Showing papers in "Surgery Today in 2008"
TL;DR: Strict asepsis and minimal blood loss were associated with a lower incidence of surgical site infection following gastrointestinal surgery, suggesting the use of absorbable suture material may be involved in reducing the risk of SSI.
Abstract: Purpose
To assess the risk factors of surgical site infection (SSI) in gastrointestinal surgery.
154 citations
TL;DR: Laparoscopic sleeve gastrectomy is comparable with LAGB for promoting short-term weight-loss in the super-super-obese and includes a decreased need for reoperation; first, because foreign material is not implanted in the body; and second, because the residual ghrelin-producing gastric mass is much smaller.
Abstract: Purpose
We reviewed our experience of performing laparoscopic sleeve gastrectomy (LSG) in super-superobese (body mass index >60 kg/m2) patients and compared our results with those of laparoscopic adjustable gastric banding (LAGB) performed in similar patients.
103 citations
TL;DR: Locally invasive pancreatic cancer without distant metastases or major arterial invasion is treated most effectively by surgical resection, with better survival after surgery than after radiochemotherapy.
Abstract: Although the outcome of surgery for locally advanced pancreatic cancer remains poor, it is improving, with 5-year survival up to about 10% in Japan. The preliminary results of our multi-institutional randomized controlled trial revealed better survival after surgery than after radiochemotherapy. We report the final results of this study after 5 years of follow-up. Patients with preoperative findings of pancreatic cancer invading the pancreatic capsule without involvement of the superior mesenteric or common hepatic arteries, or distant metastasis, were included in this randomized controlled trial, with their consent. If the laparotomy findings were consistent with these criteria, the patient was randomized to a surgery group or a radiochemotherapy group (5-fluorouracil 200 mg/m2/day and 5040 Gy radiotherapy). We compared the mean survival time, 3-and 5-year survival rates, and hazard ratio. The surgery and radiochemotherapy groups comprised 20 and 22 patients, respectively. Patients were followed up for 5 years or longer, or until an event occurred to preclude this. The surgery group had significantly better survival than the radiochemotherapy group (P < 0.03). Surgery increased the survival time and 3-year survival rate by an average of 11.8 months and 20%, respectively, and it halved the instantaneous mortality (hazard) rate. Locally invasive pancreatic cancer without distant metastases or major arterial invasion is treated most effectively by surgical resection.
95 citations
TL;DR: Liver resection, when done in combination with adjuvant therapy, can improve the prognosis of selected patients with BCLM, and the number of liver metastases was identified as a significant independent factor of survival.
Abstract: Purpose
To assess the outcome and prognostic factors of liver surgery for breast cancer metastasis.
78 citations
TL;DR: This work reviewed the updated literature on the pathogenesis of and strategies for using SFS grafts and found it essential to have precise knowledge and tactics to evaluate graft quality and graft volume, when performing these LDLTs with portal pressure control.
Abstract: The extended application of living donor liver transplantation (LDLT) has revealed the problem of graft size mismatching called “small-for-size (SFS) graft syndrome.” The initial trials to resolve this problem involved increasing the procured graft size, from left to right, and even extension to include a right lobe graft. Clinical cases of living right lobe donations have been reported since then, drawing attention to the risks of increasing the liver volume procured from a living donor. However, not only other modes of increasing graft volume such as auxiliary or dual liver transplantation, but also control of the increased portal pressure caused by an SFS graft, such as a portosystemic shunt or splenectomy, have been trialed with some positive results. To establish an effective strategy for transplanting SFS grafts and preventing SFS graft syndrome, it is essential to have precise knowledge and tactics to evaluate graft quality and graft volume, when performing these LDLTs with portal pressure control. We reviewed the updated literature on the pathogenesis of and strategies for using SFS grafts.
77 citations
TL;DR: Abdominal rebound tenderness, advanced leukocytosis, or a high level of manual band form (>6%) were the positive predictive factors for bowel ischemia, whereas a history of chronic intermittent abdominal pain was a negative indicator.
Abstract: Purpose
To define the indicators of bowel ischemia caused by congenital or acquired internal hernia, based on our 10-year experience in one center.
