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Comparison of Clinical Outcomes after Laparoscopic and Open Appendectomy for Complicated Appendicitis.

Jong Min KIM ; Sung Ryol LEE ; Hyung Ook KIM ; Won Joon CHOI ; Byung Ho SON

Journal of Minimally Invasive Surgery.2013;16(4):98-103. doi:10.7602/jmis.2013.16.4.98

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

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Long-term Clinical Results of Laparoscopic Splenectomy for Surgical Disease of the Spleen: Recent Outcomes.

Jeong Eun SEO ; Seog Ki MIN ; Hyeon Kook LEE

Journal of Minimally Invasive Surgery.2013;16(4):91-97. doi:10.7602/jmis.2013.16.4.91

PURPOSE: Laparoscopic splenectomy (LS) is one method for treatment of various diseases of the spleen, especially hematological conditions. However, few recent long-term follow-up results have been reported. The purpose of this study is to evaluate the outcome of patients in a single institution who recently underwent LS and to analyze their long-term follow-up results. METHODS: Of 366 splenectomies, this study was conducted as a retrospective review of 52 patients who underwent LS for treatm ent of hematological or primary diseases of the spleen from January 1998 to October 2011. The data included age, sex, pathological diagnosis, operative time, postoperative hospital stay, rate to open conversion, perioperative transfusion, morbidity, mortality, and relapse. We analyzed outcomes of variable results through long-term follow-up. RESULTS: The mean follow-up period was 84 months (range, 4~147 months). The most common indication for LS was immune thrombocytopenic purpura (ITP). The median postoperative hospital stay was eight days (range, 3~28 days). Mean operative time was 203 minutes (range, 115~475 minutes). Two patients underwent open conversion. Thirty eight patients received perioperative transfusions. The mean spleen weight was 294.9 g (range, 31~2,564 g). The overall morbidity rate was 5.8% and one patient experienced relapse. Of the 28 patients with ITP, 89.3% responded to LS. CONCLUSION: LS should be one of the best treatment options regardless of splenomegaly and spleen-associated diseases. In particular, for patients with ITP, LS has shown very effective long-term follow-up results. Therefore, LS should be more actively considered as an early treatment option in surgical disease of the spleen, such as ITP.
Diagnosis ; Follow-Up Studies ; Hematologic Diseases ; Humans ; Length of Stay ; Methods ; Mortality ; Operative Time ; Purpura, Thrombocytopenic, Idiopathic ; Recurrence ; Retrospective Studies ; Spleen* ; Splenectomy* ; Splenomegaly

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Implementation of a Critical Pathway for Patients with Acute Cholecystitis.

Sa Hong MIN ; Ho Seong HAN ; Jai Young CHO ; Yoo Seok YOON ; Dae Wook HWANG ; Kyuwhan JUNG ; Young Ki KIM ; Hong Kyung SHIN ; Woohyung LEE

Journal of Minimally Invasive Surgery.2013;16(4):87-90. doi:10.7602/jmis.2013.16.4.87

PURPOSE: Since introduction of the laparoscopic procedure for cholecystectomy, it has become the treatment of choice for symptomatic gallbladder diseases. Previous studies have demonstrated that implementation of critical pathway (CP) in laparoscopic cholecystectomy (LC) is effective in reducing cost in terms of length of stay (LOS) and revisit rates. However, few studies have proven the effectiveness of critical pathway specifically in patients with acute cholecystitis (AC). METHODS: CP was introduced for LC for chronic cholecystitis (CC) in April 2008. Then, indication for CP was extended to AC in May 2010. We compared outcomes of LC for patients with AC between two eras, including Pre-CP (Jan 2007 to Mar 2008) and Post-CP (May 2010 to Jun 2011). Among 78 patients with AC, 70 patients (90%) were enrolled for the critical pathway. Among them, 55 patients (79%) were discharged with full application of CP; however, it was suspended in 15 patients (21%). RESULTS: No differences in demographics and clinical characteristics were observed between Pre-CP (n=97) and Post-CP (n=70) patients. The mean LOS before surgery was shorter in the Post-CP group (2.6 vs. 4.0 days, p=.012). In addition, the mean total LOS was shorter in the Post-CP group (5.5 vs. 8.7 days, p<.001). However no differences in postoperative complications were observed between the two groups (10 vs. 5 cases, p=.483). CONCLUSION: Implementation of CP in AC resulted in a decrease in the LOS in total and before surgery, without increasing morbidity. Therefore, critical pathway can be safely implemented for selected patients with AC.
Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute* ; Critical Pathways* ; Demography ; Gallbladder Diseases ; Humans ; Length of Stay ; Postoperative Complications

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Reduced Port Laparoscopic Reversal of Hartmann's Procedure Using the Colostomy Site.

