Laparoscopic Hartmann’s Reversal: Application of a Single-Port Approach Through the Colostomy Site

Purpose@#Recently, laparoscopic reversal of Hartmann’s colostomy was performed with favorable outcomes by many surgeons. We partially applied the concepts of single-port laparoscopic procedure through the colostomy site to remove intraperitoneal adhesion during initial step of the laparoscopic Hartmann’s reversal. This study aimed to evaluate the feasibility and safety of the laparoscopic reversal of Hartmann’s colostomy with the application of single-port laparoscopic techniques through the colostomy site. @*Methods@#From October 2008 to November 2018, the laparoscopic Hartmann’s reversal was attempted in 20 patients. After colostomy take-downs, the single-port device was installed at the colostomy site and the single-port laparoscopic procedure was performed to remove intraperitoneal adhesions to provide space for additional trocars. After additional trocars were inserted, the descending colon and rectal stump were mobilized, and the colorectal anastomosis was completed. We retrospectively reviewed the medical records and analyzed the data to identify the perioperative complication rates as the primary outcome. @*Results@#Of the 20 patients, 3 patients (15.0%) had open conversions due to severe adhesions. Intraoperative small bowel injuries occurred in 2 patients (10.0%) and these were repaired through the colostomy site. Postoperative complications developed in 4 patients (20.0%) and were managed with medical treatments or wound closures under local anesthesia. @*Conclusion@#The single-port laparoscopic procedure through the colostomy site is sufficiently safe in order to complete the Hartmann’s reversal. We recommend that the colostomy site should be used as the access route into the abdominal cavity for the Hartmann’s reversal.

Impact of COVID-19 on the care of acute appendicitis:a single-center experience in Korea

Purpose@#Coronavirus disease 2019 (COVID-19) affects healthcare systems worldwide; however, few studies have assessed the impact of COVID-19 on emergent surgical diseases. This study aimed to investigate the impact of COVID-19 on the care given to patients with acute appendicitis in Korea. @*Methods@#Between November 2019 and November 2020, 495 patients underwent laparoscopic surgery for acute appendicitis. The patients were divided into prepandemic and pandemic groups. The baseline characteristics and perioperative outcomes were compared. @*Results@#The time between admission and surgery was longer in the pandemic group than in the prepandemic group (17.6 hours vs. 9 hours, P < 0.001). The operation time was longer (5.8 minutes, P = 0.014), inflammation was more severe (10%, P = 0.036), and more patients visited the emergency room (82.1% vs. 73.3%, P = 0.025) in the pandemic group than in the prepandemic group. There were no significant differences in postoperative complications or length of hospital stay between the 2 groups. After propensity score matching, the time to surgery was delayed (17.3 hours vs. 9 hours, P < 0.001) and more patients visited the emergency room (84.5% vs. 73.3%, P = 0.020) in the pandemic group. @*Conclusion@#In the COVID-19 era, the characteristics of patients with acute appendicitis and inflammation worsened. The time to surgery was delayed due to the requirement for preoperative COVID-19 testing and increased the severity of appendicitis did not affect the perioperative outcomes.

Validation of Korean Version of Low Anterior Resection Syndrome Score Questionnaire

Purpose@#Patients who undergo radical surgery for rectal cancer often experience low anterior resection syndrome (LARS). Symptoms of this syndrome include frequent bowel movements, gas incontinence, fecal incontinence, fragmentation, and urgency. The aim of this study was to investigate the convergent validity, discriminative validity, and reliability of the Korean version of the LARS score questionnaire. @*Methods@#The English LARS score questionnaire was translated into Korean using the forward-and-back translation method. A total of 146 patients who underwent radical surgery for rectal cancer answered the Korean version of the LARS score questionnaire including an anchor question assessing the impact of bowel function. Participants answered the questionnaire once more after 2 weeks. @*Results@#The Korean LARS score questionnaire showed high convergent validity in terms of high correlation between the LARS score and quality of life (perfect fit 55.5% vs. moderate fit 37.6% vs. no fit 6.8%, respectively; P 8 cm; P = 0.021), and radiotherapy (32 for yes vs. 24 for no; P = 0.001). The LARS score also demonstrated high reliability at test-retest with no difference between scores at the first and second tests (intraclass correlation coefficient: Q1 = 0.932; Q2 = 0.909, Q3 = 0.944, Q4 = 0.931, and Q5 = 0.942; P < 0.001, respectively). @*Conclusion@#The Korean version of the LARS score questionnaire has proven to be a valid and reliable tool for measuring LARS in Korean patients with rectal cancer.

