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Recent Advances in Coloproctology.
  1. A LEATHER

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Recent Advances in Coloproctology. Edited by J Beynon, ND Carr (Pp182; illustrated; £80/$149). Germany: Springer-Verlag, 1999. ISBN1-85233-169-0.

This book addresses 10 topics in which there has been significant development over the past decade. The subjects discussed are diverse, ranging from the combined surgical treatment for advanced pelvic malignancy to incontinence surgery, and from imaging of the anal canal and rectum to the management of anal fissure.

All topics have dual authorship with the exception of the useful chapter on legal matters by PF Schofield. These authors are all UK based apart from MR Salum and SD Wexner (Cleveland Clinic, Florida).

Do you have comprehensive answers to the following questions? If yes, do not read this book!

Question 1. What surgical procedures are now possible for the elderly unfit patient in whom you have just discovered a small malignant rectal polyp?

The outstanding chapter by Cook and McC Mortensen (John Radcliffe Hospital) on transanal endoscopic microsurgery describes this recent advance eloquently. There is an unusually large number of good illustrations and tables in this chapter which cover all aspects of this minimally invasive technique.

Question 2. What's the latest on troublesome haemorrhoids?

The chapter by EA Carapeti and RKS Phillips (St Mark's Hospital) on the treatment of haemorrhoids is very thorough, ending by focussing on the perioperative care package that has made day case surgery possible. The goal posts really have moved since the days of lengthy inpatient care for all.

Question 3. So doctor, what is the chance that this pouch surgery will work?

Are you up to date on the extensive knowledge that has been gained over the past 15 years on complications and long term outcome of pelvic pouch surgery? In the UK, none has performed more first time pouches nor has anyone as great an experience in revisional pouch surgery as John Nicholls, who addresses this topic.

Question 4. Is laparoscopic colorectal surgery here to stay? What are the indications for it and is there any evidence that it is better than open surgery?

Interestingly, the editors decided to look further afield for the answers in this controversial area.

Coloproctology is the most popular subspecialty among general surgical trainees. One reason for this is that it is a specialty on the move. There are recent advances in many other areas left for future editions of this book: management of acute colitis, colonic stenting, training, the input of colorectal nurse specialists, to name a few. I hope these future editions will also have input from gastroenterology, nursing, oncology, and radiology. After all, the editors acknowledge in the preface that coloproctology has now been transformed from a purely surgical to a multidisciplinary specialty.

The reputation of the colorectal unit at Singleton Hospital (where the editors are based) will certainly be further enhanced by this well collated and useful book.

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