Single-center experience of thoracoscopic sympathectomy for palmar hyperhidrosis with long-term postoperative questionnaire survey.

OBJECTIVES: Thoracoscopic sympathectomy is an effective treatment for palmar hyperhidrosis. However, compensatory hyperhidrosis occurs frequently as a postoperative complication of the procedure. The goal of this study was to elucidate the clinical significance of thoracoscopic sympathectomy using our surgical procedure. METHODS: Consecutive 151 patients who underwent thoracoscopic sympathectomy for palmar hyperhidrosis were studied. In addition, to investigate patients' satisfaction and long-term quality of life, 111 patients were asked to complete a mailing questionnaire survey, and 84 responded (response rate of 75.7%). RESULTS: All of the 151 patients reported a reduction in palmar sweating during the immediate postoperative period. None of the patients had pneumothorax, hemothorax, Horner's syndrome, or worsening of bradycardia. Based on the questionnaire, the surgical success rate was 98.8%. None of the patients had a recurrence of palmar hyperhidrosis during the long-term postoperative period. However, compensatory hyperhidrosis was reported in 82 patients (97.6%). In total, 94.0% of patients had high levels of postoperative satisfaction. CONCLUSIONS: Thoracoscopic sympathectomy is an effective surgical treatment for palmar hyperhidrosis. By contrast, the careful preoperative explanation of compensatory hyperhidrosis is considered to be very important.

Tracheostomy for the pediatric patient with fibrodysplasia ossificans progressiva: a case report.

BACKGROUND: Fibrodysplasia ossificans progressiva (FOP) is an extremely rare connective tissue disease characterized by subsequent ossification of skeletal muscles, tendons, ligaments, and other fibrous tissues. The ossification of these tissues progresses during childhood and leads to limb and trunk deformities. Since any surgery may trigger subsequent ossification, it is relatively contraindicated for patients with FOP. In this report, we describe our experience in performing tracheostomy in a pediatric patient with FOP who developed a restrictive respiratory disorder due to progressive deformity of the trunk. CASE PRESENTATION: A 12-year-old boy, diagnosed with FOP at the age of one, was referred for a tracheotomy after requiring 2 months of oral intubation and mechanical ventilation due to severe deformity-induced dyspnea. After changing from oral intubation to nasal intubation, we carefully considered the indications and benefits of tracheostomy in patients with FOP. Eventually, tracheostomy was successfully performed using our surgical design: creating a skin incision at the level of the cricoid cartilage that can always be identified, creating inverted U-shaped incision on the anterior tracheal wall to make a flap, and suturing the entire circumference of the tracheotomy and skin. One month after the surgery, he regained normal breathing and pronunciation and returned to school. The patient showed no unfavorable postoperative outcomes over a 4-year follow-up period. CONCLUSIONS: Tracheostomy in our pediatric case of FOP required careful perioperative management. However, it could effectively improve the patient's quality of life.

Pure Laparoscopic Living Donor Left Lateral Sectionectomy Using Glissonean Approach and Original Bridging Technique.

BACKGROUND: Living donor liver transplantation (LDLT) is the final treatment for children with end-stage liver disease. Congenital biliary atresia (CBA) is the most common disease requiring LDLT in Japan, and a left lateral sector graft is preferably procured owing to its anatomic predictivity and identical graft volume for preschool recipients. Laparoscopic left lateral sectionectomy (L-LLS) for LDLT has been recently established; however, there is no report about the innovative technique in L-LLS. The aim of this study was to introduce our L-LLS using the Glissonean approach and bridging technique for pediatric LDLT. MATERIALS AND METHODS: From September 2017 to September 2020, 5 cases of L-LLS for pediatric LDLT because of CBA were performed and we performed L-LLS using the original technique on their donors. In this novel procedure, the left Glissonean pedicle was encircled at the parenchymal side of the Laennec capsule after mobilization of the lateral sector and visualization of the left hepatic vein. Then, we passed 2 tapes through the encircled Glissonean pedicle at the hepatic side and the duodenal side, as the caudate lobe branch is enclosed like a bridge. By virtue of this bridging technique, we encircled the caudate lobe branch alone by switching the tape, and we clipped and divided it; this technique secured an adequately long hepatic duct on the graft side to perform a hepaticojejunostomy. The left hepatic duct was divided after indocyanine green fluorescence cholangiography, and the left hepatic artery and portal vein were divided as well. Finally, the left hepatic vein was transected and procured from an extended intraumbilical incision. RESULTS: We achieved L-LLS by using the Glissonean approach and the bridging technique in the 5 donors. The median operating time and blood loss were 282 (268 to 332) minutes and 34 (25 to 75) mL, respectively. There was no conversion to hybrid or open LLS and no postoperative complications. Regarding recipient outcomes, hepatic artery thrombosis occurred on postoperative day 4 in a 5-year-old female. All grafts function well and all recipients are alive after discharge (range of observation period, 3 to 26 mo). CONCLUSIONS: We herein present standardized L-LLS using the Glissonean approach and bridging technique for pediatric LDLT. Our technique can secure a longer margin of the left hepatic duct for recipients' hepaticojejunotomy. Our results have demonstrated the advantage in pediatric LDLT, especially in patients with CBA after the Kasai procedure.

