Relaparotomy Two Years after Incisional Hernia Repair Using a Free Fascia Lata Graft.

Although, free fascia lata autografts can be used to reconstruct various anatomical structures, little information is available about the status of such autografts several years after the procedure, especially in a clinical setting. Here, we describe our experience with a patient who underwent relaparotomy two years after incisional hernia repair using a fascia lata graft. A 79-year-old man underwent open hepatectomy for hepatocellular carcinoma. One year later, abdominal computed tomography revealed a locally recurrent tumor 1.5 cm in diameter and a giant incisional hernia measuring approximately 15 × 6 cm on the supraumbilical midline. After repeat hepatectomy, the incisional hernia was repaired using a free fascia lata patch as an interpositional graft. Two years later, the patient was readmitted because of recurrent tumors in the liver, and repeat hepatectomy was performed. During surgery, the fascia lata graft had survived well and become incorporated into the native fascia. We incised this fascia lata graft in the same way as for a normal laparotomy. After hepatectomy, the fascia lata graft was closed in layers with interrupted sutures. The patient was discharged on postoperative day 11 with no wound-related morbidity.

Mirizzi Syndrome with Cholecystobiliary Fistula: Observation of Development from Asymptomatic Cholecystolithiasis to Surgery.

Despite a considerable number of reports of Mirizzi syndrome, none have described the process of its development from simple cholecystolithiasis. We report an extremely rare case of Mirizzi syndrome in which it was possible to observe the process of development of cholecystobiliary fistula from asymptomatic cholecystolithiasis until unavoidable surgical intervention 4 years later. A 68-year-old woman presented at our hospital with right upper quadrant pain. She had been diagnosed as having asymptomatic cholecystolithiasis 4 years previously. Diagnostic abdominal computed tomography (CT) had revealed a 1.9 cm radiopaque stone, and thereafter, the patient had been monitored by imaging alone. CT conducted 6 months before the present admission revealed that the gallbladder stone was compressing the common hepatic duct, although the patient remained asymptomatic. On admission, abdominal CT showed that the gallbladder stone was obstructing the common bile duct with dilatation of the intrahepatic duct. Endoscopic retrograde cholangiopancreatography revealed a round filling defect at the confluence of the common bile duct and the image of the cystic duct; therefore, the patient was categorized as having Mirizzi syndrome type III, according to the Csendes classification. Intraoperative findings revealed a cholecystobiliary fistula involving up to two-thirds of the circumference of the common bile duct.

Safe Skin Management during Open Hepatectomy in a Patient with Recessive Dystrophic Congenital Epidermolysis Bullosa.

Congenital epidermolysis bullosa is a rare, genetic condition in which even slight stimulation can cause blistering of the skin or mucosa. While previous reports of treatments requiring general anesthesia in these patients were focused on anesthesia-related procedures, such as endotracheal intubation, no report has described specific management required for these patients during surgery, such as preparation of the surgical site, fixation of infusion lines and other tubes, and adjustment of the operation table. This is probably the first report to address these issues. This report presents a case of recessive dystrophic congenital epidermolysis bullosa in which open hepatectomy was safely performed.

Postoperative portal vein thrombosis and gastric hemorrhage associated with late-onset hemorrhage from the common hepatic artery after pancreaticoduodenectomy.

Portal vein thrombosis (PVT) is a rare but serious postoperative complication of pancreaticoduodenectomy (PD). We reported a case of late-onset postoperative PVT with hemorrhage from the common hepatic artery (CHA) in a 73-year-old man who underwent pylorus-preserving pancreaticoduodenectomy (PPPD) for duodenum papilla cancer, followed by reconstruction using the modified Child's technique. The pancreaticojejunostomy was achieved by end-to-side, 2-layer invagination anastomosis without pancreatic duct stenting. Drain removal and hospital discharge were scheduled on postoperative day (POD) 18, but blood-stained fluid in the drain and sudden hematemesis were noted. Emergency surgery was performed because PVT and imaging findings were suggestive of necrosis of the lifted jejunum. Although no jejunal necrosis was identified during surgery, bleeding from the side of the CHA was detected and the bleeding point was suture-closed to achieve hemostasis. We suspected late-onset postoperative arterial hemorrhage and subsequent hematoma formation, which caused portal vein compression and PVT formation. We chose a conservative treatment strategy for PVT, taking into account the operation time, intraoperative vital signs and blood flow in the portal vein. Despite the complicated postoperative course, he was discharged home in a fully ambulatory state on POD 167.

Laparoscopic resection of an intra-abdominal esophageal duplication cyst: a case report and literature review.

Duplication of the alimentary tract is a rare congenital malformation that occurs most often in the abdominal region, whereas esophageal duplication cyst develops typically in the thoracic region but occasionally in the neck and abdominal regions. Esophageal duplication cyst is usually diagnosed in early childhood because of symptoms related to bleeding, infection, and displacement of tissue surrounding the lesion. We recently encountered a rare adult case of esophageal duplication cyst in the abdominal esophagus. A 50-year-old man underwent gastroscopy, endoscopic ultrasonography, computed tomography, and magnetic resonance imaging to investigate epigastric pain and dysphagia that started 3 months earlier. Imaging findings suggested esophageal duplication cyst, and the patient underwent laparoscopic resection followed by intraoperative esophagoscopy to reconstruct the esophagus safely and effectively. Histopathological examination of the resected specimen revealed two layers of smooth muscle in the cystic wall, confirming the diagnosis of esophageal duplication cyst.