Cystic disease of the spleen is a relatively rare disease. It is classified either as a true primary cyst or as a secondary pseudocyst. Most splenic cysts are pseudocysts, which have non-epithelial lining, and are caused by previous abdominal blunt trauma. Conversely, primary splenic cysts have epithelial lining and are subdivided into parasitic and non-parasitic cyst. Non-parasitic primary splenic cyst is considered congenital and comprises about 10% of all splenic cysts. Total or partial splenectomy is the treatment of choice, but parasitic infection must be excluded prior to an operation. In this present report, we described a symptomatic, large primary non-parasitic splenic cyst, which was surgically treated with partial splenectomy.
Rare Diseases ; Spleen ; Splenectomy

BACKGROUNDS/AIMS: Resection or enucleation is currently the treatment of choice for small pancreatic neuroendocrine tumors (NETs). Irreversible electroporation is a novel ablative method that is used for locally advanced pancreatic adenocarcinoma, but little data exists for its use for pancreatic NETs. We report an early experience of IRE for early pancreatic NETs. METHODS: Between April 2014 and March 2015, 3 patients with small (<2 cm) pancreatic NETs were treated with percutaneous IRE. RESULTS: There were no adverse effects during the procedure. Mean hospital stay was 2.6 days. All patients remained disease free on 12-19 months follow up. One patient developed recurrent pancreatitis with pseudocyst formation. CONCLUSIONS: IRE for small tumors of the pancreas is practical and may offer advantages over other thermal ablative techniques, since it preserves vital structures such as blood vessels, bile and pancreatic ducts. Further data regarding the long term disease free interval is required to establish efficacy.
Adenocarcinoma ; Bile ; Blood Vessels ; Electroporation* ; Follow-Up Studies ; Humans ; Length of Stay ; Methods ; Neuroendocrine Tumors* ; Pancreas ; Pancreatic Ducts ; Pancreatitis

BACKGROUNDS/AIMS: Aggressive surgical resection for hepatic metastasis is validated, however, concomitant liver and lung metastasis in colorectal cancer patients is equivocal. METHODS: Clinicopathologic data from January 2008 through December 2012 were retrospectively reviewed in 234 patients with colorectal cancer with concomitant liver and lung metastasis. Clinicopathologic factors and survival data were analyzed. RESULTS: Of the 234 patients, 129 (55.1%) had synchronous concomitant liver and lung metastasis from colorectal cancer and 36 (15.4%) had metachronous metastasis. Surgical resection was performed in 33 patients (25.6%) with synchronous and 6 (16.7%) with metachronous metastasis. Surgical resection showed better overall survival in both groups (synchronous, p=0.001; metachronous, p=0.028). In the synchronous metastatic group, complete resection of both liver and lung metastatic lesions had better survival outcomes than incomplete resection of two metastatic lesions (p=0.037). The primary site of colorectal cancer and complete resection were significant prognostic factors (p=0.06 and p=0.003, respectively). CONCLUSIONS: Surgical resection for hepatic and pulmonary metastasis in colorectal cancer can improve complete remission and survival rate in resectable cases. Colorectal cancer with concomitant liver and lung metastasis is not a poor prognostic factor or a contraindication for surgical treatments, hence, an aggressive surgical approach may be recommended in well-selected resectable cases.
Colorectal Neoplasms* ; Humans ; Liver Neoplasms ; Liver* ; Lung Neoplasms ; Lung* ; Neoplasm Metastasis* ; Retrospective Studies ; Survival Rate

BACKGROUNDS/AIMS: This study evaluated the hemostatic effects of a novel oxidized regenerated cellulose, SurgiGuard®, during liver surgery, using a reproducible and clinically relevant animal model. METHODS: Fifteen mini-pigs underwent left partial hepatectomy. They were randomized to treatment of the resected surface with SurgiGuard® (Group C [test], n=5), Surgicel® (Group B [reference], n=5), or nothing (Group A [control], n=5). Blood loss was measured 5, 7 and 9 min after resection. Time to hemostasis was recorded. Mini-pigs were necropsied 4 or 6 weeks postoperatively to evaluate toxicity changes and material dissolution. RESULTS: The median resected liver weight was 2.13 g (2.02-2.20) in control group, 2.04 g (2.01-2.13) in reference group, and 2.01 g (1.99-2.12) in test group (p=0.024). Median total blood loss was 57.18 g (52.02-59.54) in control group, 32.52 g (27.66-35.10) in reference group, and 35.52 g (25.70-38.71) in test group (p=0.008). Blood loss at 0-5 minutes and 7-9 minutes was significantly different between groups (p=0.009 and p=0.006, respectively). At necropsy, no hematomas, granulomas, or adhesions were noted in any group. Histopathological analysis revealed no changes suggesting toxicity related to SurgiGuard®. CONCLUSIONS: SurgiGuard® is as effective as Surgicel® in achieving hemostasis after porcine partial liver resection.
Cellulose ; Granuloma ; Hematoma ; Hemostasis ; Hepatectomy ; Liver ; Models, Animal ; Swine*

