ANORECTAL SURGERIES

IN A STAND ALONE DAY

CARE SURGERY CENTER

Nova Medical Centers

©2009. Nova Medical Centers. Strictly private and confidential

Dr. Nanda Rajaneesh

MBBS, MS ( Surgery), MRCS, AFCRSI (Colorectal) FICS,

FAMS (Laparoscopy) Palative care

Fellowship in Surgical Oncology( Tata Memorial Mumbai)

Consultant Surgeon- Nova Medical Centers, Bangalore

Vice President-Medical Services-Nova Medical Centers

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OVERALL

The aim of this study is to reflect the comfort level and the clinical outcomes of operating anorectal surgeries in stand alone day care center in Bangalore. A prospective study was done from August 2009 to August 2011 in Nova Medical Centers. Total of 110surgeries were done in the Koramangala centers by a single surgeon. The surgeries done were Stapled Hemmorhoidectomy, Sphincterectomy Hemorrhoidectomy, Fistulectomy, Pilonidal abscess, fissurectomy, evaluation under anesthesia and abscesses drainage.

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OVERALL

Most of the patients payed by self and remainder through the Insurance • Out of 110 patients, 42 were males and 58 were females • 101 patient GA Anesthesia was used Patients and LA was used

for 9 Patients

• Out of 110patient 103 Patients were discharged the very same day and 7patients stayed for 1 day in the center due to Insurance and Urinary retention

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OVERALL

• 3 had urinary retention

• 100% Patients came on for follow up regularly

• Average time taken for all the surgeries was around 45 mins

• Overall patients feedback was good for the surgeon and for the center and staff.

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PATIENT DEMOGRAPHICS

• All the patients were in the age group of 30-65 yrs with the mean age being 45 years

• Anorectal surgery was done in patients from Aug09 to Aug 11

• 49 patients underwent stapled hemorrhoidectomy

• 22 patients underwent Evaluation under anesthesia

• 12 patients underwent Fistulectomy

• 23 patients underwent incision and drainage

• 14 patients underwent treatment for Pilonidal sinus

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STAPLED HEMORRHOIDECTOMY

• 49 patients had stapled hemorrhoidectomy procedure.

• 25 male and 24 females • Bleeding and mass/ swelling per rectum

– 28 patients had bleeding and c/o mass PR for 5-6 months. On examination, mass was felt

• Bleeding as the only complaint – 26 patients – Out of these 1 patient had constipation for a year and in one patient banding

had already been done

• Pain and Bleeding and swelling PR

– 22 patient had all three symptoms and on examination mass was felt PR

• Perianal fistula

– 1 patient had perianal disease and had developed anorectal fistula

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STAPLED HEMORRHOIDECTOMY

• 3 patient was Hypertensive on Rx • 1 patient was operated twice for fissure in ano • 7patient had internoexterno hemorrhoids with prolapsed

thrombus

• INVESTIGATIONS

• The patients were examined in the OPD and on examination were asked to undergo Stapled Hemorrhoidectomy

• They were told to undergo Blood test HBs Ag, Urea Creatinine, ESR ,RBS, HIV I & II chest xray before the surgery

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STAPLED HEMORRHOIDECTOMY

• All patients came for surgery with all thepre-op investigations done

• No other complaints / abnormal investigation was present

• Patients were taken in for surgery

• Surgery usually lasted for 15 to 25 mins .

• Operation was done under GA

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STAPLED HEMORRHOIDECTOMY

• EXAMINATION FINDINGS UNDER GA

• 28patients diagnosis was Grade III Hemorrhoids

– 1 patient has acute and 1 patient had chronic fissure in ano with Grade III Hemorrhoids

– 1 patient had anal stenosis with Grade III Hemorrhoids

• 11 patients daignosis was Grade IV Hemorrhoids • 10 patients diagnosis was Ulcerated hemorrhoids

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STAPLED HEMORRHOIDECTOMY

• Post operatively patients were shifted to the Post operative area and some of the patients experienced mild pain for which a pain killer was advised

• After few hours patients vitals were stable and patients began to void urine and slowly liquid items were given to patients to eat and they tolerated well

• 43 patients were discharged the very same day and were told to review after 3-5 days

• 5 patients stayed for 1

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EUA

• 22 patients underwent Evaluation under anesthesia

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FISTULECTOMY

• 12 patients underwent fistulectomy

• Out of these 5 male and 7 female

• All underwent MRI or Endorectal ultrasound

• Colonoscopy above 50 years or suspition

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FISTULECTOMY

• Operation was done under GA

• Average time for the surgery was 45min hour

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INCISION AND DRAINAGE

• 5 patients underwent I& D Procedure

• 1 male and 4 females

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PILONIDAL ABSCESS

• 3 patients underwent I& D Procedure

• 1 male and 2 females

• 11 underwent elective surgery

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CONCLUSION

• These results seem to confirm the feasibility of proctological day surgery in almost all patients, with both a considerably cost reduction and enhanced patient comfort and compliance.

• Advantages of doing Colorectal surgery in a day care setting:

– is that patient can start mobilising early with lesser cost incurred to the

patient.

– There are less hospital acquired infections which occur to the patients

– With minimal disruption of personal life and reduced time of disruption from work , patient is very comfortable in this environment.

– In Nova , which is a day care surgery center, recovery time for patients is quicker than in a major hospital setting.

– Patient can return home the very same day after surgery

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THANK YOU