Surgery Today (Surg Today)

Publications in this journal

• Article: Atrial fibrillation after esophageal cancer surgery: an analysis of 207 consecutive patients.

  Toshiyasu Ojima, Makoto Iwahashi, Mikihito Nakamori, Masaki Nakamura, Masahiro Katsuda, Takeshi Iida, Keiji Hayata, Hiroki Yamaue
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  ABSTRACT: PURPOSE: The aim of this study was to identify perioperative risk factors that are associated with postoperative atrial fibrillation (AF) and the outcomes of different pharmacological interventions in esophageal cancer patients who underwent transthoracic esophagectomy. METHODS: This study included 207 patients who underwent a transthoracic esophagectomy for esophageal cancer resection by a single surgeon from January 1, 2004, through December 31, 2010. RESULTS: Postoperative AF occurred in 19 patients (9.2 %), all of whom received antiarrhythmic drug therapy at the early stage. Antiarrhythmic treatment was effective in 12 cases (63.2 %). In this study, landiolol hydrochloride, an ultrashort-acting β1-selective β-blocker, was the first-line therapy for postoperative AF. A multivariate logistic regression analysis showed that postoperative AF was significantly associated with the use of an ileo-colon for reconstruction after esophagectomy (P = 0.0023, odds ratios [OR] = 13.6) and with the presence of tachycardia with a heart rate of >100 bpm on postoperative day (POD) 1 (P = 0.0004, OR = 18.4). CONCLUSIONS: Postoperative AF is associated with the use of a colon conduit for reconstruction after esophagectomy and with tachycardia with a heart rate >100 bpm on POD 1. Identifying patients at high risk for postoperative AF will allow for more direct application of pharmacological methods of prophylaxis.
  Surgery Today 05/2013;
• Article: Hemorrhage from the pancreatic cut end into the jejunum after binding pancreaticojejunostomy: report of a case.

  Akari Itoyama, Daisuke Hashimoto, Hideharu Tsutsumi, Akira Chikamoto, Toru Beppu, Yutaka Sasaki, Hideo Baba
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  ABSTRACT: Recent studies have described that binding pancreaticojejunostomy (PJ) decreased the incidence of postoperative pancreatic fistulas and complications after pancreaticoduodenectomy. We herein describe the case of a 77-year-old male with papilla of Vater cancer who underwent subtotal stomach-preserving pancreaticoduodenectomy with end-to-side binding PJ. He developed postoperative gastrointestinal bleeding from the pancreatic cut end three separate times. Transcatheter arterial embolization was performed for the first bleeding event. Surgical hemostasis was performed and a temporary jejunostomy was constructed at the jejunal stump for the second event. For the third bleeding event, endoscopic coagulation through the jejunostomy was performed successfully, and no further bleeding was noted.
  Surgery Today 05/2013;
• Article: Successful resection of a primary cardiac fibroma in a neonate: report of a case.

  Xian-Gang Yan, Bing Jia, Bing-Xue Zhu, Xi-Hong Hu
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  ABSTRACT: During the fetal-neonatal period, a primary cardiac tumor may be completely asymptomatic and such tumors may be incidentally discovered by echocardiography. A four-hour-old male was diagnosed to have a cardiac tumor by post-natal echocardiography and was observed closely. Surgery was indicated immediately at the 3 week follow-up examination when the tumor was found to have obstructed the right ventricle outflow. The tumor was resected successfully and its histopathology indicated that it was a fibroma. Follow-up echocardiograms and magnetic resonance imaging 5 months postoperatively demonstrated no evidence of any remaining tumor and his RV function was good.
  Surgery Today 05/2013;
• Article: Landiolol hydrochloride for early postoperative tachycardia after transthoracic esophagectomy.

