Race Is Associated With Burden of Anal Condyloma and Need for Operative Intervention.

BACKGROUND: Human papillomavirus is a common sexually transmitted infection that may affect the oropharynx, genitalia, or anus. Some strains of this virus may cause bulky growths around the anus known as giant anal condylomas. These can become large, disfiguring, and may cause bleeding, as well as difficulty with defecation and hygiene. Surgical management is usually necessary for large condylomas, whereas office-based procedures are common for smaller lesions. It is unclear why some develop large anal margin tumors, whereas others develop limited disease. The aim of the present study was to evaluate for risk factors that may play a role in the development of extensive disease warranting operative management. MATERIALS AND METHODS: A retrospective chart review of patients seen within the Anal Dysplasia Clinic at the Medical College of Wisconsin was undertaken. Clinic encounters for patients with anogenital condyloma were abstracted for demographic information, operative interventions, Human Immunodeficiency Virus status, and smoking history to determine risk factors that predicted operative intervention for giant anal condylomas. RESULTS: A total of 239 patients met inclusion criteria; 211 (88.3%) were male and 28 (11.7%) were female. Racial makeup of the cohort included 49% Caucasian, 38.9% African-American, 9.2% Hispanic, and 2.9% were identified as another ethnicity. One hundred forty-three patients (60.1%) were current or past smokers. One hundred ninety-eight (82.8%) patients tested positive for human immunodeficiency virus (HIV), whereas 41 (17.2%) were negative. Multiple linear regression identified only African-American race as predictive of greater disease burden. CONCLUSIONS: African-American race was associated with increased size of anal condyloma. As the size of anal condylomas increase, management shifts from topical treatments to operative intervention. This is the first study to correlate race with burden of disease in the general population.

Routine operative swab cultures and post-operative antibiotic use for uncomplicated perianal abscesses are unnecessary.

BACKGROUND: Routine swab cultures for perianal abscesses remain commonplace in surgical practice. However, patients are often discharged post-operatively prior to the culture results being made available. Consequently, intra-operative swab cultures rarely impact subsequent management and outcomes. Similarly, the use of broad-spectrum antibiotics for perianal abscesses post-drainage also remains prevalent, albeit with questionable benefit. METHODS: The records of all patients diagnosed with perianal abscess from January 2011 to December 2011 were reviewed. Patients with complicated perianal abscesses or recurrent abscesses previously treated before the study period were excluded. The demographics, medical co-morbidities, intra-operative findings, swab cultures, microbiological results and use of post-operative antibiotics were reviewed. Subsequent wound healing and follow-up were also recorded. RESULTS: Two hundred and seven patients were admitted to our institution for perianal abscesses in 2011. After excluding 35, the remaining 172 patients were analysed. One hundred and thirty-four patients (78%) had swab cultures performed intra-operatively but 80% of these were discharged prior to the culture results being available. One hundred and eight (63%) were discharged with outpatient antibiotics. During the index admission and subsequent follow-up, swab culture results were not documented to be reviewed by the attending physician 96.5% of the time. Sixteen patients required repeat surgery for recurrence of anorectal sepsis. We found that the use of antibiotics after the index surgery did not confer a statistically significant benefit. CONCLUSION: Routine swab cultures are unnecessary and do not affect management and outcome. The use of post-operative antibiotics may reduce the rates of recurrence, but this benefit was not found to be statistically significant.

Bacteriological study in perianal abscess is not useful and not cost-effective.

BACKGROUND: The detection of gut organisms in perianal abscesses has been postulated to suggest an underlying communication with the anal canal. However, recent studies appear to contradict this observation. The aim of this study is to determine the value of bacteriological studies in perianal abscesses. METHODS: A retrospective study of all patients who have had a surgical drainage of their perianal abscesses with concomitant microbiological examination from January 2010 to December 2012 was performed. Patients with known underlying anal fistula, Crohn's disease or previous perianal operations were excluded. RESULTS: A total of 164 patients, median age of 42.0 years (range 8-87) comprising of 78.7% males formed the study group. Gut organisms were cultured in 143 (87.2%) samples while 12 (7.3%) demonstrated skin organisms and nine did not yield any bacterial growth (5.5%). Twenty-nine (17.7%) patients developed anal fistula and 34 (20.7%) patients had a recurrence of the perianal abscess. The median follow-up period was 1450 (14-2391) days. There was no significant association between the presence of gut organism and development of fistulas (odds ratio = 0.48; 95% confidence interval = 0.17-1.37) or recurrence of perianal abscess (odds ratio = 1.66; 95% confidence interval = 0.46-6.01). CONCLUSION: Bacteriological culture in perianal abscess is not useful for predicting the development of anal fistula or abscess recurrence. Hence, there is no need to perform this investigation on a routine basis.

