Masaaki Nishi

Characteristics of internal hernia after gastrectomy with Roux-en-Y reconstruction for gastric cancer.

BackgroundAlthough the internal hernias have been a huge topic in the field of bariatric surgery, there were a few reports in gastric cancer. The purpose of this study was to analyze the incidence, clinical features, and prevention of internal hernia after gastrectomy for gastric cancer.MethodsTwelve patients who underwent surgical treatment for internal hernia in our hospital after gastrectomy were analyzed. Features, including incidence, symptoms, and signs, were investigated in detail.ResultsThe operative procedures for preceding gastrectomies were open distal gastrectomy in three patients, open total gastrectomy in three patients, laparoscopic-assisted distal gastrectomy in two patients, and laparoscopic total gastrectomy in four patients. The most frequent sites of internal hernias were jejunojejunostomy mesenteric defects (five patients) and Petersen’s defect (five patients), mesenterium of transverse colon (one patient), and esophagus hiatus (one patient). There was no significant difference between open and laparoscopic preceding gastrectomies. After closure of the mesenteric defect was introduced, no further internal hernias occurred. On CT examination, the whirl sign was present in ten patients on 3D images.ConclusionsThe present data suggest the importance of early recognition and treatment of internal hernia, as well as its prevention by closure of mesenteric defects.

The beneficial effects of Kampo medicine Dai-ken-chu-to after hepatic resection: a prospective randomized control study.

BACKGROUND/AIMS After hepatic resection, delayed flatus and impaired bowel movement often cause problematic postoperative ileus. Kampo medicine, Dai-kenchu-to (DKT), is reported to have a various beneficial effects on bowel systems. The aim of this study was to prospectively evaluate effects of DKT after hepatic resection. METHODOLOGY Thirty-two patients who underwent hepatic resection between July 2007 and August 2008 in Tokushima University Hospital were prospectively divided into DKT group (n=16) and control group (n=16). In DKT group, 2.5 g of DKT was administered orally three times a day from postoperative day (POD) 1. Blood was examined on POD 1, 3, 5 and 7. Postoperative first flatus, bowel movement and full recovery of oral intake, hospital stays and complications were checked. RESULTS In DKT group, levels of c-reactive protein and beta-(1-3)-D-glucan on POD 3 were significantly decreased (p<0.05). Moreover, postoperative periods for the first flatus, bowel movement and the full recovery of oral intake were significantly shortened in DKT group (p<0.05). CONCLUSIONS DKT suppressed inflammatory reaction, stimulated bowel movement and improved oral intake after hepatic resection, which may decrease serious morbidity after hepatic resection.

Duodenal–jejunal bypass improves diabetes and liver steatosis via enhanced glucagon‐like peptide‐1 elicited by bile acids

Bariatric surgery not only elicits weight loss but also rapidly resolves diabetes. However, the mechanisms remain unclear. The present study investigates how diabetes and liver steatosis are improved after duodenal–jejunal bypass (DJB) compared with a glucagon‐like peptide‐1 (GLP‐1) analog and correlations between bile acids and GLP‐1 secretion.

Role of dihydropyrimidine dehydrogenase and thymidylate synthase expression in immunohistochemistry of intrahepatic cholangiocarcinoma.

Aims:  Dihydropyrimidine dehydrogenase (DPD) and thymidylate synthase (TS) are key enzymes in the metabolism of 5‐fluorouracil and have been implicated as possible prognostic markers for cancer patients. However, the clinical roles of DPD and TS in intrahepatic cholangiocarcinoma (IHCC) have not been investigated. The aim of this study was to clarify the clinicopathological role of DPD and TS expressions in IHCC.

Mass-forming pancreatitis with positive fluoro-2-deoxy-d-glucose positron emission tomography and positive diffusion-weighted imaging-magnetic resonance imaging: Report of a case

It is difficult to make an accurate radiological diagnosis of a pancreatic tumor because of its location and anatomical characteristics. Mass-forming pancreatitis and pancreatic cancer are particularly difficult to differentiate. New diagnostic technology, which includes diffusion-weighted imaging-magnetic resonance imaging (DWI-MRI) and 2-[18F]-fluoro-2-deoxy-Dglucose positron emission tomography (FDG-PET), offers hope for the detection of classical pancreatic cancer. Few studies have been conducted on FDG-PET and DWI-MRI as tools used to distinguish between mass-forming pancreatitis and pancreatic cancers. Furthermore, positive findings of mass-forming pancreatitis on DWI-MRI and FDG-PET have yet to be documented. We report a case of a pancreatic head tumor, present on FDG-PET and DWI-MRI which, on closer examination, revealed benign mass-forming pancreatitis. We discuss the utility of FDG-PET and DWI-MRI as preoperative diagnostic tools.

