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Benign anorectal conditions are common problems that affect scores of patients. These disorders not only provide the basis for the proctology practice of most colon and rectal surgeons but also are commonly treated by general surgeons and primary care physicians. Several new procedures and techniques have been developed over the past decade to treat these conditions. This issue of Clinics in Colon and Rectal Surgery provides a review of many of the frequently encountered benign anorectal disorders, including the latest treatment modalities and procedures.
Hemorrhoids are one of the most common reasons patients are referred to a colon and rectal surgeon and are often blamed for other anorectal problems. The issue begins with a thorough review by Dr. Amy Halverson from Northwestern University of the management of hemorrhoids, including the evaluation of patients and the medical and surgical options for treatment. Less invasive techniques such as rubber band ligation, infrared coagulation, and the newer stapled hemorrhoidopexy (PPH) are discussed in detail.
Pilonidal disease is not technically a condition of the anus or rectum but rather is a disorder of the skin adjacent to the anus. Numerous operations have been described to treat this disease, but recurrences are frequent. Dr. Franklin Bendewald and Dr. Robert Cima from the Mayo Clinic provide an in-depth review of many of the surgical procedures used to treat this difficult problem.
By strict definition, a fistula is an abnormal passage from one epithelial surface to another epithelial surface. Then next two articles discuss two of the most common fistulas seen in colon and rectal surgery. Dr. David Rivadeneira from Stony Brook University Medical Center discusses the evaluation and surgical treatment options for patients with rectovaginal fistulas, and Dr. Mark Whiteford, Clinical Associate Professor, Oregon Health & Science University and Legacy Portland Hospitals, reviews the etiology and treatment of anorectal abscess as well as the chronic form of the disease, fistula-in-ano. A variety of surgical procedures to treat anal fistulas are discussed, including less invasive techniques such as fibrin glue and the anal fistula plug.
The next three articles are devoted to disorders of defecation and the pelvic floor, all of which can be difficult and complicated to treat. Dr. Scott Steele from Madigan Army Medical Center and Dr. Anders Mellgren from the University of Minnesota discuss the work-up and evaluation of patients with constipation along with the nonsurgical management and surgical treatment options for patients with obstructed defecation, which can be a challenging clinical problem. Pelvic floor weakness can lead to full-thickness rectal prolapse, for which over 100 operations have been described owing to the difficulty and complexity of treating this condition. Dr. David O'Brien from the University of Cincinnati provides a comprehensive review of the numerous procedures that have been described, including perineal and abdominal approaches as well as laparoscopic procedures. On the opposite side of the spectrum, fecal incontinence can be a devastating and embarrassing problem that is often underreported by patients to health care providers. A thorough review by Dr. Tracy Hull from the Cleveland Clinic is presented on the evaluation of patients with fecal incontinence and the nonsurgical and surgical options for treatment, including the artificial bowel sphincter and newer less invasive procedures such as sacral nerve stimulation and the SECCA procedure.
The last article is devoted to anal fissures, which are one of the more common benign anorectal conditions treated by surgeons as well as medical physicians. Dr. Jan Rakinic from Southern Illinois University discusses the various conservative therapies as well as surgical options to treat this painful disorder.
I would like to thank Dr. David Beck for giving me the opportunity to be Guest Editor of this issue, and I have enjoyed reading the most up-to-date articles on these common conditions from many of the leaders in colon and rectal surgery.