Yoshikazu Koide

Novel Antimesenteric Functional End-to-End Handsewn (Kono-S) Anastomoses for Crohn's Disease: A Report of Surgical Procedure and Short-Term Outcomes

Introduction: Anastomotic surgical recurrence after bowel resection is a major problem in patients with Crohns disease. The aim of this prospective observational study was to evaluate the efficacy of a novel technique for restoring bowel continuity after resection involving either the small or the large intestine. Methods: The first case was instructed by Dr. Kono at Fujita Health University. The involved bowel segment was divided transversely with a linear stapler. The edges of two stapled lines are then connected to create a supporting column, which prevented surgical recurrence from anastomotic distortion due to mesenteric longitudinal ulcers. Thereafter, an antimesenteric longitudinal enterotomy was performed on each side to create a large-sized handsewn end-to-end anastomosis. Results: Thirty consecutive patients underwent Kono-S anastomoses from December 2009 to August 2013. Neither anastomotic leakage nor surgical recurrence was observed during a median follow-up period of 35 months. Endoscopic surveillance was performed in 18 cases (69.2%) undergoing ileo-colonic or ileo-rectal anastomosis with an average Rutgeerts score of 0.78 (0-3) at a mean of 14.5 months postoperatively. Conclusion: The Kono-S anastomosis for Crohns disease has been a safe and feasible technique. Long-term outcomes are required to confirm its advantage in preventing surgical recurrence at the anastomosis.

Mucoepidermoid Carcinoma of the Ascending Colon: Report of a Case

Abstract.Mucoepidermoid carcinoma of the gastrointestinal tract is a rare entity. The present case is the first report of mucoepidermoid carcinoma in the large bowel. A 71-year-old man was admitted to our hospital to undergo surgery for a recurrent chordoma of the hip. A barium enema and colonoscopy were carried out to assess whether there was any relationship between the recurrent chordoma and the rectum. An ulcerating tumor was thus identified in the ascending colon. A radical right hemicolectomy was carried out. In the resected specimen a 3-cm ulcerating lesion was observed. The tumor consisted of PAS-positive mucin-producing cells, epidermoid cells, and intermediate cells. No differentiated squamous cell carcinoma cells were identified in any part of the tumor. The malignant cells proliferated mainly in the submucosa but also invaded the muscularis and serosa. The tumor was diagnosed as a mucoepidermoid carcinoma of the ascending colon. Unfortunately, despite chemotherapy, the patient developed liver metastases and died of liver failure 10 months postoperatively.

Trans-sacral resection of a solitary fibrous tumor in the pelvis: Report of a case

Solitary fibrous tumors (SFTs) develop most commonly in the pleura, although they have occasionally been reported to arise in the pelvic cavity. We report a case of an SFT presenting as a painless nodule in the pelvis of a 56-year-old woman. Histologically, the tumor was composed of spindle-shaped cells arranged without pattern, with short and narrow fascicles and interspersed bundles of thick collagen, and numerous blood vessels with a focally hemangiopericytoma-like appearance. Immunohistochemically, the tumor cells strongly expressed vimentin, CD34, and bcl-2. The tumor was excised via a trans-sacral approach, without preoperative transcatheter embolization, and the patient remains well more than 2 years after her operation. To our knowledge, this is the first case of an SFT in the pelvis, which was excised completely via a trans-sacral approach.

Successful repair of a rectovaginal fistula caused by a tension-free vaginal mesh (TVM): a case report

Rectovaginal fistula caused by a tension-free vaginal mesh (TVM) is a rare condition. Moreover, a rectovaginal fistula is a challenging issue to address for surgeons regardless of causes. Due to a low rate of occurrence, treatment modality for a rectovaginal fistula caused by a TVM has previously received little attention. A successful surgery using several key techniques to address a rectovaginal fistula caused by a TVM is herein reported. A 78-year-old woman who underwent a TVM for a rectocele three months ago was referred to our hospital with a two-month history of anal bleeding. Mesh protruding into both the vagina and the rectum was confirmed. The patient was operated on under diagnosis of a rectovaginal fistula caused by TVM. TVM was removed by transvaginal dissection of the rectovaginal septum with division of both anterior and posterior arms of the TVM. Layer-to-layer sutures of rectal and vaginal walls were crossly performed with a drain placed in the rectovaginal septum after saline irrigation followed by a covering sigmoid colostomy. The wound healed without infection after surgery, and a water-soluble contrast enema demonstrated the healing of the rectovaginal fistula two months after surgery. No recurrent fistula was confirmed 15 months after stoma closure.

Clinical Significance of Serum Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 Levels before Surgery and during Postoperative Follow-up in Colorectal Cancer

Objective: Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are the most common colorectal cancer markers. We aimed to identify the appropriate clinical conditions for measurin...