD
Associated Colon and Rectal Surgeons, PA, Edison, NJ, USA

Dennis Yang, MD
University of Florida, Department of Gastroenterology, Gainesville, FL, USA

Karen N. Zaghiyan, MD
Cedars Sinai Medical Center, Department of Surgery, Los Angeles, CA, USA

Matthew D. Zelhart, MD
Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA

Massarat Zutshi, MD
Cleveland Clinic, Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland, OH, USA

Forward

Drs. Steele, Hull, Hyman, Maykel, Read, and Whitlow and their respective chapter authors are to be congratulated on the successful completion of the fourth edition of The ASCRS Textbook of Colon and Rectal Surgery. This edition is greatly enhanced with new authors for each chapter reflecting international experts in the treatment of colorectal disease, expansion of online videos, and a continued emphasis on algorithms and evidence-based recommendations. This edition also serves as the first step in expansion to an online modular platform, facilitating dynamic updates of content.

The ASCRS Textbook of Colon and Rectal Surgery is unique. The concept of a definitive text for state-of-the-art information for all health professional learners and practitioners, including residents in training in colon and rectal surgery as well as fully trained surgeons in practice, was conceived, implemented, and supported by the American Society of Colon and Rectal Surgeons in 2007. It was the recognition of an idea initially conceived by Bruce Wolf, co-implemented by Jim Fleshman, and fully supported by the ASCRS Executive Council. All chapters have been extensively referenced, authoritatively written and illustrated, and have included ASCRS clinical practice guidelines. The success of the first edition led to second and third editions in 2011 and 2016. With the rapid expansion of knowledge, technology, and techniques, each edition has been meticulously and thoroughly updated to reflect state-of-the-art, evidence-based practice. The editors have been continuously refreshed just like the content to keep the book fresh and contemporary. With the fourth edition, the torch has been picked up and carried by each group of editors since the inception.

The textbook remains fully supported and endorsed by the American Society of Colon and Rectal Surgeons: the work is a product of and for the Society, owned by our society with all proceeds flowing back to the Education Fund of the society to continue to support a long-term commitment of the organization to the lifelong education not just of colon and rectal surgery trainees but all clinicians.

Patricia L. Roberts, MD
Burlington, MA

Theodore J. Saclarides, MD
Chicago, IL

Anthony Senagore, MD
Holland, MI

Michael J. Stamos, MD
Irvine, CA

Preface

One given definition of the word textbook is “a book used as a standard work for the study of a particular subject.” Our collective goal for the fourth edition of The ASCRS Textbook of Colon and Rectal Surgery was to make this volume the standard for the study of colon and rectal surgery, providing a valuable resource for surgeons and health care providers at all stages of their career caring for patients with colorectal disease. This edition provides all newly written chapters, organized around the “pillars” of colorectal disease: perioperative (including endoscopy); anorectal disease; benign disease (including inflammatory bowel disease); malignancy; pelvic floor disorders; and a “miscellaneous” section that covers aspects both inside and beyond the operating room.

Colon and rectal surgery is in a golden age; our special skills and expertise are highly valued by patients and colleagues alike. Colon and rectal training programs continue to thrive, attracting the very best and brightest surgery residents – they are the rock stars of their generation! We hope this textbook will also expose the many critical gaps in our knowledge base and inspire the next generation to answer them through thoughtful and high-level scientific inquiry.

Finally, we would like to thank our Developmental Editor Elektra McDermott for her extraordinary efforts and thoroughness in overseeing and ensuring its timely completion, along with each chapter author and coauthor(s) for their devotion to this task and to the mission of the ASCRS. 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

Notices and Disclaimers

References