Laparoscopic left hemihepatectomy for left intrahepatic duct stones / 대한외과학회지

PURPOSE: The feasibility of laparoscopic left hemihepatectomy for the management of intrahepatic duct (IHD) stones was evaluated. METHODS: The clinical data of 26 consecutive patients who underwent total laparoscopic left hemihepatectomy for IHD stones at Gyeongsang National University Hospital between January 2009 and June 2011 were reviewed retrospectively. RESULTS: The mean operation time was 312.1 +/- 63.4 minutes and the mean postoperative hospital stay was 11.8 +/- 5.0 days. There were 2 cases of postoperative bile leakage and 3 cases of intra-abdominal fluid collection, which were successfully managed conservatively. Remnant stones were detected in 2 patients. The initial success rate of stone clearance was 92.3% (24 of 26). The remnant stones were located in the common bile duct in both cases and were removed by endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy. Therefore, the final success rate of stone clearance was 100% (26 of 26). During a mean follow-up of 22 months (range, 7 to 36 months), there was no patient with recurrent stone. CONCLUSION: Laparoscopic surgery could be an effective treatment modality for the management of IHD stones in select patients.

Laparoscopic Liver Resection for Hepatocellular Carcinoma

PURPOSE: With the advancement of laparoscopic instruments and accumulation of surgical technique, laparoscopic liver resection is currently performed for various benign and malignant liver diseases. However, controversies still remain over laparoscopic liver resection for malignant liver diseases including HCC and its oncologic safety is yet to be established. This study aims at determining the safety, feasibility and short-term oncologic outcomes of laparoscopic liver resection performed for HCC. METHODS: From July 2008 to March 2010, laparoscopic liver resection was performed at our hospital on a total of 45 patients with various benign and malignant liver diseases. Among these 45 patients, 16 patients diagnosed with HCC were reviewed retrospectively. RESULTS: The mean age of the patients was 59.25, comprising 11 male patients (68.8%) and 5 female patients (31.2%). The location of tumor was left lateral in 7 cases, 4 cases in segment 6, 2 cases in segment 7, 2 cases in segment 5, 1 case in segment 4 and 1 case in caudate lobe. Wedge resection was performed in 11 cases, left hemi hepatectomy in 2 cases, left lateral sectionectomy in 2 cases, caudate lobectomy in 1 case. The mean operative time was 248.75 minutes. The mean hospital stay was 13.8 days, and there were no post-operative recurrences during the post-operative follow-up period. CONCLUSION: When performed by expert surgeons in selected patients, laparoscopic liver resection for HCC is a feasible and safe procedure.

Pancreatic Diabetes after Distal Pancreatectomy: Incidence Rate and Risk Factors

PURPOSE: Pancreatectomy can impair production of endocrine and exocrine hormones. In this study, we evaluated: 1) the incidence rate of diabetes in patients undergoing distal pancreatectomy; 2) the correlation between the occurrence of pancreatic diabetes and the extent of the resected pancreas; and 3) factors associated with the development of pancreatic diabetes. METHODS: We retrospectively reviewed the cases of 26 patients who could be compared in abdominal computed tomography before and after distal pancreatectomy for benign or malignant lesions between January, 1999 to June, 2010. RESULTS: The incidence of pancreatic diabetes was 19.2%. Obese patients (BMI>25.0 kg/m2) had a higher incidence (p=0.029) of pancreatic diabetes after distal pancreatectomy than non-obese patients. The diabetes group had larger volumes of resected pancreas, but the difference was not statistically significant (p=0.105). CONCLUSION: Several factors may be associated with the development of pancreatic diabetes after distal pancreatectomy. It is necessary to closely follow-up development of pancreatic diabetes regardless of the extent of resection.

Use of Angioembolization to Replace Operative Management for Blunt Splenic Injury

PURPOSE: Over the past few decades, the treatment of traumatic splenic injuries has shifted to nonoperative management from surgical intervention. Although some nonoperative management failure have been reported, in most trauma centers, nonoperative management is now believed to be the treatment of choice in hemodynamically stable patients. Then, in this study, we have retrospectively evaluated our experience with traumatic splenic injury. METHODS: From January 2005 to July 2009, 150 patients with blunt splenic injuries were managed in our hospital. Patients' charts were retrospectively reviewed to analyze their treatment, the patients were grouped according to those who had been admitted before October 2006, defined as the "early group", and those who had been admitted after October 2006, defined as the "late group". After the patients had been divided into two group, physiologic parameters and differences between the treatments were compared. RESULTS: 150 patients were admitted to our hospital with blunt splenic trauma. In late group, both the surgical management rate and the nonoperative management failure rate were lower than they were in the early group. CONCLUSION: We expect angioembolization to effectively replace surgery for the treatment of selected patients with blunt splenic injury and to result in fewer complications.

The Feasibility of Laparoscopic Hepatectomy for the Patients with Left Intrahepatic Stones

PURPOSE: Recently, there have been several studies on the early results of hepatectomy for various intrahepatic lesions. We report the early experience of our hospital after total laparoscopic left hepatectomy in patients with intrahepatic stones in the left hemi-liver. METHODS: We retrospectively analyzed the medical records of patients who were diagnosed with left intrahepatic stones and underwent hepatectomy between January 2007 and June 2009. The patients were grouped according to operative procedure into open hepatectomy, laparoscopy-assisted hepatectomy, and total laparoscopic hepatectomy. RESULTS: There were 31 patients who underwent Lt hemihepatectomy and Lt lateral sectionectomy during this period. Hepatectomy with open method, laparoscopy-assisted method, and total laparoscopy method were performed in 10, 14, and 7 cases. There were no significant differences between the three methods for operating time and postoperative complications. But the number of fasting times and hospital days was shorter with total laparoscopic hepatectomy than with others. CONCLUSION: Total laparoscopic liver resection is a safe and useful method for treating patients with intrahepatic stones and offers the advantage of quick patient recovery. Careful selection of appropriate patients and further development in the laparoscopic surgical technique resulting from accumulated experiences will help enable the laparoscopic hepatectomy to be performed more easily and safely in patients with intrahepatic stones.

