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A parastomal hernia is the most common surgical complication following stoma formation. As the field of laparoscopic surgery advances, different laparoscopic approaches to repair of parastomal hernias have been developed. Recently, the Sugarbaker technique has been reported to have lower recurrence rates compared to keyhole techniques. As far as we know, the Sugarbaker technique has not yet been performed in Korea. We herein present a case report of perhaps the first laparoscopic parastomal hernia repair with a modified Sugarbaker technique to be successfully carried out in Korea. A 79-year-old woman, who underwent an abdominoperineal resection for an adenocarcinoma of the rectum 9 years ago, presented with a large parastomal and incisional hernias, and was treated with a laparoscopic repair with a modified Sugarbaker technique. Six months after surgery, follow-up with the patient has shown no evidence of recurrence.
Adenocarcinoma ; Female ; Follow-Up Studies ; Hernia ; Hernia, Abdominal ; Herniorrhaphy ; Humans ; Korea ; Laparoscopy ; Rectum ; Recurrence ; Surgical Stomas

Meckel's diverticulum (MD) is a true congenital diverticulum that is remnant by incomplete obliteration of the omphalomesenteric duct. It is the most common congenital anomaly of the gastrointestinal tract, with an estimated prevalence of 2% (0.3% to 3% in autopsy studies). About 90% of MD occurs within 100 cm of the ileocecal valve. A primary malignant tumor arising within an MD is extremely uncommon. Malignancies are reported to account for only 0.5% to 3.2% of the complications. Carcinoids are the most common malignant tumors occurring in MD. Adenocarcinomas are extremely uncommon and very poor prognosis has been reported. We report a case of radiographically diagnosed chronic inflammatory mass caused by adenocarcinoma arising from MD in the ileum with malrotation of the midgut incidentally discovered at exploration.
Adenocarcinoma ; Autopsy ; Carcinoid Tumor ; Diverticulum ; Gastrointestinal Tract ; Ileocecal Valve ; Ileum ; Meckel Diverticulum ; Prevalence ; Prognosis ; Vitelline Duct

PURPOSE: Single-site laparoscopic surgery has become increasingly common. We herein report an easy and low-cost thoracic trocar technique (TTT) for these types of procedures and recommend the simpler name "transumbilical scarless surgery" (TUSS) to minimize confusion in nomenclature. METHODS: We retrospectively reviewed patients who underwent TUSS by TTT using a thoracic trocar and surgical glove in our hospital between November 2011 and November 2012. Operating time, postoperative stay, and complications were detailed. RESULTS: A total of 101 TUSS by TTT were successfully performed, comprising appendectomy (n = 63), ovarian cyst excision (n = 7), splenectomy (n = 5), nephroureterectomy (n = 5), orchidopexy (n = 4), pyeloplasty (n = 3), nephrolithotomy (n = 2), orchiectomy (n = 2), varicocelectomy (n = 2), lymphangioma excision (n = 2), ureterectomy (n = 1), Morgagni diaphragmatic hernia repair (n = 1), ovarian detorsion (n = 1), antegrade continence enema (n = 1), intestinal resection anastomosis (n = 1), and intestinal duplication excision (n = 1). Kirschner wires were used for some organ traction. Nine patients required an additional port, but no major complications occurred. The postoperative stay (mean +/- standard deviation) was 3.2 +/- 1.4 days, and operating time was 58.9 +/- 38.3 minutes. CONCLUSION: We recommend the simpler name of TUSS to minimize confusion in nomenclature for all transumbilical single-incision laparoendoscopic surgeries. TTT is an easy and low-cost TUSS technique.
Appendectomy ; Bone Wires ; Enema ; Female ; Gloves, Surgical ; Hernia, Diaphragmatic ; Humans ; Laparoscopy ; Lymphangioma ; Orchiectomy ; Orchiopexy ; Ovarian Cysts ; Retrospective Studies ; Splenectomy ; Surgical Instruments ; Surgical Procedures, Minimally Invasive ; Traction

