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ABSTRACT: The patient was a male in his 70s with a history of chronic renal failure and dilated cardiomyopathy. In January 2011, he underwent abdominoperineal resection of the rectum, right hepatic lobectomy, and resection of a portal vein tumor thrombus with a diagnosis of rectal cancer and metastatic liver cancer accompanied by portal vein tumor thrombosis. Although 5-fluorouracil + l-leucovorin therapy (RPMI regimen) was carried out as postoperative adjuvant chemotherapy, the tumor marker (CEA and VA19-9) levels increased 8 months after surgery. Since the functions of major organs were impaired, UFT(®) + UZEL(®) therapy was started. The tumor marker levels decreased temporarily, but increased again 12 months after surgery, and so intravenous instillation of panitumumab was initiated. Nine administrations have been performed to date, with no increase in tumor marker levels or exacerbation of the condition. Also, no grade 2 or severer adverse event has been noted according to CTCAE v.4.0. The experience with this patient suggests the possibility that exacerbation of the condition of patients with liver metastasis of colorectal cancer accompanied by portal vein tumor thrombosis with abnormalities in the functions of major organs can be controlled temporarily by the administration of panitumumab alone.
Case Reports in Oncology 05/2013; 6(2):275-9.
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ABSTRACT: Killian-Jamieson diverticulum is a rare hypopharyngeal diverticulum, less commonly encountered compared with Zenker's diverticulum. These hypopharyngeal diverticula that cause dysphagia often mimic a thyroid tumor incidentally detected on neck ultrasonography. However, to our knowledge, Killian-Jamieson diverticula complicated by a thyroid tumor have not been previously described. We experienced a rare case of bilateral Killian-Jamieson diverticula synchronously complicated by a thyroid adenoma in a 74-year-old woman who became aware of dysphagia and a tumor in the left side of her neck. Pharyngoesophagography revealed bilateral diverticula protruding from the lateral wall of the esophagopharyngeal junction, but the appearance of the cricopharyngeal bar representing the cricopharyngeus muscle above the diverticula had become unclear because the thyroid tumor was pressing on the diverticula and the cervical esophagus. However, the diverticula were diagnosed as Killian-Jamieson diverticula because cervical computed tomography showed bilateral diverticula arising from the cervical esophagus just below the level of the cricoid cartilage, and operative finding showed that the diverticula were located above the upper esophageal longitudinal muscle. Radiographic imaging is useful for diagnosis as cause of dysphagia and cervical tumor.
Case Reports in Gastroenterology 01/2013; 7(1):188-194.
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ABSTRACT: Recent technological improvements in laparoscopic devices have significantly extended the surgeon's ability to perform laparoscopic liver surgery safely. Hand-assisted laparoscopy has been proposed in order to achieve greater safety and accessibility in laparoscopic liver surgery. Moreover, in order to expand the indications of minimally invasive liver resection and improve its safety, the "hybrid procedure" or "laparoscopy-assisted resection" has been proposed. Hand-assisted laparoscopic liver resection consists of the placement of a gas-tight port through an 8cm incision that enables a hand to be introduced into the abdomen. The "hybrid procedure" is performed through an 8-12cm midline or subcostal incision. Such a minimal abdominal incision is preferred not only for cosmetic reasons but also for obtaining adequate surgical margin. We performed laparoscopic liver resection via a minimal incision that was based on the measurement of the to-be-resected specimen intraoperatively by ultrasonography. Here, we have described our procedure and evaluated its efficacy.
