Pub Date : 2023-01-01DOI: 10.9738/intsurg-d-16-00149.1
I. El Moussaoui, I. Surdeanu, R. Diamand, M. Dika, A. Limbga, A. Mehdi
Rectal prolapse is the complete protrusion of the rectum through the anal canal. Incarceration rarely complicates rectal prolapse. Even more rarely, it becomes strangled and gangrenous, necessitating emergency surgery. We report an extremely rare case of strangulated acute rectal prolapse as the first manifestation of rectal prolapse. The patient was a 26-year-old man who presented on admission a 20 × 6 cm semispherical mass extra-anally. Rectosigmoidectomy associated to sacral rectopexy was performed with resection of 20 cm of the incarcerated rectum and sigmoid colon. The postoperative course was quite uneventful with an excellent final result after colostomy closure and continuity restoration. The successful treatment of this patient illustrates the value of surgery in the difficult and unusual case scenario of rectal incarceration.
{"title":"Strangulation of Giant Rectal Prolapse: A Case Report","authors":"I. El Moussaoui, I. Surdeanu, R. Diamand, M. Dika, A. Limbga, A. Mehdi","doi":"10.9738/intsurg-d-16-00149.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-16-00149.1","url":null,"abstract":"\u0000 \u0000 Rectal prolapse is the complete protrusion of the rectum through the anal canal. Incarceration rarely complicates rectal prolapse. Even more rarely, it becomes strangled and gangrenous, necessitating emergency surgery.\u0000 \u0000 \u0000 \u0000 We report an extremely rare case of strangulated acute rectal prolapse as the first manifestation of rectal prolapse. The patient was a 26-year-old man who presented on admission a 20 × 6 cm semispherical mass extra-anally. Rectosigmoidectomy associated to sacral rectopexy was performed with resection of 20 cm of the incarcerated rectum and sigmoid colon. The postoperative course was quite uneventful with an excellent final result after colostomy closure and continuity restoration.\u0000 \u0000 \u0000 \u0000 The successful treatment of this patient illustrates the value of surgery in the difficult and unusual case scenario of rectal incarceration.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45131940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.9738/intsurg-d-16-00238.1
S. Lobo, Andreia Felizes, P. Nogueira, Miroslava Gonçalves
Acute appendicitis remains a challenging diagnosis in pediatrics, and inflammatory markers are helpful in the management of these patients. Our purpose is to evaluate the prediction potential of specific laboratory parameters (total white blood cell count and C-reactive protein) regarding complicated appendicitis and to highlight the need for a careful interpretation of their levels. A retrospective study was performed on a population of children who underwent appendectomy between January and December 2014. Patients were clustered in 2 groups according to severity of disease: group I, uncomplicated appendicitis; and group II, complicated appendicitis. Data regarding total white blood cell count and C-reactive protein levels were obtained. Variables were compared using χ2, Student t-tests, and Pearson correlation. A total of 128 pediatric patients (age <18 years) with a mean age of 10.2 ± 3.9 years were included (76 males). Complicated appendicitis occurred in 27 patients. Age of patient was statistically different in groups I (10.6 ± 3.8 years) and II (8.5 ± 3.7 years; P = 0.011). CRP is a parameter statistically correlated to severity of appendicitis (P < 0.001), but white blood cell count is not (P = 0.295). A CRP level (above 4.3 mg/dL) was 74% sensitive and 77% specific for complicated appendicitis. The authors emphasize the role of CRP value in the prediction of the severity of appendicitis in children and present a potential usable cutoff value of 4.3 mg/dL, as a marker of complicated appendicitis.
