Single port laparoscopic appendectomy in children using glove port and conventional rigid instruments

PURPOSE: To further improve the advantages of minimally invasive surgery, single port laparoscopic techniques continue to be developed. We report our initial experience with single port laparoscopic appendectomy (SPLA) in children and compare its outcomes to those of conventional laparoscopic appendectomy (CLA). METHODS: Clinical data were prospectively collected for SPLA cases performed at Chung-Ang University Hospital by a single surgeon between March 2011 and December 2011, including operative time, perioperative complications, conversion rate, and length of hospital stay. Each case of SPLA was performed using conventional laparoscopic instruments through Glove port placed into the single umbilical incision. To compare outcomes, a retrospective review was performed for those patients who underwent CLA between March 2010 and December 2010. RESULTS: Thirty-one patients underwent SPLA and 114 patients underwent CLA. Mean age (10.5 years vs. 11.1 years, P = 0.43), weight (48.2 kg vs. 42.9 kg, P = 0.27), and operation time (41.8 minutes vs. 37.9 minutes, P = 0.190) were comparable between both groups. Mean hospital stay was longer for CLA group (2.6 days vs. 3.7 days, P = 0.013). There was no conversion to conventional laparoscopic surgery in SPLA group. In CLA group, there were nine complications (7.9%) with 3 cases of postoperative ileuses and 6 cases wound problems. There was one complication (3.2%) of umbilical surgical site infection in SPLA group (P = 0.325). CONCLUSION: The results of this study demonstrated that SPLA using conventional laparoscopic instruments is technically feasible and safe in children. SPLA using conventional laparoscopic instruments might be popularized by eliminating the need for specially designed instruments.

Intraperitoneal Ropivacaine Instillation for Postoperative Pain Relief after Laparoscopic Cholecystectomy

PURPOSE: A study was designed to assess the effect of intraperitoneal instillation of ropivacaine in larparoscopic cholecystectomy patients using computerized patient controlled anesthesia (PCA). METHODS: From January 2009 to June 2009, 40 patients with uncomplicated, symptomatic cholecystitis with cholelithiasis who were referred to Chung-Ang University Medical Center for laparoscopic cholecystectomy were included in the study. Patients in group C (control group) received normal saline 100 ml and those in group I (instillation group) received intraperitoneal instillation of 2 mg/kg of ropivacaine diluted in 100 ml saline at the initiation of pneumoperitoneum. Patients were assessed for pain by blinded investigators at 6 time intervals after surgery; 2 hr, 4 hr, 8 hr, 12 hr, 24 hr, and 48 hr. The frequency at which patients pushed the button of the PCA on bolus requirement (FPB) was assessed by a patient-controlled module on the PCA machine. RESULTS: The mean total fentanyl consumption was lower in group I (367.39+/-85.88) than in group C (535+/-100.29) during the 48 hours (P<0.001). Fentanyl velocity and FPB showed significant difference between the groups (P<0.005). Visual analogue scale (VAS) measured pain scores were significantly lower in group I than in group C at 4 hr (P=0.027), 8 hr (P=0.010), 12 hr (P=0.011). CONCLUSION: Intraperitoneal instillation of ropivacaine at the beginning of laparoscopic cholecystectomy (LC) combined with normal saline infusion is an effective method for reducing pain after LC.

Laparoscopic Approach to a Case of Appendicular Schwannoma

Appendicular schwannoma is a rare tumor originating from Schwann's cells in the Auerbach plexus. The preoperative diagnosis is difficult because the clinical features are nonspecific, and it is mostly found accidentally via a radiologic image as a tumor, mimicking malignancy. We report a case of an appendicular schwannoma coexisting with an adenocarcinoma in the lung. A laparoscopic appendectomy was done with a clear resection margin, and the immunohistochemical staining showed positive S-100 protein, which confirmed the schwannoma. The patient also underwent a left upper lobectomy of the lung. The patient has been free of recurrence for the 6 months since the operation. The laparoscopic approach could be available for treatment of an appendicular schwannoma, thus avoiding an unnecessary laparotomy.

