Coronavirus Disease 2019 Vaccine / 계명의대학술지

Coronavirus disease 2019 (COVID-19) vaccination is necessary to prevent infection, morbidity, and mortality. In addition to the usual post-inoculation hypersensitivity reactions including headaches, muscle and joint pain, and fever, especially after the second shot, the mRNA vaccine has risk of inflammation in the heart and heart lining of some recipients, mostly younger people. And the adenovirus vector vaccine can induce rare immune thrombocytopenia. Vaccination should be encouraged according to the information about the effectiveness and safety in individual situation.

Successful Treatment in a Newborn Infant with Chylous Ascites and Chylous Hydrocele

Chyle only occurs in the peritoneal cavity or around the pericardium through damage to the lymph nodes or improper drainage of the lymph and is characterized by a colostrum-like color and being rich in triglyceride. We encountered a case of a newborn infant with abdominal distention and further diagnosed chylous ascites and hydrocele by inspecting and analyzing the fluid obtained from the abdominal cavity and scrotum. Additionally, a lymphoscintigraphy was performed, which showed a decrease in the uptake of radioactive isotopes in the left iliac nodes and a delayed appearance. Here, we report a case of chyle diagnosed through puncture analysis and its subsequent successful treatment.

Three-Dimensional Bio-Printing Equipment Technologies for Tissue Engineering and Regenerative Medicine

Three-Dimensional (3D) printing technologies have been widely used in the medical sector for the production of medical assistance equipment and surgical guides, particularly 3D bio-printing that combines 3D printing technology with biocompatible materials and cells in field of tissue engineering and regenerative medicine. These additive manufacturing technologies can make patient-made production from medical image data. Thus, the application of 3D bio-printers with biocompatible materials has been increasing. Currently, 3D bio-printing technology is in the early stages of research and development but it has great potential in the fields of tissue and organ regeneration. The present paper discusses the history and types of 3D printers, the classification of 3D bio-printers, and the technology used to manufacture artificial tissues and organs.

Discrepancy between Self-Reported and Urine-Cotinine Verified Smoking Status among Korean Male Adults: Analysis of Health Check-Up Data from a Single Private Hospital / 가정의학회지

BACKGROUND: Enquiry into smoking status and recommendations for smoking cessation is an essential preventive service. However, there are few studies comparing self-reported (SR) and cotinine-verified (CV) smoking statuses, using medical check-up data. The rates of discrepancy and under-reporting are unknown. METHODS: We performed a cross-sectional study using health examination data from Healthcare System Gangnam Center, Seoul National University Hospital in 2013. We analyzed SR and CV smoking statuses and discrepancies between the two in relation to sociodemographic variables. We also attempted to ascertain the factors associated with a discrepant smoking status among current smokers. RESULTS: In the sample of 3,477 men, CV smoking rate was 11.1% higher than the SR rate. About 1 in 3 participants either omitted the smoking questionnaire or gave a false reply. The ratio of CV to SR smoking rates was 1.49 (95% confidence interval [CI], 1.38-1.61). After adjusting for confounding factors, older adults (≥60 years) showed an increased adjusted odds ratio (aOR) for discrepancy between SR and CV when compared to those in their twenties and thirties (aOR, 5.43; 95% CI, 2.69-10.96). Educational levels of high school graduation or lower (aOR, 2.33; 95% CI, 1.36-4.01), repeated health check-ups (aOR, 1.45; 95% CI, 1.03-2.06), and low cotinine levels of <500 ng/mL (aOR, 2.03; 95% CI, 1.33-3.09), were also associated with discordance between SR and CV smoking status. CONCLUSION: Omissions and false responses impede the accurate assessment of smoking status in health check-up participants. In order to improve accuracy, it is suggested that researcher pay attention to participants with greater discrepancy between SR and CV smoking status, and formulate interventions to improve response rates.

