Background: A 35-year-old married female (68 kg, 150 cm, BMI: 30.2) with pancreatic divisum complicated chronic pancreatitis and underwent pylorus-preserving pancreaticoduodenectomy in 2010. After that, her condition ...Background: A 35-year-old married female (68 kg, 150 cm, BMI: 30.2) with pancreatic divisum complicated chronic pancreatitis and underwent pylorus-preserving pancreaticoduodenectomy in 2010. After that, her condition was well. However, body weight gained progressively to 76 kg (BMI: 33.7) and hypertension developed. During these two years, tried exercise and medication control for hypertension, but in vain. She received a laparoscopic sleeve gastrectomy in October 2013. The post-operative course was uneventful. Methods: We applied three ports for laparoscopic operation, including two 12 mm and one 5 mm trocars. The liver was not needed to be elevated due to adhesion. The operative time was 75 minutes. Results: The patient’s body weight was 10 kg reduced in the first two months and reduced to 59 kg 6 months later. Conclusions: We report a case that received laparoscopic sleeve gastrectomy following pylorus-preserving pancreaticoduodenectomy due to pancreatic divisum. This case encourages us to extend the indication of laparoscopic sleeve gastrectomy.展开更多
<strong>Background:</strong> To present the experience of management of leaks following laparoscopic sleeve gastrectomy for morbid obesity in Show-Chwan memorial Hospital. <strong>Patients and Method...<strong>Background:</strong> To present the experience of management of leaks following laparoscopic sleeve gastrectomy for morbid obesity in Show-Chwan memorial Hospital. <strong>Patients and Methods:</strong> Laparoscopic sleeve gastrectomy is considered one of the surgical options for morbid obesity. It is effective, with an average loss of 50% of excessive weight after 2 years of follow-up. The first laparoscopic sleeve gastrectomy was performed in January 2010 at Show-Chwan Memorial Hospital. Between January 2010 and October 2016, 300 patients underwent laparoscopic sleeve gastrectomy for morbid obesity. There were 218 women and 82 men with a mean age of 35.4 years. Preoperative mean body weight was 90.7 kg and mean body mass index (BMI) was 37.3 kg/m2. <strong>Results:</strong> Mean operative time was 85 minutes. Mean hospital stay was 3.5 days. There were no deaths. There were 5 complications (1.67%): leakage of gastroesophageal junction. One patient was conservative treatment. Two patients were successfully treated by self-expandable metallic stents and the other two patients were treated with esophageal stent also, but failed and further treated with fibrin (Histoacryl) injection to the leak site to try to seal the fistula. In six months follow-up, mean BMI decreased from 37.3 to 29.2 kg/m2, and mean excess weight loss reached 42.8%. <strong>Conclusions:</strong> Laparoscopic sleeve gastrectomy is a beneficial operation in terms of excessive weight loss, with acceptably complications. The leaks were located in gastroesophageal junction mostly, and could be resolved with esophageal stent. For the patients failed in esophageal stents, we try Histoacryl injection to improve it.展开更多
Rupture of hepatocellular carcinoma (HCC) is a life-threatening complication. Peritoneal metastasis of HCC after spontaneous rupture was seldom noted. We report a case of intraperitoneal metastasis of HCC after spon-t...Rupture of hepatocellular carcinoma (HCC) is a life-threatening complication. Peritoneal metastasis of HCC after spontaneous rupture was seldom noted. We report a case of intraperitoneal metastasis of HCC after spon-taneous rupture. A previously asymptomatic 72-year-old man was admitted due to dull abdominal pain with abdominal fullness. He had a history of HCC rupture 10 mo ago and transarterial embolization was performed at that time. Abdominal computer tomograghy (CT) scan showed a huge peritoneal mass over the right up-per quadrant area. Surgical resection was arranged and subsequent microscopic examination conf irmed a diag-nosis of moderately-differentiated HCC.展开更多
Primary retroperitoneal mucinous cystadenomas (RMCs) are very rare and their biological behavior and histogenesis remain speculative. An accurate preoperative diagnosis of these tumors is difficult because no effectiv...Primary retroperitoneal mucinous cystadenomas (RMCs) are very rare and their biological behavior and histogenesis remain speculative. An accurate preoperative diagnosis of these tumors is difficult because no effective diagnostic measures have been established. We describe a 29-year-old woman with abdominal pain and a palpable mass. Computed tomography (CT) of the abdomen revealed a retroperi-toneal cystic mass which was resected successfully at laparotomy. Histopathological examination of the resected mass confirmed the diagnosis of RMC. There was no evidence of disease 2 years after surgery.展开更多
