Surgery today
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In Japan, the Billroth I and Billroth II operations have been used for reconstruction after a distal gastrectomy for gastric cancer. However, a Roux-en-Y reconstruction is increasingly performed to prevent duodenogastric reflux. We herein discuss the indications for Roux-en-Y in gastric surgery and review the literature to determine its advantages and disadvantages. ⋯ The disadvantages of Roux-en-Y reconstruction include the possible development of stomal ulcer, an increased probability of cholelithiasis, increased difficulty with an endoscopic approach to the ampulla of Vater, and the possibility of Roux stasis syndrome. The principal advantage of a Roux-en-Y reconstruction is that it is less likely than the Billroth I operation to result in duodenogastric reflux. Roux-en-Y reconstruction or Billroth I operation can only be selected after considering their respective advantages and disadvantages.
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Two patients with omental torsion, who presented with acute abdomen, are reported. The first case, a 14-yearold boy, was admitted for acute appendicitis. During surgery, omental torsion on the long axis was diagnosed and the involved omentum was resected. ⋯ The involved portion of the omentum was also resected. Omental torsion is a rare cause of acute abdomen in children and adults, who may present with various signs and symptoms mimicking other etiologies of acute abdomen. A preoperative diagnosis may therefore be difficult and it usually can only be established during surgery.
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To evaluate the prognostic impact of various therapeutic modalities, such as repeat hepatectomy, ablation therapy, and transcatheter arterial chemoembolization (TACE) therapy, used to treat single nodular recurrent hepatocellular carcinoma (HCC). ⋯ Repeat hepatectomy and ablation therapy are more effective than TACE therapy for improving the prognosis of patients with single nodular intrahepatic recurrent HCC.
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We assessed the significance of an extra bile duct resection by comparing the survival of patients with advanced gallbladder carcinoma who had resected bile ducts with those who had preserved bile ducts. A radical cholecystectomy that includes extra bile duct resections has been performed without any clear evidence of whether an extra bile duct resection is preventive or curative. ⋯ Our retrospective questionnaire survey showed that an extrahepatic bile duct resection had no preventive value in some patients with advanced gallbladder carcinoma in comparison to similar patients who had no such bile duct resection. An extrahepatic bile duct resection may therefore be unnecessary in advanced gallbladder carcinoma without a direct infiltration of the hepatoduodenal ligament and the cystic duct.
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We performed a prospective randomized study to assess the effectiveness of short-term intravenous antimicrobial prophylaxis in combination with preoperative oral antibiotics on a surgical site and methicillin-resistant Staphylococcus aureus (MRSA) infection in elective colon cancer surgery. ⋯ These findings suggest that short-term intravenous antimicrobial prophylaxis in combination with preoperative oral antibiotics may be successfully applied to colon cancer surgery that is generally performed in Japan.