Agenesis of the right lobe of the liver is such a rare congenital anomaly that only about 40 cases have been reported in the literature. This anomaly is considered to be caused by a developmental failure of the right portal vein or by an error of mutual induction between the primitive diaphragm and the endodermal diverticulum representing the primitive liver. When the absence or hypoplasia of the right lobe is found by radiological examinations, several condition, such as liver cirrhosis, a cholangiocarcinoma, and a previous hepatic resection, must be taken into a consideration for a differential diagnosis besides agenesis. Agenesis of the right lobe could be complicated by various biliary tract diseases, including cholelithiasis, a carcinoma of the gallbladder and Mirizzi syndrome, portal hypertension, and rarely volvulus of the stomach, and these complications usually draw clinical attention. We experienced a 58-year-old female who complained of intermittent fever, chills, and jaundice and who was diagnosed with agenesis of the right lobe of the liver with multiple intrahepatic stones by using abdominal CT and MRI. Percutaneous transhepatic biliary drainage was done to relieve the obstructive jaundice, and a percutaneous transhepatic cholangiogram revealed agenesis of the right lobe and abnormal course of the biliary tract. In operative findings, there was no right lobe, and the left lateral segment was markedly enlarged with compensatory hypertrophy. However, the medial segment of the left lobe and caudate lobe was relatively normal in size. The gallbladder was located on the right side of the liver retrohepatically. A cholecystectomy and a choledocholithotomy through a choledochotomy and a retrograde approach after a subsegmentectomy of segments II and III were done.
Bile Ducts, Intrahepatic* ; Biliary Tract ; Biliary Tract Diseases ; Chills ; Cholangiocarcinoma ; Cholecystectomy ; Cholelithiasis ; Diagnosis, Differential ; Diaphragm ; Diverticulum ; Drainage ; Endoderm ; Female ; Fever ; Gallbladder ; Humans ; Hypertension, Portal ; Hypertrophy ; Intestinal Volvulus ; Jaundice ; Jaundice, Obstructive ; Liver Cirrhosis ; Liver* ; Magnetic Resonance Imaging ; Middle Aged ; Mirizzi Syndrome ; Portal Vein ; Stomach ; Tomography, X-Ray Computed

BACKGROUND: The prognosis for a hepatocellular carcinoma (HCC) is very poor because of delayed diagnosis caused by the absence of specific clinical manifestations in the early stage, the limitation of the extent of resection, the high postoperative complication rate due to associated liver cirrhosis, and the high recurrence rate due to multifocal tumorigenesis. Among the various kinds of treatment modalities for HCC, surgical resection is still recognized as the first treatment method. However, it is true that surgical resection has many problems, such as a high operative risk and a high postoperative recurrence rate. Therefore, an evaluation of the factors associated with the overall survival rate and with the recurrence rate is very important for improving the results of operative therapy for HCC. METHODS: We retrospectively analyzed the clinical and the pathological results of 44 curative hepatic resections for HCC performed at Chonnam University Hospital from 1991 to 1997. We evaluated 19 clinical and pathological factors by univariate and multivariate analysis, and we calculated the survival rate by using the Kaplan-Meier method. RESULTS: The cumulative 1-, 3-, and 5-year survival rates were 81%, 66%, and 28%, respectively. In 25 of the 44 cases, recurrences developed, and the 1-, 3-, and 5-year recurrence rates were 38%, 60%, and 65%, respectively. Factors with an independent effect on the overall survival rates were multiplicity of tumors, HBs Ag status, and Child classification. However, liver cirrhosis, ascites, prothrombin time, AFP level, and portal vein invasion were not statistically significant. CONCLUSIONS: The significant prognostic factors detected by multivariate analysis were multiplicity of tumors, HBs Ag status and Child classification. A preoperative evaluation for these factors should be done. If early diagnosis and multidisciplinary therapies are done through frequent postoperative follow-up surveys in these high risk groups, we can anticipate better long-term survival rates after a hepatectomy.
Ascites ; Carcinogenesis ; Carcinoma, Hepatocellular* ; Child ; Classification ; Delayed Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Hepatectomy ; Humans ; Jeollanam-do ; Liver Cirrhosis ; Multivariate Analysis ; Portal Vein ; Postoperative Complications ; Prognosis ; Prothrombin Time ; Recurrence ; Retrospective Studies ; Survival Rate*

