ABSTRACT
BACKGROUND: The most severe complication following an intestinal anastomosis is the dehiscence with the consequent development of sepsis, fistulas, stenosis, and death. For this reason the compression anastomosis (NiTi) system was developed, with the aim of reducing these complications. MATERIAL AND METHODS: A retrospective study was conducted, from 1 June 2012 to 30 August 2014, on total of 14 patients operated on the Humanitas Hospital Medical Group Coyoacán, the ASMED, and Clínica Médica Sur. The subjects were predominantly male 65%, a mean age of 58 years, with range 30-79 years. RESULTS: A total of 14 patients were included. The indication for surgery was complicated diverticular disease Hinchey II-III (36%), and the procedures performed were: 6 (43%) left hemicolectomy with primary end to end compression anastomosis, 2 (14%) major complications (dehiscence wall and anastomosis), 1 (7%) minor complication (infection of the soft tissues). There was a mean 98ml (range 20-300ml) of intraoperative bleeding, with start of oral feeding on the second day, a mean hospital stay of 4 days (range 2-10), one patient with ileo-rectal anastomosis dehiscence presented on the 4th post-operative day, and performing anastomosis with stapling device and loop ileostomy. Stenosis developed in 7% during follow-up and was resolved with a new anastomosis stapler. CONCLUSIONS: The NiTi device is an additional alternative for colorectal anastomosis, mainly in low anastomosis, obtaining good results in this study without major complications.
Subject(s)
Anastomosis, Surgical/instrumentation , Colectomy/methods , Pressure , Surgical Wound Dehiscence/prevention & control , Wound Closure Techniques/instrumentation , Adult , Aged , Alloys , Blood Loss, Surgical , Colectomy/instrumentation , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
BACKGROUND: Rectourethral fistula is a rare disease with a difficult surgical treatment. The etiology of rectourethral fistula is iatrogenic, secondary to prostate surgery, pelvic radiotherapy and a rare complication of rectal surgery. Surgical treatment options for rectourethral fistula are diverse. Interposition of gracilis muscle has a curative index of 100% with close surveillance, as reported by Nyham. CLINICAL CASE: We present a case of a 58-year-old male with iatrogenic rectourethral fistula secondary to radical prostatectomy and who was treated with interposition of the gracilis muscle. Eight weeks after surgery and with colostomy closed, no evidence of recurrence was detected. CONCLUSIONS: Interposition of the gracilis muscle requires a multidisciplinary approach and demonstrates good shortterm results.
Subject(s)
Muscle, Skeletal/transplantation , Rectal Fistula/surgery , Urethral Diseases/surgery , Urinary Fistula/surgery , Humans , Male , Middle Aged , Thigh , Urologic Surgical Procedures/methodsABSTRACT
OBJECTIVE: To analyze the results of Longo stapled mucosectomy for hemorrhoidal disease in a 1 to 3 years follow up. PATIENTS AND METHODS: Clinical response and complications where analyzed in patients treated for grade II to IV non-complicated hemorrhoidal disease with Longo stapled hemorrhoidectomy. RESULTS: In a 27 months period, 160 patients were treated (105 men and 55 women), mean age was 44.1 years (range: 24 to 72 years), and 110 patients had grade III hemorrhoid disease. Non procedure complications were noted, early complications were detected in 5% of patients and late complications were detected in 10% of patients. In a mean follow-up of 18.8 months, 82.5% of the patients remained asymptomatic and 94.4 of the patients reported a good satisfaction score. A second surgery was required in three patients because of recurrence. CONCLUSION: Longo stapled mucosectomy is a safe treatment for non complicated hemorrhoid disease. In a 18 month follow up most patients were asymptomatic.