With the wide spread of laparoscopic procedures in surgery, laparoscopy has been revived as a diagnostic and therapeutic modality in blunt and penetrating abdominal trauma. From August 1995 to November 1996, we applied therapeutic laparoscopy to 15 hemodynamically stable patients with abdominal trauma, including 10 (66%) blunt and 5 (34%) penetrating injuries. The mean age of the patients was 35 (17~64) years. All were male, except for one female patient. Organs injured were 4 single perforations, 1 multiple perforation and 1 complete transsection of the small bowel; 2 mesenteric tearings with small bowel ischemia; 2 stomach perforations; 2 mesenteric lacerations; 2 omental lacerations; and 1 liver laceration. Patients with unstable vital signs, or solid organ or retroperitoneal injury were excluded by conventional diagnoses. Laparoscopic abdominal exploration was initiated by changing the position to the Trendelenburg position for evaluation of the pelvic cavity and lower-1/3 of the small bowel, to the supine position for evaluation of the mid-abdomen and mid-1/3 of the small bowel, and to the reverse Trendelenburg for evaluation of the liver, spleen, pancreas, and upper 1/3 of the small bowel. Operation methods consisted of totally laparoscopic or laparoscopic-assisted techniques in 11 cases (73.3%) and 4 cases (26.7%), respectively. Hence, we were able to reduce the rate of open surgery in 11 (73.3%) of the 15 patients who were thought to need operative treatment, 14 of whom needed actual surgical intervention (One pre-operatively undetected liver laceration revealed spontaneous ceasation of bleeding at the time of laparoscopic examination). The mean operation time was 110 min per case (113 min and 100 min for totally laparoscopic surgery and laparoscopic-assisted surgery, respectively). Flatus passed at the 2.4 (mean) post-operative day. The patients started meals at the 3.3 (mean) post-operative day and were discharged at the 7 (mean) post-operative day uneventfully. The only exception was one wound infection in the laparoscopic-assisted group. Conclusively, sytematized laparoscopic surgery is a feasible, safe, and effective procedure for the treatment of abdominal trauma.
Diagnosis ; Female ; Flatulence ; Head-Down Tilt ; Hemorrhage ; Humans ; Ischemia ; Lacerations ; Laparoscopy* ; Liver ; Male ; Meals ; Pancreas ; Spleen ; Stomach ; Supine Position ; Vital Signs ; Wound Infection

PURPOSE: Although staged operations have been thought a main treatment for obstructive left colon cancer, their disadvantages make one-stage operations popular. We tried to identify technical feasibility and oncologic safety of one-stage operation with intra-operative lavage (IOL) for the treatment of obstructive left colon and rectal cancer. METHODS: From June 1996 to May 1999, of 456 colorectal cancer patients, 25 with obstructive left colon or rectal cancer underwent surgery. In 18 of those, we intended to do a one-stage operation with IOL. Male (n=14) were predominant to female (n=4). Mean age was 61.2 (29~78) years. Lesions were located on the sigmoid colon in 8, rectum in 4, descending in 3, and rectosigmoid junction in 3 cases. Operative technique: Lymphovascular division was initiated at the origin of IMA followed by mobilization of the left colon up to the splenic flexure and distal transverse colon. Thereafter antegrade irrigation of the proximal colon with warm normal saline was done by using a corrugated tube. Anastomoses were made by hand or stapler in end-to-end or side-to-end fashion. RESULTS: Mean operative time was 221 (185~360) min. No significant post-operative complications occurred except for two wound infections and one pulmonary atelectasis. There was one unexpected conversion to Hartmann's procedure due to intra-operative fecal soilage during the lavage. Within 18 months follow-up period, 4 recurrences occurred with two of them expiring. CONCLUSIONS:: One-stage operation for the treatment of obstructive left colon cancer with IOL could avoid colostomy or reoperation, and, was technically feasible, safe, and oncologically acceptable.
Colon* ; Colon, Sigmoid ; Colon, Transverse ; Colonic Neoplasms* ; Colorectal Neoplasms ; Colostomy ; Female ; Follow-Up Studies ; Hand ; Humans ; Male ; Operative Time ; Pulmonary Atelectasis ; Rectal Neoplasms ; Rectum ; Recurrence ; Reoperation ; Therapeutic Irrigation* ; Wound Infection

