Ischemic time by the intermittent occlusion of hepatic inflow (Pringle’s maneuver) influences surgical outcome after hepatectomy

Background: Intermittent occlusion of hepatic inflow, so-called Pringle’s maneuver, is a useful technique to control intraoperative bleeding; however, it can lead to ischemia-reperfusion injury. We examined the influence of ischemic time on surgical factors, posthepatectomy liver function and morbidity. Methods: The clinical records of 296 patients who underwent an elective hepatectomy for liver disease between 2004 and 2013 were retrospectively examined. Univariate and multivariate analyses of clinicopathological and surgical factors associated withhepatic-inflow occlusion time were performed. Results: The mean and median times of total hepatic-inflow occlusion were 47±23 minutes (5-173 mL) and 45 minutes, respectively. The occlusion time was significantly correlated with increased indocyanine-green retention rate, total operation time, amount of blood loss or red cell transfusion, postoperative morbidity and hospital stay (each p<0.05). Blood loss upon the use of occlusion tended to be lower than that in its absence (568±602 mL vs. 887±841 mL) (p=0.075). The occlusion time was shorter in limited resection and longer in central bi-segmentectomy or sectionectomy (p<0.05). The occlusion time was significantly correlated with the maximum alanine aminotransferase level (r=0.291, p<0.01). The predictive cut-off value of occlusion time for these correlated parameters ranged between 45 and 46.5 minutes (p<0.05). Hepatic-inflow occlusion was not associated with morbidity in cirrhosis. Conclusion: A longer ischemic time induced increased blood loss or related transfusion, operating time, postoperative liver injury, complication rate and duration of hospital stay

Relationship between serum ghrelin level and physiology in patients who underwent hepatectomy and pancreatectomy

Aim: Ghrelin is a peptide that is secreted from the stomach and plays a role in appetite, weight gain, and skeletal muscle composition.In the present clinical study, we examined the relationship between ghrelin level and physiology in patients who had undergone major liver and pancreas surgery. Methods: Serum ghrelin level was measured before and after hepatectomy and pancreatectomy. The relationships between nutritional status and postoperative alterations of parameters including the ghrelin level were examined. Results: In 32 patients, the preoperative plasm acyl- (AG) or des-acyl-ghrelin (DAG) and AG/DAG ratio were not significantly different based on gender, type of operation, age and each disease. AG tended to be correlated with the respiration quotient but this was not statistically significant (p=0.08). AG was significantly negatively correlated with hemoglobin and albumin levels. The postoperative plasma ghrelin level was significantly decreased at day 1 in comparison with preoperative levels (p<0.05) and recovered to preoperative levels at day 3. There were no significant differences between hepatectomy and pancreatectomy groups, with no changes of postoperative metabolic parameters. Conclusions: Although serum ghrelin level was transiently decreased, this level was immediately recovered and not influencedby the surgical procedures or its invasiveness

Effects of photodynamic therapy using talaporfin sodium (Laserphyrin® ) on wound healing in an animal model

Background: Photodynamic therapy (PDT) is an effective laser treatment for locally advanced carcinoma and is promising as neoadjuvant chemotherapy before surgery. The aim of this study was to clarify the adverse effects of PDT using a photosensitizer, talaporfin sodium (Laserphyrin®), for wound healing.Methodology: For PDT, a laser light with a wavelength of 660 nm and a frequency of 10 Hz with a total energy fluency of60 J/cm2 was used. Macroscopic and histological findings of wound healing after PDT were examined in vivo (4-week-old male BALB/c mice).Results: In Model 1, in which skin was cut at 0, 3, 7 days after PDT (n=3, each), wounds were similarly healed 7 days after cutting in all groups, and regenerating epithelium and the number of fibroblasts on histological findings were not different. In Model 2, in which skin defects were created before or after PDT, the size of the defects was larger at day 7 in the groups with skin defects before or after PDT in comparison with groups with no PDT.However, macroscopic wound healing at day 14 was complete in all groups and there were no significant differences among the groups by this point. Histological findings of skin defects at day 14 showed no significant difference in terms of regenerating epithelium and number of fibroblasts in each group with or without PDT.Conclusions: PDT did not influence wound healing and can be safely applied before surgical therapy

