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Comprehensive and innovative techniques for laparoscopic choledocholithotomy:A surgical guide to successfully accomplish this advanced manipulation

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World Journal of Gastroenterology 2019年第13期25卷 1531-1549页

作者： Tomohide Hori Department of hepato-biliary-pancreatic surgery Kyoto University Graduate School of Medicine

Surgeries for benign diseases of the extrahepatic bile duct(EHBD) are classified as lithotomy(i.e., choledocholithotomy) or diversion(i.e.,choledochojejunostomy). Because of technical challenges, laparoscopic approaches for these surgeries have not gained worldwide popularity. The right upper quadrant of the abdomen is advantageous for laparoscopic procedures,and laparoscopic choledochojejunostomy is safe and feasible. Herein, we summarize tips and pitfalls in the actual procedures of *** choledocholithotomy with primary closure of the transductal incision and transcystic C-tube drainage has excellent clinical outcomes;however, emergent biliary drainage without endoscopic sphincterotomy and preoperative removal of anesthetic risk factors are required. Elastic suture should never be ligated directly on the cystic duct. Interrupted suture placement is the first choice for hemostasis near the EHBD. To prevent progressive laceration of the EHBD, full-layer interrupted sutures are placed at the upper and lower edges of the transductal incision. Cholangioscopy has only two-way operation; using dedicated forceps to atraumatically grasp the cholangioscope is important for smart maneuvering. The duration of intraoperative stone clearance accounts for most of the operative time. Moreover, dedicated forceps are an important instrument for atraumatic grasping of the cholangioscope. Damage to the cholangioscope requires expensive repair. Laparoscopic approach for choledocholithotomy involves technical difficulties. I hope this document with the visual explanation and literature review will be informative for skillful surgeons.

关键词： Laparoscopic surgery Choledocholithotomy Bile duct Laparoscopy General surgery

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Treatment for superficial non-ampullary duodenal epithelial tumors

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World Journal of Gastroenterology 2014年第35期20卷 12501-12508页

作者： Naomi Kakushima Hideyuki Kanemoto Masaki Tanaka Kohei Takizawa Hiroyuki Ono division of Endoscopy Shizuoka Cancer Center division of hepato-biliary-pancreatic surgery Shizuoka Cancer CenterShizuoka Cancer Center

Because of the low prevalence of non-ampullary duodenal epithelial tumors(NADETs),standardized clinical management of sporadic superficial NADETs,including diagnosis,treatment,and follow-up,has not yet been *** studies have revealed certain endoscopic findings suggestive of *** adenoma with high-grade dysplasia and mucosal cancer are candidates for local resection by endoscopic or minimally invasive *** use of endoscopic treatment including endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD),for the treatment for superficial NADETs is *** requires multiple sessions to achieve complete remission and repetitive endoscopy is needed after *** provides an excellent complete resection rate,however it remains a challenging method,considering the high risk of intraoperative or delayed *** invasive surgery such as wedge resection and pancreas-sparing duodenectomy are beneficial for superficial NADETs that are technically difficult to remove by endoscopic *** remains a standard surgical procedure for treatment of duodenal cancer with submucosal invasion,which presents a risk of lymph node *** or surgical treatment outcomes of superficial NADETs without submucosal invasion are *** an endoscopic diagnostic tool to differentiate superficial NADETs between adenoma and cancer as well as between mucosal and submucosal cancer is required to select the most appropriate treatment.