Adrenal Pseudocyst Mistaken as Mucinous Cystadenoma of the Pancreas: A Case Report / 대한내분비외과학회지

Adrenal cysts are a relatively uncommon disorder and most such cases are discovered at autopsy. According to the overseas cases, the reported incidence is 0.06~0.18% and the incidence is increasing due to the widespread use of ultrasonography and computed tomography scanning. Adrenal cysts are usually asymptomatic and they need to be differentiated from other cystic lesions including liver, pancreas and kidney cystic lesions. We report here on a case of a 39-year-old female with an adrenal pseudocyst that was misdiagnosed preoperatively as a pancreas mucinous cystic neoplasm.

Solitary Fibrous Tumor of the Liver

Solitary fibrous tumor of the liver is a rare neoplasm. Thirty-nine cases have been described in the English literature. Its immunohistochemical positivity for CD34 and vimentin is believed to be unique. It is known to be usually benign and only one case of metastasis is reported. We report an additional case. A 71-year-old woman presented with fatigue and weight loss. CT scan showed a solid mass occupying the left lobe of the liver. Left lobectomy was performed. Pathological examination showed spindle cell and fibroblast-like cells within the collagenous stroma. On immunohistochemical staining, these spindle tumor cells showed diffuse CD34 and vimentin positive reactivity. The post-operative course was uneventful. Solitary fibrous tumors of the liver, although rare, need to be considered in the differential diagnosis of mesenchymal lesions of the liver.

Clinical Experiences of Management of Bile Duct Injuries during Laparoscopic Cholecystectomy

PURPOSE: Laparoscopic cholecystectomy (LC) has become the gold standard of management of gallstone disease. LC is associated with a two-to-four times higher incidence of bile duct injury, which is a rare but more serious complication than open cholecystectomy. We reviewed our experiences with the management of bile duct injury during laparoscopic cholecystectomy. METHODS: From January 1999 to April 2009, 13 patients with bile duct injuries following LC were managed in our hospital. Patients' charts were retrospectively reviewed to analyze perioperative management. RESULTS: Among the 13 patients, 7 patients sustained their bile duct injuries at our hospital. Six patients were referred to our hospital to manage their bile duct injuries. Five patients' injuries were identified during LC. According to the Strasberg classification, there are 5 cases of type A, 2 cases of type C, 1 case of type D and 5 cases of type E injuries. Four type A bile duct injuries were treated by direct ductal ligation during LC and 1 type A bile duct injury and 1 type C bile duct injury were managed by non-surgical treatment. Type D and type E injuries were managed by Roux-en-Y hepaticojejunostomy. CONCLUSION: Bile duct injuries are a rare but serious complications that occur during laparoscopic cholecystectomy. Most minor bile duct injuries are well treatable with non-surgical management, whereas major bile duct injuries require surgical management. The combination of non-surgical management and surgical treatment results in successful outcomes in bile duct injuries.

Clinical Experiences with Chylous Ascites after Gastrectomy for Gastric Cancer

PURPOSE: Chylous ascites is an accumulation of lymphatic fluid within the peritoneal cavity caused by obstruction or rupture of the peritoneal or retroperitoneal lymphatic drainage system. Postoperative chylous ascites is a rare complication of abdominal surgery. In the present study, we analyzed patients who developed postoperative chylous ascites after gastrectomy. METHODS: From February 2003 to June 2006, we treated 7 cases of chylous ascites that occurred after gastrectomy for gastric cancer. We reviewed the medical charts of these patients retrospectively. RESULTS: The incidence of chylous ascites after gastrectomy was 1.7%. Mean triglyceride concentration of the ascitic fluid was 437 mg/dl (range: 128 mg/dl~816 mg/dl). Total parenteral nutrition and somatostatin were administered to 6 patients, and 1 patient was treated with oral diuretics and serial paracentesis. CONCLUSION: The incidence of chylous ascites is low, but may increase with more aggressive surgery. Surgeons should consider chylous ascites if the character of drainage is milky. Conservative management is usually effective for the treatment of postoperative chylous ascites. If conservative management fails, surgical management should be considered.

Gastrointestinal Complication Caused by Ingestion of Multiple Magnets for Children

Because of the magnetic property that attracts magnets to one another, the swallowing of magnets could provoke perforation, obstruction, and formation of fistula in the gastrointestinal tract. Here, the authors describe two cases of gastrointestinal complication caused by swallowed magnets in children. The first case occurred in a 12-year-old boy who swallowed multiple magnetic educational instruments; the patients presented with duodeno-colic and colo-colic fistula. In the second case, a 7-year-old boy swallowed two magnets and developed a jejuno-jejunal fistula associated with perforation of the jejunum. In accidental swallowing of the magnet, especially multiple pieces, the follow-up plain abdominal X-ray film should be checked, and an emergency exploration could be considered.