PURPOSE: Laparoscopic appendectomy (LA) is now widely practiced in most medical centers, yet there is no consensus regarding the indications and advantages of LA over the conventional technique. Various reports have demonstrated conflicting results about the merit of LA. Especially, complicated appendicitis was initially considered as a contraindication for LA. However, with the improvements of laparoscopic instruments and the technical proficiency, the choice of the operative approach mostly depends on the surgeon's experience or the patient's preference. Here we compared the outcome of LA versus open appendectomy (OA) overall and specifically in the patients with complicated appendicitis. METHODS: From January 2007 to December 2007, the records of 495 patients with the diagnosis of appendicitis were retrieved from the computer database for analysis. All the patients had given informed consent for LA or the OA technique and the patients chose the operative method. The two groups were compared with respect to the patients' demographic data, the clinical outcomes, the cost and the type of pathology RESULTS: During the study period, 195 patients (39.4%) underwent LA and 300 patients (60.6%) underwent OA. There were 53 cases (27.1%) of complicated appendicitis and 105 cases each (35%) in the LA and OA groups, respectively. The patients of the LA group revealed a significant female prevalence, a shorter hospital stay, less use of analgesics, a lower complication rate and a higher cost (p<0.005), and also a comparable operation time to the OA group. As for the complicated appendicitis, there was benefit for only the hospital stay. CONCLUSION: Usually LA has more advantage than OA except cost. Even in complicated appendicitis, LA is feasible without increase of complication.
Analgesics ; Appendectomy ; Appendicitis ; Consensus ; Female ; Humans ; Imidazoles ; Informed Consent ; Length of Stay ; Nitro Compounds ; Prevalence

PURPOSE: This clinical research was performed to determine the safety of laparoscopic appendectomy using a 5 mm scope by comparing the outcomes with open appendectomy. METHOD: We examined the medical records of 441 patients that underwent either laparoscopic appendectomy (LA) or open appendectomy (OA) from March 2005 to August 2007. We retrospectively reviewed the clinical data and compared: age, gender, days of hospitalization, operation time, time to oraldiet, complications, and readmission, between the LA and OA groups. RESULTS: Among the 441 patients that were diagnosed with appendicitis, LA was attempted in 332 patients; 325 (73.7%) of them received the procedure. One hundred-nine patients (24.7%) received an OA. There were no differences in operation time (p=0.072), length of hospitalization, and complication or re-admission rates; however the time to oral diet (p=0.025) was earlier in patients in the LA group. There were no differences in the outcomes of patients that had an uncomplicated appendicitis and received LA or OA; however patients diagnosed with complicated appendicitis had a shorter length of hospitalization after a LA compared to those that had an OA (p=0.03). CONCLUSION: There was no difference in safety between the laparoscopic appendectomy using a 5 mm scope and an open appendectomy. Laparoscopic appendectomy using a 5 mm scope provided a better cosmetic outcome.
Appendectomy ; Appendicitis ; Cosmetics ; Diet ; Hospitalization ; Humans ; Medical Records ; Retrospective Studies

PURPOSE: Laparoscopic gastric wedge resection (LWR) is being increasingly performed as a safe and effective treatment for gastric submucosal tumors (SMTs). However, there are few studies on the factors associated with operation time of LWR for gastric SMTs. The purpose of this study was to determine the factors associated with the operation time of LWR for gastric SMTs. METHODS: Between June 2001 and December 2008, 58 patients with gastric SMTs underwent LWR. We analyzed the clinicopathologic data, perioperative parameters and outcomes, and surgeon's experience retrospectively. We also analyzed the factors associated with the operation time of LWR for gastric SMTs. RESULTS: Among 58 patients that underwent LWR, exogastric wedge resection (n=48) was mainly performed. Transgastric wedge resection (n=8) took the longest amount of time. Intraoperative GFS (n=7) was frequently performed for smaller tumors. When the tumor was located at the cardia and fundus, more time was needed for LWR of the SMTs. There was no correlation of the operation time with the clinicopathologic data and surgeon's experience; however, the tumor location (axis) and the approach used for the resection of the stomach were statistically correlated with the operation time. CONCLUSION: The operation time of LWR for gastric SMTs was related to the tumor location (according to gastric axis) and the approach used for the resection of the stomach. If the tumor location was identified precisely and the proper approach for resection of the stomach was determined preoperatively, the operation time of LWR for gastric SMTs might be reduced.
Cardia ; Humans ; Retrospective Studies ; Stomach