65 citations
TL;DR: There is insufficient evidence that lowered ghrelin is the sole reason for the resulting weight loss after this procedure, but the initial results are promising, with one study even suggesting long-term results comparable with those of other bariatric procedures.
Abstract: To evaluate the effectiveness of laparoscopic sleeve gastrectomy (LSG), a relatively new bariatric surgical procedure associated with duodenal switch (DS), we analyzed the findings of ten published studies on LSG. No relationship was found between the excess weight loss and the size of the bougie or the follow-up period. The amount of gastric fundus removed may be an important consideration because most ghrelin-producing cells are in the fundus; however, there is insufficient evidence that lowered ghrelin is the sole reason for the resulting weight loss after this procedure. Laparoscopic sleeve gastrectomy is still considered experimental by many, but the initial results are promising, with one study even suggesting long-term results comparable with those of other bariatric procedures. Ghrelin may play a role in the weight loss associated with LSG, but is unlikely to be the sole reason for its success.
63 citations
TL;DR: Intraoperative colonoscopy revealed active bleeding from stapling anastomosis in 7 patients and the air leak test performed by IOCS was positive in 4 patients, with additional sutures being done in 2 patients and reanastomoses performed in the other 2.
Abstract: Although stapling colorectal anastomosis is widely accepted as an alternative for hand-sewn anastomosis, we continue to experience postoperative complications such as anastomotic hemorrhage and leakage, which sometimes lead to serious morbidity or even mortality. To secure stapling colorectal anastomosis, we adopted intraoperative colonoscopy (IOCS). We performed IOCS in 73 cases of colorectal resection with stapling anastomosis from November 2004 to October 2005. Intraoperative colonoscopy revealed active bleeding from stapling anastomosis in 7 patients (9.6%). Of these, additional sutures were done in 6 patients, while the anastomosis was exteriorized in the other. The air leak test performed by IOCS was positive in 4 patients (5.5%), with additional sutures being done in 2 patients and reanastomoses performed in the other 2. Incomplete cutting of the mucosa was found in one patient, but it was successfully managed. Following the introduction of IOCS, there were no cases of postoperative anastomotic hemorrhage, and only one case of anastomotic leakage (1.4%).
58 citations
TL;DR: Perioperative examination revealed a mobile cecum caused by an elongated ascending colon, which can be detected easily during laparoscopic surgery, which is minimally invasive and cosmetically, physically, and economically beneficial.
Abstract: A 44-year-old woman was admitted to our hospital for investigation and treatment of sudden abdominal pain and distention. Plain abdominal radiography and abdominal computed tomography (CT) findings were suggestive of sigmoid volvulus. She underwent an emergency colonoscopy, and the scope passed easily through the sigmoid colon and reached the ascending colon quickly. However, stenosis with concentricity of the fold was observed in the cecum, which was shifted upward and to the left. Based on these findings, we diagnosed cecal volvulus caused by mobile cecum syndrome. The patient’s symptoms resolved quickly after colonoscopic reduction and elective laparoscopic surgery was performed 18 days after admission. Perioperative examination revealed a mobile cecum caused by an elongated ascending colon. We sutured the cecum and ascending colon to the lateral peritoneum laparoscopically with interrupted sutures. The patient recovered well and was discharged on postoperative day 7. An unfixed intestine can be detected easily during laparoscopic surgery, which is minimally invasive and cosmetically, physically, and economically beneficial. Thus, we recommend laparoscopic cecopexy for mobile cecum syndrome.
55 citations
TL;DR: The preoperative elevation of serum CRP was found to be an independent prognostic indicator of CRC, and poor differentiation and advanced tumor stage wereindependent prognostic factors in patients with CRC.
