Abstract:

Laparoscopic surgery is increasingly applied to the treatment of gastrointestinal disease. However, the insertion of secondary trocars following pneumoperitoneum carries the risk of serious complications such as major vascular and bowel injuries. Such injury can arise when the force required for the trocar insertion is such that it causes the operator to have impaired control over the entry. There is a need for a procedure of secondary trocar insertion that is safe and easy to perform for training clinicians in laparoscopic surgery. We have developed the "cut-and-screw" insertion method for secondary trocar insertion using a specially developed laparoscopic cannula with a sharp edge and housing. Our procedure is simple, rapid, and safe. In this chapter, we describe the technique and present our initial clinical results.

Authors:

Naoki Hiki, M.D., Ph.D., Tetsu Fukunaga, M.D., Ph.D., Toshiharu Yamaguchi, M.D., Ph.D., Director, Souya Nunobe, M.D., Shigekazu Ohyama, M.D., Ph.D., Masanori Tokunaga, M.D., Akira Miki, M.D., Hiroya Kuroyanagi, M.D., Yasuyuki Seto, M.D., Ph.D., Vice-Director, Tetsuichiro Muto, M.D., Ph.D., President, Cancer Institute Hospital, Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

For Direct IP Access please click this link

Abstract:

Capsule Endoscopy (CE) is a recent diagnostic tool for detection of small bowel disease. The tiny imaging capsule has to be swallowed by the patient, which allows transmission by radiofrequency two images each second, to sensors worn around the patient's abdomen. After eight hours, the pictures can be downloaded and read by a Gastroenterologist. CE allows for exploration of the entire small bowel mucosa, which involves segments not accessible by classical endoscopy. Moreover, it is the only technique that involves a visualization of the entire small bowel without sedation. Tumors of the small intestine are rather infrequent and could account for »2% of gastrointestinal neoplasms. As symptoms of small bowel tumors are not specific, most published series include patients with bleeding or anemia of undetermined origin, the main indication for performing CE. Currently, no doubt exists of the ability regarding the CE to increase the diagnostic yield of small bowel tumors, or to alter their management and improve their outcome in the absence of metastases. Overall, tumors along the small intestine are located by CE in 2.5%-8.9% of patients who undergo this procedure. While being an evident improvement, CE has some limitations, such as the inability to treat lesions locally or take tissue specimens. This last point is an important shortcoming, because small bowel tumors can be malignant (»2/3 of the cases) or benign. The future of CE is bright, and special capsule devices already exist to specifically explore the esophagus as well as the large intestine.

Authors:

Daniel Urbain, M.D., Ph.D., Head of Department, Wendy Van Laer, M.D., Resident, Fazia Mana, M.D., Ph.D., Head of Unit , Vrije Universiteit Brussel (VUB), Department of Gastroenterology, Brussel, Belgium

For Direct IP Access please click this link

Abstract:

Despite refinements in the field of gastrointestinal surgical stapling, anastomotic leakage and bleeding still remain a serious problem associated with substantial morbidity and mortality. To prevent or reduce these complications, a diversity of staple line reinforcement techniques have been developed. The available literature from 1977 through 2007 was reviewed to find relevant data about innovative colorectal staple line reinforcement techniques. Many different forms of staple line reinforcement are available. Reinforcement methods can be material applied exogenously to the staple line or incorporated into the staple line. Reinforcement materials can be nonabsorbable, semi-absorbable, or fully absorbable. Gastrointestinal staple line reinforcement is well known, but it is a relatively new method for colorectal surgery. Staple line reinforcement is an effective technique in reducing complications in stapled anastomoses only if proper buttressing material is used. Absorbable material seems to have several advantages over non- or semi-absorbable staple line reinforcement. New and promising techniques are fibrin glue, C-seal, and biosynthesized absorbable cellulose used as staple line reinforcement material. Unfortunately, there is not much experience reported with these new materials, thus further investigation is needed.

