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SUTI (Single Umbilical Tangential Incision) Laparoscopic TEP Inguinal Hernia Repair.

Journal of Minimally Invasive Surgery.2015;18(1):24-29. doi:10.7602/jmis.2015.18.1.24

PURPOSE: Single port laparoscopic inguinal hernia repair has been performed to further reduce port related morbidities and to improve the cosmetic outcome. However, the cosmetic result of single port laparoscopic totally extraperitoneal inguinal hernia repair (TEP) has not been superior to that of transabdominal preperitoneal hernia repair (TAPP). The aim of this study is to introduce and assess the Single Umbilical Tangential Incision (SUTI) for Lap-TEP repair. METHODS: Forty one hernia repairs of 34 patients were performed using SUTI-TEP method. SUTI was made all along the inferolateral skin of the umbilical pit and a vertical incision of less than one centimeter was made in the supra- or infraumbilical skin if needed; the total length of the incision was 2~2.5 cm. SILS(TM) port and conventional instruments were used for the procedure. RESULTS: All procedures were completed without conversion to the conventional TEP procedure. Mean operation time was 73 minutes for unilateral primary hernia, 119 minutes for bilateral primary hernia, 88.5 minutes for unilateral recurrent hernia, and 120 minutes for bilateral recurrent hernia. There were two cases of wound seroma and four cases of urinary retention postoperatively. Other significant complications were not noted. There was no recurrence of hernia during the follow-up period of one to 24 months. At routine follow-up visit at three months postoperative, the scar was barely visible and overall level of patient satisfaction was very high. CONCLUSION: The SUTI-TEP inguinal hernia repair is safe and shows superior cosmetic results. Further studies are required in order to assess the long-term outcome.
Cicatrix ; Follow-Up Studies ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Patient Satisfaction ; Recurrence ; Seroma ; Skin ; Urinary Retention ; Wounds and Injuries

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Safety and Feasibility of Self-Expandable Metallic Stent Insertion for the Right-Side Colonic Malignant Obstruction and Its Clinical Benefits.

Seok Hwan CHOI ; Jung Myun KWAK ; Dong Woo KANG ; Han Deok KWAK ; Nak Song SUNG ; Bo ra KEUM ; Eun Sun KIM ; Jin KIM ; Seon Hahn KIM

Journal of Minimally Invasive Surgery.2015;18(1):19-23. doi:10.7602/jmis.2015.18.1.19

PURPOSE: The efficacy of stenting for the right-side colonic malignant obstruction is unknown. The purpose of this study was to evaluate the safety and feasibility of self-expandable metallic stent insertion for the right-side colonic malignant obstruction and its clinical benefits. METHODS: We retrospectively reviewed clinical data from 460 patients who underwent right hemicolectomy for right-side colon cancer from January 2006 to January 2014 at Korea University Anam Hospital. Twenty four patients who developed malignant obstruction in the right -side colon were identified and analyzed. RESULTS: Self-expandable metallic stent insertion was attempted in 14 patients, and initial technical success was achieved in 13 patients (92.9%). No immediate stent-related complications were reported. Complete relief of obstruction was achieved in all of the 13 patients. Eleven patients who failed stenting underwent emergency operation. All of the 13 patients with stent underwent laparoscopic surgery and only one case was converted to open. Only three patients in the emergency group underwent laparoscopic surgery but one was converted. Operative time and number of retrieved lymph nodes did not differ between the two groups. Postoperative hospital stay (9.8+/-3.2 in stent group vs. 16.3+/-10.9 days in emergency group, p=0.082) tended to be shorter in the stent group. Estimated blood loss (38.5+/-138.7 in stent group vs. 381.8+/-411.9 in emergency group, p=0.010) and duration for resuming diet (3.2+/-2.2 in stent group vs. 6.6+/-7.0 days in emergency group, p=0.017) were significantly better in the stent group. CONCLUSION: Self-expandable metallic stent appears to be safe and feasible in the right-side colonic malignant obstruction. It facilitates minimally invasive surgery and may result in better short-term surgical outcome.
Colon* ; Colonic Neoplasms ; Diet ; Emergencies ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Operative Time ; Retrospective Studies ; Stents* ; Surgical Procedures, Minimally Invasive

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Mesh Encircling Total Extraperitoneal (TEP) Repair of Inguinal Hernia without a Fixation Material or Preformed Mesh: Overlay Closure of Slit Without Additional Mesh.

