Reconstruction of large abdominal wall defects is a challenging problem. Various reconstructive techniques have been described in the surgical literature each with its advantages and disadvantages. In this report we describe our experience in treating a patient with large abdominal wall defect by staged abdominal wall reconstruction utilizing prosthetic mesh in conjunction with tissue expanders. A 41-year-old male presented with abdominal pain. Exploratory laparotomy showed perforated appendicitis with intraabdominal abscess of 1,500 mL. Postoperatively, he developed intraperitoneal sepsis. To prevent abdominal compartment syndrome, he was reoperated and left with "open abdomen". After several open abdomen lavages, his abdominal wall defect was allowed to granulate. After epithelization of the defect, the abdominal wall was reconstructed using prosthetic mesh and tissue expanders. The tissue expansion process was well tolerated. We suggest that the use of tissue expanders provides reliable and well-vascularized soft-tissue coverage in abdominal wall reconstruction.
Abdomen ; Abdominal Pain ; Abdominal Wall ; Abscess ; Appendicitis ; Hernia, Abdominal ; Hernia, Ventral ; Humans ; Intra-Abdominal Hypertension ; Laparotomy ; Male ; Sepsis ; Therapeutic Irrigation ; Tissue Expansion ; Tissue Expansion Devices

Symptomatic gastrointestinal metastasis from lung malignancy is rarely reported. In this report, we present a case of lung adenocarcinoma with acute abdominal pain from small bowel perforation. The patient underwent small bowel resection and the final diagnosis was metastatic adenocarcinoma originating from lung. Immunohistochemistry was positive for thyroid transcription factor-1 and cytokeratin 7 (CK7), and negative for CK20. We present this rare case and briefly review the literature.
Abdominal Pain ; Adenocarcinoma ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Keratin-7 ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Peritonitis ; Thyroid Gland

PURPOSE: Varicose veins are a major problem worldwide and improvement in quality of life (QoL) is the ultimate goal after treatment of this benign disease. However QoL is highly dependent on personal and social factors. This study compares high ligation and stripping (HS) and radiofrequency ablation (RFA) in terms of QoL and recurrence in Korea. METHODS: A retrospective analysis of prospectively collected data between August 2006 and October 2008 was performed for patients undergoing HS and RFA at a single institution. QoL was assessed with a questionnaire preoperatively, at 3 months postoperatively and annually thereafter. Recurrence was assessed by Duplex ultrasound annually after surgery. RESULTS: A total of 272 patients completed the questionnaire at 3 months. Among these patients, 155 patients returned for their annual follow-up. There were no significant differences between HS and RFA in global QoL scores, although RFA showed less pain. However, paresthesia rates were also higher after RFA. Recurrence rates were similar between the two modalities, although technical failures were more common after RFA. CONCLUSION: Overall QoL and recurrence rates were similar between the two modalities. The benefits of RFA do not seem to be enough to overcome the higher costs of HS in Korea.
Catheter Ablation ; Follow-Up Studies ; Humans ; Korea ; Ligation ; Paresthesia ; Prospective Studies ; Quality of Life ; Surveys and Questionnaires ; Recurrence ; Retrospective Studies ; Varicose Veins

PURPOSE: The aim of this study was to investigate the clinical and radiological incidence of parastomal hernia and to analyze the risk factors for parastomal hernia. METHODS: We reviewed retrospectively 108 patients with end colostomy from January 2003 to June 2010. Age, sex, surgical procedure type, body mass index (kg/m2), stoma size, and respiratory comorbidity were documented. RESULTS: There were 61 males (56.5%) and 47 females (43.5%). During an overall median follow-up of 25 months (range, 6 to 73 months), 36 patients (33.3%) developed a radiological parastomal hernia postoperatively and 29 patients (26.9%) presented with a clinical parastomal hernia. In multivariate analysis, gender (odds ratio [OR], 6.087; P = 0.008), age (OR, 1.109; P = 0.009) and aperture size (OR, 6.907; P < 0.001) proved to be significant and independent risk factors after logistic regression analysis. CONCLUSION: This study showed that the incidence of radiological parastomal hernia is higher than clinical parastomal hernia. Risk factors for parastomal hernia proved to be female, age, and aperture size.
Colostomy ; Comorbidity ; Female ; Follow-Up Studies ; Hernia ; Humans ; Incidence ; Logistic Models ; Male ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Somatotypes

