Laparoscopic Treatment of Colonic Intussusception Caused by Sigmoid Colon Cancer

Reports on the laparoscopic treatment for colonic intussusception are exceedingly rare. We report a case of colonic intussusception caused by sigmoid colon cancer which was treated with a laparoscopic approach. A 76-year-old man visited an emergency room with the chief complaint of lower abdominal pain. He was diagnosed with colonic intussusception probably due to sigmoid colon cancer on a CT scan. Upon laparoscopic exploration, sigmoid colon intussusception was noted. Manual reduction was impossible because the colonic walls were friable and due to the possibility of a cancerous leading point. Therefore, the bowel was resected with en bloc Hartmann procedure. Pathology of the resected specimen revealed a tumor measuring 4.5 cm in size and comprising moderately differentiated adenocarcinoma (pT3N0M0, pStage II). The patient's postoperative course was uneventful and was discharged on the 8th day after surgery.

The Present and Future of Intraoperative Neuromonitoring in Thyroid Surgery / 대한내분비외과학회지

Injury to the recurrent laryngeal nerve is the most common and serious complication after thyroid surgery. Many different techniques have been described in the literature and interest in intraoperative neuromonitoring (IONM) has increased in an effort to prevent adverse events. IONM implicated for identification of the nerve and evaluation of its function during the operation. Continuous IONM was recently introduced and looks promising for early recognition and safe operation in the end. This paper describes the role of IONM, and its current and future issues.

Case-Payment System in Vascular Surgery / 대한혈관외과학회지

Medical insurance, which is mandatory in Korea, has been progressed in the way of expanding the relevant population and intensifying the guarantee. However, rapid increases in medical expenses led national health insurance into a state of financial crisis. The government considered the reason of financial crisis as fee-for-service and started reorganizing the terms of payment from fee-for-service to case-payment. Therefore, an expanded diagnosis related group (DRG) payment system is carried out to decrease the expense on health and to secure financial stability. At the same time, the new case-payment system, apposite to the medical case in Korean society, is under demonstration. DRG payment system is in execution for the 7 disease entities of the four departments requested for now. However, it is supposed to be carried out in all the hospitals from the second half of 2012 and be expanded to all the general hospitals from 2013. The new case-payment system is under development because it is difficult to apply DRG to all disease entities. These shake-ups in the payment system will be conducted from the year 2015, combining both the DRG and new case-payment system. Basically, the introduction of the new case-payment system will cause doctors' passive attitude in the treatment of patients. This would be an especially serious problem for the department of surgery whose charge for operation is very low. It would be worse for the vascular surgeons because only 80% of operational or interventional procedures will be compensated, the fee for ultrasound is included in the new case-payment system, and age-related severity is not reflected in the disease entity. If relaunch is inevitable, vascular surgeons should understand the new case-payment system exactly and point out the problems. Also, standard guidelines on treatment per procedure should be set up and used for the established case-payment system, which would be helpful in reducing unnecessary medical expenses.

Laparoscopic Primary Closure: A Better Method of Treatment in Perforated Peptic Ulcer Disease than Open Repair

PURPOSE: Perforation is a dreadful complication of peptic ulcer disease requiring immediate management. This study examined the feasibility of laparoscopic primary closure in perforated peptic ulcer disease to allow an earlier return to normal life. METHODS: This study reviewed our experience retrospectively with 72 consecutive patients treated with the simple closure of a perforated peptic ulcer disease in our hospital from December 2002 to January 2011. Thirty five patients were treated laparoscopically and the rest underwent open surgery. The operative time, nasogastric tube utilization, abdominal drain usage, time to oral feeding, hospital stay, postoperative complications and recurrence in both groups were compared. A student's t-test was used to make the comparisons. A p value<0.05 was considered significant. RESULTS: The operative time, use of nasogastric tubes, and abdominal drainage were similar in both groups. After laparoscopic surgery, the patients showed an earlier return to normal oral feeding and discharge than the open surgery group (4.17+/-0.62 vs. 5.03+/-2.34 days, p=0.040, 8.63+/-1.96 vs. 10.24+/-3.59 days, p=0.021, respectively). The decreased handling of tissue in laparoscopic surgery led to less wound infection (0 in laparoscopic surgery vs. 3 in open) and postoperative ileus (0 vs. 2). CONCLUSION: Laparoscopic repair of a perforated peptic ulcer is a safe and feasible treatment that offers early oral feeding and a shorter postoperative hospital stay.

The Meaning of Open Cholecystectomy for Acute Cholecystitis

PURPOSE: Laparoscopic cholecystectomy has been used widely for effective management of acute cholecystitis. However, it has limitations. In this study, we compared laparoscopic approaches and an open method. The meaning of the open method was assessed again. METHODS: A retrospective review of 60 patients undergoing cholecystectomy for acute cholecystitis was done. Thirty patients were part of a laparoscopic cholecystectomy group; the other 30 patients were part of an open cholecystectomy group. Laparoscopic cholecystectomy was done using a 4-trochar method. We reviewed geographic characteristics, body mass index, white blood cell count, and clinical outcomes. RESULTS: Age, gallbladder wall thickness and white blood cell counts were significantly different between the 2 groups; operation time was not. The length of the postoperative hospital stay in the laparoscopic group was significantly shorter than that in the open group. There was one case of bile leakage in the laparoscopic group which was treated by endoscopic nasal bile drainage. CONCLUSION: Open cholecystectomy is still a valid choice for acute cholecystitis in the modern era of laparoscopic surgery. In severe cases, conversion is not a failure and should be done immediately if necessary.