PURPOSE: Senior surgeons prefer open gastrectomy (OG), while young surgeons prefer laparoscopic gastrectomy (LG). The purpose of this study was to evaluate the surgical outcomes of LG performed by a senior surgeon who was an expert in OG during his learning period, by comparing them with LGs performed by a young surgeon. MATERIALS AND METHODS: A senior surgeon performed 50 curative gastrectomies with laparoscopy (LG-S group) from March 2015 to August 2016. A young surgeon's initial 50 LGs comprised the LG-Y group. Clinicopathological characteristics and surgical outcomes were compared between the LG-S and LG-Y groups. RESULTS: D2 lymphadenectomy was more frequently performed in the LG-S group than in the LG-Y group (P=0.029). The operation time and number of retrieved lymph nodes did not significantly differ between the 2 surgeons (P=0.258 and P=0.410, respectively). Postoperative hospital stay and postoperative complication rate were similar between 2 groups (P=0.234 and P=1.000, respectively). Similarly, significant decreases in operation time with increasing case numbers were observed for both surgeons, whereas the number of retrieved lymph nodes increased significantly in the LG-Y group but not in the LG-S group. CONCLUSIONS: The LG outcomes when performed by the senior surgeon were comparable to those when performed by the young surgeon, despite performing more extended lymphadenectomies. Senior surgeons who are experts in OG should not refrain from performing LG.
Gastrectomy* ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Postoperative Complications ; Stomach Neoplasms ; Surgeons

Familial adenomatous polyposis and Gardner's syndrome originate from a chromosomal abnormality, and their incidence is very rare. These diseases frequently have a familial tendency, but 10-20% do not. We experienced two cases of familial adenomatous polyposis. One had a familial tendency and was only a colonic abnormality in a 25-year-old man. The other, a 25-year-old woman had not familial tendency and lesions were consisted of colonic polyposis, a desmoid tumor of abdominal wall, and congenital hypertrophy of both retinal pigmented epithelia. We report these cases with a brief review of the literature.
Abdominal Wall ; Adenomatous Polyposis Coli* ; Adult ; Chromosome Aberrations ; Colon ; Female ; Fibromatosis, Aggressive ; Gardner Syndrome ; Humans ; Hypertrophy ; Incidence ; Retinaldehyde

BACKGROUND: Among malignant diseases, gastric cancer remains a major cause of death in Korea. Many variables are considered to be important to the prognosis of patients with gastric carcinomas. METHODS: The authors evaluated the 5-year survival rates and analyzed the prognostic factors in 448 patients with gastric cancer who had under gone a gastric resection during the period between Dec. 1984 and Dec. 1992. RESULTS: The overall 5-year survival rate was 50.5%, and the survival rates according to the stage were stage Ia, 97.4%; Ib, 56.5%; II, 48.4%; IIIa, 41.6%; IIIb, 7.1%; and stage IV, 14.3%. Univariate analysis was used to relate prognostic factors, such as tumor size, gross type, depth of invasion, lymph node involvement, positive lymph node ratio, distant metastasis, complications, the surgical curability, and the TNM stage, with the survival of the patients. In a multivariate analysis using 11 variables, the TNM stage was the most significant prognostic factor. Besides the TNM stage, the depth of invasion, a lymph node involvement, a positive lymph node ratio, and complications were considered as independent prognostic factors influencing survival. CONCLUSIONS: The current TNM staging system appears to be a reasonable one, and the TMN stage of the tumor at the time of surgery is the most important prognostic factor.
Cause of Death ; Humans ; Korea ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Stomach Diseases ; Stomach Neoplasms* ; Survival Rate

We report two cases of post-extubation negative pressure pulmonary edema in otherwise healthy patients. The patients underwent laparoscopic appendectomy under general anesthesia and developed negative pressure pulmonary edema immediately after extubation. All cases fully resolved within 24 hours with supplementary oxygen. The literature suggests that post-extubation pulmonary edema occurs more frequently than is generally thought, with a frequency of 0.05-0.1% in all anesthesia, and is often unrecognized or misdiagnosed. Most cases occur in the early post-operative period, and this is potentially life-threatening condition. Therefore, anesthesiologist and surgeon are well placed to witness, investigate and manage this condition.
Anesthesia ; Anesthesia, General ; Appendectomy ; Humans ; Oxygen ; Pulmonary Edema ; Wit and Humor as Topic

