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Introduction Bladder hernia is relatively rare in cases of inguinal hernia. In some instances, bladder hernia may be treated as inguinal hernia if bladder prolapse is not recognized. Because of the rarity of inguinal bladder hernias, there are no related detailed reports from studies performed at a single institution. In our hospital, patients with suspected inguinal hernia undergo CT in the prone position, enabling the diagnosis of bladder hernia preoperatively. This study aimed to clarify the clinical characteristics of inguinal bladder hernias and consider noteworthy points in their laparoscopic treatment. Methods This retrospective analysis included data from 32 consecutive patients with bladder hernia in 1126 patients with inguinal hernia. In each patient, the lengths of the hernial orifice and prolapsed bladder were measured on the CT images and intraoperatively. Totally extraperitoneal (TEP) repair was performed in all patients, who were then followed for 1 year postoperatively. Results Inguinal bladder hernia was detected on CT in 32 of 1126 patients (2.8%). Among them, only five (15.6%) had urological symptoms such as pollakiuria or the sensation of residual urine. The 32 patients were classified into three groups according to hernia subtype: intraperitoneal (n = 12, 37.5%), para-peritoneal (n = 15, 46.9%), and extraperitoneal (n = 5, 15.6%). The prolapsed bladder of the extraperitoneal type was significantly shorter than that of the other subtypes. The prolapsed bladders were directly identified in the extraperitoneal space and repaired safely with TEP. One recurrence (3.1%) occurred 2 months postoperatively. Conclusion Preoperative CT and TEP are useful for the definitive diagnosis and treatment of inguinal bladder hernia.

Highlights • Colorectal liver metastasis with bile duct tumor thrombus is rare in clinical. • Hepatectomy is a common therapeutic procedure for colorectal liver metastasis. • Colorectal liver metastasis with bile duct tumor thrombus might be a bad prognosis., Introduction Hepatectomy including conversion therapy is recommended for colorectal liver metastasis (CRLM). CRLM complicated with bile duct tumor thrombus (BDTT) is rare, even though there are more opportunities to perform hepatectomy for CRLM in recent years. Presentation of case A 76-year-old Japanese man with a history of right hemicolectomy for ascending colon carcinoma presented with a portal hepatic tumor and the dilatation of the right bile duct found by computed tomography (CT) eighteen months after the colectomy. Magnetic resonance imaging confirmed a tumor in liver segment VIII, and magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography showed a mass in the hilar bile duct. Bile cytology did not prove carcinoma. The patient underwent right and caudate lobectomy with extrahepatic biliary tract resection plus hepaticojejunostomy. Histopathological examination revealed that both the tumor in liver segment VIII and the BDTT comprised moderately differentiated tubular adenocarcinoma, originating from the previous colon carcinoma. Six months after hepatectomy, CT revealed tumor recurrence in the residual intrahepatic bile duct. Radiation therapy was administered for the recurrent lesion, which reduced the tumor size temporarily. Despite the multimodal therapy, the disease progressed and the patient died one year after the hepatectomy. Discussion Some studies reported no correlation between CRLM bile duct invasion and clinical outcomes, but there is no available evidence focused on BDTT which is of an advanced stage in the bile duct invasion. Conclusion Hepatectomy is a common therapeutic procedure for CRLM, but CRLM with BDTT might be associated with a bad prognosis.

症例は44歳，男性．腹痛にて発症し，急性腹症として救急搬送された．腹部造影CTにて上腸間膜静脈血栓症と小腸の著明な浮腫状変化を認め，限局性腹膜炎の診断に緊急開腹術を行い，約30cmの壊死部分を含む小腸部分切除術を行った．術翌日から，ヘパリンによる抗凝固療法を施行したところ，DIC徴候等認めないにも関わらず術後11日より血小板数4.4万/μlと突然の血小板減少を認め，ヘパリン起因性血小板減少症と診断した．直ちにヘパリン投与を中止し，アルガトロバン投与を開始した．同時に抗ヘパリン-PF4複合体抗体も検出された．血小板数回復後，ワルファリンによる抗凝固療法へと移行し術後30日に軽快退院となった．

The purpose of this study is to elevate the temperature and induce necrosis tumor cells that include ferrite powder to 50–60°C by applying an alternating magnetic field. The achieved temperature is higher when compared to the conventional hyperthermia methods. We performed an experiment in which a high-water content agar phantom that was used as a quasi-tissue had 50 nm–10 μ m magnesium ferrite (MgFe2O4) dispersed in it and was then heated to a level of 190–700 kHz. The results show that the temperature of the phantom is higher for higher frequencies, larger particle sizes, and higher quantities of dispersed ferrite powder. Also, taking into account heat generation due to the magnetic powder, heat generation due to tissue metabolism, and the cooling effect of the blood flow, we solved the thermal equation related to local thermal therapy. Small differences in the distribution of ferrite powder affect the temperature increase of the tissue and the area where cell necrosis is induced.

