Type 2 diabetes mellitus (T2DM) has become an epidemic. Compared to Western countries, Asian T2DM occurs in patients with a lower body mass index, due to central obesity and decreased pancreatic beta-cell function. The efficacy of surgical treatment such as sleeve gastrectomy, adjustable gastric banding, and gastric bypass in obese patients with T2DM has been demonstrated by numerous studies from Western countries. However, current evidence on surgical treatment for non-morbidly obese diabetic patients is lacking. Recently, several preliminary studies demonstrated the remission of hyperglycemia in non-obese T2DM patients by surgical bypass. One possible hypothesis is the foregut theory an inactivation of the anti-incretin system through the exclusion of the foregut from ingested food, and the other is the hindgut theory, in which rapid hindgut exposure prompts the delivery of undigested food to the terminal ileum and promotes the activation of incretin system such as glucagon-like peptide-1 The following teaching points and direction of future study are recommended: understanding the mechanism of diabetic remission through surgical procedure, defining the surgical indications for T2DM, predicting the possible complications and disadvantages of surgical treatment, and understanding the peculiarity of each surgical procedure. The remission of hyperglycemia in non-obese T2DM patients could possibly be achieved by surgical intervention. Although long-term follow-up data and verification of its exact mechanisms are required, early operative outcomes were satisfactory in terms of glycemic control and the safety of the procedure.
Asian Continental Ancestry Group ; Body Mass Index ; Diabetes Mellitus, Type 2 ; Gastrectomy ; Gastric Bypass ; Glucagon-Like Peptide 1 ; Humans ; Hyperglycemia ; Ileum ; Incretins ; Obesity, Abdominal

PURPOSE: The introduction of a mesh to ventral herniorrhaphy ensures abdominal wall strength without tension, and this procedure has shown a decreased recurrence rate, a shorter hospital stay and less use of analgesics. However, the extensive tissue dissection required for mesh placement leads to increased postoperative complications. Yet with the development of laparoscopic ventral herniorrhaphy, we expect earlier recovery, fewer complications and decreased recurrence rates. This study was done to compare the outcomes after open and laparoscopic ventral herniorrhaphy with using mesh through a retrospective review. METHODS: The outcomes for 20 consecutive patients who underwent laparoscopic ventral herniorrhaphy were compared with those of 20 consecutive patients who underwent open herniorrhaphy. The laparoscopic repairs were performed using the intraperitoneal onlay mesh (IPOM) repair with transfascial fixation method in all the cases. RESULTS: The forty patients (24 women and 16 men) had a mean age of 57.48 years (range, 33~82). The mean follow-up time was 63.4 months. The mean surgery duration (67.4 min vs 142.3 min, respectively, p=0.003) and postoperative stay (4.7 vs 16.2 days, respectively, p<0.0001) were shorter for the laparoscopic group. The number of shots of analgesics during the first 3 days after surgery was 1.9 vs 2.4 shots, respectively (p=0.019). There were fewer complications (30%) and recurrences (5%) among the patients who underwent laparoscopic repair than those for the patients who underwent open repair (65% and 10 %, respectively). CONCLUSION: Those findings shows that laparoscopic ventral herniorrhaphy with transfascial fixation seems to be safe and effective and it showed a shorter operative time, fewer complications, a shorter hospital stay and less recurrence than did open ventral herniorrhaphy.
Abdominal Wall ; Analgesics ; Female ; Follow-Up Studies ; Hernia, Ventral ; Herniorrhaphy ; Humans ; Inlays ; Length of Stay ; Operative Time ; Postoperative Complications ; Recurrence ; Retrospective Studies

The most plausible contributing factor to non-obese type 2 diabetes may be imbalanced incretin release from the intestinal epithelium in response to nutrients. Rerouting intestinal continuity through bypass surgery to modulate incretin release is therefore a reasonable treatment. We believe that a major determinant of metabolic outcomes is entire duodenal exclusion without leaving any duodenal epithelium and exclusion of sufficient length of jejunum. More importantly, the procedure should be implemented with safety and without sequelae. To achieve this, we invented a novel procedure with acceptable surgical safety and excellent and durable metabolic outcomes. Post-surgical intestinal adaptation should be considered to achieve successful outcomes.

PURPOSE: Despite advancements in surgery, laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia in patients with previous lower abdominal surgeries has been a burden to surgeons. This study was conducted in order to assess the feasibility of laparoscopic intraperitoneal onlay m esh (IPOM) hernia repair as an alternative method for these cases. METHODS: From May 2006 to November 2010, 48 IPOM repairs were performed in 43 patients. All medical records were reviewed retrospectively. RESULTS: Mean age of patients was 61 years old and male to female ratio was 37:6. Five were direct and 43 were indirect hernias. There were 15 recurrent inguinal hernias after either open or laparoscopic hernia repair, and five of 15 were recurrent cases more than two times. Mean operative time was 44.5 minutes, and mean postoperative hospital stay was 1.41 days. There were two cases of postoperative swelling at the groin area and two patients complained of pain that required oral pain-killers during out-patient follow-ups. Recurrence developed in one case. CONCLUSION: Even though laparoscopic IPOM repair is not a preferred m ethod for inguinal hernia, it can be applied as an alternative method in specific cases involving difficulties in approaching the usual plane of repair.
Female ; Follow-Up Studies ; Groin ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Inlays* ; Laparoscopy ; Length of Stay ; Male ; Medical Records ; Operative Time ; Outpatients ; Recurrence ; Retrospective Studies

