I havee been working at my own ano-proctology clinic as a chief surgeon for nearly forty years. In this paper, an experience of this day surgery out patient clinic was reviewed. Operations of anal prolapse due to internal hemorrhoids, fistula-in-ano, anal fissure and so on have. been carried out under local anesthesia in this clinic. The patients have been managed in this out-patient clinic every morning after surgery. I always have been contriving to reduce pain of the patients and post-operative bleeding. And I would like to emphasize that we have to pay more attention to "analgesia".
Colo-Proctology Center was begun at the Department of Surgery of the Social Insurance Central Hospital in 1960. Patients with coloanal disease and number of surgeries have been gradually increased and number of patients treated at the Center were about 6, 000 and 848 instances underwent surgery in 1992. As for hemorroidal surgery, Whitehead's method had been performed in our department up to 1961, but since then Millingan-Morgan method and its modified methods have been performed. Ligation and Excision methods had been used for only 3.3 percent until 1958 in Japan but for 82.6 percent in 1977. As for fistula in ano, we presented threedimentional classification using symbols representing the extension of the fistula, sites of penetration in the sphincter and its relationship to the perirectal spaces (1972). This classification is used presently in the discussion of anal fiitula in Japan. A sphineter preserving method has been used on IIL (low inter sphincteric fistula) in which a fistulous tract is situated laterally or anteriorly to the anus. For II HC (complicated high inter sphincteric fistula) or type III (Ischiorectal fistula), conservative correction by P.H. Hanley (New Orleanse) has been used. In a treatment of anal fissure conservative methods have mostly been used ambulatory, lateral subcutaneous internal sphincterotomy has been performed in the patients with severe anal pain and only a few patients with chronic ulcer undergo surgery. As for postoperative disturbances, half of them are caused by Whitehead's method and the causes for recurrence of anorectal fistula were persistence of the primary lesion, persistence of fistula, remaining infective lesion, and inappropriate drainage. A conference on colo-proctology, in which discussion on one theme was frankly done, has been continuing, and it is useful for daily practice of colo-proctology, being well-received by doctors. Many doctors, who are interested in colo-protology, have visited the Colo-Proctology Center, after several training sessions, they have been encouraged in their work and have been trying to raise the level of knowledge and treatment in this field.