1.Analysis of Risk Factor for Major Complications after Pancreatoduodenectomy.
Eun Young KIM ; Seong Heum PARK ; Sei Hyeog PARK ; Kyung Woo CHOI
Korean Journal of Hepato-Biliary-Pancreatic Surgery 2001;5(1):155-162
BACKGROUND/AIMS: The mortality after pancretoduodenenctomy is decreased to less than 5 % in centers with experience. The morbidity, however, still remains high although the decrease has also been demonstrated. The aim of this study was to identify risk factors responsible for major complications following pancreatoduodenectomy. METHODS: Various features of forty nine consecutive patients who underwent pancreatoduodenectomy from 1990 to 1999 were statistically analyzed to determine risk factors for major postoperative complications. Anastomotic leakages, intraabdominal hemorrhage and intraabdominal abcess were categorized as major postoperative complication. RESULTS: In our series, postoperative mortality and morbidy rate were 6.1% and 51.0%, respectively. Seventeen major complications were found in 14 patients(28.6%): 7 cases with pancreaticojejuostomy leakage, 4 cases with biliojejunostomy leakage, 3 cases with intraabdominal hemorrhage and 1 case with intraabdominal abcess. The statistical analysis revealed that episode of intraoperative hypotension was the only independent risk factor for major postoperative complication.(Odds ratio: 25.4849, p=0.0048) CONCLUSION: Careful intraoperative management for maintenance of adequate blood pressure in hemodynamically unstable patients is important to reduce major complications after pancreatoduodenectomy.
Anastomotic Leak
;
Blood Pressure
;
Hemorrhage
;
Humans
;
Hypotension
;
Mortality
;
Pancreaticoduodenectomy*
;
Postoperative Complications
;
Risk Factors*
2.A Case of Squamous Cell Carcinoma of Gallbladder after Laparoscopic Cholecystectomy.
Sei Hyeog PARK ; Sun Gu LIM ; Shi Jun YANG ; Jong Heung KIM
Korean Journal of Hepato-Biliary-Pancreatic Surgery 2010;14(1):53-56
Gallbladder carcinoma is the most common primary hepatobiliary carcinoma and the fifth most common malignancy of the GI tract. The most common type of gallbladder carcinoma is adenocarcinoma. Squamous cell carcinoma of the gallbladder is rarer and is responsible for up to 12.7% of gallbladder tumors. A 78-year-old man was incidentally suspected of having a gallbladder mass on an abdominal CT scan and underwent laparoscopic cholecystectomy. Pathology results confirmed the mass as a squamous cell carcinoma. Here we report a case of keratinizing squamous cell carcinoma of the gallbladder and review the literature.
Adenocarcinoma
;
Aged
;
Carcinoma, Squamous Cell
;
Cholecystectomy
;
Cholecystectomy, Laparoscopic
;
Gallbladder
;
Gastrointestinal Tract
;
Humans
;
Keratins
3.Comparison of Laparoscopy-Assisted and Totally Laparoscopic Distal Gastrectomy: The Short-Term Outcome at a Low Volume Center.
Byung Seo CHOI ; Heung Kwon OH ; Sei Hyeog PARK ; Jong Min PARK
Journal of Gastric Cancer 2013;13(1):44-50
PURPOSE: Laparoscopic gastrectomy has been adopted for the treatment of gastric cancer, and despite the technical difficulties, totally laparoscopic distal gastrectomy has been considered less invasive than laparoscopy-assisted distal gastrectomy. Although there have been many reports regarding the feasibility and safety of totally laparoscopic distal gastrectomy at large volume centers, few reports have been conducted at low-volume centers. The purpose of this study is to try to assess the feasibility and safety of totally laparoscopic distal gastrectomy at a low volume center through the analysis of short-term outcomes of totally laparoscopic distal gastrectomy compared with laparoscopy-assisted distal gastrectomy. MATERIALS AND METHODS: The clinical data and short-term surgical outcomes of 35 patients who had undergone laparoscopy-assisted distal gastrectomy between April 2007 and March 2010, and 37 patients who underwent totally laparoscopic distal gastrectomy between April 2010 and August 2012 were retrospectively reviewed. RESULTS: There was no significant difference in the demographic and clinical data. However the reconstruction method and extent of lymphadenectomy showed statistically significant differences. Operation time and estimated blood loss did not show significant differences. Surgical and medical complications did not show significant differences but postoperative courses including time-to-first oral intake and postoperative hospital stay were significantly increased. CONCLUSIONS: Our study shows that totally laparoscopic distal gastrectomy is technically feasible at a low volume center. Therefore, totally laparoscopic distal gastrectomy can be considered as one of the surgical treatment for early gastric cancer. However the possibility that totally laparoscopic distal gastrectomy may have less benefit should also be considered.