Case of Small Bowel Perforation due to Enteropathy-Type T-Cell Lymphoma

Enteropathy-type T-cell lymphoma (ETTL) is a rare disease with a poor prognosis. According to the World Health Organization (WHO) classification, it is a subtype of the peripheral T-cell lymphomas. This disease is associated with gluten-sensitive enteropathy, has a high risk of intestinal perforation and obstruction, and is refractory to chemotherapeutic treatment. We report the case of a 73-year-old woman who was diagnosed with enteropathy-type T-cell lymphoma of the small intestine, which was positive for the markers of cytotoxic T cells, CD3, CD8, and CD56, on immunohistochemical staining after resection of the perforated terminal ileum.

Effects of Three Different Types of Anti-adhesive Agents in a Rat Abdominal Wall Defect Model

PURPOSE: Postsurgical adhesion formation is a significant clinical problem within every surgical specialty. Several adhesion barriers have been developed in the form of solution, membrane or film in an attempt to solve these problems. The purpose of the present study is to compare the efficacy of antiadhesive agents in the prevention of postsurgical adhesion formation in a standardized rat adhesion model. METHODS: We examined forty Sprague-Dawley rats, which is a cecal abrasion with partial peritonectomy model. Three treatment groups (Group I: Film-type Surgiwrap(R), Group II: Solution-type Guardix-sol(R), Group III: Membrane-type Interceed(R)), each consists of 10 rats, and a control group of 10 rats were used by saline. Ten days after surgery, the rats were killed, and the levels of adhesion were graded. Immunohistochemical staining for microvessel density (CD34, MVD) and macrophage (ED1) were performed in adhesion tissue. RESULTS: The peritoneum adhesion mean scores are as follows: control group: 2.2+/-0.78, Group I: 1.0+/-1.06, Group II: 0.9+/-0.99, Group III: 0.6+/-0.84. All treatment groups showed significantly less peritoneum adhesion (P=0.006), while there was no significant difference in each group. The intraperitoneal organs adhesion mean scores are as follows: control group: 2.8+/-0.91, Group I: 2.6+/-1.06, Group II: 1.4+/-0.84, Group III: 1.0+/-0.81. Group I had no significant difference about intraperitoneal organs adhesion with control group, but Group II and Group III showed less intraperitoneal organs adhesion. The mean numbers of microvessel density are as follows: control group: 42.5+/-4.83, Group I: 40.8+/-6.53, Group II: 30.9+/-6.15, Group III: 15.60+/-4.37, from which there was a significant difference between Group II and Group III with control group (P<0.001). The mean numbers of macrophage are as follows: control group: 223.3+/-33.12, Group I: 211.25+/-10.96, Group II: 171.60+/-23.96, Group III: 147.0+/-12.22, from which there was a significant difference between Group II and Group III with control group (P<0.001). CONCLUSION: In our animal model, three different types of antiadhesive agents (Surgiwrap(R), Guardix-sol(R), Interceed(R)) were effective in adhesion prevention, but Surgiwrap(R) had less antiadhesive effect for intraperitoneal organs adhesion. Membrane-type Interceed(R) had a better effect for microvessel density (MVD) and macrophage than solution-type Guardix-sol(R).

The Initial Experience with a Single Incision Laparoscopic Appendectomy

PURPOSE: A laparoscopic appendectomy (LA) is becoming popular for the treatment of acute and perforated appendicitis. Since it was first described, the LA has been modified many times. We present the result for a new technique of LA, in which the LA is conducted through a single umbilical incision without exteriorizing the appendix to perform the operation. METHODS: A single incision laparoscopic appendectomy was attempted in 25 patients (17 men, 8 women). Under general anesthesia, a wound retractor was inserted through the umbilicus. The appendix was grasped and dissected from surrounding tissues with a single flexible dissector or grasper. After mesenteric dissection with ultrasonic shear, the base of the appendix was ligated with an Endoloop. The appendix was withdrawn into the wound protector and extracted from the abdomen. RESULTS: A single incision laparoscopic appendectomy was completed in 25 patients. No major intraoperative or postoperative complications were encountered. The average duration of the procedure was 50.3+/-21.3 min. The average hospital stay was 4.1+/-2.4 days. CONCLUSION: This new technique, a single incision laparoscopic appendectomy, further improves the minimal invasiveness of a LA because a single incision is used. This procedure is a safe, very minimally invasive procedure with excellent cosmetic results.

