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Background: Rectal prolapse is defined as a falling out of place of the rectum through anus. Surgery is the treatment of choice to reverse abnormal anatomy and to improve anorectal function., Objective: To review the experience in recent years of surgical management of rectal prolapse in the Hospital Central Militar and Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran., Methods: All patients with rectal prolapse who underwent surgical treatment between January 1993 through December 2008 at two institutions in Mexico City were included. Clinical information was obtained of the clinical files in both hospitals. Main study variables were age, sex, degree of prolapse, morbility and type of surgery performed., Results: Fifty seven patients were included, predominantly female (59.6%) with a mean age of 45 years. The most frequent diagnosis was complete rectal prolapse. Fifteen patients (26%) were treated by perineal procedure and 42 (74%) through abdomen: 17 (40%) open and 25 (60%) laparoscopic. Morbidity rate was lower in the laparoscopic group with less length of hospital stay and a lower blood loss, but with higher recurrence rate., Conclusions: Although the laparoscopic surgery showed advantage related with a less morbility, blood loss and hospital stay, it showed higher recurrence rates."

Introduction: Recently, there have been new antiseptics for surgical scrub that do not require brushing. One of them contains 1% chlorhexidine gluconate and 61% ethyl alcohol; within its benefits, it may offer a low potential for skin sensitization, as well as cost savings and less use of water., Objectives: To evaluate satisfaction levels, washing time, safety, cost and amount of water between the traditional surgical scrub technique (group A) and brush-free surgical scrub procedure (group B)., Material and Methods: One hundred clean and clean-contaminated surgeries with four hundred members of surgical teams were included. Satisfaction levels, hand-washing time, skin disorders and problems associated with placement of gloves were evaluated. Hands cultures were taken in 20% of the population and the amount of water used by patients in group A was measured. Total costs and wound infections were analyzed., Results: Satisfaction scale in group A was 9.1 +/- 1.39 and 9.5 +/- 1.54 in group B (p = 0.004). The mean hand-washing time was 3.9 +/- 1.07 min in group A and 2.0 +/- 0.47 min in group B (p = 0.00001). Thirteen patients had dry skin in group A and four in group B (6.5% vs. 2%; p = 0.02). There were ten positives cultures in group A and five in group B (25% vs. 12.5%, p = 0.152). Wound infection rate was 3%. On average, five-hundred eighty liters of water were used by the former group, and the estimated hand-washing cost was lower in the second group., Conclusions: The handwashing technique with CGEA is as effective as traditional surgical scrub technique, and it is associated with less washing time, dry skin, cost and use of water.

Rectal affection accounts for 30% of colorectal cancer. The standard of treatment is surgical resection, which often is curative. For superior and middle-rectal involvement, low anterior resection (LAR) is the preferred procedure. For tumors involving the lower portion of the rectum, abdominoperineal resection (APR) or LAR are the options of treatment, depending on sphincter involvement. The main surgical objective is to achieve a R0 resection with an appropriated total mesorrectal excision, greater number of lymph nodes and negative distal and radial margins. These surgical parameters have been used as quality indicators and have prognostic implications in terms of overall and disease-free survival. Total mesorectal excision with preservation of hypogastric nerves has shown a reduction in rates of sexual and bladder dysfunction as well as lower local recurrence. At specialized centers such procedures are performed by minimal invasive surgery; however the number of meta-analysis is scarce.

Introduction: A protective loop ileostomy for a distal anastomosis of the rectum or anus, decreases the risk of sepsis secondary to anastomotic leak or dehiscence. This study examines whether the surgical technique employed in the construction of the anastomosis (open vs. laparoscopic) alters the subsequent closure of ileostomy., Objective: The goal of this study is to determine whether at the time of a protective ileostomy closure, the fact of doing an initial laparoscopic surgery has advantages over those who underwent open surgery., Material and Methods: This is a comparative and retrospective analysis of the results of an ileostomy closure with prior open surgery (ICPOS) vs those performed with a prior laparoscopic surgery (ICPLS). Demographic and surgical results were analyzed. Fisher's test and Chi square tests were used. A statistically significant results was defined as p < 0.05., Results: A total of 71 patients were included: 42 (59.2%) ICPOS and 29 (40.8%) ICPLS. Surgical time and hospital stay were less in the ICPLS group when compared with the ICPOS group. 79 vs. 133 min (p = 0.0001) and 3 vs. 5 days (p = 0.0001). Four patients (66.7%) from the ICPOS group developed ileum, whereas only 2 (33.3% from the ICPLS presented it (p = 0.04). Six patients had surgical wound infection, 5 (83.3%) of them represented the ICPOS group and only 1 (16.7%) represented the ICPLS group (p = 0.01). Four patients (5.6%) had anastomotic dehiscence, all of them were from the ICPOS group (p = 0.0037). On the ICPOS group 6 patients were reinterveined after the ileostomy closure, whereas none from the ICPLS required it (p = 0.01)., Conclusions: An ICPLS seems to have advantages over a ICPOS when analyzing surgical time, hospital stay and surgical ileum development, a lesser infection rate and a lesser re intervention rate at last.

