Closure method for thick pancreas stump after distal pancreatectomy: soft coagulation and polyglycolic acid felt with fibrin glue.

PURPOSE: Pancreatic fistula (PF) remains an obstacle to safe distal pancreatectomy (DP). A thick pancreatic parenchyma is a major risk factor for PF. In this paper, we elucidate the feasibility of the new closure method using soft coagulation and polyglycolic acid felt with fibrin glue. METHODS: In 2009-2013, 96 patients underwent DP with a novel closure method for pancreatic stump that utilized soft coagulation and polyglycolic acid felt with fibrin glue. We evaluated amylase levels in drainage fluid on postoperative days (POD) 1 and 3 and the incidence of postoperative PF according to International Study Group of Pancreatic Fistula (ISGPF) definitions. RESULTS: Drain amylase levels on POD1 and POD3 were 275 and 241 U/L, respectively, and ISGPF-defined Grade B/C PF rates were 16.7%. No clinical factors were significantly associated with PF. Average pancreatic parenchymal thicknesses were similar in PF-positive and PF-negative patients (10.4 ± 2.6 mm vs. 10.1 ± 2.2 mm, P = 0.639). There was no significant difference in the postoperative PF rate between patients with thick (≥12 mm) and thin (<12 mm) pancreas (11.1 vs. 18.8%, P = 0.544). CONCLUSION: Our novel pancreatic stump closure method appears to be simple and effective, particularly in patients with thick pancreas.

Navigation Guidance Using Polyglycolic Acid Felt in Pure Laparoscopic Partial Hepatectomy.

BACKGROUND: Appropriate determination of the dissecting plane for removing the tumor blood flow drainage area (TBF-D area) around a hepatocellular carcinoma as well as the tumor itself is essential in pure laparoscopic hepatectomy, but it is often difficult with the usual devices. Navigation technologies have been developed in an attempt to improve the technical accuracy, but they are still under development and cannot be easily applied yet in current clinical practice. To resolve this problem, we created a novel method of using absorbable polyglycolic acid felt (PGA felt) as a navigation guide in pure laparoscopic partial hepatectomy (PLH). METHODS: We used a PGA felt cut into the appropriate shape in accordance with the shape determined preoperatively by simulation computed tomography in each case. We applied the felt on the surface of the liver intraoperatively as a guide for PLH. RESULTS: The PGA felt was placed on the surface of the liver, with the central portion of the felt aligned to the central portion of the tumor. The resection line was marked around the felt using monopolar electrocautery. Then, after removing the PGA felt, PLH was successfully performed along the marked line. The surgical margin was confirmed to be adequate in the resected specimen, which showed complete resection of the TBF-D area as well as of the tumor in a comparison with the preoperative computed tomography angiography images. CONCLUSION: This new technique is easy and safe and enables resection of both the tumor(s) and the TBF-D area appropriately and accurately in PLH.

Failure to achieve 2-log10 viral decrease in first four weeks of peg-IFNalpha-2b plus ribavirin therapy for chronic hepatitis C with genotype 1b and high viral titer is useful in predicting non-response: evaluation of response-guided therapy.

BACKGROUND/AIMS: To clarify clinical parameters predicting sustained viral response (SVR) during 48 weeks pegylated-interferon (peg-IFN)alpha-2b plus ribavirin therapy for Japanese patients with chronic hepatitis C [CH(C)] genotype 1b and high viral titers. METHODOLOGY: One hundred and fifty-one (151) patients receiving peg-IFNalpha-2b plus ribavirin therapy for 48 weeks were enrolled. SVR and clinical parameters were evaluated. The relationship between virological parameters (substitutions in the core and NS5A) and the degree of early viral decrease was also studied. RESULTS: Seventy (46.4%) patients achieved SVR (per protocol analysis). Negative predictive value (NPV) of <2-log10 decrease after 4 weeks of therapy for SVR was 78.0%; similar to that for failing to achieve early viral response (EVR) at 12 weeks (82.2%). CONCLUSIONS: Failure to achieve 2- log10 decrease in the first 4 weeks may be an important predictor of non-SVR during 48 weeks of peg-IFNalpha-2b plus ribavirin therapy; thus, therapeutic plans should be reassessed at that point.

[A case with chronic hepatitis C who developed liver cirrhosis due to liver dysfunction caused by pegylated interferon plus ribavirin treatment despite negativity of serum HCV RNA, during therapy].

We report a case of chronic hepatitis C in whom liver cirrhosis was later diagnosed following abnormality of ALT levels during pegylated interferon α2a and ribavirin treatment. A 62-year-old woman with chronic hepatitis C was treated with pegylated interferon α2a plus ribavirin for 72 weeks. Her HCV RNA became negative 16 weeks after the start of treatment and continued to be negative for most of the treatment duration. Her AST/ALT, ALP/γ-GTP levels became elevated soon after the initiation of treatment and thereafter remained unchanged. However, most of these levels normalized after the end of treatment. Post-treatment liver biopsy showed liver cirrhosis, probably due to the interferon treatment itself. This unusual therapeutic outcome should be considered if the levels of hepatic dysfunction during interferon treatment are severe.