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Adhesive small bowel obstruction is one of the most frequent postoperative morbidities and a major cause of hospital admission. Previous surgery is the most important factor predisposing patients to adhesions. The incidence of adhesive small bowel obstruction after laparotomy has been estimated to be between 12 and 53%, but this incidence increases after major laparotomy (Lancet 353:1476–1480, 1999;Dis Colon Rectum 42:578, 1999; Aust N Z J Surg 63:848–852, 1993; Ann Surg 235:200–206, 2002). Adhesive small bowel obstruction requires appropriate management according to the patient's condition. Conservative management of ASBO is often successful, with 70 to 80% of patients experiencing resolution of their symptoms without operative intervention (Am J Surg 165(1):121–125, 1993; Am J Surg 196(1):23–27, 2008; J Gastrointest Surg 12(5)926–932, 2008). However, conservative treatment may leave adhesions that could lead to a recurrence of the obstruction. Operative techniques can remove the cause of the obstruction but can lead to the formation of new adhesions. After the operation, the mortality and complication rates have been observed to range from 0 to 3.8% and 14 to 32%, respectively (Ann Surg 240:193–201, 2004; Ann Surg 244:750–757, 2006; Int Surg 74:23–27, 1989; Ann Surg 231:529–537, 2000). Thus, the treatment strategy significantly influences the risk of recurrences and complications (Dis Colon Rectum 48:1140–1146, 2005; Arch Surg 128:765–770, 1993; Am J Surg 170:361–365, 1995). To determine the optimal treatment strategies among patients with adhesive small bowel obstruction from a long-term viewpoint, we evaluated outcomes after treatment for adhesive small bowel obstruction and identified the risk factors for recurrence. [ABSTRACT FROM AUTHOR]

Although gender should be considered a biological variable in all studies, there are few reports on long-term outcomes stratified by gender in inguinal hernia repair. The aim of this study was to compare the long-term outcomes of inguinal hernia repair between males and females. In this study, 1689 patients with primary unilateral inguinal hernia who underwent elective repair between January 2008 and December 2016 were included. Of these patients, 1517 patients were male, and 177 patients were female. The long-term outcomes assessed using a questionnaire were compared between males and females. In addition, risk factors for "pain often" answers on the questionnaire were assessed. Answered questionnaires were obtained from 1027 patients (73%) in the male group and 130 patients (75%) in the female group (P = 0.34). No significant differences were observed between the groups regarding satisfaction, numbness, and discomfort. However, there was a significant difference in pain between the groups (males: often, 2.8% and sometimes, 12%; females: often, 7.0% and sometimes, 13%; P = 0.034). On analysis by surgical procedure, although there was a significant difference in pain between the groups after anterior open mesh repair, after transabdominal preperitoneal repair, no significant difference in pain was observed between the groups. Multivariate analysis indicated that the female gender (OR: 2.41, 95% CI: 1.09–5.33, P = 0.03) was independently associated with "pain often" answers on the questionnaire. The female gender was an independent risk factor for pain. It is recommended that transabdominal preperitoneal repair should be performed in females. [ABSTRACT FROM AUTHOR]

Aim: We have routinely performed emergent laparoscopic cholecystectomy (LC) as soon as we diagnosed acute cholecystitis (AC), if patients could tolerate surgery. This study was conducted to identify the preoperative risk factors that predict the technical difficulty of emergent LC for AC. Methods: A retrospective review of patients with AC who underwent emergent LC between 2012 and 2019 was conducted. Technical difficulty was defined as the presence of the following conditions: open conversion, operative time ≥120 min, or blood loss ≥500 ml. Results: In all, 327 patients were included and divided into difficult LC (DLC, n = 61) and nondifficult LC (non‐DLC, n = 266). Multivariate logistic analysis revealed that symptom duration ≥72 h was the only independent risk factor for DLC. Comparison of late LC (beyond 72 h, LLC) and early LC (within 72 h, ELC) showed a lower rate of creation of the critical view of safety and a longer hospital stay, as well as a longer operative time, a larger amount of bleeding, and a higher open conversion rate in LLC. However, the postoperative complication rates were equivalent. Conclusion: LC for AC with symptom duration ≥72 h tends to be technically difficult. However, it is acceptable regarding operative outcomes. [ABSTRACT FROM AUTHOR]