Laparoscopic Left Hepatectomy with Middle Hepatic Vein Resection for Hepatocellular Carcinoma with Extrahepatic Portal Vein Obstruction.

BACKGROUND Extrahepatic portal vein obstruction (EHPVO) is one of the most important diseases that causes pre-hepatic portal hypertension, and EHPVO sometimes develops cavernous transformation to maintain hepatopetal flow. In this report, we describe the first case of hepatocellular carcinoma (HCC) with EHPVO having underwent pure laparoscopic left hepatectomy with middle hepatic vein (MHV) resection. CASE REPORT A 70-year-old woman with a diagnosis of mixed-type HCC or cholangiocarcinoma located in segment 4b was referred to our hospital, and computed tomography revealed EHPVO with cavernous transformation. We successfully performed pure laparoscopic left hepatectomy with MHV resection by using the individual hilar approach, frequent intraoperative sonography, and indocyanine green imaging. In this case, the routine Glissonian approach was impossible due to cavernous transformation growth and the absence of a portal vein. Therefore, frequent confirmation of intrahepatic flow was crucial to avoid intraoperative complications. The patient was discharged with no complications on postoperative day 7. A histopathological examination revealed that the moderately differentiated HCC formed a pseudoglandular pattern and cord-like structures, thereby defined as type II according to Edmondson's classification. CONCLUSIONS Currently, difficulty scoring systems for laparoscopic liver resection (LLR) usually contain the procedure and location of the hepatic tumor, but they do not contain the variety of anatomical abnormality due to its rarity. However, the false recognition of hilar vessels and biliary ducts in patients with an anatomical abnormality, including EHPVO, leads to severe injury; therefore, anatomical variety and abnormality are also important factors increasing the difficulty of LLR.

Portal bifurcation reconstruction using own hepatic vein grafts due to portal vein anomaly of the living donor for the patient with portal vein thrombosis.

A 57-year-old Japanese female was considered for living donor liver transplantation (LDLT) due to end-stage liver cirrhosis caused by primary biliary cholangitis with portal vein thrombosis (PVT) formation. A 26-year-old daughter of the patient was selected as a living donor; however, a computed tomography examination revealed trifurcated-type portal vein anomaly (PVA). Preoperative liver volumetry showed that the right lobe graft was necessary for the recipient; therefore, reconstruction of the portal vein bifurcation during LDLT was necessary. We planned to extract the recipient's own hepatic vein grafts after total hepatectomy, and these would be attached with anterior and posterior portal branches as jump grafts. We performed laparoscopic donor hepatectomy as usual, and the recipient's hepatic vein grafts were anastomosed on the bench. Then, the liver graft was inserted, and the hepatic vein reconstruction was routinely performed. We confirmed the alignment between the recipient's portal vein and the bridged hepatic vein graft of the liver graft's posterior branch, and anastomosed these two vessels. Moreover, we confirmed the front flow and expansion of the reconstructed posterior branch by declamping only the suprapancreatic side of the portal vein. The decision regarding the punch-out location was crucial. We confirmed the alignment between the reconstructed posterior branch and the bridged hepatic vein graft of the anterior branch, and anastomosed these two vessels employing the punched-out technique. In LDLT, liver transplant surgeons occasionally encounter living donors with PVA or recipients with PVT. Our contrivance may be useful when the liver graft needs reconstruction of portal vein bifurcation.

