Masanobu Hayashi

Adenocarcinoma arising in a tailgut cyst: report of a case.

We report herein the unusual case of a 66-year-old woman found to have adenocarcinoma arising in a tailgut cyst. The patient had been observed for 6 months following the discovery of a presacral cystic mass measuring 10×9 cm for which she had refused surgery. The serum tumor marker, carcinoembryonic antigen, became slightly elevated, and diagnostic imaging distinctly revealed a tumorous lesion with papillary projection into the cyst lumen. The cystic mass was then excised through the transsacral approach. The pathological findings were compatible with moderately differentiated adenocarcinoma arising in a tailgut cyst. This entity is extremely rare, and only six cases, including our own, have been reported in the English literature. Early complete excision is advised because it is almost impossible to determine for certain whether presacral cystic masses are benign or malignant prior to surgery.

Management of gallbladder and common bile duct stones: Laparoscopic cholecystectomy combined with preoperative endoscopic sphincterotomy versus open surgery

Laparoscopic cholecystectomy (LC) combined with preoperative endoscopic sphincterotomy (EST) is becoming more widely employed as a therapeutic option for the management of gallbladder stones (GBS) and common bile duct stones (CBDS). To compare the results of LC plus preoperative EST with the results of open surgery, in terms of morbidity, mortality, hospital stay, length of operation, and hospital cost, we reviewed the charts of 105 patients who had concomitant GBS and CBDS: in 34, preoperative EST had been attempted, and 71 had undergone open surgery. Twenty-six of the 71 patients who had undergone open cholecystectomy, common bile duct exploration, and T-tube placement were selected for comparison as a T-tube group, since they had exhibited no condition that contraindicated LC. EST was unsuccessful in 6 of the 34 patients in whom it was attempted, and all 6 underwent open surgery. Successful EST and duct clearance were achieved in 28 patients (82.4%); 4 of them had serious medical problems and were followed without operation, 7 underwent open cholecystectomy, and the remaining 17 underwent LC (LC-after-EST group). Total hospital stay was longest in the 6 patients who underwent open surgery because of unsuccessful EST, and their total hospital cost was significantly higher than that of the patients in the LC-after-EST group. Operation time, rate of early postoperative complications, and hospital stay were significantly lower in the LC-after-EST group than in the T-tube groups, although total hospital cost was not different. The combination of preoperative EST and LC is a safe and effective option for the management of GBS and CBDS. However, when EST is unsuccessful and the patient is switched to open surgery, the hospital stay is much longer and more costly than when EST and LC are successful. The patient should be informed of the disadvantages if EST should fail.