The role of surgical intervention in patients with diabetic gastroparesis is unclear. We report a case of a 37-year-old man with a history of recurrent episodes of vomiting and long-standing type 2 diabetes mellitus. Esophagogastroduodenoscopy did not reveal any findings of reflux esophagitis or obstructive lesions. A gastric emptying time scan showed prolonged gastric emptying half-time (344 minutes) indicating delayed gastric emptying. Laboratory tests revealed elevated fasting serum glucose and glycosylated hemoglobin (HbA1c, 12.9%) and normal fasting C-peptide and insulin levels. We performed Roux-en-Y reconstruction after subtotal gastrectomy to treat gastroparesis and improve glycemic control, and the patient showed complete resolution of gastrointestinal symptoms postoperatively. Barium swallow test and gastric emptying time scan performed at follow-up revealed regular progression of barium and normal gastric emptying. Three months postoperatively, his fasting serum glucose level was within normal limits without the administration of insulin or oral antidiabetic drugs with a reduced HbA1c level (6.9%). Long-limb Roux-en-Y reconstruction after subtotal gastrectomy may be useful to treat severe diabetic gastroparesis by improving gastric emptying and glycemic control.
Adult ; Barium ; Blood Glucose ; C-Peptide ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Endoscopy, Digestive System ; Esophagitis, Peptic ; Fasting ; Follow-Up Studies ; Gastrectomy ; Gastric Emptying ; Gastroparesis ; Hemoglobin A, Glycosylated ; Humans ; Hypoglycemic Agents ; Insulin ; Vomiting

PURPOSE: Although nonerosive and erosive gastroesophageal reflux disease (GERD) have similar symptom severity, nonerosive reflux disease (NERD) is considered a milder type of GERD and gastroenterologists have hesitated to refer these patients for antireflux surgery. The aim of this study was to compare surgical outcomes of antireflux surgery between patients with NERD and erosive reflux disease (ERD). METHODS: Seventy patients met the inclusion criteria of this study among a total of 117 patients who underwent antireflux surgery from November 2012 to October 2017. According to preoperative endoscopy, patients were classified into NERD group (minimal changes or no esophagitis) and ERD group. Clinical characteristics and surgical outcomes were compared between NERD and ERD. RESULTS: There were 26 patients in NERD group and 44 patients in ERD group. The male:female ratio was higher in the ERD group than in the NERD group (P = 0.044). Preoperative symptoms, response to acid suppressive medication, acid exposure on pH monitoring study, and esophageal manometry results were similar in the 2 groups. Reflux on barium esophagography was more frequently observed in ERD (77.3%) than in NERD (50.0%, P = 0.019). At 6 months after surgery, complete resolution and partial improvement of GERD symptoms were similar in the 2 groups (80.8% and 15.4%, respectively, in NERD vs. 88.6% and 2.3%, respectively, in ERD; P = 0.363). CONCLUSION: Laparoscopic Nissen fundoplication is equally beneficial to patients with NERD and ERD. Antireflux surgery should not be avoided for GERD patients without mucosal breaks on endoscopy as the evidence of erosive esophagitis.
Barium ; Endoscopy ; Esophagitis ; Fundoplication ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration ; Manometry

PURPOSE: An increased incidence of cholelithiasis has been widely reported following a truncal vagotomy and gastrectomy in benign peptic ulcer disease. However, there have been few studies on cholelithiasis following a gastrectomy in gastric cancer patients. Therefore, the incidence, influencing factors, natural course and whether a prophylactic cholecystectomy is required during a gastrectomy were investigated. METHODS: 1, 057 patients with gastric cancer, who received a gastrectomy at Chung-Ang University Hospital between January, 1992 and December, 2001, were reviewed. Of the 1, 057 patients, 591 were included in this study, with 420 and 46 patients excluded due to lack of follow-up after the gastrectomy and because they received a preoperative or concomitant cholecystectomy, respectively. Age, gender, extents of gastrectomy, anastomosis methods and cancer staging were investigated as factors for potential correlation with any incidence. Furthermore, the interval between the gastrectomy and the discovery of cholelithiasis and the number of patients receiving a cholecystectomy due to cholecystitis during the follow-up period were also studied. RESULTS: The preoperative prevalence of cholelithiasis was 7.22% (46/637). The incidence of cholelithiasis after a gastrectomy was 7.61% (45/591), with a mean duration of 32.13+/-28.18 months. There were no significant differences in the incidences of cholelithiasis according to age, gender, extents of gastrectomy or stage (P>0.05). 23 cases of cholelithiasis (50%) were detected within 24 months and 80% (36/45) of all cases developed within 48 months. Among the 45 gallstone patients, only 6 (13.33%) developed acute cholecy- stitis and received a cholecystectomy. CONCLUSION: The incidence of cholelithiasis after a gastrectomy was very low, and was independent of age, gender, and other influencing factors in our study. Therefore, close observation and follow-up evaluation would be helpful in the prevention and detection of cholelithiasis. Also further study will be needed on the relationship between the methods of anastomosis and the incidence of cholelithiasis. The clinical benefits of a prophylactic cholecystectomy during a gastrectomy should also be studied carefully.
Cholecystectomy ; Cholecystitis ; Cholelithiasis* ; Follow-Up Studies ; Gallstones ; Gastrectomy ; Humans ; Incidence ; Neoplasm Staging ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms* ; Vagotomy, Truncal

