No abstract available.
Choledochal Cyst*

No abstract available.
Colon* ; Fibromatosis, Aggressive*

PURPOSE: Laparoscopic surgery on the adrenal gland is a highly specific procedure that requires mastery of laparoscopic surgery. From January 2000 to October 2008, 66 laparoscopic adrenalectomies on 65 patients were performed by a single surgeon. This study was done to summarize our experience and to evaluate the safety and effectiveness of laparoscopic adrenalectomy. METHODS: A retrospective review of the patient records was carried out. The patients' demographics, the tumor characteristics, the open conversion rate, the operating time, the length of the hospital stay and other clinical outcomes were studied. RESULTS: There were 8 conversions out of 65 patients. The indications for surgery included functional tumors in 42 patients (19 pheochromocytomas in 18 patients, 14 patients of primary aldosteronism and 10 patients of Cushing syndrome), and 23 nonfunctional tumors. The average tumor size was 3.5 cm. The mean operating time was 163 min. The average length of the hospital stay was 4.1 days. Postoperative complications occurred in 8 patients with no perioperative mortality, and most of the complications could be considered as minor. During follow-up, two patients had adrenal insufficiency and port site hernia, and none had recurrence of hormonal excess. CONCLUSION: Laparoscopic adrenalectomy has several advantages such as minimal postoperative pain, few surgical complications, a short hospital stay and an early return to work. The results confirm that laparoscopic adrenalectomy is the procedure of choice for resection of various benign adrenal neoplasms.
Adrenal Gland Neoplasms ; Adrenal Glands ; Adrenal Insufficiency ; Adrenalectomy ; Demography ; Follow-Up Studies ; Hernia ; Humans ; Hyperaldosteronism ; Laparoscopy ; Length of Stay ; Pain, Postoperative ; Pheochromocytoma ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Return to Work

We experienced 3 cases of manometry-induced colon perforation. A 75-year-old man (case 1) underwent anorectal manometry (ARM) 3 years after radiotherapy for prostate cancer and a laparoscopic intersphincteric resection for rectal cancer. A 70-year-old man (case 2) underwent ARM 3 months after conventional neoadjuvant chemoradiotherapy and a laparoscopic low anterior resection for rectal cancer. A 78-year-old man (case 3) underwent ARM 2 months after a laparoscopic intersphincteric resection for rectal cancer. In all cases, a colon perforation with fecal peritonitis occurred. All were treated successfully using prompt and active operations and were discharged without any complications. ARM with a balloon, as a measure of rectal compliance, should be performed 2 months or longer after surgery. If a perforation occurs, prompt and active surgical intervention is necessary due to the high possibility of extensive fecal peritonitis.
Aged ; Arm ; Chemoradiotherapy ; Colon ; Compliance ; Humans ; Manometry* ; Peritonitis ; Prostatic Neoplasms ; Radiotherapy ; Rectal Neoplasms

PURPOSE: Single port laparoscopic inguinal hernia repair has been performed to further reduce port related morbidities and to improve the cosmetic outcome. However, the cosmetic result of single port laparoscopic totally extraperitoneal inguinal hernia repair (TEP) has not been superior to that of transabdominal preperitoneal hernia repair (TAPP). The aim of this study is to introduce and assess the Single Umbilical Tangential Incision (SUTI) for Lap-TEP repair. METHODS: Forty one hernia repairs of 34 patients were performed using SUTI-TEP method. SUTI was made all along the inferolateral skin of the umbilical pit and a vertical incision of less than one centimeter was made in the supra- or infraumbilical skin if needed; the total length of the incision was 2~2.5 cm. SILS(TM) port and conventional instruments were used for the procedure. RESULTS: All procedures were completed without conversion to the conventional TEP procedure. Mean operation time was 73 minutes for unilateral primary hernia, 119 minutes for bilateral primary hernia, 88.5 minutes for unilateral recurrent hernia, and 120 minutes for bilateral recurrent hernia. There were two cases of wound seroma and four cases of urinary retention postoperatively. Other significant complications were not noted. There was no recurrence of hernia during the follow-up period of one to 24 months. At routine follow-up visit at three months postoperative, the scar was barely visible and overall level of patient satisfaction was very high. CONCLUSION: The SUTI-TEP inguinal hernia repair is safe and shows superior cosmetic results. Further studies are required in order to assess the long-term outcome.
Cicatrix ; Follow-Up Studies ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Patient Satisfaction ; Recurrence ; Seroma ; Skin ; Urinary Retention ; Wounds and Injuries

The application of laparoscopic techniques for the surgical management of Hirschsprung's disease is the recent trend. We described the surgical technique and postoperative long-term outcomes of the one-stage, laparoscopic-assiseted endorectal pull-through operation for Hirschsprung's disease. The technique uses three to four small abdominal ports. Laparoscopic mobilization of the sigmoid colon and rectum is performed and marginal artery-preserving colon pedicle is prepared. The rectal mobilization is performed using a transanal endorectal sleeve technique. The anastomosis is performed 0.5~1 cm above the dentate line. The age at surgery ranged from 6 days to 4 years. The average operative time was 144 minutes. Almost all of the patients passed stool and flatus within 36 hours of surgery. The average hospital stay after surgery was 6.5 days. Among 42 patients, 32 patients older than 3 years old were evaluated for function on defecation. All 32 patients have been continent, of those who needed laxatives were 11 (34.3%) due to constipation and overflow incontinence. Four children (12.5%) have remained dependent on laxatives. Laparoscopic-assisted endorectal pull-through operation for Hirschsprung's disease appears to be safe, provides the less pain, shorter time to full feeding, shorter hospital stay, and excellent cosmetic outcomes. Helping patients and parents ensure the quality of life, they should be provided with counseling, education, and longer-term follow-up care.
Child ; Colon ; Colon, Sigmoid ; Constipation ; Counseling ; Defecation ; Education ; Flatulence ; Follow-Up Studies ; Hirschsprung Disease* ; Humans ; Laxatives ; Length of Stay ; Operative Time ; Parents ; Quality of Life ; Rectum

