PURPOSE: To compare standard laparoscopy-assisted Billroth I gastrectomies including standard lymph node dissection (LABIG) with hand-assisted laparoscopic surgery with the HandPort system (HALS) for the removal of early gastric cancers (EGC). METHODS: A prospective study was performed on 26 patients of EGC at Ewha Womans University Mok-Dong Hospital from July 1999 to August 2001. Seventeen patients (Group L) received LABIG using conventional laparoscopy-assisted methods and 9 patients received LABIG using HALS (Group H). We used staplers for the anastomosis, and a standard D2 lymph node dissection was done with ultrasonic shears or electrocautery. RESULTS: In group L, pathologic reports revealed 14 EGC (stage IA 14 cases), and 3 pm cancers (stage IB 1 case, II 2 cases). In group H, there were 9 early gastric cancers (stage IA 8 cases, IB 1 case). Significant differences (P<0.05) were present between group L and H in regards to the number of harvested lymph nodes (30.8 vs 18.9), estimated blood loss (462.1 vs 286.7 ml) and postoperative transfusion amounts (0.59 vs 0 unit). There were no differences in the mean operating time, distance from the lesion to the resection margin, postoperative leukocyte count, frequencies for pain control, wound size, time to diet, weight loss, serum protein, and postoperative hospital stay. Complications were present in 1 case in group L (enterocutaneous fistula) and 1 case in group H (gastric atony). There was one conversion to open surgery in group H. CONCLUSION: LABIG including standard lymph node dissections with both standard laparoscopic surgery and HALS were performed with equal outcome. The choice of surgical method depends on the characteristics of the lesion and the patient's physical factors.
Conversion to Open Surgery ; Diet, Reducing ; Electrocoagulation ; Female ; Gastrectomy* ; Gastroenterostomy* ; Hand-Assisted Laparoscopy* ; Humans ; Laparoscopy ; Length of Stay ; Leukocyte Count ; Lymph Node Excision ; Lymph Nodes ; Prospective Studies* ; Stomach Neoplasms* ; Ultrasonics ; Wounds and Injuries

Inguinal hernia is the most frequent problem requiring surgery in children. Moreover, subsequent contralateral occurrence after repair of the symptomatic unilateral inguinal hernia(UIH) is not rare. This study is to evaluate the diagnostic value of inguinal ultrasonography (IUS) for potential bilateral inguinal hernia(BIH). A prospective study was performed for preschool children less than 6 years of age who were diagnosed as UIH from July 1999 to December 2000. We selected 58 cases with potential BIH, based on the past history, such as prematurity, ventriculo-peritoneal shunt, family history of BIH, hernia on the left side (LIH), age below 2, female, and contralateral positive silk glove sign on the physical examination. Screening with IUS and bilateral surgical exploration were applied on these cases. Forty-seven cases were males (81.0%) and 11 cases were females(19.0%). Thirty-four were infants. Symptomatic right inguinal hernia (RIH) were 28 (48.3%), and LIH were 30 cases (51.7%). Six cases had no evidence of contralateral patent process vaginalis (PPV) by IUS but showed contralateral PPV by operation, Two cases were suspicious to contralateral PPV under IUS, but operative findings were negative. Fifty cases showed contralateral PPV by IUS as well as operation. The detection rate of contralateral PPV under IUS was 86.2%. The preoperative IUS may reduce contralateral exploration.
Child* ; Child, Preschool ; Female ; Hernia ; Hernia, Inguinal* ; Humans ; Infant ; Male ; Mass Screening ; Physical Examination ; Prospective Studies ; Silk ; Ultrasonography* ; Ventriculoperitoneal Shunt