虫垂癌はまれな疾患である. 我々は1991年から2005年の間に5例の虫垂癌を経験した. 5例の平均年齢は68歳で男性が1例, 女性が4例であった. 術前に虫垂癌と診断できた症例はなく, 5例中4例は術前診断が急性虫垂炎で1例は盲腸癌であった. 病理組織学的検査では, 高分化型腺癌が3例, 粘液癌が2例であった. 深達度はssが2例, seが3例であり全例ss以深であった. 症例3は術後19か月目に, 症例4は37か月目に死亡した. 虫垂癌は術前診断が困難であり, 急性虫垂炎との診断で治療されることが多かった. 診断時にはすでに進行しており, 予後不良であることが再認識された. 高齢者で, 急性虫垂炎を疑わせる症例であっても, 特に右下腹部に腫瘤を伴うような場合には虫垂癌も念頭におく必要があると考えられた.

We report the long-term survival of a patient with metastatic hepatocellular carcinoma (HCC), successfully treated with transcatheter arterial chemoembolization (TACE)/hepatic arterial infusion chemotherapy (HAIC) combined with long-term administration of sorafenib. A 74-year-old man underwent hepatectomy for a huge hepatocellular carcinoma, measuring 19 × 13 cm. Multiple intrahepatic HCCs that recurred 5 months post-surgery were treated with TACE. After 3 cycles of TACE, however, sorafenib was administered to treat progressive disease. Six months after sorafenib treatment, TACE combined with sorafenib was administered for treatment of refractory intrahepatic lesions. Following further disease progression, TACE was replaced by up to 11 rounds of HAIC. We report successfully treatment of refractory metastatic HCC with sorafenib for more than 30 months along with a review of the literature.

The purpose of this study is to investigate the thermal characteristics of Mg1−XCaXFe2O4 ferrite powder by applying AC magnetic field and to predict the effect of thermal coagulation in vivo. We found that heating characteristics of the ferrite powder became greater as the frequency through the 400 kHz to 700 kHz range. The highest heat generation was attained using 7–15 nm ferrite powder. We also carried out a heat transfer simulation in which we were able to demonstrate that this material has sufficient heat generating characteristics to thermally coagulate a tumor cell and that it is possible to predict the range of the coagulation from the present simulation.

Nano-sized FeFe 2 O 4 ferrite powder for local thermal coagulation therapy was synthesized by a reverse coprecipitation method. The crystal diameter for the samples from the reverse coprecipitation method was smaller than that from a normal coprecipitation method. The crystal diameter increased with an increase in the synthesized temperature for both methods. The maximum increasing temperature under the AC magnetic field was at around a 12 nm crystal diameter. The FeFe 2 O 4 powder was oxidized to Fe 2 O 3 by calcination at 600 °C in ambient air. The heating ability almost depended on the hysteresis loss value. Although the increased temperature under the AC magnetic field for the fresh FeFe 2 O 4 sample was very close to that for the commercialized MgFe 2 O 4 powder, it was gradually decreased for FeFe 2 O 4 with time in ambient air.

In this paper, we demonstrate investigations of metal thick layer/semiconductor interfaces (Au/Si and Ga/GaAs) by x-ray reflectivity under transmission geometry (TXR), which could not be performed by conventional x-ray reflectivity due to the macroscopic thickness and surface roughness of the overlayers. We obtain precise electron density by using the two maxima in diffuse scattering of TXR caused by the Fresnel transmission function (the so-called Yoneda wings). From in situ TXR measurements of Ga/GaAs with elevating temperature, the onset of structural variation at the interface is found to be 520 K. Such an interfacial variation at an extraordinarily low temperature agrees with an ex situ SEM study of an etched GaAs surface. Copyright © 2005 John Wiley & Sons, Ltd.

