Complete rectal prolapse clinical and functional outcome with Delorme's procedure.

INTRODUCTION: Many surgical techniques -both through the perineal and abdominal routes- have been described for the treatment of rectal prolapse. The aim of this work is to evaluate the clinical and functional outcome with Delorme's perineal procedure. PATIENTS AND METHODS: Twenty-one patients with complete rectal prolapse were studied from July 2000 to October 2005. Age, gender, anesthetic risk, and accompanying symptoms were all assessed. Diagnostic tests performed included: colonoscopy, anorectal manometry before and after surgery, and 360 masculine endoanal ultrasonography. Delorme's procedures were carried out by only one surgical team. RESULTS: No mortality occurred, and morbidity was minimal. Prolapse relapse rate was 9.52% with a mean follow-up of 34 months. Anal continence improved in 87.5% of patients, and no surgery-associated constipation ensued. Mean hospital stay was 2 (range 1-4) days. During the postoperative period no pain developed in 17 patients, and 4 patients had mild pain. Satisfaction with surgery was high in 16 cases (76.19%), moderate in 3 (14.28%), and low in 2 (9.52%). CONCLUSIONS: Delorme's procedure for the management of complete rectal prolapse is associated with low morbidity, improves anal continence, gives rise to no postsurgical constipation, and has an acceptable relapse rate. Patient satisfaction with this procedure is high because of its high comfortability (intradural anesthesia, short hospital stay, and little postoperative pain) and optimal results.

Subcutaneous venous reservoir implant: our experience in 1200 cases.

We present our experience in subcutaneous venous reservoir (SVR) implanting, laying emphasis on the surgical technique, the protocol followed for assessing difficulty, implant care and per- and post-implant complications and their management. Between March 1996 and December 2002 we installed 1200 SVRs on an outpatient basis, with subsequent result follow-up. The reservoir was successfully installed by the standard procedure in 99.33% of cases (1194), while in the remaining six patients (0.67%) the participation of the Intervention Radiology Department was required for correct implantation. Results were excellent with a morbidity of 3.3% and we had to single out two cases of immediate infection (0.16%), nine of tardive infection (over three months); twelve cases of pneumothorax (1%); seven episodes of venous thrombosis (0.58%) and four cases of catheter migration (0.3%). SVR implanting is possible on an outpatient basis but requires strict measures of asepsis and an experienced team and personnel responsible for its handling and maintenance, although there are a small number of complications inherent in the patient's general state.

[Mucinous cystadenoma of ileocecal appendix]. / Cistoadenoma mucoso de apéndice ileocecal.

We present two patients with mucinous cystadenoma and mucinous cystadenocarcinoma of the appendix, respectively. These are very uncommon lesions in that localization. We point out the lack of specificity of the term "mucocele" and also the need of strict criteria to define this type of lesions in order to establish the adequate treatment. Usually the diagnosis is not possible before surgery. The treatment consists of simple appendectomy for the benign lesions and right hemicolectomy for mucinous carcinoma.

[Diverticulum of the appendix: apropos of 1 case]. / Divertículo del apéndice: a propósito de un caso.

A case is presented of cecal appendicular diverticulum in a 52 year-old male, initially diagnosed as acute appendicitis. We emphasize the rarity or this pathology, its clinical presentation simulating a picture of acute appendicitis and its cure by appendectomy, as well as the diagnosis by pathologic study in most cases.

[Perforated diverticulitis of the colon: diagnosis and treatment]. / Diverticulitis del colon perforada: diagnóstico y tratamiento.

Twelve cases are presented of perforated diverticulitis that required emergency surgical intervention. The present guidelines for surgical action are indicated for the different situations originated by perforated diverticulitis: localized peritonitis (pericolonic abscess), suppurated peritonitis and fecaloid peritonitis. The Hartman technique is explained as the method of choice for patients with generalized peritonitis.