Dong Jin PARK ; Yeong Cheol IM ; Sung Soo YANG ; Gyu Yeol KIM

Journal of Minimally Invasive Surgery.2015;18(1):14-18. doi:10.7602/jmis.2015.18.1.14

PURPOSE: Mesh non-fixation in TEP is associated with lower cost and shorter operative time, and it is safe and recommended when performed by an experienced surgeon. In performance of TEP surgery using a non-fixation mesh, particularly by a non-experienced surgeon, prevention of mesh migration is an important issue for mesh application. The aim of this study was to report on a fixation method using a non-preformed mesh encircling a cord structure without the use of tacks, staples, or fibrin sealants in TEP surgery. METHODS: A total of 41 patients who had undergone mesh-encircling TEP without fixation from December 2008 (first case of surgery) to June 2012 were analyzed. RESULTS: The mean follow-up period was 23.2 months (12~35 months). Three patients complained of scrotal discomfort, and one patient complained of scrotal edema, but they were resolved with conservative management. There was no recurrence during the follow up period. CONCLUSION: The method of mesh-encircling TEP without fixation material and no additional mesh in which the slit of the mesh is wrapped around the cord structure using an overlay suture is a simple and safe technique without compromising recurrence or chronic pain.
Chronic Pain ; Edema ; Fibrin Tissue Adhesive ; Follow-Up Studies ; Hernia, Inguinal* ; Humans ; Operative Time ; Recurrence ; Sutures

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Single Fulcrum Laparoscopic Cholecystectomy in Situs Inversus Totalis.

Sun Jung KIM ; Jiae PARK ; Chang Moo KANG ; Woo Jung LEE

Journal of Minimally Invasive Surgery.2015;18(3):89-92. doi:10.7602/jmis.2015.18.3.89

Single fulcrum laparoscopic cholecystectomy (SFLC) is a modified version of single incision laparoscopic cholecystectomy (SILC). In this article we report on the first experience of SFLC in a patient with situs inversus totalis (SIT). A 36-year-old female patient with SIT whose gallbladder was located on the left side was admitted to hospital due to a symptomatic gallbladder stone; 2 cm of transumbilical skin and subcutaneous fat layer were dissected and the fascia layer was left undissected to make two openings at the upper and lower part each, dividing where trocars were placed. Compared to conventional SFLC or SILC, the right hand, which is dominant for most people, performed the main operating movements, such as cutting and clipping, while the other hand was retracting the fundus of the gallbladder to show the Calot triangle. SFLC is a facilitating operation in that it does not require a specialized trocar or instruments, and is also convenient for a patient with SIT.
Adult ; Cholecystectomy, Laparoscopic* ; Fascia ; Female ; Gallbladder ; Hand ; Humans ; Situs Inversus* ; Skin ; Subcutaneous Fat ; Surgical Instruments

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Laparoscopic Treatment of Gangrene of Giant Meckel's Diverticulum Secondary to Axial Torsion.

Gui Ae JEONG ; Zisun KIM

Journal of Minimally Invasive Surgery.2015;18(3):86-88. doi:10.7602/jmis.2015.18.3.86

Meckel's diverticulum is a common congenital anomaly in the small bowel. Most cases of Meckel's diverticulum are asymptomatic and are found incidentally. We herein report on a case of a 21-year-old male patient who complained of lower abdominal pain and febrile sensation with incidentally diagnosed gangrenous change of Meckel's diverticulum due to axial torsion itself. A 21-year-old man presented to our institution with acute lower abdominal pain. No accurate focus on abdominal pain such as appendicitis or diverticulitis was observed on abdominal ultrasonography and abdominal CT scan. However, the physical examination of the patient revealed the symptom of localized peritonitis with fever. Finally, laparoscopic exploration was performed to determine the cause of acute abdominal pain. During the operation, we found gangrenous change of Meckel's diverticulum with axial torsion itself and laparoscopic Meckel's diverticulectomy was performed. The patient made an uneventful recovery and was discharged on the 6th postoperative day.
Abdominal Pain ; Appendicitis ; Diverticulitis ; Fever ; Gangrene* ; Humans ; Laparoscopy ; Male ; Meckel Diverticulum* ; Peritonitis ; Physical Examination ; Sensation ; Tomography, X-Ray Computed ; Torsion Abnormality ; Ultrasonography ; Young Adult

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Safety of Laparoscopy Assisted Gastrectomy for Gastric Cancer, Including Advanced Cancers.

