Background
Percutaneous radiofrequency ablation (RFA) is an effective treatment for hepatocellular carcinoma (HCC), but delayed thermal damage can cause diaphragmatic hernia (DH). Surgery is recommended for DH, and open surgery is widely accepted. This report presents a case of laparoscopic surgery for strangulated DH that occurred after RFA.
Case presentation
An 80-year-old woman with a history of hepatitis C-induced liver cirrhosis and HCC was admitted to our institution owing to sudden-onset intense epigastric pain. Twenty-two months earlier, she received RFA treatment for HCC located in segment 6/7. Contrast-enhanced computed tomography revealed herniation of the small intestine into the thoracic cavity, with mesenteric fat haziness. Emergency laparoscopic surgery was performed, and the patient was diagnosed with strangulated DH associated with the prior RFA. The defect was closed using absorbable sutures, and the ischaemic small intestine was resected via mini-laparotomy. The patient was discharged on the 10th postoperative day without complications, and no evidence of DH recurrence 15 months after surgery was noted.
Conclusions
Laparoscopic surgery seems useful and feasible for strangulated DH.
A 67-year-old female with heartburn presented to a local clinic. She underwent upper gastrointestinal endoscopy and was diagnosed with esophageal cancer, and was then referred to our hospital for further treatment. Upper gastrointestinal endoscopy revealed a slightly depressed lesion with a wall deformity at the middle thoracic esophagus, 32 cm from the incisor. A biopsy specimen showed adenocarcinomatous change. She underwent subtotal esophagectomy with 3-field lymph node dissection. A pathological examination revealed a15-mm diameter tumor that had invaded the submucosal layer. The histological type was mucoepidermoid carcinoma (MEC). No recurrence has been identified at 24 months postoperatively. The incidence of MEC of the salivary glands is high, but the incidence of MEC of the esophagus is extremely low. Here, we report a case of esophageal MEC treated in the early stage.
Background
Thoracoscopic esophagectomy for esophageal cancer performed with single-lumen tracheal tube ventilation in the semi-prone position provides the advantages of easier anesthesia induction; easiness of left-sided recurrent laryngeal nerve lymph node dissection; and shortening of the transit time to laparotomy. The aim of this study was to clarify the surgical safety and anesthetic procedure associated with thoracoscopic esophagectomy with single-lumen tracheal tube ventilation by intraoperative monitoring of respiratory status and hemodynamic changes.
Methods
A total of 30 patients with esophageal cancer who underwent thoracoscopic subtotal esophagectomy at our institute from January 2014 to December 2017 were retrospectively reviewed. Cardiac index (CI), systemic vascular resistance index (SVRI), mean arterial pressure (MAP), partial pressure of oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2), end-tidal carbon dioxide pressure (EtCO2), and tidal volume (TV) using FloTrac system were measured.
Results
There were no significant changes in CI, SVRI, and MAP during artificial pneumothorax. Conversely, PaCO2 and EtCO2 gradually increased during artificial pneumothorax (P < 0.05) and decreased to almost their original levels thereafter. Furthermore, progressive reduction in tidal volume was observed in four cases after anti- side pneumothorax due to the injury of the left pleura with lymph node dissection. The mean TV and mean PaO2 were 0.42 L and 229.0 mmHg during artificial pneumothorax, respectively.
Conclusion
There was no exaggerated circulatory or ventilatory depression during artificial pneumothorax in the semi-prone position. Artificial pneumothorax with single-lumen tracheal tube ventilation in thoracoscopic subtotal esophagectomy may be a reliable anesthetic procedure. However, further examinations in the future will be necessary to determine its safety.
Disclosure
All authors have declared no conflicts of interest.
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