  Kazuhiko Mori, Kazuhiko Yamada, Takashi Fukuda, Takashi Mitsui, Takayuki Kitamura, Daisuke Yamaguchi, Jiro Ando, Ikuo Wada, Sachiyo Nomura, Nobuyuki Shimizu, Yasuyuki Seto
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  ABSTRACT: PURPOSE: To validate the safety and efficacy of landiolol, a beta1-selective blocker, as a primary care option for postoperative tachycardia after transthoracic esophagectomy. METHODS: The subjects were 74 consecutive patients who underwent esophagectomy between May 2008 and December 2009. Patients who developed tachycardia with a heart rate >120 bpm for >5 min were defined as candidates for the use of landiolol. The rate of successful heart control without adverse effects was the primary endpoint. The reduction of the rate pressure product (RPP) and heart rate were used as secondary endpoints. RESULTS: Thirteen patients (18 %) were treated with landiolol for postoperative tachycardia. No adverse effects were observed. Successful management using landiolol alone was achieved in 10 of the 13 patients (77 %). Of the three patients for whom landiolol treatment was unsuccessful, two were also not successfully managed promptly by other treatments. The heart rate and RPP were reduced by landiolol, with median changes of 38 and 44 %, respectively, without significant negative inotropic effects. CONCLUSIONS: Although our sample size was small, an improved cardiac performance and no severe negative inotropic effects were observed with the use of landiolol. Landiolol could therefore be an efficient and safe choice for the management of postoperative tachycardia after esophagectomy.
  Surgery Today 05/2013;
• Article: Colorectal cancer and hypercoagulability.

  Kazushige Kawai, Toshiaki Watanabe
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  ABSTRACT: Since the first report of the spontaneous appearance of venous thrombophlebitis as a sign of visceral cancer by Trousseau in 1865, many other studies have documented the existence of cancer-associated coagulation disorders. In this review, we describe the hypercoagulable state associated with colorectal cancer, from three perspectives: first, the incidence, risk factors and prevention of clinically symptomatic thromboembolic conditions associated with cancer, such as venous thromboembolism and arterial thrombosis; second, the association between hypercoagulable conditions, such as thrombocytosis, hyperfibrinogenemia, or D-dimer elevation, and the clinical progression and poor prognosis of cancer patients; third, the experimental approach to elucidate the role of various coagulation-related factors in the process of cancer progression, focusing specifically on the role of platelets and tissue factors.
  Surgery Today 05/2013;
• Article: A single-center study of vascular access sites for intravenous ports.

  Ching-Feng Wu, Po-Jen Ko, Ching-Yang Wu, Yun-Hen Liu, Tsung-Chi Kao, Sheng-Yueh Yu, Hao-Jui Li, Hung-Chang Hsieh
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  ABSTRACT: PURPOSE: This study evaluated the use of intravenous ports and provides a guide related to clinical decision making. METHODS: This study retrospectively reviewed 1505 patients who had received intravenous ports at Chang Gung Memorial Hospital in 2006. The relationships between the complications and entry routes were assessed. The intervention-free periods were also determined and compared. The patients were followed up until June 2010. RESULTS: Of the 1543 procedures performed, 412 were reinterventions to treat complications, most of which corresponded to fewer than 0.1 episodes per 1000 catheter-days; these were not associated with any particular entry route. There was a higher catheter fracture rate when the right subclavian vein was chosen as the entry vessel (p < 0.05). The intervention-free period ranged from 207 to 533 days. CONCLUSION: The subclavian vein is not recommended for the use of intravenous ports. There is not only a higher risk of iatrogenic pneumothorax or hemothorax using this entry route but also a higher fracture rate, which may be caused by pinch-off syndrome. The greater saphenous vein should only be considered when the patient has superior vena cava syndrome. However, a higher incidence of infection and a lower device survival rate should be expected with this location.
  Surgery Today 05/2013;
• Article: Potential value of sonazoid-enhanced intraoperative laparoscopic ultrasonography for liver assessment during laparoscopy-assisted colectomy.

