M. Hidalgo Pascual

Complete rectal prolapse clinical and functional outcome with Delorme's procedure: Resultados clínicos y funcionales con la operación de Delorme

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 Delormes 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. Delormes 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 Delormes 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.

Results of surgery for cancer of the rectum with sphincter conservation: a randomized study on instrumental versus manual anastomosis

We present results obtained in a group of patients included in a randomized study from 1979 to 1985 for evaluation of mechanical anastomosis after anterior resection for cancer of the rectum; 113 patients were operated on, 58 with manual and 55 with instrumental anastomosis. There was no significant difference in morbidity or mortality between the groups. The incidence of anastomotic fistulas (clinical and subclinical) was similar (12% vs. 15%), although a large number of tumors in the lower third of rectum was treated by manual anastomosis. Concerning late complications, more stenoses, although mainly asymptomatic, were detected after instrumental anastomosis (15% vs. 6%). The incidence of local recurrence within 3 years was quite similar in the 2 groups (about 15%), and usually occurred in patients who already had generalized disease.

Efecto de la endotelina-1 sobre las arterias tumorales de pacientes con neoplasia colorrectal

Endothelin-1 is an endothelium-derived vasoconstrictor peptide whose plasma levels are increased in patients with colorectal cancer, and which may be involved in tumor blood flow regulation. To study whether response to this peptide is altered in tumor arteries, mesenteric arteries supplying blood flow to colorectal tumors, and mesenteric arteries far from said tumors were obtained from 13 patients undergoing colectomy; mesenteric arteries were also obtained from patients with diverticulitis (n = 4) or inflammatory bowel disease (n = 3). Arteries were prepared for isometric tension recording in an organ bath, and in this preparation it was found that endothelin-1 induced contraction in all three types of arteries, but that sensitivity to this peptide was greater in arteries supplying blood flow to the tumor than in arteries far from the tumor or arteries from patients without cancer. These results suggest that endothelin-1 may regulate blood flow to colorectal tumors by inducing a greater contraction in tumor-supplying arteries than in non-tumor arteries.

Pancreatic cancer: Management

Pancreatic cancer still represents a serious medical concern for which no adequate solution has thus far been found. Surgery is the only appropriate therapy, but has a survival rate of around 30-35% at three years, with an operative mortality below 3% and an operative morbidity approaching 10% of radically resected patients, all of which applies to surgery performed by expert teams in highly experienced sites.