Search

The percutaneous endoscopic gastrostomy (PEG) cannot be performed for the patient after total gastrectomy. We design the new procedure to make jejunostomy with using an ultrasonography and a regular PEG kit. We name the procedure Ultrasound assisted Percutaneous Endoscopic Jejunostomy (USPEJ). Three cases has been performed USPEJ. Operating time is 30 minutes, 45 minutes and 10 minutes respectively. All cases were performed without any troubles. We conclude that the USPEJ is a useful method for the patient with dysphagia who has the past-history of total gastrectomy.

Background/aims: We performed laparoscopic cholecystectomy with a surgical team consisting of the same operator and the same first assistant to evaluate a personal learning curve of laparoscopic cholecystectomy., Methodology: In the 135 patients who underwent the laparoscopic cholecystectomy, operative complications, postoperative complications and operative time were evaluated on the basis of using different camera assistants and the chronological advancement of the same operator and the same first assistant., Results: The average operative time was 120 +/- 54 minutes. The operative time was statistically longer in the first ten cases. The major complication during operation, which was ligation of the common bile duct, occurred in the 7th case. The other operative complications, such as minor bile duct injury or mild bleeding, occurred occasionally in spite of experience or inexperience; the operative complications, however, tended to occur under the same camera assistant. On the other hand, the operative time was not related to the use of different camera assistants., Conclusions: From the personal learning curve of laparoscopic cholecystectomy, operative time is relatively longer in the early 10 cases. Complications tend to occur under the same camera assistant.

Frequent chemolipiodolization and prostaglandin E1 (PGE1) administered through a hepatic arterial infusion port were used for treatment in 2 cases of hepatocellular carcinoma (HCC) with liver cirrhosis. Chemolipiodolization was performed every 4 weeks with 6 ml lipiodol, 3 ml Optilay and 30 mg Epirubicin or 10 mg Mytomycin C. PGE1 (10 ug) was administrated to the hepatic artery once every week after the first 7 days administration. The treatment resulted in a decrease of the AFP level, an arrest of HCC growth and a reduction in ascites with an improvement of clinical and biochemical parameters in both cases. These encouraging preliminary results show that frequent lipiodolization is effective for unresectable HCC and frequent PGE1 administration via the hepatic artery is a safe and efficient treatment for liver cirrhosis.

Percutaneous transhepatic portacaval shunt (PTPS) was performed in a patient with high-risk esophageal varices prior to sclerotherapy. PTPS was accomplished with the aid of two catheters. The first catheter was placed in the right hepatic vein under ultrasonographic guidance, and the second was placed in the portal vein. The two catheters were then connected together. The color of the esophageal varices changed from blue to white, and serum protein levels were increased 8 weeks after PTPS. Sclerotherapy was then performed without any difficulty. PTPS is the easy and quick method of performing a portacaval shunt and may have importance for the management of patients with high-risk esophageal varices prior to the treatment of sclerotherapy or liver transplantation.