Pylorus-preserving pancreatoduodenectomy preserving blood supply for pancreatic cancer with a history of proximal gastrectomy and sigmoidectomy: a case report.

Background: Blood supply to the remnant stomach should be preserved during pancreatectomy in patients with a history of gastrectomy. Moreover, ischemic complications should be considered when performing pancreatoduodenectomy in patients with celiac axis and superior mesenteric artery (SMA) stenosis. However, whether these surgical procedures can be safely performed remains unclear.

Tranexamic acid and blood loss in pancreaticoduodenectomy: TAC-PD randomized clinical trial.

Background: Tranexamic acid (TXA) may reduce intraoperative blood loss, but it has not been investigated in pancreaticoduodenectomy (PD).

Methods: A pragmatic, multicentre, randomized, blinded, placebo-controlled trial was conducted. Adult patients undergoing planned PD for biliary, duodenal, or pancreatic diseases were randomly assigned to TXA or placebo groups.

Postoperative infectious complications caused by multidrug-resistant pathogens in patients undergoing major hepatectomy with extrahepatic bile duct resection.

Background: Few reports have addressed postoperative infectious complications caused by multidrug-resistant pathogens. The aim of this study was to review the surgical outcomes of patients undergoing major hepatectomy with extrahepatic bile duct resection and to clarify the incidence of and the risk factors for postoperative infectious complications caused by multidrug-resistant pathogens.

Methods: Medical records of consecutive patients who underwent major hepatectomy with extrahepatic bile duct resection between 2006 and 2017 were retrospectively reviewed.

Is constant negative pressure for external drainage of the main pancreatic duct useful in preventing pancreatic fistula following pancreatoduodenectomy?

Background: This study sought to investigate the utility of constant negative pressure for external drainage of the main pancreatic duct in preventing postoperative pancreatic fistula (POPF) after pancreatoduodenectomy.

Methods: Only patients with soft pancreas were included. In the former period (July 2013 to May 2015), gravity dependent drainage was applied (gravity dependent drainage group), and in the latter period (June 2015 to November 2016), constant negative pressure drainage (negative pressure drainage group) was applied to the main pancreatic duct stent.

Preoperative biliary colonization/infection caused by multidrug-resistant (MDR) pathogens in patients undergoing major hepatectomy with extrahepatic bile duct resection.

Background: The aim of this study was to review the surgical outcomes of patients who underwent major hepatectomy with extrahepatic bile duct resection after preoperative biliary drainage with a particular focus on the impact of preoperative biliary colonization/infection caused by multidrug-resistant pathogens.

Methods: Medical records of patients who underwent hepatobiliary resection after preoperative external biliary drainage between 2001 and 2015 were reviewed retrospectively. Prophylactic antibiotics were selected according to the results of drug susceptibility tests of surveillance bile cultures.

Recurrence after curative-intent resection of perihilar cholangiocarcinoma: analysis of a large cohort with a close postoperative follow-up approach.

Background: Although several studies have been conducted on the patterns of recurrence in resected perihilar cholangiocarcinoma, they have many limitations. The aim of this study was to investigate recurrence after resection and to evaluate prognostic factors on the time to recurrence and recurrence-free survival.

Methods: Consecutive patients who underwent curative-intent resection of perihilar cholangiocarcinoma between 2001 and 2012 were reviewed retrospectively.

Impact of the gastrojejunal anatomic position as the mechanism of delayed gastric emptying after pancreatoduodenectomy.

Background: This study investigated the impact of gastrojejunal anatomic position on the incidence of delayed gastric emptying after pancreatoduodenectomy.

Methods: A total of 160 patients were included in the retrospective analysis. The relative anatomic position of the gastrojejunostomy was evaluated using coronal and sagittal plane computed tomography images on postoperative day 7; the coronal cardia anastomotic angle and the sagittal fundus anastomotic angle were measured.

Application of three-dimensional print in minor hepatectomy following liver partition between anterior and posterior sectors.

Background: Minor hepatectomy following liver partition between the right anterior and posterior sectors requires technical ingenuities. In such hepatectomy, we used three-dimensional (3D) print; therefore, our procedure was introduced.

Methods: Digital segmentation of anatomical structures from multidetector-row computed tomography images utilized the original software 'PLUTO', which was developed by Graduate School of Information Science, Nagoya University.

