Background
Early laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) poses multiple challenges. The Tokyo Guidelines 2018 (TG18) eliminated the time limit (< 72 h) and expanded the ...surgical indication to severe AC. This study aimed to evaluate the clinical outcomes of ELC for AC following the TG18 in a single high-volume center.
Methods
From 2019 to 2021, we managed all AC patients with a TG18 flowchart and prospectively enrolled those who underwent ELC within 7 days of symptom onset. The primary outcome was overall morbidity, with a comparison between mild (Grade I) and moderate/severe (Grade II/III) AC.
Results
During the study period, 201 patients underwent ELC was for Grade I (56.2%), II (40.3%), and III (3.5%) ACs. Mean age was 69 ± 15.2 years and time to surgery from symptom onset was 0 (12.9%), 1–3 (66.7%), and 4–7 days (20.4%). Mean operative time and blood loss were 118.9 ± 42.7 min and 57.8 ± 99.4 mL, respectively. The critical view of safety (CVS) was achieved in 76.1% of patients, and bailout procedures were performed in 21.4%. There were no open conversions or bile duct injuries. Major morbidities (Clavien–Dindo classification ≥ IIIa) were observed in 5.5% of cases and mortality in 0.5%. Comparing Grades II/III to Grade I, operative time was longer (112.3 vs. 127.3 min,
p
= 0.014), blood loss was higher (40.3 vs. 80.1 mL,
p
= 0.005), the CVS rate was lower (83.2 vs. 67.0%,
p
= 0.012), and the major morbidity rate was higher (1.8 vs. 10.2%,
p
= 0.012). In the subgroup analysis of Grade II/III, there were no significant differences in major morbidities (
p
= 0.288) between the two groups (0–3 vs. 4–7 days).
Conclusion
ELC for AC following TG18 is feasible with low morbidity rates. However, ELC for Grade II/III ACs remains challenging, and surgeons must carefully assess intraoperative difficulties and surgical risks before proceeding.
Background
The Arnt3 (also termed as BMAL1 or MOP3)/Clock heterodimer is a positive regulator of circadian rhythm and activates the transcription of target genes such as per1 and vasopressin.
Results
...We investigated the transcriptional mechanism of mArnt3/mClock heterodimer. While mClock did not possess any distinct activation domain, mArnt3 contained a transcriptional activation domain at the most C‐terminal end, the activity of which was not expressed, even in the one hybrid system, until it was bound by mClock. It has been suggested that mClock plays a regulatory or structural role in exerting a transcription enhancing effect of the mArnt3/mClock heterodimer. Deletion proceeding from amino acids 559–492 of mClock markedly reduced the transactivation activity of mArnt3/mClock heterodimer, in consistence with the results of the Clock‐Δ19 mutant. Yeast and mammalian two‐hybrid systems revealed that CBP and p300 interacted with mArnt3 via the CREB binding domain. The In vivo interaction between mArnt3 and CBP was confirmed by the GST pull down assay.
Conclusion
Taken together, these results suggest that the mArnt3/mClock heterodimer exerted its transactivation activity via CBP or p300 interacting with mArnt3 in the heterodimer with mClock playing a structural or regulatory role in the transactivation process.
Based on recent reports from the field of digestive surgery, laparoscopic surgery has made rapid progress. However laparoscopic appendectomy (LA) has not been a common procedure. We investigated the ...current state of the treatment of acute appendicitis in a suburban municipal hospital. Appendectomies performed in Sanda city hospital from April 2009 to March 2011 were evaluated. Thirty four cases (male: female 23: 11) were treated with laparoscopic appendectomy, 43 cases (male: female 37: 6) with open appendectomy (OA). The operation time of LA was significantly longer than that of OA (LA 81.8±28.5minutes and OA 65.8±22.8minutes). Most of the LA procedures were performed in the daytime whereas OA tended to be performed during the night or on holidays. The hospital stay in LA was 6.4±2.6 days, and 7.5±5.8 days in OA. The frequency of surgical site infection (SSI) of LA was lower than that of OA. On review of our 77 patients, we conclude that the laparoscopic approach is useful for treatment of acute appendicitis and will develop in many hospitals.
