title: Case series of intra-abdominal adhesions induced by artificial ulceration after endoscopic submucosal dissection before additional laparoscopic gastrectomy.
abstract: BACKGROUND
  As endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) increases, increasing numbers of patients require additional gastrectomy with lymph node dissection after noncurative ESD. ESD may cause intra-abdominal adhesions, making additional laparoscopic gastrectomy technically difficult.
  
  
  OBJECTIVE
  To assess the relation of the presence of intra-abdominal adhesions and ESD treatment to allow safe laparoscopic gastrectomy.
  
  
  METHODS
  Case series from a retrospective review of additional gastrectomy after noncurative ESD.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Eight of 333 patients receiving ESD at Oita University Faculty of Medicine from 1999 to 2008 underwent additional laparoscopic gastrectomy because of noncurative ESD.
  
  
  METHODS
  Intra-abdominal adhesions were evaluated by using an adhesion scoring system (0-3 points) and clinicopathologic findings, including artificial ulcerations after ESD.
  
  
  RESULTS
  All patients successfully underwent laparoscopic gastrectomy within 1 to 2 months after ESD. Three patients with large artificial ulceration (>25 mm) after ESD treatment had severe intra-abdominal adhesions (adhesion score > or =2). These patients tended to have a large blood loss and long operation times during laparoscopic gastrectomy. Despite the 2-month interval from ESD to laparoscopic gastrectomy, ulcerations in these patients were at healing stage with inflammatory cells infiltrating the muscular deep layer.
  
  
  CONCLUSIONS
  A retrospective study.
  
  
  CONCLUSIONS
  After ESD with large artificial ulceration (>25 mm), the presence of intra-abdominal adhesions complicating additional laparoscopic gastrectomy was often observed.
authors.affiliation: Department of Gastroenterological Surgery, Oita University Faculty of Medicine, Oita, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Akagi
authors.forename: Norio
authors.initials: N
authors.lastname: Shiraishi
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Hiroishi
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Etoh
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yasuda
authors.forename: Seigo
authors.initials: S
authors.lastname: Kitano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000009:adverse effects*; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010532:Peritoneal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013276:Stomach Ulcer / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D000267:Tissue Adhesions; D016896:Treatment Outcome