Initial Experience with Laparoscopic Surgery for Treating Upper Gastrointestinal Disease / 대한내시경복강경외과학회지

PURPOSE: Performing laparoscopic surgery for upper gastrointestinal disease has gradually been increasing. The aim of this study is to review the initial experience with laparoscopic surgery for treating upper gastrointestinal diseases. METHODS: We retrospectively studied a total of 76 patients who underwent laparoscopic surgery for upper gastrointestinal disease from April 2003 to December 2008. The clinical features and surgical outcomes were analyzed. RESULTS: The types of upper gastrointestinal diseases that were treated by laparoscopic surgery were early gastric cancer (n=45), advanced gastric cancer (n=6), gastric submucosal tumor (n=14), duodenal ulcer stricture (n=5), duodenal ulcer perforation (n=2), superior mesenteric artery syndrome (n=2), gastroesophageal reflux (n=1) and dysphagia due to parkinsonism (n=1). There were 11 operative morbidities (14.5%), including 1 operative mortality (1.3%). CONCLUSION: Although this study shows the narrow range of indications for performing this laparoscopic procedure and the surgical experience is rather limited, laparoscopic surgery was applied for treating various upper gastrointestinal diseases. Based on this experience, surgeons should make efforts to improve the surgical outcomes.

Is the Yersinia enterocolitica Possible Infectious Agent in Acute Appendicitis?

PURPOSE: With increasing frequency, Yersinia enterocolitica is being recognized as an important bacterial cause of acute gastrointestinal infection with abdominal pain. In addition, the association of Y. enterocolitica infections with acute appendicitis has been suggested. This study was undertaken to ascertain whether Y. enterocolitica is a possible infectious agent in acute appendicitis. METHODS: Between December 2007 and April 2008, 162 patients who underwent appendectomy for presumed appendicitis, enrolled in this prospective study. After surgical excision of appendix, a portion of each specimen was cultured for Y. enterocolitica with highly selective media (Cefsulodin-Irgasan-Novobiocin agar). RESULTS: Pathologically, 150 of the patients had appendicitis and 12 patients had normal appendices. Only one of the 150 patients (0.7%) with appendicitis was found to be culture positive for Y. enterocolitica, while it was not detected from normal appendices. CONCLUSION: The authors were unable to implicate Y. enterocolitica as a major pathogen in acute appendicitis within the Seoul area. However, we thought there to be more need for investigation for association of Y. enterocolitica with acute appendicitis over a broader area and season.

Laparoscopic Resection of Benign Leiomyoma Arising from the Adrenal Gland / 대한내분비외과학회지

This report describes a case of a 55-year-old woman with an incidental leiomyoma arising from her left adrenal gland. Leiomyoma may occur in any part of the body where smooth muscular layers exist; however, the uterus and gastrointestinal tract are the most commonly affected sites. Adrenal leiomyomas are however rarely found in routine clinical examinations or during postmortem examinations. In addition, most leiomyomas are extremely rare, asymptomatic, nonfunctioning adrenal tumors, which are discovered fortuitously during computed tomography scanning (CT) or magnetic resonance imaging (MRI). A laparoscopic operation has been performed in numerous adrenal surgeries; however, laparoscopic resections of adrenal benign leiomyomas are not often reported. We diagnosed a case of a nonfunctional adrenal tumor which was histologically confirmed as a benign leiomyoma. We successfully resected the adrenal tumor using a laparoscopic approach. Moreover, we report this case along with a review of the recent literature.

Management of Cecal Diverticulitis That's Misdiagnosed as Acute Appendicitis

PURPOSE: Because of the difficulties in making the preoperative diagnosis of diverticulitis, most patients with cecal diverticulitis have been operated on under the preoperative diagnosis of acute appendicitis. However, controversy about the treatment exists when physicians are confronted with a cecal diverticulitis. The purpose of this study is to investigate the proper treatment of cecal diverticulitis that's misdiagnosed as acute appendicitis. METHODS: We reviewed 58 cases of cecal diverticulitis that underwent emergency operation as acute appendicitis, according to classified option of treatment. RESULTS: Of the 58 patients (82.8%), 48 were treated by appendectomy without manipulation of the cecal diverticulitis (conservative treatment, CT group), and 10 cases (17.2%) were treated by surgical resection (diverticulectomy or segmental resection of bowel) of the cecal diverticulitis (operative treatment, OT group). The difference of demographic figures was not significant between the CT and OT groups (P>0.05). However, the length of the postoperative hospital stay and the rate of complications were statistically superior for the CT group (mean hospital stay: 7.5+/-2.1 days; rate of complications: n=2/48; 4.2%) compared to the OT group (mean hospital stay: 14.0+/-7.5 days, rate of complication: n= 3/10; 30.0%) (P0.05). CONCLUSION: Given the above clinical results, we could suggest that appendectomy with postoperative antibiotic therapy is an effective management strategy for cecal diverticulitis that's misdiagnosed as acute appendicitis.