Min Hyun KIM ; Heung Kwon OH ; Il Tae SON ; Sung Il KANG ; Myung Jo KIM ; Duck Woo KIM ; Sung Bum KANG

Journal of Minimally Invasive Surgery.2016;19(3):113-114. doi:10.7602/jmis.2016.19.3.113

Utilization of the colostomy site for laparoscopic reversal of Hartmann's procedure was recently introduced, and several studies have shown the feasibility of the procedure, which allows the colostomy site to serve as an access port for the operation. We demonstrate a method utilizing an accessory 5 mm trocar to assist in the operation while employing a colostomy-deepened glove port.
Colostomy* ; Laparoscopy ; Methods ; Surgical Instruments

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Laparoscopic Excision of a Retroperitoneal Solitary Fibrous Tumor: A Case Report.

Eun Ki MIN ; Younghae SONG ; Jae Uk CHONG ; Chang Moo KANG

Journal of Minimally Invasive Surgery.2016;19(3):108-112. doi:10.7602/jmis.2016.19.3.108

Solitary fibrous tumors (SFTs) are rare mesenchymal tumors mainly originating in the pleura. Since complete resection is the most important prognostic factor, typical surgical approach has been open laparotomy. In this report, we present a unusual case of large retropancreatic SFT that was successfully treated via laparoscopic resection. A 22-year-old female was diagnosed with a 8×7 cm-sized well-demarcated mass with multiple loculating and enhancing solid portions on the left adrenal fossa. The mass showed no definite invasion of adjacent organs and laparoscopic resection was planned. Using blunt dissection and individual vessel ligation, the operation was successful. The operative time was 220 minutes, and the amount of intraoperative blood loss was estimated to be within 100 ml. The patient recovered without complications. Laparoscopic excision of large retroperitoneal SFTs can be safe and feasible if there is no evidence of local invasion or malignancy on preoperative radiologic images.
Female ; Humans ; Laparotomy ; Ligation ; Minimally Invasive Surgical Procedures ; Operative Time ; Pleura ; Retroperitoneal Neoplasms ; Solitary Fibrous Tumors* ; Young Adult

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The Role of Laparoscopic Necrosectomy in the Era of Minimally Invasive Treatment for Necrotizing Pancreatitis: A Case Series and Review of the Literature.

Chul Kyu ROH ; Yoo Seok YOON ; Ho Seong HAN ; Jai Young CHO ; Young Rok CHOI ; Jae Seong JANG ; Seonguk KWON ; Sung Ho KIM ; Jang Kyu CHOI

Journal of Minimally Invasive Surgery.2016;19(3):102-107. doi:10.7602/jmis.2016.19.3.102

PURPOSE: Despite the recent increasing application of minimally invasive techniques to treat necrotizing pancreatitis, few reports on laparoscopic necrosectomy have appeared. The aim of the present study was to evaluate the role played by laparoscopic necrosectomy in treatment of necrotizing pancreatitis. We review our own experience and the relevant literature. METHODS: All patients undergoing laparoscopic necrosectomy at Seoul National University Bundang Hospital from March 2005 to January 2016 were included in the study. Data on patient demographics, CT severity index score, American Society of Anesthesiologists' score, preoperative procedures, operative methods, operation time, estimated blood loss, postoperative complications, and length of hospital stay were retrospectively analyzed. We also performed an up-to-date review of the relevant literature. RESULTS: Laparoscopic necrosectomy was performed on four patients with infective pancreatic necrosis that was inadequately treated by percutaneous drainage. A transgastrocolic, transmesocolic, or retrocolic approach was used. The median time from diagnosis to operation was 57 days (range, 34~109 days) and the median operation time 203 min (range, 180~255 min). There was no operative mortality. The necrotic tissue was successfully removed in a single operation in three of the four patients. Three patients experienced postoperative complications, including pleural effusion and recurrence of necrosis. The median postoperative hospital stay was 39 days (range, 16~99 days). CONCLUSION: Laparoscopic necrosectomy is safe and effective when used to treat necrotizing pancreatitis. Such treatment is especially useful for patients with solid, necrotic pancreatic components that are not removed by percutaneous or endoscopic drainage.
Demography ; Diagnosis ; Drainage ; Humans ; Laparoscopy ; Length of Stay ; Mortality ; Necrosis ; Pancreatitis* ; Pleural Effusion ; Postoperative Complications ; Postoperative Hemorrhage ; Preoperative Care ; Recurrence ; Retrospective Studies ; Seoul

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Evaluation of P-POSSUM as a Risk Prediction Model in Laparoscopic Gastrectomy of Elderly Patients with Gastric Cancer.