Application of fluorescent cholangiography during single-incision laparoscopic cholecystectomy for cholecystitis with a right-sided round ligament: Preliminary experience.

An 82-year-old woman was diagnosed with cholecystitis with a right-sided round ligament. We planned a single-incision laparoscopic cholecystectomy. Based on the findings of fluorescent cholangiography, the running course of the common bile duct was confirmed before dissection of Calot's triangle, and the confluence between the cystic duct and the common bile duct was exposed after the dissection of Calot's triangle.

Successful local treatment for repeated hepatic recurrences of cholangiolocellular carcinoma: a report on a long-term survivor.

Background: Cholangiolocellular carcinoma (CoCC) is a rare liver tumor arising from the canals of Hering found between the cholangioles and interlobular bile ducts. Although morphologically CoCC mimics intrahepatic cholangiocarcinoma (ICC), CoCC exhibits a unique intermediate biologic behavior between hepatocellular carcinoma (HCC) and ICC. Curative resection is required for prolonged survival in patients with CoCC.

Single-Incision Laparoscopic Splenectomy for an Unruptured Aneurysm of the Splenic Artery.

Objective: We describe our experience of single-incision laparoscopic splenectomy (SILS) for an unruptured aneurysm of the splenic artery.

Clinical Presentation And Intervention: A 73-year-old woman was diagnosed as having a splenic aneurysm which grew from 14 to 22 mm in diameter within 2 years. Due to a contrast agent allergy, transcatheter arterial embolization could not be performed; therefore, SILS was performed with a 4-cm Z-shaped incision.

Different Clinical Characteristics Between Distal Cholangiocarcinoma and Pancreatic Head Carcinoma With Biliary Obstruction.

Objectives: The aim of this study was to compare the perioperative clinical characteristics between patients with distal cholangiocarcinoma (DCC) and pancreatic head carcinoma (PHC) with biliary obstruction.

Methods: This study included patients who underwent pancreatoduodenectomy and were diagnosed with DCC (n = 85) or PHC (n = 90) by final pathological examination. Perioperative clinical characteristics were compared for patients with DCC versus PHC with biliary obstruction.

Trefoil factor family 1 expression in the invasion front is a poor prognostic factor associated with lymph node metastasis in pancreatic cancer.

Objectives: Trefoil Factor Family protein 1 (TFF1) is secreted from mucus-producing cells. The relationship between TFF1 expression and clinical outcome in pancreatic ductal adenocarcinoma (PDAC) remains unknown. We aimed to evaluate the prognostic significance of TFF1 expression in PDAC.

Clinical influence of preoperative factor XIII activity in patients undergoing pancreatoduodenectomy.

Background: The influence of decreased factor XIII (FXIII) activity on perioperative bleeding has been reported in some surgical procedures. The purposes of this study were to investigate the perioperative dynamics of FXIII in patients undergoing pancreatoduodenectomy and to clarify the effects of low preoperative FXIII activity on intraoperative bleeding and postoperative complications.

Methods: Total of 43 patients who underwent a pancreatoduodenectomy were enrolled.

Profile of preoperative fecal organic acids closely predicts the incidence of postoperative infectious complications after major hepatectomy with extrahepatic bile duct resection: Importance of fecal acetic acid plus butyric acid minus lactic acid gap.

Background: To investigate the association between preoperative fecal organic acid concentrations and the incidence of postoperative infectious complications in patients undergoing major hepatectomy with extrahepatic bile duct resection for biliary malignancies.

Methods: The fecal samples of 44 patients were collected before undergoing hepatectomy with bile duct resection for biliary malignancies. The concentrations of fecal organic acids, including acetic acid, butyric acid, and lactic acid, and representative fecal bacteria were measured.

Long-term survival after multidisciplinary therapy for residual gallbladder cancer with peritoneal dissemination: a case report.

Background: Although surgical resection is the only curative treatment for gallbladder cancer (GBC), concomitant peritoneal dissemination is considered far beyond the scope of resection. We report a long-term survivor with a residual GBC with multiple peritoneal disseminations who underwent an extended resection after effective chemotherapy.

Case Presentation: A 59-year-old male underwent an open cholecystectomy for Mirizzi syndrome at a local hospital.

The Benefits of a Wound Protector in Preventing Incisional Surgical Site Infection in Elective Open Digestive Surgery: A Large-Scale Cohort Study.

