Laparoscopic Repair of a Ventral Hernia Using Composix E/X Dual Mesh at a Single Institution.

Introduction: Although abdominal ventral hernias are common, there is still no consensus regarding the most appropriatetechnique to be used for surgical repair. We herein present our initial experiences of laparoscopic ventral herniorrhaphy to repairabdominal ventral hernias.Patients: From April 2007 to March 2009, four patients were assigned to recieve laparoscopic ventral hernia repair. The operativetechnique was demonstrated. Additionally clinical factors, including operative time, length of hospital stay, complications,and recurrence rates, were evaluated.Results: All of the patients were successfully treated laparoscopically without conversion to open laparotomy. The median operativetime was 107.5 (range 75 - 130) minutes and the mean length of hospital stay was 13 (range 5 -19) days. There wereno significant complications or hernia recurrences during a follow-up period of 36 months ( median, 28 - 42 ).Conclusion: Laparoscopic repair of abdominal ventral hernias may therefore be a feasible option with a great potential to bothimprove treatment outcomes and reduce surgical morbidity

Small Mucinous Cystic Neoplasm of the Pancreas Successfully Detected and Resected by a Laparoscopic Approach: Report of a Case

Incidentally detected small pancreatic cyst is a therapeutic challenge. As these lesions include a spectrum of pathologies ranging from benignlesions to malignant mucinous tumors, it is important to differentiate potential malignant mucinous cystic neoplasms (MCN) from others.However, a definitive diagnosis might be difficult, since computed tomography (CT) and magnetic resonance imaging (MRI) cannot depict themorphologic features characteristic of small MCN.This report presents a case of a small pancreatic cyst incidentally detected during medical check-up for inguinal hernia. Although the preoperativediagnosis was uncertain with CT and MRI, the diagnosis of MCN was strongly suspected because the majority of MCN tend to oftenoccur in elderly women and the most common locations are in the pancreatic tail. Laparoscopic ultrasonography (LUS) was employed to obtaina correct diagnosis, and it showed a 16 mm cyst with characteristic features indicating a diagnosis of MCN. The patient underwent alaparoscopic distal pancreatectomy and the diagnosis of MCN was confirmed histopathologically. In conclusion, LUS allowed a timely curativeresection of a small MCN in this case

Laparoscopic Management of Omental Torsion Secondary to Inguinal Hernia: Report of a Case

Omental torsion is a rare cause of acute abdomen. The clinical symptoms can mimic other acute abdominal disorders, and therefore manypatients are often diagnosed during a laparotomy performed under a presumptive diagnosis of appendicitis, cholecystitis and so on. Recent advancesin diagnostic modalities has made it possible to determine the correct preoperative diagnosis of omental torsion, and the chances oftreating this rare condition are therefore expected to increase. Laparoscopic surgery has been used extensively for various emergent disorders;however, the laparoscopic management of omental torsion might be troublesome for most surgeons. A case of omental torsion secondary toinguinal hernia is herein reported, where a huge torted omentum was successfully managed laparoscopically. It was useful to hang up thepedicle of the congested and fragile omentum with polyester tape to manage it atraumatically. Moreover this device made it easy to removeof the specimen through a 4-cm minilaparotomy

A Large Hepatic Cyst with Obstructive Jaundice Successfully Treated with Single-Incision Laparoscopic Deroofing

We herein present a case of hepatic cysts causing obstructive jaundice that was treated with single-incision laparoscopic deroofing. A 72-year-old female patient was referred to hospital due to a large hepatic cyst that compressed the intrahepatic bile ducts. The patient was scheduled to undergo single-incision laparoscopic deroofing. The EZ ACCESS? oval type (Hakko Co. Ltd.) was placed at the umbilicus using a 25-mm incision with two 5-mm trocars. An additional 12-mm port was placed at the left epigastric region. We unroofed and excised the cyst wall using a vessel sealing system in liver segment 4. After surgery, the patient was found to be asymptomatic. The unroofed cysts were completely diminished. Notably, the remnant liver had fairly regenerated. The estimated regeneration volume of the normal liver was 153 cm3. To prevent surgical complications, clinicians should perform adequate management and use of devices. To prevent postoperative recurrence of cysts, performing complete deroofing is essential. Single-incision laparoscopic deroofing contributes to improving the quality of life of patients and should be considered a standard treatment

Efficacy and limitation of bone marrow transplantation in the treatment of acute and subacute liver failure in rats.