Association between Physical Activity Levels and Physical Symptoms or Illness among University Students in Korea / 가정의학회지

BACKGROUND: Low levels of physical activity can cause various physical symptoms or illness. However, few studies on this association have been conducted in young adults. The aim of this study was to investigate the association between physical activity levels and physical symptoms or illness in young adults. METHODS: Subjects were university students who participated in a web-based self-administered questionnaire in a university in Seoul in 2013. We obtained information on physical activities and physical symptoms or illness in the past year. Independent variables were defined as symptoms or illness which were associated with decreased academic performance. Logistic regression was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of each physical symptom or illness with adjustment for covariables. RESULTS: A total of 2,201 participants were included in the study. The main physical symptoms or illness among participants were severe fatigue (64.2%), muscle or joint pain (46.3%), gastrointestinal problems (43.1%), headache or dizziness (38.6%), frequent colds (35.1%), and sleep problems (33.3%). Low physical activity levels were significantly associated with high ORs of physical symptoms or illness. Multivariable-adjusted ORs (95% CIs) in the lowest vs. highest tertile of physical activity were 1.45 (1.14–1.83) for severe fatigue, 1.35 (1.07–1.70) for frequent colds, and 1.29 (1.02–1.63) for headaches or dizziness. We also found that lower levels of physical activity were associated with more physical symptoms or bouts of illness. CONCLUSION: Low physical activity levels were significantly associated with various physical symptoms or illness among university students. Also, individuals in the lower levels of physical activity were more likely to experience more physical symptoms or bouts of illness than those in the highest tertile of physical activity.

Breast Feeding Is Associated with Postmenopausal Bone Loss: Findings from the Korea National Health and Nutrition Examination Survey / 가정의학회지

BACKGROUND: Postmenopausal osteoporosis is a common disease which can cause various morbidity and economic burden. Lactation is known to cause a decline in bone mineral density (BMD), but there are controversies on whether decreased BMD is fully recovered after lactation and whether lactation duration has an influence on postmenopausal BMD. This study was conducted to see whether breastfeeding is associated with postmenopausal bone loss using a highly representative sample of Korean population. METHODS: Retrospective cross sectional study was done using data collected from Korea National Health and Nutrition Examination Survey V. The study outcome was BMD measured with dual-energy X-ray absorptiometry and divided into 2 groups: normal or low BMD (T score<-1), and breastfeeding duration was categorized into 4 groups (never, 1st, 2nd, and 3rd tertile). Logistic regression analysis was done to examine the association between lactation duration and BMD. RESULTS: Among 1,694 postmenopausal women (mean age, 63.5+/-9.1), 85.71% were in low BMD group. Compared to never breastfeeding group, postmenopausal women with longer than 79 months of breastfeeding duration are more likely to have low BMD (adjusted risk ratio [ARR]=1.24; 95% confidence interval, 1.17 to 1.32). As the duration of breastfeeding increases, ARR and risk difference for low BMD also increases (P for trend=0.008). CONCLUSION: The study results showed that total breastfeeding duration was associated with postmenopausal low BMD. All women planning on breastfeeding should be aware of its risks and should take adequate dietary calcium and vitamin D before, during, and after breastfeeding.

Risk factors and long-term outcomes of delayed graft function in deceased donor renal transplantation

PURPOSE: The purpose of this study was to analyze the risk factors for delayed graft function (DGF) and determine its impact on the outcomes of deceased donor (DD) kidney transplantation (KT). METHODS: Between January 2000 and December 2011, we performed 195 DD renal transplants. After the exclusion of primary nonfunctional grafts (n = 4), the study recipients were divided into two groups-group I, DGF (n = 31, 16.2%); group II, non-DGF (n = 160, 83.8%). The following variables were compared: donor and recipient characteristics, patient and graft survival, postoperative renal function, acute rejection (AR) episodes, and the rates of surgical and infectious complications. RESULTS: Donor-related variables that showed significant differences included hypertension (P = 0.042), diabetes (P = 0.025), and prerecovery serum creatinine levels (P 20%, P = 0.008). On multivariate analysis, only the prerecovery serum creatinine level (P < 0.001; hazard ratio [HR], 1.814) was an independent risk factor for the development of DGF. A Cox multivariate analysis of risk factors for graft survival identified these independent risk factors for graft survival: nephron mass (donor kidney weight to recipient body weight ratio) index (P = 0.026; HR, 2.328), CMV infection (P = 0.038; HR, 0.114), and AR episode (P = 0.038; HR, 0.166). CONCLUSION: In DD KT, an independent risk factor for DGF was the prerecovery serum creatinine level. Although there was a significant difference in graft survival between the DGF and non-DGF groups, DGF was not an independent risk factor for graft failure in this study.

