INTRODUCTION:Surgical site infections (SSIs) pose a significant burden in colorectal surgery. This study evaluated the advantages of triclosan-coated barbed sutures over conventional interrupted sutures for fascial closure. METHODS:We retrospectively compared patients undergoing colorectal surgery with fascial closure using either triclosan-coated barbed sutures (STF group) or conventional interrupted sutures (IS group). The primary outcome was the incidence of SSIs. Secondary outcomes included fascial closure time, postoperative pain, complications according to the Clavien-Dindo classification, length of hospital stay, and incisional hernia rates. RESULTS:Among the 199 patients, no significant difference in total SSI rates was observed between the groups (STF: 7.1% versus IS: 5.0%, P = 0.564), despite baseline differences between the groups. The STF group demonstrated significantly shorter fascial closure time (median: 6.8 min in STF versus 8.6 min in IS, P = 0.002) and was associated with a significantly lower postoperative pain score on postoperative day 3 (adjusted P = 0.013). The incisional hernia rate was similar between the groups (STF: 1.0% versus IS: 4.0%, P = 0.372). CONCLUSIONS:Triclosan-coated barbed sutures provide safety comparable to that of conventional IS group in colorectal surgery, with shorter fascial closure time and a lower pain score on postoperative day 3. These findings suggest potential benefits for patient comfort and early postoperative recovery, although they should be cautiously interpreted given the baseline imbalances between the groups.

The phenomenon that meal ingestion immediately increases colonic motility was at first referred to as the "gastrocolic reflex", but later changed to the "gastrocolonic response" because of the possible involvement of humoral mediators. This review aims to describe the various mechanisms providing stimuli that alter the gastrocolonic response by dividing it into 'cephalic', 'gastric', and 'intestinal' phases, just as the process of gastric acid secretion after feeding, for a better understanding of the gastrocolonic response. The gastrocolonic response occurs within minutes after feeding and continues for 30-120 min. Fat must be an important component of the ingested meal to induce the gastrocolonic response, but the role of carbohydrates and amino acids remains unclear. The cephalic phase of the gastrocolonic response exists, but the mechanism, including the role of brain-gut peptide ghrelin, remains largely undetermined. Mechanoreceptors and nociceptors of vagal afferents are involved in the gastric phase of GCR. Chemoreceptors in the duodenum play a role in the intestinal phase of GCR. The GCR was not observed in the extrinsically denervated colonic segment. Thus, the involvement of neural factors has been shown in all three "cephalic", "gastric", and "intestinal" phases of the gastrocolonic response. There has been no definitive evidence to show the involvement of humoral factors, but the humoral mechanism cannot be dismissed. The GCR was abnormal or diminished in patients with chronic constipation and diabetes mellitus. These results indicate that neural pathways, rather than humoral pathways, are important mediators of the gastrocolonic response.

The robotic approach improves the safety and effectiveness of gastric cancer surgery; however, it increases operative time. This study evaluated the effect of individualized adjustment of camera port positioning on short-term outcomes of robotic gastrectomy (RG). This study included consecutive patients who underwent RG for gastric cancer at our department between August 2019 and April 2025. Short-term outcomes were compared between RG with adjustment for camera port positioning at the height of the angle of Treitz using computed tomography images (A group, n = 30) and those without adjustment (NA group, n = 89). No significant differences were observed in patient characteristics between the groups; however, both operative and console times were significantly shorter in group A (both P < 0.001). The estimated blood loss and duration of postoperative stay were also lower in Group A, whereas the incidence of postoperative morbidity was similar. In a multivariate analysis, adjustment of the camera port was identified as an independent predictor of shortened operative time (odds ratio 0.039, P < 0.001). Individualized adjustment of camera port positioning could be useful for improving the short-term outcomes of RG, including reduction in operative time.

Distal gastrectomy is the most frequently performed procedure for gastric cancer. Gastric emptying after distal gastrectomy is generally considered to be accelerated due to resection of the antrum, pylorus, and duodenal bulb. Food residue, however, is frequently observed in the gastric remnant in patients after distal gastrectomy at the time of endoscopy after routine overnight fasting. This observation suggests delayed gastric emptying and conflicts with the general understanding of accelerated gastric emptying after distal gastrectomy. We searched for reports that evaluated the separate gastric emptying of liquids and solids with scintigraphy after distal gastrectomy in humans and also addressed the physiologic changes in gastric emptying after distal gastrectomy. Most all reports showed that gastric emptying of liquids after distal gastrectomy was accelerated compared to healthy controls, especially immediately after feeding. In contrast, some gastric emptying of solids was accelerated early after the meal ingestion, but thereafter emptying of solids remaining in the stomach was delayed beginning about 60 min after the meal in patients after distal gastrectomy. This delayed solid gastric emptying after distal gastrectomy was considered associated with food residue in the remnant stomach. We conclude that gastric emptying after distal gastrectomy was accelerated for liquids and solids soon after the meal ingestion but delayed for solids later than 60 min after the meal ingestion.

Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors, playing a critical role in both screening and clinical evaluation. More recently, its utility has expanded to therapeutic guidance, particularly with the advent of minimally invasive surgical techniques. Preoperative tattoo marking is commonly used for tumor localization; however, it poses challenges such as intraperitoneal ink scattering and difficulty in defining dissection planes in the lower rectum. To address these limitations, a new technology utilizing a near-infrared fluorescence clip placed preoperatively enables accurate intraoperative tumor localization. Intraoperative colonoscopy offers additional advantages, including real-time tumor localization, colonic irrigation, visualization of the proximal colon in obstructive cases, and assessment of anastomosis following colorectal resection. Notably, intraoperative colonoscopy allows for the immediate detection and management of complications, such as anastomotic bleeding and leakage, potentially improving postoperative outcomes. Furthermore, advances in endoscopic resections, including endoscopic mucosal resection, endoscopic submucosal dissection, hybrid endoscopic submucosal dissection, and combined endoscopic laparoscopic surgery, have broadened the indications for endoscopic and endoscopy-guided full-thickness resection of colorectal tumors. These approaches are increasingly applicable beyond conventional colorectal neoplasms and show promise in managing appendiceal tumors as well.

Background/objectives: Strangulated small bowel obstruction (SSBO) is a life-threatening condition that often requires emergency surgery. Identifying preoperative computed tomography (CT) findings indicative of bowel resection may improve diagnostic accuracy and inform surgical decision-making. Methods: We retrospectively analyzed patients diagnosed with SSBO who underwent contrast-enhanced abdominal CT and emergency surgery between January 2022 and April 2024. Patients were divided into two groups according to the surgical outcomes: those who underwent bowel resection and those who did not. CT images were independently reviewed by a radiologist blinded to surgical outcomes, and CT findings were compared between the resection and non-resection groups. Variables significant in the between-group comparisons (p < 0.05) were entered into a multivariable logistic regression to identify indicators for bowel resection. Results: Fifty-two patients were identified, sixteen (30.8%) of whom required bowel resection. The most reliable indicator was absent bowel wall enhancement on contrast-enhanced CT, with a sensitivity of 75.0% and specificity of 86.1%. It was also independently associated with bowel resection [odds ratio (OR) 19.7; 95% confidence interval: 3.43–113.4]. In contrast, ascites, beak sign, and mesenteric edema were commonly observed in both groups and lacked specificity. Of note, bowel resection was avoided in 5 of 17 patients with absent bowel wall enhancement based on intraoperative assessment using indocyanine green (ICG) fluorescence imaging. Conclusions: Absent bowel wall enhancement on contrast-enhanced CT is an independent preoperative indicator for bowel resection in SSBO.

Ischemic enteritis (IE) is characterized by blood flow insufficient to meet metabolic demands. The incidence of IE is increasing owing to the aging population and advancements in radiographic and endoscopic diagnostics. Many patients eventually require surgical management, indicating an irreversible and progressive pathology. Therefore, clear definitions, early diagnosis, and tailored treatments are crucial. Herein, we report three patients with ileal strictures caused by IE who were successfully treated with surgical resection. In all three cases, the stricture was segmental and located within 50 cm from the ileocecal valve, which is a characteristic radiological feature of IE. Histological analysis revealed segmental, circumferential ulcers with inflammatory-cell infiltration, and fibrosis, although the presentation may vary with the disease phase. Clinicians and surgeons should consider IE in patients with small bowel obstruction and segmental strictures without apparent acute ischemia, especially in older patients with severe comorbidities such as hypertension, diabetes, hyperlipidemia, or thromboembolic diseases.

This study presents a case of a 72-year-old man diagnosed with non-small cell lung cancer (cT4N0M0) referred to our hospital for possible surgical treatment of a solitary nodule detected in the mesorectum. The patient had received combined chemoradiotherapy and achieved a complete response 13 months before the presentation. On examination, the mesorectal nodule was incidentally detected during surveillance computed tomography, and the maximum standardized uptake value of the nodule was 10.3. Because of the potential malignancy and need for en-bloc resection of the nodule, we performed laparoscopically assisted high anterior resection of the rectum. The postoperative course was uneventful. Notably, while pathological examination revealed that the mesorectal nodule comprised an intravenous organized thromboembolism, malignancy was not observed. These findings suggest that although positron emission tomography/computed tomography with 18F-fluorodeoxyglucose is useful for the diagnosis of malignant diseases, surgical resection might be the most reliable option for complex cases such as ours.

