Intraluminal Snared-Atheroma Causing Common Femoral Artery Stenosis after Using Perclose Suture-Mediated Closure System / 대한혈관외과학회지

Mechanical closing devices were developed to shorten bed rest following percutaneous vascular intervention, and recently, the devices are replacing the conventional manual compression. Among the closing devices, the Perclose suture-mediated closure system (Perclose/Proglide) is known to be a safe and effective method that permits faster hemostasis and earlier ambulation compared with manual compression. However, with increased usage of femoral closure devices, reports of complications have emerged. Most reported complications are local bleedings, hematomas, and wound infections. Herein, we report a rare case: common femoral artery (CFA) stenosis after using Perclose suture-mediated closure system. After failure of secondary ballooning of the CFA stenotic segment, CFA was opened operatively and we found that snared atheroma by Perclose suture material was occupying the CFA lumen. Endarterectomy was performed for the lesion and the CFA stenosis was improved.

S-plasty for pilonidal disease: modified primary closure reducing tension / 대한외과학회지

PURPOSE: S-plasty for pilonidal disease reduces the tension on the midline by distributing it diagonally and flattening the natal cleft. The aim of this study was to evaluate the outcomes of S-plasty on simple midline primary closure and the clinical features of pilonidal patients in a low incidence country. METHODS: S-plasty was applied on 17 patients from July 2008 to October 2010. Data of these patients were collected with computerized prospective database forms during a perioperative period and via telephone interview for follow-up. Surgical site infection (SSI) was defined according to the Center for Disease Control guidelines. The severity of surgical site infection was graded. RESULTS: All patients were treated with primary S-plasty. Two patients (11.7%) developed low grade SSI. The average healing time after S-plasty was 18.1 days. No recurrences were observed. The mean follow-up period was 13.5 months (range, 6 to 33 months). CONCLUSION: We have shown that primary S-plasty for pilonidal disease is simple, and its surgical outcomes are compatible to the results of other surgical treatments. We present primary S-plasty as a feasible treatment option in a low incidence country.

Risk Factors Affecting Pancreatic Fistula after Pancreaticoduodenectomy

PURPOSE: Pancreacticoduodenectomy is the procedure of choice for managing periampullary malignancy. But pancreatojejunostomy site leakage is a very critical complication because it is hard to prevent leakage. The aim of this study is to analyze the risk factors of pancreatic leakage after pancreaticoduodenectomy. METHODS: We retrospectively reviewed 172 consecutive patients who had received pancreaticoduodenectomy at Inha University Hospital between Apr. 1996 and Mar. 2006. We analyzed the pancreatic leakage rates according to the clinical characteristics, the pathologic and laboratory findings and the anastomosis methods. RESULTS: There were differences in the mean age and pathologic findings between the two groups. There were 115 (66.9%) patients older than 60 years, while the other 57 patients (33.1%) were younger than 60 years. The incidence of developing pancreatic fistula in patients older than 60 years was 21.7% (25/115) while this was 8.8% (5/57) for the younger patients, and the difference was significant (p=0.03). The patients with a dilated pancreatic duct showed a lower rate of esser post-operative pancreatic fistula than the patients with a non-dilated duct (p=0.001). Other factors, including the anastomosis method and the pathologic diagnosis, didn't show any statistical difference. According to the pathologic diagnosis, the patients with pancreatitis and stomach cancer revealed pancreatic fistula to a smaller extent; there were 6 cases (3.5%) of pancreatitis and 22(12.8%) of stomach cancer. Among the case with pancreatic fistula, there were 0 cases of pancreatitis and 2 cases (6,7%) of stomach cancer, but the difference was not statistically significant. CONCLUSION: Our study demonstrated that pancreatic fistula is related to age and a dilated pancreatic duct. Surgeon must take these risk factors into consideration when performing pancreaticoduodenectomy. We recommend surgeons to use skillful technique to prevent pancreatic fistula.