Rectosigmoidectomía perineal para el tratamiento del prolapso rectal completo / Perineal rectosigmoidectomy for the treatment of rectal prolapse

Objetivo: Presentamos nuestra experiencia en el tratamiento quirúrgico de esta patología con la técnica de la rectosigmoidectomía perineal. Material y método: Se trata de una serie retrospectiva, consecutiva de 17 pacientes. Resultados: Predomina el género femenino y el promedio de edad es de 62 años. La morbilidad alcanza el 23%, aunque casi toda de menor gravedad, con solo un paciente reoperado. La recidiva es del 6%, con mejoría de los síntomas en un 88%. Conclusión: Concluimos que es una técnica segura, con una morbilidad controlada y con buenos resultados a mediano plazo con un adecuado control de la recidiva y mejoría de la continencia en un alto porcentaje de los pacientes.

Aim: We present our experience with perineal rectosigmoidectomy for the treatment of rectal prolapse. Material and method: It is a retrospective, consecutive series of 17 patients. Results: Predominantly female and the average age is 62 years. Morbidity reached 23%, but almost all less serious, with only one reoperation. Recurrence is 6%, and the improvement in continence is 88%. Conclusion: We conclude that it is a safe technique with a controlled morbidity and good results with low recurrence and improvement of continence in a high percentage of patients.

Perineostomy: the last oportunity

Objective To review the technique and outcome of perineal urethrostomy or urethral perineostomy and to identify factors related to the procedure failure. Material and methods We studied 17 patients who underwent perineal urethrostomy between 2009-2013 in a single hospital. Success was defined as no need for additional surgical treatment or urethral dilatation. We reviewed the clinical data related to age, weight, previous urethral surgery, diabetes, hypertension, ischemic cardiopathy, lichen sclerosus and other causes and studied their association with the procedure failure (univariate analysis). We completed the analysis with a multivariate test based on binary regression. Results The average follow-up was 39.41 months. From all the causes, we found Lichen Sclerosus in 35%, idiopathic etiology in 29% and prior hypospadia repair in 18%. Postoperative failure occurred in 3 patients, with a final success of 82.4%. The binary regression model showed as independent risk factors ischemic cardiopathy (OR: 2.34), and the presence of Lichen Sclerosis (OR: 3.21). Conclusions The success rate with the perineal urethrostomy technique shows it to be a valid option above all when we preserve the urethral blood supply and plate. Lichen sclerosus and ischemic vascular problems are risk factors to re-stenosis. .

Perineal colostomy: an alternative to avoid permanent abdominal colostomy: operative technique, results and reflection / Colostomia perineal: uma alternativa para evitar a colostomia abdominal definitiva: técnica operatória, resultados e reflexão

BACKGROUND: The most common injury to indicate definitive stoma is rectal cancer. Despite advances in surgical treatment, the abdominoperineal resection is still the most effective operation in radical treatment of malignancies of the distal rectum invading the sphincter and anal canal. Even with all the effort that surgeons have to preserve anal sphincters, abdominoperineal amputation is still indicated, and a definitive abdominal colostomy is necessary. This surgery requires patients to live with a definitive abdominal colostomy, which is a condition that modify body image, is not without morbidity and has great impact on the quality of life. AIM: To evaluate the technique of abdominoperineal amputation with perineal colostomy with irrigation as an alternative to permanent abdominal colostomy. METHOD: Retrospective analysis of medical records of 55 patients underwent abdominoperineal resection of the rectum with perineal colostomy in the period 1989-2010. RESULTS: The mean age was 58 years, 40 % men and 60 % women. In 94.5% of patients the indication for surgery was for cancer of the rectum. In some patients were made three valves, other two valves and in the remaining no valve at all. Complications were: mucosal prolapse, necrosis of the lowered segment and stenosis. CONCLUSION: The abdominoperineal amputation with perineal colostomy is a good therapeutic option in the armamentarium of the surgical treatment of rectal cancer. .

RACIONAL: O câncer de reto é o agravo mais frequente para a indicação do estoma abdominal definitivo. Apesar dos avanços no tratamento cirúrgico, a amputação abdominoperineal ainda é a operação indicada mais efetiva nesta indicação com invasão de esfíncter e de canal anal, o que impõe aos pacientes colostomia abdominal definitiva, condição que altera a imagem corporal e grande repercussão na qualidade de vida. OBJETIVO: Avaliar a técnica de amputação abdominoperineal mais colostomia perineal com irrigação como alternativa à colostomia abdominal definitiva. MÉTODO: Análise retrospectiva de prontuário médico de cinquenta e cinco pacientes submetidos à amputação abdominoperineal do reto mais colostomia perineal no período de 1989 a 2010. RESULTADOS: A média de idade foi de 58 anos sendo 40% em homens e 60% em mulheres. Em 94,5% dos pacientes a indicação cirúrgica foi por câncer de reto. Em alguns foram confeccionadas três válvulas, em outros duas e nos demais não foi confeccionada nenhuma válvula. As complicações foram: prolapso mucoso, necrose do segmento abaixado e estenose. CONCLUSÃO: A técnica de amputação abdominoperineal mais colostomia perineal é boa opção terapêutica no arsenal do tratamento cirúrgico do câncer de reto. .

