PURPOSE: Divided end-loop colostomy is recommended in some cases of unresectable rectal cancer or anal incontinence, because a conventional loop colostomy is difficult to managing due to bulky stoma volume for a long period. In such case of the divided end-loop colostomy, severe inflammation may occur at the stoma site by poor conditions of the patient so that cause to be retracted or detached, and distal loop may be disrupted. To avoid these problems, we designed subtotally divided end-loop colostomy and studied its clinical effectiveness retrospectively. METHODS: About a 3 cm diameter, round skin incision as presumed colostomy size was made at the left lower abdomen, and entered the abdominal cavity by splitting the rectus muscle fibers. The caudal side of colon can be identified by confirming the fusioned taenia at the rectosigmoid colon level. After pulling out the colonic loop, the distal colon far from the lesion was subtotally divided by a GIA staple or manual suture, which cut obliquely 80% or 90% from the antimesenteric side of the distal loop while maintaining the 10% or 20% mesenteric side of the colonic loop. Then an end-loop colostomy is matured with a small fistularization of the distal loop as the undivided mesenteric side of colon. RESULTS: In 8 cases, subtotally divided colonic loop using a GIA staple. But in 9 cases, divided manually because of makedly thickened, edematous colonic wall resulting from prolonged obstruction. There were several mild complications, i.e. transient dermatitis in 5 cases, transient bulky stoma due to edema in 4 cases, mild retraction of stoma in 2 cases, and mild prolapse of stoma in 1 case. There were no major functional abnormalities during the follow-up period. CONCLUSIONS: Although we need to get further clinical experiences, the subtotally divided end-loop colostomy seems to be a useful alternative surgical procedure for unresectable rectal cancer.
Abdomen ; Abdominal Cavity ; Colon ; Colostomy* ; Dermatitis ; Edema ; Follow-Up Studies ; Humans ; Inflammation ; Prolapse ; Rectal Neoplasms* ; Retrospective Studies ; Skin ; Sutures ; Taenia

Transplantation studies about the clinical differences according to the type of donors are mostly conducted in western countries with rare reports from Asians. The aims of this study were to evaluate the clinical impacts of the type of donor, and the predictors of 1-year mortality in patients who underwent liver transplantation (LT). This study was performed for liver transplant recipients between May 2010 and December 2014 at the Pusan National University Yangsan Hospital. A total of 185 recipients who underwent LT were analyzed. Of the 185 recipients, 109 (58.9%) belonged to the living donor liver transplantation (LDLT) group. The median age was 52.4 years. LDLT recipients had lower model for end-stage liver disease (MELD) score compared with better liver function than deceased donor liver transplantation (DDLT) recipients (mean ± standard deviation [SD], 12.5 ± 8.3 vs. 24.9 ± 11.7, respectively; P < 0.001), and had more advanced hepatocellular carcinoma (HCC) (62.4% vs. 21.1%, respectively; P = 0.001). In complications and clinical outcomes, LDLT recipients showed shorter stay in intensive care unit (ICU) (mean ± SD, 10.8 ± 8.8 vs. 23.0 ± 13.8 days, respectively, P < 0.001), ventilator care days, and post-operative admission days, and lower 1-year mortality (11% vs. 27.6%, respectively, P = 0.004). Bleeding and infectious complications were less in LDLT recipients. Recipients with DDLT (P = 0.004) showed higher mortality in univariate analysis, and multi-logistic regression analysis found higher MELD score and higher pre-operative serum brain natriuretic peptide (BNP) were associated with 1-year mortality. This study may guide improved management before and after LT from donor selection to post-operation follow up.
Asian Continental Ancestry Group ; Busan ; Carcinoma, Hepatocellular ; Donor Selection ; Follow-Up Studies ; Gyeongsangnam-do ; Hemorrhage ; Humans ; Intensive Care Units ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors ; Mortality* ; Natriuretic Peptide, Brain ; Tissue Donors* ; Transplant Recipients ; Ventilators, Mechanical

