Mesh migration is a rare complication of surgery for a hiatal hernia. Here, we present the case of a 72-year-old who complained of dysphasia and bodyweight loss. Upper gastrointestinal endoscopy revealed incarcerated mesh in the lumen of the esophagogastric junction. Surgery was performed under both endoscopy and laparoscopy, and the mesh was successfully removed via gastrostomy. To the best of our knowledge, our case is the first in which mesh that had migrated into the esophagogastric junction was removed by a combination of laparoscopic and endoscopic procedure, although the cases of 17 patients in which mesh migrated into the stomach after mesh hiatoplasty have previously been reported in the literature.
Gastric cancer remains the most commonlyoccurring cancer and the third most frequent cause of cancer-associated mortality in Japan. Solitary pulmonary metastasis of gastric cancer is rare and the outcome of pulmonary metastasectomy is still unclear. Herein we report the impact of pulmonary resection in patients with metastasis from gastric cancer. The present study retrospectively reviewed the preoperative data and clinical courses of 10 patients who underwent pulmonary resection for metastasis from gastric cancer at our institution between July 1986 and December 2017. The data on the outcomes, including morbidity, mortality and survival, were obtained from the patient records. All patients were followed-up from the time of pulmonary resection until mortality or referral to another hospital. The statistical analyses were performed using EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan), which is a graphical user interface for the R software program (The R Foundation for Statistical Computing, Vienna, Austria). The study population included 7 male patients and 3 female patients. A total of 5 patients underwent total gastrectomy, and 5 underwent distal gastrectomy. The median disease-free interval after initial gastric resection was 34.5 months. Five patients received adjuvant chemotherapy, of the 10 thoracotomies, 5 were lobectomy, 3 were wedge resection and 2 were segmentectomy. The median overall survival following pulmonary metastasectomy was 59 months and the 5-year survival rate was 40.5%. Taken together, the results of the present study suggest that pulmonary resection may be an effective therapeutic option for metastatic gastric cancer when a patient has a solitary metastatic lesion.
Primary gastric undifferentiated pleomorphic sarcoma (UPS) is a rare disease with insufficient long-term follow-up data. In the present study, a 70-year-old male complained of abdominal fullness and visited our hospital.Abdominal computed tomography revealed a large tumor in the upper part of the stomach, which was accompanied by smaller tumors in the small intestinal mesentery. An endoscopic ultrasound-guided fine-needle biopsy examination of the gastric tumor revealed features of pleomorphic sarcoma and high-grade spindle-shaped cells. Total gastrectomy was performed on the primary tumor, together with combined resection of the small intestine for the metastatic tumors. However, the tumor recurred in the mesentery of the sigmoid colon 6 months after the operation. A second operation was performed to resect the recurrent tumor. Since the second surgical procedure, the patient has remained free from recurrence for >7 years. Although the prognosis of abdominal UPS was considered to be poor, even after curative surgery, the present case experienced a long-term survival of gastric UPS after undergoing surgical resection alone.
There was no significant difference of postoperative complications (10.6% vs. 10.4%, P = 0.909) and major complications requiring radiologic intervention or reoperation (1.2% vs. 1.3%, P = 0.971) between two groups. The length of postoperative hospital stay was significantly shorter in group A compared with group B (1.9 AE 2.7 vs. 3.3 AE 2.3, days, P = 0.000). Conclusion: Solo LC had comparable operative safety and feasibility compared with conventional LC. Frequent intraoperative gallbladder perforation might be considered when selection of surgical candidates.
Background: Laparoscopic/robotic distal gastrectomy (LDG/RDG) as a treatment for early gastric cancer has become increasingly and widely accepted for its minimal invasiveness and proportionate outcomes. Over the years, in addition to the LDG/RDG technique and the lymphadenectomy and gastrectomy procedures, various reconstruction methods have been developed and further improved upon. In particular, the number of minimally invasive intracorporeal anastomosis reconstruction techniques has been increasing. Materials and Methods: The medical records of 445 patients with gastric cancer who underwent reconstruction following LDG/RDG via either trapezoidal-shaped gastroduodenostomy (TAPESTRY; n=126) or delta-shaped anastomosis (DSA; n=319) at our hospital between April 2012 and May 2021 were retrospectively reviewed. Short-term surgical outcomes, including the operation time, blood loss, length of hospital stay, and complications, were compared between the 2 groups. Anastomosis-related complications, namely leakage, bleeding, stricture, and delayed gastric emptying, were monitored and graded using the Clavien-Dindo classification. Results: All operations were either performed or supervised by qualified surgeons. Patients’ characteristics in the TAPESTRY group and the DSA group were biased in terms of the surgical approach, but they were well-balanced after propensity score matching. Overall anastomosis-related complications (Clavien-Dindo grade II or above) within 30 days after surgery in the TAPESTRY group were comparable with those in the DSA group, either all patients (1.5% vs. 5.0%, P=0.115) or after propensity score–matching analysis (2.1% vs. 6.5%, P=0.134). There were no records of reoperation or mortality during hospitalization in either group. Conclusions: TAPESTRY was performed safely, with a low rate of anastomosis-related complications. These findings suggest that trapezoidal-shaped gastroduodenostomy could be a feasible option for reconstruction in patients undergoing LDG/RDG.
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