Eun Mee PARK ; Hyung Ook KIM ; Byung Ho SON ; Jun Ho SHIN ; Sung Ryol LEE

Journal of Minimally Invasive Surgery.2015;18(3):79-85. doi:10.7602/jmis.2015.18.3.79

PURPOSE: Laparoscopy-assisted gastrectomy (LAG) is considered an alternative treatment option for gastric cancer. LAG is safe, however the long-term oncologic efficacy and survival of patients including those with advanced gastric cancer have not been assessed. The aim of this study was to evaluate long-term outcomes and survival of patients with gastric cancer, including advanced cases, who underwent LAG performed by a single surgeon. METHODS: Between January 2006 and December 2010, 161 patients with gastric cancer underwent LAG performed by a single surgeon. Clinicopathological data were collected retrospectively along with data on survival and prognosis. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. RESULTS: A total of 161 patients diagnosed with gastric cancer underwent LAG. Postoperative morbidity occurred in 12 patients. The median OS was 67.0 months (range, 1.0~97.0 months), and the median DFS was 67.0 months (range, 1.0~97.0 months). T stage, N stage, TNM stage, lymphatic invasion, and venous invasion influenced overall survival and disease recurrence. The OS rates according to N stage were 96.8% for N0, 94.4% for N1, 45.5% for N2, and 42.9% for N3. CONCLUSION: The current study showed that LAG for gastric cancer, including advanced gastric cancer, is technically feasible with acceptable long-term oncologic outcomes.
Disease-Free Survival ; Gastrectomy* ; Humans ; Laparoscopy* ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms*

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Does Laparoscopic Splenectomy have the Advantage on Postoperative Pain?.

Jae Ryong SHIM ; Sung Pil YUN ; Hyung Il SEO

Journal of Minimally Invasive Surgery.2015;18(3):75-78. doi:10.7602/jmis.2015.18.3.75

PURPOSE: The aim of this study is to elucidate the fundamental characteristics of the laparoscopic splenectomy and to compare the clinical outcomes and postoperative pain between the laparoscopic splenectomy and the conventional open splenectomy. METHODS: From January 2005 to January 2013, 28 patients underwent a splenectomy at Pusan National University Hospital, South Korea (PNUH). This study was a comparison of the demographic features and clinical results between the laparoscopic splenectomy (n=15) and open splenectomy (n=13). RESULTS: For the two groups of patients, the following were similar: estimated blood loss, transfusion, operative time, duration of patient-controlled analgesia, and the additional administration of painkillers. In the laparoscopic splenectomy group, the postoperative hospital stay (7.9+/-1.6 days versus 5.9+/-1.4 days, p=0.002) and the diet start time (2.7+/-0.3 days versus 1.8+/-0.8 days, p=0.003) were significantly shorter. No significant difference in postoperative pain was observed between the two groups. CONCLUSION: In this study, there was no benefit for postoperative pain in the LS group. However, the laparoscopic splenectomy has several benefits, including a shorter postoperative hospital stay and an earlier diet start time; in addition, it is feasible and safe.
Analgesia, Patient-Controlled ; Busan ; Diet ; Humans ; Korea ; Length of Stay ; Operative Time ; Pain, Postoperative* ; Splenectomy*

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Operative Outcomes of Open versus Laparoscopic Total Proctocolectomy with Ileal Pouch Anal Anastomosis in Ulcerative Colitis.

Soomin NAM ; Eun Jung PARK ; Min Soo CHO ; Jeonghyun KANG ; Hyuk HUR ; Byung Soh MIN ; Seung Hyuk BAIK ; Kang Young LEE ; Nam Kyu KIM ; Seung Kook SOHN

Journal of Minimally Invasive Surgery.2015;18(3):69-74. doi:10.7602/jmis.2015.18.3.69