Identifying Cystic Vein Perfusion Area Employing Indocyanine Green Fluorescence Imaging during Laparoscopic Extended Cholecystectomy for Clinical T2 Gallbladder Cancer.

We present an original surgical technique for identifying the perfusion area of the cystic vein with indocyanine green (ICG) fluorescence imaging and laparoscopic extended cholecystectomy with lymphadenectomy for a 56-year-old woman with diagnosis of clinical T2 gallbladder cancer (GBC). First, we encircled Calot's triangle using the Glissonean approach from the ventral side of the gallbladder plate and then taped the hilar Glissonean pedicles; these were temporally clamped, and ICG was injected into the vein. The perfusion area of the cystic vein was scrutinized, specifically the stained area of the hepatic parenchyma was marked, and extended cholecystectomy was performed along the resection line. Subsequently, we performed lymphadenectomy of the hepatoduodenal ligament to complete the operation. A postoperative histopathological examination revealed moderately differentiated adenocarcinoma with pathological T1bN0M0. Although extended cholecystectomy is currently recommended for clinical T2 GBC, there is no consensus on the definition of the gallbladder bed, and the ideal extent of hepatic resection has, therefore, not yet been determined. In addition, gallbladder bed resection with 2-3 cm of surgical margin is an empirical procedure that lacks scientific verification. Regarding anatomical features, the cystic vein sometimes drains directly into the anterior branch of the portal vein, penetrating the gallbladder plate and Laennec's capsule of the anterior Glissonean pedicle. To address this background, we have developed a technique to identify the perfusion area of the cystic vein to determine the extent of hepatic parenchyma that should be resected during laparoscopic extended cholecystectomy for clinical T2 GBC.

Modification of plant cell wall structure accompanied by enhancement of saccharification efficiency using a chemical, lasalocid sodium.

The cell wall is one major determinant of plant cell morphology, and is an attractive bioresource. Here, we report a novel strategy to modify plant cell wall property by small molecules. Lasalocid sodium (LS) was isolated by chemical screening to identify molecules that affect the cell morphology of tobacco BY-2 cells. LS treatment led to an increase in cell wall thickness, whilst the quantity and sugar composition of the cell wall remained unchanged in BY-2 cells. The chemical also disordered the cellular arrangement of hypocotyls of Arabidopsis plants, resulting in a decrease in hypocotyl length. LS treatment enhanced enzymatic saccharification efficiency in both BY-2 cells and Arabidopsis plants. Microarray analysis on Arabidopsis showed that exposure to LS upregulated type III peroxidase genes, of which some are involved in lignin biogenesis, and jasmonic acid response genes, and phloroglucinol staining supported the activation of lignification by the LS treatment. As jasmonic acid-mediated lignification is a typical reaction to cell wall damage, it is possible that LS induces cell wall loosening, which can trigger cell wall damage response. Thus, LS is a unique chemical for modification of cell wall and morphology through changes in cell wall architecture.

A Case of Occipital Malignant Peripheral Nerve Sheath Tumor with Neurofibromatosis Type 1.

INTRODUCTION: The prognosis of malignant peripheral nerve sheath tumor (MPNST) with neurofibromatosis type 1 (NF-1) is worse than that of a solitary MPNST, because of the tumor size and location difficult to resect completely. We experienced a case of MPNST in the occipital region with NF-1. CASE REPORT: A 59-year-old woman presented with NF-1 and an MPNST of the occipital region. We performed wide excision involving the occipital bone, and reconstructed with a titanium plate and a free latissimus dorsi muscle flap. Despite three operations and postoperative radiotherapy, the tumor locally recurred after each surgery; further complicated by lung and mediastinal metastasis. Adjuvant therapy was insufficient to control local recurrence, which was observed intracranially, resulting in sagittal sinus invasion. Thirty months after the initial surgery, the patient died of respiratory failure due to lung metastasis. CONCLUSION: MPNST with NF-1 has poorer prognosis than that of a solitary lesion. Recently, it is reported in several literature that combination therapy with surgery and radiotherapy improve survival rates. But as we presented, when the complete local resection with free margin could not achieved due to the size and anatomical location of the tumor, the effectiveness of radiotherapy is not sufficient to control local recurrence.

Structural basis for the membrane association of ankyrinG via palmitoylation.

