Umbilical Port Site Hernia and Diastasis Recti

Purpose@#The port site hernia (PSH) is a specific type of incisional hernia related to the trocar sites of laparoscopic surgery. Diastasis recti of the abdominis muscle (DR) is the separation of the rectus muscle by a certain distance. The present study aims to present our experience with umbilical PSH and concomitant DR and to raise awareness of DR as one of the risk factors of umbilical PSH. @*Methods@#Eighteen patients with umbilical PSH after laparoscopic abdominal surgery, was retrospectively reviewed. Preoperative CT was analyzed to measure the Inter-recti distance (IRD) for all patients. Other factors, such as trocar size, wound infection, obesity (BMI), port extension, suture materials, and pre-existing co-morbidities, were recorded and analyzed. @*Results@#Extension of the port incision was associated with umbilical PSH. Ten out of eighteen umbilical PSH patients (56%) had DR before they had first laparoscopic surgery. Nine (50%) patients showed sarcopenia. Moreover, four out of five recurrences had DR. More than two recurrences were all associated with DR. @*Conclusion@#Port extension and sarcopenia were risk factors of umbilical PSH. Also, DR might be a possible risk factor of umbilical PSH occurrence and recurrence. Surgeons should be aware of the presence of DR before the planning of the laparoscopic surgery by diagnostic imaging. If DR is associated with umbilical PSH, we need to consider the correction of both pathologies at the same time.

Clinical profiles of patients with surgically resected pheochromocytoma and paraganglioma

Background/Aims@#Pheochromocytoma and paraganglioma (PPGL) are catecholamine-producing tumors that can cause blood pressure (BP) elevation and cardiovascular complications. Clinical presentation of these tumors may be changed through widespread use of imaging studies, which enables detection of PPGLs before onset of symptoms. We investigated clinical profiles of patients with surgically resected PPGLs. @*Methods@#From 2005 to 2017, 111 consecutive patients with surgically resected PPGLs in two tertiary hospitals in Korea were studied. @*Results@#Mean age was 52 ± 16 years, 57 patients (51.4%) were male and 54 (48.6%) were hypertensive. Twenty-nine PPGLs (26.1%) were extra-adrenal paragangliomas. Sixteen (14.4%) and seven patients (6.3%) (Group 1, n = 23) were diagnosed during work-up of hypertension and transient cardiomyopathy respectively, and the remainder (Group 2, n = 88) were incidentalomas detected during routine abdominal imaging. Patients in the Group 1 were younger and more frequently symptomatic, and had higher BPs, heart rates and levels of urinary catecholamines than those in the Group 2. Paragangliomas were less frequent and secretion of epinephrine and metanephrine was more predominant in the Group 1 than in Group 2. After the surgical resections, 18.2% of patients still needed antihypertensive medications. @*Conclusions@#Out of 111 patients with surgically resected PPGLs, 88 (79.3%) were diagnosed as incidentalomas. Seven patients presented with transient cardiomyopathy and 16 with hypertension. Tumor location and secretion of catecholamine may vary depending on the presence of symptoms.

Nutritional Therapy Related Complications in Hospitalized Adult Patients: A Korean Multicenter Trial

PURPOSE: Nutritional therapy (NT), such as enteral nutrition (EN) or parenteral nutrition (PN), is essential for the malnourished patients. Although the complications related to NT has been well described, multicenter data on symptoms in the patients with receiving NT during hospitalization are still lacking. METHODS: Nutrition support team (NST) consultations, on which NT-related complications were described, were collected retrospectively for one year. The inclusion criteria were patients who were (1) older than 18 years, (2) hospitalized, and (3) receiving EN or PN at the time of NST consultation. The patients' demographics (age, sex, body mass index [BMI]), type of NT and type of complication were collected. To compare the severity of each complication, the intensive care unit (ICU) admission, hospital stay, and type of discharge were also collected. RESULTS: A total of 14,600 NT-related complications were collected from 13,418 cases from 27 hospitals in Korea. The mean age and BMI were 65.4 years and 21.8 kg/m2. The complications according to the type of NT, calorie deficiency (32.4%, n=1,229) and diarrhea (21.6%, n=820) were most common in EN. Similarly, calorie deficiency (56.8%, n=4,030) and GI problem except for diarrhea (8.6%, n=611) were most common in PN. Regarding the clinical outcomes, 18.7% (n=2,158) finally expired, 58.1% (n=7,027) were admitted to ICU, and the mean hospital days after NT-related complication were 31.3 days. Volume overload (odds ratio [OR]=3.48) and renal abnormality (OR=2.50) were closely associated with hospital death; hyperammonemia (OR=3.09) and renal abnormality (OR=2.77) were associated with ICU admission; “micronutrient and vitamin deficiency” (geometric mean [GM]=2.23) and volume overload (GM=1.61) were associated with a longer hospital stay. CONCLUSION: NT may induce or be associated with several complications, and some of them may seriously affect the patient's outcome. NST personnel in each hospital should be aware of each problem during nutritional support.

