Inguinal hernia repair in patients with liver cirrhosis accompanied by ascites / 대한외과학회지

PURPOSE: We describe the clinical characteristics and assess the outcomes and stability of inguinal hernia repair under local anesthesia for patients with liver cirrhosis accompanied by ascites. METHODS: We retrospectively reviewed the medical records of 22 patients with cirrhosis and ascites who underwent mesh plug hernia repair performed by a single surgeon from January 2002 to August 2009, and the clinical characteristics and outcomes of the patients were analyzed. RESULTS: Twenty-two patients were included in the study. Fifteen (68.2%) were Child's class B and seven (31.8%) were Child's class C. Hernia repairs were successful without major complications or recurrence in all patients. Minor complications occurred in only three patients, consisting of two hematomas and one case of scrotal swelling. Complications were resolved spontaneously without the need for blood transfusion or reintervention. Thirteen patients died during follow-up (59.1%); eight of these patients died within 1 year after hernia repair. However, there was no 30-day postoperative mortality. Five of the eight patients who died were Child's class B and the remaining three patients were Child's class C. Deaths were all related to cirrhotic complications, and there was no operation-related mortality. CONCLUSION: Inguinal hernia repairs under local anesthesia in patients with cirrhosis accompanied by ascites were performed safely and effectively. Therefore, surgical repair is recommended even in patients with refractory ascites and poor hepatic function to prevent life-threatening complications or severe pain and improve quality of life.

Inguinal hernia repair in overweight and obese patients / 대한외과학회지

PURPOSE: To describe the clinical characteristics and outcomes after inguinal hernia repair in overweight and obese patients. METHODS: We retrospectively reviewed the medical records of 636 adult patients who underwent mesh plug inguinal hernia repair performed by one surgeon from November 2001 to January 2009.The clinical characteristics and surgical outcomes of the patients were analyzed. According to the body mass index, patients higher than 23 were defined as overweight and obese patient group (O group) and patients between 18.5 and 23 were defined as normal weight patient group (N group). Seventeen underweight patients were excluded in this study. RESULTS: Of 619 cases, the number for O group was 344 (55.6%) and for N group was 275 (44.4%). The mean age was significantly higher in N group (62.2 +/- 12.6 vs. 64.4 +/- 14.8, P = 0.048). Underlying diseases were present in 226 (65.7%) of the O group and 191 (69.5%) of the N group (P = 0.322). Anesthesia method, operative time and postoperative hospital stay had no significant difference between the two groups. Postoperative complications developed in 41 (11.9%) of the O group and in 28 (10.2%) of the N group, respectively, and no major complications developed in either group. CONCLUSION: Adult inguinal hernias developed at a relatively younger age in overweight and obese patients than in normal weight patients. There were no specific differences in other clinical characteristics and outcomes between the two groups. Therefore inguinal hernia repair in overweight and obese patients is a safe procedure as in normal weight patients.

Fracture of a Renal Artery Stent after PTAS in a Patient with Atherosclerotic Ostial Stenosis

Renovascular hypertension occurs in 1~5% of the patients with hypertension. Renal artery stenosis (RAS) is a potentially curable cause of hypertension, and the main cause of ostial RAS is atherosclerosis. Revascularization by endovascular stent placement is one of the favorable treatments for ostial RAS that is without severe nephropathy. The complications of endovascular stents include hematoma at the inguinal region, femoral pseudoaneurysm, renal artery perforation, dissection, stent dislocation, stent fracture and so on. Fracture of a renal artery stent is a very unusual condition and it has rarely been reported in the literature. We experienced a case of renal artery stent fracture in 77-year-old male patient after right renal arterial stenting due to RAS. The fracture was found by chance during an evaluation for peripheral artery disease.

How to Save Surgical Residents in Crisis

Surgery and surgeons in Korea are currently facing a very serious dilemma even though modern surgical practices have a great impact on the improvement of health care and human well being. Traditionally, in Korea, surgical practice had been attractive as a profession and many young medical students were eager to become surgeons. Ever since the National Health Insurance policy was adopted to the whole of the population and the Insurance payment to medical professionals, especially surgeons, were below normal, private surgical practitioners are suffering low incomes. Eventually this situation was affected surgical house staff. The quality and quantity applying for surgical residency have markedly decreased and the situation is getting worse year by year. This review addresses whole possible causes of the present situation; status of surgical practices, educational problems in residency, duty stresses of young surgeons and the life style of the younger generation. Working hour restrictions in Europe and America were reviewed and an example of the Chonnam National University Hospital was elucidated. Possible solutions were suggested in terms of the training hospitals and their staff, the Korean Surgical Society and the policy makers.