By clustering various ion channels and transporters, ankyrin-G (AnkG) configures the membrane-excitation platforms in neurons and cardiomyocytes. AnkG itself localizes to specific areas on the plasma membrane via s-palmitoylation of Cys. However, the structural mechanism by which AnkG anchors to the membrane is not understood. In this study, we solved the crystal structures of the reduced and oxidized forms of the AnkG s-palmitoylation domain and used multiple long-term coarse-grained molecular dynamics simulations to analyze their membrane association. Here we report that the membrane anchoring of AnkG was facilitated by s-palmitoylation, defining a stable binding interface on the lipid membrane, and that AnkG without s-palmitoylation also preferred to stay near the membrane but did not have a unique binding interface. This suggests that AnkG in the juxtamembrane region is primed to accept lipid modification at Cys, and once that happens AnkG constitutes a rigid structural base upon which a membrane-excitation platform can be assembled.

An Adverse Implication of Radiation Therapy for Implant-Retained Maxillofacial Prostheses.

We report the 19-year postoperative course of a patient whose maxillary defect was reconstructed with maxillofacial implant-retained facial prostheses. The patient received 60 Gy of radiation therapy. Adjunctive hyperbaric oxygen therapy was administered and four 4.0-mm long maxillofacial implants were inserted. Four years and 6 months after insertion surgery, two of the four implants were lost and the others showed bone regression in the surrounding bone. All implants were replaced with Epitec System maxillofacial implants placed in non-irradiated bone. Eleven years and 6 months after replacement, the Epitec System has been maintaining good and firm osseointegration. Appropriate selection of implant sites and no history of radiation therapy are keys to successful implant reconstruction. However, adjunctive hyperbaric oxygen therapy is believed to be effective, osseointegrated implant should be inserted at a point appropriately distant from an irradiated lesion.

Pyogenic Granuloma: A Retrospective 10-year Analysis of 82 Cases.

OBJECTIVE: Pyogenic granuloma (PG) is a common acquired hemorrhagic benign vascular lesion of the skin and mucous membranes. Recently, PG was considered a capillary hemangioma and was renamed as lobular capillary hemangioma (LCH). A clinical retrospective analysis of PG cases in our institute over a period of 10 years was performed. METHODS: The study involved 82 cases of pathologically diagnosed PG managed and treated at the Plastic Surgery Department of Tokai University between 1995 and 2004. Individual data from charts were reviewed for age, gender, affected site, size of lesion, predisposing factors, and treatment. All lesions were treated surgically using an excision followed by suture, or shave excision followed by CO2 laser ablation. RESULTS: The overall male to female ratio was 1.5:1. In 28% of the total cases, a preceding lesion was evident prior to the occurrence of PG. The head and neck area were the most commonly affected sites (56%), followed by the upper limb (22%), trunk (16%), and lower limbs (6%). CO2 laser ablation was performed successfully in 24% of patients and resulted in no recurrences. CONCLUSION: Based on our results, we recommend surgical excision followed by CO2 laser ablation as the first-choice treatment for PGs.

Lip Repair Surgery for Bilateral Cleft Lip and Palate in a Patient Diagnosed with Trisomy 13 and Holoprosencephaly.

We report a case of lip repair surgery performed for bilateral cleft lip and palate in a patient diagnosed with trisomy 13 and holoprosencephaly. At the age of 2 years and 7 months, the surgery was performed using a modified De Hann design under general anesthesia. The operation was completed in 1 h and 21 min without large fluctuations in the child's general condition. The precise measurement of the intraoperative design was omitted, and the operation was completed using minimal skin sutures. It is possible to perform less-invasive and short surgical procedures after careful consideration during the preoperative planning. Considering the recent improvements in the life expectancy of patients with trisomy 13, we conclude that surgical treatments for non-life threatening malformations such as cleft lip and palate should be performed for such patients.

Cranial Reconstruction in a Pediatric Patient Using a Tissue Expander and Custom-made Hydroxyapatite Implant.

A tissue expansion technique in conjunction with a custom-made artificial bone implant was effective for a large cranial reconstruction in a pediatric patient. The patient was an eight-year-old boy with cranial bone fracture, acute subdural hematoma in the left lobe, and acute epidural hematoma in the right lobe due to an accident. Wound dehiscence and artificial dura infection were observed as postoperative complications. Because of insufficiency of the skin flap caused by scar contracture, a scalp skin expansion using a tissue expander was necessary before reconstruction with the artificial bone implant. This combined procedure provided safe coverage of the implant and resulted in good wound healing. There are relatively few reports involving the use of tissue expanders for cranioplasty; furthermore, our search of the literature did not reveal any reports involving children. We believe that this procedure is safe and effective for early rehabilitation in pediatric patients.

