Retrospective observational cohort study of laparoscopic surgical strategies for gastrointestinal stromal tumors.

Laparoscopic surgery has been used to treat gastric submucosal tumors (SMTs). Laparoscopic and endoscopic cooperative surgery (LECS) has been used when subtotal resection has been difficult, which enabled resection of these tumors. In this study, we reviewed the medical records of patients with gastric SMTs who underwent laparoscopic surgery in our hospital with the aim of reporting the surgical indications, procedures (especially for LECS), and outcomes of surgery. This study involved 55 patients who underwent laparoscopic surgery between April 2014 and March 2021. We classified the patients into two groups: laparoscopy-assisted surgery group (non-LECS group, n = 30) and LECS group (n = 25). LECS was performed in the upper stomach, in the greater curvature of the lower stomach, and in both intraluminal and intramural locations in the middle stomach. Non-LECS was selected for extraluminal and intramural tumors in the greater curvature of the upper stomach. There were no severe complications associated with the operation. There was one postoperative complication in the LECS group. The length of postoperative hospital stay did not significantly differ between the LECS and non-LECS groups. We reported the surgical procedures for gastric SMTs in our hospital. It is essential to make full use of the multiple techniques reported in this article and examine the location of the tumor to avoid excess or insufficient resection. Our review of the present case series allowed us to select the appropriate surgical approach for gastric SMTs based on the lesion location and type of development.

Analysis of Thoracoscopic Enucleation Combined with Esophagoscopy in the Prone Position for Esophageal Submucosal Tumor.

Background: Esophageal submucosal tumors (SMTs) are rare, occurring in less than 1% of esophageal neoplasms. For surgical treatment of esophageal SMTs, enucleation is usually the procedure of choice for benign tumors. This study aimed at evaluating the surgical technique and outcomes of thoracoscopic enucleation with esophagoscopy for esophageal SMTs. Methods: Patients with esophageal SMTs who underwent thoracoscopic enucleation between 2015 and 2022 were retrospectively investigated. Surgery was performed with the patient in the prone position. First, an esophagoscope was inserted, and a sodium hyaluronate solution with indigo carmine dye was injected into the submucosal layer just below the tumor. Next, under thoracoscopy, the tumor was exposed through a thoracoscopic incision and dissection of the muscularis propria and adventitia was performed at the tumor site. The colored layer resulting from the previously injected dye was identified, and tumor enucleation was performed under guidance of the dye so as not to damage the mucosa or pseudocapsule. Results: In total, 5 surgeries were performed. The mean operative time was 122.6 minutes (range 84-168 minutes), mean blood loss was 21.1 mL (range 0-80 mL), and mean postoperative hospital stay was 8 days (range 7-10 days). There were no postoperative complications. Pathological diagnosis revealed 2 cases of gastrointestinal stromal tumors, 2 cases of schwannoma, and 1 case of leiomyoma. Conclusions: We believe that this technique is a useful and safe method of performing thoracoscopic enucleation of esophageal SMTs because the injected dye provides an indicator of the resection line during enucleation.

Presentation of unruptured right gastric aneurysm due to segmental arterial mediolysis resected laparoscopically: A case report.

INTRODUCTION: Timely diagnosis and treatment of intra-abdominal arterial aneurysms before rupture are highly recommended. We successfully prevented rupture through arterial aneurysm excision, highlighting the importance of the lack of reports on resection before rupture. CASE PRESENTATION: A 60-year-old male with previous history of ureteral stones presented complaining primarily of left-sided abdominal pain. Computed tomography (CT) revealed a left ureteral stone and incidentally identified a submucosal gastric tumor and right gastric artery aneurysm, leading to referral to our department. Blood tests showed no abnormalities. CT revealed a 23-mm submucosal tumor protruding outward from the middle gastric body wall. A 13-mm aneurysm was observed in the right gastric artery, and no other aneurysms were detected, including intracranially. Upper gastrointestinal endoscopy revealed a smooth elevation covered by normal mucosa in the middle gastric body. Endoscopic ultrasound-fine needle aspiration resulted in a diagnosis of gastrointestinal stromal tumor (GIST) and surgery. We performed simultaneous surgery involving laparoscopic local resection of the gastric GIST and identification and excision of the right gastric artery aneurysm due to its enlargement (7 mm on CT conducted six years ago). The patient's postoperative course was uneventful, and he was discharged on postoperative day 6. Pathological examination confirmed a diagnosis of segmental arterial mediolysis. DISCUSSION: Intra-abdominal arterial aneurysms affect approximately 1 % of the population. Splenic artery aneurysms are the most common at 58.7 %, whereas the gastric artery and gastroepiploic artery account for only 4.7 %. CONCLUSION: Right gastric artery aneurysms are exceedingly rare, with no reported cases of successful resection before rupture.

[A Case of Unresectable Gastric Cancer Who Underwent Conversion Surgery after SP Therapy and Achieved Long-Term Survival].

The case was a man in his 60s. With a complaint of loss of appetite, a peripheral type 3 lesion was found from the lower body of the stomach to the vestibule, and a biopsy revealed poorly differentiated adenocarcinoma. CT examination revealed that the tumor had invaded the left lobe of the liver and the transverse colon, and that the para-aortic lymph nodes were swollen and multiple nodules of the gastrocolonic mesentery were found. After 6 courses of S-1 plus cisplatin(SP)therapy were performed, the tumor shrank and lymph node swelling and nodule disappearance were observed. Laparotomy and pyloric gastrectomy, partial liver resection, D2 dissection, and Roux-en-Y reconstruction were performed. As a result of histopathological examination, R0 was resected. After the operation, S-1 was taken orally for 1 year, and no recurrence or metastasis has been observed 6 and a half years after the operation. This time, we report a valuable case in which SP therapy was successful for unresectable gastric cancer and long-term survival was obtained by conversion surgery.

Can a pressure-limited vesico-amniotic shunt tube preserve normal bladder function?

INTRODUCTION: We have previously shown that a vesico-amniotic shunt (V-A shunt) produces fibrotic bladders with poor compliance in normal fetal lambs. We hypothesized that using a ventriculo-peritoneal shunt (V-P shunt) as a V-A shunt in normal bladders may preserve the filling/emptying cycle and normal bladder development. MATERIALS AND METHODS: The V-A shunting in normal fetal lambs was performed at 74 days of gestation using a V-P shunt (group A) and a free-draining shunt tube (group B). Sham-operated lambs were used as controls (group C). They were all delivered at term (145 days), and the pressure-volume curve, bladder volume, and histologic features of the bladder wall were compared. RESULT: The mean bladder volume in group B (n = 5), 5 +/- 2.4 mL, was significantly smaller (P < .01) than that in group A (n = 6), 53 +/- 14 mL, and group C (n = 10), 57.3 +/- 12 mL. The bladder wall thickness in group A was 338 + 94.2 microm; group B, 741 +/- 128 microm; and group C, 374 +/- 120 microm. Group B bladders had very poor compliance with thick bladder wall (P < .01). Histologically, group B bladders showed prominent submucosal fibrotic change, but group A bladders were similar to controls. CONCLUSION: This study shows that a pressure-limited shunt tube for V-A shunting preserves the normal fetal bladder development.