Incarcerated Obturator Hernia: The Need of Herniorrhaphy in Self-reduced Obturator Hernia

An obturator hernia is an exceptionally rare form of hernia. It occurs mostly in elderly, thin, multiparous, and emaciated women. Correct diagnosis and treatment is important because delayed treatment can lead to a higher mortality rate. Recently, we experienced two cases of mechanical small bowel obstruction due to incarcerated obturator hernia. One of these patients was an 83-year-old woman who was diagnosed with left incarcerated obturator hernia by computed tomography (CT). The patient's symptom disappeared abruptly. A recheck CT scan revealed self-reduction of the obturator hernia, and the patient refused operation. Two weeks later, the patient was presented again to the emergency clinic with incarcerated small bowel in the left obturator hernia, which was seen on CT. The other patient was a 79-year-old woman who had a 2-day history of abdominal pain. She was diagnosed with a right obturator hernia by CT. Both patients were treated without bowel resection.

Clinical Characteristics of Incarcerated Inguinal Hernias of the Greater Omentum

PURPOSE: Incarcerated inguinal hernia may have very unusual hernial sac contents. In this study we aim to present clinical characteristics about incarcerated inguinal hernia of the greater omentum. METHODS: We retrospectively analyzed hospital records of 643 adult patients who underwent inguinal hernia repair from November 2001 to January 2009. The age, sex, location, type, symptom duration, body mass index (BMI), comorbidity, type of anesthesia, operative time, postoperative hospital stay and complications were reviewed. RESULTS: Of the 643 cases, 18 cases were omental incarcerated inguinal hernia group (O group). Seventeen in 18 cases of O group were male patient (NS). In O group, 16 cases were indirect type and 2 cases were femoral type (P=0.021). Mean age was younger in O group than in non-omental incarcerated inguinal hernia group (N group) (P=0.017). Duration of symptom was longer (P=0.013), and body mass index (BMI) was larger in O group (P=0.042). Operative time was longer in O group than in N group (P=0.006). CONCLUSION: The patients with omental incarcerated inguinal hernia mostly had long durations of protruding mass without pain. In these patients, operation was relatively difficult due to severe adhesion between the hernial sac and greater omentum. In addition, operative time took approximately 10 minutes longer. Therefore, general and spinal anesthesia is more feasible than local anesthesia.

Bilaterality of Inguinal Hernia in Adult Patients: Synchronous Bilateral and Metachronous Contralateral Hernia

PURPOSE: We are to describe the incidence and accordance rate of hernia type in synchronous bilateral and metachronous contralateral inguinal hernia. METHODS: We retrospectively reviewed the medical records of 625 adult patients who underwent inguinal hernia repair by a single surgeon at our institute between November 2001 and October 2008. We divided the patients into 3 groups; Synchronous bilateral inguinal hernia group (SH), Metachronous contralateral inguinal hernia group (MH) and Unilateral inguinal hernia group (UH) and analyzed patients' general clinical features and outcomes. RESULTS: Male patients numbered 578 (92.5%) and female patients numbered 47 (7.5%), so the male to female ratio was 12.3:1. Each number of SH and MH were 49 (7.8%) and 59 (9.4%). In MH, the mean interval of counterlateral hernia development following ipsilateral hernia repair was 8.9 years and 20 (33.9%) were developed in a 3-year period. And the incidence of right hernia development after repair of left hernia predominated over left hernia development after repair of right hernia by a ratio of 1.27:1. Accordance rate of hernia type in both sides was 83.8% in SH and 91.2% in MH. CONCLUSION: The incidence of SH and MH were each 7.8% and 9.4% and accordance rate of hernia type is very high in SH and MH. In MH, many patients (33.9%) developed in 3 years after ipsilateral hernia repair. In this study, patients have high accordance rate of hernia type in both sides and indirect type is dominant, especially in MH.

Spontaneous Rupture of Primary Angiosarcoma of the Spleen

Primary angiosarcoma of the spleen is an extremely rare malignancy, the pathogenesis of which is not completely understood, with high metastatic potential and an exceedingly poor prognosis, regardless of treatment regimen. The major complication is splenic rupture, which often leads to fatal hemoperitoneum. Overall, since 1879 when Langerhans described the first case of angiosarcoma of the spleen, there have been approximately 200 cases reported in the literature. Moreover, to the best of our knowledge, spontaneous rupture of primary splenic angiosarcoma and spontaneous rupture of remnant or recurred angiosarcoma is extremely rare, and no cases were reported in English literature. We report a case of spontaneous splenic rupture due to angiosarcoma in a 68-year-old man, and also review the existing literature.

