PURPOSE: Although the prevalence of gastroesophageal reflux disease (GERD) is relatively low in Korean population, the number is increasing. The aim of this study is to analyze our experience with laparoscopic Nissen fundoplication. PATIENTS AND METHODS: From Sep. 2003 to Mar. 2008, 31 adult Korean patients diagnosed with GERD underwent laparoscopic Nissen fundoplication. A 360degrees fundoplication was carried out in all patients. RESULTS: There were 19 males and 12 females with an average age of 46.8 +/- 17.0 years. Typical symptoms were present in 15 (48%) of patients, and atypical symptoms in 16 (51.6%). Both typical and atypical symptoms were present in 4 of patients (12.9%). Preoperative studies showed hiatal hernias in 13 patients (41.9%), Barrett's esophagus in 10 (32.3%), and reflux esophagitis in 18 (58.1%). Mean DeMeester score was 17.4 +/- 16.7, mean operative time 206.1 +/- 47.8 min and mean hospital stay 5.2 +/- 2.1 days. Perioperative complications occurred in 5 patients (16.1%), including gastric perforation, subcutaneous emphysema, atelectasis, and prolonged ileus. Gastroesophageal junction stenoses with subsequent endoscopic balloon dilations were required in 5 patients (16.1%). After surgery, symptoms were completely controlled in 17 patients (54.8%), partially improved in 12 patients (38.7%) and not controlled in 2 patients (6.5%). CONCLUSION: In our series, 93.5% of patients had either complete or partial remission of symptom after laparoscopic Nissen fundoplication. Atypical symptoms were more predominant in our Korean patients. Laparoscopic Nissen fundoplication is an efficacious method of controlling symptoms of GERD, even for those who have atypical symptoms.
Adult ; Female ; Follow-Up Studies ; *Fundoplication ; Gastroesophageal Reflux/ethnology/*surgery ; Humans ; Korea ; *Laparoscopy ; Male ; Middle Aged ; Patient Satisfaction ; Prevalence ; Treatment Outcome

BACKGROUNDS: Intussusception in adults, a rare disease, constitutes approximately 5% of all intussusceptions and accounts for 5% of all cases of intestinal obstruction. METHODS: The medical records of 21 adult patients with documented intussusception, who were treated at Catholic University Medical College from 1986 to 1997, were retrospectively analyzed, and the results were compared with those previously published in Korea and Western countries. RESULTS: Etiologic factors were found in 86% of cases, of which 8 cases (38%) were due to malignant disease. Clinically, abdominal pain, tenderness, nausea, and vomiting were most frequently found, but were nonspecific. Correct preoperative diagnosis was made in 28% of patients, and the diagnostic methods included plain abdominal radiography, barium contrast study, abdominal ultrasonography, and abdominal CT, the latter two playing an important role in the diagnosis. Ileocolic was the most common anatomical type. CONCLUSIONS: The surgical treatment of choice depends on the anatomical location of the lesion and on whether or not preoperative diagnosis has been made. In colonic intussusceptions primary resection without manual reduction is recommended while in enteric intussusceptions, a previous knowledge of preoperative diagnosis permits us to choose the most acceptable surgical procedure. A vigorous effort should be made, utilizing diagnostic methods, such as abdominal ultrasonography or CT, in order to make the correct preoperative diagnosis and, therefore, to help in making a correct surgical decision.
Abdominal Pain ; Adult* ; Barium ; Colon ; Diagnosis ; Humans ; Intestinal Obstruction ; Intussusception* ; Korea ; Medical Records ; Nausea ; Radiography, Abdominal ; Rare Diseases ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography ; Vomiting

When jaundice persists for more than 14 days postnatally, the early diagnosis of surgical jaundice is important for the prognosis in extrahepatic biliary atresia after draining procedure. The role of diagnostic laparoscopy to differenctiate medical causes of jaundice from biliary atresia is evaluated in this report. Four patients with prolonged jaundice have been included in this study. When the gallbladder was not visualized we proceeded to laparotomy. In patients with enlarged gallbladder visualized at laparoscopy, laparoscopic guided cholangiogram was performed, and laparoscopic liver biopsy was done for those who had a patent biliary tree. Two patients had small atretic gallbladder and underwent a Kasai hepato-portoenterostomy. One patients showed a patent gallbladder and common bile duct with atresia of the common hepatic and intrahepatic ducts, and they underwent a Kasai hepatic-portoenterostomy. One patient showed an enlarged gallbladder and laparoscopic-guided cholangiogram were normal. Laparoscopic liver biopsy was performed. There were no complications. Laparoscopy wth laparoscopic-guided cholangiogram may be a valuable method in accurate and earlier diagnosis in an infant with prolonged jaundice.
Biliary Atresia ; Biliary Tract ; Biopsy ; Common Bile Duct ; Diagnosis ; Early Diagnosis ; Gallbladder ; Humans ; Infant ; Jaundice ; Jaundice, Obstructive* ; Laparoscopy* ; Laparotomy ; Liver ; Prognosis