Correlation between the Expression of Nuclear Factor-kappaB p65 Protein with the Expression of Nuclear Factor-kappaB p50 Protein and the Clinicopathologic Factors in Colorectal Cancer

PURPOSE: Nuclear Factor-kappaB p65 (NF-kappaB p65) and nuclear Factor-kappaB1 p50 (NF-kappaB p65) have been shown to play roles in cell proliferation, apoptosis, cytokine production and oncogenesis. This study was designed to investigate the expressions of NF-kappaB p65 and NF-kappaB p50 proteins in premalignant lesions and colorectal adenocarcinoma. METHODS: Paraffin sections of 20 normal mucosa specimens, 20 low grade tubular adenoma specimens, 20 high grade tubular adenoma specimens and 64 adenocarcinoma specimens were analyzed immunohistochemically for the expressions of NF-kappaB p65 and NF-kappaB p50 proteins. RESULTS: The expressions of NF-kappaB p65 and NF-kappaB p50 proteins were significantly higher in the adenocarcinoma tissue compared with that in the normal mucosa, the low grade tubular adenoma and the high grade tubular adenoma tissues. The frequency of a NF-kappaB p50 expression was higher in the poorly differentiated histologic grade specimens, in the presence of nodal metastasis and in the high stage specimens. There were significant correlations between the NF-kappaB p65 and NF-kappaB p50 proteins. CONCLUSION: The expressions of NF-kappaB p65 and NF-kappaB p50 proteins may play a role in the pathogenesis of colorectal carcinoma.

Comparative Clinical Analysis of 111 Laparoscopic Cholecystectomy Cases Converted to Open Procedures

PURPOSE: While laparoscopic cholecystectomy can be successfully performed in the majority of patients, conversion to open procedure is still necessary in certain cases. The purpose of this study was to identify the discerning factors that helped to predict the need for conversion to open cholecystectomy. METHODS: A retrospective review was conducted on the data for 2,523 laparoscopic cholecystectomies performed at Chung-Ang University Hospital between January 2002 and July 2007. Patient sex, age, height, weight, body mass index (BMI), duration of preoperative hospital stay, preoperative physical examination, laboratory data, radiologic findings, and reasons for conversion to open procedure were evaluated. RESULTS: Adhesion was perceived to be the most critical factor for conversion in 56 of 111 total cases (50.5%). Bleeding (22.5%), bile duct injury (11.7%), inflammation (9.0%), and uncertain anatomy (6.3%) followed sequentially in incidence. Factors found to significantly increase the risk of conversion on univariate analysis were patient age >70 years, male sex, previous abdominal operation, preoperative common bile duct stone, tenderness in the right upper quadrant, distended shape of the gallbladder, and pericholecystic fluid collection. On multivariate analysis, the following factors were found to be associated with a higher risk: patient age >70 years (p=0.002), male sex (p=0.012), previous abdominal operation (p<0.0001), and preoperative common bile duct stone (p=0.041). CONCLUSION: In the case of operations with such discerning factors, surgeons should be more cautious and delicate in all procedures throughout the operative period. Furthermore, to reduce the risk of additional severe complications, surgeons need to decide early on if they will perform a conversion.

