Preface: Anorectal Disease

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Scott R. Steele, MD, FACS, FASCRS Guest Editor

The American Board of Proctology (now the American Board of Colon and Rectal Surgery) was founded in 1934, and achieved formal approval as an independent specialty board in 1949. Despite this relatively recent acceptance, the wide range of anorectal pathology confronting surgeons has been described since historical times. Over the years, colon and rectal surgery as a specialty, which grew in many instances out of community-based programs, has evolved and transformed through a variety of technological advances and a better understanding of the complex physiology and pathology that occurs in this small region. As such, even the more common anorectal conditions are now often treated by specialists or those with a dedicated interest in the field. Unfortunately, in some cases this has left a void in confidence and proficiency in graduating residents and in experienced general surgeons.

This issue of the Surgical Clinics of North America covers a broad spectrum of specifics on anorectal disease such as basic anatomy, physiology, and testing of the anorectal region; and the most current diagnostic and management strategies for many of the common anorectal conditions encountered by surgeons, including hemorrhoids, anal fissures, abscess, and fistula. Also presented are new techniques in the management of pilonidal disease, perianal infections including HIV and condyloma, pruritis ani, and anal stenosis. These difficult conditions often are frustrating for patient and surgeon alike. Two articles are dedicated to the current management of anorectal Crohn's disease and rectovaginal fistulas, including the evolving multidisciplinary approach. In addition, advances in the evaluation and current management of retrorectal tumors and anal neoplasms, including the role of local excision and transanal endoscopic microsurgery for selected rectal tumors, are covered. Rounding out this issue are approaches to the difficult situation of anorectal trauma, including foreign body management, and two articles dedicated to the evaluation of pelvic floor disorders and fecal incontinence.

The authors of each of these articles are experts in their respective fields, and it is my sincere pleasure to thank them for taking time out of their busy schedules to provide the most up-to-date management in these topics. It is my wish that this issue serve as an reference for not only those surgeons well versed in the care of colorectal disease, but also as a guide for surgeons who find themselves confronted with anorectal pathology and wish to improve their knowledge, confidence, and care for these patients. Although many of the techniques and practices presented may become outdated, the personal reward and pleasure that comes with caring for patients who are not only ailing, but also often frightened and embarrassed, never will.