AcquisitionsEditor:KeithDonnellan EditorialCoordinator:TimRinehart EditorialAssistant:LeviBentley MarketingManager:DanDressler SeniorProductionProjectManager:AliciaJackson DesignCoordinator:HollyMcLaughlin Artist/Illustrator:BodyScientificInternational,LLC ManufacturingCoordinator:BethWelsh PrepressVendor:S4CarlislePublishingServices

Names:Wexner,StevenD.,editor.|Fleshman,James,editor. Title:Colonandrectalsurgery.Anorectaloperations/editedbySteven D.Wexner,JamesW.Fleshman. Othertitles:Anorectaloperations|Mastertechniquesinsurgery. Description:Secondedition.|Philadelphia:WoltersKluwer,[2019]| Series:Mastertechniquesinsurgery Identifiers:LCCN2017044369|ISBN9781496348579(hardback)| eISBN:9781496348593 Subjects:|MESH:RectalDiseases—surgery|Rectum—surgery|Anal Canal—surgery|Colon—surgery Classification:LCCRD543.C57|NLMWI650|DDC617.5/547—dc23LC recordavailableathttps://lccn.loc.gov/2017044369 Thisworkisprovided“asis,”andthepublisherdisclaimsanyandall warranties,expressorimplied,includinganywarrantiesastoaccuracy, comprehensiveness,orcurrencyofthecontentofthiswork.  Thisworkisnosubstituteforindividualpatientassessmentbasedon healthcareprofessionals’examinationofeachpatientandconsideration

of,amongotherthings,age,weight,gender,currentorpriormedical conditions,medicationhistory,laboratorydata,andotherfactorsunique tothepatient.Thepublisherdoesnotprovidemedicaladviceorguidance andthisworkismerelyareferencetool.Healthcareprofessionals,and notthepublisher,aresolelyresponsiblefortheuseofthisworkincluding allmedicaljudgmentsandforanyresultingdiagnosisandtreatments.  Givencontinuous,rapidadvancesinmedicalscienceandhealth information,independentprofessionalverificationofmedicaldiagnoses, indications,appropriatepharmaceuticalselectionsanddosages,and treatmentoptionsshouldbemadeandhealthcareprofessionalsshould consultavarietyofsources.Whenprescribingmedication,healthcare professionalsareadvisedtoconsulttheproductinformationsheet(the manufacturer’spackageinsert)accompanyingeachdrugtoverify,among otherthings,conditionsofuse,warningsandsideeffectsandidentifyany changesindosagescheduleorcontraindications,particularlyifthe medicationtobeadministeredisnew,infrequentlyusedorhasanarrow therapeuticrange.Tothemaximumextentpermittedunderapplicable law,noresponsibilityisassumedbythepublisherforanyinjuryand/or damagetopersonsorproperty,asamatterofproductsliability, negligencelaworotherwise,orfromanyreferencetoorusebyany personofthiswork.

LWW.com

Thisbookisdedicatedtomyfamily:tomylatefatherIraandmymother Arlene,foralloftheguidancethattheyhavegivenmethroughoutmylife. InadditiontomysonsWesleyandTrevorforalthoughIhavehopefully impartedknowledgetothem,Ihavealsoacquiredaninordinateamount ofinsightfromthem.Furthermoretomylife-partnerDr.MarianaBerho, forherwisdom,counsel,andespeciallylove.Thisdedicationwouldbe incompletewithoutthankingpeoplebesidesmyfamily.Thankyou,Jim Fleshman,fordecadesoffriendshipduringwhichwehavecollaborated onmanyendeavors,includingthisbook.Thankstothehundredsof alumniwhohaveallowedmetotrytohelpthemhelptheirpatients.I hopethatthisbookfurthersyoureducationandremindsyouofyourtime atClevelandClinicFlorida.Thank-youtomyexecutiveassistant,Debbie Holton,andmypublicationsassistant,ElektraMcDermott,foryour patience,indulgence,assistance,andperseveranceinthisprojectandin manyothersbeforeit.

Onecanneverrepaycompletelytheincrediblegiftthatmyfriends, colleagues,andacquaintanceshavecontributedtothissetofbooks.As timegoeson,Iwouldliketothinkthattheywillalllookbackwithpride toseethatisindeedagreatcontributiontothetrainingandpracticeof colorectalsurgery.Thank-youisnotenoughbutissincerelygiventoeach oneofyou.ThankstoSteveWexnerforincludingmeinthiseffortandto Dr.JosefFischerforhistrust.Iwouldliketodedicatethisbooktomy wifeLinda,whohastoleratedmymentalabsencesthroughoutmanyof thelastyear’sweekendsandeveningstoeditthesechapters.WhileIam sureshewillneverreadthesebooks,shehascontributedsupportand tolerance.JenniferHernandez,inourdepartmentatBaylorUniversity MedicalCenter,deservesspecialmentionforherabilityandpatienceto readmyeditsoneachmanuscriptandforkeepingtrackofthewhole process.Thankstoyou.