The repair of abdominal aortic aneurysm (AAA) in patients with functioning renal transplant is critical because it is important to avoid ischemic and reperfusion injury to the transplanted kidney. Endovascular aneurysm repair (EVAR) avoids aortic cross clamping and can prevent renal graft ischemia. Here we report the endovascular management and outcome of AAA in two renal transplant patients using a bifurcated aortic stent graft. One patient underwent EVAR using a small amount of contrast (30 mL) due to decreased renal function resulting from chronic rejection. Another patient had EVAR performed with iliac conduit because of the heavily calcified, stenotic lesion of external iliac artery. EVAR in patients with a renal transplant is a feasible option without impairing renal arterial flow.
Aneurysm ; Aortic Aneurysm, Abdominal ; Constriction ; Endovascular Procedures ; Humans ; Iliac Artery ; Ischemia ; Kidney ; Kidney Transplantation ; Rejection (Psychology) ; Reperfusion Injury ; Stents ; Transplants

We report a case of bile fistula after cholecystectomy in a patient with severe right liver atrophy, which was managed by endoscopic nasobiliary drainage and conservative treatment. The patient was a 76-year-old man with a sudden onset in the right flank and abdominal pain. Computed tomography revealed calculous cholecystitis and severely atrophied right lobe of the liver. Gallbladder was located in the superior-posterior portion of the liver as opposed to the normal position. The patient underwent cholecystectomy and showed massive bleeding and bile leakage at the gallbladder bed during operation. A bile fistula was detected three days after surgery, which was managed by interventional bile drainage. Right liver agenesis or severe atrophy is rare. Additionally, the report of combined bile duct injury after cholecystectomy in these settings is extremely rare.
Abdominal Pain ; Atrophy ; Bile ; Bile Ducts ; Cholecystectomy ; Cholecystitis ; Drainage ; Fistula ; Gallbladder ; Hemorrhage ; Humans ; Liver

PURPOSE: To identify the risk factors of major adverse cardiac event (MACE) in patients with chronic atherosclerotic lower extremity ischemia (CALEI) undergoing revascularization without noninvasive stress testing (NIST). METHODS: From January 2007 to January 2012, patients with CALEI who underwent revascularization were retrospectively reviewed. Emergent operations, revision procedures for previous surgery, or patients with active cardiac conditions were excluded. NIST was not performed for patients without active cardiac conditions. Cardiac risk was categorized into low, intermediate and high risk, according to the Lee's revised cardiac risk index. MACE was defined as acute myocardial infarction or any cardiac death within 30 days after surgery. RESULTS: A total of 459 patients underwent elective lower extremity revascularization procedures (240 open surgeries, 128 endovascular procedures, and 91 hybrid surgeries). The treated lesions comprised of 18% aorto-iliac, 58% infrainguinal, and 24% combined lesions. With regard to cardiac risk, low-, intermediate- and high risks were 67%, 32% and 2%, respectively. MACE was developed in 7 patients (2%). High or intermediate risk group by the Lee's index was related to postoperative MACE. Subgroup analysis for open surgery or hybrid surgery group identified female gender as an independent risk factor of MACE (P = 0.049; odds ratio, 5.168; confidence interval, 1.011 to 26.423). CONCLUSION: The Lee's index was a useful predictor of MACE. MACE is more common in female patients than male patients after open or hybrid surgery. Routine preoperative NIST is not suggested for all patients undergoing revascularization for CALEI, especially for those in the low risk group.
Chimera ; Death ; Endovascular Procedures ; Exercise Test ; Female ; Humans ; Ischemia ; Lower Extremity ; Male ; Myocardial Infarction ; Odds Ratio ; Peripheral Arterial Disease ; Postoperative Complications ; Retrospective Studies ; Risk Factors

