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1.
Surg Case Rep ; 9(1): 27, 2023 Feb 20.
Article in English | MEDLINE | ID: mdl-36807016

ABSTRACT

BACKGROUND: Ventral hernia repair (VHR) for obese patients is often associated with an increased risk of postoperative complications and hernia recurrences. Achieving preoperative weight loss is ideal before VHR; however, it is difficult to attain with medical treatment. Metabolic and bariatric surgery (MBS) offers the most effective and durable treatment for obesity. Therefore, massive weight loss occurring after MBS will improve the outcome of VHR. CASE PRESENTATION: A 49-year-old man (122.9 kg, BMI 39.1 kg/m2) presented to our hospital wishing to undergo laparoscopic sleeve gastrectomy and VHR. Physical examination revealed a tennis ball-sized lower midline defect. Computed tomography (CT) scans revealed a hernia orifice 5 cm in width and 10 cm in height. As the hernia orifice was large, mesh reinforcement was essential. We planned for him to undergo VHR after massive weight loss was achieved by MBS. VHR was performed using the enhanced-view totally extraperitoneal (eTEP) technique after weight loss of 38 kg was achieved 9 months following laparoscopic sleeve gastrectomy. His postoperative course was uneventful, and neither recurrence nor seroma was observed at 1 year follow-up. CONCLUSIONS: eTEP repair of a ventral hernia after massive weight loss following MBS would appear to be the best combination treatment for obese patients with ventral hernias. However, long-term follow-up is necessary to establish its safety and efficacy.

2.
Asian J Surg ; 46(1): 6-12, 2023 Jan.
Article in English | MEDLINE | ID: mdl-35568616

ABSTRACT

Laparoscopic (lap) colectomies for advanced colorectal cancer (CRC) often require resection of other organs. We systematically reviewed currently available literature on lap multi-visceral resection for CRC, with regard to short- and long-term oncological outcomes, and compared them with open procedures. We performed a systematic literature search in MEDLINE, EMBASE, Google Scholar and PubMed from inception to November 30, 2020. The aim of this study was to synthesize short-term and oncological outcomes associated with laparoscopic versus open surgery. Pooled proportions and risk ratios (RRs) were calculated using an inverse variance method. We included six observational cohort studies published between 2012 and 2020 (lap procedures: n = 262; open procedures: n = 273). Collectively, they indicated that postoperative complications were significantly more common after open surgeries than lap surgeries (RR: 0.53; 95% confidence interval [CI]: 0.39-0.72; P < 0.00001), but the two approaches did not significantly differ in positive resection margins (RR: 0.75; 95% CI: 0.38-1.50; P = 0.42), local recurrence (RR: 0.66; 95% CI: 0.28-1.62; P = 0.37), or (based on two evaluable studies) 5-year OS (RR: 0.70; 95% CI: 0.46-1.04; P = 0.08) or 5-year DFS (RR: 0.86; 95% CI: 0.67-1.11) for T4b disease. In conclusion, laparoscopic and open multi-visceral resections for advanced CRC have comparable oncologic outcomes. Although a randomized study would be ideal for further research, no such studies are currently available.


Subject(s)
Colorectal Neoplasms , Laparoscopy , Humans , Laparoscopy/methods , Colectomy/methods , Colorectal Neoplasms/surgery , Margins of Excision , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Treatment Outcome
3.
Asian J Endosc Surg ; 15(2): 463-466, 2022 Apr.
Article in English | MEDLINE | ID: mdl-34994085

