Early experiences of minimally invasive surgery to treat gastroesophageal reflux disease / 대한외과학회지

PURPOSE: There are fewer patients with gastroesophageal reflux disease (GERD) in Korea compared with Western countries. The incidence of GERD has increased in recent years however, concerning many physicians. Here, we report our early experiences of using a recently introduced method of laparoscopic antireflux surgery for the treatment of GERD in Korean patients. METHODS: Fifteen patients with GERD were treated using antireflux surgery between May 2009 and February 2012 at the University of Ulsan College of Medicine and Asan Medical Center. Laparoscopic Nissen fundoplication with 360degrees wrapping was performed on all patients. RESULTS: Eleven male and four female patients were evaluated and treated with an average age of 58.1 +/- 14.1 years. The average surgical time was 118.9 +/- 45.1 minutes, and no complications presented during surgery. After surgery, the reflux symptoms of each patient were resolved; only two patients developed transient dysphagia, which resolved within one month. One patient developed a 6-cm hiatal hernia that had to be repaired and reinforced using mesh. CONCLUSION: The use of laparoscopic surgery for the treatment of GERD is safe and feasible. It is also an efficacious method for controlling the symptoms of GERD in Korean patients. However, the use of this surgery still needs to be standardized (e.g., type of surgery, bougienage size, wrap length) and the long-term outcomes need to be evaluated.

Anatomical Danger Zone in Open Inguinal Herniorrhaphy

PURPOSE: Because of complex inguinal structures, we cannot overcome the neurogenic complications in open inguinal herniorrhaphy. Nowadays, there are few studies of anatomical danger zones in open herniorrhaphy. So, in this study we would cover the danger zones in hernia surgery with a cadaver. METHODS: We studied the anatomic structures of three male cadavers. There was no anatomical variation among them. We can ascertain the running of the ilioinguinal nerve, iliohypogastric nerve, and genitofemoral nerve. RESULTS: We can see that the ilioinguinal nerve runs anterior to the spermatic cord in the inguinal canal and lies beneath the external oblique aponeurosis. The iliohypogastirc nerve runs on the anterior surface of the internal oblique muscle, and aponeurosis medial and superior to the internal ring. The genital branch of the genitofemoral nerve lies on the iliopubic tract and accompanies the cremaster vessels to form a neurovascular bundle. In these areas, we often suture the anchor in open herniorrhaphy, increasing probability of these nerves suffering injury. CONCLUSION: In open inguinal herniorrhaphy, surgeons must have a comprehensive understanding of the neural anatomy of the groin to reduce post-operative complications. Moreover, we must consider not only anatomical understanding but also surgical procedures reducing neurogenic complications. So, we suggest certain procedures to reduce nerve injury such as three dimensional mesh or the use of fibrin glue.