After having experienced more than 2,000 cases of adult living donor liver transplantation (LDLT), we established the concepts of right liver graft standardization. Right liver graft standardization intends to provide hemodynamics-based and regeneration-compliant reconstruction of vascular inflow and outflow. Right liver graft standardization consists of the following components: Right hepatic vein reconstruction includes a combination of caudal-side deep incision and patch venoplasty of the graft right hepatic vein to remove the acute angle between the graft right hepatic vein and the inferior vena cava; middle hepatic vein reconstruction includes interposition of a uniform-shaped conduit with large-sized homologous or prosthetic grafts; if the inferior right hepatic vein is present, its reconstruction includes funneling and unification venoplasty for multiple short hepatic veins; if donor portal vein anomaly is present, its reconstruction includes conjoined unification venoplasty for two or more portal vein orifices. This video clip that shows the surgical technique from bench to reperfusion was a case presentation of adult LDLT using a modified right liver graft from the patient's son. Our intention behind proposing the concept of right liver graft standardization is that it can be universally applicable and may guarantee nearly the same outcomes regardless of the surgeon's experience. We believe that this reconstruction model would be primarily applied to a majority of adult LDLT cases.
Adult* ; Hepatic Veins ; Humans ; Intention ; Liver Transplantation* ; Liver* ; Living Donors* ; Portal Vein ; Reperfusion* ; Tissue Donors ; Transplants* ; Vena Cava, Inferior

Carcinoid tumors of ampulla of Vater are rare and slow growing neoplasms that are composed of variable numbers of cells that contain endocrine secretory granules in their cytoplasm, which can be identified by immunohistochemistry, and electron microscopy. Symptoms of Carcinoid tumors of ampulla of Vater are jaundice, hemorrhage, abdominal discomfort, duodenal obstruction or carcinoid syndrome. The incidence of Carcinoid tumors of ampulla of Vater is 1% of all gastrointestinal carcinoid tumors in Western countries. We report a case of no recurrence for 53 months after pylorus preserving pancreaticoduodenectomy for carcinoid tumor of ampulla of Vater
Ampulla of Vater* ; Carcinoid Tumor* ; Cytoplasm ; Duodenal Obstruction ; Hemorrhage ; Immunohistochemistry ; Incidence ; Jaundice ; Microscopy, Electron ; Pancreaticoduodenectomy ; Pylorus ; Recurrence ; Secretory Vesicles

Laparoscopic cholecystectomy has been widely performed as a gold standard in patients with symptomatic gallstone disease. To avoid bile duct injury during operation, it is recommended that dissection should be kept close to the gallbladder despite the potential risk of long cystic duct stump. Post-cholecystectomy syndrome refers to a wide spectrum of conditions that often pose a diagnostic and therapeutic dilemma for surgeon. Cystic duct remnant may cause postcholecystectomy syndrome in the presence of stones. A case is presented in which a symptomatic gallbladder remnant with gallstone was removed successfully by laparoscopic technique. In the era of laparoscopic surgery, which favors a long cystic duct remnant, we should be aware of cystic duct remnant stones as a possible cause of post-cholecystectomy syndrome.
Bile Ducts ; Calculi* ; Cholecystectomy, Laparoscopic ; Cystic Duct* ; Gallbladder* ; Gallstones ; Humans ; Laparoscopy ; Postcholecystectomy Syndrome

Neuroendocrine pancreatic tumors (NPTs) arise from the pancreatic islet cells and belong to the amine and precursor uptake and decarboxylation (APUD) system. These tumors are rare and account for only 1% to 5% of pancreatic tumor. The pancreas is an extremely uncommon site of neoplasia in children and adolescents. For this reason, our understanding of these tumors is still quite limited. Although the complete surgical resection is the key to successful management of all malignant adolescence pancreatic tumors, the information on the possible role of chemotherapy and radiation in recurrent, unresectable, or metastatic cases is purely anecdotal. The 17-year-old man transferred to our hospital with abnormal ultrasonographic findings. Result of abdominal ultrasonographic examination showed a mass in the upper abdomen. He presented with 6months history of intermittent abdominal pain and vomiting and diarrhea. A computed tomography (CT) scan and magnetic resonance showed a 4.5 x 6 cm mass in the head of the pancreas. An ultrasound-guided core biopsy confirmed an pancreatoblastoma or pancreas islet cell tumor. On operative findings, there was locally advanced, unresectable tumor within the pancreatic head. We report a 17-years-old man patient with non-functional panceratic islet cell carcinoma.
Abdomen ; Abdominal Pain ; Adenoma, Islet Cell ; Adolescent* ; Biopsy ; Carcinoma, Islet Cell ; Child ; Decarboxylation ; Diarrhea ; Drug Therapy ; Head ; Humans ; Islets of Langerhans* ; Pancreas ; Vomiting

