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Yoshihiro Kakeji - One of the best experts on this subject based on the ideXlab platform.
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evaluation of the venous drainage pattern of the splenic flexure by preoperative three dimensional computed tomography
Asian Journal of Endoscopic Surgery, 2019Co-Authors: Akira Arimoto, Takeru Matsuda, Tetsu Nakamura, Yasuo Sumi, Kimihiro Yamashita, Hiroshi Hasegawa, Satoshi Suzuki, Yoshihiro KakejiAbstract:INTRODUCTION: Anatomical evaluation of the splenic flexure Vein is essential for complete mesoColic excision with central vascular ligation when treating patients with splenic flexure cancer. Although there have been several studies relating to the arterial branches of the splenic flexure, very limited data are available regarding the variation in venous anatomy in this region. METHODS: Sixty-six patients with colorectal cancer who underwent preoperative 3-D CT between April 2016 and April 2017 were included in this retrospective study. The pattern of the venous drainage of the splenic flexure and its association with the inferior border of the pancreas were evaluated. RESULTS: The inferior mesenteric Vein flowed into the splenic Vein in 32 patients (48.5%), into the superior mesenteric Vein in 27 patients (40.9%), and into the confluence of splenic Vein and superior mesenteric Vein in 7 patients (10.6%). The splenic flexure Vein joined the inferior mesenteric Vein in 62 patients (93.9%), the splenic Vein in 2 patients (3.0%), and the Middle Colic Vein in 2 patients (3.0%). The splenic flexure Vein flowed into the inferior mesenteric Vein below the level of the inferior border of the pancreas in 58 patients (90.6%) and above it in 4 patients (6.3%). CONCLUSION: Preoperative evaluation of the venous pattern of the splenic flexure on 3-D CT is useful before complete mesoColic excision with central vascular ligation to avoid intraoperative bleeding during splenic flexure cancer surgery.
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evaluation of the venous drainage pattern of the splenic flexure by preoperative three dimensional computed tomography
Asian Journal of Endoscopic Surgery, 2019Co-Authors: Akira Arimoto, Takeru Matsuda, Tetsu Nakamura, Yasuo Sumi, Kimihiro Yamashita, Hiroshi Hasegawa, Satoshi Suzuki, Yoshihiro KakejiAbstract:INTRODUCTION: Anatomical evaluation of the splenic flexure Vein is essential for complete mesoColic excision with central vascular ligation when treating patients with splenic flexure cancer. Although there have been several studies relating to the arterial branches of the splenic flexure, very limited data are available regarding the variation in venous anatomy in this region. METHODS: Sixty-six patients with colorectal cancer who underwent preoperative 3-D CT between April 2016 and April 2017 were included in this retrospective study. The pattern of the venous drainage of the splenic flexure and its association with the inferior border of the pancreas were evaluated. RESULTS: The inferior mesenteric Vein flowed into the splenic Vein in 32 patients (48.5%), into the superior mesenteric Vein in 27 patients (40.9%), and into the confluence of splenic Vein and superior mesenteric Vein in 7 patients (10.6%). The splenic flexure Vein joined the inferior mesenteric Vein in 62 patients (93.9%), the splenic Vein in 2 patients (3.0%), and the Middle Colic Vein in 2 patients (3.0%). The splenic flexure Vein flowed into the inferior mesenteric Vein below the level of the inferior border of the pancreas in 58 patients (90.6%) and above it in 4 patients (6.3%). CONCLUSION: Preoperative evaluation of the venous pattern of the splenic flexure on 3-D CT is useful before complete mesoColic excision with central vascular ligation to avoid intraoperative bleeding during splenic flexure cancer surgery.
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Cranial-to-caudal approach for radical lymph node dissection along the surgical trunk in laparoscopic right hemicolectomy.
Surgical endoscopy, 2014Co-Authors: Takeru Matsuda, Takeshi Iwasaki, Masaaki Mitsutsuji, Kenro Hirata, Yoko Maekawa, Tomoko Tanaka, Etsuji Shimada, Yoshihiro KakejiAbstract:Complete mesoColic excision with central vascular ligation is considered to contribute to superior oncological outcomes after colon cancer surgery [1]. For advanced right-sided colon cancer, this surgery sometimes requires lymph node (LN) dissection along the superior mesenteric Vein (SMV), with division of the Middle Colic vessels, or their right branches, at origin [2]. Here, we present cranially approached radical LN dissection along the surgical trunk during laparoscopic right hemicolectomy. The omental bursa is first opened wide, and the gastroColic trunk of Henle is exposed, using the right gastroepiploic vessels and the accessory right Colic Vein (ARCV) as landmarks. After division of ARCV, SMV and Middle Colic Vein (MCV) are identified. After dividing MCV at its root, LN dissection along SMV is conducted in a cranial-to-caudal manner. Concurrently, the Middle Colic artery, or its right branch, is exposed and divided at origin. The transverse colon is then raised ventrally, and LN dissection along SMV using a cranial-to-caudal approach is again performed. The ileoColic and right Colic vessels are divided at origin. The ascending and transverse mesocolon, including the pedicles, are then separated from the retroperitoneal tissues, pancreatic head, and duodenum, using a medial approach. The key characteristics in this procedure consist of easy access to pancreas, early division of ARCV and Middle Colic vessels at origin, and easy dissection along SMV. We performed a laparoscopic colectomy using this approach for 18 patients with right-sided colon cancer. The mean operative time and blood loss were 288 min and 83 ml, respectively. The mean number of harvested LNs was 24. There were 6 cases with positive LN metastasis. There were no recurrent cases at a median follow-up period of 24 months. We consider this approach to be safe and useful for radical LN dissection along SMV for right-sided colon cancers.
