Book Review

Surgery of the Anus, Rectum and Colon

N Engl J Med 1994; 331:136July 14, 1994

Article

Surgery of the Anus, Rectum and Colon
By Michael R.B. Keighley and Norman S. Williams. 2448 pp. in two volumes, illustrated. Philadelphia, W.B. Saunders, 1993. $295. ISBN: 0-7020-1278-5

It was impossible in the time available for review of this textbook to do justice to the stunning amount of scholarship and effort that went into its making. As one experiences the rites of passage in becoming a surgeon, one encounters along the way rare, monumental works that are never forgotten, such as the British edition of Gray's Anatomy or later, for me, Professor John Goligher's Surgery of the Anus, Rectum and Colon (London: Bailliere Tindall, 1984). Somehow these books speak to us as would mentors and portray experience, rather than simply reciting then-current information. Professors Keighley and Williams have not only retained the name of Goligher's book but have also managed to retain its wisdom and elegance.

Keighley and Williams's intention was to produce a current reference work in the widening specialty of coloproctology. There are 76 chapters covering the breadth of the field, 65 of which have been written by one or the other of the principal authors. Each chapter was read and amended by the other, with a resulting uniformity of style that makes it difficult to determine who covered which subject. When the main authors could not write from personal experience, other experts covered specialty areas (anesthesia, sexually transmitted disease, urology, gynecology, tropical disease, laparoscopic colectomy, and five chapters on topics in pediatrics).

The authors have tried, usually with success, to present their views of appropriate management strategies for the diverse problems faced by colorectal surgeons. Although, in general, these approaches reflect the policies in Leeds, Birmingham, and London, I found that with few exceptions they can be easily incorporated into American-style practice.

The factual information provided and referenced in detail is encyclopedic in scope. In the chapters related to functional disorders such as incontinence and constipation, the physiologic foundations are exceptionally well laid. The authors themselves have made many important contributions to this area of study. The chapters on colorectal neoplasia are only slightly less impressive; perhaps the only weakness is a somewhat superficial handling of the important advances in the understanding and applications of genetics and biochemical markers. Williams also stays away from the controversial topic of using less extensive surgical procedures for advanced rectal lesions in combination with other treatments. At the moment, only history will tell us if this is an oversight.

In general, however, this book covers controversial areas with objectivity and uncommon evenhandedness. The chapter on laparoscopic colectomy, a topic that at present is imbued with more passion than fact, is a concise compilation of techniques and facts without evident bias. Its very inclusion supports the notion that this book is intended to be as current as possible.

For anyone in the field of general surgery, this book will be a valuable addition to the reference library. For colon and rectal surgeons, it will become a classic surpassing in depth, breadth, and style all other currently available textbooks. Although the facts may slowly change with the advances of science, the wisdom and experience captured here will keep me returning to this book for counsel for many years to come.

Alan W. Hackford, M.D.
Tufts University School of Medicine, Boston, MA 02111