  Tetsuya Itabashi, Akira Sasaki, Koki Otsuka, Toshimoto Kimura, Hiroyuki Nitta, Go Wakabayashi
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  ABSTRACT: PURPOSE: Laparoscopy-assisted colectomy (LAC) has gained acceptance for the treatment of colorectal cancer. However, conventional palpation of the liver and adequate observation of the abdominal cavity are not achievable during LAC. The aim of this study was to assess the clinical value of using Sonazoid (contrast enhanced)-intraoperative laparoscopic ultrasonography (S-IOLUS) in patients with primary colorectal cancer. METHODS: From May 2005 to August 2008, 454 patients underwent 339 LACs and 115 open colectomies for colorectal cancer. One hundred forty-eight patients with clinical stage II or III colorectal cancer, as determined by preoperative imaging, who were undergoing LACs were prospectively enrolled. RESULTS: Although IOLUS did not detect any lesions, small hypoechoic lesions were detected by the S-IOLUS (n = 71) in the Kupffer-phase view of two patients (2.8 %). None of the 71 patients who underwent S-IOLUS showed liver metastases within 6 months after LAC. In the conventional IOLUS group (n = 77), metastatic lesions were identified in two patients (2.6 %). The new liver metastases in these two patients were detected within 6 months after LAC. CONCLUSIONS: S-IOLUS of the liver during colorectal cancer surgery is useful for staging and as a diagnostic modality. It can identify lesions that are undetectable by preoperative imaging, and may be considered for routine use during LAC.
  Surgery Today 05/2013;
• Article: Laparoscopic mesh-augmented hiatoplasty without fundoplication as a method to treat large hiatal hernias.

  Georg R Linke, Tobias Gehrig, Lena V Hogg, Anna Göhl, Hannes Kenngott, Fritz Schäfer, Lars Fischer, Carsten N Gutt, Beat P Müller-Stich
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  ABSTRACT: PURPOSE: Laparoscopic hiatal hernia repair with additional fundoplication is a commonly recommended standard surgical treatment for symptomatic large hiatal hernias with paraesophageal involvement (PEH). However, due to the risk of persistent side effects, this method remains controversial. Laparoscopic mesh-augmented hiatoplasty without fundoplication (LMAH), which combines hiatal repair and mesh reinforcement, might therefore be an alternative. METHODS: In this retrospective study of 55 (25 male, 30 female) consecutive PEH patients, the perioperative course and symptomatic outcomes were analyzed after a mean follow-up of 72 months. RESULTS: The mean DeMeester symptom score decreased from 5.1 to 1.8 (P < 0.001) and the gas bloating value decreased from 1.2 to 0.5 (P = 0.001). The dysphagia value was 0.7 before surgery and 0.6 (P = 0.379) after surgery. The majority of the patients were able to belch and vomit (96 and 92 %, respectively). Acid-suppressive therapy on a regular basis was discontinued in 68 % of patients. In 4 % of patients, reoperation was necessary due to recurrent or persistent reflux. A mesh-related stenosis that required endoscopic dilatation occurred in 2 % of patients. CONCLUSIONS: LMAH is feasible, safe and provides an anti-reflux effect, even without fundoplication. As operation-related side effects seem to be rare, LMAH is a potential treatment option for large hiatal hernias with paraesophageal involvement.
  Surgery Today 05/2013;
• Article: A case-matched comparison of the short-term outcomes between laparoscopic and open abdominoperineal resection for rectal cancer.

  Ryo Inada, Seiichiro Yamamoto, Taihei Oshiro, Masashi Takawa, Shin Fujita, Takayuki Akasu
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  ABSTRACT: PURPOSE: The aim of this study was to evaluate the short-term surgical outcomes of laparoscopic abdominoperineal resection (APR) for rectal cancer, by comparing it with a case-control series of open APR. METHODS: Fourteen patients with rectal cancer who underwent laparoscopic APR between August 2004 and November 2011 were compared with the open APR group of 14 patients matched for age, gender, and surgical procedure. RESULTS: There were no cases of conversion to laparotomy in the laparoscopic APR group and no mortality in either of the groups. The median operation was longer (P = 0.002), but the median amount of blood loss was smaller (P = 0.019), in the laparoscopic APR group. The median length of hospital stay of the laparoscopic APR group was 8 days, shorter than that of the open APR group (16 days, P < 0.001). The changes of the WBC count and serum CRP level after operations were significantly smaller in the laparoscopic APR group (P < 0.05). There were no significant differences between the groups in terms of the perioperative morbidity and readmission rates within 30 days. CONCLUSION: Patients undergoing laparoscopic APR had superior perioperative outcomes to those undergoing open APR, except for the longer operation.
  Surgery Today 05/2013;
• Article: Massive hemorrhage after Kasai portoenterostomy in a patient with a congenital extrahepatic portosystemic shunt, malrotation and a double aortic arch: report of a case.

