1.Familial Adenomatous Polyposis: Two cases.
Yoo Shin CHOI ; Kyong Choun CHI ; In Taik CHANG
Journal of the Korean Surgical Society 1999;57(5):745-752
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
2.Analysis of Prognostic Factors in 448 Gastric Cancer Patients Treated with a Gastric Resection.
Sung Pil AHN ; Young Kum PARK ; Kyong Choun CHI ; In Taik CHANG
Journal of the Korean Surgical Society 1999;57(5):684-692
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
3.Post-extubation negative pressure pulmonary edema complicating laparoscopic appendectomy: A report of two cases.
Seung Eun LEE ; Kyong Choun CHI ; Yong Hun JUNG
Anesthesia and Pain Medicine 2012;7(1):34-37
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
4.Laparoscopic Gastrectomy Performed by an Expert in Open Gastrectomy.
Kyong Choun CHI ; Joong Min PARK
Journal of Gastric Cancer 2017;17(3):237-245
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
5.Long-limb Roux-en-Y Reconstruction after Subtotal Gastrectomy to Treat Severe Diabetic Gastroparesis
Joong Min PARK ; Jong Won KIM ; Kyong Choun CHI
Journal of Gastric Cancer 2019;19(3):365-371
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
6.Antireflux surgery is equally beneficial in nonerosive and erosive gastroesophageal reflux disease.
Joong Min PARK ; Kyong Choun CHI
Annals of Surgical Treatment and Research 2018;95(2):94-99
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
7.Factors for Conversion from Laparoscopic Cholecystectomy to Open Cholecystectomy.
Yong Seok KIM ; In Taik CHANG ; Yong Gum PARK ; Jung Hyo LEE ; Kyong Choun CHI ; Sang Jun KIM
Journal of the Korean Surgical Society 2002;63(3):233-237
PURPOSE: Laparoscopic cholecystectomy (LC) has replaced open cholecystectomy (OC) for the majority of patients. However, a minority of patients still require conversion to open cholecystectomy during the perioperative period. This study was designed to determine the contributing factors related to conversion to open cholecystectomy. METHODS: The data from 3,510 laparoscopic cholecystectomies, performed at Chung-Ang university hospital from September 1990 to June 2001, were reviewed retrospectively. Pre-operative laboratory data, post-operative pathologic findings, complications, and the reasons for conversion to open cholecystectomy were evaluated. RESULTS: Sixty six (1.88%) of 3,510 patients were converted to open surgery, due to bleeding (39%), adhesion (26%), bile duct injury (23%) and inflammation (6%). These conversion cases were more prevalent in males and needed longer hospital stay. Thickening of the gallbladder wall and gangrenous cholecystitis were frequent pathologic findings among the conversion cases. CONCLUSION: Thickening of the gallbladder wall, inflammation and anatomical variation of the gallbladder were important factors for conversion to open surgery. Thus, these predictive findings allow the surgeons to preoperatively discuss the higher risk of conversion and allow for an earlier judgement and decision on conversion if intraoperative difficulty is encountered.
Bile Ducts
;
Cholecystectomy*
;
Cholecystectomy, Laparoscopic*
;
Cholecystitis
;
Conversion to Open Surgery
;
Gallbladder
;
Hemorrhage
;
Humans
;
Inflammation
;
Length of Stay
;
Male
;
Perioperative Period
;
Retrospective Studies
8.Comparison of Clinical Differences between Colonic Obstruction and Non-obstruction Groups in Colon Surgery.
Woo Jung SIM ; Yong Keum PARK ; Kyong Choun CHI ; Jung Hyo LEE ; In Taik CHANG ; Sang Jhoon KIM
Journal of the Korean Society of Coloproctology 2002;18(2):65-72
PURPOSE: The purpose for this study is to compare the clinical differences of the two groups (ie. colonic obstruction and non-obstruction) in colonic surgery. METHODS: A retrospective clinical analysis was done in 149 patients with colorectal disease who had been surgically treated from January 1995 to December 1997 at our institution. RESULTS: 1) The peak age of incidence was in the 7th. and 8th. decades (53.3%)in the obstruction group and 6th. and 7th. decades (54.3%) in the non-obstruction group, the sex ratio of male to female was higher in the obstruction group (2.00:1) than in the non-obstruction group (1.04:1). 2) The most common cause of colonic obstruction was malignant disease in both groups (75.4% in the obstruction group and 78.3% in the non-obstruction group). 3) The most frequent symptom and sign of the two groups were abdominal pain (36.8% and 2.6% respectively). 4) The most common location was cecum (24.6%) followed by sigmoid colon (22.8%) and rectum (15.8%) in the obstruction group, and rectum (40.2%) followed by ascending colon (15.2%), cecum (13.0%), and transverse colon (13.1 %) in the non obstruction group. 5) The right hemicolectomy was the most common procedure in the obstruction group (29.8%) while abdominoperineal resection was most frequently performed in the non-obstruction group (23.9 %). The surgical resection rate was 77.4% and 100% in obstruction group and non-obstruction group, respectively. 6) In the case of colon cancer, the stage of cancer (according to Modified Astler-Coller classification) was much higher in the obstruction group. An average 6.5 metastatic lymph nodes were found from 18.5 dissected lymph nodes in the obstruction group whereas 2.7 out of 13.9 lymph nodes in the non-obstruction group. 7) The postoperative complication rate of obstruction group were 21.4% whereas that of non-obstruction group were 15.0% respectively. The postoperative mortality rate was 14% in the obstruction group and 3.3% in the non-obstruction group. The complication rate and postoperative mortality of the obstruction group was higher than those of the non-obstruction group, especially in the malignant disesae group. CONCLUSIONS: The results of our study indicate that the obstruction group has a different clinical course from the non- obstruction group and associated higher postoperative complication and mortality rate.
Abdominal Pain
;
Cecum
;
Colon*
;
Colon, Ascending
;
Colon, Sigmoid
;
Colon, Transverse
;
Colonic Neoplasms
;
Colorectal Neoplasms
;
Female
;
Humans
;
Incidence
;
Lymph Nodes
;
Male
;
Mortality
;
Postoperative Complications
;
Rectum
;
Retrospective Studies
;
Sex Ratio
9.Factors predicting outcomes of laparoscopic Nissen fundoplication for gastroesophageal reflux disease: experience at a single institution in Korea.
Joong Min PARK ; Beom Jin KIM ; Jae Gyu KIM ; Kyong Choun CHI
Annals of Surgical Treatment and Research 2017;92(4):184-190
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
10.A Case of Massive Hemobilia after Laparoscopic Cholecystectomy.
Woo Jung SIM ; Yong Keum PARK ; Kyong Choun CHI ; Jung Hyo LEE ; In Taik CHANG ; Sang Jhoon KIM
Journal of the Korean Surgical Society 1999;57(2):299-303
"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