Chylous Leakage: A Rare Complication after Axillary Lymph Node Dissection in Breast Cancer and Surgical Management / 한국유방암학회지

Chylous leakage is an extremely rare complication of surgery for breast cancer. We experienced a case of chylous leakage after axillary lymph node dissection. A 38-year-old woman with invasive ductal carcinoma in the left breast underwent a modified radical mastectomy after four cycles of neoadjuvant chemotherapy. The postoperative serosanguinous drainage fluid became "milky" on the fourth postoperative day. After trying conservative management, we re-explored the axilla and ligated the lymphatic trunk. Although the success of many cases supports conservative management, timely surgical intervention represents an alternative in cases where leakage persists or where the output is high.

Clinical Analysis of Endoscopic Thyroidectomy by the Axillary Approach for Papillary Thyroid Microcarcinoma / 대한내시경복강경외과학회지

PURPOSE: The aim of this study is to evaluate the feasibility and surgical outcomes of endoscopic thyroidectomy by the axillary approach for treating papillary thyroid microcarcinoma (PTMC). METHODS: We analyzed 56 patients who underwent endoscopic thyroidectomy by the axillary approach for treating PTMC between May 2002 and October 2008 at Bucheon ST hospital. We evaluated the operation type, the tumor size, the operative time, the hospital days, the number of retrieved lymph nodes and the complications. RESULTS: All the patients except one were women. The mean age was 40.5+/-8.7 years. All the procedure was performed by one surgeon and endoscopic thyroidectomy was done by the axillary approach. There was no conversion to open surgery. The type of operation was classified according to the extent of the surgery. The mean operative time for lobectomy and isthmectomy with CLND (24 cases) and total thyroidectomy with CLND (5 cases) was 142.5+/-40 minutes and 270+/-84.3 minutes, respectively. The mean tumor size was 0.66+/-0.46 cm. The mean number of retrieved lymph nodes was 3.7+/-2.4. The mean number of hospital days was 3.7+/-1.4 days. There were no serious complications. There were no tumor recurrence and the mean follow-up was 50.7 months. All the patients were satisfied with the cosmetic results. CONCLUSION: Endoscopic thyroidectomy by the axillary approach for PTMC is feasible and safe. Although a larger series and longer follow up are necessary, endoscopic thyroidectomy can be a alternative treatment method for selected patients with PTMC.

Composite Large Cell Neuroendocrine Carcinoma and Adenocarcinoma of the Ampulla of Vater

Large Cell Neuroendocrine Tumors (LCNEC) in the ampulla of Vater are extremely rare. This report addresses a case of concurrent LCNEC and adenocarcinoma in the ampulla of Vater. A 60-year-old male patient experienced fever, body chills and jaundice. He had a periampullary ulcerative lesion and underwent radical pancreaticoduodenectomy. Histopathologically, the tumor consisted of an LCNEC component and an adenocarcinoma component. Simultaneous LCNEC and adenocarcinoma has been reported in a few cases. Our patient had a coexisting LCNEC and an adenocarcinoma of the ampulla of Vater. We also present a review of the literature

Experience of Open Herniorrhaphy Using the PerFix(R) Plug for Patients with Recurrent Groin Hernias

PURPOSE: The recurrence of a groin hernia presents few surgical options for repair. We investigated the safety and efficacy of herniorrhaphy using PerFix(R) plug for patients with recurrent groin hernias. METHODS: Between October 2000 and December 2004, 30 herniorrhaphies for recurrent groin hernia were performed and followed-up. The operation time, length of hospital stay, time of analgesic use, complication rates, and recurrence were investigated. RESULTS: Surgery had been initially performed in 26 patients with the non-mesh method, and with mesh in 4 patients; 12 patients had a direct recurrence at the medial side of the inguinal area near the pubic tubercle, 7 patients had a direct recurrence at other sites, and 11 patients had an indirect recurrence. Eight patients had urinary retention and 2 patients had minor wound complications. Hospital stays and analgesic use were comparable to non-recurrent groin hernia operations, although operation time was significantly longer in recurrent group, and there were no recurrences during the 70 months of followup. CONCLUSION: Comparing open or laparoscopic preperitoneal approach, the PerFix(R) plug method is simple and effective for recurrent groin hernia repair.

Clinical Analysis of Choledochal Cysts in Children

PURPOSE: The object of this study is to evaluate the clinical findings and the outcome of choledochal cysts (CC) in children. METHODS: All cases of CC that underwent operation between 1983 and 2006 were studied retrospectively. We evaluated the symptoms and signs, types, anomalous pancreaticobiliary union (APBDU) and complications of CC. RESULTS: Forty-five children were included. The common age range was from 1 year to 5 years. The male to female ratio was 1 to 3. The most common symptom was abdominal pain (71.1%). The main methods of diagnosis were US and CT. According to Todani's classification, type I (60%) and type IV (35.6%) were most common types. APBDU was confirmed in 21 cases. B-P type (13 cases) was more common than P-B type (8 cases). Three among four patients with pancreatitis had a stone or protein plug in the common channel. Cyst excision with hepaticojejunostomy was performed in most cases. The overall morbidity and mortality were 8% and 0%, respectively. There were no problems, such as cholangitis, biliary stone and biliary cancer during the follow up. Intrahepatic duct dilatations of type IVa disappeared in the postoperative follow up study, except one. CONCLUSION: The outcome of cyst excision with hepaticojejunostomy was excellent. As for CC accompanied with the pancreatitis, the presence of stone or protein plug in the common channel needs to be examined. It is hard to precisely interpret that intrahepatic duct dilatation in type IVa normalize during the postoperative follow up until more evidence is accumulated.

Laparoscopic Cystogastrostomy for the Patient of Pancreatic Pseudocyst with Intra-abdominal Adhesion

A large symptomatic and unresolved pancreatic pseudocyst is treated surgically by internal drainage to a neighboring adherent viscus. Recently the various minimal invasive approaches have been used to treat this condition. A 30- year-old man who had been in clinical follow-up for a chronic pancreatitis. For the necrotizing pancreatitis, the patient had undergone surgical debridement and external drainage 5 years, and 3 years ago, respectively. Abdominal ultrasonography and computed tomography revealed 8.2x7.7 cm sized pseudocyst in the body of pancreas. Endoscopic internal fistula formation was tried, but it was failed due to bleeding. We underwent adhesiotomy and cystogastrostomy totally with laparoscopic techniques. The patient started a diet on the 5th postoperative day and discharged on the 11th postoperative day. There was no postoperative complicationand no recurrence during 6 months. Laparoscopic cystogastrostomy is safe and feasible method in the pancreatic pseudocyst even in case of severe abdominal adhesion.