Ischemic Necrosis of the Gastric Remnant without Splenic Infarction Following Subtotal Gastrectomy

Gastric remnant necrosis after a subtotal gastrectomy is an extremely uncommon complication due to the rich vascular supply of the stomach. Despite its rareness, it must be carefully addressed considering the significant mortality rate associated with this condition. Patients vulnerable to ischemic vascular disease in particular need closer attention and should be treated more cautiously. When gastric remnant necrosis is suspected, an urgent endoscopic examination must be performed. We report a case of gastric remnant necrosis following a subtotal gastrectomy and discuss possible risk factors associated with this complication.

A Comparative Analysis of Single Umbilical Tangential Incision vs. Conventional Three-port Totally Extraperitoneal Inguinal Hernia Repair

PURPOSE: We have explored the question of what benefits SUTI-TEP can provide over conventional three-port TEP (C-TEP) surgery for the treatment of inguinal hernia. METHODS: One hundred forty cases (70 SUTI-TEP and 70 C-TEP) were reviewed in this study. SUTI-TEP procedure was carried out with SILS™ port as we reported before. Patient demographics and perioperative outcomes of SUTI-TEP were analyzed and compared with those of C-TEP. RESULTS: There was no conversion to open surgery or C-TEP in SUTI-TEP group. Median VAS immediate postoperatively was slightly higher in SUTI-TEP group, but it was statistically significant. POD 7th day pain after surgery were similar in both groups. Regarding the length of operation time, SUTI-TEP group (71.2 min) was significantly longer than that of the C-TEP group (41 min) (p<0.001). There was no major morbidity or mortality postoperatively in either group. There was also no recurrence or chronic pain during follow up. Patient overall satisfaction including cosmetic outcome was excellent in SUTI-TEP group. CONCLUSION: Although the longer operation time tends to be required, SUTI-TEP can provide better cosmesis and patient satisfaction, and also safety. That may be good indicator of the success of after surgery. Also we should not presume that one large incision causes less pain than small multiple incision because it is just single one. If there is more pain in one single wound, we should find the solution through the innovation of technology or preventive measures.

Clinical Outcome of Doublet and Triplet Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: In gastric cancer, the rate of recurrence and metastasis following radical resection is high, necessitating improvement in survival and cure rates. Neoadjuvant chemotherapy (NAC) has potential benefits for locally advanced gastric cancer; however, the surgical benefits and effects on survival are unclear. This study evaluates the effectiveness of NAC in locally advanced gastric cancer and compares clinical outcomes of doublet and triplet regimens. METHODS: We reviewed patient medical records of 383 patients who underwent NAC (n=41) or surgery only (n=342) for treatment of locally advanced gastric cancer. The baseline characteristics and clinical outcomes were compared between the groups. Chemotherapy patients were classified according to regimen, doublet (n=28) and triplet (n=13), and NAC-related clinical response, safety, and toxicity were analyzed. RESULTS: The baseline characteristics did not differ significantly between groups. After NAC, the tumor downstage rate was 51.2% (21/41); however, overall survival (p=0.205) and disease-free survival (p=0.415) were not significantly different between the groups. On subgroup analysis, no significant differences in drug toxicity (p=0.604) or clinical response (p=0.374) were found between outcomes of doublet and triplet chemotherapy regimens. CONCLUSIONS: In patients with locally advanced gastric cancer, NAC showed tolerable drug toxicity and increased tumor downstage, but NAC failed to increase the survival rate, which may be caused by a high D2-lymphadenectomy rate. Therefore, NAC was found to be a therapeutic option for select gastric cancer patients.