PURPOSE: Multiple segment 5 vein (V5) anastomoses are common and inevitable in living donor liver transplantation (LDLT) using modified right lobe (MRL) graft. Sacrifice of segment 4a vein (V4a) can simplify bench work and avoid graft congestion. But it could be harmful to some donors in previous simulation studies. This study aimed to evaluate donor safety in LDLT using caudal middle hepatic vein trunk preserved right lobe (CMPRL) graft. METHODS: LDLT using MRL grafts were performed on 33 patients (group A) and LDLT using CMPRL grafts were performed on 37 patients (group B). Group B was classified into 2 subgroups by venous drainage pattern of segment 4: V4a dominant drainage group (group B1) and the other group (group B2). Parameters compared between group A donors and group B donors included operation time, bench work time, number and diameter of V5, remnant liver volume and postoperative course. Those were also investigated in group B1 compared with group B2. And, we reviewed postoperative course of the recipients in groups A and B. RESULTS: Operation time and bench work time in group B were significantly shorter. There were no significant differences in most postoperative parameters between groups B1 and B2. As a result of recipient, V5 patency rates after LDLT were significantly higher in group B. CONCLUSION: LDLT using CMPRL graft is a safe procedure for living donors. Donors with any type of V4 could be proper candidates for CMPRL graft if remnant liver volume is greater than 30% with minimal fatty change.
Drainage ; Estrogens, Conjugated (USP) ; Hepatectomy ; Hepatic Veins* ; Humans ; Liver ; Liver Transplantation* ; Living Donors* ; Tissue Donors ; Transplants* ; Veins

Idiopathic portal hypertension (IPH) is a rare disorder which is clinically characterized by portal hypertension, splenomegaly, hypersplenism and the absence of liver cirrhosis. Patients with IPH have massive splenomegaly leading to increased portal venous flow and subsequent portal hypertension. In selected IPH patients with splenomegaly and hypersplenism, splenectomy can be regarded as an effective treatment protocol for decreasing portal hypertension. We report a case of a 44-year-old woman who was diagnosed with IPH accompanied by splenomegaly and hypersplenism. She underwent laparoscopic splenectomy and clinical symptoms and hypersplenism resolved. Our study shows that laparoscopic splenectomy can be considered as a procedure for treating patients with splenomegaly and hypersplenism due to IPH.
Adult ; Clinical Protocols ; Female ; Humans ; Hypersplenism* ; Hypertension, Portal* ; Liver Cirrhosis ; Splenectomy* ; Splenomegaly*

A 13-year-old girl, who had undergone the total correction of partial atrioventricular septal defect at the age of 4 years, was admitted with severe tricuspid regurgitation in echocardiography. She had received one-and-a-half ventricle repair during follow-up. Her right ventricle showed global akinesia, and the ejection fraction of the left ventricle was 25% with paradoxical interventricular septal motion. We performed right ventricular exclusion adjunct to the Fontan procedure. She is doing well two years after the operation without complications.
Adolescent ; Echocardiography ; Female ; Follow-Up Studies ; Fontan Procedure* ; Heart Ventricles* ; Humans ; Magnetic Resonance Imaging ; Tricuspid Valve Insufficiency

BACKGROUND: The Damus-Kaye-Stansel (DKS) procedure is a method for mitigating the risk of systemic ventricular outflow tract obstruction (SVOTO). However, there have been few reports on which surgical technique shows a better outcome. The objective of this study was to compare the outcome of the DKS procedure according to the surgical technique used. METHODS: We retrospectively reviewed 12 consecutive patients who underwent the DKS procedure from March 2004 to April 2013. When the relationship of the great arteries was anterior-posterior, the double-barrel technique (group A) was performed. If the relationship was side-by-side, the ascending aortic flap technique (group B) was performed. RESULTS: There was no early mortality and 1 late mortality in group B. There was no statistically significant difference in the median peak pressure gradient of preoperative subaortic stenosis in both groups: 14 mmHg (range, 4 to 53 mmHg) in group A and 15 mmHg (range, 0 to 30 mmHg) in group B (p=0.526). Further, a significant postoperative pressure gradient was not observed in either group A or group B. More than moderate postoperative neoaortic regurgitation was observed in 1 patient of group B; this patient underwent neoaortic valve replacement 66 months after the DKS procedure. No one had a recurrent SVOTO during follow-up. CONCLUSION: The DKS procedure is an effective way to minimize the risk of SVOTO, and there is little difference in the outcomes of the DKS procedure according to the surgical technique used.
Arteries ; Constriction, Pathologic ; Follow-Up Studies ; Fontan Procedure ; Humans ; Mortality ; Retrospective Studies

Traumatic neuroma (TN), also known as amputation neuroma, is a reactive hyperplasia of nerve fibers and connective tissue arising from Schwann cells after trauma or surgery. TN of the bile duct is usually asymptomatic, but rarely can lead to right upper quadrant pain, biliary obstruction, and acute cholangitis. It is very difficult to discriminate TN from malignancy before surgery, although doing so could avoid an unnecessary radical resection of the lesion. In the course of surgery, TN can be caused by unintentional injury of a nerve fiber near the common bile duct (CBD) and heat damage to an artery, complete ligation of an artery, and excessive manipulation of the CBD. Therefore, to prevent TN after cholecystectomy, surgery should be performed carefully with appropriate consideration of anatomic variations, and a cystic duct should not be resected too close to the CBD. The possibility of TN should be considered if a patient who has undergone CBD resection with hepaticojejunostomy or cholecystectomy long ago experiences symptoms of jaundice, cholangitis, or obliteration of the CBD. In this report, we present a case of TN mimicking cholangiocarcinoma that emerged from a cystic duct stump after cholecystectomy.

