No abstract available.

"Big Incision, Big Surgeon !!" At the beginning of surgery, excellence was associated with big incisions and rapidity of the operation because of the anesthesia. But, nowadays there has been a big change after the development of laparoscopic surgery. It is not a discipline unto itself, but more a philosophy of surgery, a way of thinking. " Small Incision, Best Surgeon!!" So-called Minimally invasive surgery (MIS) is a means of performing major operations through small incisions, often using miniaturized, high-tech imaging systems, to minimize the trauma of surgical exposure. Laparoscopic cholecystectomy became the stepping stone of the present status of MIS and is opening the dawn of the least invasive and eventually to non-invasive surgery, for exemple, Natural Orifice Transluminal Endoscopic Surgery (NOTES). I review the history of laparoscopic cholecystectomy cholecystectomy and introduce what procedures the surgeons are performing in the field of hepatopancreato biliary diseases.
Anesthesia ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Laparoscopy ; Natural Orifice Endoscopic Surgery ; Philosophy ; Thinking

Kimura's disease is a rare benign disease characterized by subcutaneous or dermal tumors occurring predominantly on the head and the neck. It usually occurs in young adults without constitutional symptoms, except for peripheral blood eosinophilia. The histopathologic features of the tumor are characterized by dense lymphoid aggregates containing a prominent germinal center and by the proliferation of endothelial cells associated with varying degrees of lymphocytic, histiocytic, and eosinophilic infiltration. We report a case of Kimura's disease without peripheral blood eosinophilia in a 24-year-old male who had had a painless and slowly growing tumor-like swelling on his right groin for one year. The mass was excised, and the specimen was confirmed as Kimura's disease. After surgical excision, the lesion recurred, so 30 mg of oral prednisone was given daily for one month and then decreased gradually for another one month. Now, the lesion is completely healed.
Endothelial Cells ; Eosinophilia ; Eosinophils ; Germinal Center ; Groin* ; Head ; Humans ; Male ; Neck ; Prednisone ; Young Adult

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors since it has many advantages; a more rapid and comfortable recovery, shorted hospitalization, and fewer complications. The purpose of this study was to report the initial 4 years experiences of LA and describe the unusual findings encountered during the operations. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Several techniques of LA have been described already. We prefer the transabdominal approach in the lateral decubitus position using 3 or 4 trocars. RESULTS: 20 patients had all unilateral tumor. The pathological findings were 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. 18 cases of 20 patients were successfully operated by laparoscopic procedure and 2 cases were converted to open adrenalectomy. The reasons of conversion were sudden cardiac arrest due to unknown origin and intraoperative bleeding due to periadrenal massive fat. During the laparoscopic operation, 2 patients showed abnormal EKG findings. The pathologies of those patients were non-catecholamine-secreting cortical adenomas. After operation, they have been completely normal in EKG. The average operating time for the complete laparoscopic adrenalectomies was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There was no postoperative complication and no operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: The LA is relatively fast and safe method and is accepted as the preferred procedure for the adrenal tumors but it should be well prepared perioperatively. Surgeons and anesthesiologists should be aware of those possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.
Adenoma ; Adrenal Glands ; Adrenalectomy* ; Death, Sudden, Cardiac ; Electrocardiography ; Hemorrhage ; Hospitalization ; Humans ; Length of Stay ; Methods ; Mortality ; Pathology ; Pheochromocytoma ; Postoperative Complications ; Surgeons ; Surgical Instruments