Hepato-gastroenterology 11/2012; 59(120):2598-601. · 0.66 Impact Factor
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ABSTRACT: Background/Aims: Pancreaticogastrostomy during pancreaticoduodenectomy is associated with a very low rate of anastomotic leakage. However, gastric peristalsis is disturbed by pancreaticogastrostomy, which stabilizes the posterior stomach at that point leading to delayed gastric emptying. We evaluated which anterior gastrostomy, i.e. horizontal or vertical incision on the anterior gastric wall, is better for maintaining peristaltic movement of the anterior stomach to prevent delayed gastric emptying after pancreaticogastrostomy. Methodology: We retrospectively studied 50 patients who underwent subtotal stomach-preserving pancreaticoduodenectomy with pancreaticogastrostomy. These patients were divided into 2 groups depending on the type of anterior gastrostomy: horizontal incision (H group) and vertical incision (V group). Results: The observed grade of delayed gastric emptying was lower in the V group than in the H group; however, the difference was not significant. Conclusions: We conclude that a vertical incision on the anterior gastric wall is preferable for preventing delayed gastric emptying after a pancreaticogastrostomy.
Hepato-gastroenterology 11/2012; 59(120):2627-30. · 0.66 Impact Factor
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ABSTRACT: We experienced a rare case of intussusception due to sigmoid colon cancer during chemotherapy. A-62-year-old female was started on mFOLFOX6 due to sigmoid colon cancer and hepatic metastases(stage IV). After 2 courses, she had abdominal pain and bloody stool. Abdominal ultrasonography showed a target sign, and abdominal CT showed edema of the mucosa of the sigmoid colon and invagination. She was diagnosed with intussusception due to sigmoid colon cancer, and underwent a bloodless reduction. However, because it was unavailable, we performed an emergency operation. The sigmoid colon invaginated 10 cm to the anal side. We then performed sigmoidectomy and lymphadenectomy(D2). The histopathological diagnosis was mucinous carcinoma, stage I. There was no report of intussusception with the chemotherapy. It is important to consider the intussusception of colon cancer even during chemotherapy.
Gan to kagaku ryoho. Cancer & chemotherapy 10/2012; 39(10):1571-3.
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ABSTRACT: Key Words: Juxtapapillary duodenal diverticula; Gallstone disease; Cholangitis; Duodenal switch operation; Choledochojejunostomy. Abbreviations: Common bile duct (CBD); Gall bladder (GB). Background/Aims: Since the first case of juxtapapillary diverticlum reported by Lemmel, several reports have demonstrated an association between periampullary diverticulum and gallstone disease. Thus, we compared the efficiency of the duodenal switch operation and choledchojejunostomy for patients who underwent surgery for cholangitis with juxtapapillary duodenal diverticula. Methodology: We retrospectively studied 17 patients who had cholangitis associated with juxtapapillary duodenal diverticula. These patients were divided into 2 groups on the basis of the operative procedure: the duodenal switch operation group (DS group) and the choledochojejunostomy group (CJ group). Results: The mean operative time and blood loss were significantly lesser in the DS group than in the CJ group (p<0.0001 and p<0.0005, respectively); however, the duration of nasogastric suction requirement and time after which oral ingestion of solid diet could be safely resumed after surgery were significantly longer in the DS group than in the CJ group (p<0.0001 and p<0.0001, respectively). Gallstone formation after the surgery did not occur in both groups. Conclusions: Duodenal switch operation is useful and less invasive for cholangitis associated with juxtapapillary duodenal diverticula and for preventing cholangitis for a long period after the operation; however, gastric stasis still remains a problem with this procedure.
Hepato-gastroenterology 10/2012; 59(119):2075-8. · 0.66 Impact Factor
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ABSTRACT: Key Words: Pancreatic duct patency; Pancreaticoduodenectomy; Pancreaticogastrostomy; Dilated pancreatic duct; Duct-to-mucosa anastomosis. Abbreviations: Pancreaticoduodenectomy (PD); Pancreaticogastrostomy (PG); Modified Subtotal Stomach-Preserving Pancreaticoduodenectomy (MSSPPD)Background/Aims: Patency of pancreaticogastrostomy (PG) is one of the most important factors affecting the function of the remnant pancreas and quality of life. We evaluated the early postoperative changes in pancreatic duct dilation after pancreaticoduodenectomy (PD) and PG with duct-to-mucosa anastomosis in patients with remarkably dilated pancreatic ducts. Methodology: We retrospectively analyzed 26 patients who had remarkably dilated pancreatic ducts (diameter,>=7mm) and who underwent PD followed by PG. They were divided into 2 groups on the basis of the endoscopic findings of the anastomotic orifice of PG: Group A, clear pancreatic duct orifice with pancreatic juice output; and Group B, unclear pancreatic duct orifice with pancreatic juice output. Results: The mean diameter of the duct of the remnant pancreas after the surgery was smaller in Group A than in Group B. With regards to postoperative pancreatic exocrine function, there was no significant difference between the 2 groups. Conclusions: Invagination with duct-to-mucosa anastomosis is a useful technique to prevent pancreatic leakage; however, it is difficult to prevent inflammation and fibrosis around the anastomotic site of PG, and this can lead to anastomotic stricture in patients with a remarkably dilated pancreatic duct (diameter >=7mm).