Spontaneous Hepatic Rupture Following an Uncomplicated Pregnancy and Delivery / 한국간담췌외과학회지

Spontaneous rupture of the liver in pregnancy is extremely uncommon. The most of cases have occurred in pregnancy with preeclampsia/eclampsia. We report one case of spontaneous capsular rupture following an uncomplicated pregnancy. A 33 year old woman was admitted at 38 weeks of gestation to the Obstetrics department. On admission her pulse and blood pressure were normal and there was no proteinuria. On the next day, a cesarean section was performed with delivery of a male infant (3.8 kg). but persistent uterine bleeding was developed due to uterine atony. and then subtotal hysterectomy was performed. Postoperatively she was remained unstable requiring further transfusion of blood and fresh frozen plasma. She was reoperated for controling persistent bleeding and evacuation hematoma of previous hysterectomy site. Postoperatively she was stable during 48 hours. However she again became hypotensive and on examination was noted intra-abdominal fresh bleeding. Laboratory evaluation demonstrated a high level of LFT. Contrast enhanced CT revealed subcapsular hematoma rupture and active bleeding of liver. We tried to embolized the terminal hepatic arterial branch for controling the ruptured subcapsular hematoma. and then she was stable but after 5th days, liver necrosis was developed and progressed to abscess. Despite radiologic drainage, necrotic abscess was remained persistently. She was managed with open drainage and debridement of necrotic liver. After 2 weeks, she was discharged without any morbidity.

Treatment of Acute Colonic Pseudo-obstruction (Ogilvie's Syndrome) with Intravenous Neostigmine

Acute colonic pseudo-obstruction is a functional disorder that closely mimics a mechanical large-bowel obstruction. Two such patients were treated by pharmacological manipulation of the parasympathetic innervation to the colon with intravenous neostigmine infusion. The two responded to treatment with passage with flatus and stool within several minutes with complete resolution of the symptoms, although the first patient required two additional infusions and the second patient required one additional infusion for subsequent recurrence. Dizziness occurred in one patient, and no other serious side effects were apparent. This pharmacological approach to the management of acute colonic pseudo-obstruction is suggested as an alternative to the other treatment options of colonoscopic decompression or surgery when conservative management has failed.

Gastroduodenostomy after Distal Subtotal Gastrectomy in Gastric Cancer Patients Comparison between manual and stapled anastomosis

PURPOSE: A gastroduodenostomy after a distal subtotal gastrectomy is known to have several advantage over a gastrojejunostomy. However, recently, anastomotic methods using an EEA stapler during a gastro duodenostomy have been developed and have been reported to be superior to manual anastomosis with respect to operative time and complications. Thus, we investigated the differences between a manual and a stapled gastroduodenostomy by comparing the clinicopatholoic features and clinical course. METHODS: From January to October 1999 at Korea University Guro Hospital, a gastroduodenostomy using an EEA stapler was performed on 30 gastric cancer patients after a distal subtotal gastrectomy. From January 1996 to December 1998, a manual anastomosis had been used on 40 patients at the same hospital. A retrospective analysis of these two groups was made with respect to patients, tumor, operation, post operative complications and clinical course. RESULTS: The mean age of the stapled group was older than that of manual group (62.3+/-8.4 vs 53.0+/-10.7 years), and most of the tumors were located at the antrum and the body. In the stapled group, the operative time was significantly shorter than I was in the manual group (205.0+/-20.0 vs 239.6+/-37.3 minutes, p<0.001), and there was no significant difference in the resection margin between the two groups. The time of nasogastric (NG) tube removal was earlier in the stapled group (4.8+/-0.8 vs 5.9+/-2.2 days, p=0.007), but no significant differences were observed with respect to the oral intake and the complication rate between the two groups. Anastomotic stenosis was observed in one case of manual group, but it was not significant. CONCLUSIONS: A gastroduodeno stomy using an EEA stapler has an advantage over conventional manual anastomosis with respect to operation time and NG tube removal, so this method can be employed safely in aged and generally morbid patients to improve the postoperative course.

