Prone vs Supine for perianal Surgery

Completed

Brief Summary: Perianal surgeries like hemorrhoids,fistula in ano,fissure in ano and anorectal abscess are operatedmostly in lithotomy position.In our experience lithotomy position isuncomfortable to both the patients,surgeon and the assistant with regard to awkward position ofthe patient with limited exposer and poor ergonomicsto the surgeon and assistant.Constant soiling ofthe operative field with blood during dissection and poor exposer due to bulky gluteal muscle.The surgeon has tobend and assistants have to twist and bend their body to properly handle theoperative site.This poor ergonomicstheoretically affects both the performance and physical health of the surgeonand assistant.In contrast proneposition with leg split and buttocks kept apart by elastic tape provideexcellent exposer,better ergonomics andunder-vision exchange of instruments.Another theoreticaladvantage is pooling of blood away from operative field.The literature issparse regarding advantages of these positions over each other. No guidelines existsregarding preference of position based on anatomical location of perianal pathology.Both positions havenever been compared earlier with regard to surgeon comfort,patient comfort,ergonomics and position relatedcomplications.

Recruitment & Eligibility

Inclusion Criteria

Patients aged 18 years or older and scheduled to undergo perianal surgery for fistula in ano, haemorrhoids and fissure in ano.

Exclusion Criteria

Patients with contraindications to any of the two positions and failed to understand or sign the informed consent.

Primary Outcome Measures

Name	Time	Method
1.Local Experienced Discomfort (LED) scale- physical stress	At the end of the Surgery Outcome will be measured.
2.Subjective Mental Effort Questionnaire (SMEQ) - mental stress	At the end of the Surgery Outcome will be measured.
3.Exposer of operative site will be measured in a scale of 1-5	At the end of the Surgery Outcome will be measured.

Secondary Outcome Measures

Name	Time	Method
Duration of surgery, procedure and position related complications and change in position will be noted separately for different type of surgeries.	Comfort level of patients will also be noted using LED scale if operated under local anaesthesia.

Locations (1): AIIMS Bhubaneswar
🇮🇳
Khordha, ORISSA, India
AIIMS Bhubaneswar
🇮🇳Khordha, ORISSA, India
Pankaj Kumar
Principal investigator
9438884253
surg_pankaj@aiimsbhubaneswar.edu.in