Gastrectomy
;
Humans
;
Laparoscopy
;
Length of Stay
;
Lymph Node Excision
;
Retrospective Studies
;
Stomach Neoplasms
4.The Benefits of Percutaneous Transhepatic Gallbladder Drainage prior to Laparoscopic Cholecystectomy for Acute Cholecystitis.
Byeonghun OH ; Eunyoung KIM ; Eun Jeong AHN ; Jong Min PARK ; Sei Hyeog PARK
Journal of Minimally Invasive Surgery 2016;19(2):63-69
PURPOSE: Several studies have reported that laparoscopic cholecystectomy with percutaneous transhepatic gallbladder drainage (PTGBD) is associated with a reduced duration of surgery and a lower rate of conversion to open laparotomy compared with laparoscopic cholecystectomy without PTGBD and delayed laparoscopic cholecystectomy after conservative therapy. However, these results are contradictory. This retrospective study investigated the safety and usefulness of laparoscopic cholecystectomy combined with pre-operative PTGBD in patients with acute cholecystitis. METHODS: The clinicopathologic data and surgical outcomes of 101 patients who underwent laparoscopic cholecystectomy between January 2010 and September 2015 were reviewed retrospectively. RESULTS: Patients in the PTGBD group vs. the non-PTGBD group were significantly older (mean age: 65.47±12.2 vs. 56.32±13.7; p=0.001). Underlying diseases were also significantly more common in the PTGBD group (75.4% vs. 45.5%; p=0.002). There were no significant differences between the two groups in terms of operative time, blood loss, rate of open conversion, postoperative oral intake, and postoperative hospital stay. Total hospital day was significantly longer in the PTGBD group (11.14±7.22 vs. 6.23±5.17; p=0.049). There was no significant difference in the postoperative complications between the two groups, and all patients in this study lived. CONCLUSION: This study suggested that satisfactory results can be achieved with selective preoperative PTGBD in older and sicker patients with acute cholecystitis.
Cholecystectomy, Laparoscopic*
;
Cholecystitis, Acute*
;
Drainage*
;
Gallbladder*
;
Humans
;
Laparotomy
;
Length of Stay
;
Operative Time
;
Postoperative Complications
;
Retrospective Studies
5.Early Experience with Laparoscopic Primary Closure of Peptic Ulcer Perforation.
Jin Suk LEE ; Eun Jung AHN ; Sei Hyeog PARK ; Jong Heung KIM ; Jong Min PARK
Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons 2009;12(2):63-67
PURPOSE: Among the surgeries that can be performed for patients with acute peptic ulcer perforation, the frequency of performing laparoscopic surgeries is gradually increasing and it is being reported that laparoscopic surgeries have many advantages over laparotomies. So we will examined if laparoscopic surgery has advantages as compared to open surgery for appropriately selected patients. METHODS: The subjects were 15 patients who were diagnosed with peptic ulcer perforation and they were operated on by a single surgeon between September 2007 and January 2009 at the National Medical Center. The subjects were divided into an LG and an OG. Statistical analyses were performed using two-tailed students T-tests. RESULTS: There were 6 patients in the LG and 9 patients in the OG. All the patients in the two groups were male. The time until fist flatulence was 1.6 days in the LG and 2.6 days in the OG. The time until the first oral intake was 3 days in the LG and 3.4 days in the OG. The time during which pain control was necessary was 2.6 (range: 2~4) days in the LG and 3.3 (range: 2~4) days in the OG. The number of days of the hospital stay after surgery was 5.6 days (range: 4~7) in the LG and 10 days (range: 6~26) in the OG. There were 2 cases of complications in the OG only, and all of them were wound infections. CONCLUSION: It is thought that laparoscopic surgeries can be performed relatively easily and safely for patients with peptic ulcer perforation by selecting appropriate patients.