Toshitaka Tsukiyama - One of the best experts on this subject based on the ideXlab platform.
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Collateral venous pathways in the transverse mesocolon and greater omentum in patients with pancreatic disease.
American Journal of Roentgenology, 2004Co-Authors: Kenji Ibukuro, Rei Ishii, Hozumi Fukuda, Shoko Abe, Toshitaka TsukiyamaAbstract:OBJECTIVE. The purpose of this study was to describe the radiologic findings of the collateral venous pathways in the transverse mesocolon and the greater omentum associated with pancreatic diseases and to correlate these venous pathways and the accompanying arterial anatomy.CONCLUSION. The collateral pathway in the transverse mesocolon consists of the inferior mesenteric Vein, left transverse Colic Vein, marginal Vein of the transverse colon, and Middle Colic Vein. The pathway in the greater omentum consists of anastomosis of the left and right epiploic Veins deriving from the gastroepiploic Vein. The former pathway is the vena comitans of Riolan's arch and the latter is the vena comitans of the arch of Barkow.
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Peripancreatic Veins on thin-section (3 mm) helical CT.
AJR. American journal of roentgenology, 1996Co-Authors: Kenji Ibukuro, Toshitaka Tsukiyama, K Mori, Inoue YAbstract:The purpose of this study was to evaluate thin-section helical CT for the frequency of visualization of the peripancreatic Veins, the venous anatomy at the head of the pancreas, and variations of the venous anatomy.We performed 30-sec helical CT of the pancreas with one breath-hold and a 3-mm scanning collimation in 50 patients. The scan was started 60 sec after injection of an i.v. contrast medium at the rate of 2 ml/sec (total amount of contrast medium, 100 ml). The axial scan data were reviewed for the following information: the frequency of CT visualization of the peripancreatic Veins (anterior superior pancreaticoduodenal Vein, first jejunal Vein, gastroColic trunk, inferior mesenteric Vein, left gastric Vein, Middle Colic Vein, posterior superior pancreaticoduodenal Vein, right Colic Vein, and right gastroepipolic Vein) and the anatomic relationship between the large portal venous system (portal Vein, superior mesenteric Vein, and splenic Vein) and its tributaries.The frequency of visualization on C...
Kenji Ibukuro - One of the best experts on this subject based on the ideXlab platform.
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Collateral venous pathways in the transverse mesocolon and greater omentum in patients with pancreatic disease.
American Journal of Roentgenology, 2004Co-Authors: Kenji Ibukuro, Rei Ishii, Hozumi Fukuda, Shoko Abe, Toshitaka TsukiyamaAbstract:OBJECTIVE. The purpose of this study was to describe the radiologic findings of the collateral venous pathways in the transverse mesocolon and the greater omentum associated with pancreatic diseases and to correlate these venous pathways and the accompanying arterial anatomy.CONCLUSION. The collateral pathway in the transverse mesocolon consists of the inferior mesenteric Vein, left transverse Colic Vein, marginal Vein of the transverse colon, and Middle Colic Vein. The pathway in the greater omentum consists of anastomosis of the left and right epiploic Veins deriving from the gastroepiploic Vein. The former pathway is the vena comitans of Riolan's arch and the latter is the vena comitans of the arch of Barkow.
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Peripancreatic Veins on thin-section (3 mm) helical CT.
AJR. American journal of roentgenology, 1996Co-Authors: Kenji Ibukuro, Toshitaka Tsukiyama, K Mori, Inoue YAbstract:The purpose of this study was to evaluate thin-section helical CT for the frequency of visualization of the peripancreatic Veins, the venous anatomy at the head of the pancreas, and variations of the venous anatomy.We performed 30-sec helical CT of the pancreas with one breath-hold and a 3-mm scanning collimation in 50 patients. The scan was started 60 sec after injection of an i.v. contrast medium at the rate of 2 ml/sec (total amount of contrast medium, 100 ml). The axial scan data were reviewed for the following information: the frequency of CT visualization of the peripancreatic Veins (anterior superior pancreaticoduodenal Vein, first jejunal Vein, gastroColic trunk, inferior mesenteric Vein, left gastric Vein, Middle Colic Vein, posterior superior pancreaticoduodenal Vein, right Colic Vein, and right gastroepipolic Vein) and the anatomic relationship between the large portal venous system (portal Vein, superior mesenteric Vein, and splenic Vein) and its tributaries.The frequency of visualization on C...
