Motoki Nagai

Inhibition of Hepatic Regeneration after 70% Partial Hepatectomy by Simultaneous Resection of the Bowel in Rats

This study was aimed to evaluate bow simultaneous resection of the bowel influences hepatic regeneration after partial hepatectomy (HTX). Two hundred and sixty-four rats underwent 70% partial HTX, ileocecal resection (ICR), transverse colon resection (TR), colon amputation and simulatenous resection of the liver and the bowel (HTX+ICR, HTX+TR). Hepatic DNA synthesis was remarkably suppressed by simultaneous resection compared with the 70% HTX group (p < 0.01). In simultaneous resection groups, delayed enhanced hepatic protein synthesis (HPS) was observed after the operation as compared with the 70% HTX group, which showed an early postoperative peak of HPS. Postoperative anastomosis leakage occurred more frequently and survival rates were significantly lower in simultaneous resection groups. Higher plasma endotoxin levels of the portal and the peripheral veins were found in simultaneous resection groups as compared with other groups (p < 0.01-0.001). This study suggested that simultaneous resection of the bowel with partial HTX might inhibit hepatic regeneration and result in the increased risk of anastomosis leakage and high surgical mortality rate by increased plasma endotoxin levels and delayed enhanced HPS.

Laparoscopic Management of Mirizzi Syndrome Without Dissection of Calot's Triangle

BACKGROUND Mirizzi syndrome (MS) is a rare complication of cholecystolithiasis that causes compacted gallstones and is often accompanied by severe inflammation of Calots triangle. This study compared the use of laparoscopic surgery for MS without dissection of Calots triangle with routine laparoscopic cholecystectomy (LC). METHODS A total of 411 consecutive patients underwent laparoscopic surgery for benign gallbladder (GB) disease between January 2013 and December 2014. Five patients underwent laparoscopic surgery for MS (MS group) while 406 underwent routine LC (LC group). The preoperative diagnosis was accurate in all patients in the MS group. RESULTS The LC and MS groups did not differ significantly in the operation time, blood loss, length of hospital stay, or incidence of GB carcinoma. In addition, conversion, bile duct injury, and bile leak rate were not different between the two groups. CONCLUSIONS This study demonstrates the safety of laparoscopic partial cholecystectomy without dissection of Calots triangle for MS. In addition, an accurate preoperative diagnosis is critical in surgical decision making to avoid injury to the bile duct.

A mixed mesodermal tumor of the cecum: Report of a case

We herein report the case of a 69-year old woman presenting with an abdominal mass, who was found to have a mixed mesodermal tumor (MMT) of the cecum. Imaging studies and endoscopic investigations were consistent with the diagnosis of a nonepithelial malignant tumor of the cecum. On laparotomy, a knuckle-sized firm mass involving the cecum was noticed. As a result, a right hemicolectomy was performed. Pathological examinations, including immunohistochemical staining, resulted in the diagnosis of mesodermal mixed tumor, homologous type. The patient was advised to undergo postoperative chemotherapy but she did not comply. She has been followed up as an outpatient and is still alive 1.5 years after the operation.

Reply to three Editorials by Luris N et al ., Sussmann N, and Vather R, et al .

We are grateful to read three editorials by Lluis et al ., Sussmann, and Vather, et al . (1-3) for our recent study entitled “Perioperative factors predicting prolonged postoperative ileus after major abdominal surgery” in Journal of Gastrointestinal Surgery (4). We devised a nomogram to predict the development of prolonged postoperative ileus (PPOI) based on the multivariable logistic regression analysis for patients undergoing major abdominal surgery.

Significance of aminopyrine breath test as a parameter of hepatic functional reserve in 40% partial hepatectomy of rats with CCl4-induced liver injury

Rats with CCl4-induced liver injury underwent partial (40%) hepatectomy. The [14C]aminopyrine breath test (ABT) values in rats with CCl4-induced liver injury were reduced by 34% compared with those in rats with normal liver. Preoperative ABT values clearly discriminated between survivors and those that died following 40% partial hepatectomy in rats CCl4-induced liver injury (P<0.05). Hepatic protein synthesis was remarkably enhanced in CCl4-induced liver injury compared with normal liver (P<0.001), and this was inversely correlated with ABT values (P<0.001). These data show that the enhanced hepatic protein synthesis could induce a decrease of hepatic functional reserve. ABT seems to be a useful preoperative test for predicting surgical mortality following hepatectomy.