Minimally invasive surgery has revolutionized the treatment of gastrointestinal tumors. Submucosal tumors of the stomach can be resected using laparoscopic techniques. We report here a case of ectopic pancreas tissue ...Minimally invasive surgery has revolutionized the treatment of gastrointestinal tumors. Submucosal tumors of the stomach can be resected using laparoscopic techniques. We report here a case of ectopic pancreas tissue in the gastric wall that was removed using robotic-assisted laparoscopic resection. The patient was a 15-year-old female who presented with abdominal discomfort and tarry stools. Laboratory analysis showed iron deficiency anemia. Preoperative endoscopy revealed a submucosal lesion in the posterior wall of the gastric high body. Intraoperative upper endoscopy clearly located the lesion. A robotic-assisted laparoscopic wedge resection of the putative gastric submucosal tumor was performed. The pathology results showed an ectopic pancreas. The patient had an uneventful recovery and we believe that this is a valid treatment option for this benign condition.展开更多
Purpose: Perforated peptic ulcer is an emergency condition. Laparoscopic ulcer repair is a feasible and safe procedure. The aim of this study was to research the efficacy of laparoscopic repair of peptic ulcer and to ...Purpose: Perforated peptic ulcer is an emergency condition. Laparoscopic ulcer repair is a feasible and safe procedure. The aim of this study was to research the efficacy of laparoscopic repair of peptic ulcer and to discuss the causes of conversion from laparoscopy to laparotomy. Methods: We collected 34 patients with perforated peptic ulcer underwent laparoscopic surgery from October 2003 to October 2008. Thirty four patients with perforated peptic ulcer underwent laparoscopic intervention and 6 cases were converted to laparotomy. The demographics, laboratory data, perioperative data, morbidity and mortality were compared. Results: In demographics of two groups, there were no significant differences in sex, age, location, and mean duration of symptoms of acute abdominal pain. However, there were significant differences in median size of perforation, mean duration of history of peptic ulcer related pain, and the experiences of surgeon. There were no significant differences in the laboratory data and perioperative data of two groups. In morbidity?and mortality of two groups, there were no significant differences in leakage, wound infection, intra-abdominal abscess, ileus, urinary tract infection, pneumonia, and mortality, but there was significant difference in overall morbidity in two groups. Conclusions: Laparoscopic repair of perforated peptic ulcer is safe and could be used in routine clinical practice. However, patients with larger perforations (>10 mm), longer duration of history peptic ulcer related pain (>2 years), and learning curve of surgeon could be associated with conversion rate. It is associated with higher morbidity in patients with conversion from laparoscopy to laparotomy.展开更多
A 60-year-old female patient suffered unhealed wounds over left flank for around 30 years after surgical removal of left renal stones. Fecal material spilled from the two small openings of the scar, bothered her all d...A 60-year-old female patient suffered unhealed wounds over left flank for around 30 years after surgical removal of left renal stones. Fecal material spilled from the two small openings of the scar, bothered her all day long. During the course of the 30 years, she suffered from intermittent fever, diarrhea and wound pain and presented with malnourished condition. After serial examinations, tumor associated with iatrogenic colo-cutaneous fistula was impressed and she received en bloc resection. Pathology revealed squamous cell carcinoma arising from the fistula with colon and spleen invasion. To the best of our knowledge,no such case has been reported, as yet.展开更多