  Shinya Takazawa, Hiroo Uchida, Hiroshi Kawashima, Yujiro Tanaka, Kaori Sato, Takahiro Jimbo, Kyoichi Deie, Kazuki Koiwai, Koji Nomura, Tadashi Iwanaka
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  ABSTRACT: A newborn female was transferred to our hospital presenting with severe respiratory distress. She underwent tracheal intubation and nasogastric tubing. Investigations revealed a congenital extrahepatic portosystemic shunt (CEPS) type 1, biliary atresia, heterotaxia, polysplenia, malrotation and a double aortic arch (DAA). She underwent the Kasai portoenterostomy and the Ladd procedure when she was 29 days old. On postoperative day 20, she developed sudden hematemesis with bright red blood. Endoscopy showed massive bleeding from an esophageal ulcer, and endoscopic therapy was performed successfully. During left thoracotomy, an aortoesophageal fistula (AEF) was detected and repaired by direct suturing. The postoperative course was uneventful. CEPS type 1 is commonly associated with other congenital malformations; however, there have been no previous reports of an association between CEPS and DAA. Nasogastric tube insertion in a patient with DAA can result in catastrophic AEF. The treatment strategy should be carefully considered in patients with CEPS type 1 and multiple congenital fetal anomalies.
  Surgery Today 05/2013;
• Article: Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity.

  Koji Okabayashi, Hutan Ashrafian, Emmanouil Zacharakis, Hirotoshi Hasegawa, Yuko Kitagawa, Thanos Athanasiou, Ara Darzi
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  ABSTRACT: Abdominal adhesions are associated with increased postoperative complications, cost and workload. We performed a systematic review with statistical pooling to estimate the formation rate, distribution and severity of postoperative adhesions in patients undergoing abdominal surgery. A literature search was carried out for all articles reporting on the incidence, distribution and severity of adhesions between January 1990 and July 2011. Twenty-five articles fulfilled the inclusion criteria. The weighted mean formation rate of adhesions after abdominal surgery was 54 % (95 % confidence interval [CI] 40-68 %), and was 66 % (95 % CI 38-94 %) after gastrointestinal surgery, 51 % (95 % CI 40-63 %) after obstetric and gynaecological surgery and 22 % (95 % CI 7-38 %) after urological surgery. The mean overall severity score was 1.11 ± 0.98 according to the Operative Laparoscopy Study Group classification. Laparoscopic surgery reduced the adhesion formation rate by 25 % and decreased the adhesion severity score (laparoscopic; 0.36 ± 0.69 vs. open; 2.14 ± 0.84) for gastrointestinal surgery. Our results demonstrate that the incidence and severity of abdominal adhesions varies between surgical specialties and procedures. An increased awareness of adhesions can help in identifying the underlying mechanisms of adhesion formation and novel therapeutic approaches, while also improving the surgical consent process.
  Surgery Today 05/2013;
• Article: Development of gelatin flakes, a new type of anti-adhesive material: a preliminary study of in vivo rat adhesion models.

  Hiroyuki Tsujimoto, Hideki Takamori, Misaki Tsuji, Maho Hayashi, Junki Ikeda, Taichi Orikasa, Hiroko Torii, Yuki Ozamoto, Shuko Suzuki, Shinichiro Morita, Yoshito Ikada, Akeo Hagiwara
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  ABSTRACT: To overcome the problems associated with sheet- or film-type anti-adhesive materials, we developed a new type of anti-adhesive material, gelatin flakes. We made two types of gelatin flakes with or without thermal cross-linking, and preliminarily examined their basic properties and the anti-adhesive efficacy using a rodent adhesion model. Both types of the gelatin flakes rapidly turned into gel and tightly attached the injured surfaces, absorbing the moisture and blood, when applied onto the abraded sites of rats. In addition, these flakes could be sprayed into the desired area by compressed air through a device with a long, thin tube, which could be used in laparoscopic surgery. The anti-adhesive effects of both types of gelatin flakes were similar, and both types were significantly superior compared to the non-treated group. Although further investigations are necessary, the gelatin flakes have unique and useful properties and satisfactory anti-adhesive effects, which indicate that they may be applicable in laparoscopic surgery.
  Surgery Today 05/2013;
• Article: CAM 5.2 shows specific reactivity for cytokeratin 8, but less strict reactivity for cytokeratin 7 and no reactivity for cytokeratin 18: in response to "Fujikawa T, Tanaka A, Abe T et al. 'Undifferentiated carcinoma of the common bile duct with intraductal tumor thrombi: report of a case'. Surg Today 2011;41(4):579-84."

