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Surgical outcomes of pancreatectomy with jejunal vein resection for pancreatic head cancer
Yuichi NAGAKAWA,Jin-Young JANG,Manabu KAWAI,Song Cheol KIM,Yosuke INOUE,Yasuhiro YABUSHITA,Jin Seok HEO,Masayuki HONDA,Teiichi SUGIURA,Shingo KAGAWA,Aoi HAYASAKI,Wooil KWON,Kenichiro UEMURA,Ho-Seong H 한국간담췌외과학회 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.-
Unexpected Complications and Safe Management in Laparoscopic Pancreaticoduodenectomy
Yuichi Nagakawa,Yatsuka Sahara,Yuichi Hosokawa,Chie Takishita,Tetsushi Nakajima,Yousuke Hijikata,Kazuhiko Kasuya,Kenji Katsumata,Akihiko Tsuchida Korean Society of Gastrointestinal Cancer 2017 Journal of digestive cancer reports Vol.5 No.1
Although laparoscopic pancreaticoduodenectomy (LPD) is considered as minimally invasive surgery, an advanced level of laparoscopic skill is still required. LPD comprises various procedures including reconstruction. Therefore, establishment of a safe approach at each step is needed. Prevention of intraoperative bleeding is the most important factor in safe completion of LPD. The establishment of effective retraction methods is also important at each site to prevent vascular injury. I also recommend the "uncinate process first" approach during initial cases of LPD, in which the branches of the inferior pancreaticoduodenal artery are dissected first, at points where they enter the uncinate process. This approach is performed at the left side of the superior mesenteric artery (SMA) before isolating the pancreatic head from the right aspect of the SMA, which allows safe dissection without bleeding. Safe and reliable reconstruction is also important to prevent postoperative complications. Laparoscopic pancreatojejunostomy requires highly skilled suturing technique. Pancreatojejunostomy through a small abdominal incision, as in hybrid-LPD, facilitates reconstruction. In LPD, the surgical view is limited. Therefore, we must carefully verify the position of the pancreaticobiliary limb. A twisted mesentery may cause severe congestion of the pancreaticobiliary limb following reconstruction, resulting in severe complications. We must secure the appropriate position of the pancreaticobiliary limb before starting reconstruction. We describe the incidence of intraoperative and postoperative complications and appropriate technique for safe performance of LPD.
Ryosuke Tonozuka,Takayoshi Tsuchiya,Shuntaro Mukai,Yuichi Nagakawa,Takao Itoi 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.5
Gastric outlet obstruction (GOO) can be caused by periampullary malignancies and often leads to a reduction in a patient’s quality oflife. Recently, endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) using a lumen-apposing self-expandable metal stent(LAMS) has been developed as a minimally invasive and durable endoscopic treatment for GOO. There are three types of EUS-GEtechnique: (1) the direct technique; (2) device-assisted techniques, such as a balloon catheter, nasobiliary drainage tube, and ultraslimendoscopy; and (3) EUS-guided double balloon-occluded gastrojejunostomy bypass. Previous reports of EUS-GE with LAMS haveshown technical and clinical success rates (regardless of technique and etiology) of 87%–100% and 84%–100%, respectively. Studiescomparing EUS-GE and surgical astrojejunostomy have shown similar success rates, reintervention rates, and cost benefits, witha lower rate of early adverse events in EUS-GE. A comparison of EUS-GE and endoscopic enteral stent placement revealed similar technical success rates, but initial clinical success rate was higher and the rate of stent failure requiring reintervention was lower with EUS-GE.