PURPOSE: The purpose of this study is to review the roll changes of surgical treatment for peripheral artery disease in endovascular era. METHODS: One hundred and twelve surgically treated cases of peripheral artery disease at a single institution during the period from 2006 to 2011 were studied retrospectively. The cases were divided into two groups of different time periods, one before 2009 (surgical period group) and the other from 2009 onward (endovascular period group). We analyzed the type and location of surgery as well as clinical characteristics of patients and treatment results. RESULTS: Fifty-three cases were for the surgical period group and 59 cases for the endovascular group. No difference in the demographic characteristics and the distribution of major atherosclerosis risk factors was found between the two groups. Additionally, the technical and functional success rate was similar in both groups. However, it is found that there were more acute cases in the endovascular period group than in the surgical period group. The number of cases in need of suprainguinal or below knee exposure was similar in both groups. In hybrid cases, suprainguinal or below knee exposures were more frequently needed during the former period than the latter period. CONCLUSION: The role of surgical treatment is currently in the process of changing. Surgical treatment seems to be a complementary alternative to endovascular treatment for chronic limb ischemia. However, it still seems to play a major role for acute limb ischemia.
Atherosclerosis ; Chimera ; Embolectomy ; Extremities ; Humans ; Ischemia ; Knee ; Peripheral Arterial Disease ; Retrospective Studies ; Risk Factors ; Thrombectomy

PURPOSE: Tumor invasion to the portal vein (PV) or superior mesenteric vein (SMV) can be encountered during the surgery for pancreatic cancer. Venous reconstruction is required, but the optimal surgical methods and conduits remain in controversies. METHODS: From January 2007 to July 2012, 16 venous reconstructions were performed during surgery for pancreatic cancer in 14 patients. We analyzed the methods, conduits, graft patency, and patient survival. RESULTS: The involved veins were 14 SMVs and 2 PVs. The operative methods included resection and end-to-end anastomosis in 7 patients, wedge resection with venoplasty in 2 patients, bovine patch repair in 3 patients, and interposition graft with bovine patch in 1 patient. In one patient with a failed interposition graft with great saphenous vein (GSV), the SMV was reconstructed with a prosthetic interposition graft, which was revised with a spiral graft of GSV. Vascular morbidity occurred in 4 cases; occlusion of an interposition graft with GSV or polytetrafluoroethylene, segmental thrombosis and stenosis of the SMV after end-to-end anastomosis. Patency was maintained in patients with bovine patch angioplasty and spiral vein grafts. With mean follow-up of 9.8 months, the 6- and 12-month death-censored graft survival rates were both 81.3%. CONCLUSION: Many of the involved vein segments were repaired primarily. When tension-free anastomosis is impossible, the spiral grafts with GSV or bovine patch grafts are good options to overcome the size mismatch between autologous vein graft and portomesenteric veins. Further follow-up of these patients is needed to demonstrate long-term patency.
Angioplasty ; Constriction, Pathologic ; Follow-Up Studies ; Graft Survival ; Humans ; Mesenteric Veins ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Polytetrafluoroethylene ; Portal Vein ; Saphenous Vein ; Thrombosis ; Transplants ; Veins

PURPOSE: The optimal time between neoadjuvant chemoradiotherapy (CRT) and surgery for rectal cancer has been debated. This study evaluated the influence of this interval on oncological outcomes. METHODS: We compared postoperative complications, pathological downstaging, disease recurrence, and survival in patients with locally advanced rectal cancer who underwent surgical resection <8 weeks (group A, n = 105) to those who had surgery > or =8 weeks (group B, n = 48) after neoadjuvant CRT. RESULTS: Of 153 patients, 117 (76.5%) were male and 36 (23.5%) were female. Mean age was 57.8 years (range, 28 to 79 years). There was no difference in the rate of sphincter preserving surgery between the two groups (group A, 82.7% vs. group B, 77.6%; P = 0.509). The longer interval group had decreased postoperative complications, although statistical significance was not reached (group A, 28.8% vs. group B, 14.3%; P = 0.068). A total of 111 (group A, 75 [71.4%] and group B, 36 [75%]) patients were downstaged and 26 (group A, 17 [16.2%] and group B, 9 [18%]) achieved pathological complete response (pCR). There was no significant difference in the pCR rate (P = 0.817). The longer interval group experienced significant improvement in the nodal (N) downstaging rate (group A, 46.7% vs. group B, 66.7%; P = 0.024). The local recurrence (P = 0.279), distant recurrence (P = 0.427), disease-free survival (P = 0.967), and overall survival (P = 0.825) rates were not significantly different. CONCLUSION: It is worth delaying surgical resection for 8 weeks or more after completion of CRT as it is safe and is associated with higher nodal downstaging rates.
Chemoradiotherapy ; Disease-Free Survival ; Female ; Humans ; Male ; Neoadjuvant Therapy ; Polymerase Chain Reaction ; Postoperative Complications ; Preoperative Period ; Rectal Neoplasms ; Recurrence