Elevation of aspartate aminotransferase (AST), alanine aminotransferase(ALT),and bilirubin levels was noted incidentally in patients who received laparoscopic cholecystectomy(LC). This study was attempted to investigate the elevation of liver enzymes and bilirubin levels after LC and its clinical significance. Twenty patients who showed normal levels of preoperative liver function test were entered into this study, and blood was collected at 24hours, 72hours and 7days after operation for measurement of AST, ALT, alkaline phosphatase(ALP), and bilirubin levels. In AST, a mean 2.76-fold postoperative increase was observed in 18 patients(90%) and 12 patients(60%) showed an elevation rise above normal limits. In ALT, a mean 2.14-fold postoperative increase was observed in 16 patients(80%) and 10 patients(50%) showed an elevation rise above normal limits. A mean 1.42-fold and a mean 2.12-fold increase were observed in total and direct bilirubin level respectively and elevation above normal limits occured in 7 patients(35%) and 4 patients (20%) respectively. The patients with an elevation of AST, ALT and bilirubin levels did not show any related clinical problem, and the elevations were transitory and returned to normal value within several days without any specific treatment.. Although the exact causes of these elevations need further investigation, theys appear to have no obvious clinical significance.
Alanine ; Aspartate Aminotransferases ; Bilirubin* ; Cholecystectomy, Laparoscopic* ; Humans ; Liver Function Tests ; Liver* ; Reference Values

BACKGROUNDING/AIMS: Although several papers provided evidence of a survival advantage for preoperative transcatheter arterial chemoembolization(TAE), recent studies have revealed that patients with resectable tumors have not been benefited from this adjuvant therapy. This study has been done for investigating the effect of the preoperative TAE with resectable hepatocellular carcinoma(HCC) which were diagnosed and treated by surgery and surgery with TAE by analysis and comparison with patient's survival rate between two different methods of treatment. METHODS: We retrospectively reviewed the medical records of 39 patients who underwent the hepatic resection for hepatocellular carcinoma at Chonnam National University Hospital between 1986 and 1997. Median follow-up period was 28 months. Survival rates were estimated by Kaplan-Meier method and difference was detected by Log-rank test using SPSS program.. RESULTS: Male patients were 28 and female were 11 and their mean age was 54.4 years. The patients treated by operation alone were 17 and by preoperative TAE with operation were 22. A reduction of tumor size was achived in 13 of the 22 patients(59.1%) who underwent preoperative TAE. The cumulative survival rate of 1 year, 2 year, 3 year were 90%, 84%, 70% in patients treated by operation alone, 86%, 75%, 52% in patients treated by preoperative TAE and operation respectively. And the relative risk of death for TAE with operation and operation alone was 0.974. The postoperative mean liver function test of the patients who underwent preoperative TAE was higher than those who did not. CONCLUSIONS: The advantage of preoperative TAE with resectable HCC still remains disputable. However, preoperative TAE has the advantage of reducing tumor size and make it easy to operate and decrease the resection field. But the liver function after TAE may deteriorate in some of the patients with liver dysfunction. In conclusion, preoperative TAE must not be performed for resectable HCC as a routine procedure because the overall survival rate was similar between the two groups.
Carcinoma, Hepatocellular* ; Female ; Follow-Up Studies ; Humans ; Jeollanam-do ; Liver ; Liver Diseases ; Liver Function Tests ; Male ; Medical Records ; Prognosis* ; Retrospective Studies ; Survival Rate