关键词： Duodenal neoplasms Duodenal cancer pancreaticoduodenectomy Endoscopic surgery Esophagogastroduodenoscopy

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Reconstruction after pancreatoduodenectomy:Pancreatojejunostomy vs pancreatogastrostomy

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World Journal of Gastrointestinal Oncology 2014年第9期6卷 369-376页

作者： Tatiana Gómez Ana Palomares Mario Serradilla Luis Tejedor Department of surgery Hospital Punta de Europa division of hepato-pancreatic-biliary surgery Department of SurgeryComplejo Hospitalario de Jaén

pancreatic surgeons try to find the best technique for reconstruction after pancreatoduodenectomy(PD) in order to decrease postoperative complications,mainly pancreatic fistulas(PF).In this work,we compare the two most frequent techniques of reconstruction after PD,pancreatojejunostomy(PJ) and pancreatogastrostomy(PG),in order to determine which of the two is better.A systematic review of the literature was performed,including major meta-analysis articles,clinical randomized trials,systematic reviews,and retrospective studies.A total of 64 articles were finally *** and PG are usually responsible for most of the postoperative morbidity,mainly due to the onset of PF,being considered a major trigger of life-threatening complications such as intra-abdominal abscess and *** included systematic reviews reported a significant difference only in the incidence of intraabdominal collections favouring ***,delayed gastric emptying and mortality were not *** there was heterogeneity between these studies,all were conducted in specialized centers by highly experienced surgeons,and the surgical care was likely to be similar for all the *** disadvantages of PG include an increased incidence of delayed gastric emptying and of main pancreatic duct obstruction due to overgrowth by the gastric *** function appears to be worse after PG than after PJ,resulting in severe atrophic changes in the remnant *** on the type of PJ or PG used,the PF rate and other complications can also be *** best method to deal with the pancreatic stump after PD remains *** choice of method of pancreatic anastomosis could be based on individual experience and on the surgeon's preference and adherence to basic principles such as good exposure and *** conclusion,up to now none of the techniques can be considered superior or be recommended as standard for reconstruction after PD.

关键词： Pancreatoduodenectomy Pancreatojeju-nostomy Pancreatogastrostomy pancreatic fistula pancreatic cancer Surgical technique

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Endoscopic and biopsy diagnoses of superficial, nonampullary, duodenal adenocarcinomas

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World Journal of Gastroenterology 2015年第18期21卷 5560-5567页

作者： Naomi Kakushima Hideyuki Kanemoto Keiko Sasaki Noboru Kawata Masaki Tanaka Kohei Takizawa Kenichiro Imai Kinichi Hotta Hiroyuki Matsubayashi Hiroyuki Ono division of Endoscopy Shizuoka Cancer Center division of hepato-biliary-pancreatic surgery Shizuoka Cancer Center division of Pathology Shizuoka Cancer Center

AIM: To investigate the accuracy of endoscopic or biopsy diagnoses of superficial nonampullary duodenal epithelial tumors(NADETs).METHODS:Clinicopathological data were reviewed for84 superficial NADETs from 74 patients who underwent surgery or endoscopic resection between September2002 and August 2014 at a single prefectural cancer *** NADETs were defined as lesions confined to the mucosa or *** and clinicopathological data were retrieved from charts,endoscopic and pathologic *** reports included endoscopic diagnosis,location,gross type,diameter,color,and presence or absence of *** diagnoses were made by an endoscopist in charge of the examination before biopsy specimens were *** images were obtained using routine,front-view,high-resolution video endoscopy,and chromoendoscopy with indigocarmine was performed for all *** images were reviewed by at least two endoscopists to assess endoscopic findings indicative of *** diagnoses based on endoscopy and biopsy findings were compared with histological diagnoses of resected ***,specificity,and accuracy were assessed for endoscopic diagnosis and biopsy ***:The majority(81%)of the lesions were located in the second portion of the *** median lesion diameter was 14.5 mm according to final *** was performed for 49 lesions from 39 patients,and 35 lesions from 35 patients were endoscopically *** histology confirmed 65carcinomas,15 adenomas,and 3 hyperplasias.A finaldiagnosis of duodenal carcinoma was made for 91%(52/57)of the lesions diagnosed as carcinoma by endoscopy and 93%(42/45)of the lesions diagnosed as carcinoma by *** sensitivity,specificity,and accuracy of endoscopic diagnoses were 80%,72%,and 78%,respectively,whereas those of biopsy diagnoses were 72%,80%,and 74%,*** diagnoses of carcinomas were made in88%(57/65)of