Background: The objective of this study was to evaluate the benefits of wound protectors (WPs) in preventing incisional surgical site infection (I-SSI) in open elective digestive surgery using data from a large-scale, multi-institutional cohort study.

Methods: Patients who had elective digestive surgery for malignant neoplasms between November 2009 and February 2011 were included. The protective value of WPs against I-SSI was evaluated.

Study on the segmentation of the right anterior sector of the liver.

Background: The segmentation of the right anterior sector of the liver still is debatable due to the lack of an anatomic landmark of the boundary between Couinaud segments V and VIII (cranio-caudal segmentation). Some authors have proposed the concept of a ventro-dorsal segmentation. The aim of this study was to evaluate which concept of segmentation better reflects the anatomy.

Pulmonary Metastasis After Resection of Cholangiocarcinoma: Incidence, Resectability, and Survival.

Background: There are few reports on pulmonary metastasis from cholangiocarcinoma; therefore, its incidence, resectability, and survival are unclear.

Methods: Patients who underwent surgical resection for cholangiocarcinoma, including intrahepatic, perihilar, and distal cholangiocarcinoma were retrospectively reviewed, and this study focused on patients with pulmonary metastasis.

Results: Between January 2003 and December 2014, 681 patients underwent surgical resection for cholangiocarcinoma.

Occult mucin-producing cholangiocarcinoma in situ: a rare clinical case with difficult tumour staging.

Background: Mucin-producing cholangiocarcinoma (MPCC) is an uncommon tumour that is clinically characterized by mucin-hypersecretion. Because the initial symptoms of MPCC may be attributed to the viscus mucobilia, the primary tumour mass may potentially be unrecognizable. We report an interesting case of curatively resected occult MPCC in situ.

The Complete Loss of Tyrosine Kinase Receptors MET and RON Is a Poor Prognostic Factor in Patients with Extrahepatic Cholangiocarcinoma.

Background: Although the survival of patients with cholangiocarcinoma has improved, the prognosis remains unfavorable. The overexpression of mesenchymal-epithelial transition factor (MET) and recepteur d'origine nantais (RON) has been considered to be indicative of a poor prognosis in some types of cancer. On the other hand, some studies have shown that the expression of MET and RON is a favorable prognostic factor in certain types of tumors.

Perineal alveolar soft part sarcoma treated by laparoscopy-assisted total pelvic exenteration combined with pubic resection.

A 20-year-old woman with a perineal alveolar soft part sarcoma was referred to our hospital. MRI showed that an irregular oval tumor occupied the perineum. The tumor was contiguous to the vagina, rectum, levator muscle, and pubis and was diagnosed as alveolar soft part sarcoma by transvaginal biopsy.

Application of Fluorescent Cholangiography for Determination of the Resection Line During a Single-Incision Laparoscopic Cholecystectomy for a Benign Lesion of the Cystic Duct: Preliminary Experience.

Background: To avoid bile leakage from the stump of a cystic duct that is closed at edematous and/or involved areas, the decision regarding the location of the resection line during a laparoscopic cholecystectomy for benign lesions extending into the cystic duct is important and requires technical ingenuity. For these situations, we used fluorescent cholangiography.

Methods: Our procedure for single-incision laparoscopic cholecystectomy utilized the SILS-Port, and an additional pair of 5-mm forceps was inserted via an umbilical incision.

Clinical value and pitfalls of fluorescent cholangiography during single-incision laparoscopic cholecystectomy.

Purpose: To clarify the clinical value and pitfalls of fluorescent cholangiography (FC) during single-incision laparoscopic cholecystectomy (SILC).

Methods: Our SILC procedure utilized the SILS-Port with additional 5-mm forceps through an umbilical incision. A laparoscopic fluorescent imaging system developed by Karl Storz Endoskope was utilized for fluorescent cholangiography.

Duration of Antimicrobial Prophylaxis in Patients Undergoing Major Hepatectomy With Extrahepatic Bile Duct Resection: A Randomized Controlled Trial.

Objective: To evaluate the optimal duration of antimicrobial prophylaxis in patients undergoing "complicated"' major hepatectomy with extrahepatic bile duct resection.

Background: To date, 4 randomized controlled trials (RCTs) have assessed the duration of antimicrobial prophylaxis after hepatectomy. However, all of these previous studies involved only "simple" hepatectomy without extrahepatic bile duct resection.