We report the case of a 72-year-old man with esophageal schwannoma who underwent the Ivor Lewis procedure. He suffered from dysphagia for 6 months. Esophagoscopy revealed a submucosal tumor bulging on the posterior wall 30 cm distant from the incisors. Endoscopic ultrasonography (EUS) revealed tumor located within the muscularis propria, the fourth layer of the esophageal wall. Upper gastrointestinal series showed an elevated lesion, 6 cm in diameter, on the posterior wall of the upper thoracic esophagus. These findings were suggestive of leiomyosarcoma. The area of esophagus including the tumor was resected using the Ivor Lewis procedure. The tumor was 5.5 × 4.5 × 4.5 cm in size, with a smooth surface that was elastic and firm. Histological examination revealed spindle-shaped cells with oval nuclei, and Antoni A and B types coexisted in the tumor tissue. Immunohistochemical studies yielded positive results for S-100 protein and negative results for CD34, desmin, and α-smooth muscle actin. A diagnosis of esophageal schwannoma was established. He was discharged from the hospital and has been doing well with no recurrence for 20 months after surgery.

両側肺転移を伴った肝芽腫の経過良好例を報告する.症例は1歳4カ月の男児.汗疹を主訴に近医を受診し,腹部腫瘤を指摘され,当院に入院した. AFPは1.38×106ng/mlと高値で,胸腹部CTで両側多発性肺腫瘤と肝左葉全体と右葉に及ぶ巨大肝腫瘍を認め,両側肺転移を伴うStage IV肝芽腫と診断した. cisplatine (CDDP)とpinorubin (THP-ADR)を中心とした化学療法4クールと肝動注塞栓療法を施行後,治療開始3カ月後に拡大肝左葉切除, 4カ月後に両側肺部分切除および2年後に左肺部分切除を施行した.術後1年2カ月後, AFPは正常域で,再発の徴候を認めていない. 初診時より両側肺転移を伴った進行肝芽腫に対し,化学療法と積極的な外科療法によって,原発巣の完全切除と転移巣のコントロールができ,良好な結果を得ることができた.

We report a rare case of carcinoma of the cystic duct (CCD) associated with pancreaticobiliary maljunction (PBM). A 63-year-old man had presented with relapsing cholecystitis of 4 months, duration. Computed tomography showed a distended gallbladder: however, small mass in the cystic duct was overlooked. Endoscopic retrograde cholangiopancreatography demonstrated a long common channel (20-mm-long) and fusiform dilatation of the common bile duct, findings, which were consistent with PBM. At laparotomy, we found a papillary tumor, 20 mm in diameter, that obstructed the cystic duct. The patient underwent resection of the gallbladder and the common bile duct, lymph node dissection in the hepatoduodenal ligament, and hepaticojejunostomy. Histologic study revealed a papillary adenocarcinoma confined within the subserosal space. There was no lymphatic or perineural invasion of cancer cells. The surrounding cystic ductal mucosa showed dysplasia and hyperplasia, and the gallbladder and common bile duct showed severe inflammation. The patient has been doing well for 16 months after surgery, without tumor recurrence. This case suggests a relationship between CCD and chronic biliary inflammation caused by PBM, as in cases of gallbladder carcinoma.

腸間膜癒着によるイレウスを伴った回腸アニサキス症を経験した.症例は,42歳男性.カツオの刺身摂取後,臍下部の腹痛が続くため,当科を受診した.腹部単純写真で小腸の拡張と鏡面像が認められた.イレウスを伴う急性腹症と診断し緊急手術を行った.回腸末端より約90cmの小腸が発赤し,約10cmにわたり腸間膜の浮腫を認め,内腔に弾性軟の隆起性病変を触知した.また,回腸末端より40cmの腸間膜に炎症性癒着を認め,癒着性腸閉塞をおこしていた.癒着剥離と小腸部分切除術を行った.切除標本では,粘膜壁が腫大し,陥凹病変の中心に粘膜に刺入する線虫を認め,回腸アニサキス症と診断した.アニサキスによるイレウス発生機序を文献から考察した.イレウスは,虫体の存在する部位の腸管浮腫および狭窄さらには腸間膜血流障害などから発生する事が多いと考えられた.

