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Surgery of the Anus, Rectum, and Colon
  1. N MORTENSEN

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Surgery of the Anus, Rectum, and Colon, 2nd edn, vols 1 and 2. Edited by M R B Keighley, N S Williams (Pp 2702; illustrated; £285). UK: Harcourt Publishers Ltd, 2000. ISBN 0702023353.

This is a monumental effort and the editors, who have written much of this textbook themselves, are to be congratulated on a terrific job. They have taken on the task of reworking the iconic textbook first started by the late and great John Goligher. His was a very personal style, with repeated references to his own practice and results, and then a weighing of the evidence and a firm opinion, an approach which was much loved. With the growing emphasis on a larger body of evidence, the editors have widened their search in the world's literature and updated it for the now established specialty of coloproctology which tends to be surgical but spans the many disciplines looking after patients with diseases of the lower gastrointestinal tract. And here, despite the view that electronic publishing will consign many textbooks to history, is a second edition, tribute to its success and what Vie Fazio in his foreword calls the perspective “thing”. There must still be a place for one or two prominent and authoritative reference textbooks in any specialty provided they are kept up to date, and I have no doubt this will continue to be just such a tome.

There is much here which will be of interest to gastroenterologists as well as surgeons. If you want to argue the point with your local surgeon, give a talk which includes some surgical outcomes, write a medicolegal report, or find a reference, it is all there. The style of the previous edition has been retained, with clear text, excellent line drawings, and helpful tables. The bibliography arranged at the end of each section is exhaustive and comprehensive. New sections have been added on medical management of anal fissure, newer treatments for incontinence, and the combined management of pelvic floor disorders. In inflammatory bowel disease, the place of newer therapies have been discussed, and pouch salvage procedures are reviewed. Cancer has been updated with additions to the whole area of biology, natural history, and hereditary and polyposis syndromes, as well as adjuvant therapy, The chapter on laparoscopy in colorectal cancer which includes length of stay and cost issues, anticipates the recent pronouncement of the NICE in concluding that open surgery still has room for improvement, and until specialisation and quality improve these results and there are clear advantages, laparoscopic resection must remain in abeyance outside clinical trials. A good examination of the place of local excision includes transanal endoscopic microsurgery but with so many surgical staff carrying out colonoscopy, the section on technique was rather short and the newer approaches to polypectomy, including endoscopic mucosal resection, and placement of clips and ligatures, and tattooing was disappointing.

Inevitably there are some gaps. Although the place of nitrites is reviewed for the treatment of fissure, the more recent introduction of calcium channel blockers and a growing disenchantment with GTN are missed. In the management of Crohn's fistulae, anti-tumour necrosis factor may have a profound impact on surgical practice but this too did not reach the cut. And the controversial new stapling procedure for haemorrhoids arrived too recently for inclusion.

These are minor criticisms however. Although it comes in two hefty volumes and at a similarly weighty price, this is a must have. It is in my view the finest reference textbook on the subject on both sides of the Atlantic, and will be taken frequently and enjoyably from the bookshelves in offices and studies of those who really care deeply about the management, medical and surgical, of these embarrassing, distressing, and challenging conditions. The owners will just have to make sure the books are returned.

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