Flatulence
;
Humans
;
Laparoscopy
;
Laparotomy
;
Length of Stay
;
Male
;
Peptic Ulcer
;
Peptic Ulcer Perforation
6.Comparison of Laparoscopic Cholecystectomies between the Two 5-year Intervals.
Jin Cheol KO ; Sei Hyeog PARK ; Jae Kwan HWANG ; Seong Heum PARK ; Kyong Woo CHOI
Journal of the Korean Surgical Society 2001;61(1):69-74
PURPOSE: The laparoscopic cholecystectomy has become a common procedure for treating gallbladder disease. The objectives of this study was to evaluate the learning curve by reviewing 145 patients treated with laparoscopic cholecystectomy, between Group A (From January 1991 to December 1995) and Group B (From January 1996 to December 2000). METHODS: We retrospectively analyzed 145 laparoscopic cholecystectomies performed at the Department of General Surgery, National Medical Center, from January 1991 to December 2000. The sex, age, operation time, associated disease, previous operation history, hospital stay, and pathology were reviewed. RESULTS: The ratio of Females to males was 1.9:1, and their age ranged from 18 to 80 years with the majority in their fifties and sixties. Most of the operative indications were cholelithiasis. The mean operative time was 89 minutes, which varied between 40 and 180 minutes, and the average admission time was five days. The operation times of Group A and Group B were statistically significant with respect to learning curve (p value<0.000). A linear regression test of the operation time and operation cases was also significant. The postoperative analgesic injection and hospital stay were improved in Group B, but had no statistical significance. A conversion to open cholecystectomy was done in four cases due to bleeding, severe adhesion, or clip migration of the cystic duct during surgery. CONCLUSION: The laparoscopic cholecystectomy was a safe and effective treatment for gallbladder disease, and wepredict that the operation time will become shorter with more experience.
Cholecystectomy
;
Cholecystectomy, Laparoscopic*
;
Cholelithiasis
;
Cystic Duct
;
Female
;
Gallbladder Diseases
;
Hemorrhage
;
Humans
;
Learning Curve
;
Length of Stay
;
Linear Models
;
Male
;
Operative Time
;
Pathology
;
Retrospective Studies
7.Surgical Treatment for Chronic Peptic Ulcer with Gastric Outlet Obstruction.