The aim of this study was to find out an effective method of laparoscopic oncologic right hemicolectomy based on vascular anatomy of the right colon and patterns of lymph node metastasis. From September 1994 to November 1997,20 hemodynamically stable patients received curative laparoscopic-assisted right hemicolectomy for adenocarcinoma by one surgeon. Simultaneously anatomic variations of right colonic vessels and patterns of lymph node metastasis were analyzed. All operations were performed by laparoscopic-assisted method that consisted of intracorporeal mobilization of the right colon followed by extracorporeal resection and anastomosis and lymph node dissection up to superior mesenteric vessels under direct vision through mini-incision just above the root of superior mesenteric vessels. Ileocolic (ICA) and mid colic artery (MCA) existed constantly (100%), right colic artery (RCA) existed only in 12 cases (60%). Mean distance from origin of MCA to ICA was 3.2cm. Mean number of lymph nodes harvested from SMA area was 2.9 per case. In 2 cases, they showed metastasis. Astler-Coilers stage Bl, B2, Cl, C2 were distributed in 6, 8, 1, 5 cases respectively. Mean number of lymph node dissected and length of resection margin was 29.3 and 8.7 cm. Operative time, time to oral intake, hospital stay was 187 minutes,2.6 days,7.2 days, respectively. Open conversion was needed in 1 case due to duodenal invasion. Mean 14 months follow-up showed 2 recurrences. One who have had duodenal wedge resection due to cancer invasion underwent reresection of duodenum because of duodenal recurrence 12 months after the first operation. The other suddenly died of myocardial infarction after operation for ovarian recurrence 8 months later to her right hemicolectomy. Right colonic vascular anatomy was so various but the area from MCA to ICA was constantly within 4 cm and, lymph nodes in that area must be cleared. Therefore, laparoscopic intracorporeal mobilization and extracorporeal resection of the right colon and lymph node dissection through small incision was effective, safe and one of the best method to get advantages of laparoscopic and open surgery simultaneously.
Adenocarcinoma ; Arteries ; Colic ; Colon ; Duodenum ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Myocardial Infarction ; Neoplasm Metastasis ; Operative Time ; Recurrence

No abstract available.

This study has been examined different morphologic measurements in the evaluation of patients with lumbar spinal stenosis. Preoperative CT-Myelography from 30 patients who underwent surgery for central lumbar stenosis were analyzed. Based on this, we concluded as follows : 1) Bony measurement alone did not reliably identify patients with spinal stenosis. 2) Measurement of the transverse area of the dural sac on CT-Myelography was the most accurate method for identifying stenosis. 3) Lumbar myelography was still considered to have an important role in the valuation of a patient with stenosis because of correlation between the cross-sectional area of the dural sac and the anteroposterior diameter of the dural sac was excellent. 4) We identified soft-tissue problems as the main cause of stenosis. 5) The most common level of maximum stenosis was L4-5.
Constriction, Pathologic ; Humans ; Myelography* ; Spinal Stenosis*

BACKGROUND: The aim of this study is to show the effectiveness and the safety of laparoscopic surgery for the treatment of complicated duodenal ulcers. METHODS: From September 1994 to July 1997, 30 hemodynamically stable patients underwent laparoscopic surgery for the treatment of complicated duodenal ulcers, including 13 free perforations, 12 obstructions and 5 intractabilities. Operations consisted of a truncal vagotomy with a drainage procedure, a proximal gastric vagotomy (posterior truncal vagotomy with anterior seromyotomy) and simple closure of the perforation in 16, 9, 5 cases, respectively. In the beginning of this study, congo-red tests were attempted in 12 patients, intraoperatively in 7 and postoperatively in 5, to assess the reliability of a laparoscopic vagotomy. Long-term follow up was evaluated using by modified Visik criteria. RESULTS: The mean operation time was 150 (80-230) minutes. Oral intake resumed on the third postoperative day. The mean hospital stay was 8.4 days. There was one intraoperative open conversion. In another case, a distal subtotal gastrectomy followed due to persistent postoperative gastric stasis. Six of 7 intraoperative congo red tests showed black-to-red discoloration of the gastric mucosa, which meant reduced gastric acidity. However, in the postoperative group, only 2 of 5 cases did. The mean follow-up period was 21 (3-38) months. There were 2 recurrent ulcers. One was on the duodenum; the other was a marginal ulcer. CONCLUSIONS: Laparoscopic surgery for the treatment of complicated duodenal ulcers is technically feasible, effective, and safe.
Congo Red* ; Congo* ; Drainage ; Duodenal Ulcer* ; Duodenum ; Follow-Up Studies ; Gastrectomy ; Gastric Acid ; Gastric Mucosa ; Gastroparesis ; Humans ; Laparoscopy ; Length of Stay ; Peptic Ulcer ; Ulcer ; Vagotomy* ; Vagotomy, Proximal Gastric ; Vagotomy, Truncal

PURPOSE: The preservation or removal of the spleen during a total gastrectomy has been greatly debated. We analyzed early results of a prospective randomized trial of 146 patients with gastric cancer who underwent a total gastrectomy to evaluate the impact of a combined splenectomy on the postoperative course. METHODS: Patients were randomized intraoperatively using a computer-generated random number table to remove the spleen versus preservation of the spleen. RESULTS: There were 73 patients in the preservation group and 73 in the splenectomy group. There was one patient in the preservation group who died of postoperative complication. There were two deaths in the splenectomy group. After a splenectomy 27% of the patients experienced postoperative complications versus 25% in the preservation group. Preservation of the spleen showed improved overall survival as compared to a splenectomy, but this difference was not statistically significant. For patients with curative resections, the 3-year survival tended to be higher after preservation of the spleen (0.7146 versus 0.5203; p=0.1038). Improvement in survival was not statistically significant for subgroups of patients with metastatic lymph nodes at the hilum of the spleen (p=0.9303), and in subgroups of patients with metastatic lymph nodes along the splenic artery (p= 0.8681). CONCLUSION: Survival benefit with or without preservation ofthe spleen during total gastrectomy in patients with gastric cancer will be clarified on continued follow-up.
Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Postoperative Complications ; Prospective Studies* ; Spleen ; Splenectomy* ; Splenic Artery ; Stomach Neoplasms*