Significance of Intra & Extra Hepatic Duct Stone Removal via Percutaneous Transhepatic Biliary Drainage Tube in Patients Undergoing Laparoscopic Cholecystectomy

PURPOSE: One of the popular and widespread treatments for intra- & extra-hepatic duct (IEHD) stone associated gallbladder (GB) stone is laparoscopic cholecystectomy (LC) with stone removal through endoscopic retrograde cholangiopancreatography (below ERCP). Because LC with stone removal through percutaneous transhepatic biliary drainage (below PTBD) is well known for its safety and feasibility in removing IEHD stones, we did this study to see the significance (safety, feasibility, effectiveness etc) of PTBD and stone removal. METHODS: We compared the odds by collecting 71 retrospective cases, victims of IEHD stone associated GB stone from January, 2004 to December, 2007 in Chung-Ang University Hospital. Comparative analysis took place in 51 cases who underwent PTBD and 20 cases treated with ERCP. We excluded 6 patients who underwent PTBD for intra hepatic duct stone. Age, sex, American Society of Anesthesiologists score, pain, nausea, pre- and post- laboratory value, symptoms, size, location and number of stones, diameter of extra hepatic duct, recurrence and clearance rate, frequency of each procedure, complications, cost were investigated in this study. RESULTS: There were no statistical differences in each group in recurrence and clearance rate or frequency of procedure. However post-procedure pancreatitis and amylase level were significantly difference in each group. PTBD group experienced much longer hospital stay but was not significantly different. Although procedure cost is three times more expensive than that of PTBD group, there were no differences in total cost and patients' expenses between the two groups. CONCLUSION: PTBD would be an alternative solution in managing IEHD stone associated with GB stone for its lower rate of complication, higher clearance with minimal discomfort.

Adrenal Ganglioneuroma Treated by Laparoscopic Surgery

Adrenal ganglioneuromas are rare benign tumors arising from the neural crest tissue of the sympathoadrenal nervous system. Because most of these tumors are hormonally silent and patients with them are often asymptomatic, they are often identified incidentally in patients undergoing abdominal imaging studies for unrelated reasons. Diagnosis of this entity is very difficult to make, with definitive diagnosis being based on histological examination. Surgical resection may be both diagnostic and therapeutic. A technique for laparoscopic adrenalectomy of benign adrenal tumors has recently been developed. If the tumor is excised with an adequate resection margin, the postoperative prognosis is very good. In this report, we describe two cases of adrenal ganglioneuroma that were treated using a laparoscopic resection procedure, and we also present a review of the pertinent literature.

The Efficacy of the Alvarado Score in the Diagnosis of Acute Appendicitis

PURPOSE: Acute appendicitis is the most common cause of an acute abdomen that needs an emergency operation. However, the preoperative diagnosis is difficult. The purpose of this study is to assess the diagnostic efficacy of the Alvarado score by a comparison with CT and to determine the indication of CT evaluation. METHODS: From August 2006 to October 2006, 111 consecutive patients were admitted to Chung-Ang University hospital under the impression of acute appendicitis, and a CT scan was done. The Alvarado score, which consists of migration, anorexia, nausea-vomitig, tenderness, rebound tenderness, fever, leukocytosis, and left shift, was applied to the patients. RESULTS: Of the 111 patients, 85 patients underwent an operation, and 26 were discharged without an operation on the basis of the CT finding. The negative appendectomy rate were 4.7%. CT showed a sensitivity, of 0.90 a specificity of 0.97 and an accuracy rate of 0.92. Tenderness and leukocytosis were confirmed as the most important tests and showed accuracy rates of 0.73 and 0.70, respectively. The sensitivity was 0.90 at score 5 and 0.85 at score 7. Therefore, there was no single cut-off score that satisfied all diagnostic values. CONCLUSIONS: The Alvarado score alone is not a satisfactory diagnostic method acute appendicitis. Of the appendicitis patients, 90% might be included in the diagnosis for Alvarado scores above 5, and the negative appendectomy could be as high as 15% for Alvarado scores above 7, which is the score generally accepted for a diagnosis of appendicitis.

Morgagni Hernia with Cecal Perforation

Morgagni hernia is known as the smallest form of diaphragmatic hernia and it is usually asymptomatic. However, almost all the cases reported in the Korean literature have been symptomatic and they were surgically repaired. The authors report here on a case of Morgagni hernia that was found accidentally during the preoperative workup of a patient who suffered from panperitonitis with cecal perforation. The patient was transferred from the local hospital with complaints of pain in the entire abdomen. On the preoperative CT, a large paracardial mass and a collection of intra-peritoneal free air were identified. After reduction of the hernia contents, the hernia was repaired with using mesh. The patient showed a rapid recovery without any complication.

