Clinical study of single-incision laparoscopic cholecystectomy

We experienced 63 patients with non-inflammatory disease who underwent single-incision laparoscopic cholecystectomy (TANKO-LC). Herein we report the procedure of operation and the short-term results. We compared 63 cases of TANKO-LC with 109 cases of non-inflammatory conventional laparoscopic cholecystectomy (S-LC) within the same period. At first, our standard procedure was to insert multiple trocars in the abdominal cavity through a single wound ; now, we insert only a single trocar all cases. In the 63 cases investigation, 3 cases required trocar addition and one case converted to open surgery. Intra and postoperative complications were recognized in 2 cases (port-site infection). No significant complications were recognized. In comparing the TANKO-LC group and the S-LC group, the operation time was intentionally longer in the TANKO-LC group (TANKO-LC group : 118 min, S-LC group : 90 min), but there were no differences in the blood loss, the rates of intra and postoperative complications and the conversion rate. Laparoscopic cholecystectomy is a standard operation for gallbladder removal, but single-incision laparoscopic cholecystectomy is considered a useful operation with the same low operative complication rate yet more satisfactory cosmetic results

Clinical study of the prognostic factors in colorectal cancer patients with synchronous liver metastasis

This study was aimed to clarify the prognostic factors in colorectal cancer patients with synchronous liver metastasis. Fifty-four patients were assessed to evaluate prognoses according to various clinico-pathological factors and therapeutic procedures. The patients' survival was significantly related to extrahepatic distant metastasis and therapeutic procedures. Regarding therapeutic procedures, the liver resection group showed significantly improved survival compared with the chemotherapy group, especially in liver metastasis Grade B. For colorectal liver metastases, it is clear that liver resection is the most effective treatment at present. Further improvement of patient prognoses is expected to be achieved by future research on combination chemotherapy

A surgical case of small intestinal anisakiasis with symptoms of ileus

We report a surgical case of intestinal anisakiasis in which we identified a complete larva. A 48-year-old man complaining of epigastralgia after eating roasted mackerel was admitted to the hospital with a diagnosis of ileus with peritonitis. Abdominal CT showed dilatation and partial thickening of the small intestine. An emergency operation was carried out. On laparotomy, severe stricture of the jejunum was revealed. The affected intestine was resected. A larva whose head was invading the mucosa was found in the resected portion of the jejunum, and we diagnosed the case as intestinal anisakiasis

A surgical case of phlegmonous gastritis after endoscopic submucosal dissection for early gastric cancer

Phlegmonous gastritis is a rare inflammatory lesion in which bacterial infection occurs in the gastric wall. A 92-year-old man was admitted to the medical ward due to early gastric cancer. The patient received endoscopic submucosal dissection (ESD), and he complained of sudden-onset upper abdominal pain the day after ESD. On physical examination he showed rebound tenderness in the upper abdomen. The white blood cell count was 16,100/μl, and an abdominal CT-SCAN showed diffuse and irregular thickening of the gastric wall. At emergency operation, a subtotal gastrectomy was performed, and the patient had an uneventful recovery

A case of superior mesenteric artery syndrome after left hemicolectomy for descending colon cancer

A 58-year-old man was diagnosed as having descending colon cancer and underwent a left colectomy with D3 node dissection and end-to-end anastomosis reconstruction. The accessory middle colic artery was secured as a feeding artery, and the middle colic artery was preserved. Diet was started on postoperative day 5 (POD5), and nausea and vomiting appeared on POD10. An upper gastrointestinal series revealed to-and-fro peristalsis in the third portion of the duodenum and dilatation of the proximal duodenum. Abdominal CT showed that the second portion of the duodenum was markedly dilated and the third portion was compressed by the superior mesenteric artery (SMA). As a result, he was diagnosed with post-operative superior mesenteric artery syndrome (SMAS) and treated with conservative therapy. The symptoms improved with a nasogastric tube, and he started to eat after POD26, followed by a successful outcome