ABSTRACT

INTRODUCTION: Laparoscopic bariatric surgery (BS) is not readily performed in Japan. To facilitate safe initial access to the abdominal cavity, we insert an optical viewing trocar at a unique site in the left upper quadrant (LUQ). Herein, we describe the technique, its advantages, and outcomes. MATERIALS AND SURGICAL TECHNIQUE: Briefly, the optical trocar is inserted just below the left subcostal margin, 8 cm from the midline. On insertion, layers of the abdominal wall are visualized on the monitor. Depending on the angle of insertion, five, seven, or eight layers are seen. DISCUSSION: In assessing our initial entry technique, used in 21 obese patients undergoing laparoscopic sleeve gastrectomy, we found median insertion time to be 25 seconds. There were no related complications. In nearly all (20/21) patients, the abdominal wall was visualized as seven layers: subcutaneous fat, anterior rectus sheath, rectus abdominis muscle, posterior rectus sheath, transverse abdominis muscle, transversalis fascia, and peritoneum. Understanding the layers of the abdominal wall visualized during optical trocar insertion in the LUQ will provide for safe and rapid initial entry in patients undergoing laparoscopic BS and can further the widespread acceptance of laparoscopic BS.


Subject(s)
Abdominal Cavity , Abdominal Wall , Bariatric Surgery , Laparoscopy , Abdominal Wall/surgery , Bariatric Surgery/methods , Humans , Laparoscopy/methods , Surgical Instruments
4.
Asian J Endosc Surg ; 13(3): 457-460, 2020 Jul.
Article in English | MEDLINE | ID: mdl-31332930

ABSTRACT

Reports of recurrence after obturator hernia repair are few. We describe the case of an 89-year-old woman who presented to us with a thrice recurrent obturator hernia. She had undergone open non-mesh repair twice and then laparoscopic non-mesh repair. She was readmitted to our hospital 6 months after the laparoscopic repair. Manual reduction was successful, paving the way for elective transabdominal preperitoneal repair. During the endoscopic repair, surgical mesh was placed extraperitoneally over the hernia defect and then fixed to Cooper's ligament with absorbable tacks. The patient was discharged on postoperative day 2 without complications. In the 2 months that have passed since the surgery there has been no sign of recurrence, but the patient will be carefully followed up. Repair of a recurrent obturator hernia is technically challenging; however, the transabdominal preperitoneal approach seems to be reliable and safe.


Subject(s)
Hernia, Inguinal , Hernia, Obturator , Laparoscopy , Aged, 80 and over , Female , Hernia, Inguinal/surgery , Hernia, Obturator/complications , Hernia, Obturator/diagnostic imaging , Hernia, Obturator/surgery , Herniorrhaphy , Humans , Recurrence , Surgical Mesh
5.
Int J Surg Case Rep ; 53: 259-261, 2018.
Article in English | MEDLINE | ID: mdl-30445358

ABSTRACT

INTRODUCTION: The self-expanding metal stent (SEMS) has been used in malignant colorectal obstruction as a bridge to surgery or for palliative treatment. We report a case of obstructive descending colon diverticulitis in-stent restenosis, which is difficult to distinguish from colon cancer. PRESENTATION OF CASE: A 48-year-old man presented with abdominal pain. Computed tomography demonstrated a segment of thickened wall in the descending colon with near-complete obstruction. Colonoscopy revealed stenosis over the entire circumference of the descending colon. Biopsy revealed no malignant findings. SEMS was inserted to improve bowel obstruction. However, bowel obstruction did not improve, and stent-in-stent insertion was performed. Because colon cancer could not be completely excluded, left hemicolectomy with lymph node dissection was performed. The pathological examination revealed colon diverticulitis and no malignant finding. DISCUSSION: Benign colorectal diseases can present with symptoms similar to those of obstructive colorectal cancer. As a result, it was benign colorectal stenosis, but it was thought that resection should be considered when the malignant lesion is suspected. The use of SEMS in benign colorectal disease has been reported a few. Reinsertion of the stent for restenosis, in bridge to surgery, was also considered useful from the viewpoint of avoiding emergent operation and reducing complications. CONCLUSION: For colon stenosis suspected of malignant disease, it was thought that resection by inserting SEMS should be taken into consideration even for benign disease as a result.