Hepatocellular carcinoma (HCC) is the most common malignancy of the liver and most commonly associated with hepatitis B infection in Korea. Since HCC arises in cirrhotic livers and is often multicentric, liver transplantation (LT) seems to be a rational and effective approach. Furthermore hepatitis B can be eradicated after LT in more than 90% patients. Current selection criteria of LT for HCC are Milan criteria; single nodule < or = 5cm in diameter, or 3 nodules < or = 3cm each, without major vessel invasion, without extrahepatic metastasis. Patients within Milan criteria showed 75% 5-yeaer survival rate after LT, which was comparable to that of a transplant candidate without HCC. Expanding selection criteria result in more patients with HCC being cured at the expense of a higher incidence of recurrence. Because some, but not all patients with unresectable HCC more than 5cm in diameter have significant vascular invasion and high recurrence rate, this highlights the need to incorporate molecular/biologic information. Pretransplant transarterial chemoembolization and salvage transplantation had a role for down stage or biologic selection of HCC. However, these methods had many controversies about their indication and safety. Iindication of LT for HCC patients is similar in living donor LT. In Korea, living donor LT is more popular in LT for HCC and outcome is comparable to that in deceased donor liver transplantation. In the future, with better understanding of tumor biology, a more and better group of patients with HCC can be selected for LT.
Biology ; Carcinoma, Hepatocellular ; Glycosaminoglycans ; Hepatitis B ; Humans ; Incidence ; Korea ; Liver ; Liver Transplantation ; Living Donors ; Neoplasm Metastasis ; Patient Selection ; Recurrence ; Survival Rate ; Tissue Donors ; Transplants

Small-for-size syndrome (SFSS) is a critical complication of partial liver transplantation, particularly in adult-to-adult living donor liver transplantation (ALDLT) using a small graft. Minimally required liver graft size for a successful ALDLT is classically 40% of a standard recipient’s liver volume or 0.8% of recipient body weight. Recent progress in perioperative care and technical improvement push the lower limit of safe graft size to 25% of the recipient’s standard liver volume or 0.6% of the graft versus recipient weight ratio although this is an ongoing debate. The clinical manifestations of SFSS include various symptoms and signs related to graft dysfunction and portal hypertension in patients with small grafts. The risk factors for SFSS include poor preoperative patient condition, including portal pressure, surgical techniques to reduce portal pressure, and graft quality and size. Hence, various approaches have been explored to modulate inflow and pressure to a small graft and to decrease the outflow block to alleviate this SFSS as well as the selection of a patient and graft. Additionally, recent research and efforts to prevent and treat SFSS are reviewed.

During the last 15 years, much progress has been made in the technical aspect of living donor liver transplantation (LDLT). In fact, LDLT has contributed to understanding of the detailed anatomy of the liver and performing more precise hepatectomy. Recently, more complex cases which were relative contraindications for liver transplantation such as Budd-Chiari syndrome and portal vein thrombosis have been challenged in LDLT area. This review focuses on donor hepatectomy and hanging maneuver in the donor, and hilar dissection and venous reconstruction in the recipient. In addition, recent technical advances in complex cases were also introduced. Biliary complication has been the most common, intractable complication to disturb the quality of life of the long-term survivors. Reduction of its complication rate is a pending question of the transplant surgeon. In LDLT, donor safety is paramount. Technical innovations should be balanced with any unexpected harm to the donors.
Budd-Chiari Syndrome ; Hepatectomy ; Humans ; Liver Transplantation* ; Liver* ; Living Donors* ; Quality of Life ; Survivors ; Tissue Donors ; Venous Thrombosis

No abstract available.
Abscess* ; Eosinophils* ; Humans ; Liver Transplantation* ; Liver* ; Living Donors* ; Transplants*

Since the hepatocellular carcinoma (HCC) develops in cirrhotic liver and is often multicentric, liver transplantation (LT) seems to be a rational approach for the treatment of HCC. Current selection criteria of LT for HCC are Milan criteria (single nodule < or = 5 cm , or < or = 3 nodules and Carcinoma, Hepatocellular/etiology/*mortality/*surgery ; Humans ; Liver Cirrhosis/*complications ; Liver Neoplasms/etiology/*mortality/*surgery ; *Liver Transplantation ; Salvage Therapy ; Survival Rate

