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Positioning the Patient for Anorectal Surgical Procedures

  • Richard E. Karulf
  • Stanley M. Goldberg
  • H. Randolph Bailey
  • Martin A. Luchtefeld

Abstract

Surgeons pride themselves on their ability to adapt to unforeseen circumstances. New situations are stimulating and prompt the surgeon to stop and to focus on basic principles. However, common procedures, which lack the luster of new and challenging cases, may become routinized because of the tyranny of a busy practice. The choice of the position of a patient during anorectal surgery is an example of a detail that may become a matter of habit rather than a conscious decision. This subchapter focuses on the prone jack-knife position, the rightful gold standard for anorectal surgery. It describes the appropriate use of this position during anorectal surgery and factors that would prompt the surgeon to use an alternative position.

Keywords

Prone Position Lithotomy Position Sciatic Nerve Injury Left Lateral Decubitus Position Anorectal Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Positioning the Patient for Anorectal Surgical Procedures

References

  1. 1.
    Nivatvongs S, Fang DT, Kennedy HL. The shape of the buttocks: a useful guide for selection of anesthesia and patient position in anorectal surgery. Dis Colon Rectum 1983;26:85–86.PubMedCrossRefGoogle Scholar
  2. 2.
    Hatada T, Kusunoki M, Sakiyama T, et al. Hemodynamics in the prone jackknife position during surgery. Am J Surg 1991;162:55–58.PubMedCrossRefGoogle Scholar
  3. 3.
    Khubchandani IT, Clancy JP, Rosen Let al. Endorectal repair of rectocele revisited. Br J Surg 1997;84:89–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Block IR, Rodriguez S, Olivares AL. The Warren operation for anal incontinence caused by disruption of the anterior segment of the anal sphincter, perineal body and rectovaginal septum: report of five cases. Dis Colon Rectum 1975;18: 28–34.PubMedCrossRefGoogle Scholar
  5. 5.
    Reissman P, Weiss E, Teoh T, et al. Laparoscopicassisted perineal rectosigmoidectomy for rectal prolapse. Surgical Laparoscopy & Endoscopy 1995;5:217–218.Google Scholar
  6. 6.
    Pang AS, Chung MR, Lee KK, Schraut WH. An analysis of 50 cases of restorative proctocolectomy. Ann Acad Med Singapore 1994;23:76–82.PubMedGoogle Scholar
  7. 7.
    Horai T, Kusunoki M, Shoji Y, et al. Clinicopathological study of anorectal mucosa in total colectomy with mucosal proctectomy and ileal anastomosis. Eur J Surg 1994;160:233–8.PubMedGoogle Scholar
  8. 8.
    Smith LE. Ambulatory surgery for anorectal diseases: an update. South Med J 1986;79:163–136.PubMedCrossRefGoogle Scholar
  9. 9.
    Maroof M, Khan RM, Siddique M, Tariq M. Hypo-bark spinal anesthesia with bupivacaine (0.1%) gives selective sensory block for ano-rectal surgery. Can J Anaesth 1995;42:691–694.PubMedCrossRefGoogle Scholar
  10. 10.
    Bodily MN, Carpenter RL, Owens BD. Lidocaine 0.5% spinal anaesthesia: a hypobaric solution of short-stay perirectal surgery. Can J Anaesth 1992;39:770–773.PubMedCrossRefGoogle Scholar
  11. 11.
    Courington FW, Little DM. The role of posture on anesthesia. Clinical Anesthesia 1968;3:24–54.PubMedGoogle Scholar
  12. 12.
    Ziser A, Friedhoff RJ, Rose SH. Prone position: visceral hypoperfusion and rhabdomyolysis. Anesth Analg 1996;82:412–415.PubMedGoogle Scholar
  13. 13.
    Pivalizza EG, Katz J, Singh S, et al. Massive macroglossia after posterior fossa surgery in the prone position. J Neurosurg Anesthesiol 1998;10: 34–36.PubMedCrossRefGoogle Scholar
  14. 14.
    Dilger JA, Tezlaff JE, Bell GR, et al. Ischaemic optic neuropathy after spinal fusion. Can J Anaesth 1998;45:63–66.PubMedCrossRefGoogle Scholar
  15. 15.
    Laakso E, Ahovuo J, Rosenberg PH. Blood flow in the lower limbs in the knee-chest position: ultrasonographic study in unanaesthetised volunteers. Anaesthesia 1996;51:1113–1116.PubMedCrossRefGoogle Scholar

