PURPOSE: Hypertrophic pyloric stenosis (HPS) is a common condition affecting infants that causes severe projectile non-bilious vomiting in the first few months of life. Although open pyloromyotomy is the standard treatment for HPS, recently, the laparoscopic approach has rapidly been adopted by pediatric surgeons. The aim of this study is to determine the efficacy and safety of laparoscopic pyloromyotomy by comparing the clinical results of laparoscopic and open pyloromyotomy. METHODS: Between January 2007 and September 2012, a cohort of 69 children who underwent pyloromyotomy at Seoul National University Children's Hospital were followed; open pyloromyotomy (OP, n=56) and laparoscopic pyloromyotomy (LP, n=13). A retrospective analysis of patient's characteristics and clinical outcomes in patients with open or laparoscopic pyloromyotomy for HPS was performed. The evaluated characteristics included gestational age, sex, birth weight, age and weight at operation. Clinical outcomes included operation time, length of hospital stay, time to postoperative full feeds without vomiting, number of postoperative vomiting and complications. RESULTS: There were no significant differences in characteristics, length of hospital stay and time to postoperative full feeds without vomiting between the two groups. Incidence of postoperative vomiting in the LP group was significantly lower than that in the OP group (OP: 5.07+/-4.60 vs. LP: 2.00+/-2.16, p=0.035). In contrast, the operation time was longer, following the LP group (OP: 26.30+/-9.95 vs. LP: 44.15+/-19.56, p<0.001). Complications such as perforation of mucosal layer (OP: 2 vs. LP 1, p>0.999) and wound problems (OP: 4 vs. LP 1, p>0.999) were found to be similar in both groups. CONCLUSION: Both open and laparoscopic pyloromyotomy are safe procedures for the management of hypertrophic pyloric stenosis. Incidence of vomiting was statistically superior in the laparoscopic group. In addition, postoperative complications were fewer in this group. However, an improvement in the operation time will be needed for the future development of laparoscopic pyloromyotomy.
Birth Weight ; Child ; Cohort Studies ; Gestational Age ; Humans ; Incidence ; Infant ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Postoperative Nausea and Vomiting ; Pyloric Stenosis, Hypertrophic ; Retrospective Studies ; Vomiting

PURPOSE: The objective of this retrospective study is to evaluate the practical feasibility and safety of applying hem-o-lok clips for the closure of the appendiceal stump in complicated appendicitis. METHODS: From January 2009 to April 2010, 267 patients who underwent laparoscopic appendectomies at the Pusan National University Yangsan Hospital were included in this study. Of these patients, 161 were diagnosed by computed tomography as having complicated acute appendicitis. In 107 patients, the appendiceal stump was closed with hem-o-lok clips, whereas in the remaining 160 patients, it was closed with endoloops. These two groups were compared for clinicopathologic data and procedural cost-effectiveness. RESULTS: No significant differences were found between the two groups in terms of age, sex, hospital stay, or blood loss. Furthermore, postoperative complications were similar and highly acceptable in both groups. However, operation times were significantly shorter and hospital cost was lower for the hem-o-lok group. CONCLUSION: The hem-o-lok clips has advantages such as simplicity of application, a shorter operation time, and lower hospital cost when used as a means of securing the base of the appendix in relation to the endoloop procedure.
Appendectomy ; Appendicitis ; Appendix ; Hospital Costs ; Humans ; Length of Stay ; Postoperative Complications ; Retrospective Studies

PURPOSE: Laparoscopic surgery is a minimally invasive surgery which has been widely used in abdominal surgery, such as appendectomy and cholecystectomy. There were several strong points in single incision laparoscopic cholecystectomy (SILC). However, no definite study comparing SILC with three port laparoscopic cholecystectomy (TPLC) has been reported. Therefore, this study focused on feasibility and safety of SILC in comparison with conventional TPLC. METHODS: This study included 86 cases of SILC and 230 cases of TPLC from April, 2010 to February, 2011. The patients were divided into two groups according to the surgical procedure, group 1 was SILC and group 2 was TPLC. All operations were performed by a single surgeon, and the retrograde approach was the fundamental surgical procedure used in both groups. RESULTS: Eighty five patients in group 1 underwent SILC and 229 patients in group 2 underwent TPLC. In comparison of preoperative data, statistical significance regarding age, gender, and preoperative PTGBD insertion was observed between the two groups. In comparison of intraoperative data, the average operation time and average hospital day did not show any statistical significance. Intraoperative multiple port conversion was performed in group 1 to TPLC due to cystic artery bleeding, and in group 2, TPLC was changed into a four port operation due to the same reason. CONCLUSION: In this study, no significant difference in operation result, time, and acute complication was observed between SILC and conventional TPLC. Besides the cancers, SILC could definitely be applied without exclusion criteria mentioned above if improvement of instruments and accumulation of surgeon's experience were satisfied.
Appendectomy ; Arteries ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Hemorrhage ; Humans ; Laparoscopy