Toshiyuki Unno - One of the best experts on this subject based on the ideXlab platform.
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Impact of portal Vein resection with splenic Vein reconstruction after pancreatoduodenectomy on sinistral portal hypertension: Who needs reconstruction?
Surgery, 2018Co-Authors: Masayuki Tanaka, Hiromichi Ito, Yoshihiro Ono, Kiyoshi Matsueda, Yoshihiro Mise, Takeaki Ishizawa, Yosuke Inoue, Yu Takahashi, Makiko Hiratsuka, Toshiyuki UnnoAbstract:Background Resection of the porto-mesenterico-splenic confluence is at times necessary during pancreatoduodenectomy with portal Vein resection for pancreatic cancer. Although splenic Vein ligation can cause sinistral portal hypertension, the incidence of clinically relevant sinistral portal hypertension remains unknown, and the roles of the preservation of potential collateral Veins and splenic Vein reconstruction are controversial. Methods Patients with pancreatic cancer who underwent pancreatoduodenectomy with porto-mesenterico-splenic confluence resection were assessed for incidence of development of varices by computed tomography at 6 months after pancreatoduodenectomy. We evaluated the risk factors for sinistral portal hypertension and the impact of splenic Vein reconstruction on sinistral portal hypertension. Results Of the 118 patients who underwent pancreatoduodenectomy with porto-mesenterico-splenic confluence resection, 31 (26%) underwent splenic Vein reconstruction, 44 patients (37%) developed gastroesophageal varices, and 5 (11%) experienced varix rupture. Sacrifice of all 3 potential collateral Veins (what we refer to as the critical Veins: left gastric Vein, Middle Colic Vein, and superior right Colic Vein arcade) and absence of any spontaneous splenorenal shunt had a substantial impact on formation of varices. The risk of variceal formation could be stratified based on the number of preserved critical Veins, and patent splenic Vein reconstruction was associated with a decreased incidence of varices (60% versus 100%, P = .018) among the patients without preservation of the critical Veins. In contrast, patients with multiple intact critical Veins developed no varices, regardless of splenic Vein reconstruction. Conclusions Sinistral portal hypertension is not uncommon after pancreatoduodenectomy with porto-mesenterico-splenic confluence resection, and the number of preserved critical Veins helps to predict the risk of sinistral portal hypertension. Thus, the indication for splenic Vein reconstruction should be tailored according to individual risk factors.
Hiroshi Shimada - One of the best experts on this subject based on the ideXlab platform.
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Successful pancreatoduodenectomy for carcinoma of the ampulla of vater after esophagectomy with remnant gastrectomy.
Hepato-gastroenterology, 2005Co-Authors: Yasuhiko Nagano, Hitoshi Sekido, Kenichi Matsuoi, Kyoko Ohtsuki, Katsuya Gorai, Chikara Kunisaki, Hideyuki Ike, Toshio Imada, Hiroshi ShimadaAbstract:A 59-year-old man was admitted to our hospital because his serum hepatobiliary enzymes were elevated on the medical check-up in September 2003. In his past history, he had undergone distal gastrectomy for a gastric adenoma 17 years before. Furthermore, he had undergone subtotal esophagectomy with remnant gastrectomy, the right colon and ileum were used for the reconstruction, and a cervical esophago-ileostomy and an abdominal colo-duodenostomy were made in the fashion of an interposition. Duodenoscopy was performed and showed the protruded lesion of the ampulla of Vater, biopsied specimens from this tumor revealed adenocarcinomas. Accordingly, we performed pancreaticoduodenectomy with regional lymph nodes dissection. The problem in this case was that the rt Middle Colic artery (MCA), and the Middle Colic Vein (MCV) tend to be injured because these vessels are situated near the caudal region of the pancreas. We were able to identify the superior mesenteric Vein (SMV) safely due to approaching this Vein from the flank and mobilizing the duodenum, dissecting behind the mesenteric trunk from right to left. Double cancer of the ampulla of Vater and the esophagus are extremely rare, with only 4 cases reported. And we recommended the use of the dorsal approach to the SMV to avoid injuring the MCV such as in this case.
