Preface

Proctology is the branch of surgery that deals with diseases of the anus and rectum. In my long experience, this subject has always been the last choice. This is true both for teachers and for students. It is taught briefly. It is tested lightly. Many students, and even many young doctors, try to avoid it. This is strange. Diseases of the anorectal region are very common. Almost every general practitioner sees such patients every week. The subject is neglected not because it is unimportant. It is neglected because it makes people feel shy.

This shyness is not only found in students. It is found in patients too. There, it is often worse. A patient may have bleeding, pain, or a swelling near the anus for many months. But he or she will often tell no one. The patient does not tell a friend, a spouse, and sometimes not even a parent. The patient waits and waits. He or she comes to a doctor only when the problem becomes very bad. In my fifty years of practice, I have seen many such patients. Shame stops them from speaking, far more than lack of knowledge does.

This book is written to fight both problems together. It fights the neglect in teaching, and the silence of patients. It is not a history book. It is a working guide. It takes the reader step by step through every anorectal patient. It shows how to take the history. It shows how to examine the patient. It shows how to reach a provisional diagnosis. It shows which investigations to order. Finally, it shows how to decide between conservative treatment and surgery. Every disease chapter follows the same simple pattern: presentation, examination, differential diagnosis, investigations, and management. This way, the reader learns not just facts. The reader also learns a clear method of clinical thinking, one that can be used again and again.

Wherever my own technique is useful in treatment, I have explained it in plain words. This technique is the Modified Open Lateral Internal Sphincterotomy, or MOLIS. I have placed it alongside the standard techniques that every surgeon must know.

My hope for this book is simple. I want students to take proctology seriously, not to skip past it. I want busy surgeons to find quick, dependable answers at the bedside. And I want every reader to remember one thing. When a patient stays silent about this part of the body, it is not because the patient does not care. It is because the patient feels shy. The first duty of a good doctor is to make that silence easier to break, not harder.

— Dr. Om Prakash Bhandari

Chittorgarh, Rajasthan