PURPOSE: There are fewer patients with gastroesophageal reflux disease (GERD) in Korea compared with Western countries. The incidence of GERD has increased in recent years however, concerning many physicians. Here, we report our early experiences of using a recently introduced method of laparoscopic antireflux surgery for the treatment of GERD in Korean patients. METHODS: Fifteen patients with GERD were treated using antireflux surgery between May 2009 and February 2012 at the University of Ulsan College of Medicine and Asan Medical Center. Laparoscopic Nissen fundoplication with 360degrees wrapping was performed on all patients. RESULTS: Eleven male and four female patients were evaluated and treated with an average age of 58.1 +/- 14.1 years. The average surgical time was 118.9 +/- 45.1 minutes, and no complications presented during surgery. After surgery, the reflux symptoms of each patient were resolved; only two patients developed transient dysphagia, which resolved within one month. One patient developed a 6-cm hiatal hernia that had to be repaired and reinforced using mesh. CONCLUSION: The use of laparoscopic surgery for the treatment of GERD is safe and feasible. It is also an efficacious method for controlling the symptoms of GERD in Korean patients. However, the use of this surgery still needs to be standardized (e.g., type of surgery, bougienage size, wrap length) and the long-term outcomes need to be evaluated.
Deglutition Disorders ; Female ; Fundoplication ; Gastroesophageal Reflux ; Hernia, Hiatal ; Humans ; Incidence ; Korea ; Laparoscopy ; Male ; Operative Time

PURPOSE: To evaluate the antiadhesive effects and safety of an oxidized regenerated cellulose (Interceed) after thyroidectomy. METHODS: Seventy-six thyroidectomized patients were prospectively randomized into two groups with regard to the use of Interceed. We evaluated each group for their adhesive symptoms using four subjective and four objective items at the 2nd week, 3rd and 6th month after thyroidectomy. All patients were examined for vocal cord motility by indirect laryngoscope at each period. RESULTS: Total adhesion scores at each postoperative follow-up period decreased with time, but were not significantly different in each group. The median score for swallowing discomfort for liquid was significantly lower in the Interceed group than in the control group 2 weeks after surgery. In addition, the severity of skin adhesion to the trachea was reduced in the Interceed group compared with the control group 6 months after surgery. During the study, there were no adverse effects or significant differences in postoperative complications between the groups. CONCLUSION: Interceed appeared to be safe and effective in improving neck discomfort at early postoperative periods and preventing skin adhesion to the trachea 6 months after thyroidectomy.
Adhesives ; Cellulose ; Cellulose, Oxidized ; Deglutition ; Follow-Up Studies ; Humans ; Laryngoscopes ; Neck ; Postoperative Complications ; Postoperative Period ; Prospective Studies ; Skin ; Thyroidectomy ; Trachea ; Vocal Cords

A gastric carcinoma with the endoscopic features resembling submucosal tumor (SMT) is rare, and reportedly account for only 0.1% to 0.63% of all resected gastric carcinomas. The preoperative diagnosis of SMT-like gastric carcinoma is challenging, and thus, diagnosis is usually made intraoperatively or postoperatively. Furthermore, mucinous adenocarcinoma is an uncommon histologic subtype of gastric carcinoma characterized as an elevated lesion resembling SMT due to abundant mucin pools in submucosa. Here, we report two cases in which a gastric mucinous adenocarcinoma was mistaken as a SMT.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Gastric Mucins ; Mucins ; Stomach ; Stomach Neoplasms