PURPOSE: Laparoscopic cholecystectomy (LC) has become the treatment of choice for most gallbladder disease. The aim of this study was to identify the factors related to extended hospital stay following LC. METHODS: Between March 2005 and December 2007, 819 patients underwent LC at our institution. Based on length of hospital stay (mean postoperative hospital stay was 3.7 days), patients were divided into two groups: group A staying for no more than 4 hospital days (715 patients) and group B staying for more than 4 hospital days (104 patients). The clinicopathologic characteristics, perioperative outcomes and hospital courses were retrospectively compared between the two groups. We also analyzed the causes of delayed discharge after LC. RESULTS: Group A was younger than group B and there were significant differences between the two groups in terms of gender, comorbidity, ASA score, operation time, clinical symptoms, laboratory findings, and final diagnosis (p<0.05). Delayed discharge was mainly due to refusal of patients or relatives (13 cases), occurrence of perioperative complications (19 cases), severe inflammation of the gallbladder (13 cases) and abdominal discomfort of unknown origin (10 cases). Bile leakage occurred in 1 patient and he had the longest hospital stay. CONCLUSION: The causes of delayed discharge after LC were varied and were mainly associated with patients themselves. However, several causes were associated with the operative procedure and may be avoided by careful surgical approach.
Bile ; Cholecystectomy, Laparoscopic ; Comorbidity ; Disulfiram ; Gallbladder ; Gallbladder Diseases ; Humans ; Inflammation ; Length of Stay ; Retrospective Studies ; Surgical Procedures, Operative

PURPOSE: A laparoscopic appendectomy is now commonly performed. The push in recent years toward reducing the number of ports required to perform this surgery has led to the development of a single-port laparoscopic appendectomy (SPA). We compared postoperative pain after an SPA using a glove port with a percutaneous organ-holding device (group 1) with that of an SPA using a commercially-available multichannel single-port device (group 2). METHODS: Between March 2010 and July 2011, a retrospective study was conducted of a total of 77 patients who underwent an SPA by three surgeons at department of surgery, Kangbuk Samsung Medical Center. Thirty-eight patients received an SPA using a glove port with a percutaneous organ-holding device. The other 39 patients received an SPA using a commercially-available multichannel single port (Octo-Port or SILS Port). Operative details and postoperative outcomes were collected and evaluated. RESULTS: There were no differences in the mean operative times, times to pass gas, postoperative hospital stays, or cosmetic satisfaction scores between the two groups. The pain score in the first 24 hours after surgery was higher in group 2 than group 1 patients (P < 0.001). Furthermore, the trocar used in group 2 was more expensive than that used in group 1. CONCLUSION: An SPA using a glove port with a percutaneous organ-holding device was associated with a lower pain score during the first 24 hours after surgery because of the shorter fascia incision length and a cheaper cost than an SPA using a commercially-available multichannel single-port device.
Appendectomy* ; Fascia ; Humans ; Length of Stay ; Operative Time ; Pain, Postoperative ; Retrospective Studies ; Surgical Instruments

Purpose: There are various opinions about the postoperative complications of the two methods for laparoscopic inguinal hernia surgery; totally extraperitoneal repair (TEP) and transabdominal preperitoneal repair (TAPP). The aim of this study was to compare the postoperative course after TAPP and TEP, focusing on immediate postoperative pain, incidence of postoperative urinary retention (POUR), and chronic pain. Methods: This study retrospectively analyzed a consecutive series of 344 inguinal hernia patients who were treated with laparoscopic surgery between November 2016 and December 2019 at a single tertiary referral center. Results: Patient demographics did not differ significantly between the groups. The operation time was significantly shorter in the TEP group than in the TAPP group (43.1 ± 14.9 minutes vs. 63.5 ± 16.5 minutes, p < 0.001). The postoperative pain scores were significantly lower in the TEP group than in the TAPP group immediately (3.6 ± 1.3 vs. 4.4 ± 1.1, p < 0.001) and 6 hours (1.5 ± 1.4 vs. 2.3 ± 1.8, p < 0.001) after the operation. The other complications did not differ significantly between the groups. Age was a significant risk factor for POUR (odds ratio [OR], 1.083; 95% confidence interval [CI], 1.018–1.151; p = 0.011), and history of benign prostate hyperplasia (BPH) was a significant risk factor for chronic pain (OR, 5.363; 95% CI, 1.028–27.962; p = 0.046). Conclusion TEP and TAPP seem to be safe and effective for laparoscopic inguinal hernia repair and have similar postoperative outcomes. Age was a significant risk factor for POUR, and BPH history was a significant risk factor for chronic pain.

