PURPOSE: Laparoscopic cholecystectomy has become the standard modality of acute and chronic gallbladder disease. This study was performed to evaluate a change in the indication for laparoscopic cholecystectomy according to period by analyzing our experiences. METHODS: We retrospectively analyzed 2,096 cases of laparoscopic cholecystectomy that were treated at the Department of Surgery, Dong-A University. They were divided into 3 groups from October 1992 to December 1996 (Group 1), from January 1997 to December 2001 (Group 2) and from January 2002 to March 2007 (Group 3). RESULTS: The mean age was 50.14+/-13.89 years and the male-to-female ratio was 1 : 1.23. Previous abdominal surgery was noted in 12.24% from Group 1, 14.96% from Group 2 and 21.48% from Group 3. Chronic cholecystitis was the most common pathologic diagnosis in all cases. However, while the incidence of acute cholecystitis and gallbladder empyema in Group 1 was 3.36% and 0%, that of Group 2 was 12.52% and 3.88% and that of Group 3 was 31.79% and 7.59%, which was increased. The mean operation time of each group was 101.00+/-51.00, 69.86+/-40.55, 78.01+/-45.55 minutes (P<0.05). The conversion rate of each group was nine cases (6.04%), 21 cases (3.02%), and 51 cases (4.07%). The surgical complication rate was 7.38%, 3.88% and 4.71%, respectively. The length of hospital stay was 6.08+/-3.65, 3.16+/-2.99 and 2.91+/-3.34 days, which was significantly decreased (P<0.05). CONCLUSION: As surgical experience increased and laparoscopic surgical skills developed, the indication for laparoscopic cholecystectomy changed. The results of this study showed that laparoscopic cholecystectomy was feasible for the treatment of complicated gallbladder lesion.
Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Gallbladder ; Gallbladder Diseases ; Incidence ; Length of Stay ; Retrospective Studies

No abstract available.
Ulcer*

Primary splenic tumors are rare and mainly found incidentally on radiologic studies. Among them, sclerosing angiomatoid nodular transformation (SANT) of the spleen is a new entity defined as a benign pathologic lesion. Most SANTs have no clinical symptoms and are occasionally accompanied by other splenic diseases such as malignancies. So, the exact diagnosis of the nature of the splenic tumor is mandatory for further treatment. But, preoperative diagnosis is not easy since it is difficult to obtain the tissue from the spleen for pathological study. Recently, laparoscopic splenectomy has become the more standard procedure for the spleen for diagnosis and treatment. Here, we report a rare case of SANT diagnosed following laparoscopic splenectomy.
Spleen ; Splenectomy ; Splenic Diseases

Laparoscopic wedge resection for treating a gastric submucosal tumor is a widely accepted and feasible procedure. As the skills for performing laparoscopic surgery have been developed, a great deal of effort has also been given to minimize the size of the abdominal wound and its scar. Some studies have introduced single port laparoscopic surgery for these purposes, but most of these single port laparoscopic surgeries were carried out to perform appendectomy and cholecystectomy. There have been fewer reports on this for gastric surgeries. We report here on 2 cases of single port laparoscopic gastric wedge resection for treating gastric submucosal tumor.
Appendectomy ; Cholecystectomy ; Cicatrix ; Laparoscopy

The growth and maintenance of solid tumors are dependent on new capillary ingrowth:a process called "angiogenesis." Thus, after a new tumor has attained a smallsize of a few millimeters in diameter(about 106 cells), further expansion of the tumor-cell population requires the induction of new capillary blood vessels. These new vessels also increase the opportunity for hematogenous or lymph node metastasis. Thus this study was designed to examine the microvessel count at the invasive margin in colorectal carcinoma to determine how angiogenesis correlates with clinicopathologic factors and prognosis. Paraffinembedded tissues from 127 patients with primary colorectal carcinomas that had been completely removed were retrieved and analyzed for angiogenesis. Vessels were immunostained with anti-factor VIII polyclonal antibody, and areas with the most discrete microvessels were counted in a 200 x field, which were defined as angiogenesis score(AS). The mean AS for anti-factor VIII antibody in this study was 55+/-08; therefore, cases were classified into two subgroups : AS high group(n=67), for which AS was greater than 55 and AS low group(n=60), for which AS was equal to 55 or less. There were no significant intergroup difference regarding sex ratio, histologic grade, depth of invasion, or lymphatic invasion. AS was, however, significantly related to tumor size, venous invasion, lymph node metastasis, and liver metastasis(P=0.000, P=0.001, P=0.021, and P=0.004, respectively). The incidence of high AS group in Antler-Coller D was significantly greater than that in Antler-Coller A and B, and Antler-Coller C(P<0.05, respectively). The recurrence rate in high AS group was 32.0%, which was, though statistically insignificant, higher than that in low AS group(17.2%). The 3 year survival rates of high AS group were significantly (P=0.004 both for overall cases and curatively-resected ones) worse than those of low AS group. This study suggests that the growth of colorectal carcinoma is dependent on ingrowth of new blood vessels, and that angiogenesis assessed by the microvessel count using immunohistochemical stains is an important predictor of tumor behavior and may identify patients at higher risk for recurrence and early death.
Blood Vessels ; Capillaries ; Colorectal Neoplasms ; Coloring Agents ; Humans ; Incidence ; Liver ; Lymph Nodes ; Microvessels ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Sex Ratio ; Survival Rate

