ABSTRACT
Purpose@#The number of bariatric surgeries performed at our tertiary hospital has gradually increased since the national health insurance began to cover their expenses in January of 2019. This study examined the early surgical outcomes of laparoscopic sleeve gastrectomy (LSG) performed by experienced gastric cancer surgeons. @*Materials and Methods@#We retrospectively reviewed and analyzed data from 50 patients who underwent LSG between November of 2018 and April of 2020 at the Asan Medical Center by 1 of 5 experienced surgeons each of whom performed approximately 100–300 cases of gastrectomy annually. The age, body mass index (BMI), weight, presence of comorbidities, operation time, hospital stay after surgery, postoperative complications, postoperative excess weight loss (EWL), and resolution of comorbidities were examined. @*Results@#The mean age, BMI, and weight were 37.29±9.77 years, 37.12 kg/m2, and 102.00 kg, respectively. The mean operation time and postoperative length of hospital stay were 109.59±35.88 and 5.06±1.20 days, respectively. Two patients (4.00%) had early postoperative complications and postoperative leakage; bleeding and stenosis were not reported. The EWL after 1 and 6 months of operation was 26.55% and 60.34%, respectively. The resolution of diabetes, hypertension, and dyslipidemia after 6 months of operation was 88.89%, 54.54%, and 50.00%, respectively. @*Conclusion@#LSG is safe and effective when performed by an experienced gastric cancer surgeon; however, a long-term follow-up of patients is required.
ABSTRACT
Purpose@#This study aimed to compare the surgical outcomes of total laparoscopic total gastrectomy without mesentery division (LTG without MD) and conventional total laparoscopic total gastrectomy (CLTG), as well as evaluate the appropriate method for esophagojejunostomy (EJ) reconstruction after total laparoscopic total gastrectomy (TLTG). @*Materials and Methods@#We retrospectively analyzed data from 301 consecutive patients who underwent TLTG for upper or middle third gastric cancer between January 2016 and May 2019. After propensity score matching, 95 patients who underwent LTG without MD and 95 who underwent CLTG were assessed. Data on clinical characteristics and surgical outcomes, including operation time, length of postoperative hospital stay, pathological findings, and postoperative complications were analyzed. @*Results@#The LTG without MD group showed a shorter time to first flatus (3.26±0.80 vs.3.62±0.81 days, P=0.003) and a shorter time to soft diet (2.80±2.09 vs. 3.52±2.20 days, P=0.002). The total EJ-related complications in the LTG without MD group were comparable to those in the CLTG group (9.47% vs. 3.16%, P=0.083). EJ-related leakage (6.32% vs. 3.16%, P=0.317) and EJ-related stricture (3.16% vs. 1.05%, P=0.317) rates were not significantly different between the LTG without MD and CLTG groups. No significant differences were found between the two groups in terms of other early surgical outcomes such as early complications, late complications, hospital stay, and readmission rate. @*Conclusions@#LTG without MD is a safe surgical treatment for upper or middle third gastric cancer. LTG without MD may be an alternative procedure for EJ anastomosis during TLTG.
ABSTRACT
Purpose@#Acute kidney injury (AKI) is an uncommon but serious complication after trauma. The objective of this study was to evaluate the clinical characteristics, risk factors, and outcomes of AKI after trauma. @*Methods@#A retrospective cohort study of 386 trauma patients who visited the emergency department at the Asan Medical Center between January 2012 and December 2013 was performed. There were 322 patients included in this study. Patients were assigned into the AKI group and no AKI group. Regression analysis was performed to identify the factors associated with development of AKI following trauma. @*Results@#The overall incidence of AKI following trauma was 6%. There was no difference in patients`age, sex, and body weight between groups. Whereas there was a significant difference in Injury Severity Score, Glasgow Coma Scale, presence of shock, need for a transfusion, lactic acid levels, and severe rhabdomyolysis. In multivariate analysis, the independent risk factors associated with AKI after trauma included the Injury Severity Score [odds ratio (OR) = 1.065, p < 0.01], presence of shock (OR = 3.949, p = 0.012), and severe rhabdomyolysis (OR = 4.475, p < 0.01). Patients in the AKI group were classified (according to the RIFLE criteria) as at Risk in 9 cases (43%), Injury present in 3 (14%), Failure in 7 (33%), Loss in 0 (0%) and End-stage in 2 (10%). Renal replacement therapy was required for 10 patients (47%) in the AKI group and 4 of them (40%) underwent successful weaning. Hospital mortality rate was higher in the AKI group (5/21, 23%) than the no AKI group (3/301, 1% ; p < 0.01). @*Conclusion@#The development of AKI was associated with the severity of trauma, and trauma increased mortality rates.
ABSTRACT
Purpose@#Acute kidney injury (AKI) is an uncommon but serious complication after trauma. The objective of this study was to evaluate the clinical characteristics, risk factors, and outcomes of AKI after trauma. @*Methods@#A retrospective cohort study of 386 trauma patients who visited the emergency department at the Asan Medical Center between January 2012 and December 2013 was performed. There were 322 patients included in this study. Patients were assigned into the AKI group and no AKI group. Regression analysis was performed to identify the factors associated with development of AKI following trauma. @*Results@#The overall incidence of AKI following trauma was 6%. There was no difference in patients`age, sex, and body weight between groups. Whereas there was a significant difference in Injury Severity Score, Glasgow Coma Scale, presence of shock, need for a transfusion, lactic acid levels, and severe rhabdomyolysis. In multivariate analysis, the independent risk factors associated with AKI after trauma included the Injury Severity Score [odds ratio (OR) = 1.065, p < 0.01], presence of shock (OR = 3.949, p = 0.012), and severe rhabdomyolysis (OR = 4.475, p < 0.01). Patients in the AKI group were classified (according to the RIFLE criteria) as at Risk in 9 cases (43%), Injury present in 3 (14%), Failure in 7 (33%), Loss in 0 (0%) and End-stage in 2 (10%). Renal replacement therapy was required for 10 patients (47%) in the AKI group and 4 of them (40%) underwent successful weaning. Hospital mortality rate was higher in the AKI group (5/21, 23%) than the no AKI group (3/301, 1% ; p < 0.01). @*Conclusion@#The development of AKI was associated with the severity of trauma, and trauma increased mortality rates.