Dietary Fat Intake and the Risk of Metabolic Syndrome in Korean Adults / 가정의학회지

BACKGROUND: The effect of dietary fat intake on the risk of cardiovascular disease remains unclear. We investigated the association between dietary fat and specific types of fat intake and the risk of metabolic syndrome. METHODS: The study population included 1,662 healthy adults who were 50.2 years of age and had no known hypertension, diabetes, hyperlipidemia, or metabolic syndrome at the initial visit. Dietary intake was obtained from a 1-day food record. During 20.7 months of follow-up, we documented 147 cases of metabolic syndrome confirmed by self-report, anthropometric data, and blood test results. The intakes of total fat, vegetable fat, animal fat, saturated fatty acid (SFA), polyunsaturated fatty acid (PUFA), monounsaturated fatty acid (MUFA), and cholesterol level divided by quintile. Multivariate analyses included age, sex, body mass index, smoking status, alcohol intake, physical activity, total calorie, and protein intake. RESULTS: Vegetable fat intake was inversely associated with metabolic syndrome risk (odds ratio for the highest vs. the lowest quintile, 0.33; 95% confidence interval, 0.14 to 0.76). Total fat, animal fat, SFA, PUFA, MUFA, and cholesterol intakes showed no association with metabolic syndrome. Vegetable fat intake was inversely associated with the risk of hypertriglyceridemia among the components of metabolic syndrome. CONCLUSION: These data support an inverse association between vegetable fat and the risk of metabolic syndrome.

The optimal follow-up period in patients with above 5-year disease-free survival after curative liver resection for hepatocellular carcinoma / 대한외과학회지

PURPOSE: Although many patients with hepatocellular carcinoma experience recurrence within 2 years after hepatectomy, some patients with T1 and T2 hepatocellular carcinoma show recurrence-free survival for more than 5 years after surgery. This study was designed to analyze the optimal follow-up period on patients with T1 and T2 hepatocellular carcinoma (HCC) showing recurrence-free survival 5 years after surgery. METHODS: One hundred seventy patients underwent hepatectomy from January 1995 to December 1999. Numbers of patients with T1 and T2 HCC were 76 and 73, respectively. The recurrence patterns of patients experiencing recurrence more than 5 years after liver resection were analyzed in aspect of clinicopathological features and follow-up period. RESULTS: Thirteen patients experienced recurrence more than 5 years after surgery. Only age was found as a significant factor for recurrence. Eight patients were checked regularly with 6-month intervals and the others were checked with 12-month or more intervals. The size of the recurrent tumors in the 6-month interval group had a median of 1.1 cm (range, 1 to 4.2 cm) and the size of the recurrent tumors in the 12-month or more interval group had a median of 3 cm (range, 1.6 to 4 cm). The tumor size was significantly smaller in the 6-month interval group. CONCLUSION: Though the patients with early stage HCC showed high overall survival, some patients experienced a late recurrence of more than 5 years after surgery. Patients less than 60 years old with early stage HCC should be checked regularly with 6-month intervals even over 5 years after liver resection.

Successful One-Stage Transabdominal Excision of Intravenous Leiomyomatosis with Extension into the Right Atrium / 대한혈관외과학회지

Intravenous leiomyomatosis is a rare benign tumor originating from the uterus that spreads through vessels. In rare cases, intracaval and intracardiac involvement has been described. We report a case of a 64-year-old woman who presented intravenous leiomyomatosis, which originated from the right uterine vein and extended through the inferior vena cava into the right atrium. The tumor was completely removed through a one-stage transabdominal approach with transesophageal echocardiography monitoring. Sparing thoracotomy is important in order to reduce postoperative morbidity and tumor removal by pulling down was technically possible without the risk of embolization.

Optimal System for Deceased Organ Donation and Procurement in Korea / 대한이식학회지

Since the first deceased donor kidney transplantation in 1979, continuous efforts have been made to increase deceased organ donation in Korea. However, a critical shortage of human organs for transplant is still a serious problem and is partly caused by the absence of a system to actively identify and properly manage deceased donors in Korea. Considering this, Korea needs to create a new national system for deceased donor identification, management, and organ procurement. There are three kinds of organ procurement systems in the world: The "Spanish model", the "United States model", and the "other European model". We reviewed each system and suggested the optimal organ procurement system for Korea. We also proposed requirements for operating an organ procurement organization and increasing deceased organ donation. Further improvements in the organ procurement system will contribute to improve the current organ shortage.

