BACKGROUND: To determine the advantage of laparoscopic splenectomy techniques in immune thrombocytopenic purpura (ITP), we compared it with an open splenectomy. METHODS: The cases of all patients who had undergone (52) a splenectomy for ITP at St. Mary's Hospital from January 1993 to December 1997 were reviewed. From the 52 cases, 21 cases were managed with a laparoscopic technique only and 31 cases were managed with an open technique. RESULTS: Blood and platelet transfusion requirements were reduced in the laparoscopic group. Although the mean operating time was slightly longer in the laparoscopic group (110 versus 184 minutes, p<0.001), the mean hospital stay (9.7 versus 5.9 days, p<0.001) was slightly shorter and the postoperative analgesic requirement (p<0.001) and the incidence of post operative complications (9.5 versus 48.4%) were greatly reduced. The detection rates of accessory spleens was low in the laparoscopic group. CONCLUSIONS: The laparoscopic splenectomy produced better clinical outcomes than an elective splenectomy for ITP. Also, such laparoscopic methods reduced costs.
Humans ; Incidence ; Laparoscopy ; Length of Stay ; Platelet Transfusion ; Purpura, Thrombocytopenic, Idiopathic* ; Spleen ; Splenectomy*

PURPOSE: Although the prevalence of gastroesophageal reflux disease (GERD) is relatively low in Korean population, the number is increasing. The aim of this study is to analyze our experience with laparoscopic Nissen fundoplication. PATIENTS AND METHODS: From Sep. 2003 to Mar. 2008, 31 adult Korean patients diagnosed with GERD underwent laparoscopic Nissen fundoplication. A 360degrees fundoplication was carried out in all patients. RESULTS: There were 19 males and 12 females with an average age of 46.8 +/- 17.0 years. Typical symptoms were present in 15 (48%) of patients, and atypical symptoms in 16 (51.6%). Both typical and atypical symptoms were present in 4 of patients (12.9%). Preoperative studies showed hiatal hernias in 13 patients (41.9%), Barrett's esophagus in 10 (32.3%), and reflux esophagitis in 18 (58.1%). Mean DeMeester score was 17.4 +/- 16.7, mean operative time 206.1 +/- 47.8 min and mean hospital stay 5.2 +/- 2.1 days. Perioperative complications occurred in 5 patients (16.1%), including gastric perforation, subcutaneous emphysema, atelectasis, and prolonged ileus. Gastroesophageal junction stenoses with subsequent endoscopic balloon dilations were required in 5 patients (16.1%). After surgery, symptoms were completely controlled in 17 patients (54.8%), partially improved in 12 patients (38.7%) and not controlled in 2 patients (6.5%). CONCLUSION: In our series, 93.5% of patients had either complete or partial remission of symptom after laparoscopic Nissen fundoplication. Atypical symptoms were more predominant in our Korean patients. Laparoscopic Nissen fundoplication is an efficacious method of controlling symptoms of GERD, even for those who have atypical symptoms.
Adult ; Female ; Follow-Up Studies ; *Fundoplication ; Gastroesophageal Reflux/ethnology/*surgery ; Humans ; Korea ; *Laparoscopy ; Male ; Middle Aged ; Patient Satisfaction ; Prevalence ; Treatment Outcome

Laparoscopic surgery describes the performance of surgical procedure with the assistance of a video camera and several other instruments. It is now being used in all surgical fields and especially operations for gastrointestinal diseases adopting a laparoscopic procedure in a relatively short period of time. Many benefits of minimally invasive surgery had been proved. With improvement in equipments, instrumentations, and surgical skills, it would be growing and be able to be approached for a more complex procedure. This paper briefly reviews the history, current status, and future of laparoscopic surgery.
Gastrointestinal Diseases ; Laparoscopy

No abstract available.
Allografts* ; Animals ; Mice*

Endoscopic surgeries are popularly performed these days because of the advantages in rehabilitation and cosmetic aspects. But some accompanying disadvantages should not be neglected. For surgeons unfamiliar with the endoscopic surgery techniques, the operation takes more time and dangerous complications may occur more frequently. Most endoscopic surgery techniques, also called minimal invasive surgery techniques, were developed and disseminated from Europe and the U.S. They require specialized equipment and instruments that are expensive, and for this reason the total operation cost compared to conventional open surgery is higher. Despite all the advantages of endoscopic surgery, the high cost due to the of imported specialized instruments is holding back its spread in Korea. The development of self-supporting endoscopic instruments in Korea is mandatory for reducing the expense, and in this regard I have designed trocars of various size, specimen retrieval bags, suction and irrigation tubing sets, gasless laparoscopic surgery sets, scissors of various types, and forceps. Instruments used in suture and ligation which are currently under development will also soon be introduced.
Endoscopy* ; Human ; Korea ; Laparoscopy ; Ligation ; Surgical Instruments* ; Suture Techniques