Despite the screening efforts in the general population and particularly in families with hereditary colon cancer, locally advanced colon cancer remains a common clinical problem. In block resection is considered mainstay therapy in these patients. The aim of this report is to present a case of right-sided colon cancer with a medullar phenotype invading the duodenum treated through in block resection. A case of a 54-year-old male with a family history of colon and pancreatic cancer with lower gastrointestinal tract bleeding is presented. Colonoscopy and computed tomography scan showed a tumor in the colonic hepatic flexure invading the duodenum. The patient underwent an in block resection of the right colon, duodenum, pancreas and antrum. The histopathological study showed a T4N0M0 adenocarcinoma invading the duodenum, pancreas and antrum with negative margins. His postoperative evolution was complicated with a pancreatic fistula, which resolved with conservative measures. In conclusion, in block resection is the treatment of choice for locally advanced colon cancer with invasion to duodenum and pancreas and should be performed in high-volume centers familiar with this type of procedures. Key words: pancreaticoduodenectomy, colon cancer, Lynch syndrome, pancreas, surgery, Mexico.

The information regarding the association of gastric cancer and type 2 Lynch syndrome is limited. Previous studies have reported that both entities may be present in the same individual in less than 5% of the cases. The most frequent form of hereditary colorectal cancer is the Lynch syndrome or Hereditary Non-polyposic Colorectal Cancer, which is associated with germ-line mutation mostly of two genes, MLH1 and MSH2, which account for almost 90 percent of all identified mutations. The hereditary diffuse gastric cancer syndrome is caused by a germ-line mutation in the E-cadherin (CDH1) gene; only about 50 families with this syndrome have been reported. We present a case report of a patient who was diagnosed with both syndromes.

An angiomyxoma is a pelvic neoplasia compound of myofibroblasts. This is a case report of a 41 years old female patient, who presented with a painful, pelvic mass, identified by a tomography with malignant characteristics. Total surgical excision was performed and coursed with good evolution time.

Because definitive long-term results are not yet available, the oncologic safety of laparoscopic surgery in rectal cancer remains controversial. Laparoscopic total mesorectal excision (LTME) for rectal cancer has been proposed to have several short-term advantages in comparison with open total mesorectal excision (OTME). However, few prospective randomized studies have been performed. The main purpose of our study was to evaluate whether relevant differences in safety and efficacy exist after elective LTME for the treatment of rectal cancer compared with OTME in a tertiary referral medical center. This comparative nonrandomized prospective study analyzes data in 56 patients with middle and lower rectal cancer treated with low anterior resection or abdominoperineal resection from November 2005 to November 2007. Follow-up was determined through office charts or direct patient contact. Statistical analysis was performed using chi2 test and Student's t test. Twenty-eight patients underwent LTME and 28 patients were in the OTME group. No conversion was required in the LTME group. Mean operating time was shorter in the laparoscopic group (LTME) (181.3 vs 206.1 min, P < 0.002). Less intraoperative blood loss and fewer postoperative complications were seen in the LTME group. Return of bowel motility was observed earlier after laparoscopic surgery. There was no 30-day mortality and the overall morbidity was 17 per cent in the LTME group versus 32 per cent in the OTME group. The mean number of harvested lymph nodes was greater in the laparoscopic group than in the OTME group (12.1 +/- 2 vs 9.3 +/- 3). Mean follow-up time was 12 months (range 9-24 months). No local recurrence was found. LTME is a feasible procedure with acceptable postoperative morbidity and low mortality, however it is technically demanding. This series confirms its safety, although oncologic results are at present comparable with the OTME published series with the limitation of a short followup period. Further randomized studies are necessary to evaluate long-term clinical outcome.