Myxoid Liposarcoma of the Spermatic Cord with Multiple Distant Metastasis

Myxoid liposarcoma of the spermatic cord (MLSC) is a rare variant of spermatic sarcoma. Typically, it presents during the sixth decade of life as a painless scrotal or inguinal mass. Although local recurrences are not uncommon, prognosis following complete tumor removal is good because metastases are rare. Although myxoid liposarcoma is common elsewhere in the body, less than 20 cases have been described in the spermatic cord. Distant metastasis with MLSC (e.g., bone, liver, lung) is extremely rare, and no cases have been reported in the English literature. We report one case of MLSC with multiple bone, liver and peritoneal metastasis, incidentally found during inguinal hernia repair.

Discrepant Bowel Perforation from a Primary Lesion after Chemotherapy of Diffuse Large B Cell Lymphoma

Diffuse large B cell lymphoma is the most common type of non-Hodgkin's lymphoma, representing approximately one-third of all cases and involving the gastrointestinal tract in about 18%. With the development of modern chemotherapeutic regimens and advances in medical care, the prognosis for malignant lymphoma can be excellent. However, because of the aggressive adjuvant therapy required, complications such as bowel perforation may be fatal. In cases of chemotherapy for malignant lymphoma, we should keep in mind the possibility of perforation of the bowel after chemotherapy. Early detection is important to save patients.

Inguinal Hernia Repair under Local Anesthesia in Octogenarians

PURPOSE: We are to describe the clinical characteristics and treatment outcomes in patients aged between 80 and 89 years who underwent inguinal hernia repair under local anesthesia. METHODS: We retrospectively reviewed the medical records of patients aged between 20 and 89 years who underwent tension free hernia repair under local anesthesia by a single surgeon between June 2001 and January 2009 and compared clinical characteristics and outcomes between octogenarians who were the eldest and sexagenarians whose incidence was the highest. RESULTS: Of the 514 patients, the number of octogenarians was 52 (8.6%) and sexagenarians were 225 (35.0%). Body mass index (BMI) was 22.5 kg/m2 in octogenarians and 23.7 kg/m2 in sexagenarians (P=0.003). Underlying diseases were present in 67.3% of octogenarians and 73.5% of sexagenarians (P=0.238). The incidence of liver disease was significantly lower in the octogenarians (1.9% vs 15.7%, P=0.004). The proportion of patients who underwent local anesthesia was significantly higher among the octogenarians (94.5% vs 82.2%, P=0.014). Operative time and postoperative hospital stay had no significant difference between both groups. Postoperative complications developed in 4 (7.7%) of the octogenarians and in 18 (9.7%) of the sexagenarians. Scrotal swelling was developed most frequently and surgery-related mortality did not developed in both groups. CONCLUSION: If local anesthesia is used appropriately, inguinal hernia repair in octogenarians is a safe procedure as like in sexagenarians and may reduce the psychiatric burden related to complications for both surgeons and elderly patients.

A Transmesenteric Hernia in a Child: Gangrene of a Long Segment of Small Bowel through a Large Mesenteric Defect / 대한소화기학회지

Intestinal obstruction is a common surgical emergency. Transmesenteric hernia is an unusual cause of bowel obstruction that may result in irreversible damage of the bowel and a fatal outcome. Once incarceration of the bowel occurs, strangulation and gangrene follow immediately. The mortality rate associated with this condition is about 15%, but in the presence of gangrene of the bowel, the mortality rate is more than 50%. An accurate preoperative diagnosis of a transmesenteric hernia is very difficult and rarely made. Therefore, in patients with small bowel obstruction, in the absence of a history of previous surgery to suggest adhesions or an external hernia, the possibility of a transmesenteric hernia must be considered. We describe a case with gangrene of a long segment of the small bowel caused by a transmesenteric hernia through a large defect of small bowel mesentery in a child.

Recurrence after Repair of Primary Acquired Grynfeltt Hernia

Lumbar hernias are rare posterolateral abdominal wall defects. There are two types of lumbar hernia. One is a superior lumbar hernia through the deep superior orifice (Grynfeltt triangle), and the other is a lower lumbar hernia through the superficial lower orifice (Petit triangle). A lumbar hernia is often misdiagnosed as a lipoma, so a cautious clinical examination is very important. Reports of recurrent lumbar hernia are extremely rare in the literature. We experienced a case of recurrence in an acquired primary lumbar hernia in a 71-year-old male who had undergone mesh-plug herniorrhaphy. The hernia orifice was 1 cm in diameter and exhibited a fibrous smooth margin. Hernia repair using 3-D mesh was performed. The patient had uncomplicated postoperative course and was discharged one day after the operation.

Retraction: A Transmesenteric Hernia in a Child: Gangrene of a Long Segment of Small Bowel through a Large Mesenteric Defect / 대한소화기학회지

No abstract available.

