**1. Introduction**

In the last decades, efforts and resources have been focused on developing health care services, resulting in newer facilities, greater resources of equipment and improved staffing, so that nowadays, surgical procedures can be carried out in large hospitals, providing both surgeons and patients safety and comfort. Consequently, not only major surgical interventions, but also minor procedures not requiring

preoperative preparation, special equipment, nor hospital stay, are performed in these hospitals, thus tremendously increasing both the costs of medical treatment and the length of waiting lists for hospitalisation [1].

Recently, attention has shifted to outpatient care aiming to ensure safe surgical and medical assistance at reduced costs, spared resources and in shorter waiting times, through both office-based procedures, which include minor operation performed under local anaesthesia, requiring a short time to discharge (ranging from minutes to hours after the procedure) and day-surgery interventions, encompassing surgical operations more complex than office-based procedures, but easier than major surgery requiring at least an overnight stay [1, 2].

During the last 30 years, government with the support of health insurance companies, medical groups and hospital associations focused their concerted efforts on the development of proctologic office-based procedures in order to reduce hospital costs and release beds for major surgeries. While almost 30–50% of all surgeries can be safely realised in outpatient sectors, this rate raises to 90% in anorectal operations [1]. In fact, even if complications rate following anorectal office-based procedures are extremely variable, the majority of them are minor complications and do not require hospitalisation, nor further surgical intervention.

Factors appealing to physicians include significant costs saving achieved avoiding the cost of admission, use of ward-based supplies, respiratory therapy, increased medication costs, and laboratory charges. Other advantages include lack of need to perform trichotomy, prophylactic antibiotic treatment, and enema administration. Moreover, also patients' satisfaction degree is increased thanks to the ease of scheduling cases, the advantage of avoiding a hospital stay and the early return home [1, 3].

However, to perform ambulatory anorectal surgery, a proper patient selection is necessary. Patient comorbidities as well as functional limitations should be assessed. The type and extent of surgery should be considered since not all anorectal procedures are minor [3].