SUTI (Single Umbilical Tangential Incision) Laparoscopic TEP Inguinal Hernia Repair

PURPOSE: Single port laparoscopic inguinal hernia repair has been performed to further reduce port related morbidities and to improve the cosmetic outcome. However, the cosmetic result of single port laparoscopic totally extraperitoneal inguinal hernia repair (TEP) has not been superior to that of transabdominal preperitoneal hernia repair (TAPP). The aim of this study is to introduce and assess the Single Umbilical Tangential Incision (SUTI) for Lap-TEP repair. METHODS: Forty one hernia repairs of 34 patients were performed using SUTI-TEP method. SUTI was made all along the inferolateral skin of the umbilical pit and a vertical incision of less than one centimeter was made in the supra- or infraumbilical skin if needed; the total length of the incision was 2~2.5 cm. SILS(TM) port and conventional instruments were used for the procedure. RESULTS: All procedures were completed without conversion to the conventional TEP procedure. Mean operation time was 73 minutes for unilateral primary hernia, 119 minutes for bilateral primary hernia, 88.5 minutes for unilateral recurrent hernia, and 120 minutes for bilateral recurrent hernia. There were two cases of wound seroma and four cases of urinary retention postoperatively. Other significant complications were not noted. There was no recurrence of hernia during the follow-up period of one to 24 months. At routine follow-up visit at three months postoperative, the scar was barely visible and overall level of patient satisfaction was very high. CONCLUSION: The SUTI-TEP inguinal hernia repair is safe and shows superior cosmetic results. Further studies are required in order to assess the long-term outcome.

Primary Laparoscopic-Assisted Endorectal Pull-Through for Hirschsprung's Disease

The application of laparoscopic techniques for the surgical management of Hirschsprung's disease is the recent trend. We described the surgical technique and postoperative long-term outcomes of the one-stage, laparoscopic-assiseted endorectal pull-through operation for Hirschsprung's disease. The technique uses three to four small abdominal ports. Laparoscopic mobilization of the sigmoid colon and rectum is performed and marginal artery-preserving colon pedicle is prepared. The rectal mobilization is performed using a transanal endorectal sleeve technique. The anastomosis is performed 0.5~1 cm above the dentate line. The age at surgery ranged from 6 days to 4 years. The average operative time was 144 minutes. Almost all of the patients passed stool and flatus within 36 hours of surgery. The average hospital stay after surgery was 6.5 days. Among 42 patients, 32 patients older than 3 years old were evaluated for function on defecation. All 32 patients have been continent, of those who needed laxatives were 11 (34.3%) due to constipation and overflow incontinence. Four children (12.5%) have remained dependent on laxatives. Laparoscopic-assisted endorectal pull-through operation for Hirschsprung's disease appears to be safe, provides the less pain, shorter time to full feeding, shorter hospital stay, and excellent cosmetic outcomes. Helping patients and parents ensure the quality of life, they should be provided with counseling, education, and longer-term follow-up care.

Laparoscopic Adrenalectomy: Lessons Learned from 111 Consecutive Cases / 대한내분비외과학회지

PURPOSE: Laparoscopic adrenalectomy has become the standard of care for a variety of benign adrenal pathologies. A total of 111 consecutive adrenalectomies were performed using a lateral transperitoneal or posterior retroperitoneal approach, each with its own inherent benefits and shortcomings. The authors compared the effectiveness and safety of posterior retroperitoneal adrenalectomy (PRA) with that of lateral transperitoneal adrenalectomy (LTA). METHODS: Medical records of 111 patients diagnosed with adrenal tumor who underwent laparoscopic adrenalectomy from January 2000 through April 2012 at Chungnam National Hospital were reviewed retrospectively. Study variables included operative time, length of hospital stay, number of days of pain control, diet beginning and advance, and complications. RESULTS: PRA was shorter in most variables, including operative time, hospital stay, first diet beginning, and full diet advance time compared with that of LTA. In pheochromocytoma less than or equal to 7 cm in size, operation time for LTA was longer than that of PRA. One PRA-specific complication was pseudo-hernia of the ipsilateral abdominal wall, which was resolved spontaneously within 1~2 months. CONCLUSION: Laparoscopic adrenalectomy is a safe and effective approach to benign adrenal pathology, and PRA should be considered in patients with tumors less than or equal to 7 cm.

