Shinsuke Takeno

A case of separation surgery with drainage tube-less (DRESS) esophagostomy for advanced cancer with a respiratory fistula

Highlights • An esophagorespiratory fistula can cause severe pneumonia or a lung abscess.• Control of inflammation and initiation of chemoradiotherapy promptly.• Separation surgery provides good control of inflammation.• Separation surgery is less invasive and allows prompt initiation of chemoradiotherapy.• Drainage tube-less (DRESS) esophagostomy might improve patient’s quality of life.

Salvage photodynamic therapy accompanied by extended lymphadenectomy for advanced esophageal carcinoma: A case report

Highlights • A case of esophageal cancer was treated with PDT after salvage Appleby operation.• Salvage lymphadenectomy is a safer procedure than salvage esophagectomy.• Salvage lymphadenectomy may be insufficient as a curative treatment.• PDT is a novel promising option for control primary carcinoma.

Jejunogastric intussusception after distal gastrectomy with Roux-en-Y reconstruction: A case report

Highlights • We report a case of jejunogastric intussusception after distal gastrectomy.• Diagnosis and management of the condition are discussed with a literatures review.• The authors suggest ways to prevent jejunogastric intussusception after gastrectomy.

Gastrointestinal: Severe congestive heart failure and acute gastric mucosal necrosis

A 51-year-old man was admitted to our hospital after one day of experiencing vomiting, epigastric pain, and hematemesis. Two months earlier, he was admitted for the treatment of pneumonia and acute renal failure. He had a history of surgical repair of an atrioventricular septal defect, bypass for aortic coarctation, open surgical mitral valve replacement, cerebral infarction, and liver cirrhosis secondary to congestive heart failure. On presentation, his abdomen was soft. Enhanced computed tomography showed air within the entirely thickened gastric wall, lack of contrast enhancement of the gastric wall, portal venous gas (Fig. 1a), and ascites in the pelvic cavity. An emergency laparotomy was performed. On laparotomy, the peritoneal cavity contained serosanguineous fluid and the liver showed cirrhosis. The distal esophagus, gastric body, and duodenum were normal in appearance (Fig. 2a). However, pneumatosis was found in the gastric body. Intraoperative esophagogastroduodenoscopy (EGD) under carbon dioxide insufflation demonstrated black circumferential mucosa in the stomach and bloody fluid consistent with acute gastric necrosis (AGN) (Fig. 1b). He subsequently underwent total gastrectomy with feeding jejunostomy for primary repair. Histopathological examination confirmed AGN in the mucosa and massive submucosal edema (Fig. 2b). However, no necrosis was found in the muscular layers and subserosa. In addition, neutrophilic infiltration with venous congestion and hemorrhage were found in all layers. His postoperative course was complicated by multiple organ failure. AGN is a rarely encountered clinical scenario, which is lifethreatening. EGD plays important roles in both diagnosing and judging the extent of AGN. The viability of gastric mucosa can be assessed by EGD, thereby supporting appropriate surgical intervention. However, caution is required when performing EGD for AGN because of risk of gas embolism. Therefore, in selected cases, EGDwith carbon dioxide insufflation should be attempted for early diagnosis, as the management of AGN is essential.

Thoracoscopic enucleation in the left decubitus position for leiomyoma of the upper thoracic esophagus: Utility of preoperative diagnosis applying endoscopic ultrasound-guided fine needle aspiration

Highlights • We report a case of esophageal leiomyoma enucleated by thoracoscopic procedures.• Preoperative EUS-FNA is useful to decide the operative procedure.• Preoperative EUS-FNA does not adversely influence subsequent enucleation.• Precise preoperative diagnosis is necessary to avoid excessive surgery.

Accompanying role of hepato-biliary-pancreas surgeon in urological surgery

Highlights • Accompanying support by full use of procedure of general or cardiovascular surgeons for urological surgery in malignancies provide curability.• Cardiovascular intervention should be necessary to remove long extension of tumor thrombus into the vena cava or right atrium.• Hepatic or pancreatic mobilization or combined resection is required for invasive or metastatic urological malignancies.• Operative safety is also required by precise preoperative planning and arrangement of procedure during operation by the good combination in each.

Significance of a soft-coagulation system with monopolar electrode for hepatectomy: A retrospective two-institution study by propensity analysis

BACKGROUNDnThe VIO soft-coagulation system (VIO) with a monopolar electrode is a novel hemostatic device that provides hemostasis by superficial contact at the bleeding site without carbonization. Because heat injury remains a concern, surgical records and postoperative liver dysfunction were retrospectively evaluated in a cohort study.nnnMETHODSnBetween September 2010 and March 2016, 322 patients underwent hepatectomy in which hemostatic devices were used at two institutions. Surgical results with use of VIO at one institute (VIO group) were compared with those without use of VIO at a second institute (control group), and propensity analysis was performed.nnnRESULTSnIn limited resection and segmentectomy or sectionectomy performed in the VIO group, the prevalence of liver cirrhosis was significantly higher and the operation time was significantly longer in comparison with the control group (pxa0<xa00.05). In all hepatectomies, postoperative levels of total bilirubin and aspartate or alanine transaminase tended to be increased and prothrombin activity tended to be lower in the VIO group in comparison with the control group (pxa0<xa00.05). The prevalence of hepatic failure in the VIO group was significantly higher in comparison with that in the control group (pxa0<xa00.05). In cases of segmentectomy or sectionectomy, blood loss was significantly increased in the VIO group in comparison with that in the control group (pxa0<xa00.05) Propensity score matching showed that although the surgical records and outcomes were not significantly different between the groups, postoperative liver dysfunction was significant in the VIO group in comparison with the control group (pxa0<xa00.05).nnnCONCLUSIONSnMild postoperative hepatic thermal injury with VIO was confirmed, and therefore, surgeons should take care when using the VIO system to make frequent wide resected cuts on the surface of the liver.