  Chiew-Loon Koo, Wan-Ru Chao, Chi-Kuan Chen, Chih-Ping Han
  Surgery Today 05/2013;
• Article: Carcinosarcoma of the liver: report of a case.

  Takatsugu Yamamoto, Yukiko Kurashima, Kazunori Ohata, Ryoya Hashiba, Shogo Tanaka, Takahiro Uenishi, Koichi Ohno, Takashi Ikebe, Katsuhiko Miyaji, Nobusuke Fukumoto
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  ABSTRACT: A 64-year-old Japanese woman without a history of viral hepatitis was admitted for investigation of a huge liver mass. The tumor, measuring 14 × 12 × 22 cm, had invaded the diaphragm, right lung, and inferior vena cava. Serum examinations demonstrated high levels of carbohydrate antigen 19-9 (CA19-9), and the Child-Pugh score was A. She underwent right lobectomy of the liver and partial resection of the right diaphragm, right lung, and inferior vena cava. Radio- and chemotherapy were also given, but she died of recurrence 3 months after surgery. Microscopically, the tumor exhibited intermingled adenocarcinomatous and atypical mesenchymal components. The carcinomatous component was positive for cytokeratins 7, 19, and 20, chromogranin A, epithelial membrane antigen, c-KIT, and vimentin. The sarcomatous component was positive for vimentin and c-KIT. A review of 36 cases of hepatic carcinosarcoma revealed the following: chronic hepatitis or cirrhosis in 57 % of the patients; increased serum CA19-9 levels in 30 %; a mean tumor diameter of 10 cm; invasion of the adjacent organs or metastasis to distant organs in 47 %; wide intrahepatic infiltration in 44 %; and 50 % survival of only 5 months. Significant differences were seen according to tumor diameter (diameter >5 cm; p < 0.05), wide intrahepatic infiltration (p < 0.05), and extrahepatic invasion/metastasis (p < 0.01). Neither chemotherapy nor radiotherapy contributed to prognosis, but surgical resection resulted in some improvement (p < 0.05).
  Surgery Today 05/2013;
• Article: Increase of bone morphogenetic protein-7 expressing pulmonary resident cells in pneumonectomized rats.

  Taro Ohba, Hironobu Wada, Ichiro Yoshino, Shigetoshi Yoshida, Tetsuzo Tagawa, Fumihiro Shoji, Koji Yamazaki, Yoshihiko Maehara
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  ABSTRACT: PURPOSE: Compensatory lung growth (CLG) is recognized in rodents subjected to major pulmonary resection; however, the source of cells constituting regenerated tissues during the CLG is still unknown. We investigated the differentiation of lung resident cells and the participation of bone marrow (BM)-derived cells in the remnant lung of pneumonectomized rats. METHODS: After left pneumonectomy, the right remnant lung of Wistar rats was subjected to morphologic and molecular experiments at several time points. We studied the expression of bone morphogenic protein 7 (BMP-7), an accelerator of epithelial differentiation, based on the gene expression profile data of the remnant lung. Next, we evaluated the presence of GFP-positive cells in the remnant lung of Wistar rats that had received BM transplantation from green fluorescent protein (GFP) gene-transgenic Wistar rats prior to left pneumonectomy. RESULTS: We observed progression of emphysematous change, modulation of gene expression profile, and proliferating cellular nuclear antigen-positive cells in the alveoli of the remnant lungs. BMP-7 protein positive cells were detected in the alveolar septa, which increased significantly over time with the progression of emphysematous change. No bone marrow-derived cells were detected in the right remnant lung of the GFP-BM transferred rats by fluorescence microscopy, immunohistochemistry, or polymerase chain reaction at any time. CONCLUSION: Lung resident cells appear to contribute to CLG, possibly via a trans-differentiation pathway.
  Surgery Today 05/2013;
• Article: Positive action is required to achieve the 2020.30 goal of gender equality in Japanese medical societies.

