Operative and Anesthetic Techniques

The medical and surgical management of anorectal disease represents a substantial portion of a typical colorectal surgery practice. A variety of diseases are encountered, ranging from the benign processes of hemorrhoidal and cryptoglandular fistula disease to a range of premalignant and neoplastic lesions of the anorectum. For many of these conditions, there is no consensus on optimal surgical approach or technique. An individual patient may also present some challenges. Adequate operative and airway exposures can be difficult to optimize in the obese; a simple sphincterotomy under local and sedation may not be appropriate for an opioid tolerant patient. Although anorectal procedures may seem to be routine, a patient specific operative plan will guide the surgeon, operative team, and patient through a successful procedure. In this chapter, we will review patient positioning, anesthetic techniques, and instrumentation that are employed in modern anorectal surgical procedures.