Jei Hee LEE ; Shi Joon YANG ; Young Woong JEON ; Sei Hyeog PARK ; Jong Heung KIM ; Jong Min PARK
Journal of the Korean Gastric Cancer Association 2008;8(3):160-165
PURPOSE: With the introduction of H. pylori eradication and proton pump inhibitor, the operative treatments for the acute or chronic complications of peptic ulcer, such as perforation, bleeding and stricture, have decreased. Also owing to the development of non-operative treatment such as interventional endoscopic treatment, the surgical approach to the acute complications, like perforation and bleeding, has diminished. The non-operative treatments for the stricture and obstruction of chronic peptic ulcer in part related to discontinuation of medication have not been satisfactory. We analyzed the clinical outcomes of the patients who underwent operative treatment for outlet obstruction with peptic ulcer. Materials of Methods: From January 1994 to December 2007, we reviewed 31 patients who had been operated on at the National Medical Center for peptic ulcer obstruction. We excluded the cases of adhesive obstructions that were caused by a former ulcer operation and also the cases of obstructions found during emergency operations for treating perforation and bleeding. We classified the surgical treatment group into the bypass operation group and the surgical resection group. We evaluated the effects of the operations by the Visick score. The recurrences were confirmed only by the endoscopic observation of peptic ulcer. RESULTS: The number of patients in the bypass operation group was 6 (19.4%) and that of resection group was 25 (80.6%). The mean age was 57.5 (25~81) years. The number of male patients was 29 (93.5%) and the number of females was 2 (6.5%). The mean symptom duration was 29.6 months. There were 19 smokers (61.3%), 6 NSAID users (19.4%) and 7 H. pylori positive patients (22.6%). Two patients underwent endoscopic balloon dilatation with no success. The locations of lesion were the stomach, the duodenum and both in 9, 20 and 2 cases, respectively. There were operative complications in 13 cases (41.9%), recurrent ulcers in 2 cases (6.5%), and reoperations in 4 cases. The mean Visick score was 1.8 (1~4). There were no statistically significant clinicopathologic differences between the bypass operation group and the resection group. The two groups had 1 case each of recurrence. Although the bypass group had a greater complication rate (83.3%) than the resection group (32%), this was not statistically meaningful (P=0.175). The mean Visick score was 3.0 in the bypass group and 1.6 in the resection group, so the resection group was better (P=0.001). CONCLUSION: For a case of chronic peptic ulcer with outlet obstruction, even though it has been reported that endoscopic balloon dilatation worked well, surgery is still regarded as an important treatment. If you consider the patients' satisfaction and the difficulty of diagnosing malignant ulcers, surgical resection should be recommended more often than a bypass operation.
Adhesives
;
Constriction, Pathologic
;
Dilatation
;
Duodenum
;
Emergencies
;
Female
;
Gastric Outlet Obstruction
;
Hemorrhage
;
Humans
;
Male
;
Peptic Ulcer
;
Proton Pumps
;
Recurrence
;
Stomach
;
Ulcer
8.Laparoscopically Assisted Total Colectomy with J-pouch Formation for Intractable Chronic Constipation due to Hypoganglionosis: A Case Report.
Shi Jun YANG ; Eun Jung AHN ; Sei Hyeog PARK ; Jong Heung KIM ; Hye Seon AHN ; Jong Min PARK
Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons 2010;13(2):153-156
Chronic constipation has been successfully treated with specific medications and bio-feedback therapy. Surgical manipulation for this condition can be an option when non-surgical interventions fail. We report here on a patient who was diagnosed as having intractable chronic constipation with hypoganglionosis. The patient was a 60 year-old male with the history of seizure and diabetes. This patient did not gain any clinical benefits from non-surgical regimens. Therefore, we performed a laparoscopically assisted total colectomy with J-pouch ileorectal anastomosis on this patient. The patient recovered from the surgery without complications and he had normal bowel functions. The postoperative anatomical pathology revealed a hypogaglionosis. In conclusion, a laparoscopically assisted total colectomy for a patient with intractable chronic constipation with hypoganglionosis is a good option and it may be a curative method.
Colectomy
;
Colonic Pouches
;
Constipation
;
Humans
;
Male
;
Seizures
9.The Early Experience of Laparoscopy-assisted Gastrectomy for Gastric Cancer at a Low-volume Center.
