International Surgery Volume 102: Issue 5-6

Two of the most magical words in the English language are “thank you,” as these words convey a sincere appreciation to those addressed for all that they do, in this case, for International Surgery.

As indicated in my most recent Editorial Letter, we are celebrating the 80^th Anniversary of the existence of International Surgery! Being a fully functional journal in the global scientific and medical publishing world since 1938 is not only noteworthy, but also remarkable. Eighty years is a testimony to being willing to change as the scientific and medical publishing norms change,

During fiscal crisis there was a period of shortage of staplers in our hospital, which drove us to manual suturing of bronchi and pulmonary vessels during major lung resections. We present our experience during that period in comparison to a subsequent period when staplers became available again. A total of 256 lobectomies and 78 pneumonectomies using manual suturing (group A) were performed between September 2009 and September 2010, and were compared regarding surgical outcome with 248 lobectomies and 60 pneumonectomies using staplers (group B), performed between September 2011 and September 2012. Although we did not observe statistically significant differences but only a trend toward shorter operative time, for both lobectomies (P = 0.21) and pneumonectomies (P = 0.31) we actually noted savings of 41 and 47 minutes, respectively, in operative time using staplers (group B), in comparison with manual suturing (group A). We also observed a trend toward lower morbidity rates in group B patients who underwent lobectomy (10.48%) and pneumonectomy (20%) versus group A patients who underwent lobectomy (15.62%) and pneumonectomy (30.76%); we did not observe any substantial differences in the other surgical outcome variables, in patients' demographic, comorbidities, or in anatomic allocation of surgical procedures performed. The use of staplers offers safety with secure bronchial or vascular sealing, as well as reduction of operative time. Their unavailability at an interval during fiscal crisis, although it did not affect surgical outcome, revealed their usefulness and value.

Total pelvic exenteration (TPE) may be the only curative procedure for locally advanced rectal gastrointestinal stromal tumor (GIST) that is contiguous with the adjacent organs and pelvic wall. There is no previous report of laparoscopic TPE for advanced rectal GIST. Here, we describe our experience of performing laparoscopic TPE on a locally advanced rectal GIST after neoadjuvant imatinib chemotherapy. A 62-year-old Japanese man was diagnosed with locally advanced rectal GIST that was contiguous with the seminal vesicles, prostate, and left pelvic sidewall. He received imatinib mesylate for 5 months, after which the mass had shrunk but was still contiguous with adjacent organs. We therefore needed to perform TPE, and we accomplished the operation laparoscopically. The total operative time was 540 minutes and estimated blood loss was 280 mL. There were no intraoperative complications and not required conversion to open surgery. The patient had his first stool on the first postoperative day and discharged on the 21st postoperative day with no major complication. Pathologic examination of the resected specimen revealed negative margins. The patient had further adjuvant imatinib chemotherapy and had no recurrence for 20 months postoperatively. Laparoscopic TPE appears to be minimally invasive surgery and safe in the present case of rectal GIST. This is the first report of a case in the world that underwent laparoscopic TPE for advanced rectal GIST.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a vascular disorder of unknown etiology characterized by severe asthma, eosinophilia, and granulomatous vasculitis. It is sometimes associated with gastrointestinal lesions, although perforations are uncommon. Corticosteroids are commonly used in the treatment of patients with EGPA; however, they may impair tissue repair and induce fibrotic changes in the vascular intima, which can lead to vascular occlusion, ischemia, and perforation. The anti-inflammatory properties of corticosteroids may mask symptoms of gastroduodenal ulcers or other intra-abdominal conditions, which can lead to a delay in diagnosis. From January 1, 2001 to December 31, 2014, 71 patients underwent surgery for small intestinal perforations. Of these, 4 operations were performed on 3 patients with EGPA who were receiving corticosteroids. We retrospectively reviewed the clinical and pathologic features of these patients. All 3 patients with EGPA were men, with a mean age of 56 years. The length of resected intestine ranged from 10 to 60 cm. Histopathologic examination revealed ulcers and perforations of the small intestine associated with vasculitis, compatible with EGPA. All patients had an uneventful postoperative course. Patients with EGPA presenting with abdominal pain must be carefully evaluated for possible intestinal perforation, especially those receiving corticosteroid therapy.

Inadequacy of anterior-only fixation for reducible three-column injury of the subaxial cervical spine: case report

Yu-ying WuM.D.,

Po-Yuan ChenM.D.,

Kang LuPhD., and

I-Fan LinM.D.

Thank You to Authors and Reviewers

Major Lung Resections Using Manual Suturing Versus Staplers During Fiscal Crisis

Laparoscopic Total Pelvic Exenteration After Neoadjuvant Imatinib Therapy for Gastrointestinal Stromal Tumor of the Rectum: A Case Report

A Clinicopathologic Study of Small Intestinal Perforations in Patients With Eosinophilic Granulomatosis With Polyangiitis: A Series of 3 Patients

Health on the Net: Do Website Searches Return Reliable Health Information on Hemorrhoids and Their Treatment?

Objective:

Summary of background data:

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IgG4-Related Hashimoto's Thyroiditis of the Thyroid Gland

Total IVC Occlusion as an Unusual Cause of Acute Renal Failure After Orthotopic Liver Transplantation

Should We Perform Routine Upper Gastrointestinal Endoscopy Before Cholecystectomy?

Surgical Resection of Metachronous Lymph Node Metastasis From Hepatocellular Carcinoma: Three Case Reports and Review of the Literature

Better Long-Term Prognosis: Comparison Between Surgery and TACE as Initial Treatment for Operable Huge HCCs (≥10 cm) After More Than 5 Years of Follow Up

Presence of Aberrant Anatomy Is an Independent Predictor of Bile Duct Injury During Cholecystectomy

C-Reactive Protein Was an Early Predictor of Postoperative Infectious Complications After Pancreaticoduodenectomy for Pancreatic Cancer

Objective

Summary of Background Data

Methods

Results

Conclusions

A Case of Intracystic Papillary Neoplasm With an Associated Invasive Adenocarcinoma

Prediction of Postoperative Early Recurrence and Prognosis in Pancreatic Cancer Patients

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A Mediastinoscopic Approach With Bilateral Cervicopneumomediastinum in Radical Thoracic Esophagectomy

Significance of Splenectomy for Upper Gastric Carcinoma With Invasion to the Greater Curvature

Inadequacy of anterior-only fixation for reducible three-column injury of the subaxial cervical spine: case report

Lasers for Pulmonary Resections

miR-135a promotes tumor invasion by targeting BACH1 and GATA3 in gastric cancer

Treatment of Intertrochanteric Fractures in the Elderly with Minimally Invasive DAA for Hip Arthroplasty

Comparison of clinical outcomes between percutaneous transhepatic biliary drainage with local lithotripsy and ERCP alone for treating intrahepatic bile duct stones