关键词： Biopsy Endoscopic diagnosis Duodenal adenoma Duodenal carcinoma Duodenal neoplasms

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Hepatitis B virus infection in Indonesia

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World Journal of Gastroenterology 2015年第38期21卷 10714-10720页

作者： Shoji Kubo Shigekazu Takemura Shogo Tanaka Hiroji Shinkawa Takayoshi Nishioka Akinori Nozawa Masahiko Kinoshita Genya Hamano Tokuji Ito Yorihisa Urata Department of hepato-biliary-pancreatic surgery Osaka City University Graduate School of Medicine

Approximately 240 million people are chronically infected with hepatitis B virus(HBV),75% of whom reside in Asia. Approximately 600000 of infected patients die each year due to HBV-related diseases or hepatocellular carcinoma(HCC). The endemicity of hepatitis surface antigen in Indonesia is intermediate to high with a geographical difference. The risk of HBV infection is high in hemodialysis(HD) patients,men having sex with men,and health care workers. Occult HBV infection has been detected in various groups such as blood donors,HD patients,and HIVinfected individuals and children. The most common HBV subgenotype in Indonesia is B3 followed by C1. Various novel subgenotypes of HBV have been identified throughout Indonesia,with the novel HBV subgenotypes C6-C16 and D6 being successfully isolated. Although a number of HBV subgenotypes have been discovered in Indonesia,genotyperelated pathogenicity has not yet been elucidated in detail. Therefore,genotype-related differences in the prognosis of liver disease and their effects on treatments need to be determined. A previous study conducted in Indonesia revealed that hepatic steatosis was associated with disease progression. Pre-S2 mutations and mutations at C1638 T and T1753 V in HBV/B3 have been associated with advanced liver diseases including HCC. However,drug resistance to lamivudine,which is prominent in Indonesia,remains obscure. Although the number of studies on HBV in Indonesia has been increasing,adequate databases on HBV infection are limited. We herein provided an overview of the epidemiology and clinical characteristics of HBV infection in Indonesia.

关键词： Hepatitis B virus Epidemiology Prevention Clinical

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Central pancreatectomy: The Dagradi Serio Iacono operation. Evolution of a surgical technique from the pioneers to the robotic approach

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World Journal of Gastroenterology 2014年第42期20卷 15674-15681页

作者： Calogero Iacono Andrea Ruzzenente Luca Bortolasi Alfredo Guglielmi Department of surgery Division of General Surgery "A" Unit of Hepato-Biliary-Pancreatic Surgery University of Verona Medical School "GB Rossi" University Hospital

Central pancreatectomy(CP) is a parenchyma-sparing surgical procedure. The aims are to clarify the history and the development of CP and to give credits to those from whom it came. Ehrhardt, in 1908, described segmental neck resection(SNR) followed, in 1910, by Finney without reconstructive part. In 1950 Honjyo described two cases of SNR combined with gastrectomy for gastric cancer infiltrating the neck of the pancreas. Guillemin and Bessot(1957) and Letton and Wilson(1959) dealt only with the reconstructive aspect of CP. Dagradi and Serio, in 1982, performed the first CP including the resective and reconstructive aspects. Subsequently Iacono has validated it with functional endocrine and exocrine tests and popularized it worldwide. In 2003, Baca and Bokan performed laparoscopic CP and, In 2004, Giulianotti et al performed a robotic assisted CP. CP is performed worldwide either by open surgery or by using minimally-invasive or robotic approaches. This confirms that the operation does not belong to whom introduced it but to everyone who carries out it; however credit must be given to those from whom it came.