Aim: Recent reports have shown that bone marrow cells (BMC) retain the potential to differentiate into hepatocytes. Thus, the BMC have been recognized as an attractive source for liver regenerative medicine. However, it has not been clarified whether BMC transplantation can be used to treat liver damage in vivo. In the present study, we explored whether BMC possess therapeutic potential to treat acute and/or subacute liver failure. Methods: Fulminant hepatic failure (FHF) was induced by 70% hepatectomy with ligation of the right lobe pedicle (24% liver mass), followed by transplantation of BMC into the spleen. Dipeptidyl peptidase IV-positive (DPPIV(+)) BMC were then transplanted into DPPIV-negative (DPPIV(-)) recipients following hepatic irradiation (HIR) in which 70% of the liver was resected and the remnant liver irradiated. Results: There was no benefit of BMC transplantation towards survival in the FHF model. DPPIV(+) hepatocytes appeared in the liver tissues of the DPPIV(-) HIR model rats, but DPPIV(+) hepatocytes replaced less than 13% of the recipient liver. Conclusion: BMC transplantation may have limitations in the treatment of fulminant or acute liver failure because they do not have sufficient time to develop into functional hepatocytes. Preparative HIR may be beneficial in help to convert the transplanted BMC into host hepatocytes, and provide a survival benefit. Although, However, the precise mechanism warrants further studies

Complete Dissection of a Hepatic Segment after Blunt Abdominal Injury Successfully Treated by Anatomical Hepatic Lobectomy: Report of a Case

A 21-year-old male patient was transferred to the emergency room of our hospital after suffering seat belt abdominal injury in a traffic accident. Abdominal computed tomography revealed a massive hematoma in the abdominal cavity associated with deep hepatic lacerations in the right lobe. The presence of a solid tissue possibly containing pneumobilia was observed above the greater omentum. These findings were consistent with a tentative diagnosis of hepatic laceration due to blunt trauma; therefore, this prompted us to perform emergency laparotomy. The operative findings revealed a massive hematoma and pulsatile bleeding from the lacerated liver and a retroperitoneal hepatoma, which was most likely due to subcapsular injury of the right kidney. In accordance with the preoperative imaging studies, a pale liver fragment on the greater omentum was observed, which was morphologically consistent with the defect in the posterior segment of the liver. Since the damaged area of the liver broadly followed the course of the middle hepatic vein, we carefully inspected and isolated the inflow vessels and eventually performed a right hepatic lobectomy. The patient's postoperative course was uneventful, and he was doing well at 10 months after surgery

Low-dose recombinant human hepatocyte growth factor enhances effect of hepatocyte transplantation in rats treated with retrorsine.

BACKGROUND/AIMS: The aim of this study was to regenerate transplanted hepatocytes selectively in a recipient using retrorsine and recombinant human hepatocyte growth factor (rhHGF). METHODOLOGY: Nagase analbuminemic rats (NARs) received pretreatment with retrosine and were divided into three experimental groups. Group1: Hepatocyte transplantation (HcTx) + 50 microg/kg/day rhHGF. Group2: HcTx + 250 microg/kg/day rhHGF. Group3: HcTx + normal saline. The serum levels of albumin and the albumin-positive hepatocytes in the liver were investigated. The rat endogenous HGF of the rats given only retrorsine was measured. RESULTS: The serum albumin levels of Group11 were higher than those of Group2, while there was no significant difference between Group2 and GroupS. Histological examination of Group1 and 3 showed the presence of a large number of albumin-positive hepatocytes, which frequently consisted of large clusters and occupied 53.90 +/- 2.31% and 31.25 +/- 5.36% of host liver, respectively. The liver sections of Group2 showed numerous albumin-positive hepatocyte, which were not seen as clusters. The rat endogenous HGF concentration was extremely high. CONCLUSION: Low-dose rhHGF enhances the effect of HcTx under the suppressive state of proliferation of host hepatocytes. Because of the high endogenous HGF, the administration of a high concentration of rhHGF suppressed the regenerative activity of the transplanted hepatocytes

Compressive stenosis of the inferior vena cava due to localized ascites after living-donor liver transplantation.

A 54-year-old woman was admitted to our hospital following the diagnosis of decompensated liver cirrhosis with hepatitis C. She underwent living-donor liver transplantation, performed using the left hepatic lobe with the middle hepatic vein donated by her husband. After the transplantation, the patient suffered from massive ascites with liver dysfunction. Computed tomography demonstrated stenosis of the suprahepatic inferior vena cava (IVC) with focal collection of fluid. A second laparotomy was performed 19 days after the transplantation. When the encapsulated localized ascites on both sides of the IVC was opened, the ascites was flushed away. Subsequently, the grafted liver was easily mobilized and it was placed in the natural position without any tension, and the pressure gradient of the IVC was improved. Herein, we report a very rare case of compression stenosis of the IVC resulting in Budd-Chiari syndrome caused by localized encapsulated ascites