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Sciatic hernia is a rare type of pelvic floor hernia. The hernia contents can include the ureter, small and large bowel, or ovary, among others. Only a few cases of laparoscopic treatment for a sciatic hernia with small bowel incarceration have been reported.We report our experience using a laparoscopic approach for the treatment of a sciatic hernia in an 83-year-old woman and present a review of previous reports to characterize sciatic hernias more clearly. The patient was referred to our hospital complaining of constipation and abdominal bloating. A computed tomography (CT) examination showed a right sciatic hernia containing the small bowel. Laparoscopic repair of the sciatic hernia was performed using a self-fixating mesh. The patient was discharged after an uneventful postoperative course. The patient has not experienced abdominal bloating or constipation since the surgery. This case report describes the successful repair of a sciatic hernia using a laparoscopic trans-preperitoneal approach and the ProGrip™ Self-Fixating Mesh.

Bariatric surgery is performed worldwide to address morbid obesity. The benefits of this surgery are continued weight loss and decreased obesity-related complications. The relationship between bariatric metabolic surgery and reemployment has already been evaluated in Western countries, but there are few papers reporting these relationships in Japan since the number of bariatric metabolic surgery is small. Few Japanese studies have evaluated the effects of bariatric surgery on obesity stigma, which affects obese people's chances of employment and advancement, and may result in dismissal. We describe a 39-year-old man who underwent bariatric surgery after being dismissed from his job because of morbid obesity. Traditional weight loss methods failed to maintain weight loss. Preoperatively, the patient was treated for type 2 diabetes, hypertension, and abnormal lipid metabolism. He underwent sleeve gastrectomy and lost 50.4 kg (percent excess weight loss: 68.1%) in the first postoperative year. All medications were stopped after improved blood laboratory test results, and he was re-employed 8 months after surgery. Increased social activity associated with employment is a factor in suppressing rebound weight gain after bariatric surgery, and the weight loss associated with bariatric surgery helps decrease anti-obesity social stigma.

Purpose: Management strategies for acutely incarcerated/strangulated groin and obturator hernias may differ from institution to institution, although, conventionally, the open approach has...

Background A Bochdalek hernia (BH) is a congenital defect of the diaphragm that generally presents in the newborn as life-threatening cardiorespiratory distress. In contrast, the diagnosis of a BH in adults is rare. Surgical repair for adult BH is recommended, but the optimal surgical method remains unclear. Case presentation A 75-year-old woman presented with progressive dyspnea and back pain, and a diagnosis of BH was made based on chest X-ray and computed tomography. Laparoscopic evaluation revealed a defect in the left posterior attachment of the diaphragm, and a left-sided BH without hernia sac was diagnosed. Parts of the stomach, small intestine, colon, pancreas, and spleen had prolapsed into the left thoracic cavity, without ischemic change, and these herniated organs were reduced to the abdominal cavity. A direct closure of the hernia orifice was possible by the laparoscopic suture technique using a mesh reinforcement. The patient made an uneventful recovery, and no recurrence was found in the 2-year follow-up. Conclusion A recently published study reviewing detailed cases of repair of adult BH from 1999 to 2019 identified 96 cases, including the present case. The number of reports on laparoscopic and/or thoracoscopic surgery for BH in adults has recently increased, and the approach for repairing BH should be selected carefully on a case-by-case basis.

Prosthetic mesh infection after open or laparoscopic hernia repair is a rare complication. Superficial wound infection can be resolved by treatment with a combination of antibiotics and wound drainage, whereas deep-seated mesh infection, which can lead to chronic groin sepsis, usually requires removal of the mesh. A 56-year-old Japanese man was admitted to our hospital for the treatment of deep-seated mesh infection. The patient had undergone inguinal hernia repair at another hospital 18 months earlier. The operation was prosthetic mesh repair via an anterior approach. The patient developed deep-seated mesh infection despite conservative treatment for infection, such as abscess drainage and antibiotic therapy. Since the patient eventually developed chronic groin sepsis, he was referred to our hospital, and infected mesh was removed successfully by laparoscopic surgery via a totally extraperitoneal approach. The laparoscopic approach provides several advantages, including less postoperative pain, a shorter hospital stay, and earlier rehabilitation. Furthermore, seeding of the abdominal cavity with pus never occurs with this approach unlike the laparoscopic transabdominal preperitoneal approach.

Complete surgical excision is the standard treatment for hydrocele of the canal of Nuck. We developed a novel open posterior wall technique for laparoscopic transabdominal pre-peritoneal (TAPP) excision. A 38-year-old woman with a 5-month history of a painless reducible lump in the right groin had recently noticed a slight increase in the size of lump. Computed tomography showed a simple cystic lesion measuring 30 × 27.5 mm. We performed laparoscopic excision of the hydrocele by using the TAPP approach and the open posterior wall technique developed by us. Complete excision of the hydrocele was satisfactorily performed because the region from the external inguinal ring to the periphery could be clearly observed. After an uneventful postoperative course, the patient was discharged. Laparoscopic TAPP excision with open posterior wall technique was useful for complete excision of hydrocele of the canal of Nuck.

