Annals of Coloproctology

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Benign proctology,Surgical technique

Lithotomy versus prone position for perianal surgery: a randomized controlled trial: Pankaj Kumar, Tushar S. Mishra, Siddhant Sarthak, Prakash Kumar Sasmal; Ann Coloproctol. 2022;38(2):117-123. Published online June 7, 2021; DOI: https://doi.org/10.3393/ac.2020.12.16

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Purpose
Studies objectively comparing lithotomy and prone positions regarding surgeon comfort, ergonomics, patient comfort, and position related complications are scarce.
Methods
The patients posted for surgery of either fistula in ano, hemorrhoids, or were included in this study. Subjective Mental Effort Questionnaire (SMEQ) and Local Experienced Discomfort (LED) scale were used to score the level of mental and physical stress among the operating surgeon, assistants, and the scrub nurse. Other parameters studied were the exposure of the operative site, patient comfort level, and position-related complications.
Results
Thirty patients were operated in each position. Mean±standard deviation of jackknife prone vs. lithotomy surgeon SMEQ score (15.6±10.4 vs. 107.0±11.5, P<0.05) and LED score (1.8±1.5 vs. 6.7±0.5, P<0.05) were found to be statistically significant. Prone vs. lithotomy assistant SMEQ score (29.1±13.1 vs. 100.6±8.7, P<0.05) and LED score (4.6±1.1 vs. 7.4±0.8, P<0.05) were also found to be statistically significant. SMEQ (10.0±0.0 vs. 20.6±2.5, P<0.05) and LED scores (1.1±0.3 vs. 3.3±0.5, P<0.05) of scrub nurses and LED scores (2.5±0.5 vs. 6.3±0.7, P<0.05) of patients were also statistically significant. Exposure of the operative site was significantly better in the prone position (5.0 vs. 2.1, P<0.05).
Conclusion
Significantly better SMEQ, LED, and exposure score suggests the superiority of jackknife prone position over the lithotomy in terms of significantly less mental and physical stress to the operating surgeon, assistant, and scrub nurse; better ergonomics, and excellent exposure.

Citations

Citations to this article as recorded by

A scoping review of participant reported outcome measures assessed during live and simulated surgical procedures
Aaron K. Budden, Sophia Song, Amanda Henry, Claire E. Wakefield, Jason A. Abbott
The American Journal of Surgery.2025; 240: 116131. CrossRef
A comparative study of prone split-leg position and lithotomy position in posterior uterine myomectomy by transvaginal natural orifice transluminal endoscopic surgery
Yayu Zhou, Yonghong Lin, Dingyu Xu, Li He, Lu Huang
BMC Women's Health.2025;[Epub] CrossRef
Latest Research Trends on the Management of Hemorrhoids
Sung Il Kang
Journal of the Anus, Rectum and Colon.2025; 9(2): 179. CrossRef
A scoping review of cognitive load assessment tools suitable for clinicians performing REBOA
Codey Simmons, Robbie Lendrum, Zane Perkins, Gareth Grier, Max Marsden
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2025;[Epub] CrossRef
Vaginal natural orifice transluminal endoscopic surgery (vNOTES) in myomectomy: a novel minimally invasive technique review
Liufeng Xu, Jiaying Tao, Jigang Jia, Yonghong Lin, Li He
Archives of Gynecology and Obstetrics.2025;[Epub] CrossRef
Jackknife versus Lithotomy Position for Hemorrhoidectomy Surgery: A Randomized Controlled Trial
Sina Ghasemi, Behzad Imani, Alireza Jafarkhani, Ashkan Karimi, Ali Yamini
Scientific Journal of Kurdistan University of Medical Sciences.2024; 29(5): 76. CrossRef
A Randomized Controlled Comparative Study of the Three Over-Bed Techniques for Positioning and Repositioning the Lithotomy Position While Using Stirrups
Ling-Ling Zhang, Zhi-Fang Luo, Guang-Jing Yang
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Mingxin Cao, Junlong Zhang, Yu Chen, Yueyou Liang
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Comparison of a Fistulectomy and a Fistulotomy with Marsupialization in the Management of a Simple Anal Fistula: A Randomized, Controlled Pilot Trial: Bhupendra Kumar Jain, Kumar Vaibhaw, Pankaj Kumar Garg, Sanjay Gupta, Debajyoti Mohanty; J Korean Soc Coloproctol. 2012;28(2):78-82. Published online April 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.2.78