PURPOSE: We reviewed our data compiled prospectively for evaluation of post-operative complications and recurrence of laparoscopic inguinal hernia repair. METHODS: Among the 1000 patients (age, > or =20 years old) who were undergone laparoscopic inguinal hernia surgery from January 2007 to July 2011, the age, sex, location, hernia type, operation time, postoperative morbidity, and conversion of 992 patients were analyzed. RESULTS: Among 992 patients, 919 (92.6%) were male and the mean age was 54.2 years (range, 20~90). Operation times (m inutes) for unilateral and bilateral hernia were 40.0 and 53.4, respectively. Mean operation time (minutes) showed a decrease over time, as that for the first half of all cases was 43.5 and that for the second half was 39.7 (p<0.001). Seven cases of conversion (post-radical prostatectomy hernia=7) were recorded to TAPP (n=3) or IPOM (n=4) from TEP. Eleven cases of postoperative catheterization (1.1%), five cases of port site seroma (0.5%), one case of mesh removal due to infection, 24 cases of seroma/hematoma (2.4%), 26 cases of neuralgia (2.6%), and four cases of bleeding with a drop in hemoglobin of more than 3 mg% (0.4%) were also recorded. There were three cases of recurrence (0.35%) at the median follow-up of 46 months (range, 20 to 70 months). CONCLUSION: Laparoscopic inguinal hernia repair can be performed safely, with low rates of complication and recurrence. This technique achieves good results combined with the benefits of minimally invasive surgery. We should be cautious in order to avoid postoperative bleeding, especially in cases of TEP.
Amidines ; Catheterization ; Catheters ; Follow-Up Studies ; Hemoglobins ; Hemorrhage ; Hernia ; Hernia, Inguinal ; Humans ; Male ; Neuralgia ; Prospective Studies ; Prostatectomy ; Pyrazines ; Recurrence ; Seroma

PURPOSE: Laparoscopic surgery has recently shown rapid development, and has been applied in most abdominal surgeries. It has also been adopted in hepatobiliary surgery, especially in the resection of liver tumors. Significant advantages of laparosopic surgery over the conventional open method have been reported, however, the safety of the surgical resection margin and radicality of the tumor resection remain to be clarified. This study was conducted in order to assess the feasibility and potential superiority of laparoscopic liver resection of hepatocellular tumors to open surgery. METHODS: This study included 76 patients who underwent liver resection for hepatocellular carcinoma at Dong-A University Hospital from January 2008 through June 2010. Of these 63 cases, 31 patients underwent laparoscopic resections and 33 underwent open liver resections. Both groups were confirmed as hepatocellular carcinoma by postoperative pathology and analyzed retrospectively. RESULTS: There were no statistically significant differences in preoperative parameters, such as age, height, body weight, Child Pugh score, ASA, and tumor size in both groups. There were no significant differences in operating time, duration of hospital stay, safety margins of surgical resection, postoperative complications, and rate of recurrence and occurrence of new lesions in both groups, however, better disease free survival was observed in the laparoscopic group (p=0.024). CONCLUSION: Findings of this study showed that the laparoscopic group had better results in free survival period than the open group. Conduct of larger scale prospective studies wound confirm the superiority of the laparoscopic liver resection to the conventional open procedure in patients with hepatocellular carcinoma. Findings of this study also suggest that assessment of the factors associated with the quality of life, such as degree of postoperative pain, and size of the incisional scar, and long term postoperative complications may play an additional role in favoring the laparoscopic liver resection. To elucidate the superiority of the laparoscopic liver resection to the conventional open method, conduct of study involving a larger study group and a longer prospective research period will be needed.
Body Height ; Carcinoma, Hepatocellular ; Child ; Cicatrix ; Disease-Free Survival ; Humans ; Laparoscopy ; Length of Stay ; Liver ; Pain, Postoperative ; Postoperative Complications ; Quality of Life ; Recurrence

Authors requested to change the name of the hospital to proper name.

PURPOSE: Laparoscopic single site surgery is currently available, but may not be feasible for delicate and complex surgical procedures. However, computer technology embedded into robotic surgical system could provide the way to advanced laparoscopic single site surgery. METHODS: 86-year-old, female cadaver who died from sepsis was used for testing technical feasibility of robotic single site surgical system (the da Vinci Surgical System_(Intuitive Surgical, Sunnyvale, CA)) in performing central pancreatectomy. RESULTS: About 4 cm×3 cm×1.5 cm sized segment of pancreatic neck portion was resected. Distal remnant pancreas was managed by two-layered, duct-to-mucosa pancreaticojejunostomy by intracorporeal suture technique. Operative procedure was completed in 150 min. CONCLUSION: Robotic single site central pancreatectomy with pancreaticojejunostomy was technically feasible in the present cadaveric experiment.
Aged, 80 and over ; Cadaver* ; Female ; Humans ; Neck ; Pancreas ; Pancreatectomy* ; Pancreaticojejunostomy* ; Sepsis ; Surgical Procedures, Operative ; Suture Techniques

