Katsunori Miyake

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.

Comparison of efficacies of the self-expandable metallic stent versus transanal drainage tube and emergency surgery for malignant left-sided colon obstruction

BACKGROUND/OBJECTIVEnPatients with left-sided malignant colorectal obstruction require emergency treatment. Emergency stoma surgery has traditionally been recommended, however many stomas became permanent, decreasing patient quality of life. Recently, self-expandable metallic stents (SEMS) and transanal decompression tubes (TDT) have become widely used decompression methods to avoid stoma surgery. In this study, we evaluated: 1) the efficacy of SEMS compared with TDT and emergency surgery (ES) to avoid permanent stomas; and 2) the safety and success rate of each treatment.nnnMETHODSnWe retrospectively reviewed data from 56 patients who underwent SEMS, TDT, or emergency surgery for malignant left-sided colon obstruction. We compared the permanent stoma rate of each group, and assessed whether or not each treatment was an independent risk factor for permanent stomas. We compared morbidity and mortality for each treatment group (SEMS, TDT, ES), and the success rate of the decompression procedures (SEMS and TDT).nnnRESULTSnThe permanent stoma rates in the SEMS, TDT, and ES groups were 5.3%, 50.0%, and 56.0%, respectively. Emergency surgery (vs. SEMS) and TDT (vs. SEMS) were independent risk factors for permanent stomas, as was agexa0≥xa075 years. Operative morbidity, mortality, and hospital stay were not different between groups. The success rate of SEMS was significantly higher than TDT; however, two deaths, including one perforation, occurred in the former group.nnnCONCLUSIONnSEMS seems to be effective in avoiding permanent stomas, but caution should be taken to avoid complications.

Can Living Transplant Donors Refuse Blood Transfusion? Case Reports of Living Kidney Transplantation From Jehovah's Witnesses: Letter to the Editor

or.jp/overview/pdf2006/p48.pdf (in Japanese). 3. Habbous S, Przech S, Acedillo R, Sarma S, Garg AX, Martin J. The efficacy and safety of sevelamer and lanthanum versus calcium-containing and iron-based binders in treating hyperphosphatemia in patients with chronic kidney disease: a systematic review and meta-analysis. Nephrol Dial Transplant 2017;32:111–25. 4. Jamal SA, Fitchett D, Lok CE, Mendelssohn DC, Tsuyuki RT. The effects of calcium-based versus non-calcium-based phosphate binders on mortality among patients with chronic kidney disease: a meta-analysis. Nephrol Dial Transplant 2009;24:3168–74.

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.

Lumbar Arterial Bleeding Treated with Endovascular Aneurysm Repair: A Report of 4 Patients

BACKGROUNDnLumbar arterial bleeding is a severe condition. Surgical exploration is not indicated because of its rich collateral flow. Transarterial embolization (TAE) is reportedly effective, but there have been cases of failure. It may be a time-consuming procedure for patients with multiple bleeding sources or those with poor vital signs. In this case series, we used endovascular aneurysm repair (EVAR) instead of TAE.nnnMETHODnIn this case series, we described 4 male patients (2 with traumatic injury, 1 with iatrogenic injury, and 1 with drug-induced hypocoagulability) with lumbar arterial bleeding. The reasons we chose EVAR are because 2 patients had poor vital signs, one patient was a technically difficult case for selective cannulation, and one patient had accompanying aortic dissection.nnnRESULTnIn all patients, EVAR was performed successfully, and hemostasis was obtained although one patient died of pneumonia on postoperative dayxa023.nnnCONCLUSIONSnEVAR is an effective alternative for lumbar arterial bleeding although TAE is a first choice of treatment.

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.