Modified Hand-Sewn Closure With Retroperitoneal Tissue-covering Method Prevents Pancreatic Fistula in Laparoscopic Distal Pancreatectomy.

BACKGROUND: In laparoscopic distal pancreatectomy, the stapler transection of the pancreas remains the preferred method; however, pancreatic fistula continues to be a critical unsolved problem. The aim of this study was to compare complications associated with distal pancreatectomy, especially regarding the formation of pancreatic fistula, with particular attention to the stapler and hand-sewn closure technique. PATIENTS AND METHODS: Between January 2004 and June 2012, 47 patients underwent laparoscopic distal pancreatectomy. These patient's pancreatic bodies were similar, and they were subjected to closure of the pancreatic stump either by stapler (Staple group, n=21) or by a modified hand-sewn technique (Sewn group, n=26), and were subsequently retrospectively reviewed. RESULTS: The incidence of PF was significantly higher in the "Staple group" compared with the "Sewn group." Likewise, the amylase levels in the drainage fluid, were significantly higher in the "Staple group" compared with the "Sewn group." Patients in the Sewn group had shorter median hospital stay compared with those in the Sewn group (5 vs. 8 d, P<0.001). CONCLUSIONS: The 2-layer hand-sewn technique is a simple method, and it significantly decreased the incidence of PF and hospital stay compared with the use of staples in laparoscopy.

The preliminary experience in simultaneous treatment of rectal cancer and synchronous liver metastases with laparoscopy.

BACKGROUND/AIMS: There is no consensus for laparoscopy first in patients with rectal cancer and synchronous liver metastases, whose metastases are confined to the liver. This study aimed to evaluate its indications for one-stage surgery in laparoscopy. MATERIALS AND METHODS: Eighteen patients with rectal cancer and synchronous liver metastases, who had undergone laparoscopic colorectal resection and simultaneous treatment for liver metastases, were retrospectively reviewed. RESULTS: Concomitant with laparoscopic colorectal resection, eight patients received liver resection simultaneously; 10 patients underwent a variety of down-staging management including local ablation, right hepatic portal vein ligation, and implantation of chemotherapy pumps into the hepatic artery. The colo-anal/rectal anastomoses were performed with a stapler or "pull-though" mode though the anus. Three patients underwent two-stage liver resection following tumor down-staging. Median survival time was 22.3 months. CONCLUSIONS: Laparoscopy approach for rectal cancer and synchronous liver metastases is feasible in selected patients. Colon pull-through anastomosis was a potential method to avoid abdominal incision and decrease the risk of anastomotic leakage. It is worth further investigation regarding its advantages over traditional modalities with a prospective randomized controlled study.

Perioperative analysis of laparoscopic liver resection with different methods of hepatic inflow occlusion.

BACKGROUND: During liver resection, bleeding remains the most important challenge. A reduction in blood loss and avoiding the need for a blood transfusion are important objectives for liver surgeons today. The authors compared the intra- and postoperative course of patients undergoing laparoscopic liver resections under intermittent total pedicle occlusion (IPO), hemihepatic vascular occlusion (HVO), and selective vascular occlusion (SVO). SUBJECTS AND METHODS: Retrospective analysis was conducted of patient data from 41 cases of laparoscopic liver resection in three groups of patients under different occlusion methods, including 15 cases of IPO, 15 cases of HVO, and 11 cases of SVO. The advantages and disadvantages of the various methods were compared, as well as blood loss, operation time, changes in postoperative liver function, and complications. RESULTS: There was no operative death in any of the 41 patients. Generally, there was no significant difference among the three groups in blood loss, clamping time, or operative time. After the operation, the effect on liver function for the HVO and SVO groups was significantly less severe than that for the IPO group (P<.05). The incidence of postoperative complications was mainly related to IPO and the larger amount of bleeding. CONCLUSIONS: Both HVO and SVO are feasible in laparoscopic hepatectomy and have the advantage of reducing liver remnant ischemia injury and modality rate over IPO. HVO is easy to do for left lateral lobe or resection of the left half of the liver. SVO is suitable for right lobe resection.

Short-term outcomes from a multicenter retrospective study in China comparing laparoscopic and open surgery for the treatment of infected pancreatic necrosis.