PURPOSE: Mirizzi syndrome is caused by extrinsic compression of the common hepatic duct by stones impacted in the cystic duct or the gallbladder neck. The standard treatment for Mirizzi syndrome has been open cholecystectomy. The aim of this study was to review our experience of Mirizzi syndrome and consider its surgical treatment. METHODS: Data were collected retrospectively through chart review of 9,360 patients who underwent cholecystectomy between April 1983 and August 2016. RESULTS: Mirizzi syndrome was identified in 21 of 9,360 patients (0.22%). The mean age at diagnosis was 56 years. The most common symptom was abdominal pain (85.7%). A total of 16 patients (76.2%) were diagnosed with McSherry type I and 5 patients (23.8%) with McSherry type II. Laparoscopic cholecystectomy (LC) was initiated in 13 patients and open cholecystectomy (OC) in 8 patients. Conversion from LC to OC was reported for 3 patients (conversion rate 18.8%). In 4 patients with McSherry type II, an additional procedure (T tube insertion or hepaticojejunostomy) was required. CONCLUSION: Preoperative diagnosis of Mirizzi syndrome is very important in order to plan surgical strategy. LC is possible in selected patients with Mirizzi syndrome. However, OC is suitable in patients with McSherry type II. In the near future, laparoscopic procedures may be adaptable in patients with McSherry type II.
Abdominal Pain ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cystic Duct ; Diagnosis ; Gallbladder ; Hepatic Duct, Common ; Humans ; Mirizzi Syndrome* ; Neck ; Retrospective Studies

PURPOSE: The adverse effects of obesity on short-term surgical outcomes after laparoscopic colorectal surgery have been reported. However, the influence of obesity on long-term oncological outcomes after laparoscopic surgery in Asian patients has not been well understood. The aim of this study was to evaluate the effect of obesity on long-term oncologic outcomes in patients who underwent laparoscopic surgery for colorectal cancer. METHODS: Overall, 424 consecutive patients who underwent laparoscopic resection for colorectal cancer between January 2005 and July 2012 were included in this retrospective study. Patients were classified as non-obese (body mass index [BMI] <25.0 kg/m²) and obese (BMI ≥25.0 kg/m²) according to the categories proposed by the International Obesity Task Force. A survival analysis was performed using clinicopathologic characteristics, including obesity. RESULTS: Of the 424 patients, 325 (76.7%) were classified as non-obese and 99 (23.3%) as obese. The clinicopathologic characteristics of the obese and non-obese groups were similar, except that there were more underlying comorbidities, a lower frequency of smoking, and fewer tumors in rectum in the obese group. Results of the multivariate analysis showed that older age, elevated serum carcinoembryonic antigen, high-grade histology, advanced tumor stage, and perineural invasion were associated with poorer disease-free survival and overall survival. Obesity was not significantly associated with disease-free survival (hazard ratio [HR], 1.196; 95% confidence interval [CI], 0.686~2.086; p=0.528) or overall survival (HR, 1.156; 95% CI, 0.584~2.289; p=0.677). CONCLUSION: Laparoscopic surgery for colorectal cancer seems to be safe and feasible for obese patients in terms of long-term oncologic outcomes.
Advisory Committees ; Asian Continental Ancestry Group* ; Body Mass Index ; Carcinoembryonic Antigen ; Colorectal Neoplasms* ; Colorectal Surgery ; Comorbidity ; Disease-Free Survival ; Humans ; Laparoscopy* ; Multivariate Analysis ; Obesity* ; Rectum ; Retrospective Studies ; Smoke ; Smoking

PURPOSE: L aparoscopic cholecystectomy (LC) i s a c ommonly p erformed procedure for t he management of acute cholecystitis. The presence of an inexperienced scopist or a shortage of manpower could be problematic in emergency surgical cases. To overcome these potential problems while ensuring a stable surgical view during LC, we performed solo surgery. METHODS: We retrospectively reviewed the results of 22 patients who underwent solo three-incision LC (S-TILC) and 31 patients who underwent the conventional three-incision LC (C-TILC) from March 1, 2015, to August 31, 2015. We compared the two groups with respect to the patients' clinical characteristics, and intraoperative and postoperative results; and severity grade as defined by the updated Tokyo guidelines 2013 (TG13) criteria. RESULTS: No significant differences in baseline characteristics were found between the two groups. The intraoperative perforation rates were higher in the C-TILC group than in the S-TILC group (p=0.016). Two cases were converted to human-assisted LC in the S-TILC group because of severe adhesions and the scope holder breaking down. No significant differences were found between the groups with respect to length of hospital stay; postoperative diet habit; or rates of post-cholecystectomy diarrhea, abdominal pain, wound complication, or complication according to the Clavien-Dindo grade. CONCLUSION: S-TILC and C-TILC were comparable in terms of results, and this solo surgery in LC could be performed for cases of acute cholecystitis during shortage of skilled manpower.
Abdominal Pain ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute* ; Diarrhea ; Emergencies ; Food Habits ; Humans ; Length of Stay ; Retrospective Studies ; Wounds and Injuries