No abstract available.
Carcinoma, Hepatocellular* ; Catheter Ablation* ; Neoplasm Metastasis*

Gastroesophageal reflux disease (GERD) is a chronic disease deteriorating patient's quality of life. With the advent of proton pump inhibitors, treatment failures have decreased considerably. However, surgical therapy offers the potential for cure in more than 90% of patients with GERD. Specific indications for antireflux surgery are: incomplete response to medical therapy, frequent recurrences despite the medical treatment, laryngopharyngeal, and/or respiratory symptoms, and complications of GERD, such as esophageal stricture, erosive esophagitis, esophageal ulcer, and/or Barrett's esophagus. The introduction of laparoscopic surgery in early ninties had a profound impact on many surgical fields, including the treatment of GERD. In this review, laparoscopic Nissen fundoplication is described and controversial topics, such as total vs. partial fundoplication, and the natural history of Barrett's esophagus after antireflux surgery are addressed.
Barrett Esophagus/surgery ; Fundoplication/methods ; Gastroesophageal Reflux/*surgery ; Humans ; Laparoscopy/methods ; Surgical Procedures, Minimally Invasive/methods

PURPOSE: A laparoscopic approach, rather than conventional laparotomy, is the well-accepted first choice for excision of an adrenal or perinephric retroperitoneal mass. The purpose of this study was to investigate the factors that affect surgical outcomes and analyze the clinical effectiveness of this surgical treatment modality. METHODS: We conducted a retrospective analysis of 62 patients who underwent laparoscopic adrenalectomies from September 2007 to February 2013. These operations were performed by a single surgeon. Demographic characteristics, operative data, tumor characteristics, and surgical outcomes were analyzed. RESULTS: Of 62 patients, 21 were men and 41 were women. The mean operative time was 151.16+/-48.58 minutes and the mean amount of blood loss was 179.51+/-161.66 ml. There were two cases of metastatic adrenal tumors that were resected completely with prolonged survival. There was one case of recurrence during the postoperative period. Preoperatively, it was only a tumor measuring 3.5 cm without evidence of malignancy. Postoperative complications occurred in three patients. However, there was no case of conversion to laparotomy. Previous history of open abdominal operation did not affect post-operative outcomes. CONCLUSION: Laparoscopic approach for adrenal tumors is indicated regardless of its type or past history of abdominal surgery. Unless greater than 10 cm, relatively large tumors can be safely removed using this method. In particular, due to the possibility of malignant potential, aggressive surgical intervention is recommended for tumors measuring between 3 and 5 cm. Use of a laparoscopic approach is associated with low risk of surgical complication and the benefits outweigh the disadvantages.
Adrenal Gland Neoplasms ; Adrenalectomy ; Female ; Humans ; Laparoscopy ; Laparotomy ; Male ; Operative Time ; Postoperative Complications ; Postoperative Period ; Recurrence ; Retrospective Studies

Situs inversus, a left-to-right transposition of the normally asymmetrical organs of the body, is a rare anomaly that occurs in 1:5,000-1:10,000 adults. In the total form, the thoracic organs, as well as the abdominal organs, are completely reversed in a "mirror image" of their normal arrangement. Herein, we present a case of an adenocarcinoma of the proximal bile duct in a 68-year-old man with total situs inversus. Without any technical problems, he successfully underwent a bile-duct resection and bilioenteric anastomosis. He did well postoperatively, and after one course of chemotherapy, was discharged on postoperative day 12. A review of the international literature on this subject is presented.
Adenocarcinoma ; Adult ; Aged ; Bile Duct Neoplasms* ; Bile Ducts* ; Bile* ; Drug Therapy ; Humans ; Situs Inversus*

