Exposure of the angle of His (AOH) with liver retraction is one of the key processes during laparoscopic sleeve gastrectomy (LSG). A new internal liver retractor, the LiVac (LiVac, Pty Ltd.) has recently been introduced. This study was conducted to evaluate the feasibility of the LiVac in LSG. We applied the LiVac in 20 patients who received LSG. The feasibility was assessed by exposure of the AOH, operation time, complications, and changes of aspartate transaminase and alanine transaminase. In all 20 patients, exposure of the AOH was successful. The mean operation time was 88 minutes. The changes in preoperative and postoperative aspartate transaminase and alanine transaminase levels were 18.6 and 9.1 U/L, respectively. There were no related morbidities. In LSG, exposure of the AOH using the LiVac was technically feasible.

Exposure of the angle of His (AOH) with liver retraction is one of the key processes during laparoscopic sleeve gastrectomy (LSG). A new internal liver retractor, the LiVac (LiVac, Pty Ltd.) has recently been introduced. This study was conducted to evaluate the feasibility of the LiVac in LSG. We applied the LiVac in 20 patients who received LSG. The feasibility was assessed by exposure of the AOH, operation time, complications, and changes of aspartate transaminase and alanine transaminase. In all 20 patients, exposure of the AOH was successful. The mean operation time was 88 minutes. The changes in preoperative and postoperative aspartate transaminase and alanine transaminase levels were 18.6 and 9.1 U/L, respectively. There were no related morbidities. In LSG, exposure of the AOH using the LiVac was technically feasible.

OBJECTIVES: This study aimed to identify the characteristics of depression in early dementia and mild cognitive impairment patients. METHODS: We included 412 community-dwelling elderly. They were assessed with Mini-Mental Status Examination in the Korean version of the CERAD Assessment Packet (MMSE-KC), Clinical Dementia Rating Scale (CDR), Korean version of Geriatric Depression Scale (GDS) and Korean version of Hamilton Depression Rating Scale (HDRS). All patients were divided three groups, nondemented group (ND), mild cognitive impairment group (MCI), and early dementia group (ED). We compared depressive symptoms between three groups using each items of HDRS. RESULTS: Prevalence of depression (GDS> or =16) was 24.6% in ND, 33.3% in MCI and 41% in ED. Several items of HDRS, depressed mood, feeling of guilt, loss of work & interests, psychomotor retardation, psychomotor agitation, psychic anxiety, somatic anxiety, and gastrointestinal symptoms, were significantly associated with cognitive decline in all subjects. However, no item of HDRS was significantly associated with cognitive decline in depressive patients. CONCLUSION: This study suggests that the prevalence of depression may increase as cognitive function declines. There was no difference in depressive symptoms between three groups.
Aged ; Alzheimer Disease* ; Anxiety ; Dementia ; Depression* ; Guilt ; Humans ; Mild Cognitive Impairment* ; Prevalence* ; Psychomotor Agitation

Purpose: The purpose of this study is to evaluate the usefulness of individualized metabolic surgery score for Korean patients in determining bariatric surgical procedures. Materials and Methods: A total of 135 patients with type 2 diabetes mellitus who underwent sleeve gastrectomy (n=19) or Roux-en-Y gastric bypass (n=116) at our institute with a 1-year follow up were analyzed for the predictive power of diabetes remission using the individualized metabolic surgery scoring system. Results: At the postoperative follow-up of 1 year, the remission of type 2 diabetes mellitus (HbA1C＜6.5%, off medications) was achieved in 88 (65.2%) patients. The remission rates showed no significant differences between patients who underwent sleeve gastrectomy and Roux-en-Y gastric bypass (63.2% versus 65.5%; P=0.84), regardless of the severity of type 2 diabetes mellitus. Although there was no statistically significant difference in the remission rate according to the bariatric surgery procedures (P＞0.99 in mild, P=0.11 in moderate, P＞0.99 in severe IMS score), remission rates were higher in moderate severity patients who underwent Roux-en-Y gastric bypass than in those who underwent sleeve gastrectomy (69.7% versus 37.5%). Conclusion The remission rates after bariatric surgery procedures were similar to that of the previously reported study. Despite the limitations of our data, the individualized metabolic surgery score can be used as a complement to other scoring systems in Korean patients.

