Cholelithiasis and cholecystitis frequently necessitate cholecystectomy. Experience is increasing with laparoscopic cholecystectomy, a technique that avoids much of the morbidity, pain, prolonged hospital day, and recovery complications associated with the traditional approach. And the safety of laparoscopic cholecystectomy was confirmed. Besides appendectomy, cholecystectomy is the second most common nonobstetric procedure performed in pregnant women. We have performed one case of a successful laparoscopic cholecystectomy in the second trimester of pregnancy. Pregnancy was once a contraindication of laparoscopic operation, but no longer.
Appendectomy ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholelithiasis ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Pregnant Women

The success and rapid spread of laparoscopic cholecystectomy have prompt the application of laparoscopic approach to abdominal surgical problems. As better in- strumentation is introduced, more complicated surgical procedrues will be performed. In some hematologic disorders, splenectomy was required to cope with these disorders. So laparoscopic splenectomy also has been perfomed inspite of several specific difficulties for handling and mobilization of a parenchymatous organ and the retrieval of the specimen. We experienced a case of idiopathic thrombocytopenic purpura which was treated safely and successfully by laparoscopic splenectomy in 35-year-old female. This technique allows the patient to return to normal activity sooner than with open splenectomy.
Adult ; Cholecystectomy, Laparoscopic ; Female ; Humans ; Purpura, Thrombocytopenic, Idiopathic* ; Splenectomy*

Changes of blood pressure, heart rate, ECG, respiration rate and pupil size by intracerebroventricular(ICV) infusion of hypertonic NaCl with 0.04 ml/min for 5 min(total 0.2ml) were observed in urethane-anesthetized rabbits. ICV infusion of 0.75M NaCl produced slight pressor effect (11mmHg) and did not affect other parameters. ICV infusion of 1.5M NaCl began to increase blood pressure from 2~3 min after the infusion and produced maximal increase(24mmHg) at 5~10 min. Then the pressor effect was recovered to the original level at 30~60 min. Change of heart rate by the infusion was not clear, but ST-segment of ECG was markedly depressed. Respiration rate increased about 1.5 times than the control in accordance with the pressor effect and the state was continued even after the recover of the pressor effect. Both pupils dilated markedly and light-reflex was lost. Changes of parameters by ICV infusion of 3.0M NaCl were similar to those by 1.5M NaCl and some rabbits caused severe arrhythmias and died. The purpose of present study is to investigate the mechansim(s) of the pressor effect induced by the ICV infusion of 1.5M NaCl. The pressor effect of 1.5M NaCl was attenuated by the continuous infusion of vasopressin antagonist(20microm/kg/min) but not affected by intravenous treatment with 2mg/kg phentolamine, 2mg/kg propranolol and 1mg/kg chlorisondamine. The pressor effect was not altered with ICV 0.12mg/kg phenoxybenzamine, 0.4mg diltiazem, 0.1mg/kg mecamylamine and 0.2mg/kg atropine. After ICV infusion of 25microg/kg/min of diazepam, however, the pressor effect was completely abolished and restored 3~4 hours after stopping diazepam infusion. The pressor effect was rather potentiated than inhibited in bilateral adrenalectomized or nephrectomized rabbits. Infusion of 2microg/kg/min of saralasin for 10 min in the bliateral adrenalectomized rabbit did not affect the pressor effect at all. These results suggest that hypertensive effect induced by ICV infusion of hypertonic NaCl is mediated by the increase of vasopressin secretion.
Arrhythmias, Cardiac ; Atropine ; Blood Pressure ; Chlorisondamine ; Diazepam ; Diltiazem ; Electrocardiography ; Heart Rate ; Infusions, Intraventricular* ; Mecamylamine ; Phenoxybenzamine ; Phentolamine ; Propranolol ; Pupil ; Rabbits* ; Respiratory Rate ; Saralasin ; Vasopressins