Background: The liver is the organ in which often metastasize primary tumors. Knowledge of the etiology and forms of presentation of metastatic disease is key to deciding on the different treatment options., Objective: Describe the surgical management of liver metastases in colorectal cancer and factors that affect the survival of patients., Patients and Methods: We reviewed 43 cases of patients with metastatic liver cancer of the colon or rectum, who underwent liver surgery, attended January 1990 to December 2007. We analyzed demographic variables and perioperative associated with the survival of patients. There was the course and type of postoperative complications as well as the direct causes of mortality., Results: Were conducted mostly metastasectomies (n = 25), followed by right hepatectomy (n = 9),and left hepatectomy (n = 9). Surgical mortality was 4.6% (n = 2). The survival rate at 1, 3 and 5 year were 45% (18 patients), 42.5% (18 patients)and 12.5% (5 patients), respectively. The presence of a single metastatic lesion (p = 0.006), size of the lesion larger than 5 cm (p = 0.003), positive lymph nodes (p = 0.002), synchronous tumor (p = 0.04),presence of extra hepatic disease (p = 0.01), positive margin (p = 0.001) and blood loss >2000 mL were significantly associated with a lower survival rate., Conclusion: After hepatic resection for metastatic colorectal cancer the presence of more than one tumor, > of 5 cm, with presence of synchronous tumor, nodes and positive margins, extra hepatic disease, as well blood loss > 2000 mL are factors associated with a worse survival.

Introduction: Because definitive long-term results are not yet available, the oncologic safety of laparoscopic surgery in rectal cancer remains controversial. Laparoscopic total mesorectal excision (LTME) for rectal cancer has been proposed to have several short-term advantages in comparison with open total mesorectal excision (OTME). However, few prospective randomized studies have been performed., Objectives: The main purpose was to evaluate whether there are relevant differences in safety and efficacy after elective LTME for the treatment of rectal cancer compared with OTME in a tertiary academic medical center., Material and Methods: This comparative non-randomized prospective study analyzes data of 20 patients with middle and low rectal cancer treated with low anterior resection (LAR) or abdomino perineal resection (APR) from November 2005 to April 2006. Follow-up was determined through office charts or direct patient contact. Statistical analysis was performed using chi2 test and Student's t-test., Results: Ten patients underwent LTME and 10 patients underwent OTME. No conversion was required in the LTME group. Mean operating time was shorter in the laparoscopic group (LTME) (186.7 vs. 204.4 min, p < 0.007). Less intraoperative blood loss and fewer postoperative complications were seen in the LTME group. An earlier return of bowel motility was achieved after laparoscopic surgery. There was no 30-day mortality and the overall morbidity was 20% in the LTME group vs. 40% in the OTME group. The mean number of harvested lymph nodes was greater in the laparoscopic group than in OTME group (10.2 +/- 2.5 vs. 8.3 +/- 3). Mean follow-up time was 12 months (range 9-15 months). No local recurrence was found., Conclusion: LTME is a feasible procedure with acceptable postoperative morbidity and low mortality, however it is technically demanding. This series confirms its safety, while oncologic results are at present comparable to the OTME published series, with limitation of a short follow-up period though. Further randomized studies are necessary to evaluate long-term clinical outcome.

Pyoderma gangrenosum is one of the most severe extraintestinal manifestations in patients with ulcerative colitis (UC) and Crohn s disease. This lesion is frequently located on the lower extremities and the torso. Peristomal pyoderma gangrenosum (PPG) is extremely rare. We report the first published patient with PPG and UC in Mexico. PPG occurred six weeks after restorative proctocolectomy. Diagnosis was performed by clinical presentation and biopsy. Ulcer resolution was achieved with oral steroids and local wound care. Patient did not show any recurrence at one year follow-up. We suggest suspecting this illness in all patients with UC who had a restorative proctocolectomy and present difficult management peristomal ulcers.

