TAPP with liquid-injection and gauze dissection

Purpose : This report describes a novel technique for trans-abdominal pre-peritoneal (TAPP) inguinal hernia repair using liquid injection and gauze dissection. Methods : Twenty-five cases underwent TAPP inguinal hernia repair with liquid-injection and gauze dissection. Before the initial peritoneal incision, liquid injection was performed percutaneously into the pre-peritoneal space at the outside of the internal inguinal ring and the inside of the seminal duct. Especially, at the inside of the seminal duct, the liquid was injected into the space between the superficial and deep lobe of pre-peritoneal fascia. Gauze was effectively used to dissect this liquid-injected space. Results : In comparison with the cases of inguinal hernia repair without liquid-injection and gauze dissection, the cases who underwent TAPP inguinal hernia repair with liquid-injection and gauze dissection experienced shorter operation times and no complications or recurrence. Conclusions : TAPP inguinal hernia repair with liquid-injection and gauze dissection appears to be a safe and feasible procedure

Evaluation system for non-technical skills

Purposes : Non-technical skills contribute to safe and efficient team performance. The aim of this study was to clarify the importance of non-technical skills by a questionnaire and the usefulness of feedback to the operator. Method : A questionnaire was administered to the operator and paramedical staff for 404 operations. Total and individual scores were compared, and the effect of feedback was analyzed by comparison between pre-feedback and post-feedback. Results : The total score of the paramedical staff was 100 [full score] [n = 186], 90-99 [n = 133], and 80-89 [n = 47]. In all cases, the score of the paramedical staff was significantly better than that of the operator. After feedback, the rate of a score less than 80 was significantly decreased. In junior doctor cases with laparoscopy, feedback tended to have a positive effect. Conclusions : Questionnaires completed by both surgeons and paramedical staff are useful for identifying problems with non-technical skills

Bevacizumab-associated intestinal perforation and perioperative complications in patients receiving bevacizumab

Aim: The purposes of this study are to present cases of emergency surgery in which gastrointestinal perforation occurred during bevacizumab administration, consider the indications for emergency surgery, and examine the safety of scheduled surgery after a washout period for bevacizumab. Methods: (a) We retrospectively investigated seven patients who underwent emergency surgery for bevacizumab-associated intestinal perforation. (b) We investigated 104 patients with advanced colorectal cancer treated with neoadjuvant therapy who underwent surgery from 2008 to 2018, retrospectively. Results: (a) In the seven patients undergoing emergency surgery for gastrointestinal perforation, the median bevacizumab administration and washout periods were 16 weeks and 24 days, respectively. A stoma was created in all patients except in those who were not candidates. Two patients developed postoperative abdominal abscesses, and two patients died from perioperative sepsis and gastrointestinal bleeding, respectively; both of these patients had poor performance status. (b) In patients receiving bevacizumab (n = 45) and patients treated with bevacizumab-free regimens as neoadjuvant therapy (n = 59), 31 and 52 patients received chemoradiotherapy, respectively. We found no correlation with postoperative complications with or without bevacizumab. Conclusion: The surgical indications should be considered carefully in patients with gastrointestinal perforation secondary to bevacizumab administration. Meanwhile, after appropriate cessation time, scheduled surgery following bevacizumab administration is feasible

ICG fluorescence catheter system in TaTME

Background. Sometimes intraoperative urethral injury occurs in Transanal total mesorectal excision (TaTME). The aim of this study is to investigate the usefulness of indocyanine green (ICG) fluorescent catheter system for avoiding intraoperative urethral injury in TaTME in experimental model. Methods. A urethral catheter was filled with the mixture of albumin and ICG and raw hams were applied in layers as the surrogate model of rectourethral muscle. The detectability of ICG fluorescence in this catheter was investigated by using laparoscope-type fluorescence camera system. Results. Fluorescence was detected when ICG was mixed with albumin or peripheral blood. ICG fluorescence could be detected within 4 mm depth of layered raw hams as the surrogate model. Quantitative analysis of the picture detected that ICG fluorescence plateaued in lower concentration than that of serum. Conclusion. ICG fluorescent catheter system may be useful for avoiding intraoperative urethral injury in TaTME

ICG fluorescence system in colorectal surgery

Background: One of the major cause of anastomotic leakage (AL) in anterior resection of the rectum is insufficient blood flow of the remnant colon. The indocyanine green fluorescence system (ICG-FS) can visualize the blood flow of organs intra-operatively. The aim of this study is to investigate the usefulness of ICG-FS for evaluating the blood flow of the remnant colon in laparoscopic anterior resection. Materials and Methods: Rectal cancer patients (n=24) who underwent laparoscopic anterior resection were included in this study. After resection of the rectum, 7.5mg of ICG was administered intravenously, and the blood flow of the oral stump was evaluated by the ICG-FS. The relationship between the fluorescence time (FT) of the oral stump and AL was investigated retrospectively. Result: Two of twenty-four patients (8.3%) suffered AL. The FT of these two cases were over 60 seconds. In the case with the FT was over 80 seconds, we performed additional resection of the late fluorescence portion of the remnant colon and could avoid AL. In patients whose FT was under 60 seconds, no patients suffered AL. Conclusion: ICG-FS may be useful for evaluating the blood flow of the remnant colon to avoid AL in laparoscopic anterior resection