PURPOSE: Obesity has become a global epidemic disease, and bariatric surgery is now being increasingly performed in Korea as well as in western countries. Bariatric surgery has been performed in Korea since 2003. However, there is no data on cases of Korean bariatric surgery regarding the weight loss as well as the factors associated with the surgical outcome. METHODS: 120 total cases of bariatric surgery [LRYGB=48, LAGB=72] were done at St. Mary's Hospital. We retrospectively reviewed the series of bariatric cases and we analyzed the surgical outcome, the complications and the clinical factors associated with the surgical outcomes. RESULTS: There were no significant differences in age, BMI and pre-existing comorbidities for both procedures. The percentage of excess weight loss (%EWL) of the LRYGB at 6, 12 and 24 months was 63.8%, 73.7% and 87.5%, respectively, and the %EWL of the LAGB was 33.4%, 44.7% and 43.8%, respectively. Factors such age and gender were not associated with the surgical outcome. Yet the initial BMI tended to affect the surgical outcome. CONCLUSION: The results of our study indicate that LRYGB and LAGB are technically feasible and safe procedures. Both are quite satisfactory and promising procedures for loosing a significant amount of weight.
Bariatric Surgery ; Comorbidity ; Korea ; Obesity ; Obesity, Morbid ; Retrospective Studies ; Weight Loss

PURPOSE: Access to the peritoneal cavity requires a pneumoperitoneum for laparoscopic procedures. Safe insertion of the first port during laparoscopic surgery has always been problematic, from the early use of the Veress needle to the open Hasson technique. Many procedures must be done blindly. The blind insertion of a Veress needle or first trocar, to create the pneumoperitoneum, has been shown to cause vascular and visceral injuries. To reduce the risks associated with peritoneal entry, many surgeons prefer an open- access technique, similar to the Hassson method. The aim of this study was to assess the safety of peritoneal entry and avoidance of vascular and visceral injuries with a new technique. METHODS: In a series of 385 patients, a modified new method of laparoscopic port insertion using exposure of the rectus sheath fascia and Z-type sutures was performed to obtain a pneumoperitoneum for laparoscopic cholecystectomy from 2004 to 2008, at the Gospel Hospital, Kosin University College of Medicine. RESULTS: There were no visceral or vascular complications among the 385 patients that had laparoscopy using this technique. CONCLUSION: This technique was safe and effective for laparoscopic cholecystectomy procedures and should be considered an option to reduce entry injuries during laparoscopic surgery involving the peritoneal cavity.
Cholecystectomy, Laparoscopic ; Fascia ; Humans ; Laparoscopy ; Needles ; Peritoneal Cavity ; Pneumoperitoneum ; Surgical Instruments ; Sutures

In the case of using surgical clips for division of the cystic duct during laparoscopiccholecystectomy, surgical clip migration into the common bile duct is known to be an extremely rare complication. However, its mechanism is currently unclear. The incidence of performing laparoscopic hepatectomy has significantly increased in the laparoscopic center of hospitals. Accordingly, the complications associated with using clips in laparoscopic cholecystectomy have increase as well. A 49 year-old female patient underwent laparoscopic left hepatectomy due to left intrahepatic duct stones with cholangitis. We report here on a case of a clip that migrated into the common bile duct and the duct had bile stones. We also review the relevant literature.
Bile ; Bile Ducts, Extrahepatic ; Cholangitis ; Cholecystectomy, Laparoscopic ; Common Bile Duct ; Cystic Duct ; Female ; Hepatectomy ; Humans ; Incidence ; Surgical Instruments