PURPOSE: We have explored the question of what benefits SUTI-TEP can provide over conventional three-port TEP (C-TEP) surgery for the treatment of inguinal hernia. METHODS: One hundred forty cases (70 SUTI-TEP and 70 C-TEP) were reviewed in this study. SUTI-TEP procedure was carried out with SILS™ port as we reported before. Patient demographics and perioperative outcomes of SUTI-TEP were analyzed and compared with those of C-TEP. RESULTS: There was no conversion to open surgery or C-TEP in SUTI-TEP group. Median VAS immediate postoperatively was slightly higher in SUTI-TEP group, but it was statistically significant. POD 7th day pain after surgery were similar in both groups. Regarding the length of operation time, SUTI-TEP group (71.2 min) was significantly longer than that of the C-TEP group (41 min) (p<0.001). There was no major morbidity or mortality postoperatively in either group. There was also no recurrence or chronic pain during follow up. Patient overall satisfaction including cosmetic outcome was excellent in SUTI-TEP group. CONCLUSION: Although the longer operation time tends to be required, SUTI-TEP can provide better cosmesis and patient satisfaction, and also safety. That may be good indicator of the success of after surgery. Also we should not presume that one large incision causes less pain than small multiple incision because it is just single one. If there is more pain in one single wound, we should find the solution through the innovation of technology or preventive measures.
Chronic Pain ; Conversion to Open Surgery ; Demography ; Follow-Up Studies ; Hernia ; Hernia, Inguinal* ; Humans ; Mortality ; Patient Satisfaction ; Recurrence ; Treatment Outcome ; Wounds and Injuries

Hydrofluoric acid is one of the strongest irritating, corrosive and poisonous inorganic chemicals. Hydrofluoric acid burns are occurring with ever-increasing frequency due to the wide use of this acid in industries. Hydrofluoric acid burns are characterized by severe progressive tissue destruction and excruciating pain due to the unique properties of the freely dissolvable fluoride ion. The authors reviewed medical records of 32 cases(36 spells) of hydrofluoric acid burns which occurred in a hydrofluoric acid manufacturing factory from Sep. 1, 1990 to June 30, 1993. The results are as follows; 1. Eleven measurements of air concentrations of hydrofluoric acid by detection tube method from 1990 to 1992 were all below TLV(Department of Labor, R. O. K). 2. There were 19 cases(22 spells) of hydrofluoric acid burns which occurred during the study period among regular employees. The overall incidence density of hydrofluoric acid was 17.8 cases(20.6 spells) per 100 person-year. Incidence density was 19.0 cases(22.0 spells) per 100 person-year among male workers and there were no female cases. Incidence density was 32.9 cases(38.3 spells) per 100 person-year among production workers and 1.9 cases(1.9 spells) per 100 person-years among management workers with the difference being statistically significant(P<0.01). 3. Of 32 cases(36 spells) of hydrofluoric acid burns among workers who were regularly employed or temporarily employed, 26 spells(81.2%) were between age 20 to 39. In 15 spells(41.7%) burns occurred between 12 : 00 and 17 : 59 with 16 spells(44.3%) having arrived at hospital within 2 hours after the accident. 4. Of 36 spells, the main cause of hydrofluoric acid burns were by splashes(8 spells, 22.2 %). The most frequent site of burns were fingers and pain was the most frequent symptom. Thirty spells(83.3%) of the hydrofluoric acid burns were treated with local injection of antidote(calcium gluconate). Complete recovery without scarring were observed in most of the cases(34 out of 36 cases, 94.4%). The study results suggest that to prevent hydrofluoric acid burns, environmental control and the wearing of hydrofluoric acid resistant protective clothes and gloves are important. It is also stressed that establishment of an emergency management and a transfer system for hydrofluoric acid burn victims is necessary.
Burns* ; Burns, Chemical ; Cicatrix ; Emergencies ; Female ; Fingers ; Fluorides ; Humans ; Hydrofluoric Acid* ; Incidence ; Inorganic Chemicals ; Male ; Medical Records

Traumatic splenic vein aneurysm (SVA) is an extremely rare entity. Traditionally, treatment varied from noninvasive followup to aneurysm excision with splenectomy. However, there has been no prior report of traumatic SVA treated with endovascular stent graft for SVA via percutaneous transsplenic access. Therefore, we report the case of a 56-year-old man successfully treated with endovascular stent graft for traumatic SVA via percutaneous transsplenic access.
Aneurysm* ; Blood Vessel Prosthesis* ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Middle Aged ; Splenectomy ; Splenic Vein* ; Stents*

Traumatic splenic vein aneurysm (SVA) is an extremely rare entity. Traditionally, treatment varied from noninvasive followup to aneurysm excision with splenectomy. However, there has been no prior report of traumatic SVA treated with endovascular stent graft for SVA via percutaneous transsplenic access. Therefore, we report the case of a 56-year-old man successfully treated with endovascular stent graft for traumatic SVA via percutaneous transsplenic access.
Aneurysm* ; Blood Vessel Prosthesis* ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Middle Aged ; Splenectomy ; Splenic Vein* ; Stents*