[Rectal perforation as a result of stapled hemorrhoidectomy]. / Perforación rectal posterior a hemorroidectomía con engrapadora.

BACKGROUND: The procedure for prolapsing hemorrhoids (PPH) has the potential to overcome many of the disadvantages of excisional hemorrhoidectomy; nevertheless, rare serious postoperative complications have been reported. CLINICAL CASE: We present a case of a 31-year-old male who was admitted and treated at another hospital with a stapled mucosectomy, which was carried out using a PPH01 33-mm stapling device. During the immediate postoperative period a fistula presented from the rectum to the right gluteus and a primary closure was attempted. However, the patient continued with the same symptoms and was referred to our hospital in October 2009. On examination at our Department of Colorectal Surgery, a right gluteus abscess was found and a primary orifice in the rectum with a diameter of 10 mm at 4 cm from the anal verge, confirmed with magnetic resonance imaging. A primary closure was attempted; however, during follow-up the patient presented edema, erythema and induration of the right gluteus and a failed closure of the fistula. Afterwards an endorectal advancement flap was successful in the closure of the fistula. CONCLUSIONS: Complications with PPH may compromise function or may be life-threatening for the patient, requiring further surgeries with increased morbidity and mortality. Therefore, it is recommended to be performed by surgeons with special training in this procedure.

[Surgical team satisfaction levels between two preoperative hand-washing methods]. / Niveles de satisfacción del equipo quiúirgico entre dos métodos de lavado de mano.

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.