PURPOSE: To evaluate the NT in the first trimester associated with fetal chromosomal abnormality, fetal structural abnormality and adverse pregnancy outcome. METHODS: From Mar. 1993 to Dec. 1997, 133 cases of increased NT were reviewed retrospectively. All these fetues were taken a karyotyping and/or a high resolution ultrasonography for associated anomaly. The NT was measured by transvaginal ultrasonography(TVS) and transabdominal ultrasonography(TAS) if difficulty was encountered with TVS in the period of the 10th-14th week of gestation. The increased NT is approved when it is over 3mm. RESULTS: Of these 133 cases, 102 cases(76.7%) revealed normal outcomes and 31 cases(23.3%) revealed abnormal outcomes such as chromosomal abnormality, structural abnormality and adverse pregnancy outcome, The mean value of NT was 3.44+/-0.68mm in the normal group and 4.93+/-2.70mm in the abnormal group, respectively. The chromosomal abnormalities were found in 16 of the 31 cases: nine Down SD, two Patau syndrome, one Tuner synrome, one triploidy, one 46, XX,i(18q), one 47,iso(Xp)/46,XX one confined placental mosaicism. In 12 cases of the 31 cases, the structural anomalies were detected. Of these 12 cases, 3 cases were eventually developed to cytsic hygroma, 3 cases were cardiac anomaly, 3 cases were renal anomaly, 1 case was congenital diaphragmatic hernia, 1 case was skeletal dysplasia and 1 case was suspected syndrome. The adverse pregnancy outcome such as intrauterine growth restriction, intrauterine fetal death and preterm labor was revealed in 3 cases. In the cases of NT over 7mm, the result was 100% abnormal outcome. CONCLUSION: Increased NT in the first trimester could be a highly efficient the predictor for detection of chromosomal abnormality, structural anomaly and adverse pregnancy outcome.
Chromosome Aberrations ; Female ; Fetal Death ; Hernia, Diaphragmatic ; Humans ; Karyotyping ; Lymphangioma, Cystic ; Mosaicism ; Nuchal Translucency Measurement ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Trimester, First ; Pregnancy* ; Retrospective Studies ; Triploidy ; Ultrasonography

PURPOSE: Although the incidence of gastric cancer has declined in the general population, it is the second most frequent cause of death due to malignancy in the world with its incidence in the elderly increasing as a result of increased life expectancy. This present study tried to find the optimal treatment for patients aged 75 years or older with gastric cancer through comparison of the clinicopathological characteristics, surgical outcomes, and identifying prognostic factors of survival. METHODS: Elderly patients who underwent gastric resection for gastric cancer from January, 1999 to February, 2009 (n = 470) were divided into two groups: very elderly patients, 75 years or older (n = 95), and younger elderly patients, between 65 and 74 years old (n = 365). RESULTS: Distinct characteristics of very elderly patients included more frequent underlying disease, deeper invasion, and more frequent lymph node metastasis. There were significant differences in overall survival between the two groups at stages III-B and IV. However, postoperative hospital stays, postoperative morbidity, mortality and early stage did not differ between curatively resected patients in the two groups. CONCLUSION: Due to improved postoperative care, gastrectomy of gastric cancer is the treatment of choice in very elderly patients. Therefore, early diagnosis through regular medical screening and curative gastrectomy with lymph node dissection should be performed in very elderly gastric cancer patients.
Aged ; Cause of Death ; Early Diagnosis ; Gastrectomy ; Humans ; Incidence ; Length of Stay ; Life Expectancy ; Lymph Node Excision ; Lymph Nodes ; Mass Screening ; Neoplasm Metastasis ; Postoperative Care ; Stomach Neoplasms