Effects of Antiplatelet Agents on the Graft Survival in Murine Cardiac and Skin Transplantation Model / 대한이식학회지

BACKGROUND: At the initiation of immunologic response, platelets rapidly release chemical mediators which may induce rejection of transplanted organ. The purpose of this study was to investigate the effect of antiplatelet agents in murine cardiac and skin transplantation models. METHODS: In the minor major histocompatibility (MHC) mismatch model, BALB/c (H2d) mice underwent heart transplantation from B10.D2 (H2d) mice. In the major MHC mismatch model, CBA (H2k) mice were used as the recipients and C57BL/10 (H2b) mice as donors. The recipients were divided into four groups and each group was treated with distilled water (DW), sarpogrelate, cilostazol, or clopidogrel respectively. For skin transplantation, the recipients in the minor MHC mismatch model were divided into four groups similar to those in cardiac transplantation. The recipients in the major MHC mismatch model were divided into DW-treated and sarpogrelate-treated groups. All treatments were done by the per oral route of administration. RESULTS: For graft survival in the minor MHC mismatch model of cardiac transplantation, sarpogrelate-treated group showed increased median survival time (MST) compared to the other groups (DW-treated group 17.5 days, sarpogrelate-treated group 88 days, cilostazol-treated group 13 days, clopidogrel-treated group 23 days). Similar results were observed in the major MHC mismatch model. In the major MHC mismatch model, the expression of adhesion molecules (L-selectin, intercellular adhesion molecule-1 [ICAM-1], Mac-1, lymphocyte function associated antigen-1 [LFA-1]) was significantly higher in DW-treated group compared to sarpogrelate-treated group (P<0.05) In the minor MHC mismatch model, MST in the antiplatelet-treated skin graft group was not remarkably prolonged compared to DW-treated group. In the major MHC mismatch model, sarpogrelate-treated group showed prolonged survival compared to DW-treated group (MST 25 vs. 19 days, P<0.05). There was no statistically significant difference in the proportion of activated T cells and regulatory T cells. CONCLUSIONS: The tendency for a better survival of grafts was observed in the sarpogrelate-treated skin and heart transplant group compared to DW-treated group. However, further mechanistic study is necessary to these results.

Oral Ulceration an Overlooked Complication of Mycophenolate Mofetil in a Renal Transplant Recipient / 대한이식학회지

Mycophenolate mofetil (MMF) is being widely used as a maintenance imunosuppressive therapy in renal transplant patients. Myelotoxicity and gastrointestinal symptoms are the well-known adverse effects of this immunosuppressant. However, there areexistonly two reports on oral ulceration associtated with MMF. Although oral ulcerations are not life-threatening, they may seriously affect the quality of life. We report ourthe experience of a case of a 57-year-old female patient with painful oral mucosal ulcerations that improved following MMF discontinuation.

Iliac Artery Thrombosis Due to Plaque Rupture During Performance of Anterior Lumbar Interbody Fusion: A Case Report

Anterior lumbar interbody fusion (ALIF) is a popular procedure that is used in spine surgery for treating disc herniation. Although this operation is usually safe, it can cause vascular injury, including arterial thrombosis. We report here on the case of 59-year-old woman who developed acute arterial thrombosis during ALIF. Toward the end of the operation, the somatosensory evoked potential signals decreased more than 50% in the left lower extremity, suggesting acute arterial occlusion. Therefore, a vascular surgeon was contacted and immediate thrombo-endarterectomy was performed. Thrombosis developed due to rupture of preexisting plaque during the arterial retraction. After the endarterectomy, the somatosensory evoked potentials signals and pulse were restored. To avoid vascular injury, preoperative evaluation of the vascular images and careful handling of the vessels during surgery are important. A vascular surgeon should be available not only in the event of complications, but such a surgeon should also be included from the planning of the operation.

