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Pure single-incision laparoscopic D2 lymphadenectomy for gastric cancer: a novel approach to 11p lymph node dissection (midpancreas mobilization).

Sang Hoon AHN ; Do Hyun JUNG ; Sang Yong SON ; Do Joong PARK ; Hyung Ho KIM

Annals of Surgical Treatment and Research.2014;87(5):279-283. doi:10.4174/astr.2014.87.5.279

We developed a novel approach to perform a perfect 11p lymph node dissection (LND), the so-called 'midpancreas mobilization' (MPM) method. Briefly, in pure single-incision laparoscopic distal gastrectomy (SIDG), after the completion of 7, 8a/12a, and 9 LND in the suprapancreatic portion, we started 11p LND after midpancreas mobilization. After mobilization of the entire midpancreas from the white line of Toldt, two gauzes were inserted behind the pancreas. This maneuver facilitated exposure of the splenic vein and complete detachment of soft tissue, including 11p lymph nodes, from the white line of Toldt, which was possible because of the tilting of the pancreas. The dissection plane along the splenic artery and vein for 11p LND could be visualized just through control of the operator's grasper without the need of an assistant. Fourteen patients underwent the procedure without intraoperative events, conversion to conventional laparoscopy, or surgery-related complications, including postoperative pancreatic fistula. All patients underwent D2 LND by exposure of the splenic vein. The mean numbers of retrieved lymph node and 11p lymph node were 61.3 +/- 9.0 (range, 49-70), and 4.00 +/- 3.38 (range, 1-10). Thus, we concluded that MPM for 11p LND in pure SIDG appears feasible and embryologically ideal; this method can be used in conventional laparoscopic gastrectomy.
Gastrectomy ; Humans ; Laparoscopy ; Lymph Node Excision* ; Lymph Nodes ; Pancreas ; Pancreatic Fistula ; Splenic Artery ; Splenic Vein ; Stomach Neoplasms* ; Veins

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Incidental cholecystojejunal fistula treated with successful laparoscopic management.

Hae Il JUNG ; Taesung AHN ; Sung Woo CHO ; Sang Ho BAE ; Moon Soo LEE ; Chang Ho KIM

Annals of Surgical Treatment and Research.2014;87(5):276-278. doi:10.4174/astr.2014.87.5.276

Internal biliary fistula (IBF) is occurred spontaneously due to the biliary disease in most cases. Bilioenteric, biliobiliary, bronchobiliary, and vasculobiliary type of IBF have been reported in the literature. We herein describe our experience with an incidental cholecystojejunal fistula, a very rare type of bilioenteric fistula in laparoscopic cholecystectomy. A 61-year-old woman with several years' history of intermittent right upper abdominal pain was admitted to Soonchunhyang University Cheonan Hospital. Abdominal CT scan showed the pneumobilia in gallbladder with common bile duct dilatation. Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy were done. On operative findings, there was a cholecystojejunal fistula. We performed laparoscopic cholecystectomy and fistulectomy with jejunal partial resection. To our knowledge, this is the first report on incidental cholecystojejunal fistula uncombined with any other disease and was treated with laparoscopic procedure.
Abdominal Pain ; Biliary Fistula ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Chungcheongnam-do ; Common Bile Duct ; Dilatation ; Female ; Fistula* ; Gallbladder ; Humans ; Middle Aged ; Sphincterotomy, Endoscopic ; Tomography, X-Ray Computed

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Prognostic factors after curative resection hepatocellular carcinoma and the surgeon's role.

Dong Do YOU ; Dong Goo KIM ; Chang Ho SEO ; Ho Joong CHOI ; Young Kyung YOO ; Yong Gyu PARK

Annals of Surgical Treatment and Research.2017;93(5):252-259. doi:10.4174/astr.2017.93.5.252

PURPOSE: Patient, surgical, and tumor factors affect the outcome after surgical resection for hepatocellular carcinoma (HCC). The surgical factors are only modifiable by the surgeon. We reviewed our experience with curative resection for HCC in terms of surgical factors. METHODS: After analyses of the prospectively collected clinical data of 256 consecutive patients undergoing surgical resection for HCC, prognostic factors for disease-free survival (DFS) and overall survival (OS) were identified; all patients were stratified by tumor diameters > or <5 cm and their outcomes were compared. RESULTS: Multivariate analyses showed that microvascular invasion, estimated blood loss, blood transfusion, and the number of tumors were independent adverse prognostic factors for DFS, whereas microvascular invasion, serum alpha fetoprotein, and tumor diameter were independent adverse prognostic factors for OS. Blood transfusion had borderline significance (P = 0.076). After stratification by tumor diameter, blood transfusion was only associated with poor DFS and OS in patients with tumor diameters > 5 cm. CONCLUSION: Tumor recurrence after liver resection for HCC depends on tumor status, bleeding, and transfusions, which subsequently lead to poor patient survival. Surgeons can help improve the prognosis of patients by minimizing blood loss and transfusion, particularly in patients with larger tumors.
alpha-Fetoproteins ; Blood Transfusion ; Carcinoma, Hepatocellular* ; Disease-Free Survival ; Hemorrhage ; Hepatectomy ; Humans ; Liver ; Liver Cirrhosis ; Multivariate Analysis ; Prognosis ; Prospective Studies ; Recurrence ; Surgeons

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Effect of end-to-side inverted mattress pancreaticojejunostomy following central pancreatectomy on the prevention of pancreatic fistula.