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Venous Anatomy of the Right Colon
Diseases of the Colon & Rectum, 2002Co-Authors: Shigeki Yamaguchi, Hiroya Kuroyanagi, Jeffrey W. Milsom, Richard Sim, Hiroshi ShimadaAbstract:PURPOSE: This study was designed to describe the precise venous anatomy of the right colon, which is especially important for laparoscopic right hemicolectomy. METHODS: Fifty-eight adult cadavers were dissected to define the three major venous tributaries of the right colon: the ileoColic Vein, right Colic Vein, and Middle Colic Vein. Two or three Middle Colic Veins were often present, and the biggest one was designated as the main Middle Colic Vein. The Middle Colic Vein and the right Colic Vein occasionally formed a common trunk with the right gastroepiploic Vein and/or the pancreaticoduodenal Vein. This common trunk was defined as the gastroColic trunk. RESULTS: All 58 cadavers had a single ileoColic Vein. All of the ileoColic Veins drained into the superior mesenteric Vein. The right Colic Vein was absent in 56.9 percent (33/58), and the other 43.1 percent had a single right Colic Vein. The right Colic Vein joined the superior mesenteric Vein directly in 56 percent (14/25) and the gastroColic trunk in 44 percent (11/25). The Middle Colic Vein was the most variable. A single Middle Colic Vein was present in 37.9 percent (22/58), 2 Middle Colic Veins were present in 50 percent (29/58), and 3 Middle Colic Veins were present in 12.1 percent (7/58). The main Middle Colic Vein drained into the superior mesenteric Vein directly in 84.5 percent (49/58), whereas 12.1 percent (7/58) drained into the gastroColic trunk. In two cadavers, there was anomalous drainage of the main Middle Colic Vein to the splenic Vein and the inferior mesenteric Vein. Forty-three accessory Middle Colic Veins were present in total. These drained into the superior mesenteric Vein in 17 cadavers and into the gastroColic trunk in 23. The gastroColic trunk was present in 69 percent (40/58), being formed with the right Colic Vein in 27.5 percent (11/40; 1 was together with an accessory Middle Colic Vein) and with the Middle Colic Vein in 75 percent (30/40; 7 with the main Middle Colic Vein, 23 with the accessory Middle Colic Vein). CONCLUSION: Venous anatomy of the right colon is highly variable. It is especially important to recognize the lack of direct drainage of the right Colic Vein to the superior mesenteric Vein and the high frequency of the presence of plural Middle Colic Veins and the gastroColic trunk.
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Venous anatomy of the right colon: precise structure of the major Veins and gastroColic trunk in 58 cadavers.
Diseases of the colon and rectum, 2002Co-Authors: Shigeki Yamaguchi, Hiroya Kuroyanagi, Jeffrey W. Milsom, Richard Sim, Hiroshi ShimadaAbstract:PURPOSE: This study was designed to describe the precise venous anatomy of the right colon, which is especially important for laparoscopic right hemicolectomy. METHODS: Fifty-eight adult cadavers were dissected to define the three major venous tributaries of the right colon: the ileoColic Vein, right Colic Vein, and Middle Colic Vein. Two or three Middle Colic Veins were often present, and the biggest one was designated as the main Middle Colic Vein. The Middle Colic Vein and the right Colic Vein occasionally formed a common trunk with the right gastroepiploic Vein and/or the pancreaticoduodenal Vein. This common trunk was defined as the gastroColic trunk. RESULTS: All 58 cadavers had a single ileoColic Vein. All of the ileoColic Veins drained into the superior mesenteric Vein. The right Colic Vein was absent in 56.9 percent (33/58), and the other 43.1 percent had a single right Colic Vein. The right Colic Vein joined the superior mesenteric Vein directly in 56 percent (14/25) and the gastroColic trunk in 44 percent (11/25). The Middle Colic Vein was the most variable. A single Middle Colic Vein was present in 37.9 percent (22/58), 2 Middle Colic Veins were present in 50 percent (29/58), and 3 Middle Colic Veins were present in 12.1 percent (7/58). The main Middle Colic Vein drained into the superior mesenteric Vein directly in 84.5 percent (49/58), whereas 12.1 percent (7/58) drained into the gastroColic trunk. In two cadavers, there was anomalous drainage of the main Middle Colic Vein to the splenic Vein and the inferior mesenteric Vein. Forty-three accessory Middle Colic Veins were present in total. These drained into the superior mesenteric Vein in 17 cadavers and into the gastroColic trunk in 23. The gastroColic trunk was present in 69 percent (40/58), being formed with the right Colic Vein in 27.5 percent (11/40; 1 was together with an accessory Middle Colic Vein) and with the Middle Colic Vein in 75 percent (30/40; 7 with the main Middle Colic Vein, 23 with the accessory Middle Colic Vein). CONCLUSION: Venous anatomy of the right colon is highly variable. It is especially important to recognize the lack of direct drainage of the right Colic Vein to the superior mesenteric Vein and the high frequency of the presence of plural Middle Colic Veins and the gastroColic trunk.