Abstract: Purpose. The preoperative elevation of serum Creactive protein (CRP) is thought to be a prognosticator of carcinomas of the digestive tract. We conducted this study to investigate the clinical importance of the preoperative elevation of serum CRP in patients with colorectal carcinoma (CRC). Methods. We investigated the correlation between an elevated preoperative serum CRP level and the clinicopathologic factors, including prognosis, of 116 patients who underwent resection of CRC. Results. Forty-seven (40.5%) patients had an elevated serum CRP value preoperatively (group H) and 69 (59.5%) did not (group L). There were signifi cant differences in the tumor size, proportion of poorly differentiated tumors, depth of invasion, lymph node metastasis, lymphatic invasion, and tumor stage between the two groups. Survival was signifi cantly lower in group H than in group L (P < 0.0001). Multivariate analysis showed that the preoperative elevation of serum CRP (P = 0.0007), as well as poor differentiation (P = 0.027) and advanced tumor stage (P = 0.007) were independent prognostic factors in patients with CRC. Conclusion. We found the preoperative elevation of serum CRP to be an independent prognostic indicator of CRC.
53 citations
TL;DR: It is concluded that a subtotal thyroidectomy is also the treatment of choice for asymptomatic benign substernal goiter and the visual identification of at least two parathyroid glands is essential to prevent permanent postoperative hypoparathyroidism.
Abstract: Purpose
Substernal goiter is defined as a thyroid mass of which more than 50% is located below the thoracic inlet. In this article we report the diagnosis, symptoms, thyroid function, treatment, and postoperative complications of 59 patients with substernal goiter.
TL;DR: Pancreaticojejunostomy with an internal stent is considered to be an effective treatment alternative after PD, with an acceptable morbidity and no mortality.
Abstract: Purpose
In pancreaticojejunostomy (PJ), the occurrence of an injury during the removal of a stented tube is sometimes related to pancreatitis or late-onset stenosis of the pancreatic duct. In this study, we compare the outcomes of a PJ with an external stent versus an internal stent in a randomized study.
TL;DR: The pathological differentiations of non-well differentiation and tumor budding are useful predictors for lymph node metastasis in T1 colorectal cancer.
Abstract: To clarify pathological predictor for lymph node metastasis in T1 colorectal cancer. One hundred and sixty-four patients who underwent surgery for single T1 colorectal cancer were reviewed. The pathological differentiations of non-well differentiation, invasion depth (≥2 000 μm), lymphatic channel involvement, venous invasion, and tumor budding were selected as candidate predictors. Tumor budding was estimated according to the definition proposed by Ueno et al. (Gastroenterology 2004; 127:385–394). The lymph node status was set for the endpoint. Logistic regression model was applied to analyze the predictors. Lymph node involvement was observed in 9.8%. The positive rates were 13.4% for the pathological differentiations of non-well differentiation, 51.8% for invasion depth (≥2 000 μm), 6.1% for lymphatic channel involvement, 8.5% for venous invasion, and 14.6% for tumor budding. The pathological differentiations of non-well differentiation (P < 0.001) and tumor budding (P = 0.002) were significantly associated with lymph node metastasis in multivariate analysis. When either two significant factors was adopted for the prediction of the lymph node metastasis, the sensitivity, specificity, positive predictive value, and negative predictive value were 94%, 82%, 36%, and 99%, respectively. The pathological differentiations of non-well differentiation and tumor budding are useful predictors for lymph node metastasis in T1 colorectal cancer.
TL;DR: These results provide further evidence of the anti-inflammatory and anti-apoptotic activities of oxymatrine, which may become a potent drug for protecting the intestines against I/R injury.
Abstract: Intestinal ischemia/reperfusion (I/R) is a common and serious clinical condition. The anti-inflammatory and anti-apoptotic properties of oxymatrine, the extract from a traditional Chinese herb, Sophora flavescens Ait, have been shown to protect the liver from I/R injury and attenuate colitis. The objective of this study was to investigate if oxymatrine could attenuate intestinal I/R injury induced in rats. The experimental design consisted of three groups of 24 Wistar rats each: a sham-operation group (control group), a group subjected to intestinal I/R and then given saline (saline group), and a group subjected to intestinal I/R and then given oxymatrine (oxymatrine group). Intestinal I/R was induced by occluding the superior mesenteric artery for 45 min. Six rats from each group were killed at selected time points, and blood and intestinal samples were collected. Morphological alteration, reduction of γ-glutamyl transpeptidase (γ-GGT) activity, and increased cell apoptosis confirmed intestinal I/R injury. The oxymatrine group had a significantly lower histological score and apoptosis index than the saline group, demonstrating that the preadministration of oxymatrine attenuated gut damage. Moreover, oxymatrine inhibited the production of lipid peroxides (LPO), decreased the serum levels of tumor necrosis factor (TNF)-α, and downregulated expression of phosphorylated p38 mitogen-activated protein kinase, Fas, and FasL, which had been elevated by I/R. These results provide further evidence of the anti-inflammatory and anti-apoptotic activities of oxymatrine, which may become a potent drug for protecting the intestines against I/R injury.