PURPOSE: Laparoscopic techniques have gained wide clinical acceptance in surgical practice today. The laparoscopic approach has been established as the technique of choice for elective splenectomies performed on normal sized spleens. The purpose of this study was to evaluate the outcome of patients undergoing laparoscopic splenectomy (LS) at the TOBB University of Economics and Technology (ETU) Hospital and Kecioren Training and Research Hospital. METHODS: One hundred and thirty-five patients underwent splenectomy between January 2000 and July 2010. For comparison, the records of 130 patients undergoing splenectomy were evaluated for age, gender, hospital stay, time to start of diet, conversion rate, operation time and wound infection. RESULTS: Mean operation time means the time interval between surgeon commencing operation to end of operation. Mean operation time in patients treated by LS was 132 minutes and 121 minutes in open splenectomy (OS). Mean hospital stay was 5.65 days in patients undergoing LS and starting of diet was 1.21 days. In patients treated by OS, mean hospital stay was 9.17 days, starting of diet was 2.37 days. Four patients were converted to open surgery. Conversion rate was 6.4 percent. In the early post operative period (within 10 days of surgery) 9.2%, LS group had lower incidences of wound infection rate after surgery than OS group (4.8%, 7.4%, respectively; P = 0.06). CONCLUSION: LS is a safe and effective alternative to OS for treatment of splenic diseases in patients of all ages.
Diet ; Humans ; Incidence ; Laparoscopy ; Length of Stay ; Spleen ; Splenectomy ; Splenic Diseases ; Wound Infection

PURPOSE: Diverticulitis of vermiform appendix is known as a rare cause of acute appendicitis, most of which are diagnosed after surgery. We compared appendiceal diverticulitis with acute appendicitis to study the clinical characteristics of appendiceal diverticulitis. METHODS: Among 1,029 patients who received appendectomy from January 2009 to May 2011, 38 patients with appendiceal diverticulitis (diverticulitis group) were compared with 98 randomly collected patients with acute appendicitis (appendicitis group) during the same period. Patients' characteristics, clinical features, laboratory findings, operative findings, and postoperative course were compared between the two groups. RESULTS: Thirty-eight patients (3.7%) were pathologically diagnosed with acute appendiceal diverticulitis among 1,029 cases of appendectomy. The mean age of patients in the diverticulitis group was significantly older than that of the appendicitis group (49.0 +/- 15.2 years vs. 25.4 +/- 14.2 years, P < 0.05). Mean duration of preoperative symptoms was longer in the diverticulitis group (3.6 +/- 3.8 days vs. 1.8 +/- 3.2 days, P < 0.05). The site of abdominal pain, fever, signs of localized peritonitis, accompanying gastrointestinal symptoms, and white blood cell count showed no differences between the two groups. Twenty-five patients (65.8%) of the diverticulitis group and 10 patients (10.2%) of the appendicitis group showed perforation of appendix (P < 0.05). Mean operating time and postoperative hospital stay were longer in the diverticulitis group (55.3 +/- 28.8 minutes vs. 41.4 +/- 17.8 minutes, 6.8 +/- 3.4 days vs. 4.9 +/- 1.5 days, P < 0.05). CONCLUSION: Acute diverticulitis of the appendix can be classified into quite different disease entities compared with acute appendicitis. Regarding high rates of perforation, immediate surgical treatment is needed for patients with a high index of suspicion of acute diverticulitis of the appendix.
Abdominal Pain ; Appendectomy ; Appendicitis ; Appendix ; Diverticulitis ; Fever ; Humans ; Length of Stay ; Leukocyte Count ; Peritonitis

PURPOSE: The purpose of this study was to investigate the safety and usefulness of the Hem-o-lok clip for the closure of appendicular stumps and limitations of the Hem-o-lok clip. METHODS: From May 2010 to August 2011, 105 consecutive patients underwent laparoscopic appendectomies by three surgeons. XL size Hem-o-lok clips were used for the closure of appendicular stumps by one surgeon. The remaining surgeons used double endoloop ligatures. Prospectively collected data from patients who underwent laparoscopic appendectomy due to acute appendicitis were retrospectively reviewed. RESULTS: A total of 105 laparoscopic appendectomies were performed. The endoloop group consisted of 66 patients (mean age, 34.6 years; range, 16 to 82 years), while the Hem-o-lok group consisted of 39 patients (mean age, 43.5 years; range, 11 to 88 years). In three cases, the Hem-o-lok clip was not used due to enlargement and severe inflammation of the appendix base. No specific intraoperative or postoperative complications were observed in either group. CONCLUSION: The use of Hem-o-lok clips for the closure of appendicular stumps in laparoscopic appendectomy is a feasible, safe, fast and cost-effective procedure in patients with a mildly to moderately inflamed appendix base of less than 10 mm in diameter.
Appendectomy ; Appendicitis ; Appendix ; Humans ; Inflammation ; Ligation ; Postoperative Complications ; Prospective Studies ; Retrospective Studies

