Regional Anatomy of the Anus and Rectum 001
1.1 Anus 001
1.2 Anal Canal 001
1.2.1 Def inition 001
1.2.2 Structure of the Anal Canal 002
1.3 Rectum 004
1.3.1 Morphology of the Rectum 004
1.3.2 Vicinity of the Rectum 005
1.4 Muscles Surrounding the Anorectum 007
1.4.1 Internal Anal Sphincter (IAS) 007
1.4.2 External Anal Sphincter (EAS) 007
1.4.3 Conjoined Longitudinal Muscle 008
1.4.4 Levator Ani 009
1.5 Anorectal Spaces 010
1.6 Anal and Rectal Vasculature 012
1.6.1 Arteries 012
1.6.2 Veins 013
1.7 Lymphatic Drainage of the Rectum and Anus 014
1.7.1 The Upper Group 014
1.7.2 The Lower Group 015
1.8 Anal and Rectal Nerves 015
1.8.1 Rectal Nerves 015
1.8.2 Anal Nerves 015
2 Hemorrhoids 017
2.1 Introduction 017
2.1.1 Etiology and Pathology 017
2.1.2 Clinical Classif ication and Staging 025
2.1.3 Diagnosis 033
2.1.4 Treatment 036
2.2 Surgical Illustrations of Hemorrhoids 041
2.2.1 Stripping and Resection of Thrombosed External Hemorrhoids 041
2.2.2 Hemorrhoidectomy of the Connective Tissue Type of External
Hemorrhoids 043
2.2.3 Stripping and Excision of External Hemorrhoids Characteristic
of Varicose Veins 044
2.2.4 Circumferential Ligation of Internal Hemorrhoids at a High
Location 045
2.2.5 Excision of the External Portion and Ligation of the Internal
Portion of Mixed Hemorrhoids (1) 047
2.2.6 Excision of the External Portion and Ligation of the Internal
Portion of Mixed Hemorrhoids (2) 049
2.2.7 Excision of the External Portion and Ligation of the Internal
Portion of Incarcerated Mixed Hemorrhoids 051
2.2.8 Stripping of the External Portion and Ligation of the Internal
Portion of the Incarcerated Mixed Hemorrhoid 052
2.2.9 Mixed Hemorrhoids with Eczema 054
2.2.10 Mixed Hemorrhoids with Hypertrophied Anal Papillae 055
2.2.11 Mixed Hemorrhoids with Anal Papilloma and Fissure 056
2.2.12 Resection (of External Components) and Ligation (of Internal
Components) of Circular Mixed Hemorrhoids 057
2.2.13 Separation, Resection (of the External Component) and Ligation
(of the Internal Component) of Circular Mixed Hemorrhoids (1) 061
2.2.14 Separation, Resection (of the External Component) and Ligation
(of the Internal Component) of Circular Mixed Hemorrhoids (2) 064
2.2.15 Circular Mixed Hemorrhoids (Surgery in Stages) 066
2.2.16 Circular Mixed Hemorrhoids Incarcerated 067
2.2.17 Internal Hemorrhoid Ligation Technique 075
2.2.18 Internal Hemorrhoid Injection Technique 076
3 Anal Fistula 080
3.1 Introduction 080
3.1.1 Etiology and Pathology 080
3.1.2 Clinical Classif ication 082
3.1.3 Diagnosis 085
3.1.4 Treatment 089
3.2 Surgical Illustrations of Anorectal Fistulas 097
3.2.1 Fisturotomy of the Simple Low Anal Fistula 097
3.2.2 Fisturotomy of the Complex Low Anal Fistula 099
3.2.3 Fisturotomy of High Complex Anal Fistula in Conjunction
with an Elastic Rubber Band 103
3.2.4 Counter Drainage Technique in Association with a Posterior
Horseshoe-Shaped Anal Fistula 115
3.2.5 Laying Open Perineal Fistulas and Seton Placement Techniques 117
3.2.6 Fisturotomy of the Perineal Fistula 118
3.2.7 Anal Fistula with Mixed Hemorrhoid 120
3.2.8 Perianal Fistulas in Children 122
3.2.9 Plug Treatment for Anorectal Fistulae 123
3.2.10 Anal Mucinous Adenocarcinoma 124
4 Anal Fissures 130
4.1 Introduction 130
4.1.1 Etiology and Pathology 130
4.1.2 Clinical Classif ication 132
4.1.3 Diagnosis 133
4.1.4 Treatment 136
4.2 Surgical Illustrations of Anal Fissures 138
4.2.1 Integrated Approach of Fissurectomy and Sphincterotomy 138
4.2.2 Probe-Guided Lateral Internal Sphincterotomy 150
5 Anorectal Abscesses 154
5.1 Introduction 154
5.1.1 Etiology and Pathology 154
5.1.2 Clinical Classif ication 156
5.1.3 Diagnosis 157
5.1.4 Treatment 160
5.2 Surgical Illustrations 162
Incision and Drainage of Anorectal Abscess 162
6 Hypertrophied Anal Papillae 166
6.1 Introduction 166
6.1.1 Etiology and Pathology 166
6.1.2 Clinical Manifestations 166
6.1.3 Diagnosis 167
6.1.4 Treatment 167
6.2 Surgical Illustrations 168
Ligation and Excision of Anal Papilloma 168
7 Other Anorectal Diseases 172
7.1 Anal Eczema 172
7.2 Rectal Polyps 173
7.3 Flaccid Rectal Mucosa 174
7.4 Necrotizing Fasciitis 176
8 Routinely Used Surgical Instruments and Drugs in
Anorectal Department 181
8.1 Routinely Used Surgical Instruments 181
8.1.1 General Surgical Instruments 182
8.1.2 Specialty Surgical Instruments 182
8.2 Chinese Medicine for Topical Use 184
8.2.1 Qingdai Powder 184
8.2.2 Jiuyi Pellet 184
8.2.3 Hongyu Paste 184
8.2.4 Shengji Powder 184
8.2.5 Sanhuang Paste 184
Postscript 185
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