Perineal rectosigmoidectomy on treatment of rectal procidentia: analysis of 48 cases

OBJECTIVE: To evaluate results obtained in 48 cases of perineal rectosigmoidectomy in patients with rectal procidentia. METHODS: 48 medical records of patients undergoing PRS were analyzed, retrospectively. RESULTS: Before surgery, 44 patients (77.1%) reported complaints of anal mass and rectal bleeding was reported 13 times (22.8%). The period of hospitalization was 3.91 days (2 to 12 days). Women were the majority (85.4%). The mean age was 73.8 years (49 to 101 years). The average time of surgery was 72 minutes (40 to 90 minutes). Mechanical anastomosis was performed in 72.9% and manual in 27.1%. Among the 12 (25%) patients with fecal incontinence, continence was achieved in 2 cases. Postoperative complications occurred in five cases - 10.5% (two pneumonia and three anastomotic leakages). Recurrence was verified in four patients (8,3%). There were no deaths related to the procedure. CONCLUSION: Perineal rectosigmoidectomy is a good surgical option for rectal procidentia, with low morbidity and mortality, low recurrence rate and short hospitalization length. (AU)

OBJETIVO: Avaliar o resultado de 48 casos de procidência retal submetidos a retossigmoidectomia perineal. MÉTODO: Análise retrospectiva de 48 prontuários de pacientes submetidos a retossigmoidectomia perineal. RESULTADO: Antes da cirurgia, 44 pacientes (77,1%) queixavam-se de "massa na região anal" e sangramento transretal foi relatado em 13 (22,8%) casos. O tempo de internação médio foi de 3,91 dias (2 a 12 dias). O gênero feminino prevaleceu na amostra (85,4%). A idade média foi 73,8 anos (49 a 101 anos). O tempo médio de cirurgia foi 72 minutos (40 a 90 minutos). Optado por anastomose mecânica em 72,9% dos casos e manual em 27,1%. Entre os 12 (25%) pacientes com incontinência fecal, foi alcançada continência em 2 casos. Complicações pós-operatórias ocorreram em cinco casos - 10,5% (duas pneumonias e três deiscências de anastomose). Recorrência foi verificada em quatro pacientes (8,3%). Não houve óbito relacionado ao procedimento. CONCLUSÃO: A retossigmoidectomia perineal é uma boa opção cirúrgica para procidência retal, com baixa morbimortalidade, baixo índice de recorrência e curta internação hospitalar. (AU)

Abdominoperineal resection does not decrease quality of life in patients with low rectal cancer

PURPOSE: Issues related to body image and a permanent stoma after abdominoperineal resection may decrease quality of life in rectal cancer patients. However, specific problems associated with a low anastomosis may similarly affect quality of life for patients undergoing low anterior resection. The aim of this study was to compare quality of life of low rectal cancer patients after undergoing abdominoperineal resection versus low anterior resection. METHODS: Demographics, tumor and treatment characteristics, and prospectively collected preoperative quality-of-life data for patients undergoing low anterior resection or abdominoperineal resection for low rectal cancer between 1995 and 2009 were compared. Quality of life collected at specific time intervals was compared for the two groups, adjusting for age, body mass index, use of chemoradiation, and 30 days postoperative complications. The short-form-36 questionnaire was used to determine quality of life. RESULTS: The query returned 153 patients (abdominoperineal resection = 68, low anterior resection = 85) with a median follow-up of 24 (3-64) mo. The after abdominoperineal resection group had a higher mean age (63 + 12 vs. 54 + 12, p < 0.001) and more American Society of Anesthesiologists classification 3/4 patients (65 percent vs. 43 percent, p = 0.03) than low anterior resection. Other demographics, tumor stage, use of chemoradiation, overall postoperative complication rates, and quality-of-life follow-up time were not statistically different in both groups. Patients undergoing abdominoperineal resection had a lower baseline short-form-36 mental component score than those undergoing low anterior resection. However, 6 mo after surgery this difference was no longer statistically significant and essentially disappeared at 36 mo after surgery. CONCLUSION: Patients undergoing abdominoperineal resection for low rectal cancer have a similar long-term quality of life as those undergoing low anterior resection. These findings can help clinicians to better counsel patients with low rectal cancer who are being considered for abdominoperineal resection.