PURPOSE: We evaluated the predictive value of preoperative lung spirometry test for postoperative morbidity and the nature of complications related to an abnormal pulmonary function after gastric cancer surgery. METHODS: Between February 2009 and March 2010, 538 gastric cancer patients who underwent laparoscopic (n = 247) and open gastrectomy (n = 291) were divided into the normal (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] > or = 0.7, n = 441) and abnormal pulmonary function group (FEV1/FVC < 0.7, n = 97), according to the preoperative lung spirometry test. The predictive value of lung spirometry for postoperative morbidity was evaluated using the univariate and multivariate analysis. RESULTS: After surgery, the abnormal pulmonary function group showed a significantly increased incidence of local (29.9% vs. 18.1%, P = 0.009) and systemic complications (8.2% vs. 2.0%, P = 0.005) than the normal group. Of local complications, anastomosis leakage and wound complication were found to be more common in the abnormal pulmonary function group. In the univariate and multivariate analysis, an abnormal pulmonary function was an independent predictor for postoperative local complication (odds ratio, 1.75; 95% confidence interval, 1.03 to 2.97) after adjusted by old age, total gastrectomy, open surgery, and tumor-node-metastasis stage. Meanwhile, an old age and a history of pulmonary disease were independent predictors for systemic complication. CONCLUSION: Preoperative lung spirometry is a simple and useful means to predict postoperative morbidity after gastric cancer surgery. In view of its simplicity and low cost, we recommend adding preoperative lung spirometry test to assess the operative risk and aid in proper perioperative treatment planning.
Gastrectomy ; Humans ; Incidence ; Lung ; Lung Diseases ; Multivariate Analysis ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Spirometry ; Stomach Neoplasms ; Vital Capacity

PURPOSE: We evaluated the relationship between the degree of osteopontin (OPN) expression in papillary thyroid carcinoma (PTC) specimens and the presence of the BRAF mutation and clinicopathologic variables. METHODS: Fifty-six snap-frozen thyroid tumor samples, including those of 49 PTCs, four follicular adenomas, two follicular carcinomas, and one Hurthle cell adenoma, were studied. We performed reverse transcription-polymerase chain reaction (RT-PCR) to assess the OPN expression levels. We also tested the BRAF codon 599 mutations using RT-PCR with the direct sequencing method. All of the tumors were microscopically reexamined by a pathologist with a special interest in thyroid neoplasia. RESULTS: OPN mRNA was significantly overexpressed in the PTC samples compared with other thyroid tumors (P = 0.011). In PTCs, the OPN expression level was higher in the BRAF mutation group than in the wild-type group (P = 0.041). Among the clinicopathologic variables, nonfollicular variant histologic subtypes (P = 0.002) and the presence of lymph node metastases (P = 0.042) were correlated with elevated level of OPN expression. CONCLUSION: OPN might play a crucial role in tumorigenesis and the progression of PTC.
Adenoma ; Carcinoma ; Cell Transformation, Neoplastic ; Codon ; Factor IX ; Lymph Nodes ; Neoplasm Metastasis ; Osteopontin ; RNA, Messenger ; Thyroid Gland ; Thyroid Neoplasms

The standard treatment for patients with locally advanced rectal cancer is preoperative chemoradiotherapy followed by total mesorectal excision. This approach is supported by randomized trials, but there are still many unanswered questions about the multimodal management of rectal cancer. In surgical terms, these include the optimal time interval between completion of chemoradiotherapy and surgery; adequate distal resection margin and circumferential radial margin; sphincter preservation; laparoscopic surgery; and conservative management, including a 'wait and see' policy and local excision. This review considers these controversial issues in preoperative chemoradiotherapy.
Chemoradiotherapy ; Humans ; Rectal Neoplasms