下血を主訴に来院した73歳,男性に対して上部消化管内視鏡検査を行ったところ, 十二指腸球部に有茎性広茎性隆起病変を認めた.内視鏡生検でgroup IVであり,胆嚢結石症を伴う早期十二指腸球部癌と診断した.球部の広茎性腫瘍であったため,内視鏡的切除は困難と判断し,幽門側胃切除および球部切除術,胆嚢摘出術を施行した.病理組織検査で,十二指腸球部の腺腫内癌 (carcinoma in adenoma) と診断された. 十二指腸球部の腺腫内癌症例は本症例を含め19例報告されている. m癌症例がほとんどであり,リンパ節転移を示したものはなかった.腺腫内癌症例は内視鏡生検で必ずしも確定診断できるとは限らないので,内視鏡的切除あるいは外科的切除が必要であると考えられた.

Infectious epidermid cysts of the spleen with high serum levels of CA19-9 and CA125 are rare. We successfully performed a laparoscopic splenectomy for a 20-year-old woman who was diagnosed as having the disease. The patient was admitted to the hospital becuse of high fever and left hypochondralgia. After a workup of ultrasonography, CT and magnetic resonance imaging, she was diagnosed as having infectious splenic cyst. In addition, malignancy was suspected because serum levels of CA19-9 and CA125 were as high as 1.1×106U/ml and 1.8×104U/ml, respectively. Immunological stainings indicated that CA19-9 might escape from epithelium of the cystic wall to the blood. CA19-9 and CA125 decreased to 100U/ml and

An 81-year-old man with early gastric cancer chronic with renal failure was successfully treated by intragastric endoscopic surgery. He had early gastric cancer locating beyond the pyloric ring. After making a temporary gastrostomy under epidural anesthesia, a mucosal resection was performed using a Buess's endoscope. Operation time was 120 minutes. He was discharged from the hospital uneventfully. In conclusion, among minimally invasive surgeries for gastric cancer, this method seems to be advantagenus to lesions locating near the cardia and pylorus and can be recommeded for patients with risk factors such as elderly and same underlying diseases.

パルス式色素希釈法にて心拍出量, 循環血液量 (BV) を測定できるDDG-2001を使用し, 術前後に心係数 (CI), BVを測定し, その精度を検定した. さらに術後管理における意義について検討した. 開心術14例を対象に, DDG-2001により, 人工心肺前, 手術終了直後, 4時間後, 12時間後にCI, BVを測定した. CIは熱希釈法と比較し, BVは人工心肺開始前後に測定したヘモグロビン値と充填量から計算した値と比較した. CI; 相関係数0.77, 回帰直線の傾き0.849, BV; 相関係数0.821, 傾きは0.844であった. 手術終了時BVは低下していたが, 4時間後, 12時間後BVは増加した. しかし, 体液バランスは負であった. パルス式色素希釈法によるCI, BVは他の方法による値と良好な相関があった. 術直後BVは低下しており, その後, 体液バランスは負であったが, BVは増加した.

Twenty-three cases of congenital biliary dilatation in children experienced at the hospital in a recent two decade were didided into two groups by type of the common bile duct, namely, cystic type dilatation (C-type; 12 cases) and fusiform type dilatation (F-type; 11 cases). There were five male and 18 female patients. Averaged age at operation was 2.8, ranging from 2 months to 10 years old. Items investigated included the age of onset of the disease, symptoms at the onset, blood biochemical data (white blood cell count, CRP, and total bilirubin), histopathologic types.The onset age was younger in C-type patients who manifested the disease less than one year of age. Higher total bilirubin level in serum noted in C-type cases than F-type cases. Elevated amylase level in the common bile duct was noted in F-type cases compared to the others.In C-type cases there were more pancreatico-choledochus types, and in C-type cases there were more choledoco-pancreas types in a type of pancreatico-biliary maljunction. Pathological sections of the common bile duct revealed severe chronic inflammation such as wall thickness and fibrosis in C-type cases.It is suggested that the age of onset, the presence of obstructive mechanism at the common bile duct, and type of pancreatico-biliary maljunction might be contributing factors to the type of dilatation.

