Case report of a traumatic rectal neuroma

Traumatic neuroma is a well-recognized complication of lower extremity amputation,yet has also been noted to occur elsewhere.We report a clinical case and English-language literature review of traumatic rectal neuroma,a well-known pathologic entity not previously reported in this anatomic location.

The impact of surgeon choices on costs associated with uncomplicated minimally invasive colectomy:you are not as important as you think

Background:There is increasing public discussion about the escalating cost of healthcare in America.There are no published data regarding the contribution of individual surgeons’choices on the cost of uncomplicated minimally invasive colectomy.Methods:A review of a hospital cost-accounting database of the direct costs related to the index operation and postoperative care of all patients who underwent elective minimally invasive segmental colectomy over a 1-year period was performed.Results:A total of 111 cases were enrolled in this study,18 of which were performed robotically.The average direct cost after minimally invasive colectomy was$5536.The cost of robotic colectomy was 53%greater than laparoscopic($7806 vs$5096,p<0.001).There was no statistically significant difference in overall costs among laparoscopic cases performed by three surgeons($5099 vs$5108 vs$5055,p¼0.987).Average operating room supply costs among the three surgeons were$1236,$1105 and$1030,respectively(p¼0.067),with a standard deviation of$328(6.4%of overall cost).Conclusions:No significant difference in overall costs between surgeons was demonstrated despite varied training,experience levels and operative techniques.Total costs are relatively institutionally fixed and minimally influenced by variations in individual surgeon preferences.

Changing approaches to rectal prolapse repair in the elderly

Aim:The abdominal approach to rectal prolapse is associated with lower rates of recurrence but a higher chance of complications and has been traditionally reserved for younger patients.However,longer life expectancy and wider use of laparoscopic techniques necessitates another look at the abdominal approach in older patients.Methods:This was a retrospective review of data from patients undergoing abdominal repair of rectal prolapse between 2005 and 2011.Results:Forty-six abdominal repairs(laparoscopic or open suture rectopexy,sigmoidectomy and rectopexy and low anterior resection)were performed during the study period.Twenty-nine repairs(63%)were performed in patients under the age of 70(average age 51)and 17(37%)in patients older than 70(average age 76;range 71-89).Most of the cases performed during the initial 3 years of the study were via laparotomy.However,in the last 4 years,the laparoscopic approach was used in 83%of younger patients and 69%of older patients.Average length of stay was 2.6 days for younger and 3.8 days for older patients.Both groups had similar rates of re-admission:20%vs 23%.The rate of wound infection was higher in the younger patients(5%vs nil).However,rates of urinary tract infection,two instances(10%)vs four(30%),urinary retention,one instance(5%)vs two(15.4%),ileus,one instance(5%)vs two(15.4%)were higher in the older group.Conclusion:Wider use of laparoscopy has precipitated a change in the approach to rectal prolapse in older patients.Although associated with a slightly higher rate of post-operative complications,the abdominal approach to rectal prolapse is feasible,safe and effective in patients older than 70 years.