PURPOSE: Gastric surgery may potentiate delayed gastric emptying. Billroth I gastroduodenostomy using a circular stapler is the most preferable reconstruction method. The purpose of this study is to analyze the risk factors associated with delayed gastric emptying after radical subtotal gastrectomy with Billroth I anastomosis using a stapler for early gastric cancer. METHODS: Three hundred and seventy-eight patients who underwent circular stapled Billroth I gastroduodenostomy after subtotal gastrectomy due to early gastric cancer were analyzed retrospectively. One hundred and eighty-two patients had Billroth I anastomosis using a 25 mm diameter circular stapler, and 196 patients had anastomosis with a 28 or 29 mm diameter circular stapler. Clinicopathological features and postoperative outcomes were evaluated and compared between the two groups. Delayed gastric emptying was diagnosed by symptoms and simple abdomen X-ray with or without upper gastrointestinal series or endoscopy. RESULTS: Postoperative delayed gastric emptying was found in 12 (3.2%) of the 378 patients. Among all the variables, distal margin and circular stapler diameter were significantly different between the cases with delayed gastric emptying and no delayed gastric emptying. There were statistically significant differences in sex, body mass index, comorbidity, complication, and operation type according to circular stapler diameter. In both univariate and multivariate logistic regression analyses, only the stapler diameter was found to be a significant factor affecting delayed gastric emptying (P = 0.040). CONCLUSION: In this study, the circular stapler diameter was one of the most significant predictable factors of delayed gastric emptying for Billroth I gastroduodenostomy. The use of a 28 or 29 mm diameter circular stapler rather than a 25 mm diameter stapler in stapled gastroduodenostomy for early gastric cancer can reduce postoperative delayed gastric emptying associated with anastomosic stenosis or edema with relative safety.
Abdomen ; Body Mass Index ; Comorbidity ; Constriction, Pathologic ; Edema ; Gastrectomy ; Gastric Emptying ; Gastroenterostomy ; Humans ; Logistic Models ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms

PURPOSE: Gasless transaxillary endoscopic thyroidectomy has become a widely used surgical alternative due to the recent advances in the operative techniques and laparoscopic instruments, and its cosmetic superiority. The aim of this study is to analyze the factors associated with complications following surgery by reviewing 49 patients who underwent gasless transaxillary endoscopic thyroidectomy. METHODS: Between Nov. 2006 and Jun. 2009, 49 patients underwent gasless transaxillary endoscopic thyroidectomy via an axillary approach. The clinical and pathologic characteristics, operation type, postoperative hospital stay, operation time and post operative complications were retrospectively analyzed. RESULTS: Among the 49 patients, 37 had benign tumors and 12 had malignant tumors. Unilateral thyroid lobectomies were generally performed for benign tumors. For malignant ones, 7 lobectomies and 5 lobectomies with central lymph node dissection were done. In pathological review, most common benign disease was nodular hyperplasia, and the most common malignancy was papillary microcarcinoma. The mean operative time was 160.7±38.2 minutes (100~295). The postoperative complications were as follows; neck and anterior chest discomfort (19 cases), operation wound infection (5 cases), seroma (3 cases), swallowing difficulty (3 cases) and hoarseness (3 cases). CONCLUSION: Gasless transaxillary endoscopic thyroidectomy is a feasible and safe operation, and provides excellent cosmetic results. But there are still postoperative complications, it should be considered to reduce.
Deglutition ; Hoarseness ; Humans ; Hyperplasia ; Length of Stay ; Lymph Node Excision ; Neck ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Seroma ; Thorax ; Thyroid Gland ; Thyroidectomy* ; Wound Infection

