**2. Patient position**

Patient positioning during proctologic assessment is important for patients and doctors. Patients undergoing both proctologic examination and ambulatory procedures are usually embarrassed because they lay naked on uncomfortable position, that can be:


Even though the majority of individuals would favour Sims' position if they had the choice, they do not feel less embarrassed, thus preferring to let doctors free to choose the most suitable position to get reliable diagnoses of anal complaints [4]. The most performed positions are left lateral Sims' position and jack-knife position. The former is more comfortable for the patients and is easily and quickly achieved by the patient itself, allowing doctors to save time. This position is the most suitable to analyse haemorrhoids, but can be adapted to each proctologic disease. The

#### *Ambulatory Surgery for Perianal Disease DOI: http://dx.doi.org/10.5772/intechopen.97119*

jack-knife position, on the contrary, requires a scissoring table able to lift the hip, letting head and legs down and takes more time to be obtained. The sloping position of the patient makes it difficult to analyse haemorrhoids, however as the buttocks fall to each side, and finger tips of both hands of the investigator are free, it provides a better field of view on anal and perianal surface in good lighting. Since sensitivity, specificity, and the predictive value of anal diagnoses in different proctological positions are unknown, and considering that none of different proctological positionings are most embarrassing to patients, doctors choice usually depends on their own customs and preferences.