BACKGROUND: Correlations between the AFP, CEA, CA19-9, and CA125 levels of portal and peripheral blood were examined in 42 patients (male, 29; female, 13; mean age, 55.9) with gastric cancer in order to identify a better blood sample for measuring these tumor markers. METHODS: The levels of these tumor markers were measured by the immunoradiometric assay. The cut-off levels of positivity were 6 ng/ml for AFP, 7 ng/ml for CEA, 25 U/ml for CA19-9, and 35 U/ml for CA125. RESULTS: The positive rates of AFP, CEA, CA19-9, and CA125 were 11.9%, 19.0%, 14.3%, and 7.1% in portal blood and 9.5%, 19.0%, 14.3%, and 4.8% in peripheral blood, respectively. The positive rate of portal venous CEA was significantly higher in cases with lymph node metastasis, distant metastasis, and lymphatic invasion than those without these variables. The positive rate of peripheral venous CEA was significantly higher in cases with lymph node metastasis, distant metastasis, high stages, and large tumor size. The positive rate of peripheral venous CA19-9 was higher in cases with distant metastasis. The positive rate of CA125 in portal and peripheral blood was higher in cases of lymphatic invasion. Neither portal nor peripheral AFP correlated with pathologic factors. Regression analysis revealed that the portal venous levels of AFP, CEA, CA19-9, and CA125 could be estimated by using the peripheral venous levels of these tumor markers. CONCLUSION: We can avoid intraoperative sampling of portal blood to measure the portal venous levels of AFP, CEA, CA19-9, and CA125 because the peripheral venous level of these tumor markers reflects the portal venous levels. The measurement of peripheral venous levels of CEA and CA19-9 can be used as non-anatomical prognostic indicators for staging of gastric cancer.
Biomarkers, Tumor ; Female ; Humans ; Immunoradiometric Assay ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms*

For more than a decade, laparoscopic surgery has been adopted as a treatment of colorectal cancer. With promising evidences from multi-center prospective randomized studies, laparoscopic approach is accepted as an alternative for the management of colon cancer. However, laparoscopic surgery is still technically demanding and has little evidence to convince most surgeons of its usefulness for rectal cancer. Laparoscopic surgery for malignant diseases must stress on oncologic safety as well as its functional excellence. Oncologic principles in surgery for rectal cancer are complete resection of the tumor with safe margins, en-bloc resection of regional lymph nodes and appropriate treatment for metastatic lesion. Despite the lack of results in prospective randomized comparative trials, many studies have been investigating whether laparoscopic resection for rectal cancer can follow these principles. In this review, we analyze early outcomes, long-term result of oncologic adequacy in laparoscopic surgery for rectal cancer, and discuss its potential advantages.
Digestive System Surgical Procedures/*methods ; Humans ; Laparoscopy/*methods ; Rectal Neoplasms/*surgery

PURPOSE: Familial adenomatous polyposis (FAP) normally appears in the early twenties and needs a restorative total proctocolectomy with ileal pouch-anal anastomosis (TPC/ IPAA). Thus, most patients with FAP are young, in socially active stage, and very concerned about their body image. Vast experience with laparoscopic colorectal surgery led us to perform laparoscopic-assissted TPC/IPAA for patients with FAP with or without cancer, and we evaluated the results from technical and oncologic aspects. METHODS: Seventeen of 20 FAP patients underwent laparoscopic- assisted surgery between July 1996 and June 2004. All procedures were done in a totally laparoscopic, a laparoscopic-assisted, or a hand-assisted laparoscopic fashion. RESULTS: Fifteen patients underwent laparoscopic-assisted TCP/IPAA; two others had a total colectomy with ileorectal anastomosis and a TCP with permanent ileostomy laparoscopically. Eight patients showed coexisting colorectal cancers. The mean operation time was 396.5 min. Patients passed flatus or liquid at the 2.2 post-operative day (POD), resumed meals at the 4th. POD, and were discharged at the 10th. POD. There were no intra-operative complications or open conversions. Post-operative complications occurred in 5 different patients. One patient with colon cancer had multiple hepatic metastases at 11 months after the operation and died at 24 months after the operation. CONCLUSIONS: Laparoscopic-assisted surgery for the patients with FAP was technically feasible and could be an alternative method. The systematized and experienced approach could reduce a operation time to be acceptable. In selected cases and with a vast of experience, coexisting colorectal cancer would not be contraindicated for laparoscopic approach for the treatment of FAP.
Adenomatous Polyposis Coli* ; Body Image ; Colectomy ; Colonic Neoplasms ; Colorectal Neoplasms* ; Colorectal Surgery ; Flatulence ; Humans ; Ileostomy ; Laparoscopy ; Meals ; Neoplasm Metastasis