The impact of perianal disease in young patients with inflammatory bowel disease.

BACKGROUND: Perianal disease is a potentially significant source of morbidity for patients with inflammatory bowel disease (IBD). We sought to identify the impact of perianal disease on IBD outcomes in children, adolescents, and young adults. METHODS: We studied 12,465 inpatient admissions for patients ≤20 years old with IBD in 2009 using the Kids' Inpatient Database (KID). Patients were stratified by their principal diagnosis of ulcerative colitis (UC) or Crohn's disease (CD). Perianal disease (perianal abscess, anal fissure, or anal fistula), complex fistulas (rectourethral, rectovaginal, or enterovesical), and growth failure were defined by ICD-9 codes. Logistic regression was performed adjusting for CD or UC, gender, age, need for surgical intervention, fistulas, or growth failure. RESULTS: Of the 511 (4.1%) patients with perianal disease, 480 had CD (94%, p < 0.001). Girls were less likely to suffer perianal disease (OR = 0.63, CI 0.52-0.76, p < 0.001). Those with perianal disease were more likely to suffer complex fistulas (OR = 3.5, CI 1.98-6.20, p < 0.001) but less likely to suffer enteroenteral fistulas (OR = 0.30, CI 0.15-0.63, p = 0.001) than those without perianal disease. Perianal disease did not increase the incidence of growth failure (p = 0.997) but doubled the likelihood of an operation of any type during admission (p < 0.001). Additionally, patients with perianal disease spent on average 1.29 more days in the hospital (7.45 vs. 6.16 days, p < 0.001) and accrued $5838 extra in hospital charges (p = 0.005). CONCLUSIONS: Perianal disease in younger patients is associated with a longer length of stay, higher hospital charges, and increased rates of both perineal and abdominal operative procedures. These data support the notion that, similar to adults, the presence of perianal disease in pediatric Crohn's patients is associated with a more severe course.

Role of tridimensional endoanal ultrasound (3D-EAUS) in the preoperative assessment of perianal sepsis.

PURPOSE: The aim of this study was to evaluate the accuracy of tridimensional endoanal ultrasound (3D-EAUS) in the diagnosis of perianal sepsis comparing the results with the surgical findings, considered as reference standard. METHODS: From January 2009 to January 2013, all the patients referred for the assessment and treatment of perianal sepsis with suspected anorectal origin were enrolled in the study. All patients gave informed written consent. Prior to surgery, all the patients underwent anamnestic evaluation, clinical examination, and unenhanced and H2O2-enhanced 3D-EAUS. Surgery was performed by a colorectal surgeon blinded to the 3D-EAUS results. RESULTS: A total of 212 patients with suspected perianal suppurations were assessed during the study period. In 12 patients, the H2O2-enhanced 3D-EAUS was not performed, and so, they were excluded from the study. Very good agreement between 3D-EAUS and examination under anesthesia (EUA) in the classification of primary fistula tracts (kappa = 0.93) and in the identification of fistula internal opening (kappa = 0.97) was found. There was a good concordance (kappa = 0.71) between 3D-EAUS and surgery in the detection of fistula secondary extensions. The overall sensitivity and specificity of 3D-EAUS in the diagnosis of perianal sepsis were 98.3 and 91.3% respectively. CONCLUSION: 3D-EAUS is a safe and reliable technique in the assessment of perianal sepsis. It may assist the surgeon in delineating the fistula tract anatomy and in determining the origin of sepsis, supporting the preoperative planning of definitive and appropriate surgical therapy.

Surgical excision of extensive anal condylomata is a safe operation without risk of anal stenosis.