Introduction: The peribiliary gland is an accessory bile duct gland. Hyperplasia of these tissues may lead to elevation of the mucosa in the bile ducts and bile duct stenosis. We herein report a case of peribiliary gland hyperplasia that required preoperative differentiation from bile duct cancer, with a discussion of the literature. Case Presentation: The patient had an adenomatous lesion in the ascending colon that was difficult to treat endoscopically; therefore, surgery was planned. Preoperative abdominal ultrasonography revealed a bile duct tumor, and endoscopic ultrasonography revealed a mass lesion around the confluence of the cystic duct. Computed tomography revealed localized wall thickening in the middle bile duct, and the upstream bile ducts were slightly dilated. In addition, continuous thickening of the bile duct wall from the gallbladder to the confluence of the cystic duct was observed. No distant metastases, such as liver metastases, or nearby enlarged lymph nodes were observed. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography revealed a papillary-like elevated lesion in the bile duct near the confluence of the cystic duct, and a biopsy and bile cytology from the same area showed no malignant findings. As a result, the possibility that the patient had gallbladder or bile duct cancer could not be ruled out; therefore, a policy of surgery together with the ascending colon tumor was decided after receiving sufficient informed consent. During surgery, the patient underwent extrahepatic bile duct resection, reconstruction of the biliary tract using the Roux-en-Y method, and right hemicolectomy. Both duodenal and hilar bile duct transects were subjected to a fast frozen section analysis during surgery, and the results were negative for cancer. A histopathological examination of the resected specimen revealed no malignant findings in the bile duct lesions, and a diagnosis of peribiliary gland hyperplasia with chronic inflammatory cell infiltration and fibrosis of the extrahepatic bile duct wall was made. Conclusions: We encountered a case of peribiliary gland hyperplasia that was difficult to distinguish from bile duct cancer.

Emerging evidence has shown remarkable advances in the multimodal treatment of esophageal squamous-cell carcinoma. Despite these advances, the oncological outcomes for advanced esophageal cancer remain controversial due to the frequent observation of local recurrence in the regional or other lymph nodes and distant metastasis after curative treatment. For cases of locoregional recurrence in the cervical lymph nodes alone, salvage surgery with lymph node dissection generally provides a good prognosis. However, if recurrence occurs in multiple regions, the oncological efficacy of surgery may be limited. Radiotherapy/chemoradiotherapy can be employed for unresectable or recurrent cases, as well as for selected cases in neo- or adjuvant settings. Dose escalation and toxicity are potential issues with conventional three-dimensional conformal radiotherapy; however, more precise therapeutic efficacy can be obtained using technical modifications with improved targeting and conformality, or with the use of proton beam therapy. The introduction of immune checkpoint inhibitors, including pembrolizumab or nivolumab, in addition to chemotherapy, has been shown to improve the overall survival in unresectable, advanced/recurrent cases. For patients with lymph node recurrence in multiple regions, chemotherapy (5-fluorouracil [5-FU] plus cisplatin) and combination therapy with nivolumab and ipilimumab have shown comparable oncological efficacy. Further prospective studies are needed to improve the treatment outcomes in patients with esophageal cancer with locoregional recurrence.

TECHNIQUE:The Endoscopic Mini- or Less-open Sublay operation (EMILOS) is a transhernial repair that allows endoscopic dissection and mesh placement in the retrorectus/retromuscular space, and simultaneous transversus abdominis release (TAR) for larger hernias. The operative summary is as follows. 1 A 7-cm longitudinal skin incision was made immediately above the hernial orifice. 2 The hernial sac was circumferentially dissected to the border of the defect, and the abdomen was opened. 3 The posterior rectus sheath (PRS) was incised approximately 5 mm lateral to the medial border of the rectus sheath to enter the retrorectus space. 4 Exploratory laparoscopy was performed, and the peritoneum was closed. 5 A single port platform was attached to the wound, and the abdominal wall was insufflated. The retrorectal space was dissected laterally to the outer edge of the rectus abdominis muscle. The linea alba was incised at least 5 cm cranially and caudally from the border of the hernia defect to obtain sufficient mesh overlap. 6 The TAR was added to the left side to facilitate medial advancement of the PRS. (7) The PRS was approximated with continuous suture. A self-gripping mesh was trimmed and implanted in the retrorectus space. The mesh was secured with 3-0 absorbable sutures (8) A closed-suction drain was placed on the mesh, and the wound was trimmed and closed.RESULTS:The postoperative course was uneventful. No recurrence was observed at 6-month follow-up.CONCLUSIONS:This technique may be advantageous because it allows minimal skin incision with physiological reconstruction of abdominal wall.