6.
Int J Surg Case Rep ; 44: 135-138, 2018.
Article in English | MEDLINE | ID: mdl-29501018

ABSTRACT

INTRODUCTION: This report presents a case of anorectal malignant melanoma treated with combined laparoscopic abdomino-endoscopic perineal total mesorectal excision. PRESENTATION OF CASE: An 82-year-old female presented with hematochezia. Colonoscopy revealed a 5-cm tumor in the anorectal junction, and biopsy specimen showed malignant melanoma. Modified ransanal total mesorectal excision was performed to get the sufficient surgical resection margins. After lymph node dissection in usual manner, mobilizing the rectum to the level of levator ani muscle. Then a skin incision was made around the anus and the transperineal access platform was placed. The fat tissue of the ischioanal fossa was divided until the levator ani muscle was exposed. The oral side of the colon was transected and specimen was extracted through the perineal incision site. Then stoma was placed laparoscopically. DISCUSSION: This procedure provides not only better exposure of the extralevator surgical field, but also efficient resection margins compared with the conventional andominoperineal resection. CONCLUSION: To the best of our knowledge, this is the first report of combined laparoscopic abdomino-endoscopic perineal total mesorectal excision for anorectal malignant melanoma. Our experience showed safety and feasible option for anorectal malignant diseases.

7.
Gan To Kagaku Ryoho ; 42(10): 1211-4, 2015 Oct.
Article in Japanese | MEDLINE | ID: mdl-26489551

ABSTRACT

A 65-year-old woman underwent iliocecal resection for cecal cancer. During post-operative follow-up, she was diagnosed with metastasis to the abdominal wall and a curative resection was performed. After 12 courses of adjuvant chemotherapy with a modified combination of folinic acid, 5-fluorouracil, and oxaliplatin (mFOLFOX6), recurrence was noted in the lung. A curative resection was successfully performed and she was subsequently treated with bevacizumab and a combination of folinic acid, 5-fluorouracil, and irinotecan (FOLFIRI). One year after surgical resection, recurrence in the remnant lung was diagnosed. Because of the KRAS mutation, she could not be treated with anti-epidermal growth factor antibodies. The metastatic lung tumor continued to enlarge. Therefore, we selected regorafenib as third-line chemotherapy. After treatment with regorafenib, the size of the target lesion decreased significantly.


Subject(s)
Cecal Neoplasms/genetics , Cecal Neoplasms/pathology , Lung Neoplasms/drug therapy , Phenylurea Compounds/therapeutic use , Proto-Oncogene Proteins/genetics , Pyridines/therapeutic use , ras Proteins/genetics , Aged , Cecal Neoplasms/therapy , Female , Humans , Lung Neoplasms/secondary , Mutation , Proto-Oncogene Proteins p21(ras) , Recurrence , Time Factors , Tomography, X-Ray Computed
8.
Case Rep Gastroenterol ; 7(2): 219-23, 2013 May.
Article in English | MEDLINE | ID: mdl-23741210

ABSTRACT

A case of mucinous adenocarcinoma arising on a long-standing anorectal fistula is described. A 60-year-old man with a long history of mucinous discharge, pain and perianal induration underwent a biopsy of the external opening of the fistula that showed a mucinous infiltrating adenocarcinoma. Due to the large size of the tumor and the fact that it had extended into the surrounding tissue, preoperative radiotherapy was performed. Radiotherapy was given with 40 Gy in 25 fractions for 5 weeks through posterior and bilateral portals. After radiotherapy the tumor was markedly shrunk and the serum level of carcinoembryonic antigen was also improved. Abdominoperineal resection was performed 8 weeks after the termination of radiotherapy. Histological examination of the resected specimen revealed that the invasion of the tumor remained within the sphincter muscle and that no cancer cells were present on the surgical margin. The histological effect of radiotherapy was judged as grade 1b. This treatment can result in downstaging and R0 resection, which also has a possibility to prevent local recurrence. This case suggests that preoperative radiotherapy may play an important role in the definitive treatment of locally advanced perianal mucinous adenocarcinoma.