Purpose: Early recurrence of hepatocellular carcinoma (HCC) remains a challenging issue after hepatic resection (HR) because of the associated poor prognosis. Models for tumor recurrence after liver transplantation (MoRAL) have been designed to predict tumor recurrence in HCC patients in the liver transplantation setting. This study aimed to validate the predictability of MoRAL for HCC recurrence or patient death and to evaluate the predictors of early HCC recurrence in hepatectomy patients with treatment-naïve solitary HCC. Methods: This study included 443 patients with HCC recurrence after HR from January 2005 to December 2011. Patients were stratified into early recurrence (n = 312) and late recurrence (n = 131) groups according to the development of recurrence either within or more than 2 years after hepatectomy. Results: The median levels of alpha-fetoprotein and protein induced by vitamin K absence-II and the median MoRAL score were significantly higher in the early recurrence group than in the late recurrence group. Regarding pathologic characteristics, the median tumor size, prevalence of tumor grade 3 or 4, microvascular invasion, presence of tumor necrosis, and macrovascular invasion in the early recurrence group were greater than those in the late recurrence group.Multivariate analysis showed that tumor grade 3 or 4, microvascular invasion, and high preoperative MoRAL score were predisposing factors for early HCC recurrence after HR. Conclusion The MoRAL score can be used to predict early recurrence in patients with HCC who undergo curative HR.Using this model, other treatments could be considered for patients with early recurrence predicted after HR.

PURPOSE: This is a trial attempting to show that the addition of mycophenolate mofetil (MMF) can reduce toxicity without impacting efficacy in patients undergoing adult living donor liver transplantation (LDLT) who experience adverse events on tacrolimus (Tac). METHODS: Between February 1999 and December 2002, 47 cases of adult LDLT were administered Tac as a first-line immunosuppressive agents. Patients were categorized to a Tac Group (Tac+steroid; n=24) or a Tac/MMF Group (Tac+steroid+MMF; n=23). RESULTS: The actuarial 2-year patient survival rate was similar in the two groups (91.3% vs. 87.0%, P=0.591), and the 2-year rejection-free survival rate was also comparable (95.2% vs. 90.0%, P=0.672). In 14 patients with nephrotoxicity, mean creatinine levels decreased significantly from 1.80+/-0.24 mg/dL to 1.31+/-0.30 (P=0.001) within 3 months of adding of MMF. Of two patients with neurotoxicity, the clinical symptoms of one patient improved after adding MMF. In 7 patients with a lower therapeutic level, the mean Tac doses could be reduced from 6.4+/-4.0 mg at study entry to 2.4+/-1.4 mg 12 months after adding MMF. CONCLUSION: The addition of MMF to Tac is a potent immunosuppressive agent to reduce the Tac-induced toxicity, and which does not increase the risk of allograft rejection in LDLT.
Adult* ; Allografts ; Creatinine ; Humans ; Immunosuppressive Agents ; Liver Transplantation ; Liver* ; Living Donors* ; Survival Rate ; Tacrolimus* ; Transplantation*

Despite the therapeutic equivalence between twice-daily and once-daily tacrolimus, patient safety after conversion is still a concern. We reviewed 218 liver transplantation (LT) patients who converted twice-daily to once-daily tacrolimus between May 2011 and January 2014. Thirty (13.8%) patients had adverse events after conversion, with a liver function test (LFT) abnormality being the most common adverse event (n = 17). Despite the decrease in serum tacrolimus of > 30% after conversion, none of the patients who were converted to a dosage ratio (once-daily tacrolimus dosage: twice-daily tacrolimus dosage) > 1 had an LFT abnormality. Most patients with an LFT abnormality improved after increasing the once-daily tacrolimus dosage (n = 2), returned to a previous medication, and/or added another immunosuppressant (n = 15). One patient had acute cellular rejection, which improved after steroid pulse treatment, and another patient had graft failure. In patients with a dosage ratio ≤ 1, the conversion time within 5 years after LT was the only significant risk factor for an LFT abnormality after conversion (odds ratio: 11.850, 95% confidence interval: 1.321–106.325, P = 0.027). In conclusion, the dosage ratio and time after LT should be carefully considered during conversion from twice-daily to once-daily tacrolimus.
Humans ; Liver Function Tests ; Liver Transplantation* ; Liver* ; Patient Safety ; Risk Factors* ; Tacrolimus* ; Transplants