Hyo Jung KO ; Ki Hyun KIM ; Si Hak LEE ; Cheol Woong CHOI ; Su Jin KIM ; Chang In CHOI ; Dae Hwan KIM ; Tae Yong JEON ; Dong Heon KIM ; Sun Hwi HWANG

Journal of Minimally Invasive Surgery.2016;19(3):97-101. doi:10.7602/jmis.2016.19.3.97

PURPOSE: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a validated scoring system for auditing surgical outcomes. However, evaluation of this system has primarily been applied to open surgical techniques. The present study demonstrates the validity of P-POSSUM in predicting morbidity and mortality in the treatment of elderly patients with gastric cancer who underwent curative laparoscopic gastrectomy. METHODS: All patients aged 70 years or over, who underwent curative laparoscopic gastrectomy between January 2014 and January 2015, were collected from our hospital database. A case-note review was used to collate data in terms of clinical and operative factors as described in P-POSSUM. Observed/Estimated ratio of morbidity and 30-day mortality were calculated. RESULTS: Laparoscopic gastrectomy was performed in 101 patients. The mean age was 74.9 years (70~83 years). A significant postoperative morbidity was observed in 20 (19.8%) of 101 patients. There was no 30-day mortality. Using exponential analysis, P-POSSUM predicted morbidity in 22 patients. Thus, O/E ratios for morbidity and mortality were 0.9 and 0, respectively. CONCLUSION: P-POSSUM scoring slightly overestimated predictions of morbidity and mortality. An assessment of its application to laparoscopic gastrectomy of elderly patients with gastric cancer merits further evaluation. Also, laparoscopic gastrectomy was a feasible and safe treatment for elderly patients in terms of P-POSSUM.
Aged* ; Gastrectomy* ; Humans ; Mortality ; Stomach ; Stomach Neoplasms*

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Safety and Feasibility of Single Incision Laparoscopic Spleen Preserving Distal Pancreatectomy.

Huisong LEE ; Jin Seok HEO ; Seong Ho CHOI ; Dong Wook CHOI

Journal of Minimally Invasive Surgery.2016;19(3):89-96. doi:10.7602/jmis.2016.19.3.89

PURPOSE: Single-incision laparoscopic distal pancreatectomy (SIL-DP) has recently been attempted in the treatment of left-sided benign neoplasms of the pancreas. This study was conducted to evaluate the perioperative outcomes of SIL-DP compared with conventional laparoscopic DP (CL-DP). METHODS: Patients who received laparoscopic DP from a single surgeon for benign pancreatic neoplasm from January 2012 to January 2014 were included. The patients were divided into two groups, SIL-DP and CL-DP. We used four trocars for CL-DP and a custom-made glove port for SILDP and analyzed the conversion cases separately. Perioperative outcomes were compared between types of surgery. RESULTS: SIL-DP was attempted in 13 patients, five of whom required conversion to CL-DP or dual-incision surgery. CL-DP was attempted in 27 patients and all were successful without open conversion. The spleen was preserved in all patients who underwent SIL-DP without conversion, in four of five (80%) in the conversion group, and 21 (78%) of those who underwent CL-DP. The complication rate was 13% in the SIL-DP-only group, 60% in the conversion group, and 19% in the CL-DP group. The operation time, estimated blood loss, numeric pain intensity score, and hospital duration were similar in the SIL-DP and CL-DP groups. CONCLUSION: SIL-DP was associated with a moderate need for an additional port, and the complication rate was high in the conversion group. Our findings indicate that SIL-DP should be attempted carefully. Further studies are needed to evaluate the lon g term follow-up outcomes of SIL-DP.
Follow-Up Studies ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Pancreas ; Pancreatectomy* ; Pancreatic Neoplasms ; Spleen* ; Surgical Instruments

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Current Status of Pediatric Minimal Invasive Surgery (MIS) in Korea.

Daeyeon KIM

Journal of Minimally Invasive Surgery.2016;19(3):84-88. doi:10.7602/jmis.2016.19.3.84

Minimal invasive surgery (MIS) has rapidly gained acceptance for the management of a wide variety of pediatric diseases. The evolution of minimally invasive surgery (MIS) in children, especially newborns, has been delayed because of the limited working space and unique physiology. With the development of smaller instruments and advanced surgical skills, many of the initial obstacles have been overcome. MIS in children has been used in specialized centers with excellent results, and its application in Korea has been increasing recently. Obvious advantages include better cosmoses, less trauma, and better postoperative musculoskeletal function, especially after thoracic procedures. However, prospective randomized trials and high-level evidence of the benefits of MIS are still scarce. Questions to be answered in the upcoming years will therefore include identify both advantages and potential disadvantages of MIS, especially in neonates. In this review, recent surveys regarding use of MIS by the Korean Association of Pediatric Surgeons were also discussed.
Child ; Humans ; Infant, Newborn ; Korea* ; Minimally Invasive Surgical Procedures ; Pediatrics ; Physiology ; Prospective Studies ; Surgeons

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Safety and Feasibility of Single Incision Laparoscopic Spleen Preserving Distal Pancreatectomy.

Kee Hwan KIM

Journal of Minimally Invasive Surgery.2016;19(3):81-83. doi:10.7602/jmis.2016.19.3.81

No abstract available.
Pancreatectomy* ; Spleen*

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