Yosuke Fukunaga

Hand-assisted laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer.

Recently, a minimally invasive operation for gastric malignancies has been advocated, and the laparoscopic operation is noted as a technique that raises the quality of life. We performed distal gastrectomy with regional lymph node dissection by hand-assisted laparoscopic surgery for 60 cases of gastric cancer located in the middle or lower third of the stomach. Billroth I reconstruction was applied intracorporeally to the first 30 cases by using the double stapling method with a conventional circular stapling device, and in the final 30 cases, the quadrilateral (square) stapling technique with a laparoscopic linear stapling device was used to prevent postoperative anastomotic bleeding. This technique not only is less invasive, but also is similarly curative compared with open gastrectomy that was performed for 60 gastric cancer cases of similar staging before the beginning of this procedure.

Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer.

Abstract.Recently, a minimally invasive operation for gastric malignancies has been developed, and this laparoscopic operation is seen as a technique that will raise quality of life for patients. Previously, we reported this technique, as well as the results of a distal gastrectomy with regional lymph node dissection using hand-assisted laparoscopic surgery (HALS) for gastric cancer located in the middle or lower third of the stomach. This paper describes total or proximal gastrectomy with regional lymph node dissection by HALS on 28 cases of gastric cancer located in the upper portion of the stomach. After the mobilization of stomach and lymph node dissection via HALS, an anastomosis of the esophagus was performed intracorporeally with a conventional circular stapling device (PCEEA), whereas jejunojejunostomy and jejunogastrostomy were carried out extracorporeally with a conventional hand-sewn procedure through a HALS wound. The operation time and the amount of blood loss in all the patients were considered to be satisfactory, and the average number of dissected lymph nodes per patient was similar to that in open surgery. The patients had minimal morbidity and quick recovery after their operation. This technique was thought to be not only less invasive, but also similarly curative compared with open gastrectomy.

Laparoscopy-assisted resection for jejunal carcinoma.

Laparoscopic surgery has been applied in small bowel resections for various diseases, such as obstruction including intussusception, diverticula, and tumors. We report a case of successful resection of a jejunal carcinoma that was diagnosed before surgery by using a laparoscopy-assisted technique.

A Case of Epiphrenic Esophageal Diverticulum Associated with Esophageal Dysmotility.

食道運動異常と胃食道逆流を伴う横隔膜上食道憩室に外科的な処置を加え良好な結果を得たので報告する.患者は71歳の女性で, 嚥下困難を主訴として来院.上部消化管造影で下部食道に憩室を認め, 内視鏡で憩室炎を認めた.食道内圧測定では憩室より上部の食道に嚥下に伴う正常な蠕動波が認められず, 24時間食道内pH測定では明らかな酸逆流を認めた.手術としては経胸的憩室切除術にBelseyの噴門形成術を付加した.切除標本は組織学的には炎症所見のみで悪性所見はなかった.われわれは食道憩室では食道内圧測定や24時間食道内pH測定検査を行い, 憩室切除術のみではなく病態に応じた付加治療を考慮すべきであると考える.

Experimental Study on Function of the Upper Esophageal Sphincter After Radical Operation for Esophageal Cancer

The upper esophageal sphincter (UES), located between the esophagus and the pharynx, provides a barrier against esophagopharyngeal reflux and subsequent aspiration of intraesophageal contents such as food or digestive juices. This consists of the cricopharyngeus muscle and the upper part of esophageal circular muscle. The UES is presented as a high pressure zone manometrically, with the pressure (UESP) higher than pharyngeal or esophageal pressure, i.e., around 39mmHg as reported by Tokuhara et al. [1], and the length of this high pressure zone is about 2–4 cm.