BACKGROUND: Laparoscopic surgery for confirmed infected pancreatic necrosis (IPN) represents a relatively new solution. There are no studies comparing the outcomes of laparoscopic and open surgery for patients with IPN. The aims of this study were to investigate the feasibility of laparoscopic management for patients with IPN and to compare the outcomes of laparoscopic and open surgery. METHODS: Seventy-six patients with IPN who underwent open surgery (Open-group) or laparoscopic surgery (Lap-group) were retrospectively reviewed. Demographic data, white blood cell count, and APACHE II score upon admission, operative findings, major complications, and mortality were compared between the Open-group and the Lap-group. The Lap-group was further divided into two subgroups (early and late), and the operative difficulty was compared between the two subgroups. RESULTS: There were no significant differences between the Open-group and the Lap-group with respect to demographic data, white blood cell count, and APACHE II score. Although the mean operative time was significantly shorter in the Open-group than in the Lap-group, the estimated blood loss was significantly greater in the Open-group than in the Lap-group, as was the rate of complications. The mean postoperative hospital stay in the Open-group was significant longer than in the Lap-group, too. In the Lap-group, the mean operating time, estimated blood loss, and conversion rate in the early subgroup were significantly lower than in the late subgroup. CONCLUSION: Laparoscopic necrosectomy and the placement of an intermittent irrigation and continuous suction drainage system for IPN is feasible, effective, and of minimal invasiveness. The late laparoscopic necrosectomy is relatively difficult.

Growth-inhibitory effects of MOB2 on human hepatic carcinoma cell line SMMC-7721.

AIM: To investigate the growth-inhibiting and apoptosis-inducing effects of the gene MOB2 on human hepatic carcinoma cell line SMMC-7721. METHODS: The full-length cDNA of the MOB2 gene was amplified from human umbilical vein endothelial cells. The correct full-length MOB2 cDNA was subcloned into the eukaryotic expression vector pEGFP-C1. After lipofection of the MOB2 gene into cancer cells, the levels of MOB2 protein in the cancer cells were detected by immunoblotting. To transfect the recombined plasmid vector pEGFP-CI-MOB2 into SMMC-7721 cells, the cells were cultured in Dulbecco's Modified Eagle's Medium with 10% fetal calf serum and glutamine, and then mixed with liposomes, Lipofectamine 2000 and the plasmid vector pEGFP-CI-MOB2. RESULTS: We observed the growth and proliferation of SMMC-7721 cells containing pEGFP-CI-MOB2 and analyzed their apoptosis and growth cycle phases by flow cytometry. We successfully transfected the recombined plasmid vector pEGFP-CI-MOB2 into SMMC-7721 cells and screened for a single clone cell containing MOB2. After transfection, MOB2 enhanced growth suppression, induced apoptosis, increased the ratio of G0/G1, significantly inhibited the advance of cell cycle phase, and arrested cells in G0/G1 phase. CONCLUSION: MOB2 overexpression induces apoptosis and inhibits the growth of human hepatic cancer cells, which may be useful in gene therapy for hepatic carcinoma.

Comparison of laparoscopic vs open liver lobectomy (segmentectomy) for hepatocellular carcinoma.

AIM: To investigate the effects of laparoscopic hepatectomy for the treatment of hepatocellular carcinoma (HCC). METHODS: From 2006 to January 2011, laparoscopic hepatectomies were performed on 30 cases of HCC at Northern Jiangsu People's Hospital. During this same time period, 30 patients elected to undergo conventional open hepatectomy over laparoscopic hepatectomy at the time of informed consent. The degree of invasiveness and outcomes of laparoscopic hepatectomy compared to open hepatectomy for HCC were evaluated. RESULTS: Both groups presented with similar blood loss amounts, operating times and complications. Patients in the laparoscopic hepatectomy group started walking and eating significantly earlier than those in the open hepatectomy group, and these more rapid recoveries allowed for shorter hospitalizations. There were no significant differences between procedures in survival rate. CONCLUSION: Laparoscopic hepatectomy is beneficial for patient quality of life if the indications are appropriately based on preoperative liver function and the location and size of the HCC.