A Rare Case of Hernia Incarceration Under the Closed Port-Site Fascia After Robot-Assisted Laparoscopic Radical Cystectomy: Insights and Management Strategies.

Most cases of port-site hernia were due to inadequate fascial closure of the port site. We experienced a rare case of hernia incarceration under the closed port-site fascia despite adequate closure of the fascia after robot-assisted laparoscopic radical cystectomy. In this case, the small intestine was incarcerated between the transversus abdominis and oblique abdominal muscles from the 12-mm trocar site for the assistant. We inserted forceps to release the incarceration, and the fascia and peritoneum of the port site were closed using a trocar site closure device under laparoscopy. We considered that all-layer suturing, including peritoneum and inner and outer oblique fascia suturing, was necessary for port-site closure, especially in patients with obesity, because hernias can occur with fascial closure alone.

Feasibility of oral antibiotic prophylaxis in elective laparoscopic cholecystectomy during periods of limited cefazolin supply.

INTRODUCTION: In March 2019, the supply of cefazolin sodium (CEZ) became difficult owing to contamination of the drug substance. We investigated the efficacy and safety of the oral administration of cephalexin (CEX) in preventing infectious complications following elective laparoscopic cholecystectomy (LC). METHODS: From July 2018 to June 2019, 1 g of CEZ was administered intravenously within 30 min prior to LC (IV group). From July 2019 to June 2020, 0.5 g of CEX was administrated orally within 2 h prior to LC (oral group). We compared clinicopathologic variables and perioperative results between these two groups. RESULTS: During the period, 60 patients underwent elective LC; 35 from the oral group and 25 from the IV group. There was no significant difference in the surgical site infection (P = 0.37), distant infection (P = 0.23), and postoperative medical costs (P = 0.11) between both groups. Postoperative nausea and vomiting were significantly higher in the oral group (P = 0.04), whereas the C-reactive protein value on the first day after the operation was significantly lower in the oral group (P < 0.01). CONCLUSION: During the period of limited CEZ supply, oral administration of CEX may be an alternative antibiotic prophylaxis in LC.

Endovascular micro-arterial stenting for arterial pseudoaneurysm after pancreatic surgery.

Although arterial pseudoaneurysm is one of the most serious complications after pancreatic surgery, the best practice with maximum efficacy and minimum adverse effects to overcome such a serious situation has not yet been elucidated. We performed endovascular micro-arterial stenting (EMAS) to manage this serious situation while preserving a sufficient hepatic arterial flow, and herein report the technical details and challenges of the procedure. Dilation of the stent using a balloon catheter to adhere to the parent artery, and embolization of the surrounding artery to prevent type I and type II endo-leaks are the most important points for ensuring a successful procedure. We applied this technique to 6 cases of hepatic arterial pseudoaneurysm, with a mean size of 6.5 ± 1.3 mm. The mean time of the procedure was 81 ± 22 min, without adverse events, including hepatic necrosis or arterial bleeding. EMAS may be the ideal procedure for treating pseudoaneurysm after pancreatic surgery while preserving the hepatic arterial inflow.

N-terminal domain of the cholesterol transporter Niemann-Pick C1-like 1 (NPC1L1) is essential for α-tocopherol transport.

Both cholesterol and α-tocopherol are essential lipophilic nutrients for humans and animals. Although cholesterol in excess causes severe problems such as coronary heart disease, it is a necessary component of cell membranes and is the precursor for the biosynthesis of steroid hormones and bile acids. Niemann-Pick C1-like 1 (NPC1L1) is a cholesterol transporter that is highly expressed in the small intestine and liver in humans and plays an important role in cholesterol homeostasis. Cholesterol promotes NPC1L1 endocytosis, which is an early step in cholesterol uptake. Furthermore, α-tocopherol is the most active form of vitamin E, and sufficient amounts of vitamin E are critical for health. It has been reported that NPC1L1 mediates α-tocopherol absorption; however, the mechanisms underlying this process are unknown. In this study, we found that treatment of cells that stably express NPC1L1-GFP with α-tocopherol promotes NPC1L1 endocytosis, and the NPC1L1 inhibitor, ezetimibe, efficiently prevents the α-tocopherol-induced endocytosis of NPC1L1. Cholesterol binding to the N-terminal domain (NTD) of NPC1L1 (NPC1L1-NTD) is essential for NPC1L1-mediated cholesterol absorption. We found that α-tocopherol competitively binds NPC1L1-NTD with cholesterol. Furthermore, when cells stably expressed NPC1L1ΔNTD-GFP, α-tocopherol could not induce the endocytosis of NPC1L1ΔNTD. Taken together, these results demonstrate that NPC1L1 recognizes α-tocopherol via its NTD and mediates α-tocopherol uptake through the same mechanism as cholesterol absorption.