{"title":"Can C-Reactive Protein and White Blood Cell Count Predict Complicated Appendicitis in Children?","authors":"S. Lobo, Andreia Felizes, P. Nogueira, Miroslava Gonçalves","doi":"10.9738/intsurg-d-16-00238.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-16-00238.1","url":null,"abstract":"\u0000 \u0000 Acute appendicitis remains a challenging diagnosis in pediatrics, and inflammatory markers are helpful in the management of these patients. Our purpose is to evaluate the prediction potential of specific laboratory parameters (total white blood cell count and C-reactive protein) regarding complicated appendicitis and to highlight the need for a careful interpretation of their levels.\u0000 \u0000 \u0000 \u0000 A retrospective study was performed on a population of children who underwent appendectomy between January and December 2014. Patients were clustered in 2 groups according to severity of disease: group I, uncomplicated appendicitis; and group II, complicated appendicitis. Data regarding total white blood cell count and C-reactive protein levels were obtained. Variables were compared using χ2, Student t-tests, and Pearson correlation.\u0000 \u0000 \u0000 \u0000 A total of 128 pediatric patients (age <18 years) with a mean age of 10.2 ± 3.9 years were included (76 males). Complicated appendicitis occurred in 27 patients. Age of patient was statistically different in groups I (10.6 ± 3.8 years) and II (8.5 ± 3.7 years; P = 0.011). CRP is a parameter statistically correlated to severity of appendicitis (P < 0.001), but white blood cell count is not (P = 0.295). A CRP level (above 4.3 mg/dL) was 74% sensitive and 77% specific for complicated appendicitis.\u0000 \u0000 \u0000 \u0000 The authors emphasize the role of CRP value in the prediction of the severity of appendicitis in children and present a potential usable cutoff value of 4.3 mg/dL, as a marker of complicated appendicitis.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71208204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.9738/0020-8868-107.1.i
{"title":"International Surgery and the World Health Organization (WHO)","authors":"","doi":"10.9738/0020-8868-107.1.i","DOIUrl":"https://doi.org/10.9738/0020-8868-107.1.i","url":null,"abstract":"","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41635022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.9738/intsurg-d-21-00024.1
E. Park, S. Song, Y. Koh
Immature teratomas are very rare tumors, representing only 1% of ovarian cancers. Distant metastases to the liver effect late disease manifestation, rendering chemotherapy the only viable option. Here, we report the successful surgical management of stage IVB immature teratoma after cisplatin-based chemotherapy. A 20-year-old woman presented with a huge abdominal palpable mass and dyspnea. Postoperative pathology confirmed immature teratoma with metastases to the liver, diaphragm, and thoracic cavity (stage IVB). The patient underwent right hemihepatectomy, diaphragm resection, thoracic mass resection, and diaphragm repair using aortic artificial graft. She did not receive postoperative adjuvant chemotherapy. After the complete surgical resection of the tumor, the patient had no recurrence during the 44-month follow-up period. No established treatment modalities have been developed for further treatment, once the first-line combination chemotherapy achieves unfavorable results in stage IVB immature teratoma. Surgical resection may offer hope for excellent disease control in this dismal stage. To obtain best possible outcomes, coordinated care between oncologists and general surgeons is required.
{"title":"Successful Surgical Treatment of Stage IVB Immature Teratoma Involving the Liver and Thoracic Cavity, With Combination Chemotherapy: A Case Report","authors":"E. Park, S. Song, Y. Koh","doi":"10.9738/intsurg-d-21-00024.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-21-00024.1","url":null,"abstract":"\u0000 \u0000 Immature teratomas are very rare tumors, representing only 1% of ovarian cancers. Distant metastases to the liver effect late disease manifestation, rendering chemotherapy the only viable option.\u0000 \u0000 \u0000 \u0000 Here, we report the successful surgical management of stage IVB immature teratoma after cisplatin-based chemotherapy. A 20-year-old woman presented with a huge abdominal palpable mass and dyspnea. Postoperative pathology confirmed immature teratoma with metastases to the liver, diaphragm, and thoracic cavity (stage IVB). The patient underwent right hemihepatectomy, diaphragm resection, thoracic mass resection, and diaphragm repair using aortic artificial graft. She did not receive postoperative adjuvant chemotherapy. After the complete surgical resection of the tumor, the patient had no recurrence during the 44-month follow-up period.\u0000 \u0000 \u0000 \u0000 No established treatment modalities have been developed for further treatment, once the first-line combination chemotherapy achieves unfavorable results in stage IVB immature teratoma. Surgical resection may offer hope for excellent disease control in this dismal stage. To obtain best possible outcomes, coordinated care between oncologists and general surgeons is required.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48277555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.9738/0020-8868-106.4.i
