Retrograde jejunogastric intussusception: A case report and review of the literature.

Retrograde jejunogastric intussusception (JGI) is a rare but potentially fatal complication after previous gastrectomy or gastric bypass surgery. Because of the prevalence of bariatric surgery, the number of cases of postoperative intussusception has increased markedly. Here, we present the case of a patient with retrograde jejunogastric intussusception, having a previous history of subtotal gastrectomy and gastrojejunostomy for peptic ulcer disease. Correct preoperative diagnosis was made by plain abdominal film, upper gastrointestinal series, computed tomographic scan, and esophagogastroduodenoscopy. The diagnosis was confirmed by laparoscopic examination.

Totally laparoscopic living donor right hepatectomy in a donor with trifurcation of bile duct.

Donor operation in adult living donor liver transplantation is associated with significant postoperative morbidity. To avoid laparotomy wound complications and shorten postoperative recovery, laparoscopic liver graft harvest has been developed recently. However, to determine the cut point of bile duct is challenging. Herein, we report the application of totally laparoscopic approach for right liver graft harvest in a donor with trifurcation of the bile duct. A19-year-old man volunteered for living donation to his father who suffered from hepatitis B virus-related cirrhosis of liver and hepatocellular carcinoma. The graft was 880 mL with a single right hepatic artery and portal vein. The graft to recipient weight ratio was 1.06. The middle hepatic vein was preserved for the donor and the liver remnant was 42.3%. Two branches of middle hepatic veins were > 5 mm in diameter and needed reconstruction with cryopreserved allograft. Ductoplasty using laparoscopic intracorporeal suture technique was done to achieve single orifice of the graft bile duct. The postoperative course was uneventful for the donor. This report adds evidence of the feasibility of pure laparoscopic right donor hepatectomy and describes the necessary steps for bile duct division in donors with trifurcation of bile duct.

Robotic left hepatectomy with revision of hepaticojejunostomy.

Laparoscopic hepatectomy and hepaticojejunostomy remain a surgical challenge despite the recent advances in minimally invasive surgery. A robotic surgical system has been developed to overcome the inherent limitations of the traditional laparoscopic approach. However, techniques of robotic hepatectomy have not been well described, and a description of robotic major hepatectomy with bilioenteric anastomosis can be found only in two previous reports. Here, we report a 33-year-old man with a history of choledochocyst resection. The patient experienced repeat cholangitis with left hepatolithiasis during follow-up. Robotic left hepatectomy and revision of hepaticojejunostomy were performed smoothly. The patient recovered uneventfully and remained symptoms-free at a follow-up of 20 months. The robotic approach is beneficial in the fine dissection of the hepatic hilum and revision of hepaticojejunostomy in this particular patient.