Perineal and perirectal sarcomas: report of two cases.

PURPOSE: Perineal sarcomas are rare tumors that are typically of an extensive nature by the time of diagnosis. In this article, two case reports are followed by a brief review of different types of sarcomas that may occur in the perineal and perirectal region. STUDY PATIENTS: This study consists of two cases that are representative of the many types of perineal/perirectal sarcomas. PRINCIPLE CONCLUSIONS: Perineal and perirectal sarcomas are generally of poor prognosis mainly because of delayed diagnosis. Computed tomography and magnetic resonance imaging can be extremely useful to help assess these tumors. It is well known that the most important criterion for diagnosing leiomyosarcomas appears to be the presence of mitotic activity. Anorectal stromal tumors having five or more mitoses per 50 high powered fields are considered to be malignant. The mainstay of treatment is surgical excision with wide margins. Currently, chemotherapeutic and radiotherapy trials are under way.

Laparoscopic assisted colectomies versus open colectomy.

Minimally invasive techniques are having an impact on a variety of surgical procedures. Before their widespread acceptance as the standard of care, studies need to document their efficacy in comparison to open techniques. This study compared 25 laparoscopic-assisted colectomies to 25 open colectomies all performed within the last five years by the same surgeon. In terms of adequacy of resection, laparoscopic assisted colectomy compared favorably with open colectomy in both length of resection (15.7 cm vs 19.3 cm) and average number of nodes (6 vs 10). In addition to lessening patient discomfort, the other advantages were earlier return of bowel function (regular diet postoperative day 2 vs postoperative day 5) and shorter length of stay (4 vs 8 days). Operating costs were significantly greater, but this was offset by the shorter length of stay. This study supports laparoscopic assisted colectomy as a technically safe procedure with substantial patient benefits.

Early complications and outcomes of the current technique of transperitoneal laparoscopic herniorrhaphy and a comparison to the traditional open approach.

We conducted a prospective study to evaluate early complications and complaints of 60 patients who underwent laparoscopic transperitoneal hernia repair at our institution. Average follow-up was 9 months. Patients graded levels and duration of postoperative pain subjectively. Nine patients (15%) had complications of anterior/medial thigh numbness, 4 (6.7%) scrotal swelling, 4 (6.7%) scrotal ecchymosis, 3 (5%) hematoma, 2 (3.3%) prolonged sensation of tightness/pressure, 1 (1.7%) seroma, 1 (1.7%) urinary retention, and 1 (1.7%) pain with intercourse. Twenty-six (43%) had no postoperative complaints. Overall, 57 (95%) stated they were satisfied with their repair and would recommend the laparoscopic technique. Fifty-five patients (92%) returned to basic activities of daily living in less than 2 weeks. Thirty-five (73%) of the 48 patients who were employed returned to work within 3 weeks. In comparison, only 7 (29%) of 24 patients in an open hernia repair group resumed normal activity during the first 2 postoperative weeks, and only 3 (14%) of the 21 employed patients in this group returned to work at 3 weeks. The laparoscopic and traditional open herniorrhaphy methods were compared in terms of operating room time and cost. The average unilateral laparoscopic repair (n = 51) cost $3,094 and lasted 81 minutes. Bilateral laparoscopy procedures (n = 9) averaged $3,774 and 110 minutes. Unilateral traditional hernia repairs (n = 24) had an average cost of $1,990 and duration of 69 minutes. In follow-up ranging from 2 to 28 months, there has been only 1 recurrence to report in the laparoscopic group (1.7%). All patients continue to be followed to determine long-term recurrence risks.