9.
Gan To Kagaku Ryoho ; 39(7): 1131-3, 2012 Jul.
Article in Japanese | MEDLINE | ID: mdl-22790054

ABSTRACT

A 59-year-old man with type 3 gastric cancer(signet-ring cell carcinoma)underwent simple laparotomy because of peritoneal dissemination.S -1/CDDP was started.Since the icterus of Grade 2 had appeared after 2 courses, S-1 and biweekly paclitaxel combination chemotherapy was started as second-line treatment.Throughout treatment, there was no adverse event, and this regimen was continued for 14 courses(25 months).He died 32 months after his first visit.S -1/PTX may play an important role as second-line chemotherapy for patients with unresectable advanced gastric carcinoma.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Stomach Neoplasms/drug therapy , Drug Combinations , Fatal Outcome , Humans , Male , Middle Aged , Oxonic Acid/administration & dosage , Paclitaxel/administration & dosage , Peritoneal Neoplasms/drug therapy , Peritoneal Neoplasms/secondary , Salvage Therapy , Stomach Neoplasms/pathology , Tegafur/administration & dosage
10.
Nihon Geka Gakkai Zasshi ; 113(2): 257-62, 2012 Mar.
Article in Japanese | MEDLINE | ID: mdl-22582589

ABSTRACT

Recently the shortage of surgeon is one of the serious problem in our country. And the chance to introduce young doctors the surgical world is decreasing because of new educational system for intern doctors has started. We plan the surgical skill improvement seminar for the intern doctors from various hospitals to introduce the surgical world widely with senior doctors from multicenter. The aim of this seminar is also to decrease the burden for the education of each institutions and to decrease the stress of the senior doctors for education. Moreover, this kind of seminar is quite useful from regional cooperation point of view, because gathering and doing the cooperation in the seminar makes the senior doctors become the familiar faces. The seminar was held twice since 2010. According to the questionnaire for both trainer and trainee, almost all trainee answered that this seminar is quite useful for the skill up of residents. And senior doctors answered that this seminar might contribute to the resolution of shortage of surgeons and to progress of the regional cooperation. This kind of seminar with senior doctors from multicenter may play an important role to improvement of shortage of surgeon and regional cooperation of each hospitals.


Subject(s)
General Surgery/education , Internship and Residency/methods , Japan , Professional Competence , Workforce
11.
Fukushima J Med Sci ; 56(1): 38-43, 2010 Jun.
Article in English | MEDLINE | ID: mdl-21485654

ABSTRACT

We report a schwannoma of the gallbladder in a 58-year-old man who was diagnosed as cholecystolithiasis. He presented with recurrent episodes of abdominal pain in the right upper quadrant. The abdominal computed tomography scan and ultrasonography revealed stones about 15 mm in diameter in the gallbladder. Under the diagnosis of cholecystolithiasis, laparoscopic cholecystectomy was performed. The resected specimen showed chronic cholecystitis and no suspicion of neoplasm. Pathological examination revealed that the tumor consist of spindle cells without atypical appearance at small area of fundus. Immunohistologically, tumor cells were positive for S-100 protein and negative for alpha-SMA and c-kit, the lesion was diagnosed as schwannoma.


Subject(s)
Gallbladder Neoplasms/diagnosis , Neurilemmoma/diagnosis , Cholecystolithiasis/diagnosis , Diagnostic Errors , Gallbladder Neoplasms/metabolism , Humans , Male , Middle Aged , Neurilemmoma/metabolism , Proto-Oncogene Proteins c-kit/metabolism , S100 Proteins/metabolism
12.
Gan To Kagaku Ryoho ; 33(9): 1253-6, 2006 Sep.
Article in Japanese | MEDLINE | ID: mdl-16969020

