Open Gastrostomy by Mini-Laparotomy: Our Method.

When percutaneous endoscopic gastrostomy (PEG) is not feasible owing to anatomical obstacles, laparotomic or laparoscopic gastrostomy (LAG) is an alternative. At our institution, LAG has been the first choice for patients who are unable to undergo PEG; however, we have introduced a small open gastrostomy through a 2-cm-long transverse incision since 2020. By December 2022, 12 patients had undergone this procedure without complications. In one case where the stomach was located cephalad to the rib arch and the patient had a round dorsum, the incision wound was extended, and a lengthy operation was required. We believe that our small-incision gastrostomy is a useful option in addition to LAG for cases in which PEG is difficult to perform. Further studies are required to determine the indications for this procedure.

Intraductal Tubulopapillary Neoplasm Diagnosed Before Surgery: A Case Report.

Intraductal tubulopapillary neoplasm (ITPN) is a rare disease in the pancreas with a better prognosis than pancreatic ductal adenocarcinoma (PDAC) and a different treatment strategy. Therefore, it is important to confirm its diagnosis before the surgery. However, few cases have been diagnosed preoperatively. In this report, we present a case of ITPN that was successfully diagnosed preoperatively. A 70-year-old female patient was incidentally diagnosed with a pancreatic tumor. The patient was asymptomatic, and her blood tests were all within the normal range. A dynamic computed tomography scan showed an indistinct mass with small cysts and a dilated pancreatic duct. The mass was well contrasted in the arterial phase. These findings were not enough to confirm ITPN. Therefore, endoscopic ultrasonography fine needle aspiration biopsy was performed. The specimen had no mucin and the neoplastic cells exhibited a tubulopapillary growth pattern. Moreover, the neoplastic cells were immunohistochemically positive for MUC1, CK7, and CK20, but negative for MUC2, MUC5AC, synaptophysin, and Bcl-10. Consequently, the preoperative diagnosis was confirmed as ITPN. Hence, a subtotal-stomach-preserving pancreaticoduodenectomy was performed, and the patient had a good postoperative course and was discharged after 26 days. Tegafur, gimeracil, and oteracil were administered as postoperative adjuvant chemotherapies for one year. Seventeen months after the surgery, no recurrence has been detected. ITPN and PDAC have different prognoses and treatment strategies. In this report, we experienced a case of ITPN preoperatively diagnosed and successfully treated.