The experience of transumbilical endoscopic appendectomies

Minimally invasive surgery is being widely accepted in various fields of surgery. Although several appendectomy techniques have been reported but, there is no standardization. We report here the experiences of transumbilical endoscopic appendectomy in humans. Between July 2008 and September 2010, ten patients with appendicitis successfully underwent transumbilical endoscopic appendectomies. There were 7 cases of suppurative, 2 cases of gangrenous and 1 case of perforated in operative findings. The ages of the patients were 13-56 years (mean age, 32.7 +/- 15.4 years). Under general anesthesia, a 15-mm port was inserted through the umbilicus and then a two-channel endoscope was inserted in the peritoneal cavity. After appendix identification, counter-traction of the appendix with a direct abdominal wall puncture using a straight round needle prolene was performed to achieve good visualization of the operative field. Tissue dissection was performed using an endoscopic needle knife. Tissue grasping and resected appendix retrieval were done with endoscopic forceps. The average operation time was 79.5 +/- 23.6 minutes (range, 45 to 110 minutes). No procedures were converted to laparoscopic or open appendectomy. Hospital stay was 4-6 days. All patients completely recovered without complications. As it is highly maneuverable, we believe transumbilical endoscopic appendectomy can be a feasible method. And, as surgeons want to proceed from laparoscopic surgery to natural orifice transluminal endoscopic surgery, this procedure could be a triable method.

Hospital Patients Based Incidence of Acute Aortic Dissection / 대한혈관외과학회지

PURPOSE: Acute aortic dissection (AAD) is considered one of the most common aortic catastrophes. However, there are a few epidemiological studies and true incidence was unknown in the general population. With the advent of newer diagnostic techniques, AAD is more frequently detected in radiological studies. We determined the incidence of AAD in a hospital patient group. METHODS: A hospital patient group was defined as all patients from the emergency room and outpatients' department (total number, 347,204) enrolled in Chungbuk National University Hospital between 2005 and 2010. Twenty-five AADs were detected by reviewing radiological reports (22,241 chest computed tomography [CT], 39,235 abdominal CT). A traumatic aortic dissection and isolated abdominal aortic dissection was excluded. We calculated person-years in all hospital patients and the incidence of AAD. We estimated a minimal general population based incidence by dividing a total population of geographical regions where patients of AAD were living. RESULTS: The annual age- and sex-adjusted hospital patients based incidence was 6.94 per 100,000 persons (95% confidence interval, 6.92 to 6.97). Nine dissections (36%) involved the ascending aorta, whereas sixteen (64%) involved the descending aorta. AAD was found in patients with six regions. A total population was 1,032,509 and patients included in the study were 296,505, in these six regions. An estimated minimal population based incidence was 1.99. CONCLUSION: In other studies, the incidence of AAD is approximately two to four per 100,000 persons per year. AAD in north area of Chungcheong, Korea occur with similar frequency when it is compared with other population based studies.

The Prevalence of Abdominal Aortoiliac Artery Aneurysm in the Hospital Patient Group and Treatment Status / 대한혈관외과학회지

PURPOSE: Abdominal aortoiliac artery aneurysm (AIAA) is a common disease in the elderly. The prevalence of AIAA was well known in western countries. However, in Korea, there are a few studies regarding the prevalence. This study was carried out to determine the prevalence of AIAA by reviewing the radiological reports of abdominal computed tomography (CT). METHODS: We searched the words like "aneu" or "rysm" in radiological reports of 22,520 abdominal CT (11,974 patients) between January 1, 2005 and March 31, 2010 in patients over 50 years old. We found 121 patients who had AIAA of more than 3 cm or more than 1.8 cm isolated iliac artery aneurysm. We analyzed the characteristics of these patients with aneurysm. RESULTS: The prevalence of aneurysms was 1.01% (121 patients). The aneurysms in men were more prevalent than women (1.39% vs. 0.51%). In the octogenarian, the aneurysms were found to be most frequent (2.75%). Among the 121 aneurysms, aortic, aortoiliac, and isolated iliac artery aneurysms were 66 (54.6%), 28 (23.1%), and 27 (22.3%). In terms of aneurysmal size, greater than 6 cm, 5 to 6 cm, and less than 5 cm were 19 (20%), 13 (14%), and 62 (66%), respectively. The rupture rate was 18% (6 patients) in more than 5 cm abdominal aortic aneurysm. CONCLUSION: The prevalence of AIAA is lower than Western countries. This is not a national-wide survey, but results are similar to the other Korean reports. Reviewing radiologic reports of abdominal CT is another way to study the prevalence of aneurysms.

