New method for prevention of bile leakage after hepatic resection.

BACKGROUND: The usefulness of fibrin glue and bioabsorbable polyglicolic acid (PGA) felt to prevent the bile leakage was studied. METHODS: Eighty-eight patients who underwent hepatic resection without biliary reconstruction from 2001 through 2005 were studied. We divided 88 patients into 37 patients of Group A (who underwent hepatic resection between January 2001 and March 2003) and 51 patients of Group B (who underwent hepatic resection between April 2003 and January 2005). The fibrin glue was applied to the excision site of remnant liver in the patients of Group A. On the other hand, the fibrin glue and bioabsorbable PGA sheet were applied in the patients of Group B. RESULTS: In Group A, the post-operative bile leakage occurred in 3 of 37 patients (8.1%). The post-operative bleeding occurred in 1 of 37 patients (2.7%). And the post-operative wound infection occurred in 4 patients (10.8%). In Group B, no post-operative bile leakage and bleeding were observed in 51 patients. And the post-operative wound infection occurred in 3 patients (5.9%). The difference between Groups A and B in the rate of bile leakage was statistically significant. CONCLUSIONS: The combination of fibrin glue and bioabsorbable PGA felt was extremely favorable for prevention of bile leakage after hepatic resection.

The surgical procedure and clinical results of the duct to mucosa pancreaticojejunostomies with resection of jejunal serosa.

BACKGROUND: Pancreatic anastomotic leakage often results in severe complications of sepsis, intra-abdominal bleeding, pancreatic fistula, and is a significant cause of morbidity and mortality. An appropriate technique to minimize pancreatic leakage is very important. Recently we have performed duct to mucosa pancreaticojejunostomy with resection of jejunal serosa and obtained positive results. PATIENTS AND METHODS: During 1999-2005, 52 patients (25 females, 27 males) underwent duct to mucosa pancreaticojejunostomy with resection of jejunal serosa after pancreatic head resections for benign (n=6) and malignant disease (n=46). The mean age was 64.0 years (range 33-80). RESULTS: Mean post-operative hospital stay was 32.3 days. Morbidity rate due to early post-operative complication was 7.7% (pulmonary embolism in 1, pneumothorax in 1, wound infection in 2), with no pancreatic leakage. CONCLUSIONS: There were low complication rates and an absence of pancreatic anastomotic leakage was observed in 52 patients. We consider that this pancreatic anastomotic technique is extremely favorable for pancreaticojejunostomy.

A resected case of advanced duodenal carcinoma with occlusion of the celiac artery.

A 75-year-old woman with vomiting, admitted on March 7 2002, was diagnosed with advanced duodenal carcinoma based on ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangio-ancreatography (MRCP), percutaneus transhepatic cholangiography. Angiography showed the celiac artery to be occluded. The common hepatic artery was demonstrated via the gastroduodenal artery (GDA). We conducted a probe laparotomy and resected connective tissue with the celiac ganglion and lymph nodes surrounding the celiac artery. The frozen specimen showed no malignancy. Then the celiac artery was exposed and celiac axis compression syndrome was not seen. A portion of the greater saphenous vein was taken from the patient's right thigh and grafted between the common hepatic artery and the supraceliac portion of the aorta. One end of the saphenous vein was anastomosed to the side of the common hepatic artery. The other end of the saphenous vein was anstomosed to the aorta in an end to side fashion. After the reconstruction of celiac circulation, we performed radical pancreaticoduodenectomy. The postoperative course was not eventful and the patient was discharged from the hospital 5 weeks after surgery.

A resected case of multiple intraductal papillary mucinous tumors of the pancreas with US-guided ductal branch-oriented partial pancreatectomy.

A 69-year-old man with epigastralgia was admitted on August 26, 2002 and diagnosed with multiple intraductal papillary mucinous tumors by various imagings. The cystic tumor of pancreas head had a diameter of 2 cm, and the mural nodule of the cystic tumor measured only 3 mm. In the pancreas body the cystic tumor was measured at 1.5 cm with the mural nodule of the cystic tumor measuring 3 mm. It was believed that the tumors were benign. However, a mural nodule of the cystic lesion was recognized, thus, the possibility of malignancy could not be completely ruled out. The reduction operation for preservation of pancreatic parenchyma should be selected for these circumstances. Ductal branch-oriented partial pancreatectomy was performed on September 6, 2002 with intraoperative ultrasonography and a Cavitron Ultrasonic Aspirator, preserving the main pancreatic duct and normal pancreatic parenchyma. The operation was successful, and the histopathological diagnosis of the tumors was intraductal papillary adenoma of the pancreas.