Xanthogranulomatous cholecystitis (XGC) is an uncommon, focal or diffuse destructive inflammatory process of the gallbladder that is assumed to be a variant of chronic cholecystitis. XGC is characterized grossly by irregular thickening of the gallbladder wall with the formation of a yellow mass (xanthogranuloma). Histologically the xanthogranuloma appears as yellow nodules or streaks in a thickened gallbladder wall and is composed of predominantly lipid-laden macrophages, inflammatory cells, and fibroblasts. These xanthogranulomatous foci may extend into adjacent structures, adhesions or ulcerations are often present, and fistula formation may occur. Although the pathogenesis of XGC is unclear, recurrent inflammation in the presence of calculi and biliary stasis are thought to be the main etiological factors because of the histologic evidence of chronic inflammation and the presence of gallstones in a majority of cases. XGC may lead to associated complications such as perforation, abscess, and fistula, and sometimes closely mimics a gallbladder carcinoma. During an operation for XGC, careful surgical technique is required to dissect the gallbladder and to excise the adjacent xanthogranulomatous tissue. Also a careful investigation to find the coincident gallbladder carcinoma is necessary. We report a case with XGC in a hemophilia A patient and a review of the clinical literatures.
Abscess ; Calculi ; Cholecystectomy ; Cholecystitis* ; Cholestasis ; Fibroblasts ; Fistula ; Gallbladder ; Gallstones ; Hemophilia A* ; Humans ; Inflammation ; Macrophages ; Ulcer

Liposarcoma is one of the most common soft tissue sarcomas in adults and its incidence rate is above 10% of all soft tissue sarcoma. The two common sites of liposarcoma are the extremities, particularly the thigh, and the retroperitoneum, but it developes rarely in spermatic cord, testis, chest wall and breast, mediastinum, omentum and mesentery. Primary solid tumors of omentum are exceedingly rare. Most of them are of mesenchymal origin and about one-half of them are malignant. Primary liposarcoma occurring in the omentum has been reported rarely, and especially round cell type liposarcoma, one of the histologic subtype of liposarcoma, has been known to be extremely rare. Recently, we experienced a patient with round cell liposarcoma arising primarily in the omentum. Herein, we report the clinical case with a consideration of the cytopathologic and ultrastructural features and a review of the literature.
Adult ; Breast ; Extremities ; Humans ; Incidence ; Liposarcoma* ; Mediastinum ; Mesentery ; Omentum* ; Sarcoma ; Spermatic Cord ; Testis ; Thigh ; Thoracic Wall

BACKGROUND: It is difficult to treat patients with hepatolithiasis because of recurrent or residual stones and serious postoperative complications. This study was done to compare the operation method and postoperative progression related to location of the hepatolithiasis. METHODS: Retrospective analysis was done in 234 patients who underwent operation due to hepatolithiasis from Jan. 1989 to Dec. 1998 in Chonnam University Hospital. RESULTS: The patients with left intrahepatic duct stones were 135, with right intrahepatic duct stones were 30 and with both intrahepatic duct stones were 69. In cases of resection of the liver, left lobectomy, left lateral segmentectomy, right posterior segmentectomy or right lobectomy was done. In a patient with stone in caudate lobe, caudate lobectomy was done. In non-resected group choledocholithotomy was done. Of 135 patients with left intrahepatic stones, 117 patients(86.7%) underwent hepatic resection and 18 patients(13.3%) underwent choledocholithotomy. Of 30 patients with right intrahepatic stones, 6 patients(20.0%) underwent hepatic resection and 24 patients(80.0%) underwent choledocholithotomy. Of 69 patients with both intrahepatic stones, 36 patients(52.2%) underwent resection and 33 patients(47.8%) underwent choledcholithotomy. Overall incidence of remnant stone was 28.2%. In resected group of left intrahepatic stones, the incidence of remnant stones was 8.5% and in non-resected group 33.3%. In resected group of right intrahepatic stones, the incidence of remnant stones was 0% and in non-resected group 37.5%. In resected group of both intrahepatic stones, the incidence of remnant stones was 55.6% and in non-resected group 63.6%. Incidence of postopertive complications was 22.6% and wound complication was most common. There was no postoperative mortality. CONCLUSIONS: Hepatic resection for hepatolithiasis confined to one lobe has an advantage of low incidence of remnant stone without increasing the morbidity and mortality rate. In both intrahepatic stones, the treatment is difficult, but if operation is performed with proper selection of extent of hepatic resection, favorable result would be expected.
Humans ; Incidence ; Jeollanam-do ; Liver ; Mastectomy, Segmental ; Mortality ; Postoperative Complications ; Retrospective Studies ; Wounds and Injuries

