[Experience in surgical management of rectal prolapse in two hospitals in Mexico City]. / Experiencia del tratamiento quirúrgico del prolapso rectal en dos hospitales de tercer nivel en la ciudad de México.

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."

[Pelvic angiomyxoma. A case report from National Institute of Medical Sciences and Nutrition, Salvador Zubiran.]. / Angiomixoma pélvico. Informe de un caso en el Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.

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.

[Hereditary non-polyposis colorectal cancer associated with hereditary gastric cancer. A case report.]. / Cáncer colorrectal hereditario no polipósico asociado a cáncer gástrico hereditario. Informe de un caso.

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.

[Factors associated with survival in liver resection for metastatic colorectal carcinoma]. / Factores asociados a superviviencia en la resecciónhepática por metástasis de cáncer de colon y recto. Experiencia en el Instituto de Ciencias Médicasy Nutrición "Salvador Zubirán".

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.

[Laparoscopic colorectal surgery: third level center experience.]. / Cirugía colorrectal laparoscópica:experiencia en un centro de tercer nivel.

BACKGROUND: The role of laparoscopic surgery in the management of colorectal pathologies is steal unclear. Some new evidence has shown some advantages over open procedures. Because it is a technically demanding procedure, the progress is very low, and used among few colorectal surgeons. OBJECTIVE: To describe the experience of laparoscopic colorectal surgery in a third level referral center, in a fourth year period. We analyzed short and median outcomes, for benign and malignant diseases. MATERIAL AND METHODS: A retrospective review of all colorectal laparoscopic procedures was analyzed in a period between June 2003 and July 2007. Procedures for benign and malignant diseases were included. RESULTS: One hundred and seventy cases were included, 52 (30%) for malignant and 118 (70%)for benign diseases. The main indication for surgery was diverticular disease followed by colorectal cancer and the most common procedure was sigmoidectomy followed by right colectomy. Conversion rate was 8.8% (15 patients) and overall morbidity and mortality were 12%, and less than 1% respectively.Oncologic results were evaluated with a median follow up of 2 years, for a loco regional recurrence rate of 6%. Mean number of nodes retrieved in the pathologic specimen were 15.69 (+/- 3.53). All malignant cases had negative margins. CONCLUSIONS: Laparoscopic colorectal procedures are safe and feasible, in large volume centers showing equivalent results when comparing with open procedures evidenced in world literature,about results of oncologic cases, due to the short follow up period we can t conclude about oncologic outcomes.