ABSTRACT

The prognosis of patients with advanced esophageal cancer is still poor. Recently, concurrent chemoradiation therapy for esophageal cancer is being utilized with increasing frequency. In this study, we reported concurrent chemoradiation for patients with T4 esophageal cancer. From July 2000, we treated 21 consecutive patients with radiation and concurrent chemotherapy using intermittent low-dose FP chemoradiation (40 Gy radiation, 2 Gy/day, for 4 weeks 280/m(2) 5-FU intermittent 24 continuous, CDDP 8 mg/m(2)/intermittent). All patients who underwent the treatment with concurrent CRT completed the planned chemoradiation. Out of 21 patients, 2 (9.5%) showed a complete response and 9 patients (42.8%) showed a partial response. The 5-year survival rate of the T4 patients with CRT was almost the same as for those who underwent surgery alone. Concurrent chemoradiation therapy for T4 esophageal cancer patients is feasible and seems to be a standard treatment for T4 esophageal cancer patients. The results indicated that CRT is an effective therapy for advanced esophageal cancer.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Esophageal Neoplasms/drug therapy , Esophageal Neoplasms/radiotherapy , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cisplatin/administration & dosage , Combined Modality Therapy , Drug Administration Schedule , Esophageal Neoplasms/mortality , Esophageal Neoplasms/pathology , Female , Fluorouracil/administration & dosage , Humans , Male , Middle Aged , Neoplasm Staging , Prognosis , Radiotherapy Dosage , Remission Induction , Survival Rate
13.
Gan To Kagaku Ryoho ; 33(3): 385-7, 2006 Mar.
Article in Japanese | MEDLINE | ID: mdl-16531725

ABSTRACT

The patient was a 35-year-old woman with lung, bone and lymphnode metastases of gastric cancer after a total gastrectomy two years earlier. For the first-line treatment, we performed TS-1+CDDP therapy but it showed no effect. Then, weekly paclitaxel was administered as second-line, but again without effect. Therefore, combination chemotherapy of weekly paclitaxel and 5'-DFUR was performed as third-line therapy. 5'-DFUR was given orally at a dose of 600 mg/day for consecutive daily administration, and paclitaxel was administered at a dose of 70 mg/m(2) on day 1, 8 and 15. This regimen was repeated every 4 weeks. No serious adverse reaction was observed. The condition of the patient had improved after 1 course, making it possible to conduct treatment on an ambulatory basis in the 2 courses and subsequent cycles. After 3 courses, the size of the lung metastasis was remarkably decreased. This case suggests that combination chemotherapy of weekly paclitaxel and 5'-DFUR might be a promising regimen for recurrent gastric cancer even for patients who show no effect with only paclitaxel administration.


Subject(s)
Adenocarcinoma/drug therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Floxuridine/administration & dosage , Stomach Neoplasms/drug therapy , Adenocarcinoma/secondary , Adenocarcinoma/surgery , Adult , Bone Neoplasms/secondary , Combined Modality Therapy , Drug Administration Schedule , Drug Resistance, Neoplasm , Female , Gastrectomy , Humans , Lung Neoplasms/secondary , Lymph Node Excision , Paclitaxel/administration & dosage , Paclitaxel/pharmacology , Quality of Life , Stomach Neoplasms/pathology , Stomach Neoplasms/surgery
14.
Gan To Kagaku Ryoho ; 32(2): 227-9, 2005 Feb.
Article in Japanese | MEDLINE | ID: mdl-15751638

ABSTRACT

A 76-year-old man had undergone a right hemicolectomy for cecal cancer. Oral UFT (450 mg/day) administration alone was started 2 months following the operation. From a CT scan of the abdomen performed 3 months postoperatively, he was diagnosed with liver metastasis. Because the liver metastasis had progressed, combination oral administration of UFT+LV was started (UFT 450 mg/day, LV 75 mg/day, 4 weeks of therapy followed by a 1-week treatment break). After 1 cycle, a good partial response of that lesion was achieved. The pulmonary metastasis had almost disappeared to within normal limits. In conclusion, this treatment was very safe and effective.