Background: Ten-millimeter ports are often used in laparoscopic surgery. It could be difficult to close the ports sites, especially in obese patients. We described a new method to close ten-millimeter port-site wounds...Background: Ten-millimeter ports are often used in laparoscopic surgery. It could be difficult to close the ports sites, especially in obese patients. We described a new method to close ten-millimeter port-site wounds, effective and easily to perform. Methods: Forty cases of laparoscopic bariatric surgery were performed from April 2010 to September 2011 at IRCAD Taiwan. Among them, 30 patients received trocar hole closed with SURGICEL® Original Hemostat and the other 10 patients received trocar hole closed with autologous fat. The results were recorded. Results: In group of SURGICEL® Original Hemostat, includes 21 female and 9 male, age range from 18 to 54 with average 39.5 years. Average BMI is 42.4 (range from 32.6 to 55). The operations include 27 cases of laparoscopic sleeve gastrectomy, 2 cases of laparoscopic gastric bypass, and 1 case of laparoscopic mini-bypass. Group of autologous fat includes 3 female and 7 male, age range from 20 to 49 with average 38.6 years. Average BMI is 39 (range from 32.8 to 64.5). The operations include 9 cases of laparoscopic sleeve gastrectomy, and 1 case of laparoscopic mini-bypass. No complications of trocar wound including infection, hematoma, and hernia were found for a mean follow-up of 6 months. Conclusions: For obese patients, closure of port sites can be difficult. We described a method of closing 10-mm port-sites wounds, which are easy, effective, and not required any special instruments.展开更多
Background: Totally implantable access ports (TIAP) could be done in two methods: puncture of subclavian vein and cephalic vein cutdown. Cephalic vein cutdown method has fewer complications but has higher failure rate...Background: Totally implantable access ports (TIAP) could be done in two methods: puncture of subclavian vein and cephalic vein cutdown. Cephalic vein cutdown method has fewer complications but has higher failure rates. We present a method to decrease the failure rates. Methods: We use the continuously injection with diluted heparin solution via catheter while introducing the TIAP catheter into the cephalic vein. Results: From January 2005 to January 2009, 20 patients were performed. This method was successfully applied in 11 patients with no complications. The other 9 patients was unsuccessfully and further underwent guidewire assisted. Conclusions: Continuously injection with diluted heparin solution via catheter while inserting TIAP catheter into the cephalic vein is safe and simple. It could be used for difficulties of insertion of TIAP and increased the successful rates of cephalic vein cut-down method.展开更多
Neutrophilic leukocytosis above 50 × 109/l exclude leukemia, defines a leukemoid reaction (LR). It is associated with several diseases. Although it simulates leukemia, most of the causes are benign. Tumor-related...Neutrophilic leukocytosis above 50 × 109/l exclude leukemia, defines a leukemoid reaction (LR). It is associated with several diseases. Although it simulates leukemia, most of the causes are benign. Tumor-related LR is more common. It is associated with ranulocyte colony-stimulating factor (G-CSF) secreted by the tumor cells. A 38-year-old woman, presented with advanced breast cancer and leukocytosis (79.9 × 103/uL) was found. After completion of MRM, the condition of leukocytosis subsided. Two months later, tumor local relapse was found and white blood cells (WBC) rose again. After completion of wide excision, the condition of leukocytosis subsided again. We think this case was associated with leukemoid reaction.展开更多
Purpose: Chilaiditi’s syndrome is the hepatodiaphragmatic interposition of the colon. Its diagnosis poses challenge to clinicians, and misdiagnosis may results in unnecessary exploratory laparotomy being performed. T...Purpose: Chilaiditi’s syndrome is the hepatodiaphragmatic interposition of the colon. Its diagnosis poses challenge to clinicians, and misdiagnosis may results in unnecessary exploratory laparotomy being performed. The purpose of this study was to report our experience in diagnosis, management, and clinical outcome of patients with Chilaiditi’s syndrome. Methods: Nine cases of Chilaiditi’s syndrome from April 2005 to January 2007 at one institute. The clinical characteristic, imaging studies, management and results were recorded. Results: Six patients presented with abdominal distension (2 patients with abdominal pain;5 patients with constipation), while Chilaiditi’s syndrome in the other three patients were found incidentally. All patients underwent chest X-ray. The Chilaiditi’s sign could be detected in seven patients;while the other two patients presented with no specific finding. Abdominal