Clinical Study of a Laparoscopic Cholecystectomy after a Percutaneous Cholecystostomy

BACKGROUND: A laparoscopic cholecystectomy has many clinical advantages and is now recognize as the choice for treatment for gallstones. However a laparoscopic cholecystectomy is often not feasible or is converted to the conventional open method in patients with acute cholecystitis because of surrounding adhesion, tissue edema, and high postoperative complications. Lately, good clinical results have been reported by many authors for a percutaneous cholecystostomy followed by a laparoscopic cholecystectomy in the management of acute cholecystitis. METHODS: Between January 1996 and March 1997, 56 acute cholecystitis patients were surgically treated in our institution. Thirteen patients underwent percutaneous drainage followed by a laparoscopic cholecystectomy (Group I). Also a laparoscopic cholecystectomy without a prior percutaneous cholecystostomy was attempted in 43 patients (Group II). RESULTS: There were no differences in the age and the sex distributions, the chief complaints on admission, and the severity of inflammation between the two groups. The only significant difference was the wall thickness of the gallbladder on postoperative pathologic examinations, 4.7 mm for Group I and 6.2 mm Group II (p=0.038). For the patients in Group I, percutaneous drainage of the gallbladder continued for 5.4 days on average, and the cholecystectomy was usually performed about 15 days later. A laparoscopic cholecystectomy was possible in 10 patients (76%) in Group I, but had to be converted to the open method in 3 patients. In Group II, only 17 patients (39.5%) out of 43 underwent a successful laparoscopic cholecystectomy. In other words, the open conversion rate was 24% in Group I and 60.5% in Group II. The wall thicknesses of the gallbladder excised laparoscopically were 3.98 mm and those of the conventionally removed gallbladder were 6.96 mm on average. This difference in the wall thickness was statistically significant (p=0.013) and was the only factor related with the open conversion rate. CONCLUSIONS: We think that a laparoscopic cholecystectomy performed several days after percutaneous drainage of the gallbladder to eliminate acute inflammation may be recommended for management of acute cholecystitis patients with severe clinical symptoms and ultrasonographic findings of marked gallbladder dilatation or pericholecystic fluid collection.

Analysis of the Survival Rate after Operations for Colorectal Cancer

BACKGROUND: Colorectal cancer is the third most common cancer in the world and the fourth most common cancer in Korea. The incidence of colorectal cancer is increasing steadily in Korea. In some countries, mortality rates have started to decline, and survival rates have increased. The survival rates of colorectal cancer is increasing due to early detection and to advances in adjuvant therapy. METHODS: This analysis studied colorectal cancer patients who had been operated on at Eul-Ji Medical college Hospital from Jan. 1991 to Dec. 1996. We analyzed the 5-year survival rate according to age, sex, duration of symptoms, stage, resectability, and histopathologic differentiation by the Kaplan- Meier method. RESULT:Age (p=0.482), sex (p=0.394), duration of Symptoms (p=0.346), and tumor location (p=0.685) did not appear to be statistically significant as prognostic factors. The 5-year survival rates according to the Dukes' stage were as follows:stage A (100%), stage B (77.7%), stage C (47.4%), and stage D (0.0%). The 5-year survival rates showed 8.2% in palliative resected cases and 67.2% in radical resected cases. In 139 radically resected adenocarcinoma cases, the 5-year survival rates were 73.4% of the highly differentiated cases, 67.6% of the moderately differentiated cases, and 35.7% of the poorly differentiated cases (p=0.043). CONCLUSION:Early diagnosis, well differentiation, and radical resection were significant as prognostic factors in our result. We could confirm that early diagnosis and radical resection are necessary to increase the survival rate in patients with colorectal cancer.

Fournier's Gangrene: A report of one case

Fournier's gangrene is a rare infection with high mortality rate. it consists of a mixed bacterial infectin of the skin, subcutaneous tissues and superficial fascia of the perinium and genitalia. Old patients especially with diabetes mellitus, alcoholism and maligancy are more affected. This disease requires prompt treatment: early diagnosis, broad spectrum antibiotic therapy, nutritional support and immediate extensive surgial debridement are necessary We report one case of Fournier's gangrene associated with diabetes mellitus.