PURPOSE: Titanium silicate (TS)-1 chemotherapy has been widely used against gastric cancer in Japan. The aim of the present study was to assess the efficacy and hematological safety of TS-1 as treatment for advanced and recurrent gastric cancer. METHODS: From September 2006 to February 2011, 51 advanced or recurrent gastric cancers were treated with TS-1. One course of treatment consisted of 40, 50, or 60 mg/m2 of TS-1 twice a day for 28 days, followed by withdrawal for two weeks. The primary end point was progression-free survival (PFS), and the secondary end point was overall survival (OS). RESULTS: The disease control rate was 39.2% (complete response, 0/51; partial response, 6/51; stable disease, 14/51; progressive disease, 23/51; not evaluable, 8/51). The median PFS was 4.0 months (95% confidence interval [CI], 2.2 to 5.7); the median PFS of the advanced group was 6.0 months (95% CI, 2.8 to 9.1), and the median PFS of the recurrent group was 3.0 months (95% CI, 1.8 to 4.1). The median OS was 11.0 months (95% CI, 6.3 to 15.6); the median OS of the advanced group was 10.0 months (95% CI, 4.9 to 15.0), and the median OS of the recurrent group was 14.0 months (95% CI, 4.1 to 23.8). Grade 3 or 4 hematological toxicity occurred in three patients (5.9%), anemia occurred in two patients (3.9%), and thrombocytopenia occurred in one patient (2%). CONCLUSION: TS-1 chemotherapy was safe and effective, with relatively long PFS and OS in patients with advanced and recurrent gastric cancers.
Anemia ; Disease-Free Survival ; Humans ; Japan ; Silicates ; Stomach Neoplasms ; Thrombocytopenia ; Titanium

PURPOSE: Continued efforts to reduce the invasiveness of conventional cholecystectomy techniques have resulted in the development of single-incision cholecystectomy. However, a single-port approach has significant limitations associated with proper triangulation and instrument crowding and collisions. Although the da Vinci Single-Site robotic system has been proposed to overcome these problems, objective evidence of the feasibility and ergonomics of single-incision robotic cholecystectomy (SIRC) is insufficient. Therefore, the present study aimed to evaluate the feasibility and efficacy of SIRC by using objective data obtained from consecutive patients who underwent surgery with the single-incision robotic platform performed by a single surgeon. METHODS: Forty patients who underwent SIRC between August 2014 and December 2015 were identified. Demographic, perioperative, and postoperative data were collected retrospectively. RESULTS: The mean docking time was 10.82±4.85 min (range, 4~30 min). The mean console time was 49.63±10.82 min (range, 24~90 min). None of the patients required an additional laparoscopic arm, an additional robotic arm, or conversion to conventional laparoscopic cholecystectomy. CONCLUSION: SIRC can provide a safe operative procedure, good operative results, and high patient satisfaction, and cause less surgeon fatigue. Therefore, our study results indicate that SIRC is feasible and favorable for both patients and physicians.
Arm ; Cholecystectomy* ; Cholecystectomy, Laparoscopic ; Crowding ; Fatigue ; Human Engineering ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Patient Satisfaction ; Retrospective Studies ; Surgical Procedures, Operative