Significance of the Decreased Expressions of Claudin-1 and ZO-1 Protein as Prognostic Factors in Breast Cancer

PURPOSE: Tight junction proteins are either over-expressed or suppressed in some cancers. These suppressions of claudin-1 and ZO-1 protein are known to have a significant relationship with the progression of breast cancer. The authors reviewed 42 cases of breast cancer and the staining status of claudin-1 and ZO-1 in order to evaluate Claudin-1 and ZO-1 as clinicopathologic risk factors. METHODS: Immunohistological staining for Claudin-1 and ZO-1 was performed in 42 post-operative pathologically diagnosed infiltrating duct carcinoma specimens. The rate of expression was compared with the clinical record, the pathological diagnosis, the estrogen receptor and progesteron receptor status and the c-erbB2 gene to evaluate the protein expression-breast cancer progression relationship and to investigate the expressions of Claudin-1 and ZO-1 as a prognostic factors in breast cancer. RESULTS: The claudin-1 and ZO-1 expressions were both decreased in all the post-operative specimens. The claudin-1 expressions were significantly decreased 100%, 82.4% and 66.7% as the histologic grade increased. The ZO-1 expressions were shown in 44.8% of the lymph node metastasis negative group and in 7.7% of the lymph node positive group. The expression of ZO-1 decreased by 53.3%, 28.6% and 0%, with statistical significance, as the stage increased. CONCLUSION: The claudin-1 expressions were decreased in the poorly differentiated group, i.e., a high histologic grade, and the ZO-1 expressions were decreased in the lymph node positive group and in the high stage cancer. This shows the possibility of Claudin-1 and ZO-1 as factors for tumorigenesis and progression and as prognostic factors in breast cancer.

Analysis and Consideration of the Complications of Laparoscopic Cholecystectomy

PURPOSE: Laparoscopic cholecystectomy has replaced open cholecystectomy as the standard treatment and it has widely gained rapid acceptance. However, laparoscopic cholecystectomy has many complications and it can require conversion to open cholecystectomy or further management. We reviewed our cases for determining the complications and clinical results in order to improve the efficacy and safety of laparoscopic cholecystectomy in our hospital. METHODS: The data from 3,224 laparoscopic cholecystectomies that were performed at our hospital from January 1995 to December 2004 were reviewed retrospectively. The pre-operative laboratory data, operative findings, post-operative pathologic findings, complications and proper treatment were evaluated. RESULTS: 52 of all the patients developed complications. The median patient age was 51.8+/-11.6 years, and the median admission time was 29.9+/-10.6 days. The most common complications were post operative bleeding (20 case), and bile duct injury (15 cases). A collection of bile was noted in 12 cases. The treatment of complications were operations (16 case) radiologic interventions (14 case), and observation with conservative management (22 case). CONCLUSION: There were various complications of laparoscopic cholecystectomy, and these patients needed a longer hospital stay and operative treatment. So, improvement of surgeons' skill with a carefully approach and better understanding of the anatomical variations of the biliary tree and vascular system, recognition of pre-operative patients' general condition and the severity of inflammation, and prompt and proper management for complications should be done to prevent serious problems.