{"title":"Role of International Surgery in the Global Scientific and Medical Publishing Industry","authors":"","doi":"10.9738/0020-8868-106.4.i","DOIUrl":"https://doi.org/10.9738/0020-8868-106.4.i","url":null,"abstract":"","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46043391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.9738/intsurg-d-18-00013.1
Ryota Iwase, H. Shiba, K. Haruki, Y. Fujiwara, K. Furukawa, Y. Futagawa, S. Wakiyama, T. Misawa, K. Yanaga
Gallbladder carcinoma (GBC) is one of the digestive cancers with poor prognosis, for which surgical resection is the only potentially curative therapy. Prognostic value of macroscopic inflammatory status of the resected gallbladder in patient with GBC has not been fully investigated. We retrospectively investigated the relation between macroscopic inflammatory status and disease-free as well as overall survival after radical resection for GBC. The subjects were 44 patients who underwent radical resection for GBC between January 2004 and April 2011 at Jikei University Hospital. We retrospectively investigated the relationship between clinicopathologic variables, including macroscopic inflammatory status and disease-free as well as overall survival. In univariate analysis, disease-free survival was poor in patients with Tumor-Nodes-Metastasis (TNM) stage ≥III (P < 0.0001) and positive vascular invasion (P = 0.0001). Patients with macroscopic chronic inflammation tended to have poor disease-free survival than those with normal type (P = 0.0930). Overall survival was poor in patients with TNM stage ≥III (P < 0.0001), presence of intraoperative blood transfusion (P = 0.0125), positive vascular invasion (P = 0.0055), and macroscopic chronic inflammation (P = 0.0281). In multivariate analysis, TNM stage ≥III (P < 0.0114) and macroscopic chronic inflammation (P = 0.0350) were independent predictors of disease-free survival. For overall survival, TNM stage ≥III (P = 0.0054) and macroscopic chronic inflammation (P = 0.0124) were the independent predictors. Moreover, macroscopic chronic inflammation correlated with the presence of gallstones. The macroscopic Inflammation status of resected gallbladder cancer correlates with oncologic outcome in patients with GBC treated by radical resection.
{"title":"Macroscopic Inflammation Status of Resected Gallbladder Predicts Therapeutic Outcome After Radical Resection for Gallbladder Carcinoma","authors":"Ryota Iwase, H. Shiba, K. Haruki, Y. Fujiwara, K. Furukawa, Y. Futagawa, S. Wakiyama, T. Misawa, K. Yanaga","doi":"10.9738/intsurg-d-18-00013.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-18-00013.1","url":null,"abstract":"\u0000 \u0000 Gallbladder carcinoma (GBC) is one of the digestive cancers with poor prognosis, for which surgical resection is the only potentially curative therapy. Prognostic value of macroscopic inflammatory status of the resected gallbladder in patient with GBC has not been fully investigated. We retrospectively investigated the relation between macroscopic inflammatory status and disease-free as well as overall survival after radical resection for GBC.\u0000 \u0000 \u0000 \u0000 The subjects were 44 patients who underwent radical resection for GBC between January 2004 and April 2011 at Jikei University Hospital. We retrospectively investigated the relationship between clinicopathologic variables, including macroscopic inflammatory status and disease-free as well as overall survival.\u0000 \u0000 \u0000 \u0000 In univariate analysis, disease-free survival was poor in patients with Tumor-Nodes-Metastasis (TNM) stage ≥III (P < 0.0001) and positive vascular invasion (P = 0.0001). Patients with macroscopic chronic inflammation tended to have poor disease-free survival than those with normal type (P = 0.0930). Overall survival was poor in patients with TNM stage ≥III (P < 0.0001), presence of intraoperative blood transfusion (P = 0.0125), positive vascular invasion (P = 0.0055), and macroscopic chronic inflammation (P = 0.0281). In multivariate analysis, TNM stage ≥III (P < 0.0114) and macroscopic chronic inflammation (P = 0.0350) were independent predictors of disease-free survival. For overall survival, TNM stage ≥III (P = 0.0054) and macroscopic chronic inflammation (P = 0.0124) were the independent predictors. Moreover, macroscopic chronic inflammation correlated with the presence of gallstones.\u0000 \u0000 \u0000 \u0000 The macroscopic Inflammation status of resected gallbladder cancer correlates with oncologic outcome in patients with GBC treated by radical resection.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48865737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.9738/intsurg-d-19-00003.1
Murad Bani Hani, Bryan Butler, J. Visco, Bashir Alttuwaybi
Primary adenocarcinoma at the ileostomy site is a rare complication, with only 57 cases reported in the literature. The primary diagnosis is usually ulcerative colitis (UC) or familial adenomatous polyposis (FAP). We present 3 cases of adenocarcinoma at the ileostomy site. Two of our 3 cases have a previous diagnosis of cancer, with no previous diagnosis of UC or FAP. Adenocarcinoma at ileostomy is a rare late complication of permanent ileostomy. Possible etiologies are chronic irritation and changes in bacterial flora that lead to metaplasia and cancer development. Adenocarcinoma at the ileostomy site is a rare complication with good prognosis if detected early. Diagnosis is by biopsy, and treatment is surgical. A biopsy should be considered in any abnormal growth around the ileostomy.
