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Background/Aims@#The objective of this study was to determine the more appropriate wound-closure method by comparing the effectiveness of two methods in a group of patients who underwent ileostomy repair. @*Methods@#The study conducted after obtaining the approval of the Institutional Review Board (IRB) included 58 patients ≥19 years of age who underwent ileostomy at the Department of Surgery at the Presbyterian Medical Center. This was a retrospective, single-center trial. Patients who underwent ileostomy closure between January 2011 and September 2017 were assigned to the primary wound-closure (PC, n=25) group and the purse-string wound-closure (PSC, n=33) group. Post-repair complications, such as wound infection, delayed healing, and patient satisfaction related to wound management, were investigated and compared according to the wound-closure method. @*Results@#The PSC group had a significantly lower surgical site infection rate than the PC group (0% vs. 44%, p30 days was not significantly different (39% vs. 20%, p=0.114). In addition, there were no significant differences in the response to questionnaires on patient satisfaction between the two groups. @*Conclusions@#PSC has a lower surgical site infection rate and the wound-healing delay was not very different from that of PC. Therefore, if patients are at risk of wound infection, such as in severe wound contamination, long operating time, and immunocompromised conditions, we should consider PSC as a wound closure method of choice.
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Purpose@#The aim of this study is to review our experience in treating indirect inguinal hernia in pediatric patients. @*Methods@#We retrospectively studied a total of 43 patients who underwent percutaneous internal ring suturing (PIRS) for indirect inguinal hernia from January 2016 to September 2018. The participants included 29 boys and 14 girls. There were cases of bilateral internal inguinal hernia (n=12), right indirect inguinal hernia (n=16), and left indirect inguinal hernia (n=15). Their mean age was 3.8±2.9 years, and mean body weight was 16 kg. Clinical features and surgical outcomes were analyzed. @*Results@#Mean operating time was 35 min for unilateral inguinal hernia and 40 min for bilateral inguinal hernia. There were five cases of intraoperative bleeding (12%) during needle insertion. In two cases, stress test resulted in escape of gas into the hernial sac and a second suture was inserted. The contralateral patent processus vaginalis was present in six (14% of cases) and closed. Follow-up was 6~30 months. Mean postoperative hospital stay was 1.2 days. No recurrence hernia and postoperative complications were reported. @*Conclusion@#Although this study investigated a small number of cases and the surgical experience was rather limited, the PIRS technique was shown to have advantages such as a short learning curve and its aid in detecting contralateral hernias. In this study, there were no reports of recurrence, metachronous inguinal hernias, and postoperative complications.
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We experienced a case of 1 patient who died from rhabdomyolysis-related complications after colonoscopy. A 60-year-old man had undergone an ‘uncomplicated’ colonoscopic polypectomy. Approximately 10 hours following this procedure, the patient complained of increasing left abdominal pain. His computed tomography image showed free gas, but his operative findings revealed no macroscopic perforation or abscess formation. Eight hours after the operation, the patient presented with myoglobulinuria, and we diagnosed the condition to be rhabdomyolysis. Based on this case, we recommend that rhabdomyolysis be added to the list of complications following a colonoscopic procedure. Moreover, for prevention and early treatment, endoscopists should be attentive to the risk factors and signs/symptoms of rhabdomyolysis.
Subject(s)
Humans , Middle Aged , Abdominal Pain , Abscess , Colonoscopy , Rhabdomyolysis , Risk FactorsABSTRACT
PURPOSE: This study compared the oncologic impact of postoperative chemotherapy and chemoradiotherapy on patients with rectal cancer without preoperative chemoradiation. METHODS: This retrospective study analyzed 713 patients with a mean follow-up of 58 months who had undergone radical resection for stage II/III rectal cancer without preoperative treatment in nine hospitals from January 2004 to December 2009. The study population was categorized a chemotherapy group (CG, n = 460) and a chemoradiotherapy group (CRG, n = 253). Five-year overall survival (OS) and disease-free survival (DFS) were analyzed, and independent factors predicting survival were identified. RESULTS: The patients in the CRG were significantly younger (P < 0.001) and had greater incidences of low rectal cancer (P < 0.001) and stage III disease (P < 0.001). Five-year OS (P = 0.024) and DFS (P = 0.012) were significantly higher in the CG for stage II disease; however, they were not significantly different for stage III disease. In the multivariate analysis, independent predictive factors were male sex, low rectal cancer and stage III disease for OS and male sex, abdominoperineal resection, stage III disease and tumor-positive circumferential margin for DFS. However, adjuvant therapy type did not independently affect OS (hazard ratio [HR], 1.243; 95% confidence interval [CI], 0.794–1.945; P = 0.341) and DFS (HR, 1.091; 95% CI, 0.810–1.470; P = 0.566). CONCLUSION: Adjuvant therapy type did not affect survival of stage II/III rectal cancer patients without neoadjuvant chemoradiotherapy. These results suggest that adjuvant therapy can be chosen based on the patient’s condition and the policies of the surgeons and hospital facilities.