TL;DR: The possibility of synchronous colorectal neoplasms in GC patients cannot be disregarded in clinical practice; however, screening of the large bowel may not be necessary inGC patients younger than 50 years.
Abstract: Purpose
Our purpose was to study the characteristics of colorectal neoplasms in patients with gastric cancer (GC).
TL;DR: The complication rates of TT performed by residents and attending surgeons were similar and it is concluded that residents can perform TT safely and effectively under the direct supervision of a senior surgeon.
Abstract: Purpose
Surgeon inexperience has been defined as a significant predictor of deleterious outcome in thyroid surgery; however, the safety of training programs in which residents are the primary surgeons is controversial. The objective of this prospective study was to compare the complication rates of total thyroidectomy (TT) performed by residents with those of TT performed by specialist surgeons in similar patient groups.
TL;DR: α-Lipoic acid and ebselen played an important role in attenuating I/R injury of the intestine by scavenging ROS and RNS.
Abstract: Reactive oxygen species (ROS) and reactive nitrogen species (RNS), generated during tissue reperfusion, are characteristic of ischemia/reperfusion (I/R) injury. We conducted this study to evaluate the protective effect of α-lipoic acid (α-LA) and ebselen against intestinal I/R injury. Forty Sprague-Dawley rats were divided into five groups: a sham-operated group; an I/R group, subjected to intestinal ischemia for 45 min and reperfusion for 3 days; an I/R+α-LA group; an I/R+ebselen group; and an I/R+α-LA+ebselen group. We collected ileal specimens, to measure the tissue levels of malondialdehyde (MDA), protein carbonyl content (PCC), superoxide dismutase (SOD), and glutathione peroxidase (GPx), and to evaluate the histologic changes. There was a significant decrease in SOD and GPx levels, with an increase in MDA and PCC levels and intestinal mucosal injury in the intestinal I/R group (P < 0.05). Superoxide dismutase and GPx levels were significantly higher, MDA and PCC levels were significantly lower, and intestinal injury was significantly less severe in the I/R+α-LA+ebselen group than in the I/R group (P < 0.05). Although shortened villi and epithelial lifting were seen in the I/R group, only slight mucosal injury was seen in the treatment groups. α-Lipoic acid and ebselen played an important role in attenuating I/R injury of the intestine by scavenging ROS and RNS.
TL;DR: Pulmonary epithelioid hemangioendothelioma is a rare vascular tumor of low-grade malignancy, the prognosis of which remains unpredictable.
Abstract: Pulmonary epithelioid hemangioendothelioma (PEH) is a rare vascular tumor of low-grade malignancy, the prognosis of which remains unpredictable. Surgical and/or chemotherapeutic options have to be evaluated depending on intrathoracic tumor spread and systemic metastases. Three cases of PEH with both clinical and pathological findings are herein summarized and the relevant current literature discussed.
TL;DR: The HUESAD is a reliable system for assessing a surgeon’s dexterity, based on direction and movement, which helps to attain a higher degree of accuracy and to create an ideal setting for optimal endoscopic surgery.
