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Strangulated Small Bowel Herniation Through a 12-mm Trocar Site In an Obese Patient.

Ji Hoon KIM ; Eun Young KIM ; Sung Kyun PARK ; In Kyu LEE ; Hyung Jin KIM ; Jong Kyung PARK ; Yoon Suk LEE ; Seung Teak OH ; Jun Gi KIM

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):157-159.

A trocar site hernia is a rare complication after laparoscopic surgery. Hence, a trocar site that's larger than 10 mm should be closed to prevent complications. Here we describe a case of strangulated small bowel herniation through a 12 mm-trocar site even though the fascia had been closed. A 78-year-old obese (BMI 30.7 kg/m2) patient with rectal cancer underwent an uncomplicated laparoscopic low anterior resection. On the eighth post-operative day, she presented with a right lower quadrant painful mass, and abdominal CT showed small bowel herniation through the right lower quadrant 12-mm trocar site. In the surgical field, the small bowel was resected via the extended trocar site wound and the fascial defect was repaired.
Aged ; Fascia ; Hernia ; Humans ; Laparoscopy ; Obesity ; Rectal Neoplasms ; Surgical Instruments

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Hand Assisted Laparoscopic Transduodenal Ampullary Mass Excision.

Soon Hwa YOUN ; Young Hoon KIM ; Ghap Joong JUNG ; Young Hoon ROH

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):153-156.

Transduodenal ampullectomy may be an alternative procedure, and at times a more appropriate procedure, for the management of benign neoplasms of the ampulla. We describe here our technique for performing the lesser invasive transduodenal ampullectomy. First, the duodenum is mobilized with the left hand, which is inserted via a hand port, and a right Harmonic scarpel(R) (Ethicon. Endo-surgery, Cincinnati, OH, USA) is used for duodenal incision and mass removal via a right subcostal incision. After checking the continuity and that there is no leakage of the pancreatic duct and common bile duct, the operation is finished. For transduodenal mass excision, the hand assisted laparoscopic transduodenal procedure is as good for the duct continuity and anastomosis leakage as that for the open procedure. Furthermore, this procedure is less invasive than the open procedure.
Common Bile Duct ; Duodenum ; Hand ; Pancreatic Ducts

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Laparoscopic Low Anterior Resection in a Rectal Cancer Patient with Situs Inversus Totalis: A Case Report.

Joong Jae YOO ; Myoung Jean JU ; Byung Kwon AHN

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):150-152.

Situs inversus totalis is a rare congenital condition with a mirror image of the thoracic and abdominal viscera. Although several cases of laparoscopic surgery for treating situs inversus have been reported, we believe that laparoscopic low anterior resection for the rectal cancer associated with situs inversus has not yet been reported on. We recently experienced a laparoscopic low anterior resection for rectal cancer and this was performed on a patient with situs inversus. The patient was a 66-year-old woman who presented with constipation for about 1 month. Chest X-rays showed dextrocardia, and the abdomen CT scans revealed situs inversus totalis with upper rectal cancer. She was successfully treated with laparoscopic low anterior resection even though the surgeon was not familiar with situs inversus totalis.
Abdomen ; Aged ; Constipation ; Dextrocardia ; Female ; Humans ; Laparoscopy ; Rectal Neoplasms ; Situs Inversus ; Thorax ; Viscera

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Laparoscopic Hiatal Hernia Repair during Laparoscopic Roux-en-Y Gastric Bypass (LRYGB).

Hong Chan LEE ; In Soo PARK ; Eung Kook KIM

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):147-149.