  Keiko Hiyama, Makiko Ozaki, Keiko Hayano, Noriko Yamamoto, Hiroshi Bando, Kenji Maeda, Yasuki Kihara, Atsuko Murashima
  Surgery Today 05/2013;
• Article: Single coronary artery with bicuspid aortic valve stenosis and aneurysm of the ascending aorta: report of a case.

  Narihiro Ishida, Katsuya Shimabukuro, Yukihiro Matsuno, Hiroki Ogura, Hirofumi Takemura
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  ABSTRACT: A 73-year-old man with a severely stenosed bicuspid valve and an aneurysm of the ascending aorta underwent valve and aortic surgery. Preoperative imaging revealed a single coronary artery arising from the right side of the sinus of Valsalva and a branch that perfused into the left side of the heart to pass through the front of the pulmonary artery. We replaced the aortic valve and ascending aorta, painstakingly avoiding damage to the coronary artery and obstruction of the sole coronary ostium.
  Surgery Today 04/2013;
• Article: Surgical repair of Kommerell's diverticulum and an aberrant subclavian artery.

  Soh Hosoba, Tomoaki Suzuki, Tohru Asai, Hiromitsu Nota, Satoshi Kuroyanagi, Takeshi Kinoshita, Noriyuki Takashima, Masato Hayakawa
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  ABSTRACT: PURPOSE: The coexistence of Kommerell's diverticulum and an aberrant subclavian artery (ASCA) is a rare congenital variation of the vascular structure. We report our experience of treating aneurysms associated with these anomalies. METHODS: Between June 2007 and November 2011, five consecutive patients underwent repair of an aneurysm associated with Kommerell's diverticulum and an ASCA at Shiga University Hospital. Four of the five patients had a right-sided aortic arch associated with the ASCA. One patient underwent emergency surgery for a ruptured thoracic aneurysm. The operations performed were descending aorta replacement through right thoracotomy in one patient and total arch replacement through a median thoracotomy, under deep hypothermic circulatory arrest and selective cerebral perfusion, in four patients. No staged operation was required. RESULTS: One patient died of mediastinitis, subsequent to a ruptured Kommerell's diverticulum, 45 days postoperatively. There were no other deaths in the early or late (6-58 months) postoperative period. One patient required re-exploration for bleeding, but none of the patients suffered neurologic complications. CONCLUSIONS: Aortic disease with an ASCA and Kommerell's diverticulum can be repaired safely under elective conditions.
  Surgery Today 04/2013;
• Article: Interposition of the hernia sac as a protective layer in repair of giant incisional hernia with polypropylene mesh.

  Mustafa Hasbahceci, Fatih Basak
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  ABSTRACT: BACKGROUND AND PURPOSE: Repair of giant incisional hernia is still associated with high postoperative morbidity and recurrence rates. We evaluated the effectiveness of placing the hernia sac between the viscera and the polypropylene mesh in the repair. METHODS: The subjects of this study were patients with an incisional hernia at least 15 cm in diameter, diagnosed between June 2004 and October 2010 and treated with on-lay polypropylene mesh at least 25 cm in length. We operated using a simplified method of placing the hernia sac between the viscera and the mesh, and fixing the mesh with interrupted trans-fascial U sutures. We evaluated the patient demographics and postoperative complications retrospectively. RESULTS: A total of 25 patients (mean age 57.1 ± 10 years) were included. The mean length of hospital stay was 1.8 ± 1.2 days. Seroma developed in four patients (16 %), but only two with cystic seroma required excision of the cyst wall with preservation of the mesh. Twenty-two patients (88 %) were followed up for a mean period of 42.6 ± 23 months. There was no incidence of chronic pain, hospitalization for intestinal obstruction, or enterocutaneous fistulization. There was only one recurrence (4.55 %). CONCLUSION: The hernia sac can be interposed in all patients undergoing giant incisional hernia repair if direct contact between the polypropylene mesh and intestine is unavoidable.
  Surgery Today 04/2013;
• Article: Key techniques for orthotopic liver transplantation model with a 30 % graft in swine.

  Tomohide Hori, Shintaro Yagi, Taku Iida, Kentaro Taniguchi, Chiduru Yamamoto, Yusuke Okamura, Kohei Ogawa, Shinji Uemto
  Surgery Today 04/2013;