Laparoscopic Resection of Presacral Tumor: A New Approach in the Era of the Minimally Invasive Surgery

Presacral tumors are rare; however, once diagnosed, surgical resection is recommended even in asymptomatic patients as there is potential risk for growth or malignant transformation. Many different types of surgical approaches to resect presacral tumors have been reported including posterior, anterior, and combined abdominosacral approaches. With introduction of the minimally invasive approach, laparoscopic or robotic approaches to resect presacral tumors are reported increasingly. We report a case of successful anterior laparoscopic resection for a presacral mass that was incidentally diagnosed during management of pancreatitis.

Patterns of antibiotics and pathogens for anastomotic leakage after colorectal cancer surgery

PURPOSE: Anastomotic leakage (AL) is a type of intra-abdominal infection (IAI) which requires appropriate antibiotics with proper intervention. This study aimed to improve the appropriateness of antibiotic treatment by assessing the patterns of antibiotic treatment and resistance of pathogen profiles in patients who had AL after colorectal cancer surgery.METHODS: From June 2006 through December 2017, the medical records of the patients who had AL after elective abdominal surgery for colorectal cancer in Kyung Hee University Hospital at Gangdong, Seoul, Korea were reviewed retrospectively. Baseline characteristics and consistence of antibiotics with culture study results were analyzed to evaluate the appropriateness of treatment.RESULTS: Among 982 patients who underwent primary surgery for colorectal cancer, 41 (4.2%) had AL. Mean time of diagnosis of AL from surgery was 6.3 days. The most commonly used prophylactic antibiotics for the primary surgery was 2nd generation cephalosporin (66.6%). Mean duration of prophylactic antibiotics usage was 2.8 days. The most commonly used empirical antibiotics after AL occurred was piperacillin and tazobactam (32.6%). Mean duration of empirical antibiotics usage was 8.2 days. The most commonly identified pathogens were Escherichia coli and Enterococci spp. (26.8% each), and 12.2% of the “ESKAPE” pathogens were identified. Resistance to empirical antibiotics was 45.5% (10/22).CONCLUSION: Penetration of culture study for AL after colorectal cancer surgery appeared relatively low, although the profile of pathogens isolated from the AL patients can give important clues and evidence for appropriate antibiotics use. Surgeons should pay attention in performing culture studies for IAI including AL for proper patient treatment.

Corrigendum: Clinical characteristics and recurrence-related factors of medication-related osteonecrosis of the jaw

This correction is being published to provide the approval number of the Institutional Review Board at the Ethics Approval and Consent to Participate section in the above article. The authors apologize for this error.

Postoperative Outcomes of Stoma Takedown: Results of Long-term Follow-up

PURPOSE: Stoma takedown is a frequently performed procedure with considerable postoperative morbidities. Various skin closure techniques have been introduced to reduce surgical site infections. The aim of this study was to assess postoperative outcomes after stoma takedown during a long-term follow-up period. METHODS: Between October 2006 and December 2015, 84 consecutive patients underwent a colostomy or ileostomy takedown at our institution. Baseline characteristics and perioperative outcomes were analyzed through retrospective reviews of medical records. RESULTS: The proportion of male patients was 60.7%, and the mean age of the patients was 59.0 years. The overall complication rate was 28.6%, with the most common complication being prolonged ileus, followed by incisional hernia, anastomotic leakage, surgical site infection, anastomotic stenosis, and entero-cutaneous fistula. The mean follow-up period was 64.3 months. The univariate analysis revealed no risk factors related to overall complications or prolonged ileus. CONCLUSION: The postoperative clinical course and long-term outcomes following stoma takedown were acceptable. Stoma takedown is a procedure that can be performed safely.