Background: There have been few comparisons of the postoperative outcomes of transabdominal preperitoneal (TAPP), open mesh plug (mesh plug) and open tissue (tissue) hernia repair. The objectives of this study were to compare these repair methods. Methods: This was a retrospective study of 1813 inguinal hernia patients between January 2008 and December 2016. Of these patients, 474 underwent TAPP repair, 1293 underwent mesh plug repair, and 46 underwent tissue repair. The short-term and long-term outcomes determined by questionnaire were compared among the three groups. In addition, risk factors for patient dissatisfaction were assessed. Results: In the TAPP group, the postoperative complications rate was the lowest at 4.6% (7.4% and 6.5% in the mesh plug and the tissue groups, respectively, P = 0.07), and recurrence rate was lower compared to the mesh plug group (0.8% vs. 3.3%, P = 0.002). As long-term outcomes, 92%, 88% and 75% of patients were satisfied in the TAPP, mesh plug and tissue groups, respectively (P = 0.03). The rate of patients with numbness was 3.1% in the TAPP group, 5.2% in the mesh plug group and 14% in the tissue group (P = 0.04). Predictive independent risk factors for patient dissatisfaction were complications (OR: 3.99, 95% CI: 1.35–11.8, P = 0.012) and infection (OR: 16.9, 95% CI: 1.25–229, P = 0.003). Conclusions: TAPP repair is superior to mesh plug and tissue repairs in terms of complications, satisfaction and numbness, as determined by questionnaire. Complications and infection were independently associated with the patient dissatisfaction. [ABSTRACT FROM AUTHOR]

Purposes: Postoperative complications are associated with poor overall and cancer-specific survival after resection of various types of cancer, including primary colorectal cancer. However, the oncological impact of surgical site infection (SSI) after liver resection for colorectal liver metastases (CLM) is unclear. The aim of this study was to investigate the oncological impact of SSI after liver resection for CLM.Methods: We reviewed data from 367 consecutive patients treated by curative liver resection for CLM between 1994 and 2015. Patients who underwent simultaneous resection of colorectal cancer and synchronous liver metastases (n = 86) were excluded from the analysis. Short- and long-term outcomes were analyzed.Results: SSI developed in 18 (6.4%) of the 281 patients in the analytic cohort (SSI group). The remaining 93.6% (n = 263) did not suffer this complication (no-SSI group). The operative duration was significantly longer in the SSI group than in the No-SSI group (p = 0.002). The overall survival rates 5 years after liver resection for CLM were 33.3% in the SSI group vs. 50.7% in the No-SSI group (p = 0.043). Multivariate analysis indicated that a liver tumor size ≥ 5 cm, R1 resection, and SSI were independently associated with overall survival after liver resection.Conclusions: SSI after liver resection for CLM is associated with adverse oncological outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopy‐assisted proximal gastrectomy with jejunal interposition (LAPG‐JI) is not yet widely used because the three anastomotic procedures involved in this operation are technically complicated. This study aimed to describe our surgical procedure for LAPG‐JI and assess its feasibility and safety. Methods: This was a retrospective study of 70 patients who had undergone proximal gastrectomy with jejunal interposition for gastric cancer in the upper third of the stomach between July 2007 and October 2016. Of these patients, 32 underwent LAPG‐JI, and 38 underwent open proximal gastrectomy with jejunal interposition. Clinical characteristics and both surgical and postoperative outcomes were compared between LAPG‐JI and open proximal gastrectomy with jejunal interposition. Results: The operation time was longer in the LAPG‐JI group (189 vs 154 min, P < 0.001) and estimated blood loss was lower (30 vs 180 mL, P < 0.001). There were no differences in the rates of early (9.4% vs 13.2%) or late postoperative complications (12.5% vs 10.5%). No anastomotic leakage was observed in either group. In the LAPG‐JI group, the time to first eating was shorter, and the white blood cell counts on postoperative days 1 and 7 and body temperature on postoperative day 3 were lower. The number of additional doses of postoperative analgesia was lower in the LAPG‐JI group. Reflux esophagitis graded C according to the Los Angeles classification was observed in only one patient (3.1%) in the LAPG‐JI group. Conclusion: Although the operation time was longer in the LAPG‐JI group, the procedure seemed to be feasible and safe. Also, it offered the advantages of laparoscopic surgery, including less invasiveness and quicker recovery. [ABSTRACT FROM AUTHOR]