Purpose: Laparoscopic pancreaticoduodenectomy (LPD) is a highly challenging procedure, which prevents its widespread adoption despite its advantages of being a minimally invasive procedure. This study analyzed the learning curve for LPD based on a single surgeon’s experience. Methods: We retrospectively analyzed the medical records of 111 consecutive patients who underwent LPD by a single surgeon between March 2014 and October 2022. The learning curve was assessed using cumulative summation (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods. Surgical failure was defined as conversion to an open procedure or the occurrence of severe complications (Clavien-Dindo grade ≥III). Based on the learning curve analysis, we divided the learning curve into the early and late phases and compared the operative outcomes in each phase. Results: Based on the CUSUM analysis, the operation time decreased after the first 33 cases. Based on the RA-CUSUM analysis, the LPD technique stabilized after the 44th case. In the late phase, operation time, length of stay, and incidence of delayed gastric emptying, severe complications, and surgical failure were significantly lower than in the early phase. Conclusion Our results indicate that 44 cases are required for stabilization of the LPD technique and improvement of operative outcomes.

Spontaneous rupture of the bile duct is an exceedingly rare and usually recognized fatal cause of peritonitis and intraabdominal sepsis. Several reports of isolated cases have demonstrated its rarity in the absence of operative trauma or severe injury. Perforation of the biliary system occurs most frequently in the gall bladder, which perforation of the hepatic duct is less common, being described mainly in infants, but extremely rarely in adults. The diagnosis of the spontaneous rupture of the bile duct depends on meticulous clinical examination and imaging investigation. The basic principles of treatment are to stop the bile leakage, evacuate the extravasated bile, apply decortication of the encapsulated fluid collection and provide adequate drainage. We report on a patient with spontaneous perforation of the right hepatic duct who presented with abdominal pain, jaundice and fever. Exploratory surgery showed proximal common bile duct obstruction with right hepatic duct perforation.
Abdominal Pain ; Adult ; Bile ; Bile Ducts ; Biliary Tract ; Common Bile Duct ; Diagnosis ; Drainage ; Fever ; Hepatic Duct, Common* ; Humans ; Infant ; Jaundice ; Peritonitis ; Rupture, Spontaneous* ; Sepsis ; Urinary Bladder

BACKGROUNDS: Despite the advance of radiologic imaging techniques, not a fewer number of patients with hepatobiliary and pancreatic malignancies are found to be unresectable just at the time of laparotomy. The aim of this study was to evaluate the accuracy of diagnostic laparoscopy for assessing resectability of hepatobiliary and pancreatic malignancies. METHODS: From May 1999 to March 2000, diagnostic laparoscopy was performed in 16 patients with suspected hepatobiliary and pancreatic malignancies after clinical examination, laboratory tests, and radiologic imaging techniques(ultrasonography, computed tomography, ERCP, and PTC). Local anesthesia with intravenous sedation was used. A 10-mm infraumbilical port was used for the telescope and another 5-mm port was used for the working instrument depending upon intra-abdominal findings. During the procedure, we tried to find any evidence of distant metastasis or advanced local invasion such as, peritoneal seeding, metastatic nodule at the liver, major vascular involvement or invasion of adjacent other intraabdominal organ. RESULTS: 4 of 16 patients were found to have unresectable malignancies because of peritoneal seeding, hepatic metastases or ascites by diagnostic laparoscopy. 3 patients had invasion to superior mesenteric vein and adjacent structures overlooked at diagnostic laparoscopy. Sensitivity, specificity, and overall accuracy for assessing resectability were 66.7%, 28.6% and 50.0% for radiologic imaging techniques and 100%, 57.1% and 81.3% for diagnostic laparoscopy. CONCLUSION: Diagnostic laparoscopy under local anesthesia proved to be an effective diagnostic tool for assessing resectability of hepatobiliary and pancreatic malignancies by means of assisting the radiologic imaging technique.
Anesthesia, Local* ; Ascites ; Cholangiopancreatography, Endoscopic Retrograde ; Humans ; Laparoscopy* ; Laparotomy ; Liver ; Mesenteric Veins ; Neoplasm Metastasis ; Sensitivity and Specificity ; Telescopes