1. Nova Medical Centers
ANORECTAL SURGERIES
IN A STAND ALONE DAY
CARE SURGERY CENTER
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
©2009. Nova Medical Centers. Strictly private and confidential

2. 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.
©2009. Nova Medical Centers. Strictly private and confidential
The surgeries done were Stapled Hemmorhoidectomy,
Sphincterectomy Hemorrhoidectomy, Fistulectomy, Pilonidal
abscess, fissurectomy, evaluation under anesthesia and abscesses
drainage.

3. 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
©2009. Nova Medical Centers. Strictly private and confidential
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

4. OVERALL
• 3 had urinary retention
• 100% Patients came on for follow up regularly
• Average time taken for all the surgeries was around 45 mins
©2009. Nova Medical Centers. Strictly private and confidential
• Overall patients feedback was good for the surgeon and for the
center and staff.

5. 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
©2009. Nova Medical Centers. Strictly private and confidential
• 12 patients underwent Fistulectomy
• 23 patients underwent incision and drainage
• 14 patients underwent treatment for Pilonidal sinus

6. 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
©2009. Nova Medical Centers. Strictly private and confidential
– 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

7. 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
©2009. Nova Medical Centers. Strictly private and confidential
• 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

8. 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 .
©2009. Nova Medical Centers. Strictly private and confidential
• Operation was done under GA

9. 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
©2009. Nova Medical Centers. Strictly private and confidential
• 10 patients diagnosis was Ulcerated hemorrhoids

10. 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
©2009. Nova Medical Centers. Strictly private and confidential
review after 3-5 days
• 5 patients stayed for 1

11. ©2009. Nova Medical Centers. Strictly private and confidential
EUA
• 22 patients underwent Evaluation under anesthesia

12. 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
©2009. Nova Medical Centers. Strictly private and confidential

13. FISTULECTOMY
• Operation was done under GA
• Average time for the surgery was 45min hour
©2009. Nova Medical Centers. Strictly private and confidential

14. INCISION AND DRAINAGE
• 5 patients underwent I& D Procedure
• 1 male and 4 females
©2009. Nova Medical Centers. Strictly private and confidential

15. PILONIDAL ABSCESS
• 3 patients underwent I& D Procedure
• 1 male and 2 females
• 11 underwent elective surgery
©2009. Nova Medical Centers. Strictly private and confidential

16. 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.
©2009. Nova Medical Centers. Strictly private and confidential
– 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

17. ©2009. Nova Medical Centers. Strictly private and confidential
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