Hiroyuki Kashiwagi

DUPLICATE GALLBLADDER DIAGNOSED WITH ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND TREATED WITH LAPAROSCOPIC CHOLECYSTECTOMY

A 44‐year‐old man was admitted to hospital because of sudden severe postprandial right epigastric pain. Abdominal echography showed multiple calculi in the gallbladder and evidence of a probable septum at the neck. Based on the results, tentative diagnoses were made of gallbladder calculosis with associated gallbladder curvature or malformation, and gallbladder adenomyomatosis. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) revealed a duplicate gallbladder consisting of two cystic ducts with two connected gallbladders. Laparoscopic cholecystectomy (Lap‐C) was performed. Inflammation of the Calots triangle was mild. The two cystic ducts with one common bile duct were identified, and the cystic ducts separated by individual clipping. Duplicate gallbladder, a malformation of the gallbladder, has been reported to occur at an incidence of 0.02%. To date, a total of 60 cases have been reported in Japan, and recent cases have been treated with Lap‐C. In the present case, the surgery could be safely performed because the bifurcation of the cystic ducts could be identified by preoperative ERCP.

Fatal liver gas gangrene after biliary surgery

Highlights • Liver gas gangrene is a rare condition with a highly mortality rate.• Development of liver gas gangrene is associated with host conditions such as malignancy and immunosuppression.• We report a case of liver gas gangrene after biliary surgery which is one of the risks of the liver parenchymal infection.

Morgagni hernia treated by reduced port surgery

Highlights • Morgagni hernia is a rare diaphragmatic hernia and standard therapy has not been established.• The laparoscopic repair of a rare diaphragmatic Morgagni hernia in an elder patient using the reduced port approach is described.• This reduced port approach is a good indication for this type of hernia because of less invasive ness, cosmetics and safety.

A rare case of an infected tracheal diverticulum requiring emergency intervention: A case report

Highlights • A case of an infected tracheal diverticulum presenting as a paratracheal mass is demonstrated.• An infected tracheal diverticulum can impair the airway and require emergency intervention including surgery.• The most commonly described procedure of surgery is resection via a transverse or lateral neck incision and drainage of the abscess.• A CT scan plays important roles to make a diagnosis and evaluate the necessity of intervention.

Small intestinal metastases from esophageal carcinoma presenting as a perforation: A case report and review of the literature.

Highlights • Small intestinal metastasis from oesophageal carcinoma is extremely rare.• Most cases of it involve male patients with squamous cell carcinoma.• Most cases are associated with ileus or perforation with fatal outcome.• The combination of resection and chemo-radio-therapy seems to be essential.

Successful treatment of hepatic gas gangrene by open drainage: A case report and review of the Japanese literature.

Highlights • Hepatic gas gangrene is with a high progression and mortality rate.• Hepatic gas gangrene due to clostridial infection has a very low prognosis.• Malignancies and Diabetes Mellitus seem to increase the risk of developing hepatic gas gangrene.• Laparotomy is the procedure of choice to prevent lethal outcomes from hepatic gas gangrene.

Stomach resection with intraoperative fluoroscopy in laparoscopic distal gastrectomy for early gastric cancer

Background: In Japan, laparoscopic distal gastrectomy (LDG) is common for early gastric cancer. Formerly, we used to verify the location of the marking clip to decide the proximal incisional line with our hand, through a small epigastric incision. In 2015, we introduced intracorporeal reconstruction and started to decide the incisional line using intraoperative fluoroscopy. Herein, we aimed to evaluate the efficacy and safety of intraoperative fluoroscopy in LDG. Patients and Methods: A total of 19 patients were included in this retrospective observational study. On the day before operation, we endoscopically clipped several points located 2 cm proximal to the tumour edge to cover about half of the tumour. After lymph node dissection, we incised the stomach with an endoscopic linear stapling device, including the previously placed clips, guided by intraoperative fluoroscopy. Reconstruction was performed in all patients who underwent Billroth I and Roux-en-Y procedures. Results: No complications were observed during pre-operative endoscopic clipping or intraoperatively. On pathological examination, all resected specimens had negative margins, and the mean distance from the tumour edge was 28.5 ± 16.5 (13–60) mm. Conclusion: Stomach resection with intraoperative fluoroscopic guidance was safe and effective.

Scarless surgery for a huge liver cyst: A case report

Highlights • Fenestration is the definitive treatment for symptomatic/complicated liver cysts.• NOTES, which has been reported recently, enables surgery without scars.• Multiple clinical and technological barriers impede further progress with NOTES.• Our safe and unique method enables minimally invasive surgery with small incisions.• This “scarless surgery” is expected to yield some clinical benefits.

Adventitial cystic disease of the popliteal artery treated by bypass graft utilizing the short saphenous vein: A case report

Highlights • CT or MRI scan is crucial in the diagnosis of adventitial cystic disease (ACD).• Surgery is the first line in the treatment of ACD at the popliteal artery.• The short saphenous vein was successfully employed in bypass graft surgery.

Dual port distal gastrectomy

Recently, the trend in laparoscopic procedures has been toward minimizing the number of incisions to reduce invasiveness. Our dual port approach potentiates less invasive surgery for early gastric cancer located in the middle or distal stomach. In this report, we describe how to perform this procedure. Seventeen patients who were diagnosed as having early stage gastric cancer, and one patient with a duodenal ulcer, were offered the dual port approach. Mean age and body mass index (BMI) were 67.6 and 22.2, respectively. A 5-mm flexible scope (Olympus, Tokyo, Japan) and SILS-Port (Covidien, Tokyo, Japan) were used in all cases. A nylon ligature with a straight needle, instead of a surgical instrument, was available to raise the gastric wall to visualize bursa space and neighboring organs. This nylon ligature is also useful for closing the suture hole with an Endo-GIA (Covidien, Tokyo, Japan). An additional 12-mm port can avoid the interference of surgical instruments due to the lack of triangulation. Outcomes of this surgery were acceptable with no short-term complication experienced by any of cases. In addition, port-related complications such as organ damage, adhesion, bleeding, wound infection and hernias may be less frequent because of the lower number of ports.