A sutureless gastroschisis closure provides a cosmetically appealing outcome. The umbilical cord is usually used as a covering material in a sutureless closure because it is a native tissue. However, during the staged closure with a silo placement, special attention is required to keep the umbilical cord moist. The authors report a simple technique to preserve the feasibility of the umbilical cord as a biologic dressing during the silo placement in staged gastroschisis closures.
The patient was a 69-year-old man who presented with a 6-month history of persistent abdominal pain and vomiting. Abdominal CT indicated an obstruction in the small intestine. Following decompression with ileus tube, laparoscopy was performed immediately under the suspicion of internal hernia. The examination revealed that the obstruction was due to a tumor arising from the serosa of the jejunum, 30 cm from the ligament of Treitz. The resection of the jejunum was extended to the mesenterium. Histopathological examination of the resected specimen revealed the diagnosis of well-differentiated adeocarcinoma, with an invasion depth of se, n0, and histological stage II disease. In general, primary cancer of the small intestine is a relatively rare disease and the presenting symptom is variable. Consequently, the most suitable preoperative diagnostic method and the treatment are still undetermined. This is the report of a case in which the low-invasive laparoscopy was shown to be advantageous to diagnose and treat primary cancer of the small intestine.
The aim of this study is to determine the effectiveness of postoperative early administration of Inchinkoto (ICKT) for patients with biliary atresia (BA) on bile drainage and survive rate of the native liver (SRNL) in jaundice-free patients. Methods : Subjects comprised of 44 patients who underwent hepatic portoenterostomy for BA between May 1993 and December 2010 at our institution. The subjects were divided into two groups. Group A patients (n=24) received no ICKT. Group B patients (n=20) received ICKT within two weeks after hepatic portoenterostomy (early administration). Medical records were retrospectively reviewed with regard to the serum total bilirubin level (T.bil), the jaundice-free ratio (JFR) and the survival rate of the native liver (SRNL) in the jaundice-free patients. Results : A significant difference was seen in T.bil (mg/dl) at one/three months after hepatic portoenterostomy (Group A; 6.5 ± 3.1/7.2 ± 5.1 , versus Group B; 4.9 ± 3.2/3.6 ± 4.4, p<0.01) and JFR (Group A; 29.2% versus Group B; 80.0% , p<0.05). SRNL tended to high in Group B (50.0%) compared to Group A (18.2%). Conclusions : The postoperative early administration of ICKT for BA patients may facilitate bile flow and improve JFR and SRNL.
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