Laparoscopy Assisted versus Open Distal Gastrectomy with D2 Lymph Node Dissection for Advanced Gastric Cancer: Design and Rationale of a Phase II Randomized Controlled Multicenter Trial (COACT 1001)

PURPOSE: Laparoscopy-assisted distal gastrectomy for early gastric cancer has gained acceptance and popularity worldwide. However, laparoscopy-assisted distal gastrectomy for advanced gastric cancer is still controversial. Therefore, we propose this prospective randomized controlled multi-center trial in order to evaluate the safety and feasibility of laparoscopy assisted D2-gastrectomy for advanced stage gastric cancer. MATERIALS AND METHODS: Patients undergoing distal gastrectomy for advanced gastric cancer staged cT2/3/4 cN0/1/2/3a cM0 by endoscopy and computed tomography are eligible for enrollment after giving their informed consent. Patients will be randomized either to laparoscopy-assisted distal gastrectomy or open distal gastrectomy. Sample size calculation revealed that 102 patients are to be included per treatment arm. The primary endpoint is the non-compliance rate of D2 dissection; relevant secondary endpoints are three-year disease free survival, surgical and postoperative complications, hospital stay and unanimity rate of D2 dissection evaluated by reviewing the intraoperative video documentation. DISCUSSION: Oncologic safety is the major concern regarding laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Therefore, the non-compliance rate of clearing the N2 area was chosen as the most important parameter for the technical feasibility of the laparoscopic procedure. Furthermore, surgical quality will be carefully reviewed, that is, three independent experts will review the video records and score with a check list. For a long-term result, disease free survival is considered a secondary endpoint for this trial. This study will offer promising evidence of the feasibility and safety of Laparoscopy-assisted distal gastrectomy for advanced gastric cancer.Trial Registration: NCT01088204 (international), NCCCTS-09-448 (Korea).

Long-term Outcomes of Laparoscopic Totally Extraperitoneal Inguinal Herniorrhaphy

PURPOSE: Laparoscopic inguinal herniorrhaphy, especially laparoscopic TEP repair, has become a standard method of inguinal herniorrhaphy. Favorable short-term results of laparoscopic inguinal hernia repair, compared with open surgery, have been reported, however, data on the long-term outcome are limited. Based now on more than 55 months of follow-up, we report here on the long-term results for patients who underwent laparoscopic TEP inguinal hernia repair. METHODS: Between January 2002 and December 2007, of patients who underwent laparoscopic TEP repair for an inguinal hernia by a single surgeon, 180 patients who have had a follow-up check with a physical examination or telephone interview were enrolled. RESULTS: A total of 196 TEP procedures in 180 patients (age range 15~88 years; men, 88.3%) were performed successfully without conversion to transabdominal preperitoneal (TAPP) or open surgery. During the follow-up period of more than 55 months (55~20 months), chronic inguinal discomfort or pain was noted in 14 patients (n=14, 7.7% per patient or 7.1% per repair) and the severity of pain was mild (n=11), moderate (n=2), or severe (n=1). In most patients, occurrence of groin pain was very infrequent and the duration of the pain varied from a few seconds to a few minutes. There was one suspicious recurrence (0.5%), which was comparable to that of open surgery. Four cases of mesh infection (2.03%) were noted. Chronic mesh infection may be more frequent than previously reported. Otherwise, most of the patients were satisfied with their results. CONCLUSION: According to the long-term results of the study, laparoscopic TEP is a safe procedure for repair of inguinal hernia, with a low incidence of chronic pain and very low recurrence rate. However, among mesh-related complications, mesh infections have become increasingly important. For clinicians the possibility of mesh infection should be promptly considered in any patient who has undergone hernia surgery involving mesh, and who has any manifestations of abdominal wall.

Prevalence and Patterns of Left Ventricular Dysfunction in Patients with Pheochromocytoma