关键词： pancreatic history pancreatic surgery Central pancreatectomy Conservative pancreatectomy

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Risk factors for occult metastasis detected by inflammation-based prognostic scores and tumor markers in biliary tract cancer

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World Journal of Clinical Cases 2021年第32期9卷 9770-9782页

作者： Yu Hashimoto Tetsuo Ajiki Hiroaki Yanagimoto Daisuke Tsugawa Kenta Shinozaki Hirochika Toyama Masahiro Kido Takumi Fukumoto Department of surgery Division of Hepato-Biliary-Pancreatic SurgeryKobe University Graduate School of MedicineKobeHyogo 650-0017Japan

BACKGROUND Radiological detection of small liver metastasis or peritoneal metastasis is still difficult,and some patients with biliary tract cancer(BTC)are unresectable after *** laparoscopy may help avoid unnecessary ***,which category of BTC is amenable with staging laparoscopy remains *** To clarify the risk factors for occult metastasis in patients with *** Medical records of patients with BTC who underwent surgery at our institution between January 2008 and June 2014 were retrospectively *** patients were divided into two groups,according to resection or exploratory laparotomy(EL).Preoperative laboratory data,including inflammation-based prognostic scores and tumor markers,were compared between the two *** importance of detected risk factors was also *** A total of 236 patients were enrolled in this ***-six(11%)patients underwent *** the EL patients,there were 16 cases of occult metastasis(7 liver metastases and 9 abdominal disseminations).Serum carcinoembryonic antigen level,carbohydrate antigen 19-9 level,neutrophil-lymphocyte ratio and modified Glasgow prognostic score were significantly higher in the EL group than in the resected group,and these factors were *** these factors,carcinoembryonic antigen>7 ng/mL was the most useful to predict occult metastasis in *** patients have more than three of these positive factors,the rate of occult metastasis *** Inflammation-based prognostic scores and tumor markers are useful in detecting occult metastasis in BTC;based on these factors,staging laparoscopy may reduce the rate of EL.

关键词： biliary tract cancer Staging laparoscopy Neutrophil-lymphocyte ratio Modified Glasgow prognostic score Carbohydrate antigen 19-9 Carcinoembryonic antigen

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Successful liver resection in a giant hemangioma with intestinal obstruction after embolization

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World Journal of Gastroenterology 2013年第19期19卷 2974-2978页

作者： Ji-Xiang Zhou Ji-Wei Huang Hong Wu Yong Zeng Department of hepato-biliary-pancreatic surgery West China HospitalSichuan University

Hepatic hemangiomas are the most common benign tumor of the *** hepatic hemangiomas remain asymptomatic and require no *** hepatic hemangiomas with established complications,diagnostic uncertainty and incapacitating symptoms,however,are generally considered an absolute indication for surgical *** present a case of a giant hemangioma with intestinal obstruction following transcatheter arterial embolization,by which the volume of the hemangioma was significantly reduced,and it was completely resected by a left hepatectomy.A 21-yearold Asian man visited our hospital for left upper quadrant *** at the first visit revealed a left liver hemangioma occupying the abdominal cavity,with a maximum diameter of 31.5 *** of the left hepatic artery was performed and confirmed a decrease in its ***,the patient was readmitted to our hospital one month after embolization for intestinal obstruction.A left hepatectomy was completed through a herringbone incision,and safely removed a giant hemangioma of 26.5 cm × 19.5 cm × 12.0 cm in size and 3690 g in ***-operative arterial embolization is effective for reducing tumor size,but a close follow-up to decide the time for hepatectomy is important.

关键词： Hepatic hemangioma Transcatheter arterial embolization Intestinal obstruction Complications Hepatectomy

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Small-for-size syndrome in liver transplantation:Definition,pathophysiology and management

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hepatobiliary & pancreatic Diseases International 2020年第4期19卷 334-341页

作者： Yuichi Masuda Kazuki Yoshizawa Yasunari Ohno Atsuyoshi Mita Akira Shimizu Yuji Soejima division of Gastroenterological Hepato-Biliary-PancreaticTransplantation and Pediatric SurgeryDepartment of SurgeryShinshu University School of Medicine3-1-1 AsahiMatsumotoNaganoJapan

