1. Because proctology is a distinct and challenging subspecialty of surgery.
2. Because it requires humor, seriousness, discretion, kindness, and the ability to remain calm in difficult situations.
3. Because patients with anal problems also deserve accurate diagnosis and effective treatment.

Proctology stands apart as a difficult surgical field. It demands a blend of professional and human traits. Anal disease patients need empathetic and skilled care. The late Ioakeim Thanasoglou from Constantinople, one of the first Greek proctologists, was our mentor and inspiration. Specializing in proctology remains a constant challenge.

Welcome to our scientific website. The “Anal Surgery Clinic” offers high-quality services for the diagnosis and treatment of anal diseases. We are equipped with the most advanced technology for accurate diagnostics, focusing on simple, conservative treatment whenever possible, avoiding unnecessary surgery.

The Importance of Proctology

Historically, proctology was considered the “poor relative” of medicine — dealing with conditions that doctors found trivial and patients found embarrassing. Around 30 years ago, we faced mockery and skepticism when we chose to specialize in this field. But we were determined, because treatment outcomes were often mediocre and patient care inadequate.

Today, awareness of the importance of proctology is growing among the medical community. Anal conditions are common, significantly impact quality of life, and create a financial burden on the healthcare system.

The anal area is vital. Proper defecation is key to physical and psychological well-being. The anal sphincters control gas and stool, and their role is critical. The area is sensitive, densely innervated, and must be handled with care. It is also prone to infection, making balanced, appropriate hygiene essential.

Historical Background

The first recorded treatments for hemorrhoids and fistulas date back to ancient Greece with Hippocrates. Despite skepticism, proctology as a specialty began in 1835. The first official proctologist, Herbert William Allingham, appeared in the U.S. in 1895.

The field advanced in the UK with Frederick Salmon, who founded St. Mark’s Hospital for anorectal disease. In France, key figures like Ernest Parnaud and Jean Arnous shaped the specialty at Léopold Bellan Hospital in Paris.

Their student, Ioakeim Thanasoglou, originally from Cappadocia, was my mentor. I had the privilege of training at both St. Mark’s in London and Léopold Bellan in Paris.

Anal Diseases and Treatments

Proctology deals with very common and disabling conditions: hemorrhoids, fistulas, fissures, incontinence, warts, prolapse, and pruritus. Nearly 1 in 2 adults will experience hemorrhoids by age 50. But not all hemorrhoids need surgery.

At any time:

• 4–5 out of 100 people have hemorrhoids
• 1–2 per 10,000 suffer from anal fistulas
• Fecal incontinence affects ~10% of older adults
• In long-term care facilities, the rate of incontinence is 3 times higher
• HPV-related anal infections occur in:
• 24% of heterosexual men
• 50% of homosexual men

Anal intercourse is associated with increased risk of certain conditions.

Proctology: A Clinical Discipline

Unlike other specialties that rely on lab tests or scans, proctology is deeply clinical, placing the doctor-patient relationship at the center of diagnosis and treatment.

• A detailed history and thorough clinical exam are often enough.
• Ultrasound of the area helps diagnose inflammation and incontinence.
• High-resolution anoscopy is crucial for detecting HPV infection, especially in MSM.
• Patient education is key — about treatments, hygiene, and toilet habits.

Most patients only know the term “hemorrhoids”, so education is essential to explain their real condition and correct any self-diagnosis.

Training and Patience

Proctology requires a wide knowledge base. While most proctologists are trained in general surgery, they must also draw from:

• Psychiatry
• Microbiology
• Gynecology
• Gastroenterology
• Dermatology
• Oncology
• Radiology

It requires:

• Delicacy when discussing sexually transmitted infections
• Flexibility across age groups and lifestyles
• Creativity in complex cases

Proctology is the specialty of patience.

Because the area is prone to infection, healing is slow and requires daily wound care and close follow-up. Yes, there is fear that anal surgery is painful, but this is not always true — thanks to modern tools and minimally invasive techniques. We avoid large incisions, prefer targeted, small procedures, and use new, specialized technologies. Some of these innovations have been short-lived and commercially motivated, offering only temporary benefit.

Real-World Outcomes

When correctly targeted, anal procedures often deliver immediate, dramatic results. Most minor surgeries can be done in-office under local anesthesia, with no hospitalization. On the other hand, complex high fistulas remain one of the most difficult challenges in medicine.

They may require:

• Multiple surgeries
• Long-term follow-up
• Doctor-patient trust and perseverance

Temporary setbacks are normal. They should not discourage either the physician or the patient. A relationship of mutual patience and understanding is essential.

With respect, Apostolos Stamatiadis & Ioannis Gkegkes