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30 Citations

Abstract PDF

Purpose

This randomized clinical trial was conducted to compare a fistulectomy and a fistulotomy with marsupialization in the management of a simple anal fistula.

Methods

Forty patients with simple anal fistula were randomized into two groups. Fistulous tracts were managed by using a fistulectomy (group A) while a fistulotomy with marsupialization was performed in group B. The primary outcome measure was wound healing time while secondary outcome measures were operating time, postoperative wound size, postoperative pain, wound infection, anal incontinence, recurrence and patient satisfaction.

Results

Postoperative wounds in group B healed earlier in comparison to group A wounds (4.85 ± 1.39 weeks vs. 6.75 ± 1.83 weeks, P = 0.035). No significant differences existed between the operating times (28.00 ± 6.35 minutes vs. 28.20 ± 6.57 minutes, P = 0.925) and visual analogue scale scores for postoperative pain on the first postoperative day (4.05 ± 1.47 vs. 4.50 ± 1.32, P = 0.221) for the two groups. Postoperative wounds were larger in group A than in group B (2.07 ± 0.1.90 cm² vs. 1.23 ± 0.87 cm²), however this difference did not reach statistical significance (P = 0.192). Wound discharge was observed for a significantly longer duration in group A than in group B (4.10 ± 1.91 weeks vs. 2.75 ± 1.71 weeks, P = 0.035). There were no differences in social and sexual activities after surgery between the patients of the two groups. No patient developed anal incontinence or recurrence during the follow-up period of twelve weeks.

Conclusion

In comparison to a fistulectomy, a fistulotomy with marsupialization results in faster healing and a shorter duration of wound discharge without increasing the operating time.

Citations

Citations to this article as recorded by

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Rakesh Quinn, Alexandra Peacock, Rebecca J Lendzion
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Enhanced surgical management of complex anal fistulas via integrated traditional Chinese medicine: A retrospective cohort study
Ji-Feng Liu, Yu Wang, Xue-Song Peng, Qing-Long Li
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
European Society of Coloproctology: Guidelines for diagnosis and treatment of cryptoglandular anal fistula
Lillian Reza, Kevin Gottgens, Jos Kleijnen, Stephanie Breukink, Peter C. Ambe, Felix Aigner, Erman Aytac, Gabriele Bislenghi, Andreas Nordholm‐Carstensen, Hossam Elfeki, Gaetano Gallo, Ugo Grossi, Baris Gulcu, Nusrat Iqbal, Rosa Jimenez‐Rodriguez, Sezai L
Colorectal Disease.2024; 26(1): 145. CrossRef
Use of Non-Thermal Plasma as Postoperative Therapy in Anal Fistula: Clinical Experience and Results
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Biomedicines.2024; 12(8): 1866. CrossRef
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Chinniahnapalaya Pandurangaiah Hariprasad, Anil Kumar, Manoj Kumar, Manoj Kumar, Shiv Shankar Paswan, Gupta Rohit, Shiv Kishor, Prem Kumar
BMC Surgery.2023;[Epub] CrossRef
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S. Bhat, W. Xu, C. Varghese, N. Dubey, C. I. Wells, C. Harmston, G. O’Grady, I. P. Bissett, A. Y. Lin
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F. Litta, A. Parello, L. Ferri, N. O. Torrecilla, A. A. Marra, R. Orefice, V. De Simone, P. Campennì, M. Goglia, C. Ratto
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