Authors:

Avine Cheragwandi, M.D., General Surgery Resident, Department of Surgery, Meander Medical Centre, Teaching Hospital, Affiliated to the University Medical Center of Utrecht, Amersfoort, The Netherlands, Dorothée H. Nieuwenhuis, M.D., General Surgery Resident, Department of Surgery, Meander Medical Centre, Teaching Hospital, Affiliated to the University Medical Center of Utrecht, Amersfoort, The Netherlands, Michel Gagner, M.D., F.A.C.S., F.R.C.S.C., Professor of Surgery, Chief, Laparoscopic and Bariatic Surgery, New York, Presbyterian/Weill Cornell Medical Center, Weill Medical College of Cornell University, New York, NY, USA, Esther C.J. Consten, M.D., Ph.D., Gastrointestinal Surgeon, Director of Department of Gastrointestinal and Oncological Surgery, Meander Medical Centre, Teaching Hospital, Affiliated to the University Medical Center of Utrecht, Amersfoort, The Netherlands

For Direct IP Access please click this link

Abstract:

Anorectal abscesses and fistulas are common maladies that are usually readily diagnosed and effectively treated. However, complex fistulous disease challenges even the most expert of surgical specialists. The management options in this subset of patients are suboptimal, with treatment often requiring multiple procedures, putting the patient at risk for continued symptoms and fecal incontinence. In this chapter, the clinical aspects of perianal suppurative disease are discussed and an attempt is made to deal with many of the more challenging aspects of patient management.

Authors:

Adam Juviler, M.D., Resident, Neil Hyman, M.D., Samuel B. and Michelle D. Labow Professor of Colorectal Surgery, Chief, Division of General Surgery, Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont, USA

For Direct IP Access please click this link

Abstract:

In 1996, we reported the technical aspects of our new method for end-to-side pancreatojejunostomy (Kakita's method) that we performed in combination with the Whipple procedure without any complications related to failure in the anastomosis. In this chapter, we will introduce our technique in end-to-end style pancreatojejunal anastomosis with fewer anastomotic complications. The purpose of this study was to review Kakita's method with pancreatoduodenectomy. From April 1990 to December 2005, 324 consecutive cases of pancreatoduodenectomy were performed in the Department of Surgery at Kitasato University. In our institute, reconstruction in pancreatoduodenectomy is basically performed according to a modified Child's procedure. Our method is simple and can be applied wherever an end-to-side pancreatojejunal anastomosis is required. It consists of three steps: First, a drainage tube is inserted into the pancreatic duct. The second step, which is the unique aspect of our method, is an attachment of the jejunal wall and the cut surface of the pancreas using a single-layer suture technique. This allows us not only to reduce the number of sutures but also to eliminate some of the complicated manipulations required by other methods. The jejunal wall fully covers the cut surface of the pancreas, leaving no uncovered area between the wall and the pancreas. Third, a direct anastomosis between the pancreatic duct and the mucosal layer of the jejunal loop is applied. In our series, pancreatojejunal anastomotic leakage occurred only in 4 out of 324 patients, which was 1.23%. All patients were successfully treated with conservative therapy using drainage for an extended period postoperatively. The newly devised pancreatojejunostomy in our department is a simple, safe, and reliable procedure with excellent results.

Authors:

Kazunori Furuta, M.D., Ph.D., Muneki Yoshida, M.D., Ph.D., Koichi Itabashi, M.D., Ph.D., Hiroyuki Katagiri, M.D., Ph.D., Kennichiro Ishii, M.D., Ph.D., Yoshihito Takahashi, M.D., Ph.D., Masahiko Watanabe, M.D., Ph.D., Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan

For Direct IP Access please click this link

Abstract:

Fecal incontinence remains a major problem with significant social and medical implications. Its causes are diverse and not always apparent. Therefore, diagnostic workup is essential to find the underlying cause and initiate adequate treatment. Treatment options include conservative interventions and surgical procedures. To improve the diagnosis and treatment of patients suffering from fecal incontinence, an update and overview of available techniques can be helpful. This chapter includes indications and complications in conservative and surgical treatment. It also includes flowcharts for everyday practice.

Authors:

Marjolein Blussé van Oud-Alblas, M.D., Resident, Bastiaan J.M., Thomeer, M.D., Resident, Hester J. Stam, M.D., Resident, Adriaan J. van Overbeeke, M.D., Ph.D., Surgeon, Esther C.J. Consten, M.D., Ph.D., Surgeon, Department of Surgery, Meander Medical Centre Amersfoort, The Netherlands

For Direct IP Access please click this link