The degree of spleen stiffness measured on acoustic radiation force impulse elastography predicts the severity of portal hypertension in patients with biliary atresia after portoenterostomy.

BACKGROUND/PURPOSE: Acoustic radiation focus impulse (ARFI) elastography is a new method for assessing the degree of tissue stiffness. We herein evaluated the degree of spleen stiffness (SS) using ARFI elastography in patients with biliary atresia (BA) after Kasai portoenterostomy (KPE). METHODS: We retrospectively collected the liver stiffness (LS) and SS values on ARFI elastography from 43 patients undergoing KPE between September 2010 and November 2013. We analyzed the correlations between these values and variables related to the severity of liver dysfunction and portal hypertension (PHT). The data were expressed as the standard deviation score (z-score) relative to the previously reported normal values for the patient's age. RESULTS: The SS value was significantly associated with the spleen diameter and development of collateral vessels, in comparison to the LS value. Interestingly, there was a significant correlation between SS value and the portal vein (PV) diameter. Thirty patients (69.8%) consequently underwent LT; these patients showed higher SS values and smaller PV diameters than the patients monitored without LT. CONCLUSIONS: The degree of SS measured on ARFI elastography can be used to predict the severity of PHT in BA patients after KPE.

Semi-automatic organelle detection on transmission electron microscopic images.

Recent advances in the acquisition of large-scale datasets of transmission electron microscope images have allowed researchers to determine the number and the distribution of subcellular ultrastructures at both the cellular level and the tissue level. For this purpose, it would be very useful to have a computer-assisted system to detect the structures of interest, such as organelles. Using our original image recognition framework CARTA (Clustering-Aided Rapid Training Agent), combined with procedures to highlight and enlarge regions of interest on the image, we have developed a successful method for the semi-automatic detection of plant organelles including mitochondria, amyloplasts, chloroplasts, etioplasts, and Golgi stacks in transmission electron microscope images. Our proposed semi-automatic detection system will be helpful for labelling organelles in the interpretation and/or quantitative analysis of large-scale electron microscope imaging data.

Neonatal portal venous blood flowmetry by Doppler ultrasound for early diagnosis of ischemia in intestinal tract.

PURPOSE: The aim of this article is to evaluate the utility of portal blood flow and other hemodynamic measurements for early diagnosis of ischemia that may cause necrotizing enterocolitis (NEC). PATIENTS AND METHODS: We measured neonatal portal blood flow by Doppler ultrasound and performed hemodynamic examinations in 75 newborns without congenital anomalies. All newborns were followed for 1 month after birth. The average gestational period was 30.5 weeks, and the average birth weight was 1,172 g. RESULTS: A positive correlation was observed between both body weight and the following parameters: portal vein cross-sectional area, blood flow velocity, and portal blood flow volume. A greater coefficient of correlation was observed between the portal vein cross-sectional area and weight in newborns weighing ≤ 1,500 g than in those weighing > 1,500 g. The portal vein cross-sectional area and blood flow velocity changed over time to maintain a fixed portal blood flow volume. The portal vein blood flow demonstrated a poor increase in patients with poor weight gain after birth. Seven infants demonstrated a reduction in portal vein blood flow before the development of abdominal symptoms. Both the cross-sectional area and blood flow velocity decreased over time before the onset of any symptoms of NEC. CONCLUSIONS: A significant decline in portal blood flow volume may be useful for the early diagnosis of NEC.

Urgent living donor liver transplantation for biliary atresia complicated by a strangulated internal hernia at Roux-en Y limb: a case report.