Clinical characteristics and recurrence-related factors of medication-related osteonecrosis of the jaw

OBJECTIVES: The purpose of this study was to investigate the demographic and clinical characteristics of patients with medication-related osteonecrosis of the jaw (MRONJ) and to elucidate factors affecting recurrence in surgical treatment. MATERIALS AND METHODS: A total of 51 patients who were diagnosed with MRONJ were analyzed according to demographic and clinical features and treatment results through a retrospective chart review from 2013 to 2017 in the Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul in Korea. RESULTS: Alendronate composed the majority of medication doses (55.6%), followed by ibandronate (20.0%), risedronate (15.6%), and zoledronate (6.7%). Forty patients (88.9%) were given oral medication, and five patients (11.1%) were intravenously treated, and the mean duration of medication use was 61.1±42.9 months. A total of 10 patients (22.2%) had a drug holiday before MRONJ-induced dental treatment lasting an average of 6.8±7.0 months. MRONJ occurred 2.7 times more in the mandible, with 41 cases (73.2%) occurring in the mandible and 15 cases (26.8%) occurring in the maxilla, and the prevalence of affected posterior parts (premolar-molar) was six times greater than that of the anterior parts (incisor-canine) (48 cases vs 8 cases, 85.7% vs 14.3%). The most common dental cause of MRONJ was tooth extraction (69.6%). Regarding recurrence, there was no statistical difference in recurrence rate according to either site or stage. However, recurrence occurred in 4 out of 34 cases (11.8%) in the primary closure group and 9 out of 20 cases (45.0%) in the secondary healing group, and there was a statistical difference with respect to closure technique. CONCLUSION: The identified risk factors in patients taking bone resorption inhibitors can aid dental clinicians in ensuring prevention and proper treatment of MRONJ.

A Case of Medullary Infarction Presented Initial Symptoms Similar to Meniere’s Disease

Fluctuating hearing loss and vertigo are the typical presentations of Meniere’s disease. However, it is unusual that fluctuating hearing loss and vertigo are caused by vertebral artery occlusion or cerebral infarction. Here, we described the case of a 54-year-old male patient with hypertension and diabetes mellitus who presented with fluctuating hearing loss in his left ear and severe whirling-type dizziness without associated neurological signs or symptoms. Temporal magnetic resonance imaging (MRI) was normal. He was diagnosed with a possible Meniere’s disease and started conservative treatment. Eight years later, the patient developed dysarthria and left-side weakness. Brain MRI revealed right anterior medullary infarction, and cerebral angiography showed occlusion of the right vertebral artery. In this case, we attempted to review the initial imaging study and reported the characteristics of the case.

microRNA-183 is Essential for Hair Cell Regeneration after Neomycin Injury in Zebrafish

PURPOSE: microRNAs (miRNAs) are non-coding RNAs composed of 20 to 22 nucleotides that regulate development and differentiation in various organs by silencing specific RNAs and regulating gene expression. In the present study, we show that the microRNA (miR)-183 cluster is upregulated during hair cell regeneration and that its inhibition reduces hair cell regeneration following neomycin-induced ototoxicity in zebrafish. MATERIALS AND METHODS: miRNA expression patterns after neomycin exposure were analyzed using microarray chips. Quantitative polymerase chain reaction was performed to validate miR-183 cluster expression patterns following neomycin exposure (500 µM for 2 h). After injection of an antisense morpholino (MO) to miR-183 (MO-183) immediately after fertilization, hair cell regeneration after neomycin exposure in neuromast cells was evaluated by fluorescent staining (YO-PRO1). The MO-183 effect also was assessed in transgenic zebrafish larvae expressing green fluorescent protein (GFP) in inner ear hair cells. RESULTS: Microarray analysis clearly showed that the miR-183 cluster (miR-96, miR-182, and miR-183) was upregulated after neomycin treatment. We also confirmed upregulated expression of the miR-183 cluster during hair cell regeneration after neomycin-induced ototoxicity. miR-183 inhibition using MO-183 reduced hair cell regeneration in both wild-type and GFP transgenic zebrafish larvae. CONCLUSION: Our work demonstrates that the miR-183 cluster is essential for the regeneration of hair cells following ototoxic injury in zebrafish larvae. Therefore, regulation of the miR-183 cluster can be a novel target for stimulation of hair cell regeneration.