INTRODUCTION The laparoscopic transabdominal preperitoneal approach requires peritoneal closure and technically skilled knotting. We have started to use a barbed running suturing device (V-Loc 180) without knotting for transabdominal preperitoneal repair of hernias. This study aimed to determine whether using V-Loc 180 was safe and shortened the time for laparoscopic peritoneal closure. METHODS Between December 2010 and February 2017, 3-0 V-Loc 180 and a multifilament absorbable running suture (3-0 Vicryl) were used for three-port transabdominal preperitoneal repair of inguinal hernia in 363 cases. Data including peritoneal closure time and the complications were retrospectively recorded. RESULTS Factors identified as significantly prolonging the peritoneal closure time were the hernia side (P = 0.0269), the type of hernia (P = 0.001), the suture device used (P

Background Single-incision laparoscopic surgery has gained increasing attention due to its potential to improve the benefits of laparoscopic surgery. However, the technique remains technically challenging for most surgeons. We developed a new technique utilizing a needle grasper held in the surgeon's left hand as an alternative to conventional single-incision laparoscopic cholecystectomy (SILC). Patients and methods From August 2011 through May 2013, 29 patients at Nippon Medical School Musashi Kosugi Hospital, with gallbladder stones or polyps underwent single-incision laparoscopic cholecystectomy (SILC) with an additional needle grasper that was held in the surgeon's left hand (SILCAN) and introduced in the right subcostal region without a trocar. We analyzed intraoperative and postoperative outcomes of 29 patients for whom SILCAN was performed and retrospectively compared these outcomes to those of 32 patients who underwent conventional 4-port laparoscopic cholecystectomy (CLC) from January 2011 through May 2013. Results No differences in patient characteristics or intraoperative/postoperative outcomes were observed between the groups. None of the patients in either group required conversion to an open procedure or additional ports. In the SILCAN group, no patients had complications within the first 4 weeks after surgery, with the exception of 1 patient with severe chronic cholecystitis in whom bile duct stenosis developed due to inadvertent clipping of the common hepatic duct. The frequency of postoperative analgesic use was similar in both groups, although none of the patients in the SILCAN group received analgesics for pain from the small, inconspicuous wound in the right subcostal region. Conclusions SILCAN is a safe and feasible alternative to SILC which does not compromise the qualities of CLC. It is less technically challenging, and postoperative pain and cosmesis are comparable to those of conventional SILC.

Since 2005, we have been conducting prospective surgical site infection (SSI) surveillance and infection control according to the U.S. Centers for Disease Control and Prevention guidelines for patients who undergo gastrointestinal surgery at our institution. Surgical site infection occurs with greater frequency in emergency than in elective surgery because of factors such as ill-conceived preoperative preparation and "dirty" operations. A large number of studies have been reported on risk factors for SSI in elective colorectal surgery; however, there are few papers on such factors in emergency colorectal surgery. The aim of this study was to identify risk factors for incisional SSI in emergency colorectal surgery.Using our SSI surveillance database, we analyzed retrospectively 78 patients who underwent emergency colorectal surgery between 2005 and 2010. Univariable and multivariable analyses were used to identify risk factors for incisional SSI. Moreover, we subclassified dirty-infected operations (class IV) by the extent of contamination according to our own definition to study the incidence of incisional SSI at each degree.The incidence of incisional SSI was 32.1% (25/78 patients). By univariable analysis, seven parameters correlated with a higher risk of incisional SSI: Surgical incision class III-IV, obesity (body mass index ≥25 kg/m(2)), American Society of Anesthesiologists score 3 or 4 points, chronic kidney disease (serum creatinine concentration1.2 mg/dL), blood loss ≥200 mL, blood transfusion, and ventilator support. Multivariable analyses showed that surgical incision class III-IV (odds ratio [OR] 5.9; 95% confidence interval [CI] 1.7, 25.2) and obesity (OR 11.9; 95% CI 2.1, 87.8) were independent risk factors for incisional SSI. The incidence of incisional SSI in colon perforation with generalized contamination was statistically higher than that in prepared colon perforation and colon perforation with localized contamination (82.4% vs. 25.0%; p0.001).The risk factors for incisional SSI in emergency colorectal surgery were incision contamination and obesity. Moreover, the incidence of incisional SSI among the incision class IV operations increased significantly with increasing extents of contamination. As a tactic for management of dirty abdominal wounds, we suggest that primary skin closure is suitable in cases of perforation of a prepared colon or colon perforation with localized contamination. On the other hand, in cases of colon perforation with generalized contamination, delayed primary skin closure or leaving an incision open to heal by secondary intention should be considered.