plain films (KUB) were all reviewed. Most of the patients (n = 8) showed ileus and one patient showed no specific finding. Impacted stool could be detected in five of nine patients. Abdominal ultrasound was performed in two patients. Gallstones were detected in one of them while the other revealed no specific finding. Six of nine patients underwent CT of abdomen, one of them revealed bowel loops in bilateral subphrenic space. One patient underwent subtotal colectomy because of volvulus of sigmoid colon. Five patients were treated with laxative and enema successfully and had been remained asymptomaticcally for a mean follow-up of 6.6 months. The other three cases were under observation. Conclusions: Presence of haustral folds of bowel loops may help us in diagnosing Chilaiditi’s syndrome. The left lateral decubitus abdominal plain film can also help to differentiate between pneumoperitoneum to Chilaiditi’s sign. Most of the cases with Chilaiditi’s syndrome can be resolved with conservative treatment and surgical intervention was reserved for patients with sign of systemic toxicity or peritonitis.展开更多
文摘Background: A 35-year-old married female (68 kg, 150 cm, BMI: 30.2) with pancreatic divisum complicated chronic pancreatitis and underwent pylorus-preserving pancreaticoduodenectomy in 2010. After that, her condition was well. However, body weight gained progressively to 76 kg (BMI: 33.7) and hypertension developed. During these two years, tried exercise and medication control for hypertension, but in vain. She received a laparoscopic sleeve gastrectomy in October 2013. The post-operative course was uneventful. Methods: We applied three ports for laparoscopic operation, including two 12 mm and one 5 mm trocars. The liver was not needed to be elevated due to adhesion. The operative time was 75 minutes. Results: The patient’s body weight was 10 kg reduced in the first two months and reduced to 59 kg 6 months later. Conclusions: We report a case that received laparoscopic sleeve gastrectomy following pylorus-preserving pancreaticoduodenectomy due to pancreatic divisum. This case encourages us to extend the indication of laparoscopic sleeve gastrectomy.
文摘<strong>Background:</strong> To present the experience of management of leaks following laparoscopic sleeve gastrectomy for morbid obesity in Show-Chwan memorial Hospital. <strong>Patients and Methods:</strong> Laparoscopic sleeve gastrectomy is considered one of the surgical options for morbid obesity. It is effective, with an average loss of 50% of excessive weight after 2 years of follow-up. The first laparoscopic sleeve gastrectomy was performed in January 2010 at Show-Chwan Memorial Hospital. Between January 2010 and October 2016, 300 patients underwent laparoscopic sleeve gastrectomy for morbid obesity. There were 218 women and 82 men with a mean age of 35.4 years. Preoperative mean body weight was 90.7 kg and mean body mass index (BMI) was 37.3 kg/m2. <strong>Results:</strong> Mean operative time was 85 minutes. Mean hospital stay was 3.5 days. There were no deaths. There were 5 complications (1.67%): leakage of gastroesophageal junction. One patient was conservative treatment. Two patients were successfully treated by self-expandable metallic stents and the other two patients were treated with esophageal stent also, but failed and further treated with fibrin (Histoacryl) injection to the leak site to try to seal the fistula. In six months follow-up, mean BMI decreased from 37.3 to 29.2 kg/m2, and mean excess weight loss reached 42.8%. <strong>Conclusions:</strong> Laparoscopic sleeve gastrectomy is a beneficial operation in terms of excessive weight loss, with acceptably complications. The leaks were located in gastroesophageal junction mostly, and could be resolved with esophageal stent. For the patients failed in esophageal stents, we try Histoacryl injection to improve it.
文摘Rupture of hepatocellular carcinoma (HCC) is a life-threatening complication. Peritoneal metastasis of HCC after spontaneous rupture was seldom noted. We report a case of intraperitoneal metastasis of HCC after spon-taneous rupture. A previously asymptomatic 72-year-old man was admitted due to dull abdominal pain with abdominal fullness. He had a history of HCC rupture 10 mo ago and transarterial embolization was performed at that time. Abdominal computer tomograghy (CT) scan showed a huge peritoneal mass over the right up-per quadrant area. Surgical resection was arranged and subsequent microscopic examination conf irmed a diag-nosis of moderately-differentiated HCC.
