Is a Single Incisional Laparoscopic Totally Extraperitoneal Approach Feasible for Inguinal Hernia Repair?

PURPOSE: This study describes our preliminary experience of a single incisional laparoscopic totally extraperitoneal approach (TEP) for inguinal hernia repair, compared to conventional TEP. METHODS: From August 2012 to February 2014, 46 patients underwent inguinal hernia repair using a laparoscopic totally extraperitoneal approach by a single surgeon at Hansol Hospital, Seoul, Korea. Three patients were excluded due to a recurrent inguinal hernia; thus, 43 patients were enrolled in two groups, the single incisional TEP (STEP) group (n=23) and the conventional TEP (CTEP) group (n=20). The mean follow-up period was 15 months. RESULTS: No differences in patient demographics (age, sex, hernia site and type, and body mass index) were detected between the two groups. The operation time in the STEP group was significantly longer than that in the CTEP group (69.7+/-28.5 vs. 51.0+/-16.4 min, p=0.017). No differences in postoperative complications were detected, including chronic pain, voiding difficulties, or the occurrence of a wound seroma (STEP, n=3 vs. CTEP, n=2). Pain scores (STEP, 1.4+/-0.7 vs. CTEP 1.4+/-0.8) and hospital stay duration (STEP, 1.0+/-0.2 vs. CTEP, 1.2+/-0.5 days) also did not differ between the groups. No patient in the STEP group required an additional port. CONCLUSION: Single incisional TEP was technically feasible, although it required a longer operation time. STEP appeared to have better cosmetic results compared with those of CTEP.

Ten year outcomes after bypass surgery in aortoiliac occlusive disease / 대한외과학회지

PURPOSE: Most outcome studies of bypass surgery are limited to five years of follow-up. However, as human life expectancy has increased, analyses of more long-term outcomes are needed. The aim of this study is to evaluate 10-year outcomes of anatomical bypasses in aortoiliac occlusive disease. METHODS: From 1996 to 2009, 92 patients (82 males and 10 females) underwent aortic anatomical bypasses to treat aortoiliac occlusive disease at Samsung Medical Center. The patients were reviewed retrospectively. Kaplan-Meier survival analyses were performed using PASW ver. 18.0 (IBM Co). RESULTS: A total of 72 patients (78.3%) underwent aorto-femoral bypasses (uni- or bi-femoral), 15 patients (16.3%) underwent aorto-iliac bypasses (uni- or bi-iliac), and 5 patients (5.4%) underwent aorto-iliac and aorto-femoral bypasses. The overall primary patency rates of the 92 patients were 86.2% over 5 years and 77.6% over 10 years. The 10-year limb salvage rate and overall survival rate were 97.7% and 91.7%, respectively. CONCLUSION: The overall patency rates of bypass graft and limb salvage rates decreased as time passed. The analysis of results after bypass surgery to treat arterial occlusive disease will be needed to extend for 10 years of follow-up.

Preliminary Experience of Laparoscopic Hepatectomy for Hepatocellular Carcinoma

PURPOSE: Laparoscopic liver resection has gained much popularity in recent years, but relatively few centers have performed hepatectomies in hepatocellular carcinoma (HCC) patients due to the technical difficulties faced with underlying liver cirrhosis. We now present our early experience with laparoscopic liver resection in HCC performed in a single institution. METHODS: From October 2003 until March 2009, 39 laparoscopic liver resections were performed on HCC patients among whom 26 had underlying liver cirrhosis. RESULTS: The location of the tumor was in the left lateral section in 15, segment 5 or 6 in 20, segment 4 in 3 and caudate lobe in 1. Resection involving less than a monosegment was done in 26 and more than 2 segments in 13. Tumor size ranged from 0.8 cm to 6.6 cm (median 2.35) and the resection margin from 0.1 to 6 cm (median 1.5 cm). All patients were either stage I (29) or II (10). There was no difference between cirrhotic and non-cirrhotic patients in operation time (median 210 minutes, range 60~637), change of hematocrit value (4.8%, -1~19.6%), or hospital stay (8 days, 3~67 days). The median follow up duration was 15.1 months, and the 2-year recurrence free survival rate was 48.3%. CONCLUSION: Laparoscopic liver resection in HCC with or without underlying cirrhosis seems to be feasible with minimal morbidity, especially in well selected cases with early stage HCC.