PURPOSE: During the course of disease, nearly 30% of ulcerative colitis patients receive surgical therapy. Total proctocolectomy with ileal pouch anal anastomosis is a standard procedure. However, the effectiveness of laparoscopic surgery in ulcerative colitis has not yet been proven. We aimed to evaluate the clinical course of both laparoscopic and open surgeries of a total proctocolectomy with ileal pouch anal anastomosis. METHODS: We reviewed charts of 34 patients who underwent a total proctocolectomy with ileal pouch anal anastomosis between April 2005 and April 2014. The laparoscopic group (n=21) and the open group (n=13) were compared retrospectively in accordance with patients' demographics, clinical features, operative data, and postoperative complications within and after 30 days after the operation. RESULTS: Patient characteristics were not significantly different between the two groups. The laparoscopic group had a longer duration of disease before the operation (42.3+/-48.5 vs. 105+/-97.6, p=0.019). The operative results, including operation time and estimated blood loss, were not different in both groups. The postoperative outcomes of laparoscopic surgery were not different from those of open surgery in postoperative complications within and after 30 postoperative days. The rate of reoperation and readmission was not different, and the days until first gas passing and soft diet were not significantly different. CONCLUSION: Laparoscopic surgery in ulcerative colitis is a feasible and safe procedure. Laparoscopic surgery may provide an alternative approach to open surgery in carefully selected ulcerative colitis patients.
Colitis, Ulcerative* ; Demography ; Diet ; Humans ; Laparoscopy ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Ulcer*

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Management of Infected Mesh after Laparoscopic Incisional Hernia Repair.

Gil Jae LEE ; Min CHUNG

Journal of Minimally Invasive Surgery.2012;15(4):161-164. doi:10.7602/jmis.2012.15.4.161

Laparoscopic repair using mesh is a standard technique for ventral hernia repair. Complications of laparoscopic ventral hernia repair increase according to the increment of laparoscopic repair. Subcutaneous emphysema and mesh infection are major complications of laparoscopic repair of ventral hernia. The principle of management of infection is removal of a foreign body. However, in the case of repair with mesh, removal of infected mesh induces recurrence of hernia. Preservation of mesh is the best option for treatment of infected mesh. We have experienced treatment without removal of mesh in a case of infected subcutaneous emphysema after laparoscopic ventral hernia repair. The infection spread slowly to mesh and seroma. Drainage and debridement of infected tissue and evacuation of infected seroma resulted in healing of the infection without removal of mesh.
Debridement ; Drainage ; Foreign Bodies ; Hernia ; Hernia, Ventral ; Herniorrhaphy ; Laparoscopy ; Recurrence ; Seroma ; Subcutaneous Emphysema ; Surgical Mesh

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A Prospective Study of Non-Prophylatic Antibiotics for Totally Extraperitoneal Laparoscopic Repair of Inguinal Hernia.

Young Hoon LEE ; Tae Kyung HA

Journal of Minimally Invasive Surgery.2012;15(4):156-160. doi:10.7602/jmis.2012.15.4.156

PURPOSE: The role of prophylactic antibiotics in totally extraperitoneal (TEP) laparoscopic repair of inguinal hernia is unclear. This study was conducted to evaluate the effects of antibiotic therapy for surgical site infection (SSI) in post TEP laparoscopic repair of inguinal hernia. METHODS: We prospectively reviewed data collected from 280 patients with inguinal hernias who were treated by TEP laparoscopic repair between August 2008 and July 2012. None of the patients received prophylactic antibiotics. Patients with a history of recurrent hernias, immune suppressive disease or diabetes mellitus were excluded from the study. RESULTS: There were 265 male patients and 15 female patients aged 19 to 82 years. There were 240 indirect, 38 direct, and 2 pantaloon hernias. The mean operating time was 49 minutes, and the mean length of hospital stay was 1.4 days. The most frequent complications of TEP laparoscopic repair of inguinal hernia were ecchymosis (32.85%), followed by wound pain (16.42%). Surgery related complications occurred in two cases (0.71%) of SSI and 13 cases (8.65%) of wound hematoma. No additional surgical treatment for complications were required. No mesh infection occurred in patients during the follow up period. CONCLUSION: Non-prophylactic antibiotics for elective TEP laparoscopic repair of inguinal hernia appear to be acceptable. Randomized controlled trials of the efficiency of antibiotic therapy in SSI in patients with inguinal hernia should be conducted.
Aged ; Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Diabetes Mellitus ; Ecchymosis ; Female ; Follow-Up Studies ; Hematoma ; Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Laparoscopy ; Length of Stay ; Male ; Prospective Studies ; Pyrazines

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