Initial Experience with Single Incision Laparoscopic Appendectomy by Surgical Resident

No abstract available.

Feasibility of Emergency Laparoscopic Reoperations for Complications after Laparoscopic Surgery for Colorectal Cancer

PURPOSE: Laparoscopic surgery (LS) is an alternative to colorectal cancer surgery. Little evidence supports LS for emergency reoperation after laparoscopic colorectal surgery. The aim of this study was to assess perioperative outcomes of LS as an emergency reoperation for early complications after LS for colorectal cancer. METHODS: From June 2006 through December 2016, 732 consecutive patients underwent elective LS for colorectal cancer at Kyung Hee University Hospital, Seoul, Korea. Among these patients, we retrospectively reviewed data on those who received emergency laparoscopic reoperations for complications within 30 days after surgery. Variables associated with perioperative outcomes were analyzed. RESULTS: After exclusion of 50 patients (6.8%) who needed conversion to open surgery during LS, 79 of 682 patients (11.6%) received reoperation for complications, recurrence, and other benign diseases. Among them, 22 patients underwent emergency laparoscopic reoperation for early complications. Mean age of the patients was 62 years, and most underwent low anterior resection as a primary operation (n=17, 77.3%). Anastomotic leakage was the most common reason for reoperation (n=14, 63.6%). Postoperative complication occurred in 6 patients (27.3%), but none required further surgical intervention. Patients had first bowel movements at 2.8 days after reoperation, and length of hospital stay was 17.2 days after reoperation. CONCLUSION: Laparoscopic reoperation showed acceptable outcomes. LS as a reoperation for complications seemed to be feasible after LS for colorectal cancer.

Sialolithotomy of the submandibular duct using sialendoscopy / 대한악안면성형재건외과학회지

BACKGROUND@#Conventionally, indirect radiography has been used to diagnose salivary gland diseases. However, with the development of sialendoscopy, diagnosis and treatment of salivary gland diseases have become more effective. Herein, we report a case of sialolithotomy treated with sialendoscopy and compare it with the existing methods through a literature review.CASE PRESENTATION: Two patients with a foreign body sensation under the tongue and dry mouth visited the Anam Hospital, Korea University. Radiographic examination revealed salivary stones inside the right Wharton duct, and the patients underwent sialolithotomy under local or general anaesthesia. The stones were totally removed, and there were no postoperative complications such as bleeding or pain.@*CONCLUSION@#The development of sialendoscopy has enabled better definitive diagnosis of salivary gland diseases compared with the conventional methods; better treatment outcomes can be obtained when sialendoscopy is used in appropriate cases.

Preliminary study on the efficacy of xerostomia treatment with sialocentesis targeting thyroid disease patients given radioiodine therapy / 대한악안면성형재건외과학회지

