[Novel Liver Retraction Method Using the FJ Clip and Silicon Disk for Laparoscopic Gastrectomy].

Laparoscopic gastrectomy(LG)has been developed, and its use has spread widely. One of the merits of this methodology for surgeons is its magnifying effect, which largely contributes to precise lymphadenectomy and lower blood loss. However, by contrast, its restricted view could be a demerit, and care should be taken to avoid trouble duringan operation. Liver retraction is an essential operative procedure to maintain a good surgical field and ensure sufficient working space during LG. We present a novel approach that uses the free jaw(FJ)clip and silicon disk. Our novel approach involved 1 ) exposingthe right crus of the diaphragm and grasping it using a FJ clip; 2 ) elevatingthe left lobe of the liver by usingfree loop plus with a 10- cm Penrose drain attached to the FJ clip grasping the right crus; and 3 ) insertingthe silicon disk between the Penrose drain and the left lobe of the liver. The FJ clip is reusable and easily maneuvered with the commonly used laparoscopy forceps. The last step enables prevention of intraoperative complications such as injury by forceps or energy devices. Therefore, we believe this procedure might be useful for LG, and we will prospectively confirm its usefulness in terms of hepatic function, operative time, and other factors.

[Strangulation Ileus Caused by Incarcerated Esophageal Hiatal Hernia after Laparoscopic Total Gastrectomy - A Case Report].

Laparoscopic total gastrectomy(LTG)is one of the most increasing surgeries among gastric cancer surgery. Although LTG has many advantages on the patient, we should be more careful of its specific complications. Here we report a case of 72- year-old man with the complaint of severe acute upper abdominal pain due to strangulation ileus caused by incarcerated esophageal hiatal hernia(EHH)after LTG. Emergent operation has performed on the patient and total 180 cm length of necrotic small intestine was resected. EHH after gastrectomy was thought to be rare complication. However, some literature reported that EHH after gastrectomy, especially after LTG has more possibility than it has ever thought to be. Laparoscopic surgery has more advantages than open surgery in terms of less invasiveness, rapid postoperative recovery, and less intraabdominal adhesion. One of the causes for EHH after LTG is ironically thought to be its less intraabdominal adhesion. We concluded that crus repair is one of the effective methods for the prevention of EHH after LTG through experiencing this case.

Granulocyte colony-stimulating factor-producing hepatocellular carcinoma with abrupt changes.

Granulocyte colony-stimulating factor (G-CSF)-producing tumor is one of the rare types of cancer clinically characterized by an elevated fever and white blood cell (WBC) increment. Although G-CSF producing tumors have been reported in several types of cancer including those of the lungs, cervix and bladder, G-CSF producing hepatocellular carcinoma is extremely rare. Here, we report the case of a rapidly growing and poorly differentiated hepatocellular carcinoma producing G-CSF. The patient showed symptoms of continuous high fever, stomach pain and cough, and high serum WBC counts, C-reactive protein (CRP) and G-CSF levels were found in laboratory tests. After a radical hepatectomy, the patient completely recovered from the above symptoms and inflammatory state. The serum levels of G-CSF were reduced to normal levels after radical surgery. An immunohistochemical analysis revealed the overexpression of G-CSF in the cytoplasm of certain hepatocellular carcinoma (HCC) cell. The patient's serum WBC, CRP and G-CSF levels remained within normal levels in the six months after surgery without recurrence. This is the 9th case report of G-CSF producing hepatocellular carcinoma in English literature. We review the clinical characteristics of the G-CSF producing HCC and discuss a possible treatment strategy.

Intraperitoneal rupture of the ureter as a cause of generalized peritonitis: report of a case.

We report a rare case of generalized peritonitis caused by nontraumatic, intraperitoneal rupture of the ureter. An 80-year-old woman with a history of bilateral vesicoureteral reflux and long-term urethral indwelling catheter drainage presented with a very distended abdomen. Computed tomography showed massive ascites and intraperitoneal free gas. We performed an emergency laparotomy, assuming a gastrointestinal perforation; but could not find a cause of generalized peritonitis. Postoperatively, she presented with anuria and massive peritoneal drainage. The findings of a cystogram confirmed intraperitoneal ureteral rupture. She was managed successfully with ureteral stenting. The diagnosis of this condition requires a high degree of clinical suspicion, along with radiographic evidence and peritoneal fluid analysis. Image-guided interventions play a crucial role in the management of ureteral urine leaks after a correct diagnosis has been made.