Pancreatic Duct-to-mucosa versus Invagination or Complete External Drainage Anastomosis in Case of Small Pancreatic Duct after Pancreaticoduodenectomy: Comparative Historical Review

After pancreaticoduodenectomy (PD), pancreatic duct-to-mucosa anastomosis (PDM) has been usually applied which may prevent risk of pancreatic fistula (PF). In cases with a small pancreatic duct, however, PDM is difficult to complete. Procedures involving the invagination (IV) or complete external tube drainage (CED) are supposed to be alternative options for anastomosis. We retrospectively compared clinical results between PDM and IV or CED in 104 patients with a tiny pancreatic duct who underwent PD. The 77 patients undergoing PDM (the control group) and 27 patients undergoing other procedures, including 19 for CED and 8 for IV, were comparatively examined. Fatty pancreas was commonly observed in CED group. Pancreaticojejunostomy was significantly more frequently applied in CED group, and the operating time in the IV group was significantly longer than in control group (p<0.05). The anastomotic time in CED group tended to be shorter than those in control and IV groups (18 versus 29 and 37 min). The incidences of PF were not significantly different among groups (31% in control, 47% inCED and 14% in IV, respectively); however, a grade B or C level of PF was not observed in the IV group. PDM is often difficult to achieve and inadequate suturing may injure the pancreatic parenchyma in cases of very small pancreatic duct. Re-evaluation of the CED or IV procedure as an alternative option was suggested to be warranted

Relationship between serum ghrelin level and physiology in patients who underwent hepatectomy and pancreatectomy

Aim: Ghrelin is a peptide that is secreted from the stomach and plays a role in appetite, weight gain, and skeletal muscle composition. In the present clinical study, we examined the relationship between ghrelin level and physiology in patients who had undergone major liver and pancreas surgery. Methods: Serum ghrelin level was measured before and after hepatectomy and pancreatectomy. The relationships between nutritional status and postoperative alterations of parameters including the ghrelin level were examined. Results: In 32 patients, the preoperative plasm acyl- (AG) or des-acyl-ghrelin (DAG) and AG/DAG ratio were not significantly different based on gender, type of operation, age and each disease. AG tended to be correlated with the respiration quotient but this was not statistically significant (p=0.08). AG was significantly negatively correlated with hemoglobin and albumin levels. The postoperative plasma ghrelin level was significantly decreased at day 1 in comparison with preoperative levels (p<0.05) and recovered to preoperative levels at day 3. There were no significant differences between hepatectomy and pancreatectomy groups, with no changes of postoperative metabolic parameters. Conclusions: Although serum ghrelin level was transiently decreased, this level was immediately recovered and not influenced by the surgical procedures or its invasiveness

Influences of compounded human ghrelin for pancreatic fistula after distal pancreatectomy in a mouse model

Ghrelin is a peptide that is secreted from the stomach and plays a role in appetite, weight gain, and skeletal muscle composition.Compounded human ghrelin (CHG) is a candidate drug to improve the nutritional status after pancreatic surgery. However,adverse influences of ghrelin in terms of pancreatic fistula (PF) via the stimulation of exocrine secretion after pancreatectomy are a concern. The present study showed the influences of the administration of CHG with PF after distal pancreatectomy in a mousemodel. Distal pancreatectomy was performed on 10-week-old male Wistar rats and 3 μg/kg or 30 μg/kg CHG was injected into the inferior vena cava during laparotomy. Ten rats were divided into two groups: a control group (no injection; n=5) and a CHG group (n=5 for each of 3 μg/kg and 30 μg/kg). Changes of body weight, amount of ascites, and the serum and ascetic amylase and lipase levels were examined on days 1, 3, and 7. In the case of administration of 3 μg/kg ghrelin, changes of body weight, amount of ascites, and serum amylase level were not significantly different between the groups during 7 days. Amylase level in ascites in the ghrelin administration group tended to be lower than that in the control group on day 3 (p=0.083), but there was no difference on days 1 and 7. In the case of a high dose of 30 μg/kg ghrelin, levels of weight loss were not significantly different between the groups. Although the lipase level in the serum and ascites tended to be lower in the ghrelin group than in the control group (p=0.08), the amylase levels in serum and ascites were not significantly different between the groups. There was also noremarkable difference in histological appearance between the groups during 7 days after surgery. The administration of CHG didnot induce PF after distal pancreatectomy, which might inhibit lipase secretion in ascites. CHG injection can be safely performed after surgery

