The author was driven to write this book for several reasons. It is his belief, based on personal experience, that the subject matter, a common phenomenon, is largely ignored at worst or badly taught at best with predictably bad or uncertain outcomes. While this book is aimed mainly at General Surgeons who do not regularly treat or operate on these cases it may also be of interest to others such as colorectal surgeons, trainee surgeons or even medical students. It re¬flects my personal experience on three continents with several thousand such patients, over more than fifty years of surgical practice. Hopefully its message will help to fill existing gaps and many patients will bene t. Graduated MB BCh (equivalent MD) University of Witwatersrand Johannesburg S Africa 1950. I subsequently held various junior training positions in Johannesburg and UK, Scotland FRCS (Royal College of Surgeons UK) 1956 by examination. FACS (American College of Surgeons ) Fellow by recognition 1979. Postgraduate practical training in General and colorectal surgery in varied hospitals, UK 7 years 1950’s and early 1960’s. Postgraduate surgical training South Africa 1957 – 1962 Practicing and consultant surgeon to Mines Bene¬ t Society Johannesburg 1973- July 1980. Emigrated to USA 1980. Private surgical practice Johannesburg S Africa 1962 - 1980. Sta Coronation Hospital , University of W W Rand 1970’s Private surgical practice Pasadena Texas, at Bayshore Medical Center 1980- 2000 and Texas Medical Center as associate Clinical Associate Professor Department of Surgery 1980- 2008. Teaching and lecturer to medical students in colorectal surgery 1985- 2000. Teacher in Anatomy University of WW Rand 1951, 1962-1980. 27 published Scientific publications in international Surgical journals including British Journal Surgery, SGO (later American Journal Surgery) S African Journal Surgery.