Initial Experience of Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients

PURPOSE: Laparoscopic sleeve gastrectomy (LSG) is rapidly gaining ground as one of the surgical procedures in bariatric surgery with emerging long-term follow-up data. The aim of the present study was to report our initial experience of LSG in morbidly obese patients. METHODS: Sixty-four consecutive patients underwent LSG from April 2009 to July 2010 at our bariatric surgery center. Patients eligible for LSG were those with a body mass index (BMI) of >37 kg/m2, and >32 kg/m2 with co-morbidities. LSG was performed using 5 trocars and endo-staplers with guidance of 34 Fr bougie. Perioperative management was standardized. The clinical data were prospectively collected and retrospectively analyzed. RESULTS: Among 64 patients, 19 were male and 45 were female, mean age was 35 years (range 20~57), mean preoperative BMI was 38.8 kg/m2 (range 32~57), and mean preoperative body weight was 108 kg (range 75~164). Mean operative time was 118 minutes (range 65~340) and mean length of hospital stay was 3.4 days (range 1~82). Staple line leak occurred in 1 patient, kinking of the gastric tube occurred in 2 patients. There was no open conversion and no postoperative mortality. After 170 days of follow-up, 24.4 kg of body weight loss and 52.7% of excess weight loss (%EWL), on average, was noted. CONCLUSION: Though long-term follow-up is needed, our early operative outcome was satisfactory in terms of %EWL and safety of the procedure. LSG was a safe and effective treatment strategy for morbidly obese patients.

The Surgical Treatment of External Snapping Hip by Modified Z-plasty (N-plasty) of the Iliotibial Band

PURPOSE: Modified Z-plasty(N-plasty) was performed on patients with snapping hip syndrome arising from the iliotibial band, whose pain and clicking sensation persisted despite conservative treatment. The effectiveness of this new technique was evaluated from an analysis of the clinical results. MATERIALS AND METHODS: Among the 44 patients (58 cases), who still felt pain and reported a clicking sensation during daily life despite hospitalization for at least 2 months from January 1999 to August 2007, this study evaluated a total of 25 patients (30 cases) who underwent N-plasty and were followed up for more than 6 months. All patients were male with a mean age of 21 years. The initial symptoms developed an average of 11.5 months prior to the hospital visit (range, 1 month to 4 years). The affected side was the right side in 6 cases and the left in 10. Among 9 patients affected bilaterally, 5 patients (10 cases) underwent surgery on both sides, 1(1 case) on the right side, and 3 (3 cases) on the left side. Surgery was defined as being successful when at 6 months after surgery the patient could carry out their daily activities and exercise without a clicking sensation or pain. Failure was defined when either a clicking sensation or pain was present. RESULTS: The posterior portion of the iliotibial band was thickened by an average of 8.9 mm (range, 6~14 mm). A tenotomy of the iliotibial band lengthened the band by an average of 25 mm (range, 20~35 mm) and narrowed the width of the iliotibial band anterior to posterior. Twenty-nine cases (97%) had a successful outcome after surgery. Recurrence occurred in 1 case. After additional surgery, the recurrence was found to be due to the insufficient length of the tenotomy. CONCLUSION: N-plasty performed in external type snapping hip patients is an effective method with a high success rate.

Entry Point and Approaching Angle of Working Cannula in Endoscopic Lumbar Disecectomy / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: We report the efficacy of the entry point and approach angle of a working cannula using preoperative prone abdominal computer tomography (PACT). SUMMARY OF LITERATURE REVIEW: To date, there are no reports on the entry point and approach angle of a working cannula when performing transforaminal percutaneous endoscopic lumbar discectomy (TPELD) with consideration of the individual anatomic variations and characteristics of herniated disc and surgical instruments. MATERIALS AND METHODS: Cases of herniated intervertebral discs from L4-5, who have previously undergone PACT before TPELD, were included. A total of 25 patients were observed over a 1 year period. The entry point and approaching angle of the working cannula with PACT were calculated, and the results were applied to the TPELD. The clinical results were assessed 1 month after surgery using the VAS, ODI and MacNab criteria, and were confirmed by a radiology and MRI examination. RESULTS: The preoperative measured data using PACT showed that the mean approaching distance and mean approaching angle of the working cannula were 12.4 cm and 75.4 degree, respectively. The VAS improved from a mean of 8.1 preoperatively to a mean of 2.3 12 months after surgery. The ODI improved from a mean of 59 preoperatively to a mean of 24 at 12 months after surgery. According to the MacNab criteria, all patients were classified as either excellent and good during the follow up periods. The extruded disc of all patients had been well removed according to the MRI scan performed 1 month after surgery. CONCLUSIONS: The scientific approach method using PACT based on the characteristics of patients and surgical instruments can be performed easily and accurately, and access and decompress the extruded disc directly.