Obesity is one of the most significant causes of GERD. Nissen fundoplication is a surgical procedure that's performed world widely for treating patients with GERD and a hiatal hernia and who are intractable to medical therapy. However, Nissen fundoplication may have technical difficulties in morbidly obese patients due to the huge perigastric, intraabdominal fat tissue and hepatomegaly. During the laparoscopic Roux-en-Y Gastric Bypass (LRYGB) procedure, the stomach was divided into the gastric pouch and the remnant stomach by vertiacally stapling at the angle of His. The posterior gastric wall and hiatus were easily exposed even when there was huge deposits of perigatric and intraabdominal fat tissue. We report here on a case of concomitant hiatal hernia repair with LRYGB in a morbidly obese patient.
Fundoplication ; Gastric Bypass ; Gastric Stump ; Gastroesophageal Reflux ; Hepatomegaly ; Hernia, Hiatal ; Humans ; Obesity ; Obesity, Morbid ; Stomach

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Laparoscopic Totally Extraperitoneal Hernia Repair versus Open Lichtenstein Hernia Repair: Comparison of the Early Postoperative Outcomes and Complications.

Jung Suk RYU ; Sun Cheol PARK ; Kee Whan KIM ; Chang Hyeok AN ; Jeong Soo KIM ; Seung Jin YOO ; Keun Woo LIM ; Hang Joo CHO

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):143-146.

PURPOSE: This study compared the postoperative outcomes and complications between laparoscopic totally extraperitoneal (TEP) hernia repair and open Lichtenstein hernia repair. METHODS: A total of 64 cases (30 cases by the TEP method and 34 cases by Lichtenstein repair) were enrolled in this study. The operative time, the hospital stay, the VAS score, the amount of analgesic used, the postoperative complications and recurrence were compared between the 2 methods. RESULTS: The mean operative time was 71 min for the TEP group, which was not significantly longer than that for the Lichtenstein group (66 min). The mean postoperative hospital stay was 3.7 days for the TEP group, which was significantly shorter than that for the Lichtenstein group (4.2) (p=0.035). The mean postoperative analgesic dose was 0.9+/-0.7 and 1.1+/-1.0 within 24 hours and 0.2+/-0.5 and 0.7+/-0.8 after 24 hours, respectively. The dose of analgesic after 24 hours was significantly lower for the TEP group (p=0.011), but the dose within 24 hours and the total dose was not significantly different. The VAS score was 2.3+/-1.0 and 2.6+/-0.9 at 12 hrs and 1.2+/-0.8 and 1.7+/-0.8 at 48 hrs, respectively. The VAS score was significantly lower for TEP group than that for the Lichtenstein group at 48 hrs (p=0.011), but there was no significant difference between the groups at 12 hrs. There was one recurrence in the TEP group. CONCLUSION: For the TEP group, the hospital stay was significantly shorter than that for the Lichtenstein group and this is maybe because the postoperative pain after 24 hours from the operation was less for the TEP group. Laparoscopic TEP repair may be performed efficiently with an acceptable operating time and a shorter hospital stay, as compared to open Lichtenstein hernia repair.
Hernia ; Herniorrhaphy ; Length of Stay ; Operative Time ; Pain, Postoperative ; Postoperative Complications ; Pyrazines ; Recurrence

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The Effectiveness of Laparoscopic Ventral Hernia Repair with Transfascial Fixation.

Myung Jin KIM ; Kyung Yul HUR

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):135-142.

PURPOSE: The introduction of a mesh to ventral herniorrhaphy ensures abdominal wall strength without tension, and this procedure has shown a decreased recurrence rate, a shorter hospital stay and less use of analgesics. However, the extensive tissue dissection required for mesh placement leads to increased postoperative complications. Yet with the development of laparoscopic ventral herniorrhaphy, we expect earlier recovery, fewer complications and decreased recurrence rates. This study was done to compare the outcomes after open and laparoscopic ventral herniorrhaphy with using mesh through a retrospective review. METHODS: The outcomes for 20 consecutive patients who underwent laparoscopic ventral herniorrhaphy were compared with those of 20 consecutive patients who underwent open herniorrhaphy. The laparoscopic repairs were performed using the intraperitoneal onlay mesh (IPOM) repair with transfascial fixation method in all the cases. RESULTS: The forty patients (24 women and 16 men) had a mean age of 57.48 years (range, 33~82). The mean follow-up time was 63.4 months. The mean surgery duration (67.4 min vs 142.3 min, respectively, p=0.003) and postoperative stay (4.7 vs 16.2 days, respectively, p<0.0001) were shorter for the laparoscopic group. The number of shots of analgesics during the first 3 days after surgery was 1.9 vs 2.4 shots, respectively (p=0.019). There were fewer complications (30%) and recurrences (5%) among the patients who underwent laparoscopic repair than those for the patients who underwent open repair (65% and 10 %, respectively). CONCLUSION: Those findings shows that laparoscopic ventral herniorrhaphy with transfascial fixation seems to be safe and effective and it showed a shorter operative time, fewer complications, a shorter hospital stay and less recurrence than did open ventral herniorrhaphy.
Abdominal Wall ; Analgesics ; Female ; Follow-Up Studies ; Hernia, Ventral ; Herniorrhaphy ; Humans ; Inlays ; Length of Stay ; Operative Time ; Postoperative Complications ; Recurrence ; Retrospective Studies