Abstract: Purpose. We evaluated our system of objectively assessing endoscopic surgical skills. Methods. We developed the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD), which records the movement of the tip of an endoscopic instrument precisely. The orbits of experienced surgeons (expert group) and those of medical students (novice group) were evaluated by measuring the deviation from the ideal course on horizontal and vertical planes. These data were integrated with the time taken to move the tip of an endoscopic instrument between a distal side pole (A) and a proximal side pole (C) (Task 1), and between a left side pole (D) and a right side pole (B) (Task 2). Results. The integrated deviation of the expert group was signifi cantly lower than that of the novice group on both the horizontal and vertical planes in Task 1 (P = 0.0004, P = 0.009) and Task 2 (P < 0.0001, P = 0.0002). Thus, the spatial perception of experts was signifi cantly better than that of novices. We also found that the direction of the scope and the movement of the endoscopic instrument were related to diffi culties in spatial perception for both experts and novices. HUESAD detected and resolved these differences based on the directions of the scope and movement of the endoscopic instruments. Conclusions. The HUESAD is a reliable system for assessing a surgeon’s dexterity, based on direction and movement. It helps us to attain a higher degree of accuracy and to create an ideal setting for optimal endoscopic surgery.
TL;DR: The case of primary smallcell neuroendocrine carcinoma in a 31-year-old woman reinforces the importance of an early correct diagnosis and the standardization of a treatment regimen for this very rare tumor.
Abstract: Primary small-cell neuroendocrine carcinoma of the breast is a rare and aggressive neoplasm without an established treatment protocol because so few cases have been described. We report a case of primary small-cell neuroendocrine carcinoma in a 31-year-old woman. The patient came to our hospital 10 days after consulting another clinic, where a diagnosis of locally advanced breast cancer suitable for neoadjuvant chemotherapy had been made. Core needle biopsy under ultrasonographic guidance revealed invasive carcinoma. The doubling time of the tumor progression was calculated as 12 days based on ultrasonographic measurement. After three cycles of chemotherapeutic regimens consisting of adriamycin plus docetaxel, the disease was judged to be progressive and the patient underwent surgery. Definitive histopathological examination revealed primary small-cell neuroendocrine carcinoma. Local and mediastinal recurrence with multiple liver metastases developed only 5 weeks after surgery. Cisplatin plus irinotecan combination chemotherapy was started; however, the patient died of aggressive recurrent tumor progression 6 months after surgery, in spite of the transient tumor regression achieved by chemotherapy. This case reinforces the importance of an early correct diagnosis and the standardization of a treatment regimen for this very rare tumor.
TL;DR: BPC 157, at all investigated intervals, given locally or intraperitoneally, accelerated post-injury muscle healing and also helped to restore the full function.
Abstract: Stable gastric pentadecapeptide BPC 157 accelerates the healing of a transected Achilles tendon and a transected quadriceps muscle. It may also be of clinical relevance as a systemic and local peptide treatment for crush injury of a major muscle, such as gastrocnemius muscle complex. BPC 157 is effective without a carrier, and it is presently undergoing trials for inflammatory bowel disease, and no toxicity has so far been reported. In crushed rats (force delivered 0.727 Ns/cm2), BPC 157 was applied either intraperitoneally or locally, as a thin cream layer, immediately after injury (sacrifice at 2 h), and once a day for 14 days. BPC 157 improved muscle healing, macroscopically (less hematoma and edema, no post-injury leg contracture), microscopically, functionally, and also based on enzyme activity (creatine kinase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase). BPC 157, at all investigated intervals, given locally or intraperitoneally, accelerated post-injury muscle healing and also helped to restore the full function.
TL;DR: Living donor liver transplantation was found to be an effective option for the treatment of a patient with unresectable giant hepatic hemangiomas complicated by Kasabach-Merritt syndrome.
Abstract: We herein present a case of unresectable giant hepatic hemangiomas with Kasabach-Merritt syndrome which was successfully treated by living donor liver transplantation using a left lobe graft. The patient was a 45-year-old woman who complained of abdominal distension. Two sessions of transarterial embolization were performed, but failed to reduce the size of the tumor. The hepatic tumors were thus judged untreatable and the only option for a cure was to offer living donor liver transplantation, because of the tumor size, its location, and the association with Kasabach-Merritt syndrome. A left lobe graft with the middle hepatic vein donated by her 47-year-old brother was transplanted under venovenous bypass. The postoperative course of the recipient was complicated by small-for-size graft syndrome, which developed after episodes of acute cellular rejection on postoperative day 8 and sepsis on day 31. The patient successfully recovered from the complications and was discharged on day 72, and she remains well at 10 months after transplantation. In conclusion, living donor liver transplantation was found to be an effective option for the treatment of a patient with unresectable giant hepatic hemangiomas complicated by Kasabach-Merritt syndrome.