PURPOSE: Laparoscopic fundoplication is considered the standard surgical treatment for gastroesophageal reflux disease (GERD) in Western countries. However, some patients experience poor surgical outcomes with this procedure. The study aimed to identify the predictive factors of the surgical outcomes of laparoscopic Nissen fundoplication for the treatment of Korean GERD patients. METHODS: Sixty-one patients with GERD were treated using laparoscopic Nissen fundoplication between November 2012 and February 2015. Symptom control rates were compared according to clinical and surgical factors to identify predictive factors of successful surgical outcomes. RESULTS: Thirty-five men and 26 women were enrolled. Preoperatively, typical symptoms were present in 60 patients (98%), while atypical symptoms were present in 40 patients (66%). Postoperatively, typical symptoms were controlled in 51 of 60 patients (85.0%), while atypical symptoms were controlled in 33 of 40 patients (82.5%). Overall, at 6 months postsurgery, 54 (88.5%) reported some resolution of GERD symptoms, with 48 (78.7%) achieving complete control. Patients who exhibited a good response to proton pump inhibitor therapy had a significantly greater rate of complete symptom control (P = 0.035). CONCLUSION: Laparoscopic fundoplication is effective for controlling GERD symptoms. Response to preoperative proton pump inhibitor was a predictor of successful outcome.
Female ; Fundoplication* ; Gastroesophageal Reflux* ; Humans ; Korea* ; Laparoscopy ; Male ; Proton Pumps

"Hemobilia" upper gastrointestinal bleeding that originates from within the biliary tract, is a rare complication of the laparoscopic cholecystectomy. Only a few cases have been reported in the literature. It is more common in accidential or iatrogenic injury of the liver and bile ducts, even occurring spontaneously in cholelithiasis, several inflamatory processes, and vascular and neoplastic changes. The laparoscopic cholecystectomy is a recently developed and advanced surgical procedure that has rapidly gained acceptance. Its complications remain to be clinically analyzed. The authors experienced a case of massive hemobilia after a laparoscopic cholecystectomy. A 54-years-old man with hemobila resulting from right hepatic artery pseudoaneurysm communicating with the intra-hepatic bile duct was treated with angiographic tanscatheter embolization on the of 24th postoperative day. We report this case with a brief review of the literature.
Aneurysm, False ; Bile Ducts ; Biliary Tract ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Hemobilia* ; Hemorrhage ; Hepatic Artery ; Liver

We experienced a case of synchronously occurring multiple leiomyosarcoma in the jejunum and stomach. The presented case was a 75-year-old man with signs of panperitonitis. We performed a subtotal gastrectomy, a segmental resection of the jejunum and a Roux-en-Y anastomosis. Histologic examination of the resected specimen revealed a high-grade leiomyosarcoma having a high-grade mitosis and pleomorphism. Although it showed high malignancy potential, it was less than 5 cm in size. Also, it was a synchronously occurring multiple leiomyosarcoma having a sparing lesion in the duodenum and showed a lymphatic metastasis. In that point of view, it had many unusual aspects.
Aged ; Anastomosis, Roux-en-Y ; Duodenum ; Gastrectomy ; Humans ; Intestine, Small* ; Jejunum ; Leiomyosarcoma* ; Lymphatic Metastasis ; Mitosis ; Stomach*