Hitoshi Kin

Acute intrathoracic incarceration of the stomach after laparoscopic Nissen fundoplication.

A rare case of paraesophageal hernia with complete intrathoracic incarceration of the stomach after laparoscopic Nissen fundoplication is described. An 85-year-old woman who had undergone laparoscopic Nissen fundoplication for gastroesophageal reflux disease presented 14 months later with nausea and vomiting. Esophagogastroendoscopy showed obstruction of the esophagogastric junction and gastric mucosal necrosis. Emergency laparotomy showed the stomach to be entirely strangulated into the thorax, with areas of necrosis. Gastrotomy was followed by resection of the necrotic anterior wall of the stomach, closure of the hiatus, and suturing of the stomach to the diaphragm. Appropriate closure of crura and anchoring suture between the stomach and diaphragm are helpful to prevent recurrent hernia after laparoscopic Nissen fundoplication.

Laparoscopic low anterior resection using a triple stapling technique.

Laparoscopic low anterior resections using a triple stapling technique in five patients with rectal cancers (four Dukes A and one Dukes C) were performed. The location of the tumors was between 5 and 18 cm from the anal verge. For easy maneuverability, a 33-mm suprapubic port was used. In this technique, the Endo TA (the first stapler) is applied at the distal margin of the rectum to occlude the bowel. The bowel is irrigated with povidone-iodine solution and transected by an endolinear (the second) stapler. Anastomosis is completed by firing the circular (the third) stapler. The operative time was 177 +/- 28.0 minutes, estimated blood loss was 41.7 +/- 28.6 g, and flatus appeared 1.8 +/- 0.8 days after surgery. Follow-up studies have showed no local recurrence or distant metastasis. This procedure is safe and useful for performing laparoscopic low anterior resection.

Studies on clinical pathophysiology and treatment of hepatolithiasis.

病態を明確にしえた肝内結石症30例について検討した. 結石所在部位はR8例, RL13例, L9例であったが, 胆管狭窄に主眼をおくと, 1) 左右肝内胆管無狭窄型6例, 2) 右肝内胆管狭窄型7例, 3) 左肝内胆管狭窄型15例, 4) 左右肝内胆管狭窄型2例となった. これらについて結石の分布と個数および肝内胆管狭窄の関係から進展形式について考察すると, 肝内胆管に狭窄がある型では結石は狭窄部の末梢に原発して他の部位にも移動してゆくが, 肝内胆管無狭窄型では結石は肝外胆管に原発して積み上げによって肝内に及ぶと推察された. 治療は肝内胆管狭窄を有する症例24例中22例に狭窄胆管を含む肝切除が行われたが予後は良好であった.