Background: Various methods of reconstruction after laparoscopic distal gastrectomy (LDG) have been developed and reported. In open gastrectomy, gastroduodenostomy or gastroenterostomy is often performed with the hand-sewn technique. Therefore, hand-sewn anastomosis was performed through a small incision in LDG. The aim of this study was to evaluate the feasibility and safety of LDG with hand-sewn anastomosis.Methods: Between June 2009 and December 2015, we assessed 263 consecutive patients who underwent LDG in our institution. In all patients, the reconstruction procedures were performed extracorporeally with the hand-sewn technique. The clinical characteristics, surgical outcomes, and operation cost related to anastomosis were evaluated and compared with the other methods.Results: The average operation time was 157.5 minutes, and average blood loss was 38.8 mL. The types of reconstruction were Billroth I, 95 cases (36.1%); Billroth II, 165 cases (62.7%); and Roux-en-Y, 3 cases (1.1%). The overall incidence of postoperative complications (Clavien-Dindo classification≧Grade II) was 8.0%. Anastomotic leakage was observed in 1 patient (0.4%) and anastomotic bleeding and anastomotic stenosis in 2 patients each (0.8%). There was no postoperative mortality. The cost of the absorbable threads used in anastomosis is less than the cost of a linear or circular stapler, which is often used in intracorporeal anastomosis.Conclusion: This procedure is similar to conventional open surgery, and it is feasible, safe, and cost-effective. In addition, in an institution that plans to introduce LDG, the use of our method during the introductory phase of LDG has many advantages. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to develop a preoperative scoring system to predict the ability to achieve the critical view of safety (CVS) in patients undergoing emergency laparoscopic cholecystectomy (LC) for acute cholecystitis (AC). Methods A retrospective review of patients who underwent LC for AC between 2012 and 2015 was performed. The achievement or failure of creating the CVS was judged by operative records, video recordings, and interviews of the surgeons. Independent preoperative variables associated with failure were determined by multivariate logistic regression analysis and a prediction scoring system created. Results A C-reactive protein (CRP) >5.5 mg/dl, gallstone impaction, and symptom onset to operation >72 h were identified as independently correlated risk factors for the failure to achieve the CVS. A preoperative risk scoring system for the failure to create the CVS (0–5 points) was constructed using these 3 factors: CRP >5.5 mg/dl (2 points), gallstone impaction (1 points), and time from symptom onset to operation >72 h (2 points). When monitoring the frequency of patients who had a failure to create the CVS at each score, the incidence of failure increased as the score increased ( P <0.001). Conclusions Using only three preoperative factors, the proposed scoring system provides an objective evaluation of the likelihood that CVS can be achieved in patients undergoing emergency LC for AC. [ABSTRACT FROM AUTHOR]

