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As it is being common in Japan to perform surgery in patients over 85 years old, postoperative complications such as pneumonia, heart failure, dementia, and bedridden status become big problems for patients and their family. Although some prognostic scoring systems such as POSSUM score are available, these scoring systems do not precisely predict the postoperative complications. Aim of the present study was to evaluate mortality and morbidity after the surgery and consider surgical indication in super-old patients. Methods: We retrospectively reviewed 222 patients who underwent surgery from 2003 to 2010 at the age over 85 years and analyzed postoperative mortality and morbidity rate. In our hospital, indications of surgery in super-old patients were, 1) informed consent from patient and his/her family and 2) good pulmonary and cardiac function to tolerate operation. We evaluated POSSUM score for information, and poor POSSUM score was not considered as an absolute contraindication. Results: Among 222 operations, emergent operations were 114, while elective operations were 108. Diseases for operation were gastric cancer in 24, colorectal cancer in 49, cholecystolithiasis in 9, inguinal hernia in 19 patients. Emergent operations included perforation of GI tract for 26, acute cholecystitis for 22, intestinal obstruction for 21, inguinal hernia for 20, acute appendicitis for 10, and colorectal cancer for 7 patients. Mortality and morbidity rates in elective surgery were 1.9% (2 patients) and 31.5% (34 patients), respectively, while those in emergent operation increased to 14.9% (17 patients) and 58.4% (66 patients) (p

In this video presentation we are presenting a patient with a submucosal mass at the gastroesophageal junction (GEJ). At time of laparoscopic surgery, the mass was adherent to the GEJ and extended into the distal left esophagus. Resection of the mass included a portion of the lower esophageal sphincter and distal left esophagus. This area was then reconstructed primarily over a 42 Fr tapered Bougie with running 3.0 and 2.0 Vicryl® suture in two layer fashion. The patient did well post-operatively and was discharged home on day six.