[Colorectal anastomosis using a compression device]. / Anastomosis colorrectales por compresión utilizando el dispositivo NiTi.

BACKGROUND: The most severe complication following an intestinal anastomosis is the dehiscence with the consequent development of sepsis, fistulas, stenosis, and death. For this reason the compression anastomosis (NiTi) system was developed, with the aim of reducing these complications. MATERIAL AND METHODS: A retrospective study was conducted, from 1 June 2012 to 30 August 2014, on total of 14 patients operated on the Humanitas Hospital Medical Group Coyoacán, the ASMED, and Clínica Médica Sur. The subjects were predominantly male 65%, a mean age of 58 years, with range 30-79 years. RESULTS: A total of 14 patients were included. The indication for surgery was complicated diverticular disease Hinchey II-III (36%), and the procedures performed were: 6 (43%) left hemicolectomy with primary end to end compression anastomosis, 2 (14%) major complications (dehiscence wall and anastomosis), 1 (7%) minor complication (infection of the soft tissues). There was a mean 98ml (range 20-300ml) of intraoperative bleeding, with start of oral feeding on the second day, a mean hospital stay of 4 days (range 2-10), one patient with ileo-rectal anastomosis dehiscence presented on the 4th post-operative day, and performing anastomosis with stapling device and loop ileostomy. Stenosis developed in 7% during follow-up and was resolved with a new anastomosis stapler. CONCLUSIONS: The NiTi device is an additional alternative for colorectal anastomosis, mainly in low anastomosis, obtaining good results in this study without major complications.

[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.

Interposition of gracilis muscle for rectourethral fistula repair: case report.

BACKGROUND: Rectourethral fistula is a rare disease with a difficult surgical treatment. The etiology of rectourethral fistula is iatrogenic, secondary to prostate surgery, pelvic radiotherapy and a rare complication of rectal surgery. Surgical treatment options for rectourethral fistula are diverse. Interposition of gracilis muscle has a curative index of 100% with close surveillance, as reported by Nyham. CLINICAL CASE: We present a case of a 58-year-old male with iatrogenic rectourethral fistula secondary to radical prostatectomy and who was treated with interposition of the gracilis muscle. Eight weeks after surgery and with colostomy closed, no evidence of recurrence was detected. CONCLUSIONS: Interposition of the gracilis muscle requires a multidisciplinary approach and demonstrates good shortterm results.

[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.