Hepato-gastroenterology 10/2012; 59(119):2330-2. · 0.66 Impact Factor
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ABSTRACT: Prosthetic repair has become the gold standard for elective management of inguinal hernias; however, its use in the setting of acute incarceration is still limited for fear of prosthetic-related complications, mainly infection. Thus, in this study. we conducted a comparative investigation of the outcomes of prosthetic repair vs. tissue repair in the management of incarcerated inguinal hernias.
We retrospectively analyzed 62 patients who underwent emergency operations for incarceration of an inguinal hernia. These patients were divided into 2 groups based on the surgical procedure used: a mesh repair group (M group) and a non-mesh repair group (N group).
There were no significant differences between the 2 groups with respect to postoperative complications and the mean period of post-operative hospitalization.
Contrary to traditional belief, the use of a prosthetic mesh in the emergency setting is not contra-indicated. Its usage for the repair of incarcerated inguinal hernias appears to be safe and acceptable. However, when perforation of the intestine occurs due to incarceration of an inguinal hernia, prosthetic repair using hernioplasty should not be performed because of the high risk of infection.
Hepato-gastroenterology 10/2012; 59(119):2112-4. · 0.66 Impact Factor
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ABSTRACT: INTRODUCTION: Delayed gastric emptying (DGE) is one of the most troublesome complications of pancreaticoduodenectomy (PD). Diabetes mellitus (DM) is one of the risk factors for pancreatic cancer. Moreover, several studies have shown that diabetic patients tend to have a high incidence of upper gastrointestinal symptoms such as nausea, vomiting and DGE. Here, we compared the influence of DM on the incidence of DGE after PD. METHODS: We retrospectively analysed 67 cases of PD with pancreaticogastrostomy. These patients were categorized into the following two groups: the DM group included patients with DM, and the NDM group included patients without DM. The incidence of DGE was determined and compared between the two groups. RESULTS: In the DM group, 76.5%, 5.9% and 17.6% of the subjects developed classes A, B and C DGE, respectively; the corresponding values in the NDM group were 58%, 22%, and 20%. The incidence of DGE did not differ between the two groups (P < 0.2771). CONCLUSIONS: DM does not accelerate DGE in patients who have undergone PD. Preoperative DM does not appear to play a key role in post-operative DGE after PD.
ANZ Journal of Surgery 09/2012; · 1.25 Impact Factor
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ABSTRACT: Background/Aims: Colon interposition is the most commonly used method of esophageal reconstruction when the stomach cannot be used; however, this method may cause surgical complications such as anastomotic leakage and sepsis due to colon necrosis. Therefore, many surgeons use a retrosternal or subcutaneous route because it is easier to manage the subcutaneous drainage when anastomotic leakage occurs. However, some researchers have reported that the posterior mediastinal route provides better long-term functional outcomes after surgery than the anterior mediastinal route. Thus, in this study, we compared these reconstruction routes used for colon interposition, with or without the supercharge technique, in patients with a history of distal gastrectomy, who have undergone colon interposition after esophagectomy. Methodology: We retrospectively studied 30 patients who underwent esophagectomy with colon interposition. These patients were divided into 2 groups based on the reconstruction route: the anterior mediastinal or subcutaneous route (A group), or the posterior mediastinal route (R group). Results: Anastomotic leakages were observed in 4 patients (26.7%) in the A group and in 1 patient (6.7%) in the R group. Conclusions: Ischemia is not always the result of arterial failure, but may also originate from venous blood flow impairment due to injury or distortion of veins.