A Dissecting Aneurysm of the Common and Proper Hepatic Artery with Dissection of the Celiac Axis and the SMA / 대한혈관외과학회지

A spontaneous dissecting aneurysm of visceral arteries without trauma or an iatrogenic cause is rare. We would like to report a case of a dissecting aneurysm of the common and proper hepatic artery with dissection of the celiac axis and the superior mesenteric artery (SMA). A 55-year-old man presented abdominal pain. In the abdominal computed tomography (CT), an intraabdominal hematoma and a dissecting aneurysm of the common and proper hepatic artery with dissection of the celiac axis as well as the SMA had been found. The size of the dissecting aneurysm was growing in a follow-up CT. We performed a bypass between the right hepatic artery and a celiac artery with a saphenous vein after exclusion of the aneurysm. A bypass graft was occluded in the early postoperative period but the patient recovered without major sequelae.

Left Iliac Vein Compressions and Venous Hemodynamic Changes

PURPOSE: Left iliac vein compression is a risk factor for deep vein thrombosis (DVT) and often can be symptomatic. We wanted to know the incidence of left iliac vein compressions in the general population and the relationship between iliac vein compression and outflow fraction of the lower extremities. METHODS: 1,523 cases examined with abdomen - pelvis CT were included in this study. Left iliac vein compression was calculated as the diameter of left common iliac vein at the site of maximal compression divided by the diameter of the uncompressed caudal common iliac vein. These cases were divided into 4 groups by the degree of iliac vein compression. In addition, left lower extremity venous outflow fractions in 106 patients with abdomen - pelvis CT images were recorded and analyzed. RESULTS: The number and mean age of each group (group 1, 2, 3 and 4) were 351 (23%) & 62.3+/-13.4, 426 (28%) & 57.7+/-16.1, 529 (35%) & 50.1+/-20.4 and 217 (14%) & 40.7+/-22.9, respectively. While the age of patients was decreasing, the occurrence of left iliac vein compression increased (P<0.01). The mean left low extremity venous outflow fractions of each group (group 1, 2, 3 and 4) was 27.9+/-6.9%, 26.9+/-6.4%, 25.9+/-6.7% and 19.1+/-6.6%, respectively. The mean outflow fraction of group 4 was significantly lower than that of other groups (P<0.01). There was a tendency that the more left iliac vein compression increased, the more outflow fraction decreased (P=0.011). CONCLUSION: In 14% of 1,523 cases, there were severe left iliac vein compressions, more than 75% diameter, and the mean outflow fraction of that was lower than in others. Further study is needed to realize the relationship between left iliac vein compression and DVT.

The Incidence of Inferior Vena Cava Anomalies by MDCT

PURPOSE: Since the early 20th century, IVC anomalies have been studied by autopsy, venography, CT, and MRI. Previous studies using conventional CT were usually performed with axial view images with a distance of 3~5 mm. The aim of this study is to determine the incidence of IVC anomalies using MDCT (multi-detector computed tomography). METHODS: 1,560 cases of abdominal MDCT imaged in Chungbuk National University hospital from July 2006 to November 2006 were included in this study. We reviewed axial view images at a distance of 1~2 mm, and analyzed coronal view images and sagittal view images reconstructed by multiplanar reformatting with an E-film workstation. RESULTS: The incidence of IVC anomalies was 2.38% (43/1,560). Two left IVC (0.12%), 12 double IVC (0.76%), 25 circumaortic left renal veins (1.6%), and 4 retroaortic left renal veins (0.25%) were detected. The common iliac vein was completely separated in six among 12 double IVC cases. In circumaortic left renal veins, the anterior left renal veins were usually prominent, and the posterior left renal veins were always located on the distal side. The mean distance between the anterior and posterior left renal vein was 39 mm. The incidence of a prominent left gonadal vein was 5%. CONCLUSION: IVC anomalies are not uncommon, and can have clinical implications. Awareness of anomalies can allow clinicians to avoid diagnostic pitfalls and intraoperative morbidity.