BACKGROUND: When BA patients with end-stage liver dysfunction have bowel obstruction, especially strangulated internal hernia, selecting optimal surgical therapeutic options is crucial. CASE REPORT: An 11-month-old female with end-stage biliary atresia (BA) was admitted for a strangulated internal hernia at the Roux-en Y limb and frequent episodes of gastrointestinal bleeding requiring blood transfusion. She was scheduled within a month to receive a portion of the liver from her blood-type identical mother. Despite intensive care, her clinical condition obviously needed a prompt surgical intervention. The operative findings at laparotomy revealed exudative moderate ascites and a dilated and ischemic afferent loop that was strangulated by a band extending from the mesentery to the transverse mesocolon. The attachment of the band was released, and gangrenous changes were recognized in the incarcerated bowel, although there were no obvious findings of intestinal perforation. After the gangrenous afferent loop was resected, the remnant afferent loop was too short to anastomose again. Following these procedures, as the patient's vital signs remained stable, we decided to simultaneously perform living donor liver transplantation (LDLT). She successfully underwent LDLT and her post-transplant course was uneventful. CONCLUSIONS: When faced with candidates for LT as an urgent life-saving surgery, determining whether LDLT should be performed simultaneously during perioperative management is necessary to save the life of the patient.

Living donor liver transplantation with alternative porto-left gastric vein anastomosis in patients with post-Kasai extrahepatic portal vein obstruction.

EPVO is a common cause of prehepatic portal hypertension in pediatric patients and sometimes results in cavernous transformation of the PV. We herein present the cases of two patients who underwent LDLT for EPVO with post-Kasai biliary atresia. PV reconstruction was performed with a porto-left gastric vein anastomosis. The patient who underwent PV reconstruction using an interposition vein graft is doing well without surgical complications, whereas PV anastomotic stenosis was detected three months after LDLT in the patient who did not receive an interposition vein graft. The availability of vein grafts is limited in the LDLT setting. In such cases, performing PV reconstruction with varicose veins using interposition vein grafts is a feasible and valuable alternative option for obtaining a sufficient portal blood flow. Our experiences suggest that using interposition vein grafts may be appropriate for preventing the anastomotic stenosis caused by the fragility of varicose veins.

Capsaicin, a TRPV1 Ligand, Suppresses Bone Resorption by Inhibiting the Prostaglandin E Production of Osteoblasts, and Attenuates the Inflammatory Bone Loss Induced by Lipopolysaccharide.

Capsaicin, a transient receptor potential vanilloid type 1 (TRPV1) ligand, regulates nerve-related pain-sensitive signals, inflammation, and cancer growth. Capsaicin suppresses interleukin-1-induced osteoclast differentiation, but its roles in bone tissues and bone diseases are not known. This study examined the effects of capsaicin on inflammatory bone resorption and prostaglandin E (PGE) production induced by lipopolysaccharide (LPS) in vitro and on bone mass in LPS-treated mice in vivo. Capsaicin suppressed osteoclast formation, bone resorption, and PGE production induced by LPS in vitro. Capsaicin suppressed the expression of cyclooxygenase-2 (COX-2) and membrane-bound PGE synthase-1 (mPGES-1) mRNAs and PGE production induced by LPS in osteoblasts. Capsaicin may suppress PGE production by inhibiting the expression of COX-2 and mPGES-1 in osteoblasts and LPS-induced bone resorption by TRPV1 signals because osteoblasts express TRPV1. LPS treatment markedly induced bone loss in the femur in mice, and capsaicin significantly restored the inflammatory bone loss induced by LPS in mice. TRPV1 ligands like capsaicin may therefore be potentially useful as clinical drugs targeting bone diseases associated with inflammatory bone resorption.

Early experience with single-incision laparoscopic Nissen fundoplication for gastroesophageal reflux disease in patients with mental retardation via a gastrostomy site incision: report of five cases.

Single-incision laparoscopic fundoplication for gastroesophageal reflux disease is not widespread because of its technical difficulty. On the other hand, patients with gastroesophageal reflux frequently also have mental retardation and eating disorders. We have been performing single-incision laparoscopic fundoplication via a gastrostomy site incision since October 2009 for these patients. The treated patients were 4 males and 1 female. A small skin incision was made on the gastrostomy site and a SILS port was placed. Under pneumoperitoneum, a single-incision laparoscopic Nissen fundoplication and gastrostomy were performed with a flexible scope, conventional instruments, and high-dexterity instruments. The pneumoperitoneal time was 115-180 min and blood loss was 1-15 ml. There were no intra- or postoperative complications. The hospital stay was under 8 days for all patients. Using this procedure, the incidence of postoperative intestinal obstruction was very low. The results indicate this procedure can be used as a standard operation for these patients in the future.