PURPOSE: Leakage of the pancreaticojejunal anastomosis has been a major complication after pancreaticoduodenectomy. Over the past decades, various measures directed towards prevention of pancreatic leakage have been studied. The purpose of this study is to find better operative technique as comparing the interrupted stitches with the continuous stitches for the outer layer of the panceaticojejunostomy, ie. the stitches between the stump parenchyma of the pancreas and the jejunal seromuscular layer, and other risk factors for the incidence of pancreatic leakage. METHODS: During the period January 1997 to October 2004, 138 patients have undergone the end-to-side and duct-to-mucosa pancreaticojejunostomy reconstruction after pancreaticoduodenectomy with the interrupted suture for outer layer of the pancreaticojejunostomy and 173 patients with the continuous suture at our institution by one surgeon. A pancreatic fistula was defined as drainage of more than 30 ml of fluid with an amylase level higher than 600 U/dl on or after postoperative week 1. Major pancreatic leakage was defined as drainage of more than 200 ml of fluid or development of the intra-abdominal abscess or the pseudoaneurysm due to pancreatic fistula. Statistical differences were verified using chi-square test. RESULTS: There were no differences between the two groups in the diagnosis, texture of the pancreas, using of sandostatin and staging. For the interrupted suture group, operative time was 35.4+/-4.8 minutes, and for the continuous group, 29.1+/-3.9 minutes (p<0.001). Pancreatic fistula occurred in 14 interrupted suture cases (10.14%) and in 10 continuous suture cases (5.75%)(p=0.126). Major pancreatic leakage developed in 3 interrupted suture patients (2.17%) and 2 continuous suture patients (1.15%)(p=0.168). CONCLUSION: The two methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer revealed no significant difference in the development of pancreatic fistula. However, for the continuous suture group, operative time was significantly reduced and pancreatic fistula rate was decreased without increasing morbidity. In conclusion, the continuous suture is more feasible and safe in performing pancreaticojejunostomy.
Abdominal Abscess ; Amylases ; Aneurysm, False ; Diagnosis ; Drainage ; Humans ; Incidence ; Octreotide ; Operative Time ; Pancreas ; Pancreatic Fistula* ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy* ; Risk Factors ; Sutures

PURPOSE: During liver resection and transplantation, liver is damaged by ischemia-reperfusion injury. Until now, there is no approved method to measure or predict the extent of liver injury during the operation. This is the preliminary study to make the real time monitoring system by quantification of bioelectrical impedance and ischemia-reperfusion injury in liver. METHODS: Male Newzealand white rabbits(body weight 3.5-4.0 kg) were used. We observed changes of bioelectrical impedance during ischemia and reperfusion injury according to frequency(120 Hz-100 KHz). Bioelectrical impedance of liver tissue were measured every 5 minutes interval with two mono-polar needle coated with platinum using LCR meter (GS-4311B, ANDO, Japan). Cell viability was assessed by metabolic capacity of fatty acid (palmitic acid metabolic rate) and histologic examination (H&E stain) at every 30 minutes interval during 120 minutes ischemia. RESULTS: Liver bioelectrical impedance was changed significantly(p<0.05) during ischemia in lower frequency compared to those of higher frequency. Bioelectrical impedance(120 Hz) increased during ischemia and returned to base line level after reperfusion. The level of bioelectrical impedance(120 Hz) increased gradually after ischemia for 1 hour. After 1 hour, the level of bioelectrical impedance had tendency to maintain plateau. Palmitic acid oxidation rate were not changed significantly during 120 minutes ischemia and there were no significant difference in histologic examination. CONCLUSION: We found the possible role of bioelectrical impedance to measure and predict the extent of ischemia-reperfusion injury.
Cell Survival ; Electric Impedance* ; Humans ; Ischemia ; Liver Transplantation ; Liver* ; Male ; Needles ; Palmitic Acid ; Platinum ; Reperfusion ; Reperfusion Injury*