Amyand's Hernia with Periappendicular Abscess

The presence of a vermiform appendix in an inguinal hernia is known as Amyand's hernia. It is rare condition that occurs in about 0.51% of the cases of inguinal hernia. Appendicitis within an Amyand's hernia is found in 0.10% of all forms of external hernia sacs. It is often misdiagnosed as a strangulated inguinal hernia. We experienced a case of Amyand's hernia with a periappendicular abscess within a right inguinal hernia sac in a 71-year-old male patient. Combined appendectomy and Bassini's herniorrhaphy were performed. The patient had an uncomplicated postoperative course and he was discharged 8 days after admission.

Analysis of the Prognostic Factors for Abdominal Trauma

PURPOSE: Recently, trauma is more frequent due to the increases in the population, the number of traffic accident, and the incidence of violence. Especially, abdominal trauma is a leading cause of morbidity and mortality. We analyzed the clinical features and the factors associated with morbidity and mortality. METHODS: We analyzed 136 patients of abdominal trauma who were admitted at the Department of Surgery, Chonnam National University Hospital, from January 2003 to June 2005. We analyzed the cause of trauma, the injured organ, combined injuries, mental status, blood pressure, laboratory findings, morbidity, and mortality. The relationships between by variable were assesed by using the independent samples test and the Kruskal?Wallis test. RESULTS: The causes of trauma were traffic accidents (98 cases, 72%), falling accidents (9 cases, 6.6%), violence (6 cases, 4.4%), and stab injuries (6 cases, 4.4%). The injured organs were the small intestines (47 cases, 34.6%), the liver (35 cases, 25.7%), the spleen (26 cases, 19.1%), the mesentery (17 cases, 12.5%), the large intestines (15 cases, 11.0%), the pancreas (14 cases, 10.3%), etc. The most common combined injury was chest injury (53 cases, 39%). Comatose or semicomatose mental status and shock on admission (1.6 mg/dL) were significant prognostic factors. The incidence of postoperative complications was 40.4%, and frequent complications were wound infection (8.1%) and re-bleeding (8.1%). The overall mortality rate was 18.4%, and most common cause was hypovolemic shock (18 cases, 13.2%), however, there was no statistical difference according to injurd organ. CONCLUSION: In the multivariate analysis, mental status, hemoglobin, and serum creatinine level were the most significant prognostic factors. When an abdominal trauma patient arrives at the emergency room, a rapid and accurate evaluation of the patient's status and risk factors, and resuscitation, if necessary, have to be performed to lower the morbidity and mortality.

Multiple Tuberculous Splenic Abscesses in a Child

Splenic abscess is a rare clinical condition with a reported incidence of 0.14 % to 0.70 % in various autopsy series. Primary tuberculosis of the spleen as a cause of splenic abscess is even rarer, especially in the antitubercular era. Infants and children have a higher predisposition to extra-pulmonary tuberculosis than adults and tend to develop severe extra-pulmonary disease such as miliary tuberculosis and meningitis. The diagnosis of tuberculosis in infants and children can be difficult because of nonspecific symptoms and clinical findings. Computed tomography establishes the diagnosis of splenic abscess and demonstrates the number and location of abscesses. Splenectomy is the standard of care in most clinical setting. We present a 4-year-old girl who had multiple tuberculosis splenic abscesses and was treated successfully with splenectomy.

Yesterday, Today and Tomorrow of Korean Vascular Surgeons

No abstract available.

Yesterday, Today and Tomorrow of Korean Vascular Surgeons

No abstract available.

Clinical Significance of a Pylorus-preserving Gastrectomy for Early Gastric Cancer

PURPOSE: The five-year survival rate is over 95% for radically resected early gastric cancer. The development of diagnostic techniques enables early detection of gastric cancer, so the life expectancy of patients with early gastric cancer is prolonged. Therefore, a limited number of surgeries are performed these days for the purpose of increasing the quality of life. The purpose of this study is to assess the postoperative quality of life after a pylorus-preserving gastrectomy (PPG) compared with that after a subtotal gastrectomy with gastroduodenal anastomosis (B-I). MATERIALS AND METHODS: One hundred seven (107) patients who underwent gastric surgery for early gastric cancer from January 1999 to December 2003 at the Department of Surgery of Chonnam National University Hospital were selected. We compared patients who underwent a PPG with those who underwent a B-I. The clinical results were compared by using the chi-square test and the Student's T-test. The data were considered to be significant when the P value was less than 0.05. RESULTS: Twenty-nine patients (29) underwent a PPG, and the other seventy-eight (78) patients underwent a B-I. There was no significant difference between the two groups on sex, age, and postoperative abdominal symptoms. The patients who underwent a PPG showed shorter operation times and less reflux gastritis and esophagitis on endoscopic evaluation than the patients who underwent a B-I. CONCLUSION: The pylorus-preserving gastrectomy (PPG) is a more physiologic operation than the subtotal gastrectomy with gastroduodenal anastomosis (B-I) and improves the postoperative quality of life.