BACKGROUND@#Radioiodine therapy has been widely used for thyroid disease patients, but hyposalivation and xerostomia may occur in 10~30% of patients. Sialocentesis is a procedure that removes inflammatory substances in the salivary duct and expands the duct for the secretion and delivery of saliva. In this study, thyroid disease patients treated with radioactive iodine were selected among the patients with xerostomia who visited the hospital, and the effect of sialocentesis was compared and analyzed. And then, comparison between the radioiodine therapy-experienced group and the non-radioiodine therapy-experienced group was conducted.@*RESULTS@#In this study, we studied xerostomia patients who underwent radioiodine therapy due to thyroid diseases and who underwent sialocentesis at the Korea University Anam Hospital. Sialocentesis is conducted by one surgeon. The study also compares the clinical symptoms before and after the surgery. After the procedure, the discomfort due to xerostomia was reduced, and the symptom was improved effectively.@*CONCLUSIONS@#The results of this study showed that sialocentesis has a clinical effect in the treatment of xerostomia, which is a side effect of radioiodine therapy. In addition, the possibility of further clinical application of sialocentesis in the future is found.

Effect of arthrocentesis on the clinical outcome of various treatment methods for temporomandibular joint disorders / 대한악안면성형재건외과학회지

BACKGROUND@#We evaluated the improvement of pain and the increase in mouth opening after temporomandibular joint arthrocentesis and the possible association with various factors such as previous splint treatment, medication, and diagnosis.@*RESULTS@#We studied 57 temporomandibular joint disorder patients who underwent arthrocentesis at Korea University Anam Hospital. These patients (24 males and 33 females, aged between 15 and 76 years) underwent arthrocentesis that was performed by one surgeon. The degree of mouth opening (assessed using the maximum mouth opening: MMO) and pain (assessed using the visual analog scale: VAS) were assessed pre- and post-arthrocentesis. The study also investigated whether treatment modalities other than arthrocentesis (medication and appliance therapy) were performed. Statistical analysis revealed that there was a significant difference in mouth opening and pain after temporomandibular joint arthrocentesis. Preoperative appliance therapy affected the results of arthrocentesis, but it was not statistically significant. With regard to pain relief, preoperative diagnosis did not show a significant difference. However, with regard to maximum mouth opening, patients with disc displacement without reduction with limited mouth opening (closed lock) showed the highest recovery (11.13 mm).@*CONCLUSION@#The average of MMO increase after arthrocentesis was 9.10 mm, and patients with disc displacement without reduction with locking (closed lock) showed most recovery in maximum mouth opening and it was statistically significant. The average pain relief of patients after arthrocentesis was 3.03 in the VAS scale, and patients using anterior repositioning splint (ARS) preoperatively showed the most pain relief.

Small bowel obstruction caused by cryptorchidism in an adult

Small bowel obstruction (SBO) is a common complication after abdominal surgery, and can occur due to many reasons. However, cryptorchidism can cause SBO in patients with no history of abdominal surgery. We report the case of a 67-year-old man with SBO caused by adhesions between an undescended testis and the terminal ileum.

Postoperative Mastoid Aeration Following Canal Wall Up Mastoidectomy according to Preoperative Middle Ear Disease: Analysis of Temporal Bone Computed Tomography Scans

BACKGROUND AND OBJECTIVES: The aim of our study was to evaluate postoperative mastoid aeration according to the preoperative middle ear disease and investigate the factors affecting it. SUBJECTS AND METHODS: We retrospectively reviewed the high-resolution computed tomography (CT) scans of temporal bones that were taken 1 year after surgery. The postoperative mastoid aeration was evaluated according to the preoperative diagnosis, and classified into three groups: grade 1 (complete mastoid aeration), an air-filled epitympanum and mastoid cavity; grade 2 (partial mastoid aeration), an air-filled epitympanum and partially aerated mastoid cavity; and grade 3 (absence of mastoid aeration), no air space in the mastoid cavity. RESULTS: The overall mastoid aeration rate was 55.8%, with adhesive otitis media accounting for 21.2%, attic cholesteatoma 53.8%, and chronic otitis media 75.4%. The rates of postoperative mastoid aeration were significantly higher in the chronic otitis media cases and attic cholesteatoma cases than in the adhesive otitis media cases. There were 14 cases requiring revision operations due to the development of a retraction pocket in the tympanic membrane. All of the revised cases had grade 3 postoperative mastoid aeration, and underwent canal wall down mastoidectomies. CONCLUSIONS: The degree of postoperative mastoid aeration is associated with the preoperative middle ear disease. When planning a canal wall up mastoidectomy, the surgeon should contemplate the middle ear disease, because a canal wall down mastoidectomy or mastoid obliteration is recommended if the patient has adhesive otitis media.

