Surgical Clinics of North America RSS feed: Current Issue. For over 80 years, Surgical Clinics of North America has kept practitioners informed on the latest techniques from leading surgical centers worldwide. Each bimonthly issue is devoted to a single topic relevant to the busy surgeon, with articles written by experts in the field. Case studies and complete references are also included to give you the most thorough data you need to stay on top of your practice.http://www.surgical.theclinics.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Surgical Clinics of North America0039-6109901February 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.surgical.theclinics.com/article/PIIS0039610909001911/abstract?rss=yesContents10.1016/S0039-6109(09)00191-1Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-3viixhttp://www.surgical.theclinics.com/article/PIIS0039610909001923/abstract?rss=yesForthcoming Issues10.1016/S0039-6109(09)00192-3Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-3xixihttp://www.surgical.theclinics.com/article/PIIS0039610909001856/abstract?rss=yes I look forward to the day when news broadcasters will say Uranus properly on television without wincing or to when someone of public notoriety goes on one of the influential talk shows and wants to raise public awareness of options for managing stress fecal incontinence. Until then we must provide the best care that we can for these patients as they arrive and present themselves.ForewordRonald F. Martin10.1016/j.suc.2009.11.001Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-3xiiixivhttp://www.surgical.theclinics.com/article/PIIS0039610909001601/abstract?rss=yes 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.Preface: Anorectal DiseaseScott R. Steele10.1016/j.suc.2009.10.007Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-3xvxvihttp://www.surgical.theclinics.com/article/PIIS0039610909001194/abstract?rss=yesThe rectum and anal canal form the last portion of the gastrointestinal tract. The rectum serves as a reservoir for fecal contents, and the anal canal regulates continence and defecation via synchronization of events regulated by complex interactions between sympathetic and parasympathetic nerves, striated and smooth muscle, and environmental factors. Normal function can be compromised by various pathologies. Investigation into these pathologies includes a detailed history and thorough physical exam and can be augmented by a number of different studies, including manometry, electromyelography, defecography, nerve stimulation, and compliance. Some of these techniques have incorporated the use of ultrasound and magnetic resonance imaging.Anorectal Anatomy and PhysiologyAndrew Barleben, Steven Mills10.1016/j.suc.2009.09.001Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-3115http://www.surgical.theclinics.com/article/PIIS0039610909001583/abstract?rss=yesHemorrhoidal disease is a common problem that is managed by various physicians, ranging from primary care providers to surgeons. This article reviews the pathophysiology, clinical presentation, and updated treatment of hemorrhoids, including nonoperative options, office-based procedures, and surgical interventions from standard excision to stapled hemorrhoidopexy and Doppler-guided ligation. The article also covers complications and provides guidance for special circumstances, such as pregnancy, hemorrhoidal crisis, and inflammatory bowel disease.Diagnosis and Management of Symptomatic HemorrhoidsErica B. Sneider, Justin A. Maykel10.1016/j.suc.2009.10.005Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-31732http://www.surgical.theclinics.com/article/PIIS0039610909001200/abstract?rss=yesAnal fissure is a common disorder that is effectively treated and prevented with conservative measures in its acute form, whereas chronic fissures may require medical or surgical therapy. This article discusses the nonoperative and operative management strategies, reviews the current literature on expected outcomes, and provides guidance on dealing with fissures in special situations, such as patients with inflammatory bowel disease or hypotonic sphincters.Anal FissureDaniel O. Herzig, Kim C. Lu10.1016/j.suc.2009.09.002Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-33344http://www.surgical.theclinics.com/article/PIIS0039610909001546/abstract?rss=yesThe management of anorectal abscess and anal fistula has changed markedly with time. Invasive methods with high resulting rates of incontinence have given way to sphincter-sparing methods that have a much lower associated morbidity. There has been