Influences of compounded human ghrelin for pancreatic fistula after distal pancreatectomy in a mouse model

Ghrelin is a peptide that is secreted from the stomach and plays a role in appetite, weight gain, and skeletal muscle composition. Compounded human ghrelin (CHG) is a candidate drug to improve the nutritional status after pancreatic surgery. However, adverse influences of ghrelin in terms of pancreatic fistula (PF) via the stimulation of exocrine secretion after pancreatectomy are a concern. The present study showed the influences of the administration of CHG with PF after distal pancreatectomy in a mouse model. Distal pancreatectomy was performed on 10-week-old male Wistar rats and 3 μg/kg or 30 μg/kg CHG was injected into the inferior vena cava during laparotomy. Ten rats were divided into two groups: a control group (no injection; n=5) and a CHG group (n=5 for each of 3 μg/kg and 30 μg/kg). Changes of body weight, amount of ascites, and the serum and ascetic amylase and lipase levels were examined on days 1, 3, and 7. In the case of administration of 3 μg/kg ghrelin, changes of body weight, amount of ascites, and serum amylase level were not significantly different between the groups during 7 days. Amylase level in ascites in the ghrelin administration group tended to be lower than that in the control group on day 3 (p=0.083), but there was no difference on days 1 and 7. In the case of a high dose of 30 μg/kg ghrelin, levels of weight loss were not significantly different between the groups. Although the lipase level in the serum and ascites tended to be lower in the ghrelin group than in the control group (p=0.08), the amylase levels in serum and ascites were not significantly different between the groups. There was also no remarkable difference in histological appearance between the groups during 7 days after surgery. The administration of CHG did not induce PF after distal pancreatectomy, which might inhibit lipase secretion in ascites. CHG injection can be safely performed after surgery

Minilaparotomy Approach Employing a K?stner Incision for Rectal Cancer Resection: Report of Three Cases

A minilaparotomy approach (? 7 cm) for colorectal cancer resection is feasible and safe. Such minilaparotomy generally employs a small vertical incision. A low transverse abdominal incision (a K?stner incision) has been shown to be associated with cosmetic advantage, less postoperative pain, and fewer wound-complications than the midline incision. We report three cases (75-year-old female, 64-year-old male, and 74-year-old female) who underwent anterior resection of rectal cancer via a minilaparotomy approach employing the K?stner incision. No hand-port or laparoscope was used. The median body mass index was 18.9 (range, 18.3-19.3) kg/m2. The rectal tumors were located in the rectosigmoid and the upper rectum. There were no intraoperative complications. The median operating time and operative blood loss were 160 (range, 159-162) min and 80 (range, 30-90) ml, respectively. All tumors were curatively resected. The patients quickly returned to normal function without morbidity or mortality. No patients developed wound-related complications. During a median follow-up period of 27.4 (range, 26.8-29.0) months, all patients are alive without tumor recurrence. In addition, neither incisional hernia nor nerve damage developed. We conclude that the minilaparotomy approach employing a K?stner incision is a less invasive and an attractive method with a cosmetic advantage for rectal cancer resection in selected patients