Hepato-gastroenterology 09/2012; 59(118):1832-4. · 0.66 Impact Factor
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ABSTRACT: Background/Aims: Platelet count-to-spleen diameter ratio is reported to be the best non-invasive predictor of esophageal varices in cirrhotic patients. However, spleen enlargement is frequently detected during follow-up of patients after gastrectomy. Thus, we studied the relationship of the platelet count-to-spleen diameter ratio with the development of esophageal varices after distal gastrectomy in patients without liver cirrhosis or hepatitis. Methodology: We retrospectively studied 64 patients who underwent distal gastrectomy. Their platelet counts, spleen diameters and platelet count-to-spleen diameter ratios were correlated with the occurrence rate of esophageal varices after the surgery. Results: Esophageal varices were not detected during the first 6 months after surgery; however, esophageal varices were detected in 2 patients (3%) at 12 months after surgery and their mean platelet count-to-spleen diameter ratio was 2628±409. Conclusions: The platelet count-to-spleen diameter ratio is a useful parameter for non-invasive prediction of esophageal varices after distal gastrectomy. In addition, we suggest that the occurrence rate of esophageal varices increases beyond 6 months after distal gastrectomy and when the platelet count-tospleen diameter ratio is less than approximately 2600 and thus, endoscopy should be performed to determine the presence of esophageal varices.
Hepato-gastroenterology 09/2012; 59(118):2008-11. · 0.66 Impact Factor
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ABSTRACT: Ectopic pancreas is frequently found in the gastrointestinal tract. Lesions comprise well-developed and normally organized pancreatic tissue outside the pancreas, without anatomic or vascular connections with the true pancreas. Most patients with ectopic pancreas are asymptomatic or exhibit nonspecific symptoms. A 68-year-old Japanese woman had been experiencing intermittent pain in the right upper abdomen. Suddenly, the abdominal pain changed to intense pain in the right flank of the abdomen 2 days later. On initial medical examination, the abdomen exhibited rebound tenderness and distension. The results of laboratory tests revealed increased inflammatory reaction. Abdominal computed tomography showed free air and ascites on the surface of the liver and elevated levels of adipose tissue around the antrum and pylorus of the stomach. Perforation of the upper gastrointestinal tract was diagnosed and we performed urgent surgery. The site of perforation, whose size was 25 mm, was the lesser curvature of the antrum of the stomach. Since it was not possible to perform omentopexy, we performed extensive gastric resection. The reconstruction was a Billroth II operation. Microscopic analysis revealed pancreatic tissue within the ulceration, showing islets of Langerhans, acini, and ducts; the lesion was diagnosed as type I using Heinrich's criteria. The postoperative course was uneventful. The patient was discharged on day 13 and remains clinically healthy. Gastric perforation due to ectopic pancreas has been reported in 2 cases, including our patient, and is extremely rare. Once gastric perforation has been diagnosed, the presence of ectopic pancreas might be considered.
Case Reports in Gastroenterology 09/2012; 6(3):689-94.
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ABSTRACT: Increased incidences of gallbladder disorders after esophagectomy and gastrectomy have been reported. Moreover, several researchers have reported increased incidences of gallbladder diseases in patients receiving long-term total parenteral nutrition. We studied the incidence of cholecystitis or cholestasis and determined its relationship with total parenteral nutrition; further, we compared the incidence after esophagectomy and after total gastrectomy.
We retrospectively studied 109 patients who underwent total gastrectomy or esophagectomy. These patients were divided into 2 groups, those who underwent total gastrectomy (TG group) and those who underwent esophagectomy (E group).
The 2 groups did not significantly differ with respect to the mean duration of perioperative administration of total parenteral nutrition and the incidence rate of cholecystitis or cholestasis after esophagectomy.