Prediction of response to preoperative chemoradiotherapy and establishment of individualized therapy in advanced rectal cancer.

Preoperative chemoradiotherapy (CRT) has become the standard treatment for patients with locally advanced rectal cancer. However, no specific biomarker has been identified to predict a response to preoperative CRT. The aim of the present study was to assess the gene expression patterns of patients with advanced rectal cancer to predict their responses to preoperative CRT. Fifty-nine rectal cancer patients were subjected to preoperative CRT. Patients were randomly assigned to receive CRT with tegafur/gimeracil/oteracil (S-1 group, n=30) or tegafur-uracil (UFT group, n=29). Gene expression changes were studied with cDNA and miRNA microarray. The association between gene expression and response to CRT was evaluated. cDNA microarray showed that 184 genes were significantly differentially expressed between the responders and the non‑responders in the S-1 group. Comparatively, 193 genes were significantly differentially expressed in the responders in the UFT group. TBX18 upregulation was common to both groups whereas BTNL8, LOC375010, ADH1B, HRASLS2, LOC284232, GCNT3 and ALDH1A2 were significantly differentially lower in both groups when compared with the non-responders. Using miRNA microarray, we found that 7 and 16 genes were significantly differentially expressed between the responders and non-responders in the S-1 and UFT groups, respectively. miR-223 was significantly higher in the responders in the S-1 group and tended to be higher in the responders in the UFT group. The present study identified several genes likely to be useful for establishing individualized therapies for patients with rectal cancer.

Combined liver mobilization and retraction: A novel technique to obtain the optimal surgical field during laparoscopic total gastrectomy

During laparoscopic gastrectomy, it is important to establish a good operative field and ensure an adequate working space. The combined liver mobilization and retraction method is used to get a safe and optimal view.

Hybrid technique for laparoscopic incisional ventral hernia repair combining laparoscopic primary closure and mesh repair

Incisional ventral hernia is one of the most common surgical complications after laparotomy. Laparoscopic repair of incisional ventral hernia has been conducted recently, and the advantages of this procedure have been reported. However, in large orifice cases, the recurrence rate is increased. To improve recurrence rates in large cases, a hybrid method combining laparoscopic primary closure and mesh repair can be applied.

Living donor liver transplantation using a left hepatic graft from a donor with a history of gastric cancer operation

In some countries, because of the scarcity of cadaveric donation [1], liver transplants have been heavily dependent on living donation which has recently become an accepted procedure [2]. In such situations, selection of living donors is one of the most important matters, especially in donors with a history of an abdominal operation or malignancy [3–5]. Here we report a case of living donor liver transplantation (LDLT) using a left hepatic graft from a donor with a history of gastric cancer operation. A 60-year-old female was admitted to our hospital with decompensated hepatitis C-related cirrhosis to undergo LDLT. The preoperative Model for End-Stage Liver Disease score [6] was 18. Her husband, the only candidate living donor, was a 59-year-old man with a history

Limited lymph node dissection in elderly patients with gastric cancer

BACKGROUND The number of elderly patients with gastric cancer is continuing to increase along with the life expectancy of the general population. The purpose of this study was to investigate both the impact of age on postoperative outcome and the effect of limited lymph node dissection for elderly patients. METHODS Patients were classified into the following three groups: Group A, ≥80 years old (n=44); Group B, 70-80 years old (n=139); Group C, <70 years old (n=219). Postoperative complication and survival rates were compared between the three groups Results: Limited lymph node dissection was performed significantly more frequently in Group A. In terms of surgery-related complications, no significant difference was seen between groups. In terms of general related complications, the complication rate increased with age, from 4% in Group C to 13% in Group B and 14% in Group A (p<0.05 each). Although limited lymph node dissection was frequently performed in Group A, cancer-specific survival showed no significant difference in R0 patients. CONCLUSIONS Limited lymph node dissection for gastric cancer did not affect the cancer-specific survival in elderly patients.