Hiroto Manase

Esophageal delta-shaped anastomosis: a new method of stapled anastomosis for the cervical esophagus and digestive tract.

We describe a new technique of anastomosis between the esophagus and digestive tract, developed as an extension of a functional end-to-end anastomosis, and named the “esophageal delta-shaped anastomosis.” We also report its short-term clinical results. We used this anastomotic technique in nine patients undergoing surgery for thoracic esophageal carcinoma. The reconstruction route was posterior mediastinal (n = 5), antethoracic (n = 3), or retrosternal (n = 1), and the organs for esophageal replacement were the gastric tube (n = 7) or the colon (n = 2). When using the gastric tube, a linear stapler is inserted into two intestinal windows; one created at the stump of the esophagus and the other created in the posterior wall near the greater curvature of the gastric tube. The stapler is fired, ensuring that the staple line does not sharply cross the staple line of the lesser curvature of the gastric tube. Two linear staplers are then used to close the window transversally to form a delta shape. There were no complications related to the anastomosis. The esophageal delta-shaped anastomosis is a simple and safe method for esophagogastrostomy or esophagoenterostomy, which uses a combination of introverted and extroverted stapling, resulting in a larger lumen not limited by the lumen of the esophagus or the organs used for esophageal replacement.

Gianturco stents for the venous system: A detailed pathological study

This study was designed to examine the short-term performance of Gianturco stents placed in the venous system, in comparison with that of stents placed in the arterial system. Single-bodied modified Gianturco stents were surgically placed in six dogs (group 1), while in another six dogs, only exposure of the vessels was performed (group 2). Segments with an outer diameter 0.9 times smaller than those of the stents were targeted in the infrarenal inferior vena cava (IVC), the portal vein (PV), and the infrarenal abdominal aorta (AA). The animals were killed 4 weeks postoperatively for pathological analysis. All the segments were patent in both groups. Although the stents placed in the infrarenal IVC and PV were completely covered with neointima, those placed in the infrarenal AA were only partially covered. Furthermore, the venous stents were deeply embedded in the media, while the aortic stents remained in the intima. Medial hyperplasia occurred in the venous stents, while intimal hyperplasia occurred in the aortic stents. In conclusion, Gianturco stents placed in the IVC and PV performed better in the short term than the stents placed in the AA.

Portal vein reconstruction with conventional polytetrafluoroethylene grafts: an experimental study in dogs.

The purpose of this study was to examine the short- and long-term performance of conventional polytetrafluoroethylene (PTFE) grafts for portal vein reconstruction. The grafts were placed as a portal vein replacement in 11 mongrel dogs. At 1 month and 6 months, the grafts were then retrieved and examined for patency, while also undergoing a pathological analysis. During the observation period (at 55 days), one dog died of an unknown cause with a patent graft. The patency rates of the other 10 grafts were 83% (5/6) at 1 month and 100% (4/4) at 6 months. However, the neointima formation was incomplete even 6 months after implantation. In conclusion, although conventional PTFE grafts may be used as a synthetic alternative to autogenous vein grafts, every effort should be made to use autogenous vein grafts before considering conventional PTFE grafts.

Experimental replacement of the thoracic inferior vena cava with a high-porosity expanded polytetrafluoroethylene graft wrapped in an omental pedicle flap

We examined the patency and healing of a highporosity expanded polytetrafluoroethylene (ePTFE) graft implanted as an interposition graft in the thoracic inferior vena cava (IVC) and wrapped in an omental pedicle flap. High-porosity ePTFE grafts of 60 μ fibril length, with an internal diameter of 10 mm and a length of 4 cm, were implanted in 12 mongrel dogs. In 6 dogs, the grafts were wrapped in omental pedicle flap, and in the remaining 6 the grafts were unwrapped. The animals were killed 4 weeks after the replacement and the grafts were removed for examination. Patency of the graft in both groups was 100%; however, the thrombusfree area in the omentum-wrapped group was significantly larger (P<0.05) than that in the unwrapped group. Light microscopy revealed the marked infiltration of cells and capillaries within the graft interstices in the omentum-wrapped group. These findings suggest that encapsulation of the highporosity ePTFE graft is promoted by an omental pedicle flap.

A rare case of spontaneous esophageal rupture (Boerhaave’s syndrome) associated with pulmonary rupture

Spontaneous esophageal rupture (Boerhaaves Syndrome) is a life-threatening condition that requires early diagnosis and effective treatment. The authors describe a rare case of spontaneous rupture of the esophagus associated with pulmonary rupture in a 54-year-old man. The anatomical basis for the occurrence of a spontaneous esophageal rupture associated with pulmonary rupture is discussed.