文摘Primary retroperitoneal mucinous cystadenomas (RMCs) are very rare and their biological behavior and histogenesis remain speculative. An accurate preoperative diagnosis of these tumors is difficult because no effective diagnostic measures have been established. We describe a 29-year-old woman with abdominal pain and a palpable mass. Computed tomography (CT) of the abdomen revealed a retroperi-toneal cystic mass which was resected successfully at laparotomy. Histopathological examination of the resected mass confirmed the diagnosis of RMC. There was no evidence of disease 2 years after surgery.
文摘Minimally invasive surgery has revolutionized the treatment of gastrointestinal tumors. Submucosal tumors of the stomach can be resected using laparoscopic techniques. We report here a case of ectopic pancreas tissue in the gastric wall that was removed using robotic-assisted laparoscopic resection. The patient was a 15-year-old female who presented with abdominal discomfort and tarry stools. Laboratory analysis showed iron deficiency anemia. Preoperative endoscopy revealed a submucosal lesion in the posterior wall of the gastric high body. Intraoperative upper endoscopy clearly located the lesion. A robotic-assisted laparoscopic wedge resection of the putative gastric submucosal tumor was performed. The pathology results showed an ectopic pancreas. The patient had an uneventful recovery and we believe that this is a valid treatment option for this benign condition.
文摘Purpose: Perforated peptic ulcer is an emergency condition. Laparoscopic ulcer repair is a feasible and safe procedure. The aim of this study was to research the efficacy of laparoscopic repair of peptic ulcer and to discuss the causes of conversion from laparoscopy to laparotomy. Methods: We collected 34 patients with perforated peptic ulcer underwent laparoscopic surgery from October 2003 to October 2008. Thirty four patients with perforated peptic ulcer underwent laparoscopic intervention and 6 cases were converted to laparotomy. The demographics, laboratory data, perioperative data, morbidity and mortality were compared. Results: In demographics of two groups, there were no significant differences in sex, age, location, and mean duration of symptoms of acute abdominal pain. However, there were significant differences in median size of perforation, mean duration of history of peptic ulcer related pain, and the experiences of surgeon. There were no significant differences in the laboratory data and perioperative data of two groups. In morbidity?and mortality of two groups, there were no significant differences in leakage, wound infection, intra-abdominal abscess, ileus, urinary tract infection, pneumonia, and mortality, but there was significant difference in overall morbidity in two groups. Conclusions: Laparoscopic repair of perforated peptic ulcer is safe and could be used in routine clinical practice. However, patients with larger perforations (>10 mm), longer duration of history peptic ulcer related pain (>2 years), and learning curve of surgeon could be associated with conversion rate. It is associated with higher morbidity in patients with conversion from laparoscopy to laparotomy.
基金Supported by the National Natural Science Foundation of China, No. 30224801
文摘A 60-year-old female patient suffered unhealed wounds over left flank for around 30 years after surgical removal of left renal stones. Fecal material spilled from the two small openings of the scar, bothered her all day long. During the course of the 30 years, she suffered from intermittent fever, diarrhea and wound pain and presented with malnourished condition. After serial examinations, tumor associated with iatrogenic colo-cutaneous fistula was impressed and she received en bloc resection. Pathology revealed squamous cell carcinoma arising from the fistula with colon and spleen invasion. To the best of our knowledge,no such case has been reported, as yet.