Postoperative hyperbilirubinemia after esophagectomy may not contribute to the development of gallbladder complications. We suggest that parenteral modalities such as tube feeding be initiated immediately after surgery for preventing gallbladder complications after esophagectomy. Further, a short duration of administration of total parenteral nutrition and immediate postoperative initiation of oral feeding may prevent gallbladder complications after esophagectomy and total gastrectomy.
Hepato-gastroenterology 07/2012; 59(117):1455-7. · 0.66 Impact Factor
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ABSTRACT: Pancreatic-duct dilatation is frequently observed in the patients who have undergone pancreaticoduodenectomy (PD). Pancreaticodigestive anastomotic stricture may occasionally develop after PD. Stenosis of the pancreaticoenterostomy induces obstructive chronic pancreatitis, which occurs due to primary stenosis or obstruction of the main pancreatic duct and causes in inflammation of the distal pancreas. The patency of the pancreaticoenterostomy is one of the most important factors affecting the functioning of the remnant pancreas and the quality of life. Endoscopic dilatation is one of the treatment options for stenosis of pancreaticogastrostomy (PG). However, the failure of endoscopic dilatation necessitates surgical approaches. We have described our technique of open pancreatic stenting with a duct-to-mucosa anastomosis for a case which the stenosis of PG could not be resolved by endoscopic dilatation. This technique dose not require re-resected PG or side-to-side pancreaticojejunostomy: the risk of anastomotic leakage is quite low and the procedure is minimally invasive.
Hepato-gastroenterology 07/2012; 59(117):1631-4. · 0.66 Impact Factor
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ABSTRACT: To improve the quality of life of patients after total gastrectomy, various pouch-reconstruction techniques have been developed. However, pouch reconstruction is technically challenging and remains controversial. We therefore, determined the efficacy of the addition of a jejunal pouch to Roux-en-Y reconstruction after total gastrectomy.
We retrospectively studied 68 gastric cancer patients who had undergone total gastrectomy with simple Rouxen- Y reconstruction (RY group) or with Roux-en-Y reconstruction and jejunal pouch (JP group).
Six months after discharge from the hospital, the mean total serum albumin level was significantly lower in the RY group than in the JP group, but the mean weight loss and incidence of reflux esophagitis did not differ between the 2 groups.
The addition a jejuna pouch to Roux-en-Y reconstruction provides better reservoir function, but does not influence the incidence of reflux esophagitis. The construction of new fundus-like jejunal plication and the smooth passage of food from the esophagus to the jejunum prevent reflux esophagitis after total gastrectomy.
Hepato-gastroenterology 07/2012; 59(117):1647-50. · 0.66 Impact Factor
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ABSTRACT: We report a case of primary clear cell hepatocellular carcinoma of the liver (PCCCL) for which we performed hand-assisted laparoscopic hepatectomy. A 71-year-old female with hepatitis C infection and diabetes mellitus was admitted to our department for a hepatic tumor with gallstone. Abdominal computed tomography revealed a tumor 25 mm in diameter on the surface in segment 5 of the liver. The imaging results suggested small hepatocellular carcinoma located on the surface in segment 5 of the liver, and we performed laparoscopic surgery aiming at a minimally invasive procedure. We performed laparoscopic cholecystectomy and hand-assisted laparoscopic hepatectomy. Histopathological findings showed moderately differentiated hepatocellular carcinoma, and as the proportion of clear cells was 75%, the tumor was diagnosed as PCCCL. This is the first report of hand-assisted laparoscopic hepatectomy for PCCCL. Laparoscopic hepatectomy is a useful minimally invasive surgical procedure when the tumor is located on the surface of the liver.
Case Reports in Gastroenterology 01/2012; 6(2):328-32.