Lumbar hernia (LH) is a rare abdominal wall hernia that occurs within the anatomic boundaries of the 12th rib, iliac crest, external oblique muscles, erector spinae muscles, and vertebral column. Secondary LH after urological surgery is rare, and the limited evidence hinders consensus on optimal surgical treatment. Here, we present a case of laparoscopic intraperitoneal onlay mesh (IPOM) repair for a large, symptomatic secondary LH after retroperitoneoscopic nephrectomy (RN) with mid-term postoperative outcomes. A 58-year-old man presented with a bulge, pain, and discomfort in the right lumbar area. Three months earlier, he had undergone RN for clear cell carcinoma of the right kidney (pT3aN0M0: stage III). Computed tomography (CT) revealed a right LH with a 10 × 7 cm orifice containing the ascending colon. Considering the symptomatic LH and associated risk of bowel obstruction, laparoscopic surgery was performed eight months after the previous RN. Laparoscopic exploration revealed a 10 (transverse) × 7 (longitudinal) cm defect in the right lateral abdominal wall, with adhesion of the ascending colon. After exposing the hernia orifice, the defect was covered using a composite mesh (Ventralight™ST, BD, Franklin Lakes, NJ, USA). The mesh was trimmed to 16 (transverse) × 13 (longitudinal) cm in size and anchored to the abdominal wall using a single, full-thickness suture. Subsequently, nonabsorbable tacks (CapSure™, BD, Franklin Lakes, NJ, USA) were applied using the double-crown technique. The postoperative course was uneventful, except for the development of a subcutaneous seroma that resolved spontaneously within four months. Follow-up CT performed 36 months after the surgery revealed a slight mesh bulge. However, the patient remained in good physical condition without recurrent symptoms, including a bulge or discomfort. Laparoscopic IPOM repair for secondary LH after RN is safe and effective in alleviating symptoms and preventing recurrence in the mid-term follow-up period. This technique simplifies surgery by avoiding re-dissection of the retroperitoneal space.

Colonic metastasis from lung cancer is very rare and is typically associated with poor prognosis. Herein, we report the case of a patient who achieved intermediate-term survival using a multimodal treatment approach, including chemotherapy, immunotherapy, radiotherapy, and surgical resection for obstructive colonic metastasis from primary lung adenocarcinoma. A woman in her 50s presented with anemia and a positive fecal occult blood test. Computed tomography revealed a tumor in the right upper lobe of the lung with mediastinal lymphadenopathy and wall thickening in the transverse colon. Colonoscopy revealed a stricture involving 50

Abstract Background Polypharmacy is an escalating public health concern across various healthcare settings worldwide. We aimed to comprehensively investigate postoperative complications after laparoscopic surgery for colorectal cancer and explore their association with polypharmacy. As laparoscopic surgery is widespread, clarifying the association between polypharmacy and postoperative complications is clinically important. Methods We retrospectively surveyed the medical charts of adult inpatients who underwent laparoscopic surgery for colorectal cancer at Tohoku Medical and Pharmaceutical University Hospital between April 2019 and March 2023. Postoperative complications were determined using the Clavien–Dindo classification. We explored the factors related to postoperative complications and calculated the cut-off values for the number of medication ingredients. Results Among the 236 patients, 32 (13.6%) developed postoperative complications. On multivariable logistic regression analysis, the number of regularly used medication ingredients (odds ratio = 1.160, 95% confidence interval 1.050–1.270, p = 0.002) was identified as a factor related to postoperative complications. The identified cut-off value for complications was 10 ingredients. Patients using 10 or more ingredients had approximately 3.5 times higher occurrence of postoperative complications than those using fewer than 10 ingredients (33.3% vs. 9.3%, p < 0.001, Fisher’s exact test). Conclusions Our study comprehensively investigated postoperative complications and examined their association with polypharmacy. We found that the number of regularly used medication ingredients may be linked to complications following laparoscopic surgery for colorectal cancer. These findings have important implications for perioperative management and patient care, providing valuable insights that may influence clinical practices and enhance patient outcomes.