BACKGROUND: Excessive catecholamine release in pheochromocytoma is known to cause transient reversible left ventricular (LV) dysfunction, such as in the case of pheochromocytoma-associated catecholamine cardiomyopathy. We investigated patterns of clinical presentation and incidence of LV dysfunction in patients with pheochromocytoma. METHODS: From January 2004 to April 2011, consecutive patients with pheochromocytoma were retrospectively studied with clinical symptoms, serum catecholamine profiles, and radiologic findings. Patterns of electrocardiography and echocardiography were also analyzed. RESULTS: During the study period, a total of 36 patients (21 males, 49.8 +/- 15.8 years, range 14-81 years) with pheochromocytoma were included. In the electrocardiographic examinations, normal findings were the most common findings (19, 52.8%). LV hypertrophy in 12 cases (33.3%), sinus tachycardia in 3 (8.3%), ischemic pattern in 1 (2.8%) and supraventricular tachycardia in 1 (2.8%). Echocardiographic exam was done in 29 patients (80.6%). Eighteen patients (62.1%) showed normal finding, 8 (27.6%) revealed concentric LV hypertrophy with normal LV systolic function, and 3 (10.3%) demonstrate LV systolic dysfunction (LV ejection fraction < 50%). Three showed transient LV dysfunction (2 with inverted Takotsubo-type cardiomyopathy and 1 with a diffuse hypokinesia pattern). Common presenting symptoms in the 3 cases were new onset chest discomfort and dyspnea which were not common in the other patients. Their echocardiographic abnormalities were normalized with conventional treatment within 3 days. CONCLUSION: Out of total 36 patients with pheochromocytoma, 3 showed transient LV systolic dysfunction (catecholamine cardiomyopathy). Pheochromocytoma should be included as one of possible causes of transient LV systolic dysfunction.

Sclerosing Angiomatoid Nodular Transformation (SANT) in Spleen: A Case Report

Sclerosing angiomatoid nodular transformation (SANT) of spleen is a rare inflammatory tumor-like vascular lesion composed of angiomatoid nodules in a fibrosclerotic background. We report herein on a case of SANT in the spleen with its pathologic features, and review the related literature. A 50-year-old woman presented with mild left upper quadrant discomfort and tenderness and she showed a 6 cm-sized solitary splenic mass on computed tomography. She underwent laparoscopic splenectomy. Grossly, the spleen showed a well circumscribed round-shaped solid mass with multinodular hemorrhagic surfaces. Microscopically, the mass consisted of multiple angiomatoid nodules surrounded by collagen bundles with fibroblasts and a lymphoplasma cell infiltration. Immunohistochemically, the cells of the angiomatoid nodules were positive for CD31, CD30, CD34, alpha-smooth muscle actin, and VWF-VIII, but they were negative for CD8, anaplastic lymphoma kinase protein, and D2-40. The patient has been under close follow-up without recurrence.

Laparoscopic Adrenalectomy: A Comparison of Lateral Transperitoneal vs Posterior Retroperitoneal Approach / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic adrenalectomy has become the procedure of choice to remove a wide variety of adrenal tumors. The laparoscopic approaches to the adrenal gland include a lateral (transperitoneal) approach and the posterior (retroperitoneal) approach. The aim of the present study is to compare the clinical outcomes from both methods. METHODS: Between January 2000 and October 2008, we performed 60 laparoscopic adrenalectomies, including 29 posterior retroperitoneal approaches (RLA) and 31 lateral transperitoneal approaches (TLA). RESULTS: Sixty patients were treated for the following conditions: adrenocortical adenoma: 35 patients, pheochromocytoma: 19 patients, organizing hematoma: 2 patients, ganglioneuroma: 2 patients, myelolipoma: 1 patient and adrenal oncocytoma: 1 patient. The average tumor size was 3.2+/-1.4 cm in the TLA patient group and 2.9+/-1.4 cm in the RLA patient group. In the TLA group, the procedures were performed with the patients in the lateral position, and the patients were in the prone position in the RLA group. The average operation time of the RLA group was significantly shorter than that of the TLA group. The RLA group had a shorter postoperative hospital stay, they required less postoperative pain control and they resumed a full diet earlier. Conversion to open surgery was required in five patients (16%) in the TLA group. Complications occurred in five patients of the TLA group and in five patients of the RLA group. No mortality was observed in both groups. CONCLUSION: For experienced surgeons, if the adrenal tumor is less than 6 cm in size, posterior retroperitoneal adrenalectomy may be a safer and faster procedure, so it should be considered as the first choice of operation of benign adrenal tumors.