INTRODUCTION: Anal condylomata acuminata was a well-known disease in ancient times but in recent years there has been a rapidly increasing number of people who suffer from this disease. The main cause of this disease is infection of human papilloma virus (HPV) which occurs through sexual contact. Currently there are three different ways to treat anal condylomata. Small changes of anal condylomata can be treated with local therapeutic agents, but the best results of treatment of extensive changes are obtained by surgical techniques. MATERIAL/METHODS: The study group consisted of 30 patients with diagnosed extensive anal condylomata who underwent surgery in Mikolaj Pirogow High Specialized Hospital in Lodz. The survey was conducted from 2007 to 2011. Patients had been directed to the surgical ward by general surgeons and practitioners, proctologists and urologists. The diagnosis was made after proctological assessment in the knee-chest position. RESULTS: All patients underwent surgery and had complete macroscopic electroexcision of anal condylomata. In the research group there was no mortality. Postoperative complications occurred in 4 (13.3%) patients--postoperative bleeding. Strong pain was present in 14 (46.7%) patients but only in the postoperative period. During postoperative follow-up there was no observed infection in the anal region or recurrence of disease. In the operated group there were no observed cosmetic deformations of the anus and/or the anal canal, narrow anal canal or functional fecal incontinence symptoms. CONCLUSIONS: Surgical treatment of anal condylomata is an effective and safe method for the patient. In our research there were no serious postoperative complications or recurrence of the disease during the follow-up period.

É o exame anatomopatológico de rotina indispensável em cirurgias orificiais / Is the histopathologic examination essential in orificial sugeries

Introdução: O exame anatomopatológico é feito rotineiramente em cirurgias orificiais e é importante para diagnosticar doenças anais concomitantes, lesões malignas e doenças sexualmente transmissíveis não previstas anteriormente no exame clínico. O gasto com estes exames é bastante significativo para o serviço público o que evidencia a necessidade de avaliar o custo/benefício da sua utilização rotineira. Objetivos: Avaliar o tempo decorrido entre a entrega do material e a emissão do laudo, o nível de concordância entre a impressão diagnóstica e a conclusão do anatomopatológico, a importância clínica das patologias diagnosticadas secundariamente, o custo de realização dos exames e a relação custo/benefício dos mesmos. Metodologia: Estudo descritivo e retrospectivo de 173 exames anatomopatológicos de pacientes do Hospital Universitário de Aracaju realizados de 2005 a 2007, que foram submetidos à cirurgias orificiais. Resultados: O nível de concordância entre a impressão diagnóstica e a conclusão do anatomopatológico foi elevada e, dos laudos discordantes, poucos apresentaram relevância clínica, havendo somente um caso de neoplasia anorretal. Houve um atraso significativo na emissão dos laudos, sugerindo sobrecarga do serviço e o custo/benefício para realização dos exames foi desfavorável. Conclusão: Sugerimos triagem para um uso racional e criterioso do exame anatomopatológico em cirurgias orificiais baseada na história clínica e fatores de risco do paciente.

Introduction: The histopathologic examination is repeatedly done in orificial surgeries and it's important to diagnose anal diseases associated, malign lesions and sexually transmitted diseases that weren't previously predicted on the clinic examination. The cost of the histopathologic examinations is very significant to the public health service, which shows the need to do a cost-benefit analysis of their routine use. Objectives: Evaluate the time between the surgical specimen's delivery and the emission of the histopathologic examination's report, the concordance level between the clinic impression and the histopathologic examination's report, the clinical relevance of the diseases secondarily diagnosed, the cost of the histopathologic examinations and the cost-benefit analysis of them. Methods: Descriptive and retrospective study of 173 histopathologic examinations from patients of the Hospital Universitário de Aracaju made from 2005 to 2007, that were submitted to orificial surgeries. Results: High concordance level between the clinic impression and the histopathologic examination's report; from the discordants reports, a few had clinical relevance and was only one case of anal cancer. There was a significant delay on the reports' emission, which suggests that the pathology service is overloaded; and the cost-benefit analysis was unfavorable. Conclusions: We suggest screening to a rational and judicious use of the histopathologic examination in orificial surgeries based on the patient's clinical history and risk factors.

Persistent perineal sinus: incidence, pathogenesis, risk factors, and management.

This review discusses the incidence, pathogenesis, risk factors, diagnosis, and therapeutic options for persistent perineal sinus (PPS), defined as a perineal wound that remains unhealed more than 6 months after surgery. The incidence of PPS after surgery for inflammatory bowel disease (IBD) ranges from 3% to 70% and after abdominoperineal resection (APR) for low rectal cancer, it can be up to 30%. These unhealed wounds are frequently related to perioperative pelvic or perineal sepsis. Crohn's disease (CD) and neoadjuvant radiation therapy are also important risk factors. The management of PPS is based on an understanding of pathogenesis and clinical grounds. The advantages and disadvantages of the current therapeutic approaches, including the topical administration of various drugs, vacuum-assisted closure, and perineal reconstruction with a muscle flap or a myocutaneous flap are also discussed.

The role of surgery in the management of canine anal furunculosis. A review of the literature and a retrospective evaluation of treatment by surgical resection in 51 dogs.

