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ISBN 10: 1852336900
ISBN 13: 9781852336905
Author: Steve Wexner, Steven Wexner, Andrew P Zbar, Mario Pescatori
Part I: Foundational Principles
Chapter 1: Anatomy and Physiology of the Anorectum
1.1 Gross Anatomy: The Anal Canal, Rectum, and Pelvic Floor
1.2 Microscopic Anatomy: Histology of the Anal Mucosa, Anoderm, and Sphincters
1.3 Neurophysiology: Innervation of the Pelvic Floor and Anorectum
1.4 Physiology of Defecation and Continence: A Detailed Overview
1.5 Relevant Imaging Modalities: MRI, Endorectal Ultrasound, Defecography
Chapter 2: Diagnostic Evaluation of Complex Anorectal Disorders
2.1 Comprehensive Clinical History and Physical Examination
2.2 Anorectal Manometry and Pudendal Nerve Testing
2.3 Electromyography (EMG) and Nerve Conduction Studies
2.4 Imaging in Practice: Interpretation of MRI and Ultrasound Findings
2.5 Functional Testing: Balloon Expulsion Test and Defecography
Part II: Specific Complex Conditions
Chapter 3: Complex Anal Fistulas
3.1 Classification Systems: Parks Classification, St. James's University Hospital Classification
3.2 Etiology and Pathogenesis: Cryptoglandular vs. Crohn's-related Fistulas
3.3 Surgical Principles for Complex Fistulas: Setons, Advancement Flaps, LIFT Procedure
3.4 The Management of Recurrent and High-Level Fistulas
3.5 Case Studies: Fistula-in-ano with multiple tracts, Horseshoe Abscess
Chapter 4: Anorectal Abscesses
4.1 Pathophysiology and Clinical Presentation
4.2 Classification and Location: Perianal, Ischiorectal, Supralevator
4.3 Surgical Drainage Techniques: Incision and Drainage, Post-operative Care
4.4 The Risk of Fistula Formation Post-Drainage
4.5 Management of Recurrent Abscesses
Chapter 5: Rectovaginal and Anorectal Fistulas
5.1 Etiology: Obstetric Trauma, Crohn's Disease, Radiation
5.2 Diagnostic Workup and Assessment of Tissue Health
5.3 Surgical Repair Techniques: Transvaginal, Transanal, Abdominal Approaches
5.4 The Use of Flaps and Grafts in Repair
5.5 Case Studies: Fistula following childbirth, Radiation-induced fistula
Chapter 6: Fecal Incontinence
6.1 Pathophysiology: Sphincter Deficiency, Neuropathy, Rectal Compliance
6.2 Non-Surgical Management: Biofeedback, Pelvic Floor Physical Therapy, Sacral Nerve Stimulation
6.3 Surgical Management: Sphincteroplasty, Artificial Bowel Sphincter, Colostomy
6.4 Management of High-Grade Sphincter Tears (e.g., following delivery)
6.5 Case Studies: Incontinence following obstetric injury, Neuropathic incontinence
Chapter 7: Rectal Prolapse
7.1 Classification: Full-Thickness vs. Mucosal Prolapse, Internal vs. External
7.2 Etiology and Associated Conditions (e.g., Solitary Rectal Ulcer Syndrome)
7.3 Surgical Approaches: Transabdominal (Laparoscopic Rectopexy) vs. Transperineal (Altemeier, Delorme)
7.4 Management of Recurrence and Co-existing Incontinence
7.5 Case Studies: Complete rectal prolapse in an elderly patient, Occult prolapse
Chapter 8: Crohn's Disease-Related Perianal Disease
8.1 Unique Challenges of Crohn's Perianal Disease
8.2 Medical Management: Biologics (Anti-TNF), Immunomodulators
8.3 Surgical Management: Differentiating between Healing and Palliative Procedures
8.4 The Role of Setons and Draining Procedures
8.5 Case Studies: Perianal Crohn's with complex fistulas and strictures
Part III: Advanced Topics and Special Considerations
Chapter 9: The Anorectum and Pelvic Floor in Cancer Management
9.1 Sphincter-Sparing Surgery for Low Rectal Cancer
9.2 Management of Perineal Wounds following Abdominoperineal Resection (APR)
9.3 Radiation Proctitis and its Management
9.4 Surgical and Non-Surgical Management of Stenosis and Fibrosis
Chapter 10: Post-Operative Complications and Salvage Procedures
10.1 Management of Non-Healing Wounds and Necrosis
10.2 Salvage Procedures for Failed Repairs
10.3 The Role of Ostomy in Intractable Cases
10.4 Pain Management and Quality of Life Issues
Chapter 11: The Multidisciplinary Approach to Care
11.1 The Anorectal Surgeon's Role
11.2 The Gastroenterologist and Medical Management
11.3 The Role of the Wound Care Nurse and Physical Therapist
11.4 Psychological and Quality-of-Life Support
complex anorectal disorders
complex anorectal malformation
common anorectal conditions
anorectal disorders treatment
anorectal disorders symptoms
anorectal disorders causes
Tags: Steve Wexner, Steven Wexner, Andrew P Zbar, Mario Pescatori, Complex