Postoperative Mastoid Aeration Following Canal Wall Up Mastoidectomy according to Preoperative Middle Ear Disease: Analysis of Temporal Bone Computed Tomography Scans

BACKGROUND AND OBJECTIVES: The aim of our study was to evaluate postoperative mastoid aeration according to the preoperative middle ear disease and investigate the factors affecting it. SUBJECTS AND METHODS: We retrospectively reviewed the high-resolution computed tomography (CT) scans of temporal bones that were taken 1 year after surgery. The postoperative mastoid aeration was evaluated according to the preoperative diagnosis, and classified into three groups: grade 1 (complete mastoid aeration), an air-filled epitympanum and mastoid cavity; grade 2 (partial mastoid aeration), an air-filled epitympanum and partially aerated mastoid cavity; and grade 3 (absence of mastoid aeration), no air space in the mastoid cavity. RESULTS: The overall mastoid aeration rate was 55.8%, with adhesive otitis media accounting for 21.2%, attic cholesteatoma 53.8%, and chronic otitis media 75.4%. The rates of postoperative mastoid aeration were significantly higher in the chronic otitis media cases and attic cholesteatoma cases than in the adhesive otitis media cases. There were 14 cases requiring revision operations due to the development of a retraction pocket in the tympanic membrane. All of the revised cases had grade 3 postoperative mastoid aeration, and underwent canal wall down mastoidectomies. CONCLUSIONS: The degree of postoperative mastoid aeration is associated with the preoperative middle ear disease. When planning a canal wall up mastoidectomy, the surgeon should contemplate the middle ear disease, because a canal wall down mastoidectomy or mastoid obliteration is recommended if the patient has adhesive otitis media.

A Case of Labyrinthitis Ossificans Presenting as an Intractable Benign Paroxysmal Positional Vertigo / 대한평형의학회지

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. It is easily cured with canal repositioning maneuvers, but some patients are resistant to the repositioning maneuver and require surgical intervention. Labyrinthitis ossificans is the pathologic condition that fibrous tissue and new bone occupy the membranous labyrinthine space. It occurs as a sequela of inner ear inflammation resulting from diverse causes, mostly bacterial meningitis and otitis media. We describe here a 42-year-old female patient with refractory posterior semicircular canal (PSCC) BPPV and adhesive otitis media in same ear. Otoscopic examination revealed adhesive tympanic membrane without middle ear space and temporal bone computed tomography showed complete ossification of the labyrinth at the same side. We performed a canal wall down mastoidectomy and PSCC occlusion. The patient had complete resolution of paroxysmal vertigo and positional nystagmus, postoperatively.

A Case of Acute Inner Ear Dysfunction as a Prodrome of Transient Ischemic Attack Caused by Vertebral Artery Stenosis / 대한이비인후과학회지

A sudden hearing loss with vertigo may originate from vascular insufficiency and sometimes presents as an initial manifestation of posterior brain circulation infarction. However, it is unusual that sudden hearing loss and vertigo present as a prodrome of transient ischemic attack. Here we describe the case of a 54-year-old male patient with hypertension who presented with a sudden onset of hearing loss in his right ear and recurrent severe, whirling type dizziness without associated neurological signs or symptoms. The diffusion-weighted magnetic resonance imaging (MRI) was normal on initial presentation. Ten days later, however, the patient developed dysarthria. A follow-up MRI including the diffusion-weighted images was normal but cerebral angiography showed severe narrowing of right vertebral artery. Transient ischemic attack caused by vertebrobasilar artery stenosis should be considered in sudden hearing loss and vertigo, especially patients with vascular risk factors, even though images of brain MRI are normal.