Evidence-based Evaluation and Management of Anorectal Disease

Sean J. Langenfeld, MD, FACS

At least once a week, I have a patient in my clinic who asks me, “Why would you ever choose this field of work?” It typically occurs after an anorectal exam that they found particularly unsettling or embarrassing. Over the years, we have all come up with witty responses to this question, and I will spare the readers from my own retort, as I am sure your jokes are better than mine.

It is true that anorectal surgery is relatively unglamorous, and perhaps when some colon and rectal surgeons measure their worth, they focus on the complex laparoscopic and robotic cases, and the lives saved from colorectal cancer, rather than the abscesses, fistulas, and condylomata that frequent our clinics. However, our expertise in anorectal surgery is what truly separates us as colorectal subspecialists, and it is important that we maintain a strong focus in this area.

The goal of this volume is to summarize the up-to-date, evidence-based approach to common anorectal disorders, including controversies and areas of ongoing research. The authors have done a remarkable job of comprehensively reviewing the literature on their chosen topic, leaving no stone unturned, and acting as great ambassadors to our profession that is not satisfied with cookbook medicine.

I would like to thank all the authors for their time and their expertise. Their work was thorough and thought-provoking, and I am happy to call them friends and colleagues. I would also like to especially thank Dr. Scott Steele for inviting me to be a guest editor for this volume. While his motivation and productivity are certainly unparalleled, I have been most impressed by his advocacy for others. What makes him truly unique is his tireless commitment to helping other surgeons succeed through support and mentorship.

Thank you.