References

  1. 1.
    Milligan ET, Morgan CN, Jones LE, Officer R. Surgical anatomy of the anal canal, and the operative treatment of haemorrhoids. Lancet 1937;2:1119–1124.CrossRefGoogle Scholar
  2. 2.
    Atkinson KG, Baird RM. Modified Buie amputation for extensive hemorrhoidal disease. Am J Surg 1978;135:862–864.CrossRefGoogle Scholar
  3. 3.
    Fansler WA, Anderson JK. A plastic operation for certain types of hemorrhoids. JAMA 1933;101: 1064–1066.CrossRefGoogle Scholar
  4. 4.
    Ferguson JA, Mazier WP, Ganchrow MI, Friend WG. The closed technique of hemorrhoidectomy. Surgery 1971;70:480–484.PubMedGoogle Scholar
  5. 5.
    Nivatvongs S. Alternative positioning of patients for homorrhoidectomy. Dis Colon Rectum 1980;23: 308–309.PubMedCrossRefGoogle Scholar
  6. 6.
    Maroof M, Khan RM, Siddique M, Tariq M. Hypobaric spinal anesthesia with bupivacaine (0.1%) gives selective sensory block for ano-rectal surgery. Can J Anaesth 1995;42:691–694.PubMedCrossRefGoogle Scholar
  7. 7.
    Bodily MN, Carpenter RL, Owens BD. Lidocaine 0.5% spinal anaesthesia: a hypobaric solution of short-stay perirectal surgery. Can J Anaesth 1992;39:770–773.PubMedCrossRefGoogle Scholar
  8. 8.
    Nivatvongs S, Fang DT, Kennedy HL. The shape of the buttocks. A useful guide for selection of anesthesia and patient position in anorectal surgery. Dis Colon Rectum 1983;26:85–86.PubMedCrossRefGoogle Scholar
  9. 9.
    Scott JR, Daneker G, Lumsden AB. Prevention of compartment syndrome associated with dorsal lithotomy position. Am Surg 1997;63:801–806.PubMedGoogle Scholar
  10. 10.
    Tuckey J. Bilateral compartment syndrome complicating prolonged lithotomy position [see comments]. Br J Anaesth 1996;77:546–549.PubMedCrossRefGoogle Scholar
  11. 11.
    Goldsmith AL, McCallum MI. Compartment syndrome as a complication of the prolonged use of the Lloyd-Davies position. [Review] [26 refs]. Anaesthesia 1996;51:1048–1052.PubMedCrossRefGoogle Scholar
  12. 12.
    Reddy PK, Kaye KW. Deep posterior compartmental syndrome: a serious complication of the lithotomy position. J Urol 1984;132:144–145.PubMedGoogle Scholar
  13. 13.
    Moses TA, Kreder KJ, Thrasher JB. Compartment syndrome: an unusual complication of the lithotomy position. [Review] [8 refs]. Urology 1994;43:746–747.PubMedCrossRefGoogle Scholar
  14. 14.
    Neagle CE, Schaffer JL, Heppenstall RB. Compartment syndrome complicating prolonged use of the lithotomy position. [Review] [18 refs]. Surgery 1991;110:566–569.PubMedGoogle Scholar
  15. 15.
    Khalil IM. Bilateral compartmental syndrome after prolonged surgery in the lithotomy position. J Vasc Surg 1987;5:879–881.PubMedGoogle Scholar
  16. 16.
    Leff RG, Shapiro SR. Lower extremity complications of the lithotomy position: prevention and management. J Urol 1979;122:138–139.PubMedGoogle Scholar
  17. 17.
    Herrera-Ornelas L, Tolls RM, Petrelli NJ, et al. Common peroneal nerve palsy associated with pelvic surgery for cancer. An analysis of 11 cases. Dis Colon Rectum 1986;29:392–397.PubMedCrossRefGoogle Scholar
  18. 18.
    Tondare AS, Nadkarni AV, Sathe CH, Dave VB. Femoral neuropathy: a complication of lithotomy position under spinal anaesthesia. Report of three cases. Canadian Anaesthetists Society Journal 1983;30:84–86.PubMedCrossRefGoogle Scholar
  19. 19.
    Roblee MA. Femoral neuropathy from the lithotomy position: case report and new leg holder for prevention. Am J Obstet Gynecol 1967;97:871–872.PubMedGoogle Scholar
  20. 20.
    Batres F, Barclay DL. Sciatic nerve injury during gynecologic procedures using the lithotomy position. Obstet Gynecol 1983;62:92s-94s.PubMedGoogle Scholar
  21. 21.
    Flanagan WF, Webster GD, Brown MW, Massey EW. Lumbosacral plexus stretch injury following the use of the modified lithotomy position. J Urol 1985;134:567–568.PubMedGoogle Scholar
  22. 22.
    Biswas S, Gnanasekaran I, Ivatury RR, et al. Exaggerated lithotomy position-related rhabdomyolysis. [Review] [23 refs]. Am Surg 1997;63:361–364.PubMedGoogle Scholar
  23. 23.
    Bildsten SA, Dmochowski RR, Spindel MR, Auman JR. The risk of rhabdomyolysis and acute renal failure with the patient in the exaggerated lithotomy position. J Urol 1994;152:1970–1972.PubMedGoogle Scholar
  24. 24.
    Muret J, Farhat F, Jayr C. [Rhabdomyolysis after prolonged surgical procedure in the lithotomy posture]. [French]. Ann Fr Anesth Reanim 1994;13:262–265.PubMedCrossRefGoogle Scholar
  25. 25.
    Svendsen LB, Flink P, Wojdemann M, et al. Muscle oxygen saturation during surgery in the lithotomy position. Clin Physiol 1997;17:433–438.PubMedCrossRefGoogle Scholar
  26. 26.
    Canterbury TD, Wheeler WE, Scott-Conner CE. Effects of the lithotomy position on arterial blood flow in the lower extremities. W V Med J 1992;88:100–101.PubMedGoogle Scholar
  27. 27.
    Clarke AM, Stillwell S, Paterson ME, Getty CJ. Role of the surgical position in the development of postoperative low back pain. J Spinal Disord 1993;6:238–241.PubMedCrossRefGoogle Scholar