True splenic cysts are uncommon and are associated with elevated serum and intracystic tumor marker CA 19‑9 levels. A 33‑year‑old woman presented to our hospital with a chief complaint of epigastralgia. Computed tomography of the abdomen showed a 10‑cm cystic lesion in the spleen. The serum carbohydrate antigen (CA 19‑9 level was 3347 U mL (normal

The efficacy of total colonoscopy following a positive result of the fecal occult blood test (FOBT) for the early detection of colorectal cancer and polyps was evaluated. A total of 1,491 patients with positive FOBT results underwent total colonoscopy at the Institute of Gastroenterology, Nippon Medical School, Musashi Kosugi Hospital, from April 2002 through July 2009. Abnormalities were found in 1,312 of the 1,491 patients (88.0%). Ninety-six of the 1,491 patients (6.4%) were found to have early cancer, but 59 patients (4.0%) were found to have advanced cancer. The early cancers were treated with endoscopic mucosal resection or endoscopic submucosal dissection in 81 patients, with laparoscopy-assisted colectomy in 10 patients, and with open surgery in 5 patients. Fifty-one of the 59 patients with advanced colorectal cancer underwent conventional open surgery, and 8 patients underwent laparoscopic surgery. The cancers detected were more likely to be early cancers than advanced cancers. In addition to malignancies, other abnormalities found included inner or external hemorrhoids, diverticula of the colon, ulcerative colitis, ischemic colitis, infectious colitis, and colorectal polyps. Our results show that a high percentage of lesions detected with total colonoscopy following a positive FOBT result are early colorectal cancers and polyps.

We report an intra‑abdominal endocrine tumor possibly arising from an ectopic pancreas. A 45‑year‑old woman visited the Nippon Medical School Musashi‑Kosugi Hospital because of right‑sided hypochondralgia and upper abdominal discomfort of 1 years duration. An intra‑ abdominal tumor was diagnosed on the basis of the results of an ultrasound examination computed tomography and magnetic resonance. Surgery was subsequently performed using laparoscopic techniques and a tumor without firm adhesions was found nea rt he wall of the duodenal bulbus. The tumor was easily removed; the resected specimen (55 × 45 × 25 mm 50 g was composed of bloody fluid within a cystic tumor. Histological and immunohistochemical examinations of the tumor showed a type 3 ectopic pancreas according to the classification proposed by Heinrich. The patients recovery was uneventful. (J Nippon Med Sch 2007; 74: 168―172

We present a case of abdominal incisional hernia that was successfully treated with laparascopic surgery. An 81-year-old woman presented with symptoms of abdominal pain and discomfort. In the past history, she had distal gastrectomy for gastric carcinoma in 1995 and total gastrectomy for the remnant of gastric carcinoma combined with a cholecystectomy in 2003. Subsequently, she developed a swelling in the abdominal region. She had consulted a local hospital and surgery was suggested, but she rejected. Finally, she visited Keihin General Hospital with the hope for a treatment by endoscopic surgery. On medical examination, longitudinal and horizontal surgical scars were observed on the upper abdominal region and an incisional hernia measuring 14×15 cm in diameters was found. Laparoscopic repair operation was performed under general anesthesia using a 19.6×24.6 cm Bard Composix Kugel Patch (Bard, Inc.), inserting through three ports of about 11 mm in diameter in the lower abdomen. At present, the patient is under follow up with no pain or recurrence. In conclusion, we report a better prognosis of a case with huge incisional hernia under laparoscopic repair operation.

Somatic mutations of mitochondrial DNA (mtDNA) have been reported in different types of cancers and are suggested to play roles in metastasis, cancer development and response to anticancer agents. To predict potential roles of mtDNA alterations in colorectal cancer, we determined the entire mtDNA sequence of eleven human-derived colorectal cancer cell lines and compared with the revised Cambridge Reference Sequence to identify nucleotide alterations. Four homoplasmic and six heteroplasmic alterations were found to be novel. Among them, homoplasmic G6709A (MT-CO1) and G14804A (MT-CYB) alterations cause amino acid changes in the highly conserved residues. Heteroplasmic G1576A (MT-RNR1) and G2975A (MT-RNR2) alterations are expected to make the stem structure of mitochondrial ribosomal RNAs unstable. These nucleotide alterations are candidates that could play important roles in cancer.

We report on two patients with gastric tumors (early cancer and adema) and diabetes mellitus who were treated with argon plasma coagulation (APC) therapy. Case 1. A 78-year-old woman visited the Nippon Medical School Musashi Kosugi Hospital because of epigastric pain. An early gastric cancer (IIc) in the anterior wall of the gastric antrum was diagnosed on the basis of the results of a gastric endoscopy examination. The patient had had diabetes mellitus for 18 years and had injected insulin (NovoRapid 30 Mix, 72 units/day) by herself everyday for 10 years. Case 2. A 61-year-old man was referred to our hospital because of a gastric tumor. A gastric adenoma in the anterior of the gastric antrum was diagnosed on the basis of the results of a gastric endoscopy examination. The patient had had diabetes mellitus for 12 years and had been taking oral medication for 2 years. Endoscopic APC was performed in both patients to remove the gastric tumors. These patients have been well for 28 months and 30 months, respectively, after undergoing APC treatment. APC therapy appears to be a safe and useful treatment for patients with diabetes and gastric mucosal lesions.