TL;DR: An aggressive repair of accompanying TR should be performed at the time of initial surgery in patients with a huge left atrium, atrial fibrillation, long time from onset to surgery, or tricuspid rheumatic changes.
Abstract: Purpose
To evaluate the risk factors of tricuspid regurgitation (TR) after left-sided valve replacement (LSVR) and plan the initial surgical treatment of TR.
TL;DR: The multivariate analysis of the preoperative risk model revealed that the best predictors of operative mortality were a history of diabetes, hypertension, previous CABG, the presence of angina, arrhythmia, Canadian Cardiovascular Society Classification (CCS) of grade III or IV, ejection fraction (EF) ≤30%, three-vessel disease, and left main disease.
Abstract: Purpose
This study was conducted to investigate predictors of mortality before and after isolated coronary artery bypass grafting (CABG).
TL;DR: The indications for, and operative techniques used in LDLT have changed dramatically, even in a single center in Japan, and the operative time, blood loss, and hospital stay after LDLT also improved remarkably.
Abstract: Purpose
To evaluate the changes in living donor liver transplantations (LDLTs) over the last 10 years, we analyzed our experience of performing LDLT in a single center.
TL;DR: The relationship between the anterior (motor) laryngeal branches of the RLN and the ITA should also be considered by surgeons, because the branch innervates all the larygeal muscles except for the cricothyroid muscle.
Abstract: We read with interest the paper by Yih-Huei Uen et al. concerning the surgical anatomy of the recurrent laryngeal nerves published in the April 2006 issue of Surgery Today. Our comments are as follows. (1) Although much attention has been given to the protection of the recurrent laryngeal nerve (RLN) in thyroid surgery, cases of RLN injury are still occasionally reported in the literature. Because of the importance of this phenomenon, many researchers have investigated the anatomic confi guration between the RLN and inferior thyroid artery (ITA) in cadavers or patients and frequently described three types; the RLN was in front of or behind the ITA, or between its branches. Yih-Huei Uen et al. also investigated the relationship in 60 cases and classifi ed three types confi gurations similar to the authors. Nevertheless, we investigated the relationships in 50 specimens (100 RLNs) and found 20 different types of confi gurations. The reason for this difference in the number in our classifi cations is that we have considered the relationship between the laryngeal branches of the RLN and anterior and posterior branches of the ITA. On most sides we observed that before entering the larynx, the RLN divided into two laryngeal branches, namely an anterior and a posterior branch at the level of the upper third of the thyroid gland. In this study, we observed that the laryngeal branches of the RLN were either in front of or behind the ITA or its anterior and posterior branches. However, the authors did not mention the relationship between the laryngeal branches of the RLN and the ITA. We think the relationship between the anterior (motor) laryngeal branches of the RLN and the ITA should also be considered by surgeons, because the branch innervates all the laryngeal muscles except for the cricothyroid muscle. As a result we wish to ask why the authors did not consider the laryngeal branches of the RLN in their classifi cation data. (2) In their results, the authors stressed that the right and left RLN lay posterior to the ITA in 80% (48 cases) and 91.7% (55 cases), respectively. However, Table 2 shows that the right and left RLN lay posterior to the ITA in 61.6% (37 cases) and 70% (42 cases), respectively. In addition, in Table 3 they reported that the left RLNs were found outside Berry’s ligament in 14.4% (8 cases). However, according to their data the percentage should have been calculated as 13.3% (8 of 60 cases).
TL;DR: Laparoscopic cholecystectomy is a safe and effective treatment for symptomatic gallstone disease in patients with a history of Gastrectomy, although previous gastrectomy is associated with an increased need for adhesiolysis and a longer operative time.