Laparoscopic sleeve gastrectomy (LSG) has become a standalone primary procedure as a bariatric metabolic surgery since the early 2000s. The overall complication rate of LSG is reported to range from 2% to 15%. Staple line leakage (SLL) remains a major adverse event and occurs in approximately 1%–6% of patients. Choosing the optimal treatment modality is a complex process. Clinicians must understand that nutritional support and drainage of fluid collection are essential for initial management. Conservative endoscopic management and sufficient drainage can resolve approximately 70% of SLLs. Endoscopic management of bariatric complications has been rapidly evolving in recent years and can be considered in all patients who are hemodynamically stable. We will review the available endoscopic management techniques, including stent placement (self-expanding stents and bariatric-specific stents), clipping, tissue sealant application, and internal drainage (double-pigtail stents [DPS] placement, endoscopic vacuum therapy, and septotomy). Stent placement remains the mainstream treatment for SLLs. However, healing with stents requires multiple sessions/stents and a long course of recovery. Endoscopic internal drainage is gaining popularity and has the potential to be a superior method. The importance of early intervention and combined endoscopic methods should be recognized.

BACKGROUND/OBJECTIVES: Accumulating evidence has shown the beneficial effects of isoflavone on health. There is limited information on the usual isoflavone intake for Koreans.This study examined the usual intake of total isoflavone and its major food sources in Koreans according to age and gender. SUBJECTS/METHODS: The dietary intake data of 21,271 participants aged 1 yrs and older from the Korea National Health and Nutrition Examination Survey (KNHANES) VII 2016– 2018 were analyzed. The average isoflavone intake was estimated based on the 24-h dietary recall data in KNHANES and the isoflavone database from the Korea Rural Development Administration (RDA) and literatures. The usual isoflavone intake was estimated by applying the ratio of within- and between-participant variance estimated from the 2009 KNHANES data to the 7th KNHANES (2016–2018) data. The variance of the isoflavone intake was calculated using MIXTRAN macro with intake data for two days in the 2009 KNHANES.Complex sample analysis with stratified variables and integrated weights was conducted. RESULTS: The mean total isoflavone intake in the Korean population aged 1 yrs and older (n = 21,271) was 139.27 mg/d, which was higher than the usual intake of 47.44mg/d. Legumes were a major contributing food group (91%), with arrowroot being a major individual contributor to the isoflavone intake (67.2%), followed by 21.3% of soybean, 5.4% of bean sprouts, and 2.1% of tofu. The usual isoflavone intake was highest in the participants aged 50 to 64 yrs old and increased with age until 50 to 64 yrs and then decreased with further increases in age.The usual isoflavone intake of participants aged 65 yrs and older was higher for men than for women, showing gender differences. CONCLUSIONS The usual dietary intake of isoflavone varied according to age and gender in the Korean population. This study showed that the usual isoflavone intake was lower than the average isoflavone intake. The difference between percentiles of the usual isoflavone intake was similarly smaller than the average intake. An estimation of average intake can be hindered by the occasional consumption of foods high in isoflavones, suggesting that the usual intake estimation method can be more appropriate. Further research will be needed to establish isoflavone dietary guidelines regarding the effects of isoflavone intake on health outcomes.

PURPOSE: This study aimed to compare the oncologic and short-term outcomes of laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) for advanced gastric cancer (AGC). MATERIALS AND METHODS: From July 2006 to November 2016, 384 patients underwent distal gastrectomy for AGC. Data on short- and long-term outcomes were prospectively collected and reviewed. Propensity score matching was applied at a ratio of 1:1 to compare the LDG and ODG groups. RESULTS: The operative times were longer for the LDG group than for the ODG group. However, the time to resumption of diet and the length of hospital stay were shorter in the LDG group than in the ODG group (4.7 vs. 5.6 days, P=0.049 and 9.6 vs. 11.5 days, P=0.035, respectively). The extent of lymph node dissection in the LDG group was more limited than in the ODG group (P=0.002), although there was no difference in the number of retrieved lymph nodes between the 2 groups. The 3-year overall survival rates were 98% and 86.9% (P=0.018), and the 3-year recurrence-free survival rates were 86.3% and 75.3% (P=0.259), respectively, in the LDG and ODG groups. CONCLUSIONS: LDG is safe and feasible for AGC, with earlier recovery after surgery and long-term oncologic outcomes comparable to those of ODG.
Diet ; Disease-Free Survival ; Gastrectomy ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Operative Time ; Propensity Score ; Prospective Studies ; Stomach Neoplasms ; Survival Rate