Pancreatic heterotopia and adenomyoma are variants of the same process. Pancreatic heterotopia is characterized by the presence of pancreatic acinar, islet, and/or ductular elements, usually associated with smooth muscle proliferation, outside the topographic boundaries of the pancreas. Adenomyoma differs from pancreatic heterotopia in that acinar and islet-like tissue are not present. The common sites are stomach, duodenum, and jejunum, but ectopic pancreatic tissue may also be encountered in Meckel's diverticulum, the ampulla of Vater, gallbladder, umbilicus, fallopian tube, and mediastinum. Most examples are encountered incidentally during surgery, and on rare occasions, epigastric pain, weight loss, hemorrhage, gastric outlet obstruction, and intussusception have been attributable directly to the presence of the heterotopic pancreas. But intestinal obstruction of small bowel by pancreatic adenomyoma has not been reported as of yet. The authors have experienced one case of intestinal obstruction by pancreatic adenomyoma requiring operation in a 28-year-old female. We found the 3-fold distened proximal jejunal loop, about 1 meter length, and abrupted narrowed point, and a normal sized distal loop. We treated this case by performing longitudinal incision and transverse suture of the narrowed point, so that the diameter of narrowed point was enlarged. At that time we found the 0.7Cm sized intraluminal mass at the narrowed point. We concluded that intestinal obstruction in this case was made by contraction of circular muscle due to pancreatic adenomyoma, not by a mass effect.
Adenomyoma* ; Adult ; Ampulla of Vater ; Duodenum ; Fallopian Tubes ; Female ; Gallbladder ; Gastric Outlet Obstruction ; Hemorrhage ; Humans ; Intestinal Obstruction* ; Intussusception ; Jejunum* ; Meckel Diverticulum ; Mediastinum ; Muscle, Smooth ; Pancreas ; Stomach ; Sutures ; Umbilicus ; Weight Loss

PURPOSE: Cystic neoplasms in the liver are rarely seen tumors. Biliary cystadenoma and cystadenocarcinoma constitute less than 5% of intrahepatic cysts originating from the bile duct. The clinicopathologic and radiologic findings are important to arrive at the proper diagnosis and treatment of intrahepatic biliary cystadenoma and cystadenocarcinoma. The aims of this study were to characterize the clinical and pathologic aspects of these lesions, and also to discuss the treatment and prognosis of biliary cystadenoma and cystadenocarcinoma. METHODS: We reviewed the clinical records of six patients who had intrahepatic biliary cystadenoma and cystadenocarcinoma and who had undergone operations from January, 1986 to June, 2002 at Hanyang University Hospital. RESULTS: Primary biliary cystadenoma and cystadenocarcinoma of the intrahepatic biliary systems are rarely seen tumors. Biliary cystadenoma mainly affected women, and this was a different gender preponderance than was seen for biliary cystadenocarcinoma. We found no signs or symptoms that were specific for either of these tumors, and the diagnoses were usually made by abdominal CT and abdominal ultrasonography. These tumors were usually large, multilocular and cystic in appearance. The pathologic findings revealed multiple cystic masses lined with cuboidal to columnar epithelium. The nature of the cystic fluid was usually the mucous type. Of the 6 patients in whom the lesions were completely excised, 4 of the patients are alive. The other 2 patients died of old age and distant metastasis, respectively. CONCLUSION: Surgical resection of the tumor, including a margin of surrounding normal liver parenchyma, was the only curative method. If the tumor is confined in the liver, complete surgical excision yields an excellent prognosis. Complete resection of a biliary cystadenoma and radical resection of a biliary cystadenocarcinoma seem to offer these patients a chance for long-term survival.
Bile Ducts ; Biliary Tract ; Cystadenocarcinoma* ; Cystadenoma* ; Diagnosis ; Epithelium ; Female ; Humans ; Liver* ; Neoplasm Metastasis ; Prognosis ; Tomography, X-Ray Computed ; Ultrasonography

The small diameter and sclerosis of the veins are the main causes of failure of autogenous arterio-venous fistula(AVF) for hemodialysis. In addition, the deep location of veins prevents adequate access postoperatively, as exemplified by the frequent requirement of transposition of basilic veins either primarily or delayed. As for the cephalic veins, superficial transposition was not emphasized. We report a case of brachiocephalic AVF which required delayed superficial transposition for access. We emphasize that the depth of veins should be considered for adequate creation of AVF.
Fistula* ; Ocimum basilicum ; Renal Dialysis ; Sclerosis ; Veins*