Influence of perineal prostatectomy on anal continence

OBJECTIVE: Perineal prostatectomy has been proposed as a less invasive and safe procedure, but the risk of anal incontinence has been studied. This study aimed to evaluate the effects of perineal access on anal continence mechanisms after perineal prostatectomy. METHODS: From August 2008 to May 2009, twenty three patients underwent perineal prostatectomy. These patients were evaluated before surgery and eight months postoperatively using the Cleveland Clinic Anal Incontinence Score, the Fecal Incontinence Quality of Life Score, and anorectal manometry. RESULTS: The mean age of the subjects was 65 (range, 54-72) years, and the mean prostate weight was 34.5 (range, 24-54) grams. Gleason scores ranged from 6-7, and the mean Cleveland Clinic Anal Incontinence Score (mean±;standard deviation) values were 0.9±1.9 and 0.7±1.2 (p.0.05) before and after surgery, respectively. The Fecal Incontinence Quality of Life Score did not change significantly after surgery. The mean values for anal manometric parameters before and after surgery were, respectively: Resting Pressures of 64±23 mmHg and 65±17 mmHg (p = 0.763), Maximum Squeezing Pressures of 130±41 mmHg and 117±40 mmHg (p = 0.259), High Pressure Zones of 3.0±0.9 cm and 2.7±0.8 cm(p = 0.398), Rectal Sensory Thresholds of 76±25 mland71±35 ml (p = 0.539), Maximum Tolerated Rectal Volumes of 157±48 ml and 156±56ml (p = 0.836), and Sphincter Asymmetry Indexes 22.4±9 percent and 14.4±5 percent (p = 0.003). CONCLUSION: There was a significant decrease in the sphincter symmetry index after perineal prostatectomy. With the exception of the sphincter asymmetry index, perineal prostatectomy did not affect anal continence parameters.

Radical perineal prostatectomy and early continence: outcomes after 120 cases

PURPOSE: Evaluate the results of urinary continence on patients who had undergone radical perineal prostatectomy (RPP) for clinically localized prostate cancer. MATERIALS AND METHODS: We analyzed the continence data of 120 patients with pathology of cT1-cT2N0M0 prostate cancer and who had undergone RPP. Continence was assessed on the day of catheter removal, at the end of the first and third month, and the first year postoperatively. The patients who were continent immediately after catheter removal were classified in the group of “immediately continent” while the patients who became continent during the 3 postoperative months were classified as “early continent.” RESULTS: Mean duration of catheterization was 10 (10-25) days. Of 120 patients, 44 (36.7 percent) were immediately continent. At the end of the first and third months, 65 (54.1 percent) and 87 (72.5 percent), respectively, were early continent. At the one-year follow-up, 95.3 percent of 107 cases whose one-year follow-up data were available were continent. When the relationship between patients’ age and continence was analyzed, it was found that the early continence rates were 77.7 percent (7/9), 73.3 percent (33/45), 73.4 percent (36/49), and 64.7 percent (11/17) in the groups of = 49, 50-59, 60-69, and = 70 years, respectively (p = 0.68). CONCLUSIONS: The majority of patients who underwent RPP rapidly regained continence within 3 months. RPP is an exceptional alternative approach for radical surgery in the treatment of localized prostate cancer.

Hidradenite supurativa perineal: avaliaçäo do tratamento cirúrgico em 18 anos de experiência / Perineal suppurative hidranetis: evaluation of surgical treatment

A hidradenite supurativa é definida como uma doença crônica, supurativa, bacteriana, que compromete os ductos das glândulas sudoríparas apócrinas e mistas, causando inflamaçäo. Foram avaliados, retrospectivamente, 27 pacientes portadores de hidradenite perineal, operados no Seviço de Coloproctologia do Hospital Heliópolis-SP, no período de janeiro de 1978 a outubro de 1996. Vinte e seis (96,2 por cento) pacientes eram de sexo masculino, com média etária de 47,6 anos. A localizaçäo foi múltipla na maior parte dos casos, com predomínio nas regiöes perineal, glútea, sacral e escrotal. O tratamento cirúrgico de escolha foi a ressecçäo em bloco em 22 (81,8 por cento) casos e fistulotomia com curetagem do leito e desbridamento das bordas da ferida em cinco (18,2 por cento). Colostomia derivativa foi necessária em sete (25,9 por cento) casos. Em 10 (37 por cento) pacientes foram realizados procedimentos plásticos: em seis, enxerto de pele parcial; em dois, enxerto associado a rotaçäo de retalho e nos outros dois, apenas rotaçäo de retalho. A média de internaçöes foi de 1,6 internaçöes por paciente, com uma média de 13,3 dias por internaçäo. Complicaçäo clínica ocorreu em um (3,4 por cento) foi decorrente de insuficiência renal aguda. Complicaçöes cirúrgicas ocorreram em três (10,2 por cento) casos e foram devidas a abscesso pelvi-retal, infecçäo grave da ferida operatória e invaginaçäo com necrose de mucosa da colostomia. Näo houve óbito e nenhum caso de carcinoma epidermóide associado à hidradenite. Recidiva ocorreu em dois (7,4 por cento) pacientes, os quais foram tratados por novas fistulotomias e curetagem. Concluímos que o tratamento cirúrgico para a hidradenite supurativa é confiável, efetivo e com baixos índices de recidiva