Mitsuyoshi Tei

Comparison of perioperative and short-term oncological outcomes after single- or multiport surgery for colorectal cancer.

The aim of this retrospective study was to compare the short‐term surgical results of single‐port surgery (SPS) with those of multiport surgery (MPS) for colorectal cancer.

Short-term outcome of single-incision laparoscopic totally extra-peritoneal inguinal hernia repair.

We performed single‐incision laparoscopic surgery for totally extra‐peritoneal (SILS‐TEP) repair using a lightweight mesh fixed by absorbable tacks and without balloon dilation. Thirty‐four patients (mean age, 66.5 years) underwent SILS‐TEP repair in our hospital between September 2011 and April 2012; 30 patients had unilateral hernia and 4 had bilateral hernias. Mean operative time was 85.6 min for unilateral hernia and 137.7 min for bilateral hernias. All patients underwent successful SILS‐TEP repair. Mean hospital stay was 3.4 days. Mean duration of follow‐up was 7.1 months. Four seromas were observed, but no recurrences or major complications occurred. SILS‐TEP is an economical and useful method for decreasing postoperative complications, such as neuralgia and recurrence, and it could be an attractive approach for inguinal hernia.

Single-port laparoscopic colectomy is safe and feasible in patients with previous abdominal surgery.

BACKGROUND The aim of this study was to assess the impact of previous abdominal surgery (PAS) on single-port laparoscopic colectomy (SPLC). METHODS We studied 429 consecutive patients who underwent SPLC in our department from May 2009 to December 2013. Patients were divided into 2 groups: those with PAS (PAS group) and those with NPAS (NPAS group). Operative parameters and outcomes were analyzed between the 2 groups retrospectively. RESULTS SPLC was performed in 152 PAS patients and 277 NPAS patients. Eight patients in the PAS group and 6 patients in the NPAS group were converted to multiport laparoscopic colectomy (5.3% vs. 2.2%, respectively; P = .077). Three patients in the PAS group and 2 patients in the NPAS group had inadvertent enterotomy (2.0% vs. .7%, respectively; P = .352). No patients were converted to open surgery. There were no significant differences between the 2 groups in terms of blood loss, operative time, and postoperative outcomes. CONCLUSION Our experience has demonstrated the safety and feasibility of SPLC in patients with PAS.

Multiple hepatic sclerosing hemangioma mimicking metastatic liver tumor successfully treated by laparoscopic surgery: Report of a case.

Highlights • Sclerosing hemangioma should be included among the differential diagnoses of multiple liver tumors in patients with colorectal cancer.• Laparoscopic hepatectomy is useful for diagnostic therapy for undiagnosed multiple liver tumors.• This report is the first to describe multiple hepatic sclerosing hemangiomas treated by laparoscopic surgery.

Laparoscopic Distal Pancreatectomy for Multiple Epithelial Cysts in an Intrapancreatic Accessory Spleen. A Case Report and Review of Literature

CONTEXT Accessory spleen is a congenital abnormality consisting of normal splenic tissue in ectopic sites that is found in approximately 10-15% of the general population. However, an intrapancreatic accessory spleen has seldom been reported and multiple epithelial cysts in the intrapancreatic accessory spleen are extremely rare. CASE REPORT A 37-year-old woman with no clinical manifestations presented with two cystic lesions in the tail of the pancreas. The tumor markers CA 19-9 (251 U/mL) and SPAN-1 (38 U/mL) were increased. Computed tomography showed a multilocular cyst, 40 mm in size, and a unilocular cyst, 20 mm in size, in the tail of the pancreas and gallstones. The cystic component was hypointense on T1-weighted magnetic resonance images and hyperintense on T2-weighted magnetic resonance images. A laparoscopic distal pancreatectomy was performed with the presumptive diagnosis of a mucinous cystic neoplasm or an intraductal papillary mucinous neoplasm with gallstones. The pathological examination showed that the walls of the two cysts were covered with non-keratinized stratified squamous epithelium, surrounded by normal splenic tissue. The final pathological diagnosis was two epithelial cysts originating from an intrapancreatic accessory spleen. CONCLUSIONS Even though multiple masses were detected in the pancreatic tail, the possibility of epithelial cysts originating from an accessory spleen should be considered. Laparoscopic distal pancreatectomy might be a safe and effective procedure and provide good cosmetic result for a benign or low-grade malignant tumor in the pancreas.

Single-incision laparoscopic totally extraperitoneal obturator hernia repair in a patient on antiplatelet therapy: A case report

An 83‐year‐old woman who complained of right lower limb discomfort was diagnosed with a right obturator hernia by CT scan. On examination, she had a soft and flat abdomen without signs of peritoneal irritation. The Howship–Romberg sign was present. She had a history of vasospastic angina and paroxysmal supraventricular tachycardia, and took aspirin and dipyridamole until she was admitted to the hospital. Exploratory laparoscopy identified a spontaneously reduced small bowel from the right obturator canal, but there were no signs of ischemic and necrotic bowel. The patient underwent SILS for totally extraperitoneal obturator hernia repair without a dissection balloon. The patient recovered without perioperative complications such as hemorrhage and thrombotic episodes. She remains well, and CT scans showed no signs of obturator hernia recurrence at the 7‐month follow‐up.

Choroidal metastasis from early rectal cancer: Case report and literature review

Highlights • We report a case of choroidal metastasis from early rectal cancer.• Radiotherapy was initiated for the left eye and systemic chemotherapy is initiated for the multiple lung metastases.• The patient is living 2 years and 3 months after the diagnosis of choroidal metastasis without signs of recurrence in the left eye.

Evaluation of postoperative pain at the stoma site in patients who underwent a single-port Hartmann's procedure

The aims of this retrospective study were to evaluate postoperative pain at the stoma site in patients who underwent a single‐port Hartmanns procedure (SPH) and to compare the SPH to the multiport Hartmanns procedure (MPH) in terms of postoperative pain.

Pathological Complete Response of Advanced Rectal Cancer Treated by Preoperative Chemoradiotherapy with Oral Tegafur-Uracil and Leucovorin: A Case Report

A rare case of pathological complete response of advanced rectal cancer treated by preoperative chemoradiotherapy (CRT) with oral tegafur-uracil and leucovorin is reported. A 73-year-old man with bloody stool was diagnosed with type 2 rectal cancer located 6 cm from the anal verge. Examination of biopsy specimens revealed moderately differentiated adenocarcinoma. Computed tomography scans showed no distant or lymph node metastases. With a diagnosis of advanced lower rectal cancer of T3N0M0 stage III according to the TNM classification, he underwent preoperative CRT with oral tegafur-uracil and leucovorin. He did not experience any adverse events due to CRT. An abdominal CT scan and colonoscopy after CRT demonstrated significant tumor reduction. Then, 63 days after CRT, he underwent laparoscopic-assisted low anterior resection and diverting ileostomy. Pathological examination revealed no residual cancer cells. During 15 months of follow-up after his ileostomy was taken down, the patient continued to do well without any signs of recurrence or metastasis. Preoperative CRT with tegafur-uracil and leucovorin may thus represent a safe, well-tolerated, and effective therapeutic strategy for patients with advanced rectal cancer.