15 years experience in proctological day-surgery

Abstract

INTRODUCTION: The actual high hospitalization costs have encouraged a growing attention towards reducing hospital stay.

Nowadays, many simple surgical procedures are carried out in a one-day surgery regimen . A shorter hospital stay brings many advantages for the patients: lesser inconvenience, a lower risk of hospital infection and an earlier return to work.

In proctology, day surgery polices are still uncommon because surgeons fear possible complications. In this paper we sum up our 15 years experience, stressing the possibility to perform even complex procedures in local-regional anesthesia and in a day-surgery context.

MATERIALS AND METHODS: In our experience, to be candidate to one-day surgery proctological procdures, patients should be classed as ASA I or II.

RESULTS: Between 2005 and 2015 our operative unit executed a total of 2688 proctological procedures in a one-day surgery. 1062 procedures have been completed under local anesthesia exclusively and all patients have been discharged between two and three hours after the procedure without significant complications. In the other 1626 patients perineal posterior block was performed in 932 cases (57.3%) and provided an optimal pain control in 51,6% of cases (301 patients) while in 5,7% of cases there was the need for an intravenous administration of Fentanil.

DISCUSSION AND CONCLUSION: Day-surgery is nowadays a concrete reality, made possible by an attentive selection of patients, an accurate surgical technique, an attentive patient monitoring in the postoperative period and a continuous monitoring of the effectiveness of pain medications. Over the last decades our surgical team has developed modified techniques of loco-regional anesthesia that allow us to perform even complex procedures and discharge the patient within 24 hours