PURPOSE: We wanted to measure and compare the patient demographics and perioperative outcomes between patients with incarcerated and patients with non-incarcerated inguinal hernia. METHODS: We conducted a retrospective analysis of 945 patients who were scheduled for laparoscopic total extraperitoreal (TEP) repair of inguinal hernia from May 2002 to May 2010. There were 66 patients who had incarcerated hernia and 879 patients who had non-incarcerated hernia. RESULTS: The mean age was younger in the incarcerated hernia group than in the non-incarcerated hernia group (41.67 vs. 48.50 years, P < 0.01), and all the incarcerated inguinal hernias patients were male. Most of the incarcerated hernias (63 out of 66 cases, 95%) were indirect hernias. The mean hospital stay showed no difference between the two groups (1.03 vs. 0.93 days, P = 0.142) but the operation time was longer for the incarcerated group than that for the non-incarcerated group (33.36 vs. 24.59 minutes, P < 0.01). Postoperative swelling (including seroma) was more frequent in the incarcerated group (14 out of 66 cases, 21%, P < 0.01), but postoperative pain was similar in both groups (3.0 vs. 8.9%, P = 0.095). There was one recurrence in the non-incarcerated group, but this had no statistical significance. CONCLUSION: Laparoscopic TEP repair for the patients with chronic incarcerated inguinal hernias was safe and feasible. However, a well-designed study is needed to confirm if it is suitable for acute incarcerated inguinal hernias.
Demography ; Hernia ; Hernia, Inguinal ; Humans ; Length of Stay ; Male ; Pain, Postoperative ; Pyrazines ; Recurrence ; Retrospective Studies

No abstract available.
Aprotinin* ; Heart* ; Hemostasis* ; Thoracic Surgery*

PURPOSE: Despite acceptance of laparoscopic totally extraperitoneal (TEP) repair for repair of inguinal hernia, it is still considered to require a prolonged learning curve. We hypothesized that there would be differences in the learning curve for laparoscopic TEP repair among beginner surgeons with or without a supervisor. The current study was conducted to observe the learning curve for laparoscopic TEP repair performed by a surgeon without a supervisor. METHODS: A retrospective analysis of the consecutive 143 patients was conducted to document patients' demographics, hernia types, operative time, and operative outcomes after the operation. Patients were divided into 7 consecutive groups, each comprising 20 patients. RESULTS: The mean age of the study population was 52.5 years (+/- 18.9 SD), ranging from 16 to 89 years. The learning curve of this technique was almost horizontal throughout the time course. The mean operative time was quite stable among each group. Comparison of the mean operation time and the length of hospital stay among each group did not show significant differences. There was one recurrence in group V. CONCLUSION: The learning curve for laparoscopic TEP repair is not that prolonged if there is an experienced specialized supervisor and opportunities to observe the entire procedure performed by the supervisor are available. It is not the laparoscopic instrument skills but the way the procedure is performed that is important for successful outcomes.
Demography ; Hernia ; Hernia, Inguinal ; Humans ; Learning Curve* ; Learning* ; Length of Stay ; Operative Time ; Recurrence ; Retrospective Studies

PURPOSE: We retrospectively reviewed the medical records to estimate the feasibility and surgical outcome of laparoscopic herniorrhaphies in patients with previous lower abdominal surgery. METHODS: Between December 2000 and December 2008, a total of 1,101 cases of laparoscopic herniorrhaphies were performed in 974 patients, among them 47 cases (4.27%) of laparoscopic herniorrhaphy in 40 patients who had undergone previous lower abdominal surgery were enrolled to this study. RESULTS: Most patients (23 of 24) who had a history of appendectomy successfully underwent laparoscopic totally extraperitoneal (TEP) repair. Six patients who had history of a prostatectomy and 2 patients with a Pfannenstiel incision underwent an intraperitoneal only mesh (IPOM) repair after a failed TEP repair. Five patients had lower midline incisions due to panperitonitis, among them TEP repairs were performed in 3 patients and IPOM was performed after failed TEP repairs in 2 patients who had undergone surgery due to trauma-induced rupture of the bladder. CONCLUSION: Laparoscopic TEP hernia repair could be possible and reasonable in patients after an appendectomy; however, it is difficult in patients with previous pelvic surgeries. Additional studies are needed to determine whether or not laparoscopic TEP repair for inguinal hernias is feasible in patients who have undergone other general surgical procedures.
Appendectomy ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Laparoscopy ; Medical Records ; Prostatectomy ; Pyrazines ; Retrospective Studies ; Rupture ; Urinary Bladder

More attention has been paid to bariatric surgery due to an increase in the obese population in Korea. Laparoscopic adjustable gastric banding (LAGB) is the most popular procedure for weight-loss but the complication rate may increase with time. Revision surgery is needed if there are complications or the weight is regained after LAGB, and a laparoscopic sleeve gastrectomy could be performed in the case of band failure. Successful band removal and sleeve gastrectomy wereperformed simultaneously without complications.
Bariatric Surgery ; Gastrectomy ; Korea ; Obesity, Morbid