Functional outcomes and quality of life in patients treated with laparoscopic total colectomy for colonic inertia.

PURPOSE: To assess the functional outcomes and quality of life in patients with laparoscopic total colectomy for slow-transit constipation (STC). METHODS: All patients undergoing laparoscopic colectomy with ileorectal anastomosis for colonic inertia at two referral centers were analyzed. Their preoperative, intraoperative and postoperative details were recorded with a one-year follow-up. Their quality of life was assessed using the SF-36 questionnaire. RESULTS: Between 2004 and 2007, 710 patients were evaluated. Eight female patients (1.1 %) fulfilled the criteria for STC without obstructive defecation syndrome. Their mean age was 38 years ± 15 (range from 22 to 62). The conversion rate was 12.5 %. The morbidity rate was 37.5 %, and mortality was nil. The preoperative abdominal pain was 6.6 ± 0.3 and had decreased to 3.6 ± 2.3 postoperatively (P = 0.008). At 1 year, the defecation frequency per week had increased from 0.84 ± 0.24 to 6.75 ± 3.4 (P = 0.001). Three patients developed nocturnal leakage (37.5 %). Eighty-eight percent of the patients recommend the procedure. All parameters of the SF-36 questionnaire had improved at the one-year follow-up examination. CONCLUSION: Laparoscopic colectomy for slow-transit constipation is safe and increased the number of evacuations per week. Although nocturnal leakage may occur, these patients experience improvements in their quality of life.

[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.

[Transposition of gracilis muscle for treatment of recurrent anal and rectovaginal fistula].

BACKGROUND: Rectovaginal fistula is defined as a result of an abnormal connection between the rectum and vagina. It is often a result of inflammatory bowel disease, iatrogenic illness, malignancy or trauma. Rectovaginal fistula treatment is dependent on the classification of the fistula (simple or complex). There are few reports on transposition of gracilis muscle as a feasible option for treatment of rectal, vaginal and urethral fistula. CLINICAL CASES: We present the first three case experiences from the Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran," a tertiary-care medical center in Mexico City. CONCLUSIONS: Gracilis muscle transposition is a feasible procedure in our population for treatment of recurrent rectovaginal and anorectal fistulas.

Interposición de músculo gracilis para reparar fístulas ano y rectovaginales recurrentes / Transposition of gracilis muscle for treatment of recurrent anal and rectovaginal fistula

Introducción: La fistula rectovaginal por definición es la que comunica la región anorrectal hacia la pared posterior de la vagina, como resultado de enfermedad inflamatoria intestinal, lesión iatrogénica, malignidad y trauma. El tratamiento depende de la clasificación de la fístula (simple o compleja). Existen a la fecha pocas publicaciones acerca del uso de la interposición del músculo gracilis como tratamiento factible y seguro para las fístulas rectales, vaginales y uretrales. Casos clínicos: En este artículo presentamos la experiencia inicial en tres pacientes a quienes se les realizó interposición del músculo gracilis, en el Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, centro médico de tercer nivel en la ciudad de México. Conclusiones: El uso de músculo gracilis para reparar fístulas rectovaginales y anorrectales complejas es aplicable en nuestro medio si bien debe limitarse a fístulas recurrentes, después de haber fracasado con otros procedimientos.

BACKGROUND: Rectovaginal fistula is defined as a result of an abnormal connection between the rectum and vagina. It is often a result of inflammatory bowel disease, iatrogenic illness, malignancy or trauma. Rectovaginal fistula treatment is dependent on the classification of the fistula (simple or complex). There are few reports on transposition of gracilis muscle as a feasible option for treatment of rectal, vaginal and urethral fistula. CLINICAL CASES: We present the first three case experiences from the Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran," a tertiary-care medical center in Mexico City. CONCLUSIONS: Gracilis muscle transposition is a feasible procedure in our population for treatment of recurrent rectovaginal and anorectal fistulas.