References

  1. 1.
    Ferguson JA, Mazier WP, Ganchrow MI, Friend WG. The closed technique of hemorrhoidectomy. Surgery 1971;70:480–484.PubMedGoogle Scholar
  2. 2.
    Sims JM. Silver Suture in Surgery: The Anniversary Discourse Before the New York Academy of Medicine, November 18, 1857, New York, Samuel Ellis and William Wood, 1858.Google Scholar
  3. 3.
    Mazier WP. Hemorrhoids. In Mazier WP, Levien DH, Luchtefeld MA, Senagore AJ (eds). Surgery of the Colon, Rectum, and Anus. Philadelphia: WB Saunders, 1995, p 234.Google Scholar
  4. 4.
    Benumof JL. Respiratory physiology and respiratory function during anesthesia. In Miller RD (ed). Anesthesia, 3rd edition. New York: Churchill Livingstone, 1990, pp 505–549Google Scholar
  5. 5.
    Martin JT, Warner, MA. Patient positioning. In Barash PG, Cullen BF, Stoelting RK (eds). Clinical Anesthesia, 3rd edition. Philadelphia: Lippincott-Raven, 1997, pp 606–610.Google Scholar
  6. 6.
    Chen HH, Chen JS, Changchien CR, et al. Hemorrhoidectomy with self-retaining retraction. Dis Colon Rectum 1996;39:1058–1059.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Richard E. Karulf
  • Stanley M. Goldberg
  • H. Randolph Bailey
  • Martin A. Luchtefeld

There are no affiliations available

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