Seven cases of retroperitoneal laparoscopic lumbar sympathectomy were successfully performed in 10 patients with ischemic lesions of lower limbs or ischemic rest pain between June, 1996 and October, 1996. All patients had nonreconstructable distal vessels on femoral angiogram. Our techniques of retroperitoneal laparoscopic lumbar sympathectomy is described in detail. Procedure offers the advantage of minimally invasive surgery and can be performed more efficiently as the experience of the surgeon accumulates.
Humans ; Lower Extremity ; Surgical Procedures, Minimally Invasive ; Sympathectomy*

Bariatric surgery is considered to be the most effective treatment modality in maintaining long-term weight reduction and improving obesity-related conditions in morbidly obese patients. In Korea, surgery for morbid obesity was laparoscopic sleeve gastrectomy first performed in 2003. Since 2003, the annual number of bariatric surgeries has markedly increased, including adjustable gastric banding (AGB), Roux-en-Y gastric bypass, sleeve gastrectomy, mini-gastric bypass, and others. In Korea, AGB is much more common than in others countries. A large proportion of doctors, the public, and government misunderstand the necessity and effectiveness of bariatric surgery, believing that bariatric surgery has an unacceptably high morbidity, and that it is not superior to non-surgical treatments to improve obesity and obesity-related diseases. The effectiveness, safety, and cost-effectiveness of bariatric surgery have been well demonstrated. The Korean Society of Metabolic and Bariatric Surgery recommend bariatric surgery confining to morbidly obese patients (body mass index ≥40 or >35 in the presence of significant comorbidities).
Bariatric Surgery* ; Gastrectomy ; Gastric Bypass ; Humans ; Korea* ; Obesity ; Obesity, Morbid ; Weight Loss

Incisional or ventral hernia is a very common multifactorial disease that requires surgery to prevent complications, including pain, discomfort, bowel obstruction, incarceration, and strangulation. To perform herniorrhaphy, it is essential to understand the pathogenesis of hernia, the anatomy and physiology of the abdominal wall, and surgical techniques. Several repair methods are available, including open suture repair, open mesh repair, the component separation technique, and tissue expansion assisted closure. Currently, laparoscopic incisional or ventral hernia repair is commonly used with the major advantage being the lower recurrence and all defects can be addressed at the time of surgery as well as reduced postoperative pain and length of hospital stay. On the other hand, to do it properly, a full understanding and appropriate selection of mesh and management of probable complications, such as seroma, bowel injury, enteric fistula, and recurrence, is essential. Therefore, the surgeon and the techniques used are of paramount importance in the repair of incisional ventral hernias.
Abdominal Wall ; Fistula ; Hand ; Hernia ; Hernia, Ventral* ; Herniorrhaphy ; Incisional Hernia ; Length of Stay ; Pain, Postoperative ; Physiology ; Recurrence ; Seroma ; Sutures ; Tissue Expansion

PURPOSE: The optimal surgical technique for inguinal hernia repair continues to be debated. This study was designed to investigate optimal surgical procedures in inguinal or femoral hernia. METHOD: We analyzed 153 cases of herniorrhaphy on inguinal or femoral hernias between August 1996 and November 2000. We divided patient into four groups according to the methods of hernia repair, i.e., 1) 78 cases of laparoscopic herniorrhaphy, 2) 42 cases of Lichtenstein herniorrhaphy, 3) 24 cases of Bassini herniorrhaphy and 4) 9 cases of McVay herniorrhaphy. RESULTS: The patient in the laparoscopic and Lichtenstein herniorrhaphy groups needed shorter hospital stays than those in the Bassini or McVay herniorrhaphy groups. The severity of pain was assessed by the total amount and duration of nonsteroidal anti-inflammatory drug injections, which was minimal in the laparoscopic group. There were no differences in complications between the groups. One patient in the laparoscopy group had a hernia recurrence and was reoperated with Lichtenstein herniorrhaphy. We compared two tension-free herniorrhaphies with each other. The numbers of patients not needing analgesic injections were more in the laparoscopic than the Lichtenstein herniorrhaphy group, reflecting less pain in the former group. Hospital stays were also shorter in the laparoscopic than the Lichtenstein herniorrhaphy group. CONCLUSION: We concluded that tension-free herniorrhaphy is superior to tension herniorrhaphy in terms of postoperative pain & recovery. Of the tension-free herniorrhaphies, laparoscopic herniorrhaphy is associated with less postoperative pain and shorter hospital stays than Lichtenstein herniorrhpahy.
Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Laparoscopy* ; Length of Stay ; Pain, Postoperative ; Recurrence

