What position will be utilized for anorectal surgery? Understanding Patient Positioning

September 23, 2025 •

3 min read

Proper patient positioning is a critical factor for the success of any anorectal surgery, ensuring optimal visualization and access for the surgical team. When a patient needs this type of procedure, knowing what position will be utilized for anorectal surgery can help alleviate some anxiety and set expectations.

Quick Summary

The specific position used for anorectal surgery, such as the jackknife (prone), lithotomy, or left lateral decubitus, is carefully selected based on the type of procedure, the location of the disease, and the patient's individual health status.

Key Points

Jackknife Position: The patient is placed face-down with hips elevated, providing excellent surgical access and visibility for many anorectal procedures like hemorrhoid removal.
Lithotomy Position: This position, with the patient on their back and legs in stirrups, offers good access for anterior lesions but can be less ideal for posterior access compared to the jackknife position.
Position is Procedure-Dependent: The type of surgery, location of the issue, and patient's health status are key factors guiding the choice of surgical position.
Patient Safety and Comfort are Paramount: Regardless of the position, the surgical team takes extensive measures to ensure patient safety, protect pressure points, and minimize risks like nerve damage.
Multiple Positions are Common: While a single position may be standard for a specific procedure, variations exist, and the final decision is a collaborative effort between the surgeon and the anesthesia team.

The Primary Positions for Anorectal Procedures

For any anorectal surgery, the goal is to provide the surgeon with the best possible view of the surgical site. This can be achieved through several different standard positions, with the choice depending on a range of factors. Here are the three main positions utilized:

The Jackknife (Kraske) Position

The jackknife position, also known as the Kraske position, is a variation of the prone position. The patient lies face-down, and the operating table is adjusted to elevate the hips. The buttocks are often taped apart for better exposure.

Key Benefits: Provides excellent visualization of the anal canal and perianal area, improves surgeon ergonomics, and helps reduce blood in the surgical field.
Typical Uses: Common for hemorrhoids, anal fissures, and fistula-in-ano procedures.
Considerations: Requires patients to tolerate lying prone; care is taken to pad pressure points.

The Lithotomy Position

In the lithotomy position, the patient is on their back with legs raised and supported in stirrups. This position allows the surgical team to work between the patient's legs.

Key Benefits: Offers good access to the perineum and anterior anorectal area. It can be an alternative for patients unable to lie prone.
Limitations: May be less ideal for posterior access compared to the jackknife position and can risk nerve compression with prolonged use.
Typical Uses: Suitable when both abdominal and perineal access are needed or for complex anterior fistulas.

The Left Lateral Decubitus Position

Also known as the Sims' position, this involves the patient lying on their left side with the right leg flexed.

Key Benefits: Comfortable for office-based exams and minor procedures. Well-tolerated by patients who cannot lie prone or supine.
Limitations: Offers less extensive visualization for major surgery than jackknife or lithotomy.
Typical Uses: Often used for anoscopy, sigmoidoscopy, or draining simple abscesses.

Factors Influencing the Surgical Position

The surgeon and anesthesia team select the position based on several factors, including the type of procedure, location of the pathology, and the patient's health. The type of anesthesia and surgeon preference may also influence the choice.

Preparing for Your Surgical Position

Steps taken before positioning include administering anesthesia, using protective padding, and securing the position. Patient vitals are also monitored.

Comparison of Anorectal Surgery Positions


Feature	Jackknife (Kraske)	Lithotomy	Left Lateral Decubitus (Sims')
Patient Orientation	Prone (face-down) with hips elevated	Supine (face-up) with legs in stirrups	Lying on side with legs flexed
Surgical Exposure	Excellent for posterior anal canal and surrounding skin	Good for perineum and anterior lesions	Adequate for office-based exams and minor issues
Ergonomics for Surgeon	Generally considered superior, with better lighting and access	Can be comfortable, but may have some limitations	Good for bedside or minor procedures
Patient Comfort	Often well-tolerated, especially under sedation with proper padding	Can be uncomfortable if used for prolonged periods, especially for the lower back	Very comfortable, particularly for quick exams
Contraindications	Not suitable for some patients with respiratory or cardiac issues, pregnancy, or extreme obesity	Requires careful management to prevent nerve injury, especially with prolonged use	May not provide enough exposure for complex procedures

For more information on comparing these positions, you can refer to {Link: NIH website https://pmc.ncbi.nlm.nih.gov/articles/PMC9021856/}.

Conclusion: A Personalized Approach to Positioning

Determining what position will be utilized for anorectal surgery involves prioritizing surgical access and patient safety. While the jackknife is often preferred for its visualization, lithotomy and left lateral decubitus positions have specific uses. The surgical team will assess your individual case to choose the most effective and safest position.

Frequently Asked Questions

The jackknife position is commonly used for a wide range of anorectal surgeries, including hemorrhoidectomies, fistula repairs, and fissurectomies, because it offers superior visualization of the surgical site.

Proper patient positioning is crucial for providing the surgeon with optimal access and visibility of the surgical area, which leads to better surgical precision, reduced operating time, and minimizes complications.

No, the jackknife position may not be suitable for all patients. Conditions like severe obesity, advanced pregnancy, or cardiopulmonary diseases can make this position risky, so the surgical team will consider alternative positions like lithotomy.

The lithotomy position involves the patient lying on their back with legs in stirrups. It is often used for anorectal procedures when access to the anterior perineal area is required or when the jackknife position is contraindicated.

While it's important to discuss any concerns with your surgical team, the final decision on positioning is a clinical one based on the safest and most effective approach for your specific procedure and health status.

The left lateral decubitus position is a side-lying position used for many office-based anorectal examinations and minor procedures. It is generally very comfortable for the patient.

The surgeon, in consultation with the anesthesia team, decides on the surgical position. They consider the type of procedure, the exact location of the disease, and the patient's overall health and physical limitations to ensure the best outcome.