Background:Since the first success in an adult patient,living donor liver transplantation(LDLT)has become an universally used ***-for-size syndrome(SFSS)is a well-known complication after partial LT,especially in cases of adult-to-adult *** definition of SFSS slightly varies among transplant *** use of a partial liver graft has risks of SFSS *** portal vein(PV)hypertension and PV hyper-perfusion after LT were identified as the main ***,various approaches were explored to modulate PV flow and decrease PV pressure in order to alleviate this ***,the definition,clinical symptoms,pathophysiology,basic research,as well as preventive and treatment strategies for SFSS are reviewed based on an extensive review of the literature and on our own *** sources:The articles were collected through PubMed using search terms“liver transplantation”,“living donor liver transplantation”,“living liver donation”,“partial graft”,“small-for-size graft”,“small-forsize syndrome”,“graft volume”,“remnant liver”,“standard liver volume”,“graft to recipient body weight ratio”,“sarcopenia”,“porcine”,“swine”,and“rat”.English publications published before March 31,2020 were included in this ***:Many transplant surgeons performed PV flow modulation,including portocaval shunt,splenic artery ligation and *** these techniques,patient outcome has been improved even when using a"small"*** factors,such as preoperative recipients’nutritional and skeletal muscle status,graft congestion,and donor factors,were also identified as risk factors which all have been addressed using various ***:The surgical approach controlling PV flow and pressure could help to prevent SFSS especially in severely ill *** the absence of efficacious medications to resolve SFSS,conservative treatments,including aggressive fluid balance correction for massive ascites,anti-microbiological therapy t

关键词： Liver transplantation Living donor liver transplantation Small-for-size graft Small-for-size syndrome

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Benefits and limitations of middle bile duct segmental resection for extrahepatic cholangiocarcinoma

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hepatobiliary & pancreatic Diseases International 2020年第2期19卷 147-152页

作者： Masayuki Akita Tetsuo Ajiki Kimihiko Ueno Daisuke Tsugawa Motofumi Tanaka Masahiro Kido Hirochika Toyama Takumi Fukumoto Department of hepato-biliary-pancreatic surgery Kobe University Graduate School of MedicineKobe650-0017Japan

Background:pancreaticoduodenectomy(PD)is a standardized strategy for patients with middle and distal bile duct *** aim of this study was to compare clinicopathological features of bile duct segmen-tal resection(BDR)with PD in patients with extrahepatic ***:Consecutive cases with extrahepatic cholangiocarcinoma who underwent BDR(n=21)or PD(n=84)with achievement of R0 or R1 resection in Kobe University Hospital between January 2000 and December 2016 were enrolled in the present ***:Patients who underwent PD were significantly younger than those receiving *** frequency of preoperative jaundice,biliary drainage and cholangitis was not significantly different between the two *** duration of surgery was longer and there was more intraoperative bleeding in the PD than in the BDR group(553 vs.421 min,and 770 vs.402 mL;both PClavien-DindoⅢa)were observed in the PD group(46%vs.10%,P<0.01).Postoperative hospital stay was also longer in that group(30 vs.19 days,P=0.02).Pathological assessment revealed that tumors were less advanced in the BDR group but the rate of lymph node metastasis was similar in both groups(33%in BDR and 48%in PD,P=0.24).The rate of R0 resection was significantly higher in the PD group(80%vs.38%,P<0.01).Adjuvant chemotherapy was more frequently administered to patients in the BDR group(62%vs.38%,P=0.04).Although 5-year overall survival rates were similar in both groups(44%for BDR and 51%for PD,P=0.72),in patients with T1 and T2,the BDR group tended to have poorer prognosis(44%vs.68%at 5-year,P=0.09).Conclusions:BDR was comparable in prognosis to PD in middle bile duct *** invasiveness and lower morbidity of BDR justified this technique for selected patients in a poor general condition.

关键词： Cholangiocarcinoma Middle bile duct resection pancreaticoduodenectomy

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