Squamous Cell Carcinoma of the Descending Colon: Report of a Case and Literature Review

It is very rare that squamous cell carcinoma (SCC) arises from colorectal epithelium. An 89-year-old man was treated in 2001 with chief complaints of anorexia, abdominal pain, and low grade fever. The histological diagnosis as SCC was determined by biopsy during a colonoscopy. We diagnosed primary SCC of the colon because except in the colon no malignant lesions were found by systemic CT. Surgical complete resection was performed. However, he died three months after surgical resection because of hepatic metastasis and cachexia. The prognosis of this disease seems to be worse than that of adenocarcinoma

GSRS ガ リックンシトウ ニヨル ショウカキ ショウジョウ ノ QOL カイゼン ノ ヒョウカ ニ ユウヨウ デアッタ 1レイ

We report here an effective case of Rikkunshi-to（TJ-43）for who had gastrointestinal symptoms,nausea and diarrhea, and a usefulness of GSRS for evaluation of quality of life（QOL）ingastrointestinal symptoms. A 78 year-old male developed nausea and vomitting, and was foundwith a well to moderately differentiated adenocarcinoma of the rectum（Ra, type2, cT2, cN0, cM0,cStageⅡ）. He would be done with neoadjuvant chemoradiotherapy following transverse colostomy.However, he had heart burn and diarrhea after colostomy. Rikkunshi-to improved thesesymptoms. In GSRS, pre-and post-treatment of the total score decreased 3.9 to 2.0. The GSRS isa good relationship to QOL in gastrointestinal symptoms

The role of pathology in a new surgical procedure of gastrointestinal tract

Recently, the surgical procedure of gastrointestinal tract has been developing. Compared with open surgery, laparoscopic surgery showed less invasiveness, intraoperative blood loss, postoperative pain and hospital stay. Since２０１８, robotic surgery in gastric and rectal cancer could be covered by insurance. Robotic surgery enables to perform minimally invasive surgery with an advanced set of instruments and a ３D high-definition view of the surgical area. So, robotic surgery enables to perform more accurate and less invasive surgery. In order to secure the curability and provide less invasive surgery, the role of pathology is very important. The aim of this study is to introduce a new surgical procedure and the role of pathology in gastrointestinal tract cancer

The effect of sleeve gastrectomy

Introduction : The number of patients who undergo laparoscopic sleeve gastrectomy (LSG) has been increasing. Department of Surgery, Tokushima University performed the first LSG in 2013. The aim of this study was to report the results of the initial ten cases who underwent a LSG. Patients and methods : Ten obese patients : five males and five females ; age range from thirty-three years to fifty-six years (mean age 42.2 years) ; mean body mass index (BMI) 50.3 ; five with diabetes ; nine with hypertension (HT) ; four with hyperlipidemia (HL) ; eight with sleep apnea syndrome (SAS) who underwent LSG were enrolled in this study. The data was analyzed retrospectively and included short- and long-term outcomes. Results : There were no post-operative complications in this study. The %EWL at three and six months and one year post-operative were 44.2%, 50.2% and 48.6% respectively. In three months post-operative the non-alcoholic fatty liver (NAFLD) and non-alcoholic steatohepatitis (NASH) had improved transaminase (AST/ALT), liver to spleen ratio in plain CT value. Improvements were also evident in the obesity-related diseases : diabetes 80% (4/5) ; HT 67% (6/9) ; HL 75% (3/4) ; and SAS 88% (7/8). Conclusion : LSG is a promising option for the treatment of morbid obesity and obesity-related diseases

Intraperitoneal infusion of paclitaxel with S-1 for peritoneal metastasis of advanced gastric cancer : phase I study

Background : Intraperitoneal administration of taxanes revealed excellent anti-tumor effect for peritoneal metastasis of gastric cancer in some experimental models. The aim of this study is to determine maximum tolerated dose (MTD), dose limiting toxicity (DLT) and recommended dose (RD) of intraperitoneally infused paclitaxel (PTX) with S-1 as a phase I study. Patients and Methods : Eighteen patients with advanced gastric cancer in addition to confirmed peritoneal metastasis using laparoscopy were enrolled in this study. The regimen consists of oral administration of S-1 (Dose 80mg : BSA1.5 m2) for 14 days and intraperitoneal infusion of PTX (Dose escalation : level I : 40, II : 60, III : 80, level IV : 90, V : 100 mg/m2) at day1 and 14. PTX concentrations in serum and ascites were determined at 4, 8, 12, 24, 48 hours after the infusion, which was repeated twice every 4 weeks. Results : The number of patients were as follows : Level I : 3, Level II : 6, Level III : 3, Level IV : 3, Level V : 3. Grade 3 leukocytopenia was confirmed in 1 (Level II) and 2 (Level V). MTD is 90 mg/m2, RD is 80 mg/m2 and DLT is Grade 3 leukocytopenia. The average serum PTX concentrations remained in optimal range except for all 3 of level V patients. In all cohorts, the PTX concentrations in the ascites were approximately 1000 folds higher than those in serum for 48 hours after the infusion. Conclusions : MTD and RD were PTX 90 mg/m2, 80 mg/m2, respectively. These findings were supported by pharmocokinetics of PT