PURPOSE: This study examined the mediation effects of dietary habits, nutrient intake, daily life in the relationship between the working hours of Korean shift workers and metabolic syndrome. METHODS: Data were collected from the sixth (2013–2015) Korea National Health and Nutrition Examination Survey (KNHANES). The stochastic regression imputation was used to fill missing data. Statistical analysis was performed in Korean shift workers with metabolic syndrome using the SPSS 24 program for Windows and a structural equation model (SEM) using an analysis of moment structure (AMOS) 21.0 package. RESULTS: The model fitted the data well in terms of the goodness of fit index (GFI) = 0.939, root mean square error of approximation (RMSEA) = 0.025, normed fit index (NFI) = 0.917, Tucker-Lewis index (TLI) = 0.984, comparative fit index (CFI) = 0.987, and adjusted goodness of fit index (AGFI) = 0.915. Specific mediation effect of dietary habits (p = 0.023) was statistically significant in the impact of the working hours of shift workers on nutrient intake, and specific mediation effect of daily life (p = 0.019) was statistically significant in the impact of the working hours of shift workers on metabolic syndrome. On the other hand, the dietary habits, nutrient intake and daily life had no significant multiple mediator effects on the working hours of shift workers with metabolic syndrome. CONCLUSION: The appropriate model suggests that working hours have direct effect on the daily life, which has the mediation effect on the risk of metabolic syndrome in shift workers.
Food Habits* ; Hand ; Korea* ; Negotiating* ; Nutrition Surveys*

Purpose: The aim of this study was to report our experiences of sleeve gastrectomy (SG) in obese patients with type 1 diabetes mellitus (T1DM) and to assess its metabolic outcomes through a review of the literature and a meta-analysis. Materials and Methods: We conducted a retrospective review of the electronic medical records of all patients who underwent bariatric surgery between January 2008 and February 2019 at a single institution. A literature search was performed using PubMed, Cochrane library, and Embase, and a meta-analysis for each direct comparison between pre- and postoperative groups was performed using the random effects DerSimonian–Laird method. Results: We identified three obese patients with T1DM who underwent SG. The baseline body mass index (BMI), HbA1c, and total daily insulin dose was 40.8 (37-47.4) kg/m2 , 7.1% (6%-7.7%), and 92.3 (54-113) units, respectively. After surgery, the BMI and total daily insulin dose reduced to 32.2 (30.2-37.6) kg/m2 and 22.3 (12-40) units, respectively. However, the HbA1c increased to 7.8% (5.4%-10.8%). In the meta-analysis, the weighted mean reduction in BMI, HbA1c, and total daily insulin dose were 10.69 kg/m2 (95% CI 7.01-14.37, P＜0.00001, I2 =0%), 0.3% (95% CI −0.10-0.71, P=0.1447, I2 =0%), and 58.52 units (95% CI 15.96-101.08, P=0.07, I2 =0%), respectively. Conclusion SG showed excellent weight-reducing effects during a short follow-up period in obese patients with T1DM and improved the glycemic control by reducing insulin requirement.

Laparoscopic loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) has theoretical advantages compared with laparoscopic Roux-en-Y gastric bypass. We performed 7 cases of LDJBSG from May 2019 to September 2019. All procedures were successfully completed by laparoscopy. The mean operative time was 282.9 (210~335) minutes and the mean estimated blood loss was 82.9 (20~150) ml. There was no intraoperative complications, however, there was 1 case of postoperative anastomotic leakage. The average length of postoperative hospital stay was 5.3 (3~12) days. The mean body weight at baseline was 117.1 (88.4~151.1) kg, and was decreased to 90.4 (69.4~130.9) kg at postoperative 3 month. The mean of HbA1c at baseline was 7.6 (5.5~9.4) %, and was decreased to 5.3 (4.8~5.6) % at postoperative 3 month. Although LDJB-SG is a technically demanding procedure, it can be a feasible and safe procedure if the learning curve can be overcame.