Preoperative Differential Diagnosis of Benign and Malignant Retroperitoneal Tumors Clinicoradiologic Analysis

PURPOSE: Retroperitoneal soft tissue sarcomas are frequently found in advanced state due to the abscent or nonspecific symptoms, and the only hope for cure is a radical resection. The differentiation between benign and malignant tumor is a prerequisite for preoperative preparation and deciding the extent of resection. for the purpose of determining the malignancy of retroperitoneal tumor, we evaluate the clinic oradiologic features of the patients. METHODS: Retrospective study was done on 37 eases who were oper ated Korea University Hospital from Jan. 1990 to Dec. 1998. Their clinicoradiologic characters were analyzed and compared between benign and malignant tumor pationts. RESULTS: Among the 37 cases, 27 cases (73%) were benign tumors and the remaining 10 cases (27%) were malignant tumors. There was no significant difference in age distribution between malignant and benigntumor group (p>0.05) Among 20 male patients, 10 eases had malignant tumor (50%) but all 17 female patients had benign tumor (p=0.001) Preoperative symptoms were present in 29 cases (78.4%). and mean duration of symp toms in malignant cases was 20 months and in benign cases was 18 months but had no significance in differentiating between malignant and benign tumors (p>0.05) All eases were porformed abdominal CT scanning and it had 100% of sensitivity and 74% of specificity. Among the radiologic characteristics, size of tumor, irregular margin, and abscence of calcification were correlated with malignancy (p<0.05). CONCLUSION: Preoperative clinical symptoms and duration are not helpful in differentiating the malig naney but CT scanning has a good results for such purpose. So when the retroperitoneal tumor shows large size, irregular margin and no visible calcification especially in male patients, the patient, we should prepare and treat the patients according to malignant tumor.

Preoperative Differential Diagnosis of Benign and Malignant Retroperitoneal Tumors Clinicoradiologic Analysis

PURPOSE: Retroperitoneal soft tissue sarcomas are frequently found in advanced state due to the abscent or nonspecific symptoms, and the only hope for cure is a radical resection. The differentiation between benign and malignant tumor is a prerequisite for preoperative preparation and deciding the extent of resection. for the purpose of determining the malignancy of retroperitoneal tumor, we evaluate the clinic oradiologic features of the patients. METHODS: Retrospective study was done on 37 eases who were oper ated Korea University Hospital from Jan. 1990 to Dec. 1998. Their clinicoradiologic characters were analyzed and compared between benign and malignant tumor pationts. RESULTS: Among the 37 cases, 27 cases (73%) were benign tumors and the remaining 10 cases (27%) were malignant tumors. There was no significant difference in age distribution between malignant and benigntumor group (p>0.05) Among 20 male patients, 10 eases had malignant tumor (50%) but all 17 female patients had benign tumor (p=0.001) Preoperative symptoms were present in 29 cases (78.4%). and mean duration of symp toms in malignant cases was 20 months and in benign cases was 18 months but had no significance in differentiating between malignant and benign tumors (p>0.05) All eases were porformed abdominal CT scanning and it had 100% of sensitivity and 74% of specificity. Among the radiologic characteristics, size of tumor, irregular margin, and abscence of calcification were correlated with malignancy (p<0.05). CONCLUSION: Preoperative clinical symptoms and duration are not helpful in differentiating the malig naney but CT scanning has a good results for such purpose. So when the retroperitoneal tumor shows large size, irregular margin and no visible calcification especially in male patients, the patient, we should prepare and treat the patients according to malignant tumor.

Clinical Significance of Hyperplastic Polyps in the Distal Colon

To determine whether hyperplastic polyps found in the distal colon are associated with proximal adenomas, and to judge whether patients with distal hyperplastic polyps found during sigmoidoscopy might benefit from full colonoscopy. METHODS: We retrospectively analyzed 2333 consecutive patients who were examined with colonoscopy between January 1991 and December 1994. RESULTS: 247 of 2333 patients (10.6%) had one or more colonic polyps. The prevalence of adenomatous polyps alone was 72.5%, hyperplastic polyps 22.7%, and both 0.52%. The proportion of patients with distal hyperplastic polyps and proximal adenomatous polyps (4.4%) was not significantly different from the proportion of those without distal hyperplastic polyps (1.6%). Patients with distal adenomatous polyps, on the other hand, were significantly more likely to have proximal adenomatous polyps than those without distal adenomatous polyps. CONCLUSIONS: Distal hyperplastic polyps are not strong predictors of risk for proximal adenomatous polyps. Based on the results of this study, we do not believe that finding a hyperplastic polyp during sigmoidoscopy justifies doing a full colonoscopy to search for proximal adenomatous polpys.