Background: Haemorrhoidal disease is a frequent entity worldwide. The surgical management is indicated in third or fourth degree internal hemorrhoidal disease. The conventional hemorrhoidectomy has showed good results but the severe postoperative pain is an important complain. Currently diverse surgical alternatives have been described, mainly to avoid the postoperative pain that follows surgical hemorrhoidectomy. One of these new options is the stapled hemorrhoidectomy using the PPH stapler. This procedure may produce less postoperative pain, with a shorter inpatient stay and faster return to work., Objective: The aim of this paper is to analyze the results of using the Procedure for Prolapsed Hemorrhoids (PPH) as treatment in Hemorrhoidal Disease., Material and Methods: This is an observational and descriptive study, where 17 patients underwent stapled hemorrhoidectomy with PPH procedure, between March 2000 and August 2003., Results: 52.8% of this patients presented grade three internal hemorrhoids and 47.2% grade four; 52.9% presented mild postoperative pain; 41.2% moderate and 5.9% severe pain. In a short and median follow up, due to the persistence of hemorrhoidal disease symptoms two patients required surgical re-intervention. Two more patients presented incontinency. One patient presented stenosis in the line of staples treated satisfactory with an anal dilatation session., Conclusions: The use of PPH is a feasible and safe procedure and it could be a surgical alternative in the treatment of hemorrhoidal disease, even before than conventional hemorrhoidectomy.

Background: Even though most patients with colonic diverticular disease respond to conservative management, some patients persist with symptoms or develop complications that require surgery. The objective of this study was to identify main surgical indications for colonic diverticular disease, and to evaluate the outcomes of surgical treatment., Materials and Methods: A retrospective review of patients that underwent a surgical procedure for colonic diverticular disease from 1979 through 2000, was performed. Surgical indications were acute diverticulitis (54%) (group 1), stenosis (19%), fistula (9.54), recurrent diverticulitis (9.5%) and bleeding (8%) (group 2). Results. Seventy-four patients with a mean age of 56 years were studied. Fifty-eight percent were male. Surgical morbidity and mortality rates of acute diverticulitis were 55%, and 15%, respectively. The surgical procedures of this group were proximal stomas (45%), Hartmann's procedures (38%), and resections with primary anastomosis (17%). Second group morbidity and mortality rates were 35 and 5.8%, respectively. Thirty-six patients underwent two or more surgical procedures with statistical significance between first and second groups (61 vs. 28%; p < 0.05). The mortality of two-stage surgeries was lower than derivative procedures (13 vs. 22%; p = 0.009). A high Hinchey's score was the only factor associated with mortality (28.5 vs. 0%; p = 0.042)., Conclusions: Mortality of surgical procedures for colonic diverticular disease is associated with a high Hinchey score. Primary anastomosis is o safe, procedure in some cases.

Background: The sentinel lymph node biopsy in breast cancer can be used instead of axillary dissection when the node is negative because the sentinel lymph node (SLN) represents the first node that receive lymphatic drainage and may predict the tumor status of the entire lymph node group, so it may avoid a more morbid procedure. The objective of this study was to determinate the accuracy of this procedure and to evaluate techniques using blue dye, radiocolloid or both., Materials and Methods: Sixty-one women underwent sentinel lymphadenectomy followed by axillary lymph node dissection. Thirty-one patients underwent breast conserving surgery and 30 modified radical mastectomy. We studied three groups of patients: the first group was injected with isosulfan blue dye, the second group was injected with technetium-99m-labeled sulfur colloid and the third received both. From the patients marked with isosulfan blue, twenty two patients were injected subareolar (43.2%) and 29% into the breast parenchyma immediately surrounding the primary tumor or biopsy cavity (56.8%). Technetium-99m-labeled sulfur colloid was injected into the breast parenchyma immediately surrounding the primary tumor. Standard axillary lymphadenectomy including level I and level II was performed in all patients. Statistical analysis was performed with the SPSS 10.0 statistical software. Significance was considered at p < 0.05., Results: At least one SLN was identified in all patients (100%). The SLN predicted the tumor status of the entire lymph node group in 59 patients (96.77%). There were two false negative sentinel nodes (3.3%), each one using isosulfan blue dye injected subareolar and surrounding a primary tumor. The mean number of SLNs removed were 1.06 in the group 1, 2.2 in the group 2 and 2.37 in the group 3 (p = 0.0001 for group 1 vs. 2 and 3). The sensitivity and negative predictive value were 91 and 95%, respectively., Conclusions: This procedure has enough accuracy to justify avoidamce of standard axillary lymphadenectomy when the sentinel node is negative for me- tastases. Both isosulfan blue dye injected techniques may be used indistinctly. When the radiocolloid technique is used there are an increase in the mean number of SLNs removed per patient.