Abstract: Previous gastrectomy has been considered a relative contraindication to laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the safety and efficacy of LC in patients with a history of gastrectomy. From a database of 1 104 consecutive patients with symptomatic gallstone disease, who underwent LC between April 1992 and January 2007, 51 (4.6%) had undergone previous gastrectomy: for gastric cancer (n = 36) or gastroduodenal ulcer (n = 15). We compared the operative time, blood loss, conversion rate, morbidity rate, diet resumption, and postoperative hospital stay between patients with, and those without, a history of gastrectomy. The incidence of common bile duct stones was significantly higher (33.3% vs 8.6%, P < 0.001) and operative time was significantly longer (111.2 min vs 77.9 min, P < 0.001) in the patients with a history of gastrectomy. There was no significant difference in operative time between the first-half and second-half periods. Conversion to an open cholecystectomy was required in two patients. There was no significant difference between the two groups in blood loss, conversion rate, morbidity rate, diet resumption, or postoperative hospital stay. Laparoscopic cholecystectomy is a safe and effective treatment for symptomatic gallstone disease in patients with a history of gastrectomy, although previous gastrectomy is associated with an increased need for adhesiolysis and a longer operative time.
TL;DR: A case of effective neoadjuvant therapy for a rectal GIST expressing the c-kit gene, where a laparoscopic ultralow anterior resection was successfully performed, thus preserving the anus.
Abstract: Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal tract, and of these, GISTs involving the rectum are uncommon. This report describes a case of effective neoadjuvant therapy for a rectal GIST expressing the c-kit gene, where a laparoscopic ultralow anterior resection was successfully performed, thus preserving the anus. A 57-year-old woman visited our hospital due to constipation and was found by a digital examination to have a soft mass on the right wall of the rectum. Computed tomography revealed an 8.0 × 5.0-cm mass with an unclear margin adjacent to the rectum. A biopsy specimen was positive for CD34 and the c-kit gene product, but it was not positive for smooth muscle actin or S-100 protein, and thus the tumor was diagnosed as GIST. An abdominoperineal resection is generally essential for large rectal GISTs; however, she refused this operation. Neoadjuvant treatment with Imatinib decreased the tumor size (4.0 × 3.5 cm) and the anus was preserved by a laparoscopic ultralow anterior resection with direct coloanal anastomosis. She had no evidence of disease for 24 months postoperatively. To preserve the anus, a rectal GIST expressing the c-kit gene is best treated with Imatinib as neoadjuvant therapy.
TL;DR: A 78-year-old asymptomatic patient with a past history of a gastrectomy was referred for evaluation of an intra-abdominal mass lesion, which mimicked a gastric tumor on preoperative imaging studies, which led to a false diagnosis of textiloma.
Abstract: We describe a unique case of intra-abdominal textiloma (granuloma due to a retained foreign body), which mimicked a gastric tumor on preoperative imaging studies. A 78-year-old asymptomatic patient with a past history of a gastrectomy was referred for evaluation of an intra-abdominal mass lesion, which was incidentally observed on a computed tomography (CT) scan. Repeated CT with a higher resolution demonstrated a 5-cm heterogeneously enhanced mass with a distinct feeding artery. These findings were all compatible with a tumorous lesion originating in the gastric remnant, most likely gastric gastrointestinal stromal tumor. A diagnosis of textiloma was immediately made during surgery, and it was confirmed pathologically postoperatively. The feeding artery that appeared on CT images, which was a major reason for the false diagnosis, was considered to have resulted from a slow but continuous inflammation reaction around the retained surgical sponge. Surgeons should therefore always take the possibility of textilomas into consideration even with typical tumorous characteristics on preoperative imaging studies, especially in patients with a history of prior abdominal surgery.
TL;DR: The radiological features of HAML vary according to its histological components, and the definitive diagnosis ofHAML is challenging and depends on the presence of HMB-45-positive myoid cells.
Abstract: Purpose
We report our experience of diagnosing and treating hepatic angiomyolipoma (HAML), a rare benign mesenchymal tumor.