BACKGROUND/AIMS: Infections following liver transplant (LT) remain a major cause of mortality. This study was conducted to evaluate risk factors for infection and to review clinical characteristics. METHODS: Medical records of patients who underwent LT from 2010 to 2014 were retrospectively analyzed. Binary logistic regression analysis was used to investigate risk factors of infection. Kaplan-Meier analysis was used to predict prognosis of infected and non-infected groups. RESULTS: Of 185 recipients, 89 patients experienced infectious complications. The median follow-up period was 911 days (range, 9 to 2,031). The infected group had higher 1-year mortality (n = 22 [24.7%] vs. n = 8, [8.3%], p = 0.002), and longer postoperative admission days (mean: 53.7 ± 35.8 days vs. 28.3 ± 13.0 days, p < 0.001), compared to the non-infected group. High preoperative Model for End-Stage Liver Disease (MELD) score (odds ratio [OR], 1.057; 95% confidence interval [CI], 1.010 to 1.105; p = 0.016), deceased-donor type (OR, 5.475; 95% CI, 2.442 to 12.279; p < 0.001), and acute rejection (OR, 3.042; 95% CI, 1.241 to 7.454; p = 0.015) were independent risk factors associated with infection. Intra-abdominal infection (n = 35, 20.8%) was the major infectious complication. Among identified bacteria, Enterococcus species (28.4%) were major pathogens, followed by Escherichia coli and Klebsiella species. CONCLUSIONS: High preoperative MELD score, deceased-donor type, and acute rejection were risk factors associated with infection. To prevent infections following surgery, it is important to determine the appropriate time of operation before the recipient has a high MELD score.
Bacteria ; Enterococcus ; Escherichia coli ; Follow-Up Studies ; Humans ; Intraabdominal Infections ; Kaplan-Meier Estimate ; Klebsiella ; Liver Diseases ; Liver Transplantation ; Liver* ; Logistic Models ; Medical Records ; Mortality ; Prognosis ; Retrospective Studies ; Risk Factors ; Transplant Recipients*

Background: s/Aims: The hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is classified as the advanced stage (BCLC stage C) with extremely poor prognosis, and in current guidelines is recommended for systemic therapy. This study aimed to evaluate the surgical outcomes and long-term prognosis after hepatic resection (HR) for patients who have HCC combined with PVTT. Methods: We retrospectively analyzed 332 patients who underwent HR for HCC with PVTT at ten tertiary referral hospitals in South Korea. Results: The median overall and recurrence-free survival after HR were 32.4 and 8.6 months, while the 1-, 3-, and 5-year overall survival rates were 75%, 48%, and 39%, respectively. In multivariate analysis, tumor number, tumor size, AFP, PIVKA−II, neutrophil-to-lymphocyte ratio, and albumin–bilirubin (ALBI) grade were significant prognostic factors. The risk scoring was developed using these seven factors–tumor, inflammation and hepatic function (TIF), to predict patient prognosis. The prognosis of the patients was well stratified according to the scores (log-rank test, p < 0.001). Conclusions HR for patients who have HCC combined with PVTT provided favorable survival outcomes. The risk scoring was useful in predicting prognosis, and determining the appropriate treatment strategy for those patients who have HCC with PVTT.

Background: s/Aims: The hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is classified as the advanced stage (BCLC stage C) with extremely poor prognosis, and in current guidelines is recommended for systemic therapy. This study aimed to evaluate the surgical outcomes and long-term prognosis after hepatic resection (HR) for patients who have HCC combined with PVTT. Methods: We retrospectively analyzed 332 patients who underwent HR for HCC with PVTT at ten tertiary referral hospitals in South Korea. Results: The median overall and recurrence-free survival after HR were 32.4 and 8.6 months, while the 1-, 3-, and 5-year overall survival rates were 75%, 48%, and 39%, respectively. In multivariate analysis, tumor number, tumor size, AFP, PIVKA−II, neutrophil-to-lymphocyte ratio, and albumin–bilirubin (ALBI) grade were significant prognostic factors. The risk scoring was developed using these seven factors–tumor, inflammation and hepatic function (TIF), to predict patient prognosis. The prognosis of the patients was well stratified according to the scores (log-rank test, p < 0.001). Conclusions HR for patients who have HCC combined with PVTT provided favorable survival outcomes. The risk scoring was useful in predicting prognosis, and determining the appropriate treatment strategy for those patients who have HCC with PVTT.