{"title":"Primary Adenocarcinoma at Ileostomy—A Rare Late Complication: Three Cases and Literature Review","authors":"Murad Bani Hani, Bryan Butler, J. Visco, Bashir Alttuwaybi","doi":"10.9738/intsurg-d-19-00003.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-19-00003.1","url":null,"abstract":"\u0000 \u0000 Primary adenocarcinoma at the ileostomy site is a rare complication, with only 57 cases reported in the literature. The primary diagnosis is usually ulcerative colitis (UC) or familial adenomatous polyposis (FAP).\u0000 \u0000 \u0000 \u0000 We present 3 cases of adenocarcinoma at the ileostomy site. Two of our 3 cases have a previous diagnosis of cancer, with no previous diagnosis of UC or FAP.\u0000 \u0000 \u0000 \u0000 Adenocarcinoma at ileostomy is a rare late complication of permanent ileostomy. Possible etiologies are chronic irritation and changes in bacterial flora that lead to metaplasia and cancer development.\u0000 \u0000 \u0000 \u0000 Adenocarcinoma at the ileostomy site is a rare complication with good prognosis if detected early. Diagnosis is by biopsy, and treatment is surgical. A biopsy should be considered in any abnormal growth around the ileostomy.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45969310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.9738/intsurg-d-21-00012.1
Yasuhiro Komatsu, K. Shigeyasu, S. Takeda, Y. Mori, Kazutaka Takahashi, Nanako Hata, K. Miyamoto, Hibiki Umeda, Yoshihiko Kakiuchi, Satoru Kikuchi, S. Yano, Shinji Kuroda, Y. Kondo, H. Kishimoto, F. Teraishi, M. Nishizaki, S. Kagawa, T. Fujiwara
This study aimed to identify factors associated with outlet obstruction and high-output stoma (HOS) after ileostomy creation. Ileostomy creation is effective in preventing leakage among patients undergoing low anterior resection for rectal cancer. However, major complications such as outlet obstruction and HOS can occur after surgery. Moreover, these complications cannot be prevented. This retrospective study included 34 patients with rectal cancer who underwent low anterior resection and ileostomy creation at Okayama University Hospital from January 2015 to December 2018. Then, the risk factors associated with outlet obstruction and HOS were analyzed. Of 34 patients, 7 (21%) experienced outlet obstruction. In a multivariate logistic regression analysis, advanced T stage (P = 0.10), ileostomy with a short horizontal diameter (P = 0.01), and thick rectus abdominis (RA) muscle (P = 0.0005) were considered independent risk factors for outlet obstruction. There was a significant correlation between outlet obstruction and HOS (P = 0.03). Meanwhile, the independent risk factors of HOS were advanced T stage (P = 0.03) and thick RA muscle (P = 0.04). Thick RA muscle and advanced T stage were the common risk factors of outlet obstruction and HOS. Therefore, in high-risk patients, these complications can be prevented by choosing an appropriate ileostomy location according to RA muscle thickness and by preventing tubing into the ileostomy.