文摘Background: Ten-millimeter ports are often used in laparoscopic surgery. It could be difficult to close the ports sites, especially in obese patients. We described a new method to close ten-millimeter port-site wounds, effective and easily to perform. Methods: Forty cases of laparoscopic bariatric surgery were performed from April 2010 to September 2011 at IRCAD Taiwan. Among them, 30 patients received trocar hole closed with SURGICEL® Original Hemostat and the other 10 patients received trocar hole closed with autologous fat. The results were recorded. Results: In group of SURGICEL® Original Hemostat, includes 21 female and 9 male, age range from 18 to 54 with average 39.5 years. Average BMI is 42.4 (range from 32.6 to 55). The operations include 27 cases of laparoscopic sleeve gastrectomy, 2 cases of laparoscopic gastric bypass, and 1 case of laparoscopic mini-bypass. Group of autologous fat includes 3 female and 7 male, age range from 20 to 49 with average 38.6 years. Average BMI is 39 (range from 32.8 to 64.5). The operations include 9 cases of laparoscopic sleeve gastrectomy, and 1 case of laparoscopic mini-bypass. No complications of trocar wound including infection, hematoma, and hernia were found for a mean follow-up of 6 months. Conclusions: For obese patients, closure of port sites can be difficult. We described a method of closing 10-mm port-sites wounds, which are easy, effective, and not required any special instruments.
文摘Background: Totally implantable access ports (TIAP) could be done in two methods: puncture of subclavian vein and cephalic vein cutdown. Cephalic vein cutdown method has fewer complications but has higher failure rates. We present a method to decrease the failure rates. Methods: We use the continuously injection with diluted heparin solution via catheter while introducing the TIAP catheter into the cephalic vein. Results: From January 2005 to January 2009, 20 patients were performed. This method was successfully applied in 11 patients with no complications. The other 9 patients was unsuccessfully and further underwent guidewire assisted. Conclusions: Continuously injection with diluted heparin solution via catheter while inserting TIAP catheter into the cephalic vein is safe and simple. It could be used for difficulties of insertion of TIAP and increased the successful rates of cephalic vein cut-down method.
文摘Neutrophilic leukocytosis above 50 × 109/l exclude leukemia, defines a leukemoid reaction (LR). It is associated with several diseases. Although it simulates leukemia, most of the causes are benign. Tumor-related LR is more common. It is associated with ranulocyte colony-stimulating factor (G-CSF) secreted by the tumor cells. A 38-year-old woman, presented with advanced breast cancer and leukocytosis (79.9 × 103/uL) was found. After completion of MRM, the condition of leukocytosis subsided. Two months later, tumor local relapse was found and white blood cells (WBC) rose again. After completion of wide excision, the condition of leukocytosis subsided again. We think this case was associated with leukemoid reaction.
文摘Purpose: Chilaiditi’s syndrome is the hepatodiaphragmatic interposition of the colon. Its diagnosis poses challenge to clinicians, and misdiagnosis may results in unnecessary exploratory laparotomy being performed. The purpose of this study was to report our experience in diagnosis, management, and clinical outcome of patients with Chilaiditi’s syndrome. Methods: Nine cases of Chilaiditi’s syndrome from April 2005 to January 2007 at one institute. The clinical characteristic, imaging studies, management and results were recorded. Results: Six patients presented with abdominal distension (2 patients with abdominal pain;5 patients with constipation), while Chilaiditi’s syndrome in the other three patients were found incidentally. All patients underwent chest X-ray. The Chilaiditi’s sign could be detected in seven patients;while the other two patients presented with no specific finding. Abdominal plain films (KUB) were all reviewed. Most of the patients (n = 8) showed ileus and one patient showed no specific finding. Impacted stool could be detected in five of nine patients. Abdominal ultrasound was performed in two patients. Gallstones were detected in one of them while the other revealed no specific finding. Six of nine patients underwent CT of abdomen, one of them revealed bowel loops in bilateral subphrenic space. One patient underwent subtotal colectomy because of volvulus of sigmoid colon. Five patients were treated with laxative and enema successfully and had been remained asymptomaticcally for a mean follow-up of 6.6 months. The other three cases were under observation. Conclusions: Presence of haustral folds of bowel loops may help us in diagnosing Chilaiditi’s syndrome. The left lateral decubitus abdominal plain film can also help to differentiate between pneumoperitoneum to Chilaiditi’s sign. Most of the cases with Chilaiditi’s syndrome can be resolved with conservative treatment and surgical intervention was reserved for patients with sign of systemic toxicity or peritonitis.