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ABSTRACT: Pancreatic fistula is the most serious postoperative complication after pancreaticoduodenectomy, and it leads to intra-abdominal abscess, sepsis, hemorrhage and high mortality. To prevent pancreatic fistula, wrapping of skeletonized vessels and the anastomotic site of the pancreaticoenterostomy using the round ligament, greater omentum, or both has been evaluated. However, the round ligament and greater omentum have already been resected in patients who have previously undergone total gastrectomy, making them unavailable in pancreaticoduodenectomy. Therefore, we developed a procedure for wrapping the anastomotic site of the pancreaticojejunostomy using the jejunum, namely the 'jejunal scarf-covering method' as a novel technique to prevent pancreatic fistula following pancreaticoduodenectomy in patients who have previously undergone total gastrectomy.
Case Reports in Gastroenterology 01/2012; 6(2):472-7.
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ABSTRACT: Many studies have reported the safety and effectiveness of biofragmentable anastomotic rings (BARs). However, these devices are not widely used, especially in Japan. Therefore, we considered the clinical benefits of BARs and the reasons for their unpopularity.
We retrospectively examined 61 patients who underwent sigmoidectomy (34 patients) or high anterior resection (HAR) (27 patients). The patients were divided into 4 groups: sigmoidectomy and anastomosis with a BAR (SB group), sigmoidectomy and anastomosis with an end-to-end (EEA) stapler (SE group), HAR and anastomosis with a BAR (HARB group), and HAR and anastomosis with an EEA stapler (HARE group).
The time required for anastomosis was significantly lower in the HARE group than in the HARB group. The incidence of anastomotic stricture formation was significantly lower in the HARB group, however the duration of hospitalization after surgery was significantly longer in the HARB group rather than in the HARE group.
BARs are unpopular because of the long interval between surgery and the passage of the device in the feces, and because compared to BARs, staplers are easy to manipulate in the narrow pelvic space.
Hepato-gastroenterology 11/2011; 58(110-111):1445-9. · 0.66 Impact Factor
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ABSTRACT: The treatment of pancreatic pseudocysts is still being debated. Laparoscopic treatment of pancreatic pseudocysts enables definitive drainage with faster recovery. Moreover, the best drainage technique for pseudocysts located adjacent to the posterior gastric wall is pseudocystgastrostomy. Although, drainage via the anterior approach has been frequently reported, reports on the posterior approach are rare. Here, we evaluated the efficacy of the posterior approach technique for pancreatic pseudocyst drainage.
We retrospectively studied 28 patients who underwent cystogastrostomy for pancreatic pseudocysts: they were divided into the conventional cystogastrostomy group (CCG group) and the laparoscopic cystogastrostomy via the posterior approach group (LCGP group).
The mean operative time was significantly shorter, blood loss was significantly reduced, and the duration of hospitalization after surgery was significantly shorter in the LCGP group than in the CCG group. Recurrence was observed in 1 patient (5.6%) in the CGP group; it was an asymptomatic recurrence that did not require additional treatment. In contrast, there was no recurrence in the LCGP group patients.
We think that our technique of performing laparoscopic cystogastrosotmy via the posterior approach is easy and feasible for pancreatic pseudocyst drainage.
Hepato-gastroenterology 11/2011; 58(110-111):1771-5. · 0.66 Impact Factor
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ABSTRACT: Gastroptosis is a condition in which the stomach is enlarged and located in an abnormally low position, which impedes normal stomach function. A patient with gastroptosis has equivocal complaints such as nausea, stomach fullness and abdominal pain. Pylorus-preserving pancreaticoduodenectomy (PPPD) has a better outcome than the Whipple procedure in terms of operative mortality and morbidity, and postoperative nutritional state. However, delayed gastric emptying (DGE) is frequently observed after PPPD. If PPPD is performed for a patient with gastroptosis, the risk of postsurgical DGE may increase. Therefore, we have developed a modified Cattell's reconstruction with pancreaticogastrostomy (PG) after PPPD to prevent DGE in a patient with gastroptosis and adenocarcinoma of the ampulla of Vater.
Hepato-gastroenterology 11/2011; 58(110-111):1796-800. · 0.66 Impact Factor
