Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy: A Case Report.

Portomesenteric vein thrombosis is an uncommon but potentially life-threatening complication associated with laparoscopic sleeve gastrectomy. We present the case of a 26-year-old male who underwent an uneventful laparoscopic sleeve gastrectomy and presented on postoperative day 14 with portomesenteric vein thrombosis. The patient was treated conservatively with IV heparinization, followed by an oral anticoagulant agent. He was discharged in stable condition without further problems. A high index of suspicion for the disease is required not to miss or delay the diagnosis of portomesenteric vein thrombosis which could lead to a fatal outcome. All patients should be screened beforehand for underlying hypercoagulability before surgery.

A Novel Auxiliary Device for Preventing Band Slippage After Laparoscopic Adjustable Gastric Banding: Infra-Band Fixation Using S-Loop.

BACKGROUND: Band slippage is known to be a troublesome complication of laparoscopic adjustable gastric banding (LAGB), often requiring surgical intervention. To prevent band slippage, a new auxiliary device "S-loop" was developed. METHODS: From July 2010 to January 2014, a total of 814 LAGBs were performed by a single surgeon. The patients were divided into two groups based on the application of S-loop: conventional LAGB group (n = 378) and S-loop group (n = 436). The operative outcomes were compared between the two groups. RESULTS: The mean operative time and the length of hospital stay were significantly longer in the conventional LAGB group than in the S-loop group (64.3 minutes versus 57.1 minutes; P < .001 and 5.0 hours versus 3.6 hours; P < .001, respectively). The complications occurred in 7.1% of the conventional LAGB group and 1.6% in the S-loop group (P < .001). Slippage was the most common complication: 13 cases were observed in the conventional LAGB group, whereas no slippage was observed in the S-loop group. CONCLUSION: Infra-band fixation using S-loop is a simple and effective method for preventing band slippage compared with the conventional LAGB.

Nationwide Survey on Bariatric and Metabolic Surgery in Korea: 2003-2013 Results.

A survey to evaluate the current status of bariatric and metabolic operations in Korea was conducted. Data from 5467 cases (32 hospitals) were collected. The annual numbers of bariatric and metabolic operations increased each year, from 139 in 2003 to 1686 in 2013. Adjustable gastric band (AGB, 67.2 %) was the most common operation, followed by sleeve gastrectomy (SG, 14.2 %), and Roux-en-Y gastric bypass (RYGB, 12.7 %). Mean patient age and body mass index (BMI) were 35.4 years and 35.9 kg/m2, respectively. In-hospital morbidity and mortality rates were 6 % (114/2305) and 0.25 % (5/2176), respectively. In Korea, AGB was the most common operation because of the availability and activity of specialized bariatric clinics. These national survey results established a baseline for future data collection.

[A case of hepatocellular carcinoma presented as a huge intrahepatic hematoma].

Spontaneous intrahepatic bleeding is a rare condition. In the absence of trauma, intrahepatic hematoma may be due to underlying liver disease. We report a case of hepatocellular carcinoma in the patient who had huge intrahepatic hematoma without definite intrahepatic tumor at the time of initial presentation. A 54-year-old man was admitted to our hospital with a sudden onset of upper abdominal pain. Initial abdominal CT scan showed huge hematoma measuring more than 13 cm in diameter in the right lobe of the liver. However, there was no enhancing lesion in the liver. Laboratory data showed high alanine aminotransferase, alpha-fetoprotein and positive HBsAg. The MRI and angiography could not also depict any mass in the liver. The patient was treated with percutaneous drainage on the intrahepatic hematoma. The cytology from drainaged blood revealed no malignant cell. After hematoma decreased, follow-up CT scan depicted an enhancing tumor in the liver. He underwent right hepatic lobectomy and histopathological examination showed hepatocellular carcinoma.

[Clinical and epidemiological analysis of a 20-year experience of surgically treated gallstone patients].

BACKGROUND/AIMS: The aim of this study was to investigate the epidemiological characteristics and changing patterns of gallstone disease over the last 20 years. METHODS: Four thousands and twenty gallstone patients who had received surgery at Seoul National University Hospital (1981 to approximately 2000) were analyzed according to time of treatment; period I: 1981 to approximately 1985 (831 cases), period II: 1986 to approximately 1990 (888 cases), period III: 1991 to approximately 1995 (1,040 cases) and period IV: 1996 to approximately 2000 (1,261 cases). Data from 13 institutes in Korea reporting 13,101 gallstone cases were also reviewed with literature to elucidate the nation-wide trends. RESULTS: The number of gallstone cases has gradually increased. A female-predominance was not observed (F/M=1.17-1.37). The CBD stone patients were older than the GB and the IHD stone patients. Over the study period, the relative portion of the GB stone group increased. The portion of CBD stone group decreased, while that of the IHD stone group was unchanged. The rural pattern of gallstone disease (low GB stone, high CBD and IHD stone) has become similar to the urban pattern. Such patterns are well agreed with the other literature reported in Korea. CONCLUSIONS: The pattern of gallstone disease in Korea has become similar to that in Western countries except a high prevalence of hepatolithiasis.