Purposes: Repeat hepatectomy remains the only curative treatment for recurrent colorectal liver metastasis (CLM) after primary hepatectomy. However, the repeat resection rate is still low, and there is insufficient data on the outcomes after repeat hepatectomy. The aim of this study was to investigate the feasibility and prognostic benefit of aggressive repeat hepatectomy for recurrent CLM. Methods: Data were reviewed from 282 consecutive patients who underwent primary curative hepatectomy for CLM between January 1994 and March 2015. The short- and long-term outcomes were analyzed. Results: One hundred ninety-three patients (68 %) developed recurrence, and repeat hepatectomy was conducted in 62 patients. Overall, 62 s, 11 third, 4 fourth, and 1 fifth hepatectomies were performed. The postoperative morbidity and mortality rates were low (11.5 and 1.3 %, respectively). The overall survival rates at 3 and 5 years after primary hepatectomy for CLM in the repeat hepatectomy group were 79.5 and 57.4 %, respectively. A multivariate analysis indicated that postoperative complications were independently associated with overall survival after repeat hepatectomy. Conclusions: Repeat hepatectomy for CLM is feasible, with acceptable rates of perioperative morbidity and mortality, and the potential for long-term survival. However, postoperative complications following aggressive repeat hepatectomy for CLM are associated with adverse oncological outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Operative indications and surgical outcomes of an autologous graft usage for hepato-pancreato-biliary malignancy have not been adequately investigated. Sixty consecutive patients who underwent sleeve resection of the portal vein (PVR, n = 45) or hepatic vein (HVR, n = 15) and right external iliac vein (REIV) graft reconstruction were reviewed. Results: Median graft length and reconstruction time were 3 cm (range, 2-7 cm) and 25 min (range, 16-40 min), respectively. Overall morbidity and surgical mortality were acceptable at 48 % and 1.6 %. Postoperative graft obstructions were seen in one patient with PVR and two patients with HVR; however, these patients did not suffer from the life-threatening complications. Conclusion: REIV graft reconstruction shows acceptable morbidity and mortality. Our strategy may extend the operative indications for advanced disease and impaired liver function. [ABSTRACT FROM AUTHOR]

Intraabdominal bleeding, the most life-threatening complication following pancreaticoduodenectomy (PD), most often is associated with failure of a pancreaticojejunostomy anastomosis or with intraabdominal infection. We investigated whether placement of an omental flap around the splanchnic vessels in PD could reduce the occurrence of intraabdominal bleeding and other postoperative complications. One hundred consecutive patients who underwent PD at the authors' institution between January, 2000 and October 2004 were enrolled in this prospective study. After dissection of the hepatoduodenal ligament, the major splanchnic arteries and the portal vein were covered by the omental flap. Preoperative condition, incidence of pancreatic fistula, intra-abdominal bleeding, other complications, treatment mortality, and hospital stay were analyzed for interrelationships. The frequency of pancreatic fistula (20%) differed little from those in previous reports. However, intraabdominal bleeding was observed in only 1 (1.0%) patient, who was considered to have too thin a flap. No intraabdominal abscess was encountered. No mortality or complications occurred in relation to the omental flap. Thus, wrapping an omental flap around dissected splanchnic vessels in PD reduced postoperative intraabdominal bleeding and infection, but failed to prevent pancreatic fistulas. [ABSTRACT FROM AUTHOR]

Background: Cholangiocarcinoma in patients with choledochoenterostomy has been a rare condition with few cases reported in the literature written in English, and there have been few pathological descriptions of this disease. However, it has recently been documented as a late complication of choledochoenteric anastomosis, and has become a serious issue today since choledochoenterostomy and sphincteroplasty for benign biliary lesions were frequently resorted to in the 1970s and 1980s. The authors here present a case of a 67-year-old woman who developed a cholangiocarcinoma 21 years after choledochoduodenostomy. Methods: The patient underwent a curative resection of the tumor with a hepatopancreatoduodenectomy after a detailed preoperative assessment, including cholangiography and cholangioscopy. Results: Although this tumor has been reported to have a poor prognosis, a precise preoperative evaluation and aggressive surgery may contribute to better survival. Pathologically, the tumor originated in the bile duct mucosa of the choledochoduodenostomy, and was accompanied by intestinal and pyloric gland-like metaplasia. Conclusion: These epithelial changes presumably induced by chronic inflammation due to the reflux of intestinal contents and bile stasis may be responsible for the carcinogenesis. [ABSTRACT FROM AUTHOR]