We have established a method for in situ tissue engineering of the stomach in a canine model using an acellular collagen scaffold graft. The current study was conducted to evaluate the functional aspects of the tissue-engineered stomach wall. The anterior wall of the stomach in beagle dogs was replaced with a collagen sponge scaffold measuring 4 x 4 cm. At 16 weeks after implantation, the animals were sacrificed and the stomach specimens were evaluated immunohistochemically and physiologically. Regeneration of the proton pump and thin muscle layer, which are essential for mechanical and chemical digestion by the stomach, was observed in the tissue-engineered gastric tissue. However, acetylcholine-induced contraction was not observed in the tissue-engineered stomach wall. Although there is still room for improvement, the tissue-engineered stomach wall had a highly organized structure, and it is anticipated that this approach could eventually become an alternative for stomach reconstruction after gastrectomy.
We carried out an experimental study to evaluate the effect of basic fibroblast growth factor (bFGF)-containing collagen gel on vascularization in esophageal tissue engineering. We compared an acellular collagen sponge scaffold and an acellular collagen gel scaffold in combination with bFGF using a canine model. The construct was implanted in the cervical esophagus and the regenerated tissue was evaluated one month after surgery. Histological analysis confirmed a significantly large amount of blood vessels in the bFGF-containing collagen gel group as compared to the collagen gel group without bFGF (bFGF (-)). However, in the collagen sponge groups, no difference was observed between the bFGF (+) group and the bFGF (-) group. These results showed that bFGF-containing collagen gel is suitable not only for an acellular scaffold for tissue engineering but also for an effective tropic factor vehicle in vivo.
Background
Laparoscopic cholecystectomy (LC) for difficult acute cholecystitis (AC) cases bears a high risk of vasculobiliary injuries (VBI). The Tokyo Guidelines 2018 (TG18) recommend the use of bailout procedures and subtotal cholecystectomy to prevent VBI. Performing a safe LC is challenging, even when followed by an accurate pre-surgical assessment. Laparoscopic cholecystectomy (LSC) requires advanced skills, and there is a risk of recurrence of cancer and/or gallbladder stones (GBS) in the remnant gallbladder (GB). Moreover, it is sometimes impossible to safely close the cystic duct with either a loop tie or linear staples because of anatomical and fragility problems. Here, we report a novel technique employing barbed sutures for LSC in difficult AC cases.
Case presentation
We performed urgent LSC using barbed sutures for the stump of the cystic duct in two patients. In preoperative assessments, we found that these cases were qualified for operations rather than GB drainages, but the cystic ducts appeared difficult to close due to their severe inflammation and fragility during the operations. We applied barbed suture as a surrogate technique to close the stump of cystic duct. In patient 1, a 67-year-old woman with severe heart failure and type 2 diabetes mellitus was diagnosed with grade III AC. Pathological diagnosis was gangrenous cholecystitis. In patient 2, a 68-year-old woman who was referred to our hospital after 15 days of treatment for AC with antibiotics without drainage. The severity of AC was grade II according to TG18. Pathological diagnosis was acute-on-chronic cholecystitis. Both patients were discharged without complication.
Conclusions
The utilization of barbed sutures in LSC stems as a feasible and safe surrogate technique. Furthermore, this approach could decrease the risks associated with the remnant GB.
Although rare, persistent descending mesocolon (PDM) is an anatomical anomaly that carries potential risks for laparoscopic colorectal surgery. Impaired blood circulation of the reconstructed colon is especially risky during surgery. We report a case of sigmoid cancer with PDM, in which the patient underwent laparoscopic sigmoidectomy.
A 52-year-old man diagnosed with sigmoid cancer was referred to our hospital. PDM was identified with preoperative enhanced-contrast computed tomography, which revealed the sigmoid colon located in the right lower quadrant and a bear-claw inferior mesenteric artery (IMA). Preoperative examination showed cT1N0M0 stage I (Union for International Cancer Control {UICC} eighth). We were not able to identify the branches of IMA after the medial-to-lateral approach. We divided the mesentery and marginal artery and the main branches from IMA extracorporeally prior to lymphadenectomy. Each oral and anal side was dissected without touching the tumor. Then, we marked the line for lymphadenectomy using the dissected line of mesentery as an intracorporeal landmark. Pathological findings showed pT1N0M0 stage I (UICC eighth edition). The patient was discharged without complications.
Using this approach and the preoperative recognition of PDM, we performed laparoscopic sigmoidectomy with lymphadenectomy for early-stage PDM case successfully and safely. Our mesocolon dissection-first approach could be a feasible and safer approach for early-stage sigmoid cancer.
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