PURPOSE: A balloon dissector is widely used to achieve the preperitoneal space in totally extraperitoneal (TEP) inguinal hernia repair. The aim of this study was to compare the operative results of TEP cases performed with (the balloon dissection group) or without (the plain dissection group) a balloon dissector. METHODS: A retrospective analysis was conducted with a consecutive series of inguinal hernia repairs performed by a single surgeon in OOO Hospital between April 2008 and April 2012. All 128 patients with full-length video recordings were included. The distribution of the operation method was altered during the study period, from dissection with a balloon dissector to without it. RESULTS: Of 128 cases, 57 belonged to the balloon dissection group and the other 71 belonged to the plain dissection group. The demographic features and clinical characteristics were similar in both groups. Mean operation time (57.7 vs. 45.6 min, p<0.001) and laparoscopic recording time (31.6 vs. 25.0 min, p=0.004) were significantly shorter in the plain dissection group without differences in the degree of bloodstaining and the frequency of peritoneal tearing. Postoperative complications did not differ between the two groups. CONCLUSION: Plain dissection may be a safe and feasible alternative method of achieving the preperitoneal space in TEP by an experienced surgeon.
Hernia, Inguinal* ; Humans ; Postoperative Complications ; Retrospective Studies ; Video Recording

PURPOSE: Laparoscopy-assisted gastrectomy (LAG) is considered an alternative treatment option for gastric cancer. LAG is safe, however the long-term oncologic efficacy and survival of patients including those with advanced gastric cancer have not been assessed. The aim of this study was to evaluate long-term outcomes and survival of patients with gastric cancer, including advanced cases, who underwent LAG performed by a single surgeon. METHODS: Between January 2006 and December 2010, 161 patients with gastric cancer underwent LAG performed by a single surgeon. Clinicopathological data were collected retrospectively along with data on survival and prognosis. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. RESULTS: A total of 161 patients diagnosed with gastric cancer underwent LAG. Postoperative morbidity occurred in 12 patients. The median OS was 67.0 months (range, 1.0~97.0 months), and the median DFS was 67.0 months (range, 1.0~97.0 months). T stage, N stage, TNM stage, lymphatic invasion, and venous invasion influenced overall survival and disease recurrence. The OS rates according to N stage were 96.8% for N0, 94.4% for N1, 45.5% for N2, and 42.9% for N3. CONCLUSION: The current study showed that LAG for gastric cancer, including advanced gastric cancer, is technically feasible with acceptable long-term oncologic outcomes.
Disease-Free Survival ; Gastrectomy* ; Humans ; Laparoscopy* ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms*

PURPOSE: Acute appendicitis is one of the most common surgical emergencies worldwide. Laparoscopic appendectomy (LA) is being accepted as the 'gold standard' surgery for simple acute appendicitis over open appendectomy (OA); however, for complicated appendicitis, no consensus has been reached with regard to which produces better outcomes. METHODS: We analyzed the data of patients who were diagnosed as complicated appendicitis, older than 18 years old, and underwent LA or OA from January 2008 to December 2012. A total of 2,173 patients had acute appendicitis during this period and 461 (21.2%) of them had complicated appendicitis; 335 patients were finally enrolled and divided into LA (280), OA (49), and Converted to open Appendectomy (CA) groups (6), respectively. Age, sex, preoperative WBC, operating time, stapler usage, time to diet and discharge, total cost and complication among the three groups were analyzed. RESULTS: No significant differences were observed in sex, age, history of abdominal surgery, preoperative WBC, and total cost. Shorter operating time (62.3+/-30.0 vs 87.3+/-40.2, p=0.000), shorter time to diet (2.7+/-2.2 vs 3.7+/-1.6, p=0.001), shorter postoperative stay (4.8+/-2.6 vs 7.1+/-2.5, p=0.000), shorter duration of pain (3.4+/-1.7 vs 5.6+/-2.8, p=0.000), and less frequent usage of pain killer (68.2% vs 89.1%, p<.001) were observed in the laparoscopic group. Complication rate was significantly lower in the LA group (4.6% vs 18.4%, p=0.002). CONCLUSION: Results of this study provide clinical evidence that laparoscopic surgery is a feasible and safe surgical modality for complicated appendicitis. Conduct of more reliable, large scaled, randomized prospective study will be necessary in order to prove the superiority of laparoscopic surgery for complicated appendicitis.
Appendectomy* ; Appendicitis* ; Consensus ; Diet ; Emergencies ; Humans ; Laparoscopy