AIMS: To retrospectively evaluate the outcome of surgical management of anal furunculosis (AF) in 51 dogs. To compare the outcome of surgery with those of current medical protocols by way of a review of the literature. METHODS: Dogs referred for treatment of AF (n=51) were treated by en bloc surgical resection of diseased tissue and primary wound closure. This technique was combined with bilateral anal sacculectomy in all cases in which the anal sacs had not been previously removed. Immunomodulatory therapies were not used, with the exception of post-operative metronidazole antibiosis for 7-10 days. Follow-up was performed by the author using a telephone questionnaire. RESULTS: Forty-eight dogs were eligible for post-operative follow-up 1.5 to 36 (mean 17.4, median 18) months after surgery. Lesion recurrence, faecal incontinence and stricture formation occurred in 2%, 4% and 13% of dogs, respectively. The percentage of dogs considered by their owners to have an acceptable level of faecal continence and an improved quality of life was 94%. CONCLUSIONS AND CLINICAL RELEVANCE: The aetiopathogenesis of canine AF remains unclear. Whilst recent advances in medical management by the use of various immunomodulatory medications (such as cyclosporine) hold promise, this approach has yet to be refined with respect to affordability, long-term efficacy and morbidity. With meticulous surgical dissection and reconstruction techniques (anoplasty), excellent success rates can be achieved following a single surgical procedure with minimal complications. Surgery remains a viable treatment option, alone or in combination with immunomodulatory medications, until a more thorough understanding of this debilitating disease is achieved.

Surgical treatment of anal stenosis: assessment of 77 anoplasties.

PURPOSE: Anal stenosis is a rare, incapacitating, and challenging condition, occurring mainly after hemorrhoidectomy, for which several surgical techniques have been devised. The purpose of this study was to describe early and late (1 year) results of 77 anoplasty operations performed in the Colorectal Unit of our institution. METHODS: From 1977 to 2002, 77 patients with moderate to severe anal stenosis underwent surgery using two sliding graft techniques: 58 underwent Sarner's operation and 19 underwent Musiari's technique. Bilateral flaps were used in 7 patients. RESULTS: Early morbidity was due to pruritus occurring in 2 patients, urinary infection in 1, and temporary incontinence in 1 patient. One patient needed early reoperation following suture line dehiscence. Late results (1 year) were classified as good in 67 cases (87%). There was no reoperation due to recurrence of stenosis. CONCLUSION: The ease of performance, good functional results, and lack of severe complications show that Sarner's and Musiari's flap advancement techniques are effective and safe methods for surgical correction of anal stenosis, particularly when cutaneous fibrosis plays a major role in its etiology.

Surgical treatment of anal stenosis: assessment of 77 anoplasties

OBJETIVO: A estenose anal é uma condição rara, incapacitante e desafiadora que ocorre principalmente após hemorroidectomia, para a qual diversas técnicas cirúrgicas reparadoras foram desenvolvidas. O objetivo deste estudo é descrever os resultados precoces e tardios (um ano) de 77 anoplastias realizadas no Serviço de Cirurgia Colorretal. MÉTODOS: No período de 1977 a 2002, 77 pacientes com estenose anal moderada ou grave foram operados, utilizando-se duas técnicas diferentes de avanço de retalho: 58 foram submetidos à técnica de Sarner e 18 submetidos à Técnica de Musiari. Avanços bilaterais foram utilizados em sete pacientes. RESULTADOS: As complicações precoces foram: prurido em dois pacientes, infecção urinária em um paciente e incontinência fecal temporária em outro. Um paciente necessitou reoperação precoce por deiscência de linha de sutura. Os resultados tardios foram classificados como bons em 67 (87%). Não houve reoperação por recorrência de estenose. CONCLUSÃO: A facilidade técnica, os bons resultados funcionais e a ausência de complicações graves demonstraram que as técnicas de avanço de retalho de Sarner e Musiari são efetivas e seguras para correção de estenose anal, particularmente nos casos em que a fibrose cutânea é o principal fator etiológico.

Anesthesia for ambulatory anorectal surgery.