Bacterial translocation is believed to occur during cardiopulmonary bypass (CPB) because serum endotoxin concentrations rise. Intestinal ischemia during CPB, however, has never been proven directly. The condition of the intestinal mucosa during CPB was studied by measuring serum diamine oxidase (DAO) activity, an index of intestinal ischemia. Serum DAO activity, blood lactate concentration, and the arterial ketone body ratio (AKBR) were measured intraoperatively in four successive patients who underwent aortic arch replacement by the open distal anastomosis method. DAO activity rose after restoration of blood flow to the lower half of the body, and continued to rise throughout CPB. The lactate concentration also rose, mirroring the change in DAO activity, and returned to nearly normal 12 h after the operation. The AKBR decreased during CPB, with a mean minimum vale of 0.16 ± 0.07 immediately after the restoration of blood flow to the lower half of the body. The parallel rise in DAO activity and serum lactate concentration once blood flow to the lower half of the body was restored implies that ischemic injury to the mucosa of the small intestine occurs during CPB. The continued rise in these parameters throughout CPB is consistent with ongoing injury due to splanchnic hypoperfusion, as reflected in the decrease in the AKBR during the same period.

When familial adenomatous polyposis (FAP) is diagnosed in a patient, prophylactic surgery must be performed whether colorectal cancer is present or not. Operations for FAP have been performed through a large median abdominal incision or an additional perineal incision, depending on the coexistence of rectal cancer. Recently, we reported a technique of laparoscopic rectal amputation without abdominal skin incision for patients with rectal cancer to minimize postoperative cardiac and respiratory complications [6]. In this article, we report a case of laparoscopically assisted proctocolectomy with ileostomy through a minimal abdominal and perineal skin incision performed by a hand-assisted procedure. The purpose of combining the perineal and laparoscopic approaches is to minimize the skin incision, while retaining a rate of cure and safety equivalent to those of conventional rectal amputation, by using the advantages of laparoscopic procedures, and to facilitate postoperative recovery and improve the quality of life for relatively young patients with FAP.

Anti-HER2 antibody can induce antitumor responses, and can be used in delivering drugs to HER2-overexpressing cancer. Previously, we produced hyperthermia using magnetite nanoparticles that generate heat in an alternating magnetic field. In the present study, we constructed anti-HER2 immunoliposomes containing magnetite nanoparticles, which act as tumor-targeting vehicles, combining anti-HER2 antibody therapy with hyperthermia. The magnetite nanoparticle-loaded anti-HER2 immunoliposomes exerted HER2-mediated antiproliferative effects on SKBr3 breast cancer cells in vitro. Moreover, 60% of magnetite nanoparticles were incorporated into SKBr3, and the cells were then heated at 42.5 degrees C under an alternating magnetic field, resulting in strong cytotoxic effects. These results suggest that this novel therapeutic tool is applicable to treatment of HER2-overexpressing cancer.

Duodenum-preserving resection of the pancreatic head is a risk factor for pancreatic fistula because of the wide surface of the transected pancreas. We report on a 72-year-old woman undergoing this procedure for cystadenoma in the pancreatic head using the ultrasonic coagulating shears. The soft pancreatic parenchyma was extensively transected around the cyst with the coagulating shears. Suture of the cut stump was not necessary due to absence of bleeding. The distal pancreatic duct was well preserved for pancreatojejunostomy. We oversewed the possible opening of the main pancreatic duct on the remaining pancreas attached to the duodenum after confirming the location by intrabiliary dye injection. The postoperative course was uneventful. The draining fluid amylase level was low and there were no viscous materials from the drains. We compared histologic changes of a porcine pancreas transected with the coagulating shears or electrocautery to evaluate the sealing effect of the transected surface. The cut stump was covered by a continuing layer of thick protein coagulum in cases of coagulating shears, but by a disrupted layer of coagulating necrosis with charring in cases of electrocautery. The coagulating shears are useful for pancreatic transection in duodenum-preserving resection of the pancreatic head to prevent bleeding and pancreatic fistula from the cut surface.

For borderline malignant diseases of the pancreas such as cystic adenoma, partial pancreatectomy or pancreatoduodenectomy including pylorus-preserving pancreaticoduodenectomy have been performed depending on tumor location under large median laparotomy. To investigate the feasibility of a technique with minimal skin incision, while retaining safety equivalent to conventional resection of the pancreatic tail, by making use of the advantages of laparoscopic procedure, we performed a minimally invasive laparoscopic resection of the pancreatic tail with preservation of the spleen. A 69-year-old woman underwent surgery for a diagnostic therapy for a cystic lesion of the pancreatic tail. The procedure was performed as follows: All procedures were performed completely laparoscopically under CO2 insufflation. After dissection of the omentum, laparoscopic ultrasound was performed to identify the location of the tumor and splenic vessels. The splenic hilus was dissected with preservation of the splenocolic ligament to maintain the lower blood supply to the spleen. The left gastroepiploic artery and the short gastric arteries and veins could be preserved. After division of the splenic hilus, the splenic artery and vein were identified from behind the pancreas by being held up and dissected individually by intracorporeal ligation by 3-0 Nylon. Then, pancreatic transection was performed 1 cm proximal to the tumor with the Endo-GIAII. The duration of operation was 4.5 hours. Intraoperative blood loss was under 50 mL. Histological examination revealed mucinous cytadenoma. She could walk the day after surgery and was discharged from the hospital uneventfully. CT prior to discharge from the hospital revealed sufficient blood flow in the spleen. Thus, it may be feasible to select laparoscopic spleen-preserving distal pancreatectomy as a first choice for diagnostic therapy for cystic lesions of the pancreatic tail.