Bariatric surgery is considered the most effective treatment modality for treatment of obesity and related comorbid conditions. Bariatric surgery was introduced in the early 1950s. However, the bariatric "revolution" occurred during the late 1990s and early 2000s, which led to an exponential increase of bariatric procedures performed. This phenomenon occurred because of three events: the rapid increase of obesity rate, the introduction of laparoscopic technique, and the role of the mass media, including the internet. In Korea, surgery for obesity started in Jan. 2003 when the first laparoscopic sleeve gastrectomy was performed by Won Woo Kim (from The Catholic University of Korea). During the same year, laparoscopic gastric bypass was performed by several surgeons at 3 different institutions. Seung Ho Choi from Yonsei University, Eung Kook Kim and Sang Kuon Lee from The Catholic University of Korea, and Kyung Yul Hur (mini-gastric bypass) from Hansol Hospital performed gastric bypass laparoscopically. The next year, LAP-BAND(R) device was approved by KFDA and the first laparoscopic adjustable gastric banding was performed by Eung Kook Kim and Sang Kuon Lee from The Catholic University of Korea in Aug. 2004. In 2009, a new procedure, the duodenojejunal bypass, was first introduced in Korea, mainly for metabolic purpose. This procedure was performed by three surgeons in three different institutions, Eung Kook Kim from The Catholic University of Korea, Seung Ho Choi from Yonsei University, and Yoon Seok Heo from Inha University. In 2011, the first robotic-assisted gastric bypass was performed by Do Joong Park from Seoul National University. In 2009, the Korean Society for Metabolic and Bariatric Surgery (KSMBS) was founded and in 2012, it became an official member of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO).
Bariatric Surgery ; Gastrectomy ; Gastric Bypass ; Internet ; Korea* ; Laparoscopy ; Mass Media ; Obesity ; Republic of Korea ; Seoul

Since the first laparoscopic bariatric surgery in Korea introduced in January 2003, the number of metabolic and bariatric surgery has been steadily increasing. According to the report from National Health Insurance big data analysis, the prevalence of morbid and super obesity has greatly increased and metabolic and bariatric surgery also increased in the last 10 years. As the incidence of morbid obesity is more frequent in people of poor socioeconomic status, the need for a reimbursement by the government seemed to be necessary. Finally, the national health insurance system decided to financially cover metabolic and bariatric surgery from January 2019. In order to improve the safety and qualify of metabolic and bariatric surgery, the Korean Society for Bariatric and Metabolic Surgery (KSMBS) introduced surgeon's and institution's accreditation system. The authors intend to introduce comprehensive overview of accreditation system of bariatric surgery and discuss the contents of national health insurance for metabolic and bariatric surgery.
Accreditation ; Bariatric Surgery ; Incidence ; Korea ; National Health Programs ; Obesity ; Obesity, Morbid ; Prevalence ; Social Class ; Statistics as Topic

Excessive portal venous inflow has been known as a determining factor for hepatic injury in small-for-size graft in living-donor liver transplantation. Partial diversion of portal inflow to the systemic circulation by portacaval shunt has been reported as a promising treatment modality to prevent patient from small-for-size graft syndrome. In addition, splenectomy itself is not only a method to decrease portal flow, but also a treatment for the gastric fundal variceal bleeding. We performed living-donor liver transplantation with transient portacaval shunt and splenectomy due to small-for-size graft in a 50 year-old male suffering from hepatitis B virus related liver cirrhosis with bleeding gastric fundal varices, not amenable to control endoscopically. The donor was patient's wife and a graft to recipient body weight ratio (GRWR) was 0.64. During surgery, left portal vein was used for temporary portacaval shunt and the right portal vein was anatomosed to the graft portal vein. After all vascular anastomoses completed, an endoloop (OpenLoop(R), SJM, Paju, Korea) was placed around portacaval shunt without tightening, and the knot pusher was brought out through abdominal wall introduced in a silastic drain tube. Concomitant splenectomy was performed. Twenty-four hours after transplantation, the loop placed around portacaval shunt was tightened as a bedside procedure. The recipient had an uneventful postoperative course and was discharged with normal graft function 26 days after transplantation. Living-donor liver transplantation with transient portacaval shunt and splenectomy could be an acceptable surgical treatment strategy for patients with end-stage liver disease with small-for-size graft and bleeding gastric fundal varices.
Abdominal Wall ; Body Weight ; Dimethylpolysiloxanes ; Hemorrhage ; Hepatitis B virus ; Humans ; Liver ; Liver Cirrhosis ; Liver Diseases ; Liver Transplantation ; Male ; Portacaval Shunt, Surgical ; Portal Vein ; Splenectomy ; Spouses ; Stress, Psychological ; Tissue Donors ; Transplants ; Varicose Veins