The prevalence of minor anorectal diseases is 4-5% of adult Western population. Operations are performed on ambulatory or 24-hour stay basis. Requirements for ambulatory anesthesia are: rapid onset and recovery, ability to provide quick adjustments during maintenance, lack of intraoperative and postoperative side effects, and cost-effectiveness. Anorectal surgery requires deep levels of anesthesia. The aim is achieved with 1) regional blocks alone or in combination with monitored anesthesia care or 2) deep general anesthesia, usually with muscle relaxants and tracheal intubation. Modern general anesthetics provide smooth, quickly adjustable anesthesia and are a good choice for ambulatory surgery. Popular regional methods are: spinal anesthesia, caudal blockade, posterior perineal blockade and local anesthesia. The trend in regional anesthesia is lowering the dose of local anesthetic, providing selective segmental block. Adjuvants potentiating analgesia are recommended. Postoperative period may be complicated by: 1) severe pain, 2) urinary retention due to common nerve supply, and 3) surgical bleeding. Complications may lead to hospital admission. In conclusion, novel general anesthetics are recommended for ambulatory anorectal surgery. Further studies to determine an optimal dose and method are needed in the group of regional anesthesia.

Endoanal sonography in the assessment of perianal endometriosis with external anal sphincter involvement.

Endoanal sonography can be used in the assessment of benign and malignant anal conditions and to evaluate the anatomy of the anal sphincters. We used endoanal sonography with a 10-MHz rotating endocavitary probe to evaluate a 45-year-old woman with a perianal mass, fecal incontinence, and menses-associated perianal pain. She had had 2 vaginal deliveries requiring episiotomies. Biopsy of the mass showed endometrial tissue. The ultrasound examination showed a perianal mass and an external anal sphincter injury. A wide excision and sphincteroplasty were performed, with improvement of fecal continence and pain. Histopathologic examination of the mass confirmed perianal endometrioma in an episiotomy scar.

Giant condyloma acuminatum of the anorectum: trends in epidemiology and management: report of a case and review of the literature.

PURPOSE: Giant condyloma acuminatum (Buschke-Loewenstein tumor) of the anorectum is a rare disease with a potentially fatal course. Controversy exists as to the epidemiology, pathologic nature, and management of the tumor. METHODS: We present a 42-year-old male with a 12-cm x 10-cm exophytic mass of the anal verge. Treatment included wide local excision and partial closure with rotation flaps. Pathology revealed a giant condyloma acuminatum with foci of well-differentiated squamous-cell carcinoma. We identified 51 reported cases of giant condyloma acuminatum in the English literature, and to our knowledge this is the largest review to date. RESULTS: Giant condyloma acuminatum presents with a 2.7:1 male-to-female ratio. For patients younger than 50 years of age, this ratio is increased to 3.5:1. The mean age at presentation is 43.9 years, 42.9 in males and 46.6 in females (P = 0.44). There seems to be a recent trend toward a younger presentation. The most common presenting symptoms are perianal mass (47 percent), pain (32 percent), abscess or fistula (32 percent), and bleeding (18 percent). Giant condyloma acuminatum has been linked to human papilloma virus and has distinct histologic features. Foci of invasive carcinoma are noted in 50 percent of the reports, "carcinoma in situ" in 8 percent, and no invasion in 42 percent. Historically, treatment strategies have included topical chemotherapy, wide local excision, abdominopelvic resection, and the frequent addition of adjuvant and neoadjuvant systemic chemotherapy and radiation therapy. Recurrence is common. CONCLUSION: There seems to be a trend toward younger age at presentation and male predominance of giant condyloma acuminatum of the anorectum. Foci of invasive cancer within giant condyloma specimens are of uncertain significance and do not seem to correlate with recurrence or prognosis. Local invasion and local recurrence are the major source of morbidity in this disease. Complete excision is the preferred initial therapy when feasible. Wide local excision, fecal diversion, or abdominoperineal resection have been used. Chemotherapy with 5-fluorouracil and focused radiation therapy may be used in certain cases of recurrence or extensive pelvic disease, with unpredictable response. Controlled, prospective, multi-institutional studies are necessary to further define the nature and treatment of this rare disease.

Cirugía ambulatoria con anestesia local en afecciones anorrectales / Local anesthesia in the surgical treatment of anorectal diseases