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A Single Surgeon's Experience with Laparoscopic Adrenalectomy.

Ho Chul CHOUNG ; Ji Young SUL

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):129-134.

PURPOSE: Laparoscopic surgery on the adrenal gland is a highly specific procedure that requires mastery of laparoscopic surgery. From January 2000 to October 2008, 66 laparoscopic adrenalectomies on 65 patients were performed by a single surgeon. This study was done to summarize our experience and to evaluate the safety and effectiveness of laparoscopic adrenalectomy. METHODS: A retrospective review of the patient records was carried out. The patients' demographics, the tumor characteristics, the open conversion rate, the operating time, the length of the hospital stay and other clinical outcomes were studied. RESULTS: There were 8 conversions out of 65 patients. The indications for surgery included functional tumors in 42 patients (19 pheochromocytomas in 18 patients, 14 patients of primary aldosteronism and 10 patients of Cushing syndrome), and 23 nonfunctional tumors. The average tumor size was 3.5 cm. The mean operating time was 163 min. The average length of the hospital stay was 4.1 days. Postoperative complications occurred in 8 patients with no perioperative mortality, and most of the complications could be considered as minor. During follow-up, two patients had adrenal insufficiency and port site hernia, and none had recurrence of hormonal excess. CONCLUSION: Laparoscopic adrenalectomy has several advantages such as minimal postoperative pain, few surgical complications, a short hospital stay and an early return to work. The results confirm that laparoscopic adrenalectomy is the procedure of choice for resection of various benign adrenal neoplasms.
Adrenal Gland Neoplasms ; Adrenal Glands ; Adrenal Insufficiency ; Adrenalectomy ; Demography ; Follow-Up Studies ; Hernia ; Humans ; Hyperaldosteronism ; Laparoscopy ; Length of Stay ; Pain, Postoperative ; Pheochromocytoma ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Return to Work

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Comparison of Laparoscopic Adrenalectomy with Open Adrenalectomy for Adrenal Tumor.

Jin Chul KIM ; Young Up CHO ; Kang Yeun LEE ; Jang Yong KIM ; Yun Mee CHOE ; Sun Keun CHOI ; Yoon Seok HUR ; Keon Young LEE ; Sei Joong KIM ; Seung Ik AHN ; Kee Chun HONG ; Seok Hwan SHIN ; Kyung Rae KIM

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):123-128.