an increase in reports in the medical literature describing the success rates of the varying methods of dealing with this condition. This article reviews the various methods of treatment and evidence supporting their use and explores advances that may lead to new therapies.Anorectal Abscess and Fistula-in-Ano: Evidence-Based ManagementJulie A. Rizzo, Anna L. Naig, Eric K. Johnson10.1016/j.suc.2009.10.001Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-34568http://www.surgical.theclinics.com/article/PIIS0039610909001212/abstract?rss=yesDespite the prevalence and severe implications of rectovaginal fistula, there is no universally accepted evidence-based approach to surgical management. This article offers a disease-based review of traditional management strategies and highlights the variety of technical approaches that are currently effective for the eradication of this socially disabling condition.Rectovaginal FistulaBradley J. Champagne, Michael F. McGee10.1016/j.suc.2009.09.003Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-36982http://www.surgical.theclinics.com/article/PIIS0039610909001224/abstract?rss=yesCrohn's disease manifests with perianal or rectal symptoms in approximately one-third of patients, and is associated with a more aggressive natural history. Due to the chronic relapsing nature of the disease, surgery has been traditionally avoided. However, combined medical and surgical intervention when treating perianal fistulae has been shown to offer the best chance for success. Endoanal ultrasound examination or pelvic magnetic resonance imaging should be done in conjunction with an examination under anesthesia to characterize the disease. Any abscess should be drained and setons placed if there is active rectal inflammation or complex fistulae. Antibiotics and immunosuppressive therapy (especially with infliximab) should also be initiated. Simple fistulae can be treated surgically by fistulotomy or anal fistula plug. Complex fistulae can be closed with either an anal fistula plug or covered with flaps. Up to 20% of patients anorectal Crohn's disease require proctectomy for persistent and disabling disease.Anorectal Crohn's DiseaseRobert T. Lewis, David J. Maron10.1016/j.suc.2009.09.004Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-38397http://www.surgical.theclinics.com/article/PIIS0039610909001236/abstract?rss=yesSexually transmitted diseases (STDs) are a common public health problem and as such may be more common in a surgical practice than is believed. The recognition that a virus can be responsible for a cancer has profound significant public health implications. This article reviews the presentation and management of the more common perianal STDs including human immunodeficiency virus, as well as the pathogenesis and management of anal intraepithelial neoplasia.Condyloma and Other Infections Including Human Immunodeficiency VirusPeter K. Lee, Kirsten Bass Wilkins10.1016/j.suc.2009.09.005Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-399112http://www.surgical.theclinics.com/article/PIIS0039610909001248/abstract?rss=yesPilonidal disease is a common condition, ranging from the routine cyst with abscess to extensive chronic infection and sinus formation. It can be associated with significant morbidity and prolonged wound healing after definitive surgery. This article reviews the history and pathogenesis of this often challenging surgical problem and the numerous nonoperative and operative treatment options currently available for it.Evaluation and Management of Pilonidal DiseaseAshley E. Humphries, James E. Duncan10.1016/j.suc.2009.09.006Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-3113124http://www.surgical.theclinics.com/article/PIIS003961090900125X/abstract?rss=yesPruritus ani is a dermatologic condition characterized by an unpleasant itching or burning sensation in the perianal region. This article briefly discusses the incidence and classification of pruritus ani followed by a more lengthy discussion of primary and secondary pruritus ani. The important points are summarized and a simple algorithm is provided for the clinical management of pruritus ani.Pruritus Ani: Etiology and ManagementKatharine W. Markell, Richard P. Billingham10.1016/j.suc.2009.09.007Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-3125135http://www.surgical.theclinics.com/article/PIIS0039610909001558/abstract?rss=yesAnal stenosis occurs most commonly following a surgical procedure, such as hemorrhoidectomy, excision and fulguration of anorectal warts, endorectal flaps, or following proctectomy, particularly