Combined liver-intestine transplantation is an evolving procedure, and auxiliary liver transplantation has several advantages over standard orthotopic liver transplantation. We present a new model of combined intestine-auxiliary liver transplantation in rats. Total small bowel and 60% liver were harvested en bloc. An aortic segment that contained the celiac axis and superior mesenteric artery ensured blood supply to the graft. Venous drainage of the grafted intestine was achieved via the intact portal vein of the graft. The infrahepatic vena cava was cut at different levels during the modification period and at the oblique level of the left renal vein in consecutive series. Revascularization was accomplished by end-to-side anastomosis of the aorta and of the infrahepatic vena cava. The recipient small bowel was resected and the intestine continuity restored by anastomosis. Total operation time averaged 130 min. The overall survival rate of 3 months in the consecutive series was 80% (16/20). Exploratory laparatomy and histologic study in 3 rats on 90 days after transplantation revealed normal and viable grafts. Liver function was normal and both grafted liver and intestine showed normal histologic architectures in 5 rats observed for 12 months after transplantation. The present model is reproducible and allows preclinical research on several aspects of experimental combined intestine-auxiliary liver transplantation.

Objective: To assess the feasibility of cure of early gastric cancer by the endoscopic procedure done through a temporary gastrostomy and to use it to treat patients with various severe complications. Design: Prospective study. Setting: University hospital, Japan. Subjects: Four patients who required gastric mucosal resection for early gastric cancer. Main outcome measures: Ease of the procedure, cure rate, safety under epidural anaesthesia, and outcome. Results: All patients had the procedure under epidural anaesthesia without pain or complaints during operation. Mean operation time was 120 minutes (60-200). Histological examination showed that the surgical margin was free of tumour in 3 of the cases. One patient who had microscopic invasion of lymph nodes subsequently underwent second-look conventional gastrectomy with lymphadenectomy. Postoperative recovery was rapid, and all patients were discharged from the hospital uneventfully. Conclusion: This organ-preserving procedure enables good visualisation ...

Fine Mg1−xCaxFe2O4 ferrite powders for local thermal coagulation therapy were synthesized by a reverse coprecipitation method. The enhancement of temperature under an AC magnetic field was improved...

In order to realize a thermal coagulation technique in which tumors are locally heated up to 60–80°C by inductive heating and necrotized, selection of ferrite powder and frequency are performed. We investigate the heating properties by applying AC magnetic field for various ferrite powders (micrometer size of the particles). The temperature rise for Mg-ferrite (MgFe 2 O 4 ) powder is the largest around 360 kHz in our samples. It has sufficient heating ability for thermal coagulation therapy against cancer.

To develop materials for achieving local hyperthermia, we investigate the heating of various ferrite and metal powders by applying an external AC magnetic field. In comparison with magnetite powder, which has often been used in previous experiments, Mg-ferrite powder is more applicable for achieving local hyperthermia.

A 4-year-old girl with pyruvate kinase deficiency underwent partial splenic embolization initially. However, even after this procedure, she still had to be transfused every 2 months and then every month. At 5 years of age, she was admitted to our hospital to undergo splenectomy. She underwent laparoscopic splenectomy and concomitant cholecystectomy for gallstones. The hemogram recovered to the normal range after surgery, and her postoperative course was uneventful. Considering the absence of morbidity, the short hospitalization, the quick return to normal activity, the good cosmetic result, and the improved clinical and hematologic results, we consider that simultaneous laparoscopic splenectomy and cholecystectomy is safe and effective for the management of hemolytic anemia resulting from pyruvatre kinase deficiency and associated with cholelithiasis.