Shi Jun YANG ; Eun Jung AHN ; Sei Hyeog PARK ; Jong Heung KIM ; Jong Min PARK
Journal of Gastric Cancer 2010;10(4):241-246
PURPOSE: Laparoscopy-assisted gastrectomy (LAG) has become a technically feasible and safe procedure for early gastric cancer treatment. LAG is being increasingly performed in many centers; however, there have been few reports regarding LAG at low-volume centers. The aim of this study was to report our early experience with LAG in patients with gastric cancer at a low-volume center. MATERIALS AND METHODS: The clinicopathologic data and surgical outcomes of 39 patients who underwent LAG for gastric cancer between April 2007 and March 2010 were retrospectively reviewed. RESULTS: The mean age was 68.3 years. Thirty-one patients had medical co-morbidities. The mean patient ASA score was 2.0. Among the 39 patients, 4 patients underwent total gastrectomies and 35 patients underwent distal gastrectomies. The mean blood loss was 145.4 ml and the mean operative time was 259.4 minutes. The mean time-to-first flatus, first oral intake, and the postoperative hospital stay was 2.8, 3.1, and 9.3 days, respectively. The 30-day mortality rate was 0%. Postoperative complications developed in 9 patients, as follows: anastomotic leakage, 1; wound infection, 1; gastric stasis, 2; postoperative ileus, 1; pneumonia, 1; cerebral infarction, 1; chronic renal failure, 1; and postoperative psychosis, 1. CONCLUSIONS: LAG is technically feasible and can be performed safely at a low-volume center, but an experienced surgical team and careful patient selection are necessary. Furthermore, for early mastery of the learning curve for LAG, surgeons need education and training in addition to an accumulation of cases.
Anastomotic Leak
;
Cerebral Infarction
;
Flatulence
;
Gastrectomy
;
Gastroparesis
;
Humans
;
Ileus
;
Kidney Failure, Chronic
;
Laparoscopy
;
Learning Curve
;
Length of Stay
;
Operative Time
;
Patient Selection
;
Pneumonia
;
Postoperative Complications
;
Psychotic Disorders
;
Retrospective Studies
;
Stomach Neoplasms
;
Wound Infection
10.The Early Experience of Laparoscopy-assisted Gastrectomy for Gastric Cancer at a Low-volume Center.
Shi Jun YANG ; Eun Jung AHN ; Sei Hyeog PARK ; Jong Heung KIM ; Jong Min PARK
Journal of Gastric Cancer 2010;10(4):241-246
PURPOSE: Laparoscopy-assisted gastrectomy (LAG) has become a technically feasible and safe procedure for early gastric cancer treatment. LAG is being increasingly performed in many centers; however, there have been few reports regarding LAG at low-volume centers. The aim of this study was to report our early experience with LAG in patients with gastric cancer at a low-volume center. MATERIALS AND METHODS: The clinicopathologic data and surgical outcomes of 39 patients who underwent LAG for gastric cancer between April 2007 and March 2010 were retrospectively reviewed. RESULTS: The mean age was 68.3 years. Thirty-one patients had medical co-morbidities. The mean patient ASA score was 2.0. Among the 39 patients, 4 patients underwent total gastrectomies and 35 patients underwent distal gastrectomies. The mean blood loss was 145.4 ml and the mean operative time was 259.4 minutes. The mean time-to-first flatus, first oral intake, and the postoperative hospital stay was 2.8, 3.1, and 9.3 days, respectively. The 30-day mortality rate was 0%. Postoperative complications developed in 9 patients, as follows: anastomotic leakage, 1; wound infection, 1; gastric stasis, 2; postoperative ileus, 1; pneumonia, 1; cerebral infarction, 1; chronic renal failure, 1; and postoperative psychosis, 1. CONCLUSIONS: LAG is technically feasible and can be performed safely at a low-volume center, but an experienced surgical team and careful patient selection are necessary. Furthermore, for early mastery of the learning curve for LAG, surgeons need education and training in addition to an accumulation of cases.
Anastomotic Leak
;
Cerebral Infarction
;
Flatulence
;
Gastrectomy
;
Gastroparesis
;
Humans
;
Ileus
;
Kidney Failure, Chronic
;
Laparoscopy
;
Learning Curve
;
Length of Stay
;
Operative Time
;
Patient Selection
;
Pneumonia
;
Postoperative Complications
;
Psychotic Disorders
;
Retrospective Studies
;
Stomach Neoplasms
;
Wound Infection