The Comparative Analysis between Laparoscopic Inguinal Herniorrhaphy and Open Inguinal Herniorrhaphy

PURPOSE: Published evidence comparing laparoscopic and open herniorraphy is contraversial. Laparoscopic surgery has became or is being tried as a standard in most of abdominal surgery due to its advantages. But disadvantages of laparoscopic surgery include the need for general anethesia, a problem particularly in over increasingly aged population, limit its more use. This study aimed to investigate the availability and indication of both laparoscopic and open herniorraphy. METHODS: The records and data of 85 inguinal hernia patients who underwent laparoscopic herniorrhaphy (n=20) or open herniorrhaphy (n=65), with similiar sex and age distribution, were retrospectively analyzed. Laparoscopic herniorrhaphy equated to totallly extraperitoneal approach (TEP) repair and open herniorrhaphy to Bassini repair and Lichtenstein repair. As statistical method, the one way Anova Tests and Post Hoc Tests was used. RESULTS: There was no significant difference noted between the groups in relation to sex, age, site, complication rate, or recurrence rate in both group. The laparoscopic group has a shorter mean postoperative hospital day than open group. However there was no statistical significance. Postoperative analgesic administration is significantly decreased in mesh applied group. CONCLUSION: The advantages of laparoscopic herniorrhaphy is not revealed in all patients. Indications for laparoscopic herniorrhaphy are being restricted to recurrent, bilateral hernia. Patient selection has been stepped up. Thus elderly patients and patients with significant morbidity who may well require monitoring after procedure are being advised to undergo open tension free repair with local anethesia. These recommendation apply similarly young patients with small, simple primary defects. After studying more cases, a reevaluation must be done concerning the advantage of both laparoscopic and open herniorraphy.

Multiple Gastrointestinal Stromal Tumors of the Small Intestine

Gastrointestinal stromal tumors (GISTs) are a heterogeneous group of mesenchymal neoplasms of the gastrointestinal tract. A great majority of GISTs occur in the stomach and small intestine, but multiple GISTs of the jejunum are rare. We experienced a case of multiple GISTs of the jejunum. A 57 year old woman was admitted due to general weakness and abdominal pain. The computer tomography of the abdomen revealed solid tumor in the jejunum. We removed tumor from jejunum by resection. Histological and immunohistochemical studies revealed a gastrointestinal stromal tumor of the intermediate malignant type.

Cathepsin D expression in the tumor cells and juxta-tumoral stromal cells of T1 invasive ductal carcinoma, Nos / 한국유방암학회지

INTRODUCTION: Cathepsin D (CD) is a lysosomal protease that can be used as an important prognostic cytosolic factor for breast cancer. Its over-expression in breast cancer cells and in the host stromal cells in the tumor has been proposed as being a poor prognostic indicator. However, its prognostic value is still being debated. Therefore, CD expression needs to be examined in more relevant subsets of tissue in order to refine its prognostic significance and the clinical applications. METHODS: Regardless of the lymph node status, 110 T1 invasive ductal carcinomas of the breast were immunohistochemically evaluated for the CD expression using rabbit anti-cathepsin D monoclonal antibody. This study separately assessed the expression of CD in the invasive component (IDC), in the in situ component (DCIS), and in the juxtatumoral stromal cells (JTSC). The CD expression level in these three kinds of tissues were correlated with the nuclear grade, ER, PR, c-erb-B2, p53, the N stage, the T stage, and the 5 year metastasis-free survival. RESULTS: Positive CD expression in the JTSC was associated with the T stage (p = 0.001) and the N stage (p = 0.029), whereas positive CD expression in the DCIS and IDC was not. In addition, strong CD expression in the JTSC correlated with the nuclear grade of the invasive component (p = 0.024). In all three components, no statistically significant correlation was found between the biomarker (ER, PR, cerb-B2, p53) and the CD expression. On univariate analysis, positive expression in the JTSC was correlated with a poor 5 year- metastasis free survival (p = 0.007), but the positive expression in the IDC and DCIS was not. CONCLUSION: CD expression of the JTSC could represent the N stage, the T stage, and the nuclear grade of T1 IDC. Whether or not it would have an independent influence on the prognosis of T1 IDC, CD expression in the JTSC is probably an indicator of the tumor virulence. CD expression in the JTSC will provide an important clue for the development of new CD targeted therapies, and it will serve as an important criterion for selecting the appropriate candidates for these future targeted therapies.