Subject(s)
Adenocarcinoma/drug therapy , Adenocarcinoma/secondary , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cecal Neoplasms/pathology , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Aged , Cecal Neoplasms/surgery , Chemotherapy, Adjuvant , Colectomy/methods , Drug Administration Schedule , Drug Combinations , Fluorouracil/administration & dosage , Humans , Leucovorin/administration & dosage , Male , Tegafur/administration & dosage , Uracil/administration & dosage
15.
Gan To Kagaku Ryoho ; 31(13): 2129-31, 2004 Dec.
Article in Japanese | MEDLINE | ID: mdl-15628757

ABSTRACT

We reported the results of a questionnaire survey of doctors and patients in relation to the guideline for gastric cancer treatment which was first published 3 years ago. The purpose of this questionnaire was to know whether the degree of recognition and availability of this guideline is satisfactory or not. The results were as follows. 1) The recognition and availability of the guideline among doctors proved satisfactory. 2) For patients who underwent gastrectomy, this guideline is still unfamiliar. Reconsideration of the guideline contents is needed in accord with the medical level from time to time. Moreover, patients must be more and more educated regarding the guideline.


Subject(s)
Guideline Adherence/standards , Stomach Neoplasms/therapy , Surveys and Questionnaires/standards , Attitude of Health Personnel , Health Knowledge, Attitudes, Practice , Humans , Patients , Physicians
16.
Curr Drug Targets Inflamm Allergy ; 2(2): 113-8, 2003 Jun.
Article in English | MEDLINE | ID: mdl-14561162

ABSTRACT

Inflammatory bowel disease, notably ulcerative colitis (UC) or Crohn disease (CD), is basically benign, but sometimes develops into serious or fatal cancer. While the primary therapies are medical, such as pharmacotherapy and dietetic modification, intractable, serious, and cancerous cases can require surgical intervention. Surgery represents only one of the treatment options, but prediction of whether UC and CD are likely to progress to serious conditions and determination of when to undertake surgery is essential. Various surgical procedures have been developed over time, and the postoperative results are now generally good. Regarding laparoscopic surgeries, relatively few cases have been accumulated, and addressing the indications and limitations is premature at this point. However, this procedure is likely to fulfill a central role in surgical treatment strategies and represent a major benefit to patients. This paper discusses surgical treatment indications and methods for UC and CD, and explains the practical aspects of laparoscopic surgery, which has made remarkable progress in recent years, for such cases.


Subject(s)
Digestive System Surgical Procedures , Inflammatory Bowel Diseases/surgery , Colitis, Ulcerative/surgery , Crohn Disease/surgery , Humans , Laparoscopy
17.
Oncogene ; 22(41): 6455-7, 2003 Sep 25.
Article in English | MEDLINE | ID: mdl-14508525

ABSTRACT

BRAF is a serine/threonine kinase that receives a mitogenic signal from RAS and transmits it to the MAP kinase pathway. Recent studies have reported that mutations of the BRAF gene were detected with varying frequencies in several cancers, notably more than 60% in melanoma. We analysed mutations of BRAF and RAS genes in 100 cases of thyroid carcinoma to investigate genetic aberrations in the RAS/RAF/MEK/MAP kinase pathway. BRAF mutations were detected exclusively in papillary carcinomas (40 in 76 cases: 53%), and were exclusively V599E, a mutation frequently observed in other carcinomas. NRAS mutation was observed in six cases (6%), all in histological types other than papillary carcinoma, and was exclusively Q61R. No mutations were found in KRAS or HRAS. Our results suggest that BRAF mutations may play a critical role in the carcinogenesis of papillary carcinoma of the thyroid.


Subject(s)
Carcinoma, Papillary/genetics , Mutation , Oncogene Proteins/genetics , Thyroid Neoplasms/genetics , Humans , Proto-Oncogene Proteins B-raf , Thyrotropin/metabolism , ras Proteins/genetics
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