Naoki Igarashi

Laparoscopy-assisted combined resection for synchronous gastric and colorectal cancer: Report of three cases

In gastric cancer patients, the most common form of synchronous cancer is colorectal cancer. To reduce the invasiveness of the resection, a laparoscopy-assisted combined resection was performed in three patients with synchronous gastric and colorectal cancer. Although all gastric lesions were in the early stages, two colorectal lesions were advanced cases. In all cases, the laparoscopic gastric resection and reconstruction was performed first, followed by the colorectal resection. In the case of right-side colon cancer in addition to gastric cancer, it was relatively easy to perform the combined resection with lymph node dissection sharing the same ports used for the gastrectomy, although we needed an additional port. In one case, in which rectal cancer was present in addition to gastric cancer located in the upper portion of the stomach, a totally laparoscopic proximal gastrectomy was combined with a laparoscopy-assisted low anterior resection, leaving only a lower abdominal minilaparotomy wound. All patients quickly returned to normal activity without remarkable complications, with the exception of a wound infection in one patient. With a mean follow-up of 30.7 months, all patients survived without any sign of recurrence. This procedure represents a feasible option for minimally invasive treatment of synchronous gastric and colorectal cancer.

Laparoscopic composite-mesh repair of an adult Morgagni hernia

Congenital Morgagni hernia is a rare clinical condition. We present a 72‐year‐old man with epigastric discomfort and hematemesis who was diagnosed with hernia of Morgagni with an incarceration of the stomach and colon. The patient was treated electively by laparoscopic composite‐mesh repair without excising the hernial sac or approximating the edges of the defect, which was 10 × 6 cm in diameter. He was discharged on the seventh postoperative day without any complications. At a 1‐year follow‐up examination he had no recurrence nor clinical symptoms, although the large hernial sac contained fluid. Laparoscopic composite‐mesh repair is a less‐invasive and tension‐free method for Morgagni hernia that results in an excellent clinical outcome.