Effect of Nanoparticle with VEGF in Mouse Ischemic Hindlimb Model

PURPOSE: Vascular endothelial growth factor (VEGF) is one of the factors regulating angiogenesis. For angiogenesis, the local concentration of VEGF has to be maintained. Because of its short half-life, VEGF has been conjugated with nanoparticles. Some nanoparticles, such as poly (lactic-co-glycolic acid (PLGA)) or polyethylenimine (PEI) are commonly used in this field, but have weak points such as faster release than expected and cell toxicity. We investigated the effect of core/shell nanoparticles including lecithin lipid cores in the ischemic hindlimb model. METHODS: Mice were anesthetized and a region of the common femoral artery and vein was ligated and excised. Hindlimb ischemic mice (n=28) were divided randomly into four groups: Control group (normal saline, n=7), mouse VEGF group (mVEGF, n=7), nanoparticle including mVEGF group (N-mVEGF, n=7), and nanoparticle/hydrogel mouse VEGF group (NH-mVEGF, n=7). The drug was injected postoperatively into the thigh muscle of the ischemic limb. Perfusion, capillary number and H&E stain were assessed 28 d after treatment. RESULTS: The capillary number increased in N-mVEGF and mVEGF group (P=0.026). Improvements of ischemic limb perfusion were inferior in N-mVEGF, NH-mVEGF groups (P=0.006) compared to other groups. Mice received N-mVEGF, NH-mVEGF treatment showed significant inflammation in the H&E staining. CONCLUSION: Sustained VEGF delivery via core/shell nanoparticle with lecithin core did not show improved perfusion rate despite an increase in capillary number. Furthermore, vacuolization and induction of inflammation requiring a different composition of nanoparticle should be tested.

New Operative Treatment of Hyperfunctioning Arteriovenous Fistula for Hemodialysis: A Case Report

Hyperfunctioning fistulas are rare complications of hemodialysis access. They give rise to devastating complications, including a steal syndrome with reduced perfusion to the dependent limb and cardiac insufficiency caused by the high shunt volume. Numerous techniques such as fistula ligation, banding, plication, T-banding and distal revascularization with interval ligation have been developed. However, each technique bears the potential for its own complications, such as failure to resolve symptoms, recurrence and technical difficulty. Herein, we report a new technique that remedies the shortcomings of the other procedures. All the patients first underwent partial aneurysmal resection and lateral aneurysmorrhaphy of the enlarged vein from just distal to the anastomosis using a 6-0 prolene running sutures and then external wrapping with an 8 mm expanded polytetrafluoroethylene graft was done for a length of approximately 5 cm. Two patients with hyperfunctioning brachiocephalic arteriovenous fistula were treated this way. Doppler measurement of the fistula flow showed a mean flow reduction of about 60%. The procedure was effective and safe, with a mean follow up of 2 months.

Effect of Multi-modal Interventions for Smoking Cessation in a University Setting: A Short Course of Varenicline, Financial Incentives, E-mail and Short Message Service / 가정의학회지

BACKGROUND: Varenicline is known to have higher effect for smoking cessation than existing pharmacotherapies, including Bupropion and Nicotine replacement therapy, however, it can also bring about adverse effects such as problems in compliance due to the complicated dosage, side effects of high frequency, and financial burden resulted from a long term treatment. Moreover, the effect for smoking cessation with group program and non-pharmacotherapy, including financial incentives, E-mails or SMS is well known, but, the study on their combination is rare. Therefore, in the present study, we tried to evaluate two things; the effect for smoking cessation with multi-modal intervention, and the compliance of Varenicline. METHODS: From July 2008 to February 2009, we conducted the multi-modal smoking cessation program for 30 volunteers in Dankook university. This program consisted short course of Varenicline, financial incentives, E-mail and short message service. RESULTS: The continuous abstinence rate for weeks 9 throught 12 was 76.7% and for weeks 9 through 24 was 43.3%. Multivariate analysis revealed that duration of Varenicline treatment was significant factor affecting 12-week continuous abstinence rate. The average duration of Varenicline treatment was 17.1 (+/-10.8) days and 54.0% took Varenicline as directed. The most common adverse events were nausea (40.0%) and insomnia (23.3%). CONCLUSION: Multi-modal intervention (short course of Varenicline, financial incentive, E-mail and short message service) was effective for smoking cessation with high continuous abstinence rates in a university. We suggest multi-modal intervention because compliance of Varenicline seems to be low in real setting.