Detection of the Occult Contralateral Inguinal Hernia by thorough Physical Examination and Selective Diagnostic Laparoscopy during Laparoscopic Totally Extraperitoneal Inguinal Herniorrhaphy / 대한내시경복강경외과학회지

PURPOSE: We determined the rate of an occult contralateral inguinal hernia by conducting only a physical examination for the unilateral inguinal hernia patients who visited our hospital. METHODS: One hundred thirty nine patients were prospectively evaluated between September 2009 and October 2010. We divided the patients into 3 groups according to a physical examination of the contralateral inguinal area: Group A (no abnormality), Group B (suspicious) and Group C (definite). We defined Group B and Group C as possible occult bilateral hernia. In Group B, selective diagnostic laparoscopy was performed after the totally extraperitoneal herniorrhaphy was finishedover. We analyzed the rate of detecting a contralateral hernia, the positive predictive value and the accordance rate. RESULTS: Of the 139 patients, the number of patients in Group A, B and C were 113 cases, 4 cases and 22 cases, respectively. The age of the patients ranged from 18~86 years (mean age: 57.1), with a male to female ratio was 7:1. Twenty-six patients (18.7%) had possible occult bilateral hernia. For the left inguinal hernia patients, the incidence of contralateral hernia was 18.2% (12/66). For the right inguinal hernia patients, this was 19.2% (14/73). The detection rate of contralateral hernia by physical examination was 14.1% (19/135) and the positive predictive value was 86.4% (19/22). The accordance rate of simultaneous bilateral hernia was 57.9% for the direct hernia patients and it was 26.3% for the indirect patients. There was no recurrence or metachronous contralateral inguinal hernia occurrence. CONCLUSION: We can discover occult contralateral inguinal hernia by conducting a careful physical examination of the contralateral inguinal area. Conducting a proper physical examination is very important for detecting inguinal hernia.

The 10 Years of Experiences with GISTs

PURPOSE: Gastrointestinal stromal tumors (GISTs) possess highly variable clinical behaviors and the study thereof is insufficient. There are no standard guidelines for diagnosis and treatment of GISTs, so it is difficult to predict recurrences and conduct appropriate treatments. Throughout the last 10 years of experiences with GIST patients, we have identified the variables predicting recurrences and classified the risk groups by NIH classification, Fletcher risk stratification and UICC TNM stage. METHODS: From January 1998 to December 2007, 88 patients with pathologic confirm and surgical resection were diagnosed with GISTs. GISTs were diagnosed when the tumor had characteristic histologic features and confirmed positive by KIT, CD34, or PDGFRA. RESULTS: The size, mitotic index, existence of symptoms, and origins of tumor correlate statistically with recurrence (0.002, <0.001, 0.027, 0.011). The NIH classification, Fletcher risk stratification and UICC TNM stage are correlated with recurrence (0.001, <0.001, <0.001) and 5 year disease free survival, statistically (0.009, <0.001, <0.001). Fifteen patients experienced recurrences. 14 patients were treated with imatinib, and 6 of them showed a response to the treatment. All 4 patients who had R1 resection did not survived due to the progression of the disease. CONCLUSION: The patients with large, high mitotic index, symptomatic, or extra-gastric tumor require strict surveillance. Also, patients with low risk must be under surveillance due to the possibility of recurrence. It is important to perform R0, en bloc resection. Although the imatinib is the treatment of choice with recurred or metastatic GISTs, the disease is likely to develop resistance, further studies on newly targeted therapy is in need.

A Comparison of Segmental Gastrectomy and Distal Gastrectomy with Billroth I Reconstruction for Early Gastric Cancer That's Developed on the Gastric Body

PURPOSE: Subtotal distal gastrectomy has been accepted as the standard treatment for early gastric cancer that's developed on the gastric body. EMR and ESD have been introduced to minimize the incidence of postgastrectomy syndrome, but these procedures can not detect lymph node metastasis and they have a risk for gastric perforation. Segmental gastrectomy has recently been applied for treating early gastric cancer, but its usefulness has not been clarified. The aim of this study was to compare segmental gastrectomy and distal gastrectomy with Billroth I reconstruction for treating early gastric cancer that's developed on the gastric body. MATERIALS AND METHODS: We performed a retrospective review of all the patients who were diagnosed as having early gastric cancer that developed on the gastric body at Chungnam National University Hospital from January 2004 through July 2007. During this period, 41 patients received segmental gastrectomy and 40 patients underwent subtotal distal gastrectomy. All the patients were studied via a biannual review of the body systems, a physical examination, endoscopy, computed tomography and the laboratory findings. RESULTS: There were no significantly differences of the clinicopathologic characteristics between the two groups. The changes of the nutritional status (Hb, TP, Alb and TC) and the body weight change were not significantly different between the 2 groups. There were significantly more residual food in the SG group than that in the SDG group (RGB classification, Residual>Grade 2), but there were no differences for epigastric discomfort (P>0.05). Esophagitis developed at a similar rate for both two groups (LA classification, >Grade A), and bile reflux was found in only one patient of each group. CONCLUSION: We expected the reduction of esophagitis and gastritis and the improvement of nutritional status according to the type of procedure. Yet the results of our study showed no significant differences between the two study groups. More patients and a longer follow up time are needed for determining the advantage sand disadvantages of segmental gastrectomy.

