Hand-assisted laparoscopic subtotal colectomy with cecorectal anastomosis for chronic idiopathic colonic pseudo-obstruction: report of a case

Chronic idiopathic colonic pseudo-obstruction (CICP) is characterized by the chronic disturbance of colonic motility without mechanical obstruction, any underlying disease or medication. Currently, there are no established medical treatments for CICP. A 62-year-old female who had undergone right hemicolectomy for splenic flexure syndrome caused by idiopathic megacolon was referred to our hospital with relapse, experiencing palpitation and abdominal fullness. She was diagnosed with CICP according to findings of marked dilation of the colon without mechanical obstruction, dilation of other parts of the gastrointestinal tract, or underlying disease. The dilated colon was surgically removed by hand-assisted laparoscopic subtotal colectomy, followed by cecorectal anastomosis. Histopathologically, there was no degeneration or lack of ganglion cells in Auerbach\u27s plexus. The patient has experienced no severe symptoms after undergoing the present operation

A hybrid method of laparoscopic-assisted open liver resection through a short upper midline laparotomy can be applied for all types of hepatectomies

Background Although hepatectomy procedures should be designed to provide both curability and safety, minimal invasiveness also should be pursued. Methods We analyzed the data related to our method for laparoscopy-assisted open resections (hybrid method) through a short upper midline incision for various types of hepatectomies. Of 215 hepatectomies performed at Nagasaki University Hospital between November 2009 and June 2012, 102 hepatectomies were performed using hybrid methods. Results A hybrid method was applicable for right trisectionectomy in 1, right hemihepatectomy in 32, left hemihepatectomy in 29, right posterior sectionectomy in 7, right anterior sectionectomy in 1, left lateral sectionectomy in 2, and segmentectomy in 7 patients, and for a minor liver resection in 35 patients (12 combined resections). The median duration of surgery was 366.5 min (range 149-709) min, and the median duration of the laparoscopic procedure was 32 min (range 18-77) min. The median blood loss was 645 g (range 50-5,370) g. Twelve patients (12 %) developed postoperative complications, including bile leakage in three patients, wound infections in two patients, ileus in two patients, and portal venous thrombus, persistent hyperbilirubinemia, incisional hernia, local liver infarction each in one patient. There were no perioperative deaths. Conclusions Our method of hybrid hepatectomy through a short upper midline incision is considered to be applicable for all types of hepatectomy and is a reasonable approach with no abdominal muscle disruption, which provides safe management of the hepatic vein and parenchymal resection even for patients with bilobular disease

The risk factors and predictive factors for anastomotic leakage after resection for colorectal cancer: reappraisal of the literature

Anastomotic leakage is a serious complication that can occur after colorectal surgery. Several risk factors for anastomotic leakage have been reported based on the findings of prospective and retrospective studies, including patient characteristics, the use of neoadjuvant therapy, the tumor location, intraoperative events, etc. However, as these risk factors affect each other, the statistical results have differed in each study. In addition, differences in surgical methods, including laparoscopy versus laparotomy or stapling anastomosis versus handsewn anastomosis, may influence the incidence of anastomotic leakage. This mini-review summarizes the results of reported papers to clarify the current evidence of risk factors for anastomotic leakage

Daikenchuto improved perioperative nutritional status of the patients with colorectal cancer: A prospective open-labeled randomized exploratory study

Background and aims: The aim of this study is to exploratively evaluate the effect of Tsumura Daikenchuto Extract Granules (DKT, TJ-100) on abdominal symptoms, body weight, and nutritional function following colorectal cancer surgery. Methods: The subjects included 20 patients for curative resection of colorectal cancer. A TJ-100 administration group (n = 10) and non-administration group (n = 10) were randomized and compared. In the administration group, TJ-100 was administered from 2 days prior to surgery up to 12 weeks following surgery. The endpoints included body weight gain, Gastrointestinal Symptom Rating Scale (GSRS), and blood biochemical factors. For the purpose of observing safety, drug adverse events were evaluated including liver function tests. Results: Excluding one patient, we compared 9 cases in the administration group and 10 cases in the non-administration group. No obvious adverse events were observed in any of the cases. In the comparison of body weight gain, the TJ-100 administration group showed significantly higher values at 2, 4, and 12 weeks following the surgery. There was a tendency for lower stable GSRS scores in the administration group overall, with no statistically significant difference. Conclusion: It is suggested that TJ-100 can be safely administered in the perioperative period for cases undergoing colorectal cancer surgery, potentially preventing weight loss during the early postoperative period

Rectourethral fistula during bevacizumab administration for cecum cancer after prostate brachytherapy: A case report.

Rectourethral fistula is rare complication after 125I low-dose-rate prostate brachytherapy, and gastrointestinal fistulas are widely recognized as a complication of bevacizumab. To our knowledge, this is the first case of rectourethral fistula during bevacizumab administration for cecum cancer after prostate brachytherapy. A 75-year-old man visited our hospital because of urinary retention and fecaluria. He had been receiving chemotherapy for one year against recurrence of cecum cancer. The chemotherapy regimens were bevacizumab and capecitabine plus oxaliplatin. He had undergone laparoscopic ileocecal resection for cecum cancer 1.5 years earlier. Eight months after the operation, recurrence was recognized. He had a history of prostate cancer and had received 125I low-dose-rate prostate brachytherapy for prostate cancer 17 years earlier. Computed tomography revealed air bubble from the rectum to the prostate and urethra. To prevent urinary tract infection, laparoscopic transverse colostomy and percutaneous cystostomy were performed. Although the patient's quality of life subsequently improved, the performance status declined remarkably. He was therefore transferred to another hospital and received the best supportive care. Rectourethral fistula is a rare but serious complication after 125I low-dose-rate prostate brachytherapy. The introduction of bevacizumab to patients who have received this therapy should be carefully considered

Rectourethral fistula during bevacizumab administration for cecum cancer after prostate brachytherapy: A case report.

Rectourethral fistula is rare complication after 125I low-dose-rate prostate brachytherapy, and gastrointestinal fistulas are widely recognized as a complication of bevacizumab. To our knowledge, this is the first case of rectourethral fistula during bevacizumab administration for cecum cancer after prostate brachytherapy. A 75-year-old man visited our hospital because of urinary retention and fecaluria. He had been receiving chemotherapy for one year against recurrence of cecum cancer. The chemotherapy regimens were bevacizumab and capecitabine plus oxaliplatin. He had undergone laparoscopic ileocecal resection for cecum cancer 1.5 years earlier. Eight months after the operation, recurrence was recognized. He had a history of prostate cancer and had received 125I low-dose-rate prostate brachytherapy for prostate cancer 17 years earlier. Computed tomography revealed air bubble from the rectum to the prostate and urethra. To prevent urinary tract infection, laparoscopic transverse colostomy and percutaneous cystostomy were performed. Although the patient\u27s quality of life subsequently improved, the performance status declined remarkably. He was therefore transferred to another hospital and received the best supportive care. Rectourethral fistula is a rare but serious complication after 125I low-dose-rate prostate brachytherapy. The introduction of bevacizumab to patients who have received this therapy should be carefully considered