PURPOSE: The definite indications of laparoscopic adrenalectomy (LA) and the limitations of minimally invasive surgery have yet to be determined. To verify the benefit and safety of LA, we compared the results of LA with those of open adrenalectomy (OA) and we further analyzed the clinical results of LA in accordance with the time period of performing this surgery. METHODS: We retrospectively reviewed 69 patients who received adrenalectomy between 1997 and 2008. We compared LA with OA. The LA was divided into subsets of the early and late groups, and the transperitoneal approach and retroperitoneal approach groups, and we compared and analyzed the results of each group, along with the results of the OA and LA groups. For each of the groups, we analyzed the following factors; age, gender, tumor size, tumor location, the operative time, the time under anesthesia, the amounts of blood loss and transfusion, the time to first oral intake, the length of the postoperative hospital stay and the complications. RESULTS: LA (25 cases), as compared to OA (20 cases), showed better results for the amount of transfusion, the time to first oral intake, the length of the postoperative hospital stay and the complication rates (p=0.032; p=0.017; p=0.02). As for CA (4 cases), the time to first oral intake and the length of the postoperative hospital stay were significantly longer than that of LA (p=0.001; p=0.021). LA done in the late period demonstrated less blood loss and a shorter time to first oral intake as compared to the LA of the early period (p=0.032; p=0.019). There were no significant statistical differences between the results of the peritoneal or retroperitoneal approaches. CONCLUSION: LA has the merits of a shortening hospital stay and decreased complication. Furthermore, as the experience with this type of surgery accumulates, these merits are likely to become stronger. Thus, surgeons are expected to carefully decide on choosing the surgical methods by fully understanding the benefits and indications of LA.
Adrenal Gland Neoplasms ; Adrenalectomy ; Anesthesia ; Humans ; Length of Stay ; Operative Time ; Retrospective Studies

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Laparoscopic Removal of a Vertebral Foreign Body.

Hee Chul SHIN ; Ju Hee LEE ; Ye Seob JEE ; Do Joong PARK ; Hyung Ho KIM ; Ho Seong HAN

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(1):54-56.

We report a case of laparoscopic removal of a retained foreign body, a broken surgical instrument, after posterior lumbar decompression and interbody fusion (PLIF) for infection control of the vertebrae. The surgical instrument was broken during PLIF surgery. However, the orthopedic surgeon could not remove the broken instrument because of bleeding and a poor operative view; the surgeon finished the operation leaving the broken surgical instrument in the vertebral body. Plain films revealed a metallic pin-like material at the anterior side of the lumbar vertebral body. Six days later, through a laparoscopic approach, the broken surgical instrument was removed without complication, and the orthopedic surgeon completed the planned operation successfully.
Decompression ; Foreign Bodies ; Hemorrhage ; Infection Control ; Laparoscopy ; Orthopedics ; Spine ; Surgical Instruments

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The Incidence of the Occult Contralateral Hernia in Patients Undergoing Total Extraperitoneal (TEP) Repair of a Left Inguinal Hernia.

Choon Sik CHUNG ; Jeong Eun LEE ; Yong Geul JOH ; Sang Hwa YU ; Gyu Young JEONG ; Seung Han KIM ; Dong Keun LEE

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(1):50-53.

PURPOSE: Laparoscopic herniorrhaphy (LH) can be used to examine the asymptomatic contralateral side and repair occult contralateral hernias coincidentally with reduced morbidity. In this prospective study, we evaluated the results of diagnostic exploration of the right side during total extraperitoneal (TEP) laparoscopic repair of left side inguinal hernias. METHODS: A prospective study of 100 consecutive male patients undergoing TEP repair by a single surgeon (C.S) between January and June 2008 was conducted. Two cases that had transabdominal preperitoneal (TAPP) prosthetic repair and one intraperitoneal onlay mesh (IPOM) were excluded. We routinely explored the contralateral side to determine the incidence of right side occult hernia. RESULTS: The mean age was 52 (range; 18~82 years). Among the 100 patients, 17 had bilateral, 52 right and 31 left hernias on physical examination prior to surgery. Three of 31 diagnosed preoperatively as left inguinal hernia were confirmed to have occult right hernias (3/31, 9.7%). Among the three patients, two patients with a direct type had the same type of hernia as on the contralateral side (2/10, 20%). Another one patient with an indirect type had direct type of hernia on the contralateral side (1/21, 4.8%). CONCLUSION: Given the low incidence of contralateral side occult hernia with indirect types of hernias, routine exploration may not be indicated during TEP repair. However, it might be, reasonable to explore the contralateral side in patients with a direct type of hernia because of the higher incidence of contralateral occult hernias.
Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Incidence ; Inlays ; Male ; Physical Examination ; Prospective Studies ; Pyrazines

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