PURPOSE: The goal of this article was to characterize and explain the etiology of a left-sided gallbladders with intrahepatic portal vein anomalies, and these cases of this unusual anatomy were all encountered at a single center. METHODS: We reviewed the movies recorded during surgery, the database information and the preoperative radiologic examinations of 1,141 patients who underwent cholecystectomies at our institution between August 2007 and July 2010 to assess the presence of left-sided gallbladder and its combined anomalies. RESULTS: Four of 1141 patients (0.35%) were diagnosed with left-sided gallbladder. In all the cases, the gallbladder was located on the left side of the falciform ligament, under the left lobe of the liver with typical abnormal intrahepatic portal venous branching. The right posterior portal vein came directly from the main portal vein, and the right anterior portal vein originated from the left portal vein, but the ligamentum teres joined to the left branch of the portal vein in the liver. CONCLUSION: Left-sided gallbladder with intrahepatic portal venous branching anomaly resulted from the defective development of the central portion of the liver rather than from abnormal regression of the left umbilical vein with persistence of the right umbilical vein.
Cholecystectomy ; Gallbladder ; Gallbladder Diseases ; Humans ; Ligaments ; Liver ; Porphyrins ; Portal Vein ; Umbilical Veins

Acinar cell carcinoma (ACC) of the pancreas is a rare malignancy making up approximately 1% of pancreatic non-endocrine malignant tumors. The common finding on computed tomography is a solitary, well-defined, heterogenous hypodense mass with enhancing capsule. ACC is a highly cellular tumor with minimal stroma and a lack of stromal desmoplasia. The accurate diagnosis of ACC cannot typically be done by histology alone but rather requires immunohistochemical staining or electron microscopy for the identification of pancreatic enzymes and zymogen granules. ACC has been considered a cancer with a poor prognosis due to frequent metastasis, a high recurrence rate, and low respectability. Surgical resection is the treatment of choice that can lead to long-term survival. ACC has a better prognosis than ductal carcinoma of the pancreas, but a worse prognosis compared to islet cell carcinoma. We report two cases of ACC with 5-year survival after surgical resection.
Acinar Cells ; Carcinoma, Acinar Cell ; Carcinoma, Islet Cell ; Carcinoma, Pancreatic Ductal ; Follow-Up Studies ; Microscopy, Electron ; Neoplasm Metastasis ; Pancreas ; Prognosis ; Recurrence ; Secretory Vesicles

BACKGROUND: Pancreaticoduodenectomy is well established in the armamentarium of the surgeon treating periampullary carcinoma and benign lesion. With refinement of operative technique and more enlighting management during the postoperative period, the morbidity and mortality of this procedure have reduced significantly. Leakage of the pancreaticojejunal anastomosis has been a major complication after this procedure, frequently reported in an incidence of 5 percent to 15 percent. Therefore, authors retrospectivly reviewed about clinical experience of duct-to-mucosa anastomosis and PTBD in pancreaticoduodenectomy. OBJECTS & METHODS: The authors retrospectively reviewed the medical records of 93 patients who had undergone a pancreaticoduodenectomy with the duct-to-mucosa method between 1994 and 2000 by one surgeon. RESULTS: The male-to female ratio was 2.1:1(63:30) and mean age was 57 years old(range from 26 to 77). Thirty patients(32.6%) of 93 patients were distal common bile duct cancer, 22 patients(24%) were pancreatic head cancer, 21 patients(23%) were Ampulla of Vater cancer, 5 patients(5.4%) were chronic pancreatitis, 3 patient(3.3%) were duodenal cancer. The operative morbidity was 35.8%, and there was three perioperative mortality(3.2%). The mean operative time was 8.8 hours. A pancreatic fistula was diagnosed in 6 of the 93 patients(6.5%) and surgical intervention was done in 1 of the 6 patients. A PTBD for preoperatively biliary drainage was done 64 cases and complication related PTBD was 3 cases(4.7%, hemobilia). CONCLUSIONS: Even if this anastomotic technique requires a little more time and attention by the surgeon, we experienced that the low incidence of pancreatico-jejunal anastomosis related complication represents a validation of the method, and a motivation to adapt this anastomotic technique. But, this method is not absolute because surgeon's preference is most important factor in operation.
Ampulla of Vater ; Common Bile Duct ; Drainage ; Duodenal Neoplasms ; Female ; Head and Neck Neoplasms ; Humans ; Incidence ; Medical Records ; Mortality ; Motivation ; Operative Time ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Pancreatitis, Chronic ; Postoperative Period ; Retrospective Studies