PURPOSE: Laparoscopic splenectomy (LS) is the procedure of choice in treating hematologic diseases, however there are controversies concerning malignancy and splenomegaly. This study was performed in order to examine the safety and efficacy of LS and hand-assisted laparoscopic splenectomy (HALS) in the management of patients with various splenic tumors and splenomegaly. METHODS: Fifteen patients who had undergone laparoscopic splenectomy for suspected splenic tumors between May, 1998 and December, 2000 were evaluated. We conducted a review, recording previous abdominal surgery, diagnostic work up, size of spleen, accessory spleen, type of surgery, morbidity, mortality, and length of hospital stay. A retrograde analysis was conducted using the medical records of the patients. RESULTS: The average splenic length was 22.4 cm (range, 14~37 cm), and the average weight was 1,210 gm (range, 210~3,700 gm). There were two types of operations performed. LS was accomplished in 7 cases and HALS in 8 cases. All operations were completed without any conversion to open surgery. The average intraoperative blood loss was 153.5 ml (range, 45~830 ml). The average postoperative stay was 5.2 days (range, 3~9 days). Only one complication (subphrenic abscess) developed (7%), which was resolved by percutaneous drainage. No deaths occurred. The pathologic findings were lymphoma (4), hemangioma (4), islet cell tumor (2), lymphangioma (3), myelofibrosis (1), and hematoma (1). CONCLUSION: LS and HALS are safe and feasible procedures for the treatment of most neoplastic splenic diseases with splenomegaly. HALS is an alternative approach for overcoming the technical and oncological challenges that often accompany malignant splenic diseases such as splenomegaly, perisplenitis and hilar lymphadenopathy. As the indications for LS including HALS are expanded, the role of LS and HALS in various splenic tumors will become more clearly defined.
Adenoma, Islet Cell ; Conversion to Open Surgery ; Drainage ; Hemangioma ; Hematologic Diseases ; Hematoma ; Humans ; Length of Stay ; Lymphangioma ; Lymphatic Diseases ; Lymphoma ; Medical Records ; Mortality ; Primary Myelofibrosis ; Spleen ; Splenectomy* ; Splenic Diseases ; Splenomegaly

Sparganosis is a parasitic disease which involves various parts of the body including subcutaneous tissues. The breast is a well-known site, though case reports are uncommon. We experienced a case of breast sparganosis which shows serpiginous mixed density lesions on mammography and nonspecific hypoechoic lesions partly connected with each other without surrounding inflammoatory change on ultrasonography.
Breast* ; Mammography ; Parasitic Diseases ; Sparganosis* ; Ultrasonography

Bariatric surgery is considered to be the most effective treatment modality in maintaining long-term weight reduction and improving obesity-related conditions in patients that are morbidly obese. Since 2003 when the first bariatric surgery was performed in Korea, the annual number of cases has markedly increased. The adjustable gastric banding procedure is known to be less invasive and less destructive than gastric bypass or sleeve gastrectomy, and it is unique that the proportion of this procedure is much higher in Korea than in other countries. This phenomenon arises from a misunderstanding that bariatric surgery has an unacceptably high morbidity rate and that it is not superior to nonsurgical treatment to improve obesity and related diseases. To overcome this misunderstanding, it is essential for doctors as well as patients to understand that obesity is a disease entity that requires an intensive treatment and to comprehend that bariatric surgery is a viable treatment for obesity.
Bariatric Surgery ; Gastrectomy ; Gastric Bypass ; Humans ; Korea ; Obesity ; Weight Loss