PURPOSE: It is increasingly being recognized that the lymph node ratio (LNR) is an important prognostic factor for gallbladder carcinoma patients. The present study evaluated predictors of tumor recurrence and survival in a large, mono-institutional cohort of patients who underwent surgical resection for gallbladder carcinoma, focusing specifically on the prognostic value of lymph node (LN) status and of LNR in stage IIIB patients. METHODS: Between 2004 and 2011, 123 patients who underwent R0 radical resection for gallbladder carcinoma at the Chonnam National University Hwasun Hospital were reviewed retrospectively. Patients were staged according to the American Joint Committee on Cancer 7th edition, and prognostic factors affecting disease free survival, such as age, sex, comorbidity, body mass index, presence of preoperative symptoms, perioperative blood transfusion, postoperative complications, LN dissection, tumor size, differentiation, lymph-vascular invasion, perineural invasion, T stage, presence of LN involvement, N stage, numbers of positive LNs, LNR and implementation of adjuvant chemotherapy, were statistically analyzed. RESULTS: LN status was an important prognostic factor in patients undergoing curative resection for gallbladder carcinoma. The total number of LNs examined was implicated with prognosis, especially in N0 patients. LNR was a powerful predictor of disease free survival even after controlling for competing risk factors, in curative resected gallbladder cancer patients, and especially in stage IIIB patients. CONCLUSION: LNR is confirmed as an independent prognostic factor in curative resected gallbladder cancer patients, especially in stage IIIB gallbladder carcinoma.
Blood Transfusion ; Body Mass Index ; Chemotherapy, Adjuvant ; Cohort Studies ; Comorbidity ; Disease-Free Survival ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Joints ; Lymph Nodes ; Postoperative Complications ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors

PURPOSE: The aim of this study was to investigate the current status of the use of antiadhesive agents (AAdAs) via a questionnaire and to discuss the availability of AAdAs. METHODS: The survey was sent to a list of members that was approved by the Korean Gastric Association. The survey included questions on AAdA use by surgeons, the type of AAdAs used, and the reasons for not using AAdAs. Surgeons were also asked to describe complications related to AAdAs, and the reliability of its use. RESULTS: The response rate was 21%. The rates of frequent use stratified by procedure were 26.9% (14/52) for open gastrectomy, 5.9% (3/51) for laparoscopic gastrectomy, and 31.5% (17/54) for surgery for postoperative bowel obstruction (P < 0.01). After including data from the occasional use group, the corresponding values were 51.9% (27/52), 19.6% (10/51), and 70.4% (38/54), respectively (P < 0.01). Sefrafilm and Guardix were most commonly used for open procedures. Guardix and Interceed were most commonly used for laparoscopic surgery. The primary reasons for nonuse of AAdAs were ineffectiveness and high cost. Ten percent (4/40) of surgeons observed complications associated with AAdAs. A minority (17.3%, 9/52) had positive attitudes toward AAdAs. The majority of respondents expressed neutral (73.1%, 38/52) or negative (9.6%, 5/52) attitudes toward AAdAs. CONCLUSION: The low use rates of AAdAs in gastric cancer surgery may be attributable to perceptions that AAdAs are ineffective, unreliable, and costly. We anticipate the emergence of promising antiadhesive strategies that reach far beyond the limitations of current products.
Cellulose, Oxidized ; Gastrectomy ; Laparoscopy ; Morinda ; Postoperative Complications ; Surveys and Questionnaires ; Republic of Korea ; Stomach Neoplasms ; Surveys and Questionnaires

PURPOSE: The aim of our study is to evaluate the factors affecting surgical margin positivity among patients with invasive ductal breast cancer who underwent breast-conserving surgery (BCS) after preoperative diagnostic core biopsy. METHODS: Two hundred sixteen patients with stage I, II invasive ductal breast carcinoma who had histological diagnosis with preoperative tru-cut biopsy and underwent BCS were included in the present study. Potential factors that affect the positive surgical margin were analyzed. In univariate analysis, the comparisons of the factors affecting the surgical margin positivity were made by chi-square test. Logistic regression test was used to detect the independent factors affecting the surgical margin positivity. RESULTS: Positive axillary lymph node (odds ratio [OR], 8.2; 95% confidence interval [CI], 3.01 to 22.12), lymphovascular invasion (LVI; OR, 3.9; 95% CI, 1.62 to 9.24), extensive intraductal component (EIC; OR, 6.1; 95% CI, 2.30 to 16.00), presence of spiculation (OR, 5.1; 95% CI, 2.00 to 13.10) or presence of microcalcification in the mammography (OR, 13.7; 95% CI, 4.04 to 46.71) have been found to be the independent and adverse factors affecting surgical margin positivity. CONCLUSION: Considering decision making for the extent of the excision and for achieving negative surgical margin before BCS, positive axillary lymph node, LVI, EIC, spiculation or microcalcification in mammography are related as predictor factors for positive surgical margin.
Biopsy ; Biopsy, Large-Core Needle ; Breast ; Breast Neoplasms ; Decision Making ; Humans ; Logistic Models ; Lymph Nodes ; Mammography ; Mastectomy, Segmental