Subject(s)
Humans , Male , Chemoradiotherapy , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Incidence , Multivariate Analysis , Rectal Neoplasms , Retrospective Studies , SurgeonsABSTRACT
Lumbar hernia presents as a reducible protruding mass in the flank region between the 12th rib and the iliac crest. The superior lumbar hernia (Grynfeltt's) is covered by the thin latissimus dorsi muscle and bounded by the erector spinae and internal obliquus abdominis muscle. The lumbodorsal fascia forms the floor of the Grynfeltt's triangle. Spontaneous or acquired non-traumatic lumbar hernia occurs more frequently after middle age. The untreated lumbar hernia progresses in size gradually. As in most hernias, the larger the defect, the more complicated and difficult is the repair. Here we report 2 female patients with spontaneous lumbar hernia diagnosed at Presbyterian Medical Center with computerized tomogram. Their treatment consisted of tension-free surgical repair utilizing the overlap method for defect edge and the application of prolene mesh.
Subject(s)
Female , Humans , Middle Aged , Fascia , Hernia , Polypropylenes , Protestantism , Ribs , Superficial Back MusclesABSTRACT
PURPOSE: The aim of this study is to evaluate the effectiveness and surgical morbidity of preoperative chemoradiotherapy for locally advanced rectal cancer. METHODS: Between December 1997 and March 2000, 36 patients with locally advanced rectal cancer (clinical stage II or III) were treated with preoperative chemoradiation: bolus i.v. leucovorin, 20 mg/m2, plus 24-h continuous infusion i.v. 5-Fluorouracil, 425 mg/m2, Days 1-5, 29-33 and concurrent radiotherapy 4,500 cGy over 5 weeks. Surgery was performed 4-8 weeks after completion of the chemoradiotherapy. RESULTS: Grade 3-4 toxicity during chemoradiotherapy was low: hematological toxicities 2.8%, gastro-intestinal toxicities 5.5% and skin toxicities 8.3%. Complete response rate was 16.7% and partial response rate was 47.2%, the rate of downstaging for tumor was 65.5%. The overall rate of resectability was 94.1%. In 13 of 22 (59.1%) patients planned APR, the sphincter was preserved. The overall rate of surgical morbidity was 23.5%, but there was no postoperative mortality. One patient needed a reoperation because a complication may be associated with preoperative chemoradiotherapy. CONCLUSIONS: Preoperative chemoradiotherapy for locally advanced rectal cancer seems to afford some potential advantages: patients are able to tolerate higher chemotherapy doses with low toxicities; tumor downstaging and resectability rates are high; sphincter preservation is feasible; But perioperative morbidity has generally tolerable complications. And so we recommend the preoperative chemoradiotherapy may be one of the best treatments for locally advanced rectal cancer.
Subject(s)
Humans , Chemoradiotherapy , Drug Therapy , Fluorouracil , Leucovorin , Mortality , Radiotherapy , Rectal Neoplasms , Reoperation , SkinABSTRACT
PURPOSE: Adult intussusception is relatively rare and it's course is subacute or chronic course. It usually occurs secondary to tumors or other underlying cause. Especially the incidence of associated malignancy is increasing compare to the past. Purpose of this study was review of adult intussusception, our comprehension of the disease improved by and helped to plan treatments METHODS: During the past 11 yeasrs, from January, 1987 to December, 1997, 27 cases of adult intussusception at Department of Surgery, Presbyterian Medical Center were analyzed retrospectively. RESULTS: The age incidence was variable. But it occurred more frequently at 4th decades. Useful radiologic diagnostic tools were CT, U/S as well as barium enema. Nineteen instances of intussusception originating in the small bowel and 8 instances originating in the colon. The etiologic factors were found in 22 cases (74%). Of the 19 small bowel intussusception, 5 cases were associated with malignancy and 3 out of 8 colon intussusception were result from the malignancy. The common malignancy in small bowel was lymphoma and that in colon was adenocarcinoma. Surgical intervention was carried out in all of these 27 cases: 20 cases underwent surgical resection and 7 cases were reduced manually after surgical exploration; Only manually reduction was performed in 4 cases, manually reduction and cecopexy in 2 cases and manually reduction and adhesiolysis in 1 case. CONCLUSION: The malignancy was the major cause of adult intussusception. Especially in colonic intussusception, occupational percentage of malignancy was higher. The common malignancy in small bowel was lymphoma and that in colon was adenocarcinoma. So, we cosidered plans of treatments according to location, etiology and bowel state.
Subject(s)
Adult , Humans , Adenocarcinoma , Barium , Colon , Comprehension , Enema , Incidence , Intussusception , Lymphoma , Protestantism , Retrospective StudiesABSTRACT
A 17 month-old girl presented in the pediatric clinic on November 27th, 1990 with a neck mass. The mass was 2 cm in diameter, firm in consistency and movable on the upper pole of the thyroid cartilage in the midline. The technetium thyroid scan showed a hot reactivity at the compatible site of the mass, but no other radioactivity in either site of the normal thyroid positions. At her second visit on January 23th, 1996, the mass had enlarged up to 3.5cm in diameter in the same location of the neck. The follow up thyroid scan revealed a walnut sized, snowman-like radioactivity. One of the snowman-like double images seemed to be a lingual ectopic thyroid and the other a midline ectopic thyroid remnant in the infrahyoid level. This interpretation was supported by the computed tomography of the neck, which showed a ligual mass in the foramen cecum area and an another mass in the anterior comis-sure of the larynx in the mildline. Thyroid function test was normal except a slightly increased TSH. As a result of this changing pattern of thyroid radioactive images, a case of a lingual thyroid as well as another midline ectopic thyroid tissue at the infra hyoid level is reported.