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Introduction: The aim of this study was to clarify the impact of dementia on surgical outcomes of laparoscopic cholecystectomy for symptomatic cholelithiasis and acute cholecystitis. Methods: We reviewed medical data of 96 patients who underwent laparoscopic cholecystectomy for symptomatic cholecystitis and acute cholecystitis. The patients were divided into the dementia group (n = 18) and non‐dementia group (n = 78). Clinical features of the patients and surgical outcomes were compared between the two groups. Results: Mean age and rates of The American Society of Anesthesiologists Physical Status classification score > 2 in the dementia group were significantly higher than those of the non‐dementia group (P <.001, P =.008, respectively). Incidences of acute cholecystitis and the rate of percutaneous transhepatic gallbladder drainage in the dementia group were significantly higher than those of the non‐dementia group (P =.009, P =.01, respectively). The rates of conversion to laparotomy and non‐surgical complications in the dementia group were higher than those in the non‐dementia group (P =.02, P =.03, respectively). Postoperative hospital stay in the dementia group was significantly longer than that in the non‐dementia group (15.2 ± 9.3 vs 8.2 ± 3.2 days, P =.009). Subgroup analysis of patients with acute cholecystitis showed postoperative hospital stay in the dementia group to be significantly longer than that in the non‐dementia group (18.7 ± 10.7 vs 10.3 ± 4.2 days, P =.03). Conclusion: Patients with dementia who underwent laparoscopic cholecystectomy have a high incidence of acute cholecystitis and a high rate of percutaneous transhepatic gallbladder drainage, which may result in increased rates of conversion to laparotomy and prolong the postoperative hospital stay. [ABSTRACT FROM AUTHOR]

Surgical trauma may be associated with enhanced tumor growth and establishment. The authors studied the effect of carbon dioxide (CO2) pneumoperitoneum versus laparotomy on tumor necrosis factor-α (TNFα), migration inhibitory factor (MIF) expression, and nuclear factor kappa B (NF κB) activity in human gastric cancer. Nude mice were inoculated intraperitoneally with human gastric cancer cells (MKN45). Then laparotomy, CO2 pneumoperitoneum, and anesthesia alone were performed randomly. Tumor growth and associated TNFα and MIF expression and NF κB activity were determined. Total tumor weight, especially at the anterior abdominal wall, was higher after laparotomy than after CO2 pneumoperitoneum ( p < 0.05). The mRNA expression of TNFα was higher 24 and 48 h after laparotomy than after CO2 pneumoperitoneum ( p < 0.05 and p < 0.01, respectively). At all the examined time points, MIF mRNA expression also was higher after laparotomy than after CO2 pneumoperitoneum ( p < 0.05 until 1 week or p < 0.01 at 2 weeks). The NF κB protein was more activated after laparotomy than after CO2 pneumoperitoneum 6 h subsequent to surgical procedures. After CO2 pneumoperitoneum, tumors have less TNFα and MIF expression and less NF κB activity than after laparotomy. This may be associated with less tumor growth, supporting minimal invasive techniques in gastrointestinal oncologic surgery. [ABSTRACT FROM AUTHOR]

Background and Objectives: To clarify the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with our novel reconstruction methods., Methods: Novel method is a reconstruction with a long and narrow gastric tube with widening of the proximal side created by linear stapler, and esophagogastrostomy is performed by linear stapler. In conventional method, esophagogastrostomy is performed by a circular stapler. Short- and long-term outcomes of a novel method were compared with those of conventional method., Results: A total of 44 patients whom LPG was performed were enrolled in this retrospective study. No cases of anastomotic leakage and stenosis were observed in both groups. The cases of postoperative reflux esophagitis (Grade B or higher) at 1 year after operation in the Novel group were less than those in the Conventional group (17% vs. 44%)., Conclusion: LPG with novel reconstruction method can be easily performed, and may be feasible for the treatment of proximal gastric cancer., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Ueda, Kawasaki, Tanabe, Suzuki, Ninomiya, Etoh, Inomata and Shiraishi.)

We report a pancreaticojejunostomy with double duct-to-mucosa anastomotic technique after pyloruspreserving pancreaticoduodenectomy for chronic pancreatitis with bifid pancreatic duct. A 49-year-old Japanese man was diagnosed preoperatively as having chronic pancreatitis with common bile duct stricture and pseudocyst of the pancreatic head. In a pancreaticoduodenectomy, the main pancreatic duct (7mm in diameter) and a secondary pancreatic duct (4mm in diameter) were identified intraoperatively at the transected surface. Pancreatography showed the main pancreatic duct as well as thesecondary pancreatic duct that drained the remaining dorsal pancreas, allowing us to diagnose bifid pancreatic duct. The pancreaticojejunostomy was performed in an end-to-side manner to create double duct-to-mucosa anastomoses and to approximate the pancreatic parenchyma and jejunal seromuscular layers. Although bifid pancreatic duct is a rare anatomical anomaly, it behooves every surgeon who performs pancreatic resections to be aware of this entity and the techniques for dealing with it.

Background: Dihydropyrimidine dehydrogenase (DPD) activity in tumor tissues is thought to play an important role in the antitumor effect of 5-fluorouracil (FU). In order to define 5-FU-resistant nonsmall-cell lung cancer, we assessed the DPD level in tumor tissues with an enzyme immunoassay., Methods: Using a sandwich enzyme immunoassay, the DPD level in lung cancer tissues was quantitatively measured in 52 patients with primary lung cancer who had undergone a pulmonary lobectomy., Results: The mean DPD level in tumor tissues was significantly higher than that in normal lung tissues (194 units/mg protein vs 53 units/mg protein; P < 0.001). The DPD level in tumor tissues correlated with neither sex nor age. Although there was no difference in the DPD level according to the grade of differentiation, squamous cell carcinoma exhibited a significantly lower level of DPD than adenocarcinoma. However, the DPD level in tumor tissues did not correlate with the advance of disease., Conclusion: Compared with adenocarcinoma, squamous cell carcinoma might be a favorable target for 5-FU-based chemotherapy in the treatment of nonsmall-cell lung cancer.