PURPOSE: The objective of this study was to translate the obesity-related problems (OP) scale for Koreans and to validate it for use in Korean populations. METHODS: Translation and back-translation of the OP scale was performed and a pilot test was conducted. Following this, patients who had received treatment at the Obesity Center of Inha University Hospital were selected for participation in the field test. Cronbach's alpha (alpha) was used for assessment of the internal consistency of the OP scale. Spearman's correlation coefficients were used to assess the concurrent validity between the OP scale, the EuroQoL-5D (EQ-5D), and the Beck depression inventory (BDI) scale. One-way analysis of variance and t-test were used to assess the factors associated with the OP scale. RESULTS: A total of 67 individuals participated in the field study. The standardized Cronbach's alpha of the OP was 0.913. A significant negative correlation was observed between the OP scale and the EQ-5D and a positive correlation was observed between the OP scale and the BDI (the correlation coefficient with EQ-5D = -0.316, and the BDI = 0.305, P < 0.05). CONCLUSION: The results of this study prove that the Korean version of the OP has been translated and adapted correctly in order to meet the standard of its use.
Depression ; Humans ; Obesity ; Quality of Life ; Surveys and Questionnaires

PURPOSE: Bariatric surgery is considered an efficient treatment for severe obesity, but postoperative complications and psychosocial problems may impact quality of life (QoL). Although QoL is an important aspect of bariatric surgery, few studies have evaluated the changes in QoL. We examined whether severely obese patients who had undergone bariatric surgery had better QoL compared with severely obese adults who had not undergone bariatric surgery in Korea. METHODS: Data were obtained from 78 participants in two groups; bariatric surgery group (n = 53) and nonsurgery group (n = 25). EuroQoL-5D (EQ-5D), the impact of weight on quality of life-lite (IWQoL-lite) and the obesity-related psychosocial problem scale (OP-scale) were used to assess the improvement of QoL. RESULTS: A total of 78 patients completed the QoL forms as part of their surgical consultation. In the EQ-5D, the changes of EQ-5D 3 level and EQ-5D visual analogue scale in the surgery group was 0.174 and 24.6 versus 0.017 and 17.8 in the nonsurgery group (P = 0.197 and P = 0.179). The changes of IWQoL-lite and OP-scale were significantly improved after bariatric surgery. In the IWQoL-lite, the mean changes in the surgery group was 33.4 versus 14.3 points in the nonsurgery group (P = 0.000). In the OP-scale, the mean changes in the surgery group patients scored 39.3 versus 9.0 points in the nonsurgery group (P = 0.000). CONCLUSION: We demonstrated significant improvement of QoL observed after bariatric surgery compared to nonsurgical procedure. The results of this comparative study favor bariatric surgery for the treatment of severe obesity.
Adult ; Bariatric Surgery ; Humans ; Korea ; Obesity ; Postoperative Complications ; Quality of Life

A randomized controlled trial to evaluate the long-term outcomes of laparoscopic distal gastrectomy for gastric cancer is currently ongoing in Korea. Patients with cT1N0M0-cT2aN0M0 (American Joint Committee on Cancer, 6th edition) distal gastric cancer were randomized to receive either laparoscopic or open distal gastrectomy. For surgical quality control, the surgeons participating in this trial had to have performed at least 50 cases each of laparoscopy-assisted distal gastrectomy and open distal gastrectomy and their institutions should have performed more than 80 cases each of both procedures each year. Fifteen surgeons from 12 institutions recruited 1,415 patients. The primary endpoint is overall survival. The secondary endpoints are disease-free survival, morbidity, mortality, quality of life, inflammatory and immune responses, and cost-effectiveness (ClinicalTrials.gov ID: NCT00452751).
Adenocarcinoma ; Disease-Free Survival ; Gastrectomy ; Humans ; Joints ; Korea ; Prospective Studies ; Quality Control ; Quality of Life ; Stomach Neoplasms

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