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Purpose: Laparoscopic appendectomy (LA) for acute appendicitis has several advantages over open appendectomy (OA). In cases of complicated appendicitis, LA is converted to OA at a constant rate, though converting appendectomy (CA) has several disadvantages. We retrospectively determined preoperative risk factors for failure of LA and subsequent conversion to OA. Methods: Consecutive cases of preoperative computed tomography (CT) and attempted LA were retrieved from our hospital database and grouped by procedure (LA versus CA). Patients with negative appendectomies (n = 28), opened appendectomy (n = 210), delayed interval appendectomy (n = 3), or who were <14 years of age were excluded. Results: Average patient age, preoperative C-reactive protein (CRP) level, and diffuse peritonitis were significantly different between the groups. CT inflammation and occurrence of complicated appendicitis were significantly higher in CA than LA. Conversion to OA was mostly because of dense adhesions, diffuse peritonitis, and difficulties in excision of the appendix due to perforation or severe inflammation from surgical point of view. Postoperative complications were significantly lower in LA than CA, although the rate of intraoperative abscess was not different. Conclusion: Most patients with acute appendicitis can be successfully treated with LA. We identified the following significant risk factors of CA: CT inflammation grade 4 or 5; complicated appendicitis; higher preoperative CRP level; and diffuse peritonitis. [ABSTRACT FROM AUTHOR]

Purpose: Stroke volume variation (SVV), which is measured by analyzing arterial blood pressure waveform characteristics, is a simple and sensitive indicator of fluid responsiveness. The current retrospective study was to investigate SVV and central venous pressure (CVP) during hepatic resection under clamping of both the infrahepatic inferior vena cava (IVC) and the portal triad., Methods: All hepatic resections performed from December 2009 to February 2010 at the Department of Surgery at Iizuka Hospital in Japan were included in this study. Invasive hemodynamic monitoring including CVP and SVV were performed in 14 patients., Results: CVP was significantly lower in patients with blood loss < or = 486 g than in those with blood loss > 486 g. SVV was significantly higher in patients with blood loss < or = 486 g than those with blood loss > 486 g during both IVC clamping and IVC + portal triad clamping. Estimated blood loss was significantly less in the group with SVV values > 18% compared to the group with values < or = 18%. There was a significant correlation between SVV and CVP (R2 = 0.714; P < .01)., Conclusion: SVV is a useful indicator of intraoperative blood loss without the monitoring of CVP during hepatic resection under clamping of both the infrahepatic IVC and the portal triad.

Aim: To determine whether absorbable sutures or non-absorbable sutures are better in preventing surgical site infection (SSI), in this paper we discuss the results of a randomized clinical trial which examined the type of sutures used during hepatectomy., Methods: All hepatic resections performed from January 2007 to November 2008 at the Department of Surgery at Iizuka Hospital in Japan were included in this study. There were 125 patients randomly assigned to an absorbable sutures (Vicryl) group or non-absorbable sutures (Silk) group., Results: SSI was observed in 13.6% (17/125) patients participating in this study, 11.3% in the Vicryl group and 15.8% in the Silk group. Incisional SSI including superficial and deep SSI, was observed in 8% of the Vicryl group and 9.5% of the Silk group. Organ/space SSI was observed in 3.2% of the Vicryl group and 6.0% of the Silk group. There were no significant differences, but among the patients with SSI, the period for recovery was significantly shorter for the Vicryl group compared to the Silk group., Conclusion: The incidence of SSI in patients receiving absorbable sutures and silk sutures is not significantly different in this randomized controlled study; however, the period for recovery in patients with SSI was significantly shorter for absorbable sutures.

Background/aims: The recurrence rate after hepatectomy of hepatocellular carcinoma (HCC) remains high. Although the cause of recurrence seems to be the multicentric occurrence and metastasis of cancer cells in the patients after curative resection of HCC, the mechanism of HCC recurrence in each case is still uncertain. The recurrence pattern may illuminate these mechanisms., Methodology: A data analysis of 152 patients who underwent HCC resection, and had observed for more than 5 years was conducted. These patients were divided into three groups; group I (n=32), the patients without HCC recurrence, group II (n=86), the patients with fewer than four recurrent nodules of HCC, group III (n=34), the patients with four or more recurrent nodules of HCC. We compared the clinicopathological data of groups I and II, and of groups I and III. The linkage of risk factors linked to recurrence patterns was clarified., Results: The risk factors linked to group II by comparison with group I were high serum levels of alanine aminotransferase, low serum levels of albumin, high values in the indocyanine green retention test at fifteen minutes, hepatitis C antibody positivity. low platelet counts, and high histological hepatitis activity. The risk factors linked to group III were large tumor size, histological presence of portal vein invasion by cancer cells, intrahepatic metastasis, and poor differentiation of cancer cells., Conclusions: The risk factors linked to recurrence with no more than three HCC nodules recurrence were related to host-related factors such as hepatic function, and hepatitis activity, but not tumor related. The risk factors linked to multiple recurrence were tumor related. The analysis of recurrence patterns revealed that completely different mechanisms exist in the patients with recurrence involving no more than four nodules, which may be related to multicentric occurrence, and patients with multiple recurrence, which may be related to the metastasis of cancer cells.

Aim: To evaluate the role of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) in the preoperative diagnosis of gastrointestinal stromal tumor (GIST)., Methods: From September 2002 to June 2006, Fifty-three consecutive EUS-FNAs of GI tract subepithelial hypoechoic tumors with continuity to proper muscle layer suspected as GIST by standard EUS were evaluated prospectively. The reference standards for the final diagnosis were surgery (n = 31), or clinical follow-up (n=22). Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens were compared., Results: In 2 cases puncture was not performed because of anatomical problems. The collection rate of adequate specimens from the GI tract subepithelial hypoechoic tumor with continuity to proper muscle layer was 82% (42/51). The diagnostic rate for the tumor less than 2 cm, 2 to 4 cm, and 4 cm or more were 71% (15/21), 86% (18/21), and 100% (9/9), respectively. In 29 surgically resected cases, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EUS-FNA using immunohistochemical analysis of GIST were 100% (24/24), 80% (4/5), 96% (24/25), 100% (4/4), and 97% (28/29), respectively. No major complications were encountered., Conclusion: EUS-FNA with immunohistochemical analysis is a safe and accurate method in the pretherapeutic diagnosis of GIST. It should be taken into consideration in decision making, especially in early diagnosis following minimal invasive surgery for GIST.