Colonic stenting has had a significant positive impact on the management of obstructive left-sided colon cancer (OLCC) in terms of both palliative treatment and bridge-to-surgery (BTS). Notably, many studies have convincingly demonstrated the effectiveness of stenting as a BTS, resulting in improvements in short-term outcomes and quality of life, safety, and efficacy in subsequent curative surgery, and increased cost-effectiveness, whereas the safety of chemotherapy after stenting and the long-term outcomes of stenting as a BTS are controversial. Several studies have suggested an increased risk of perforation in patients receiving bevacizumab chemotherapy after colonic stenting. In addition, several pathological analyses have suggested a negative oncological impact of colonic stenting. In contrast, many recent studies have demonstrated that colonic stenting for OLCC does not negatively impact the safety of chemotherapy or long-term oncological outcomes. The updated version of the European Society of Gastrointestinal Endoscopy guidelines released in 2020 included colonic stenting as a BTS for OLCC as a recommended treatment. It should be noted that the experience of endoscopists is involved in determining technical and clinical success rates and possibly oncological outcomes. This review discusses the positive and negative impacts of colonic stenting on OLCC treatment, particularly in terms of oncology.

Abstract Background Improvement of the preoperative inflammation, nutrition, and other systemic conditions may reduce surgical complications and improve the prognosis of cancer. The usefulness of preoperative nutritional therapy and rehabilitation has recently been discussed. We created a novel program of preoperative rehabilitation and nutritional support to improve postoperative outcomes. We examined the nutritional status and blood electrolyte predisposition before and after this program. Methods Thirty five patients who underwent esophagectomy for esophageal cancer. These patients performed muscle strengthening exercise and received jelly beverage containing branched-chain amino acids immediately after rehabilitation and immune-modulating liquid diets for 7 consecutive days before surgery. Nutritional guidance was provided by a dietitian, who set a daily energy target of 30 kcal/kg and a protein target of 1.2 g/kg. Upper and lower limb strength training was performed with a physical therapist. Blood biochemical data on nutrition such as serum Alb, PreAlb, CRP, levels were compared after preoperative support. Results Thirty five patients who underwent esophagectomy for esophageal cancer in this period and evaluate their blood and serum samples. The average age of the patients was 66 years, 29 men and 6 women. Serum Alb level was 4.01 ± 0.4 g/dl before admission and 3.74 ± 0.35 g/dl the day before surgery (p = 0.04), and serum transthyretin level was unchanged from 28.9 ± 5.5 mg/dl to 26.1 ± 4.75 mg/dl. Serum CRP level tended to decrease from O.23 ± 0.528 mg/dl before admission to 0.14 ± 0.23 mg/dl the day before surgery. Other index of nutritional status did not change significantly before or after the program. Improvements in preoperative inflammation and nutrition are expected to decrease surgical complications and contribute to cancer prognosis. Our study and intervention in the present study may have decreased inflammation, although it was not a clear objective improvement in nutritional status. The short duration of the intervention may have prevented a significant difference. A less prolonged hospitalization is not realistic and the most effective nutritional rehabilitation intervention should be devised in the future.

Patients with inflammatory bowel diseases (IBDs), such as ulcerative colitis and Crohn's disease, have an increased risk of developing colorectal cancer (CRC). Although advancements in endoscopic imaging techniques, integrated surveillance programs, and improved medical therapies have contributed to a decreased incidence of CRC in patients with IBD, the rate of CRC remains higher in patients with IBD than in individuals without chronic colitis. Patients with IBD-related CRCs exhibit a poorer prognosis than those with sporadic CRCs, owing to their aggressive histological characteristics and lower curative resection rate. In this review, we present an updated overview of the epidemiology, etiology, risk factors, surveillance strategies, treatment recommendations, and prognosis of IBD-related CRCs.

An ileostomy is associated with multiple complications that may frequently or persistently affect the life of ostomates. All healthcare professionals should have knowledge of the diagnosis, treatment, and prevention of ileostomy complications. Peristomal dermatitis is caused by watery and highly alkaline effluent. Skin protective products are typically used for local treatment. Ischemia/necrosis occurs due to insufficient arterial blood supply. Retraction is seen in patients with a bulky mesentery and occurs following ischemia. Convex stoma appliances can be used for skin protection against fecal leakage. Small bowel obstruction (SBO) is common and occurs only at the stoma site. Trans-stomal decompression is most effective in these cases. High output stoma (HOS) is defined as a condition when the output exceeds 1,000- 2,000 ml/day, lasting for one to three days. Treatment includes intravenous fluid and electrolyte resuscitation followed by restriction of hypotonic fluid and the use of antimotility (and antisecretory) drugs. Stomal prolapse is a full -thickness protrusion of an inverted bowel. Manual reduction is attempted initially, whereas emergency bowel resection may be needed for incarcerated cases. A parastomal hernia (PSH) is an incisional hernia of the stoma site. Surgery is considered in cases of incarceration, but most cases are manageable with non-surgical treatment.