No abstract available.
Hemorrhage*

No abstract available.
Hemorrhage*

Situs inversus, a left-to-right transposition of the normally asymmetrical organs of the body, is a rare anomaly that occurs in 1:5,000-1:10,000 adults. In the total form, the thoracic organs, as well as the abdominal organs, are completely reversed in a "mirror image" of their normal arrangement. Herein, we present a case of an adenocarcinoma of the proximal bile duct in a 68-year-old man with total situs inversus. Without any technical problems, he successfully underwent a bile-duct resection and bilioenteric anastomosis. He did well postoperatively, and after one course of chemotherapy, was discharged on postoperative day 12. A review of the international literature on this subject is presented.
Adenocarcinoma ; Adult ; Aged ; Bile Duct Neoplasms* ; Bile Ducts* ; Bile* ; Drug Therapy ; Humans ; Situs Inversus*

Pediatric laparoscopic splenectomy has gained increasing acceptance in the surgical management of a variety of splenic disorders, in particular hematologic diseases. We report our experience with 16 patients who underwent this procedure because of hematologic disorders during the past 3 and a half years at the Department of Surgery, St. Mary's Hospital, Catholic University Medical College. The mean age was 10 years (Range 6-16 years) and the mean spleen weight was 210 gm (Range 85-500 gm). The indications for splenectomy were hereditary spherocytosis (6 cases), idiopatic thrombocytopenic purpura (8 cases), autoimmune hemolytic anemia (1 case), and idiopatic splenomegaly (1 case). All splenectomies were performed safely with mean estimate blood loss of 233 ml. Mean operative time and mean postoperative hospital stay was 157 min and 4.5 days. Respectively postoperative pain medication was needed in 3 case, just one injection in immediate postoperative period. Diet was started on posterative second day or third day. In conclusions, Laparoscopic splenectomy in pediatric patients surely is a safe procedure, offering better cosmesis, much less pain, and shorter hospital stay with lower post operative mobidity.
Anemia, Hemolytic, Autoimmune ; Diet ; Hematologic Diseases ; Humans ; Length of Stay ; Operative Time ; Pain, Postoperative ; Postoperative Period ; Purpura, Thrombocytopenic ; Spleen ; Splenectomy* ; Splenomegaly

PURPOSE: To investigate the immunologic effect of the gasless laparoscopic procedure, we compared it with an immunologically effective, gas insuffulated (pneumoperitoneal) laparoscopic procedure. METHODS: The temporal immune responses in two similar groups of patients randomized to gas vs gasless laparo scopic cholecystectomy were analyzed. The patients were matched by age, weight, and operation time. Immune parameters, including serum white blood cell count and TNF-alpha, INF-gamma, IL-6, IL-8, cortisol and ESR levels, were assessed preoperatively and on postoperative days 1 and 3 between the two groups. Also during the operations, cytokines were checked in cultured peritoneal macrophages. RESULTS: The results were as follows: 1) Serum cortisol and ESR levels were not statistically different between the two groups. White blood cell counts were also not statistically different. 2) The preoperative and postoperative day 1 and days 3 serum TNF-alpha, INF-gamma, IL-6, and IL-8 levels in the two group were not statistically different. However, an immediate decrease cytokine levels was significant in both groups after postoperative day 1. 3) Especially cytokine levels were more increased in cultured peritoneal macro phages than in serum, but difference between the two groups was not statistically significant. CONCLUSION: From our results the beneficial effects of immunology in a gasless laparoscopic procedure were not different from those in a gas laparoscopic procedure. Rather, immediate preservation of the immune function during the postoperative period was detected in both groups.
Allergy and Immunology ; Bacteriophages ; Cholecystectomy ; Cytokines ; Humans ; Hydrocortisone ; Interleukin-6 ; Interleukin-8 ; Laparoscopy* ; Leukocyte Count ; Macrophages, Peritoneal ; Postoperative Period ; Tumor Necrosis Factor-alpha