Effect of Multi-modal Interventions for Smoking Cessation in a University Setting: A Short Course of Varenicline, Financial Incentives, E-mail and Short Message Service / 가정의학회지

BACKGROUND: Varenicline is known to have higher effect for smoking cessation than existing pharmacotherapies, including Bupropion and Nicotine replacement therapy, however, it can also bring about adverse effects such as problems in compliance due to the complicated dosage, side effects of high frequency, and financial burden resulted from a long term treatment. Moreover, the effect for smoking cessation with group program and non-pharmacotherapy, including financial incentives, E-mails or SMS is well known, but, the study on their combination is rare. Therefore, in the present study, we tried to evaluate two things; the effect for smoking cessation with multi-modal intervention, and the compliance of Varenicline. METHODS: From July 2008 to February 2009, we conducted the multi-modal smoking cessation program for 30 volunteers in Dankook university. This program consisted short course of Varenicline, financial incentives, E-mail and short message service. RESULTS: The continuous abstinence rate for weeks 9 throught 12 was 76.7% and for weeks 9 through 24 was 43.3%. Multivariate analysis revealed that duration of Varenicline treatment was significant factor affecting 12-week continuous abstinence rate. The average duration of Varenicline treatment was 17.1 (+/-10.8) days and 54.0% took Varenicline as directed. The most common adverse events were nausea (40.0%) and insomnia (23.3%). CONCLUSION: Multi-modal intervention (short course of Varenicline, financial incentive, E-mail and short message service) was effective for smoking cessation with high continuous abstinence rates in a university. We suggest multi-modal intervention because compliance of Varenicline seems to be low in real setting.

Optimized Tacrolimus Therapy in the Early Stage after Renal Transplantation

PURPOSE: Immunosuppressive regimen based on reduced-dose Tacrolimus (TAC) is widely accepted in the field of renal transplantation. However, optimal targetsfor TAC whole blood trough concentrations during the early period after kidney transplantation remain uncertain. METHODS: A total of 184 consecutive adult renal transplant recipients with triple immunosuppression (TAC/Mycophenolate/corticosteroid) were included in this study. According to the trough level of TAC at day 7 after transplantation, patients were classified as low TAC concentration (LT, 15 ng/ml, n=24) groups. Rate of acute rejection, graft function and side effects of TAC within 1 yr after transplantation were evaluated. RESULTS: There was no difference in trough concentrations of TAC at 2 weeks, 1 month, 3 months, 6 months and 12 months after transplantation among the three groups. Significantly higher incidence of acute rejection within 2 weeks after transplantation was observed in LT group compared with IT and HT groups (17.4%, 5.6% and 4.8%, respectively, P=0.037). HT patients showed significantly better estimated glomerular filtration rates until 6 months after transplantation than IT and LT patients (75.5+/-24.8 vs. 63.8+/-12.8 and 64.3+/-15.2 ml/min at 6 months, P=0.03). There was no significant difference in TAC toxicity in terms of post-transplant diabetes and renal toxicity. CONCLUSION: Short-term high TAC exposure immediately after kidney transplantation may provide lower incidence of acute rejection and better restoration of graft function compared with low or intermediate TAC exposure.

Safety and Efficacy of Laparoscopic Distal Pancreatectomy with Preservation of the Spleen and Splenic Vessels

PURPOSE: Distal pancreatectomy has historically been accompanied by splenectomy, due to the proximity and common blood supply of the pancreas and spleen. However, spleen-preserving distal pancreatectomy was introduced in order to prevent postoperative sepsis. The aim of this study was to evaluate the feasibility and outcomes of spleen and splenic vessel preservation during laparoscopic distal pancreatectomy (LDP). METHODS: Between June 2004 and March 2007, 30 patients underwent LDP for pancreatic neoplasms. Preservation of both the spleen and splenic vessels was pursued for benign and borderline malignant tumors. RESULTS: There were 11 male and 19 female patients, with a mean age of 47 years (range; 24~79 years). In 4 patients with suspicious malignancy, the spleen and its vessels were sacrificed. Preservation of the spleen and its vessels was successfully performed in 20 of 26 patients (76.9%) in whom it was initially sought. The mean tumor size was 4.3 cm (range; 1.5~11 cm), the mean operation time was 231 min (range; 70~490 min), and the mean blood loss was 316.67 ml (range; 50~1000 ml). During LDP, no conversion to open surgery occurred. The mean hospital stay was 11 days (range; 6~23 days). There was no mortality or reoperation. Postoperative complications occurred in 9 patients (30%), but all patients recovered after conservative management. CONCLUSION: LDP is a relatively safe and feasible procedure for the management of benign or borderline malignant tumors of the distal pancreas. Preservation of the spleen and splenic vessels may be feasibly pursued during LDP.