in the setting of mucosectomy. Patients who experience anal stenosis describe constipation, bleeding, pain, and incomplete evacuation. Although often described as a debilitating and difficult problem, several good treatment options are available. In addition to simple dietary and medication changes, surgical procedures, such as lateral internal sphincterotomy or transfers of healthy tissue are other potentially good options. Flap procedures are excellent choices, depending on the location of the stenosis and the amount of viable tissue needed. This article presents the definition, pathophysiology, diagnosis, and treatment of anal stenosis, and methods to prevent it.Anal StenosisMukta V. Katdare, Rocco Ricciardi10.1016/j.suc.2009.10.002Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-3137145http://www.surgical.theclinics.com/article/PIIS0039610909001261/abstract?rss=yesA variety of lesions comprise tumors of the anal canal, with carcinoma in situ and epidermoid cancers being the most common. Less common anal neoplasms include adenocarcinoma, melanoma, gastrointestinal stromal cell tumors, neuroendocrine tumors, and Buschke-Lowenstein tumors. Treatment strategies are based on anatomic location and histopathology. In this article different tumors and management of each, including a brief review of local excision for rectal cancer, are discussed in turn.Anal NeoplasmsKelly Garrett, Matthew F. Kalady10.1016/j.suc.2009.09.008Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-3147161http://www.surgical.theclinics.com/article/PIIS0039610909001273/abstract?rss=yesRetrorectal or presacral tumors are rare and can be challenging to diagnose and treat. Because the retrorectal space contains multiple embryologic remnants derived from various tissues, the tumors that develop in this space are heterogeneous. Most lesions are benign, but malignant neoplasms are not uncommon. Lesions are classified as congenital, neurogenic, osseous, inflammatory, or miscellaneous. Although treatment depends on diagnosis and anatomic location, most retrorectal lesions will require surgical resection.Retrorectal TumorsKelli Bullard Dunn10.1016/j.suc.2009.09.009Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-3163171http://www.surgical.theclinics.com/article/PIIS0039610909001571/abstract?rss=yesRectal foreign bodies present a difficult diagnostic and management dilemma because of delayed presentation, a variety of objects, and a wide spectrum of injuries. An orderly approach to the diagnosis, management, and post-extraction evaluation of the patient with a rectal foreign body is essential. This article outlines and describes the stepwise evaluation and management of the patient with a rectal foreign body. The authors also describe the varied techniques needed to successfully remove the different foreign bodies that may be encountered.Rectal Foreign BodiesJoel E. Goldberg, Scott R. Steele10.1016/j.suc.2009.10.004Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-3173184http://www.surgical.theclinics.com/article/PIIS0039610909001595/abstract?rss=yesFecal incontinence is a debilitating and socially embarrassing condition. Significant advances in the evaluation and treatment of this condition have been made in recent years, and several new treatment modalities are in the pipeline to be made available to affected patients. This article reviews the workup and operative and nonoperative management of fecal incontinence, and it discusses the emerging role of methods, such as bioinjectable agents and sacral nerve stimulation.Fecal IncontinenceAnders Mellgren10.1016/j.suc.2009.10.006Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-3185194http://www.surgical.theclinics.com/article/PIIS003961090900156X/abstract?rss=yesDisorders of the pelvic floor are common sources of morbidity, decreased quality of life, and are unfortunately increasing in incidence. Owing to their complex and often coexistent nature, a comprehensive, multidisciplinary strategy of testing and care is required. Many nonoperative and operative approaches for management of the symptoms of pelvic floor disorders are available. This article reviews the evaluation and management for these difficult disorders.Overview of Pelvic Floor DisordersM. Shane McNevin10.1016/j.suc.2009.10.003Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-3195205http://www.surgical.theclinics.com/article/PIIS0039610909001935/abstract?rss=yesIndex10.1016/S0039-6109(09)00193-5Surgical Clinics of North America 90, 1 (2010)2010-02-01Surgical Clinics of North America2010-02-01901S0039-6109(09)X0008-3207217