Chronic constipation has been successfully treated with specific medications and bio-feedback therapy. Surgical manipulation for this condition can be an option when non-surgical interventions fail. We report here on a patient who was diagnosed as having intractable chronic constipation with hypoganglionosis. The patient was a 60 year-old male with the history of seizure and diabetes. This patient did not gain any clinical benefits from non-surgical regimens. Therefore, we performed a laparoscopically assisted total colectomy with J-pouch ileorectal anastomosis on this patient. The patient recovered from the surgery without complications and he had normal bowel functions. The postoperative anatomical pathology revealed a hypogaglionosis. In conclusion, a laparoscopically assisted total colectomy for a patient with intractable chronic constipation with hypoganglionosis is a good option and it may be a curative method.
Colectomy ; Colonic Pouches ; Constipation ; Humans ; Male ; Seizures

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

PURPOSE: We determined the rate of an occult contralateral inguinal hernia by conducting only a physical examination for the unilateral inguinal hernia patients who visited our hospital. METHODS: One hundred thirty nine patients were prospectively evaluated between September 2009 and October 2010. We divided the patients into 3 groups according to a physical examination of the contralateral inguinal area: Group A (no abnormality), Group B (suspicious) and Group C (definite). We defined Group B and Group C as possible occult bilateral hernia. In Group B, selective diagnostic laparoscopy was performed after the totally extraperitoneal herniorrhaphy was finishedover. We analyzed the rate of detecting a contralateral hernia, the positive predictive value and the accordance rate. RESULTS: Of the 139 patients, the number of patients in Group A, B and C were 113 cases, 4 cases and 22 cases, respectively. The age of the patients ranged from 18~86 years (mean age: 57.1), with a male to female ratio was 7:1. Twenty-six patients (18.7%) had possible occult bilateral hernia. For the left inguinal hernia patients, the incidence of contralateral hernia was 18.2% (12/66). For the right inguinal hernia patients, this was 19.2% (14/73). The detection rate of contralateral hernia by physical examination was 14.1% (19/135) and the positive predictive value was 86.4% (19/22). The accordance rate of simultaneous bilateral hernia was 57.9% for the direct hernia patients and it was 26.3% for the indirect patients. There was no recurrence or metachronous contralateral inguinal hernia occurrence. CONCLUSION: We can discover occult contralateral inguinal hernia by conducting a careful physical examination of the contralateral inguinal area. Conducting a proper physical examination is very important for detecting inguinal hernia.
Female ; Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Incidence ; Laparoscopy ; Male ; Physical Examination ; Prospective Studies ; Recurrence

PURPOSE: Laparoscopic herniorrhaphy (LH) has an advantage for evaluating the viability of incarcerated bowel. In this retrospective study, we aimed to review the data for use of the TEP technique in treating incarcerated hernias in order to document the feasibility of the laparoscopic procedure. METHODS: During a 2-year period from January 2008 to December 2009, one surgeon (C.S) at our institution operated on 27 patients with acutely (n=3) or chronically (n=24) incarcerated hernia. Incarcerated hernias were divided into acute or chronic types arbitrarily, based on who had symptoms of acute abdominal pain and signs of intestinal obstruction. For acute cases, the TEP procedure was done following laparoscopic transperitoneal evaluation to assess viability of the incarcerated bowel. RESULTS: All patients except one having a femoral hernia were male. Mean age was 41 years old (range, 25~75). No case converted from a laparoscopic to an open procedure. Two acute incarcerated cases contained a segment of small bowel and the other contained small bowel and omentum. All acute cases were operated on successfully on an emergency basis by laparoscopic TEP repair. All chronic cases contained omentum without bowel. In one case of acute and seven cases of chronic type, a small inguinal incision was made to reduce hernia contents. No recurrence was noticed at a mean of 13 months of follow-up. CONCLUSION: If there is no entrapment of bowel in chronic incarcerated cases, the TEP procedure will be satisfactory. It may be reasonable, however, to evaluate viability of bowel transperitoneally before doing a TEP procedure in acute cases.
Abdominal Pain ; Emergencies ; Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Imidazoles ; Intestinal Obstruction ; Laparoscopy ; Male ; Nitro Compounds ; Omentum ; Pyrazines ; Recurrence ; Retrospective Studies