PURPOSE: A acinar cell carcinoma of the pancreas is a rare malignancy arising from exocrine cells and comprising about 0.2 to 1% of all pancreatic cancers. Acinar cell carcinomas are usually seen in elderly patients and show a poor prognosis due to frequent metastasis. So far, we have not found any report of a clinical analysis of acinar cell carcinomas in Korean. METHODS: The records of 5 patients of Dong-A University Hospital and 5 patients already reported on in other literature in Korea were reviewed. The clinical and radiohistologic characteristics, treatment and prognosis were analyzed. RESULTS: The patients consisted of 8 males and 2 female. The patients ranged in age from 25 to 68 years (mean, 49.3 years). Presenting symptoms were nonspecific, and jaundice was infrequent. The symptoms from increased serum lipase levels were present in 2 (20.0%) of the patients. The tumor was frequently located on the tail (6 cases, 60.0%) of the pancreas. The histologic finding showed an acinar arrangement of the tumor cells with a minute central lumen. Ultrastructurely, the tumor cells had a few zymogen granules. The mean size of the tumors was 7.5 cm. We found that 1 case among the 10 cases had an elevated CA19-9 level among 10 cases and no one had an elevated AFP or CEA level among our 5 cases. A radical resection was performed in 7 cases, and the mean survival was 44.0 months. The mean survival of the 10 cases was 35.4 months. CONCLUSION: An acinar cell carcinoma is a rare type of pan creatic cancer and has a more favorable prognosis than a pancreatic ductal carcinoma. The clinical outcome and the radiohistologic characteristics were similar to those in other foreign literature, but the age, the tumor locations and the tumor marker (AFP or CEA) of the patients in this study were different from those of Caucasians.
Acinar Cells* ; Aged ; Carcinoma, Acinar Cell* ; Carcinoma, Pancreatic Ductal ; Female ; Humans ; Jaundice ; Korea* ; Lipase ; Male ; Neoplasm Metastasis ; Pancreas* ; Pancreatic Neoplasms ; Prognosis ; Secretory Vesicles

PURPOSE: A laparoscopy-assisted gastrectomy with lymph node dissection for gastric cancer is considered technically more complicated than the open method. To evaluate the short-term surgical validity, the surgical outcome of the laparoscopy-assisted distal gastrectomy (LADG) with extraperigastric lymph node dissection was compared with that of the conventional open distal gastrectomy (CODG) in patients with early gastric cancer. METHODS: One hundred and forty-seven patients with early gastric cancer received a radical distal gastrectomy during 2002 and 2003, where a LADG was performed on 71 patients. The clinicopathological characteristics, postoperative outcomes and courses, and the postoperative morbidities and mortalities were compared between the two groups. Data were retrieved from the stomach cancer database at Dong-A University Medical center. RESULTS: Baseline characteristics, including gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) class, tumor size, T stage, and lymph node metastasis, were similar between the two groups. No significant differences were found between these groups in terms of the number of retrieved lymph nodes with respect to D1+(D1+no. 7) and D1+beta (D1+no. 7, 8a, and 9) lymphadenectomies. In the LADG group, the wound size was smaller (P <0.0001), but the operation time was longer (P=0.0001) than in the CODG group. The perioperative recovery was faster in the LADG than in the CODG group, as reflected by the shorter hospital stay (P=0.0176) and less additional analgesics (P=0.0370). The serum albumin level in the LADG was higher (P=0.0002) on day 7 than that in the CODG group, and the leukocyte count in the LADG lower (P=0.0445) on day 1 than that in the CODG gruop. There were no significant differences in the postoperative morbidities and mortalities between the two groups. CONCLUSIONS: Our data confirmed that a LADG with an extraperigastric (no. 7, 8, and 9) lymph node dissection was a feasible and acceptable surgical technique for early gastric cancer. From a surgical point of view, a LADG with an extraperigastric lymph node dissection is suggested to be a preferred surgical option for patients with early gastric cancer. Its oncological validity awaits larger and prospective multicenterd trials.
Academic Medical Centers ; Analgesics ; Anesthesiology ; Body Mass Index ; Gastrectomy* ; Humans ; Length of Stay ; Leukocyte Count ; Lymph Node Excision* ; Lymph Nodes* ; Mortality ; Neoplasm Metastasis ; Serum Albumin ; Stomach Neoplasms* ; Wounds and Injuries

PURPOSE: Mechanical stapler is regarded as a good alternative to the hand sewing technique, when used in gastric reconstruction. The circular stapling method has been widely applied to gastrectomy (open orlaparoscopic), for gastric cancer. We illustrated and compared the hand-sutured method to the circular stapling method, for Billroth-II, in patients who underwent laparoscopy assisted distal gastrectomy for gastric cancer. MATERIALS AND METHODS: Between April 2009 and May 2011, 60 patients who underwent laparoscopy assisted distal gastrectomy, with Billroth-II, were enrolled. Hand-sutured Billroth-II was performed in 40 patients (manual group) and circular stapler Billroth-II was performed in 20 patients (stapler group). Clinicopathological features and post-operative outcomes were evaluated and compared between the two groups. RESULTS: Nosignificant differences were observed in clinicopathologic parameters and post-operative outcomes, except in the operation times. Operation times and anastomosis times were significantly shorter in the stapler group (P=0.004 and P<0.001). CONCLUSIONS: Compared to the hand-sutured method, the circular stapling method can be applied safely and more efficiently, when performing Billroth-II anastomosis, after laparoscopy assisted distal gastrectomy in patients with gastric cancer.
Gastrectomy ; Gastric Bypass ; Hand ; Humans ; Laparoscopy ; Stomach Neoplasms