The principle and procedures of our ambulatory treatment of anal diseases are reported briefly in this paper. 1) We emphasize the importance to inspect the anus after defaecation for the first step of anal examination. 2) Local anesthesia (1% procaine with adrenaline) has been used for both outpatients and inpatients in our clinic. 3) 2-3% Dibasic Calcium Phosphate suspension in glycerin has been used for the sclerotherapy of internal haemorrhoids. 4) Multiple puncture technique devised by " Stone " is useful for the therapy of pruritus ani. A total of 5-10 ml of 40% ethyl alcohol is deposited subcutaneously. (95% ethyl alcohol was used in the original tenchique.) 5) In addition to usual operations for anal diseases, so called "Medical haemorrhoidectomy " is useful especially for the patients complications. 6) Hamoligator is occationally used not only for internal haemorrhoid but also for internal haemorrhoid with external haemorrhoid.
The importance of digital examination for the diagnosis of anal diseases was emphasized. Zeroid, a plastic cylinder 1.2 cm in diameter 10 cm in height with cooled solvent, showed good results for the conservative treatment of anal diseases. As to operative procedures, ligation and excision method was recommended.
The ambulatory treatments of proctologic patients have hitherto been generally limited to the conservative medical treatments by way of the administration of internal medicines or the external applications of drugs, and also, to such methods as the topical injection or application of medicines, which give scleroting or necrotizing action, and the topical ligature. Surgical treatments that may be effective for complete cure have required hospitalization of the patients as inpatients. Heretofore, in Japan, the evils inflicted by proctologic diseases to the national life have not been taken into serious consideration, and has been made light of as the objects of minor surgery. It is too much to say that as the consequence, many therapeutic difficulties uncovered have been relegated to oblivion, with little or no progress or improvement in the surgical approach ever being devised. However, the proctology in Japan has achieved a great progress both in its academic and therapeutic phases through the effects expended for the development of the Japanese Society of Colo-Proctology since its founding (1947) until today. On the basis of my thirty years' experience in the ambulatory surgical treatments of proctologic patients, I am strongly in belief that now is the time to utilize the surgical method or operations that may bring about a complete cure for the general ambulatory treatment.
In this report, the diagnostic and therapeutic methods concerning anal diseases in out patient clinic were reported as follows; 1) Interview with patients. Analgia, anal bleeding and hemorrhoidal node, which are the common complaints of anal diseases, should be asked in detail. 2) Physical examinations. Anus and rectal mucosa are firstly palpated by naked finger after supine position and examined by the proctoscope. In the cases of anal fistula, not only the external orifice of fistula but localization of originated focus has to be carefully examined. 3) Therapeutic managements. a) Internal hemorrhoids: Internal hemorrhoids with first degree are treated by the local injection method with less than 0.5 ml of 5% phenol glycerin solution which is called as the sclerotherapy. To treat internal hemorrhoids with second degree, the sclerotherapy shows not so satisfactory results because of its temporary effect. However, recently; Helio hemorrhoidal ligater method shows good results. b) External hemorrhoids: External hemorrhoid with thrombus can be treated with local injection of less than 1.0 ml of 33% phenol glycerin solution after ligation which is called as the necrosing therapy. c) Anal fissure: Anal fissure with Trias symptoms, namely, sentinel pile, anal ulcer and hypertrophic papilla, needs to be removed. The necrosing therapy as mentioned above is also useful to remove anal fissure. However, anal fissure with deep ulceration and with hypertrophic sphincter muscle cannot be treated in out patient clinic. d) Periproctal abscess and anal fistula: The periproctal abscess is firstly treated by incision and drainage in out patient clinic. However, anal fistula in consequence of incision has to be treated after hospitalization. 4) Conclusively, anal diseases well selected by careful examination are considered to be well treated in out patient clinic by using suitable procedure.