A Single Surgeon's Experience with Laparoscopic Adrenalectomy / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic surgery on the adrenal gland is a highly specific procedure that requires mastery of laparoscopic surgery. From January 2000 to October 2008, 66 laparoscopic adrenalectomies on 65 patients were performed by a single surgeon. This study was done to summarize our experience and to evaluate the safety and effectiveness of laparoscopic adrenalectomy. METHODS: A retrospective review of the patient records was carried out. The patients' demographics, the tumor characteristics, the open conversion rate, the operating time, the length of the hospital stay and other clinical outcomes were studied. RESULTS: There were 8 conversions out of 65 patients. The indications for surgery included functional tumors in 42 patients (19 pheochromocytomas in 18 patients, 14 patients of primary aldosteronism and 10 patients of Cushing syndrome), and 23 nonfunctional tumors. The average tumor size was 3.5 cm. The mean operating time was 163 min. The average length of the hospital stay was 4.1 days. Postoperative complications occurred in 8 patients with no perioperative mortality, and most of the complications could be considered as minor. During follow-up, two patients had adrenal insufficiency and port site hernia, and none had recurrence of hormonal excess. CONCLUSION: Laparoscopic adrenalectomy has several advantages such as minimal postoperative pain, few surgical complications, a short hospital stay and an early return to work. The results confirm that laparoscopic adrenalectomy is the procedure of choice for resection of various benign adrenal neoplasms.

A Case of Gastrointestinal Stromal Tumor in a Child / 대한소아소화기영양학회지

Gastrointestinal stromal tumors (GISTs) are the most common primary mesenchymal tumors of the digestive tract. They have been commonly observed in adults but have been rarely described in children. They arise typically from the intestinal wall and rarely in the mesentery, omentum, or retroperitoneum. GISTs originate from the interstitial cell of Cajal and are characterized by overexpression of the receptor tyrosine kinase c-kit. Up to 94% of these tumors express the CD117 on immunohistochemical stain. Surgery is the main modality of treatment for primary resectable GIST. Completely resectable GIST with low risk has excellent prognosis after primary surgical intervention, with over 90% of the 5-year survival. We report a case of 10-year-old girl presenting with an upper gastrointestinal bleeding caused by gastrointestinal stromal tumor.

Laparoscopic Appendectomy: A Safe Primary Procedure for Complicated Appendicitis

PURPOSE: We performed a study comparing the morbidity of laparoscopic and open appendectomy to assess whether laparoscopic appendectomy could be an initial procedure of choice for patients suffering with complicated appendicitis (gangrene, perforation and periappendiceal abscess). METHODS: We studied the patients who underwent appendectomy by either a laparoscopic or an open technique at Chungnam National University Hospital between January 2003 and July 2006. There were 118 patients in the laparoscopic appendectomy (LA) group and 232 patients in the open appendectomy (OA) group. RESULTS: The operating times and length of hospital stay were significantly shorter for the LA group than for the OA group (P 72 hours) and small bowel obstruction. Complications were less frequent after LA compared with OA (10.2 % vs 23.7 %, respectively)(P = 0.01). There were less wound infections in the LA group than in the OA group (8.5% vs 14.2%, respectively)(P=0.02), and all the complications were minor compared with that for the OA group. A postoperative intraabdominal abscess developed in one patient in the OA group, but this didn't occur in the LA group. There were no serious complications requiring readmission or reoperation in the LA group. CONCLUSION: LA showed a significant benefit over OA in this study. The findings suggest that LA could be a safe primary choice for treating complicated appendicitis. To reach a final consensus on the scope of this study, a prospective randomized controlled study is needed in the near future.