{"title":"Association Between Advanced T Stage and Thick Rectus Abdominis Muscle and Outlet Obstruction and High-Output Stoma After Ileostomy in Patients With Rectal Cancer","authors":"Yasuhiro Komatsu, K. Shigeyasu, S. Takeda, Y. Mori, Kazutaka Takahashi, Nanako Hata, K. Miyamoto, Hibiki Umeda, Yoshihiko Kakiuchi, Satoru Kikuchi, S. Yano, Shinji Kuroda, Y. Kondo, H. Kishimoto, F. Teraishi, M. Nishizaki, S. Kagawa, T. Fujiwara","doi":"10.9738/intsurg-d-21-00012.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-21-00012.1","url":null,"abstract":"\u0000 \u0000 This study aimed to identify factors associated with outlet obstruction and high-output stoma (HOS) after ileostomy creation.\u0000 \u0000 \u0000 \u0000 Ileostomy creation is effective in preventing leakage among patients undergoing low anterior resection for rectal cancer. However, major complications such as outlet obstruction and HOS can occur after surgery. Moreover, these complications cannot be prevented.\u0000 \u0000 \u0000 \u0000 This retrospective study included 34 patients with rectal cancer who underwent low anterior resection and ileostomy creation at Okayama University Hospital from January 2015 to December 2018. Then, the risk factors associated with outlet obstruction and HOS were analyzed.\u0000 \u0000 \u0000 \u0000 Of 34 patients, 7 (21%) experienced outlet obstruction. In a multivariate logistic regression analysis, advanced T stage (P = 0.10), ileostomy with a short horizontal diameter (P = 0.01), and thick rectus abdominis (RA) muscle (P = 0.0005) were considered independent risk factors for outlet obstruction. There was a significant correlation between outlet obstruction and HOS (P = 0.03). Meanwhile, the independent risk factors of HOS were advanced T stage (P = 0.03) and thick RA muscle (P = 0.04).\u0000 \u0000 \u0000 \u0000 Thick RA muscle and advanced T stage were the common risk factors of outlet obstruction and HOS. Therefore, in high-risk patients, these complications can be prevented by choosing an appropriate ileostomy location according to RA muscle thickness and by preventing tubing into the ileostomy.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48641772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.9738/intsurg-d-20-00008.1
T. Matsubara, N. Hirahara, Yoko Nakayama, Hitomi Zotani, H. Tabara
Laparoscopic reconstruction after left colectomy is mostly performed with functional end-to-end anastomosis through about 5–7 cm sized incision. However, this procedure poses some problems, including increased intestinal mobilization range and parietal destruction, insufficient blood flow to the intestinal tract due to arterial arch malformation, and dominant artery dissection. In this paper, we present a case of descending colon cancer for which totally laparoscopic surgery and intracorporeal anastomosis could be performed safely with preoperative simulation and intraoperative navigation. A 34-year-old male was complaint fecal occult blood positive and a colonoscopy was performed. The patient was diagnosed with descending colon cancer cT2N0N0 Stage I. Preoperative CT angiography findings showed that the inferior mesenteric artery (IMA) branched into the left colic artery (LCA) and the sigmoid arteries (S1, S2) in order and showed LCA and S1 as the dominant arteries, and a totally laparoscopic descending colectomy (D2 dissection and S2 artery preserving) was scheduled. At his operation, for investigate blood flow of anastomotic region, ICG was used. After an intravenous injection of ICG, blood flow was evaluated and intestinal dissection was performed at the scheduled dissection line. Intracorporeal anastomosis was then performed using the overlap method and a linear stapler. Although the intracorporeal anastomosis procedure has a high degree of difficulty, the use of preoperative simulation and intraoperative navigation may reduce the surgeon's intraoperative stress and enable safe and accurate intestinal dissection and anastomosis in the totally laparoscopic surgery.
{"title":"Totally Laparoscopic Left Colectomy With Preoperative Simulation Using 3D CT Angiography and Intraoperative Navigation Using the Indocyanine Green (ICG) Fluorescence Method","authors":"T. Matsubara, N. Hirahara, Yoko Nakayama, Hitomi Zotani, H. Tabara","doi":"10.9738/intsurg-d-20-00008.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00008.1","url":null,"abstract":"\u0000 \u0000 Laparoscopic reconstruction after left colectomy is mostly performed with functional end-to-end anastomosis through about 5–7 cm sized incision. However, this procedure poses some problems, including increased intestinal mobilization range and parietal destruction, insufficient blood flow to the intestinal tract due to arterial arch malformation, and dominant artery dissection. In this paper, we present a case of descending colon cancer for which totally laparoscopic surgery and intracorporeal anastomosis could be performed safely with preoperative simulation and intraoperative navigation.\u0000 \u0000 \u0000 \u0000 A 34-year-old male was complaint fecal occult blood positive and a colonoscopy was performed. The patient was diagnosed with descending colon cancer cT2N0N0 Stage I. Preoperative CT angiography findings showed that the inferior mesenteric artery (IMA) branched into the left colic artery (LCA) and the sigmoid arteries (S1, S2) in order and showed LCA and S1 as the dominant arteries, and a totally laparoscopic descending colectomy (D2 dissection and S2 artery preserving) was scheduled. At his operation, for investigate blood flow of anastomotic region, ICG was used. After an intravenous injection of ICG, blood flow was evaluated and intestinal dissection was performed at the scheduled dissection line. Intracorporeal anastomosis was then performed using the overlap method and a linear stapler.\u0000 \u0000 \u0000 \u0000 Although the intracorporeal anastomosis procedure has a high degree of difficulty, the use of preoperative simulation and intraoperative navigation may reduce the surgeon's intraoperative stress and enable safe and accurate intestinal dissection and anastomosis in the totally laparoscopic surgery.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43376407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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