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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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Robot-assisted Excision of a Huge Choledochal Cyst and Roux-en-Y Hepaticojejunostomy using the da Vinci(TM) Surgical System.

Jeong Sun LEE ; Jeong Hyun PARK ; Tae Ho HONG ; Sang Kuon LEE

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2010;13(1):35-38.

Choledochal cysts are cystic dilatations of the extrahepatic biliary tree, the intrahepatic bile ducts or both. Because they can develop malignant components, the principle treatment is total excision of the cyst with biliary-enteric reconstruction, and this has been attempted with using minimally invasive techniques. But most reports have uniformly emphasized the technical challenge of laparoscopically correcting a choledochal cyst because of the restricted movements of the laparoscopic equipment. On the other hand, a robotic surgical system with three-dimensional visualization, tremor reduction, motion scaling and wristed instrumentation was introduced in the recent years. Herein, we present a case of the robotic approach to a huge choledochal cyst in an adult.
Adult ; Bile Ducts, Intrahepatic ; Biliary Tract ; Choledochal Cyst ; Dilatation ; Hand ; Humans ; Tremor ; Wrist

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Laparoscopically Assisted Hartmann's Procedure Followed by Laparoscopic Reversal in a Patient with Peritonitis Induced by Colonic Perforation.

Hye Mi YU ; Min Sung AN ; Ki Beom BAE ; Kwan Hee HONG

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2010;13(1):31-34.

Although laparoscopic surgery has been adopted for the treatment of peritonitis since the time laparoscopy was introduced for emergency operations, a laparoscopic Hartmann's procedure has not been described. We report on a Hartmann's procedure and its reversal for the treatment of peritonitis from colonic perforation by laparoscopic surgery. A 43-year-old female was diagnosed with fecal peritonitis due to a colonic perforation in the rectosigmoid colon. Five trocars were used and a Lapdisc(R) (Hakko medical, Japan) was placed at the previous Phannelstiel incision site. One hundred sixty minutes were needed for the laparoscopic Hartmann's procedure following peritoneal lavage. An oral diet was started at the postoperative 6th day and the patient was discharged on the 20th day with complete recovery. Hartmann's reversal was laparoscopically performed 3 months later. A Lapdisc was placed at the colostomy site following colostomy take-down. Four trocars were inserted at the same area as the first operation. The operative time was 180 minutes. There were no postoperative complications.
Adult ; Colon ; Colostomy ; Diet ; Emergencies ; Female ; Humans ; Laparoscopy ; Operative Time ; Peritoneal Lavage ; Peritonitis ; Postoperative Complications ; Surgical Instruments

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