The Influence of Expressions of Cyclin B1 and D1 on Clinicopathologic Prognostic Factors and Survival Rate in Gastric Cancer

PURPOSE: Disturbance in normal cell cycles by cell cycle control factors is an important process of cancer carcinogenesis. The aims of this dissertation were identify the influence of cyclin B1 and D1 on the growth and expression of gastric cancer and their effects on the prognosis. METHOD: The subjects were 128 patients selected from those who underwent gastric surgery for their gastric cancer between January 1995 and December 1998. Immunohistochemical staining was conducted for cyclin B1 and D1 using paraffin embedded tissues, followed by analysis of their protein expressions, possible prognostic factors and survival rate. RESULTS: Cyclin B1 expression was founded in 48 of the 128 patients (37.5%), and that of cyclin D1 in 96 (75%). Both cyclin B1 and D1 showed no statistical significance with T-stage, location of tumors or histologic types. However, for the case of any significance with lymph node metastasis, the higher the N-stage, the greater was the expression of cyclin B1 (P=0.014). For the case of any significance with life term, the Kaplan-Meier method showed the greater the expression of cyclin B1, the shorter the life term (P=0.042). CONCLUSION: An association was indicated between cyclin B1 and lymph node metastasis in gastric cancer, but has no relation with the T-stage, histologic type or location of tumors. Cyclin D1 shows no association with lymph node metastasis, T-stage, histologic type or location of tumors. However, cyclin B1 showed a significant association with the survival rate.

The Comparative Analysis between Laparoscopic and Open Appendectomy

PURPOSE: Nowadays laparoscopic appendectomy is widely practiced in developed countries. The purpose of this study was to evaluate laparoscopic appendectomy in comparison with open appendectomy. METHODS: On hundred cases each of laparoscopic appendectomy and open appendectomy, performed between February 2001 and June 2002, were reviewed for age, sex, operative time, hospital days, time for first meal, number of used parenteral analgesia, number of OPD visits, etc. RESULTS: Operative time was longer in the laparoscopic appendectomy group (P>0.05) and the number of used parenteral analgesia was slightly higher in the laparoscopic group (P>0.05). However, recovery time for diet was slightly shorter in the laparoscopic group (P>0.05). None of these trends were statistically significant. The times of OPD visit after discharge was less in the laparoscopic group (P<0.05). The hospital days of pathological simple appendicitis were shorter in the laparoscopic appendectomy group (P<0.05). In the laparoscopic group, intraabdominal abscess was developed in 2 cases, wound infection in 4, and intestinal obstruction in 2. The conversion rate to open appendectomy was 7% (7/100) in the laparoscopic group. CONCLUSION: Laparoscopic appendectomy can shorten overall OPD follow up days and in case of simple appendicitis, laparoscopic appendectomy can also shorten hospital days.

A Clinical Review and Comparative Study of CBD Exploration and Percutaneous Transhepatic Stone Removal for Management in Recurrent Biliary Stone

PURPOSE: Recurrent bile duct stones, following biliary surgery, cause many difficult problems and reoperation on the biliary tract has limitation due to high mortality and morbidity. In recent years, various non-operative modalities for the management of recurrent stone have been developed and reoperation on biliary. This study was designed to determine the factors contributing to the success rate, and to investigate the optimal treatment method, of reccurrent biliary stones. METHODS: Thirty-nine patients, treated by percutaneous transhepatic stone removal (PTBD group), and 42 treated by a common bile duct exploration (operation group), at Chung- Ang University Hospital, between January 1999 and August 2002, were retrospectively analyzed. RESULTS: Complete removal (Success) was achieved in 82.1 and 86.1% of the cases of the PTBD and operation groups, respectively. There were no significant differences observed relating to the sex, age, duration of hospital stay, cost, success rate. However, the complication rate was significantly decreased in the PTBD group (8 cases (20.5%) vs. 22 cases (51.2%) P=0.0057). CONCLUSION: Form the comparison of the operation and PTBD groups, similar success rates were observed. Percutaneous transhepatic stone removal is also an effective method for the management of recurrent bile duct stones. After studying more cases, re-evaluation must be performed concerning the potential advantages of percutaneous transhepatic stone removal.