Antecedentes: El tratamiento quirúrgico de las afecciones anorrectales puede ser realizado mediante diversos tipos de anestesia. Sin embargo la selección de la misma puede incidir en el tiempo de internación, riesgo y costos. Objetivo: Evaluar los resultados del tratamiento quirúrgico de afecciones anorrectales por medio de anestesia local. Material y método: Análisis de 61 intervenciones sucesivas realizadas con anestesia local y bloqueos o general. Resultados: Las complicaciones analizadas en los 2 grupos fue similar (3 y 4 pacientes, p=0,23). El tiempo de estadía promedio en el quirófano fue 52,5 minutos para la local y de 74,7 para el resto. El tiempo promedio de estadía en la sala fue para la anestesia local de 0,34 horas, en tanto para el resto fue de 14,6 horas. El costo en pesos excluídos los honorarios fue: Anestesia local, $7,966; anestesia por bloqueo, $280,80 y anestesia general, $304,696. El grado de satisfacción para la anestesia local fue de 87,8 por ciento. Conclusiones: La anestesia local bien utilizada, da un alto grado de satisfacción en el enfermo (87,8 por ciento). Las complicaciones referidas a la técnica no se relacionan con la anestesia, pudiendo ser intervenidos aquellos con contraindicación para las otras. El tiempo de quirófano, la estadía hospitalaria y los costos son considerablemente menores con anestesia local.

Orifice diseases project: experience of the Hospital das Clinicas University of Sao Paulo Medical Center in day-hospital of anorectal disease

O tratamento das patologias colorretais malignas ou benignas, que necessitam de tratamento com maior grau de complexidade sao prioritarias em hospitais terciarios, como e o Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), permanecendo assim as patologias orificiais benignas em um segundo plano. Todavia em seu carater assistencial, o numero de pacientes que procuram o HCFMUSP por doenca hemorroidaria, fistulas perianais, fissuras, condilomas e cistos piloniais e muito grande, resultando na hipertrofia dos ambulatorios e lentidao para o tratamento cirurgico preconizado (as vezes um ano e meio)...

Outcomes of anorectal disease in a health maintenance organization setting. The need for colorectal surgeons.

PURPOSE: The current trend in health delivery is managed care, in which the primary care provider (PCP) manages patient care and triages specialty referrals. It has not been established, however, that PCPs can accurately diagnose, treat, or triage anorectal disorders. MATERIALS AND METHODS: A retrospective study was undertaken at a health maintenance organization that hired a colon and rectal surgeon. Charts of the first 100 consecutive consultations for anorectal complaints were analyzed for accuracy of diagnosis and appropriateness of care. RESULTS: Correct diagnoses were made by 45 of 85 (53 percent) PCP physicians, 6 of 15 (40 percent) PCP physician assistants, and 8 of 15 (53 percent) general surgeons. A delay to diagnosis or appropriate treatment occurred in 25 patients (25 percent), resulting in an adverse outcome in 15 people. Of these, five complications were caused by delayed diagnosis, and ten patients had symptoms that persisted from 5 months to 14 years (mean, 4.5 years). Seven unnecessary referrals to a gastroenterologist resulted in three unnecessary colonoscopies. Of 19 patients evaluated by a general surgeon, 4 had inadequate/inappropriate operations, 5 were untreated because of misdiagnosis, 3 correctly diagnosed were untreated, 3 had inappropriate follow-up, 1 was referred to a gastroenterologist, and 2 were advised to have appropriate treatment. SUMMARY: The PCP correctly diagnosed anorectal disorders in 51 percent of cases and referred patients promptly 75 percent of the time. Of the 25 percent with delay, 60 percent experienced a complication of persistent symptoms. Fifteen of 19 (79 percent) patients seen by a general surgeon were inappropriately managed.

[Ambulatory anal surgery: a feasibility study]. / Chirurgie anale ambulatoire: étude de faisabilité.

Because of the current economic situation, ambulatory surgery has become a "modus vivendi" for the surgeon. The aim of this study is to examine the feasibility of anal ambulatory surgery and the results obtained over a period of 12 months. 141 consecutive patients underwent anal surgery: 108 on an ambulatory basis (77%) and 33 were admitted to the hospital (23%). The reasons for admitting the patients were the complexity of the operation in 19 (8 sphincteroplasty, 5 complex fistulae, 3 recto-vaginal fistulae...) emergency procedures in 9 and miscellaneous reasons in 5 patients. All 108 patients operated on an ambulatory basis could be discharged at the end of the day but two, one for urinary retention and another because he underwent a more extensive procedure than first planned. Three more had urinary retention; they were catheterized and discharged on the same day. The four patients (3 women and 1 man) developed urinary retention following spinal anesthesia. Three patients (2.7%) had to come back to the emergency room in the first 24 hours for bleeding from the operative site. One of them had to be transfused and reoperated for hemostasis. In conclusion, ambulatory anal surgery is feasible in a large proportion of cases (77%) with a low rate of complications (7.4%) and low rate of unexpected hospital admission (2.7%). In a specialized colorectal unit, 23% of patients required hospitalization for a longer stay.