Two patients were admitted to Ageo Central General Hospital for refractory pleural effusion. Case 1, a 53-year-old man with alcoholic cirrhosis and ascites, presented with respiratory distress. A ...plain chest radiograph showed massive right pleural. Since administration of albumin and diuretics did not improve his condition, thoracoscopy and laparoscopy were performed, which revealed a fistula in the diaphragm; the defect in the diaphragm was sealed using a tissue adhesive sheet (TacoSealⓇ︎), polyglycolic acid sheet (PGA) (Neover SheetⓇ︎), and fibrin glue (Veriplast PⓇ︎). Case 2 was a 67-year-old female patient with HCV hepatitis. Thoracic drainage was performed to relieve the pleural effusion-related respiratory discomfort. Suspecting pleuroperitoneal communication, the chest cavity was closed as in the first case. Both patients were discharged without postoperative complications. The minimally invasive laparoscopic and thoracoscopic approach is useful for the treatment of pleuroperitoneal communication. When suturing poses a challenge, reinforcement with tissue adhesive sheets may be a useful option.
To evaluate the utility of robot-assisted laparoscopic transabdominal preperitoneal repair (R-TAPP) of postprostatectomy inguinal hernia (PIH) in patients who underwent robot-assisted laparoscopic ...radical prostatectomy (RALP).
This was a prospective, single-centre retrospective cohort study. R-TAPP was conducted in 74 consecutive patients from September 2016 to March 2020. With the exception of women and patients who underwent previous abdominal surgery, 70 patients were classified into two groups based on the absence or presence of PIH. Their data were retrospectively compared to those who had not undergone RALP.
The median operative time for the PIH group was longer compared to the non-PIH group. However, postoperative complications, including seroma formation, haematoma and surgical site infections, were not significantly different between the groups. The estimated blood loss was small, and hospitalisation duration was 1 day in all cases. Moreover, there were no hernia recurrences within the 90-day follow-up period in either group.
R-TAPP is a feasible and safe approach for inguinal hernia repair, even in patients who undergo RALP for prostate cancer.
A 57–year–old man with von Recklinghausen disease was referred to our hospital for melena and severe anemia. A double–balloon assisted enteroscopy revealed a protruding mass with central depression ...in the third portion of the duodenum. Moreover, contrast–enhanced CT revealed multiple enhancing tumors showing extramural growth, in the duodenum and small intestine. Based on the findings, the duodenal tumor was judged as being the likely source of the bleeding. The patient was then taken for elective partial duodenal resection, which revealed a hard, centrally depressed tumor with extramural growth, measuring 1.5 cm in diameter. In addition, multiple gastrointestinal stromal tumors(GISTs) showing extramural growth were seen throughout the length of the duodenum and small intestine. Histopathologic assessment identified the tumors as GISTs with very low–risk features. This case serves as an important reminder that the possibility of GISTs should be considered in patients with von Recklinghausen disease presenting with gastrointestinal bleeding.
An 87–year–old man who developed severe abdominal pain was diagnosed as having an intestinal perforation with an intraabdominal abscess based on CT findings. Thus, the patient underwent an emergent ...laparoscopic operation requiring a partial intestinal resection. However, the patient postoperatively had a relapse of the same symptoms. A second CT showed another abscess near the anastomosis. Thus, conservative management was performed. The patient was discharged, but he was later re–admitted with an abscess in another location. Moreover, another abscess required the patient to be hospitalized a third time. CT and intestinal endoscopy indicated a diagnosis of intestinal diverticulitis caused by multiple intestinal diverticula. However, the persistent symptoms required the patient to undergo laparoscopic surgery. The resected specimen revealed that a needle–like foreign body was in fact a wooden toothpick. This case serves as an important reminder to consider foreign bodies in investigations of all possible causes of intraabdominal abscess with a repeated history of abscess.
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