Young Yeon CHOI ; Sang Geol KIM ; Yun Jin HWANG ; Hyung Jun KWON

Annals of Surgical Treatment and Research.2017;93(5):246-251. doi:10.4174/astr.2017.93.5.246

PURPOSE: Central pancreatectomy (CP) may be indicated for the treatment of benign or low-grade malignant tumor in the neck and proximal body of the pancreas. Pancreatic fistula is one of the most common complications after CP. In this study, we suggested an inverted mattress pancreaticojejunostomy (IM-PJ) technique to decrease the risk of pancreatic fistula. METHODS: Between 2010 and 2015, CP was performed with IM-PJ for 10 consecutive patients with a benign or low-grade malignant tumor in the neck and proximal body of the pancreas. All clinical and pathological data were analyzed retrospectively. RESULTS: Median age was 56.4 years (range, 17–75 years). Median surgery duration was 286 minutes (range, 205–410 minutes). In all cases, the distal stump was reconstructed using the IM-PJ method. Median duration of hospital stay was 23.8 days (range, 9–53 days). No patient mortality occurred. Pancreatic fistula developed in 9 cases (90%); however, all fistulas were grade A and resolved without surgical or radiological intervention. Nine patients remain well with no recurrence or new endocrine or exocrine dysfunction. CONCLUSION: Our results demonstrate that the outcomes of CP with IM-PJ are reasonable for prevention of pancreatic fistula following CP.
Fistula ; Humans ; Length of Stay ; Methods ; Mortality ; Neck ; Pancreas ; Pancreatectomy* ; Pancreatic Fistula* ; Pancreaticojejunostomy* ; Recurrence ; Retrospective Studies

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Feasibility of sentinel lymph node dissection using Tc-99m phytate in papillary thyroid carcinoma.

Se Hyun PAEK ; Ka Hee YI ; Su Jin KIM ; June Young CHOI ; Kyu Eun LEE ; Young Joo PARK ; Do Joon PARK ; Keon Wook KANG ; June Key CHUNG

Annals of Surgical Treatment and Research.2017;93(5):240-245. doi:10.4174/astr.2017.93.5.240

PURPOSE: Various methods of sentinel lymph node (SLN) biopsy in thyroid cancer have been introduced. Tc-99m phytate as a radiotracer has been successfully utilized for SLN biopsy in breast, cervix, and endometrial cancer. We assessed the feasibility of SLN dissection using Tc-99m phytate in papillary thyroid carcinoma (PTC). METHODS: Seventeen patients with PTC were prospectively enrolled. Ultrasound-guided peritumoral injection of 55.5 MBq Tc-99m phytate in 0.25-mL normal saline was performed. Preoperative single-photon emission-computed tomography (SPECT) and intraoperative gamma-probe were used for SLN detection during operation. RESULTS: Identification rate of SLNs was 70.6% (12 of 17) with SPECT, and 88.2% (15 of 17) with gamma-probe. Combined SPECT and gamma-probe had identification rates of 88.2% (15 of 17). Identification rates of SLNs in central LN compartments were 82.4% (14 of 17) and 41.2% (7 of 17) in lateral LN compartments. Overall sensitivity, specificity, positive predictive value, and negative predictive value of the results of SLN biopsy were 91.6%, 100%, 88.4%, and 100%, respectively. Eight patients (47.1%) had metastasis in SLNs; all patients had SLN metastasis in the central compartment and 2 patients had SLN metastasis in both the central and lateral compartments. CONCLUSION: Combined SPECT and gamma-probe could detect SLNs with an 88.2% identification rate in PTC. SLN biopsy using Tc-99m phytate is technically feasible. Further investigation is warranted for clinical application of Tc-99m phytate in PTC.
Biopsy ; Breast ; Cervix Uteri ; Endometrial Neoplasms ; Female ; Humans ; Lymph Node Excision* ; Lymph Nodes* ; Neoplasm Metastasis ; Phytic Acid* ; Prospective Studies ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy ; Thyroid Gland* ; Thyroid Neoplasms* ; Tomography, Emission-Computed, Single-Photon

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Assessing cosmetic results after conventional thyroidectomy using the EASY-EYE_C: a double-blind randomized controlled trial.

Kwan Ho LEE ; Eun Young KIM ; Chan Heun PARK ; Yong Lai PARK ; Ji Sup YUN ; Ga Young LEE

Annals of Surgical Treatment and Research.2017;93(5):231-239. doi:10.4174/astr.2017.93.5.231

PURPOSE: The incidence of thyroid cancer is relatively high, especially in young women, and postoperative scarring after thyroidectomy is an important problem for both patients and clinicians. Currently, there is no available product that can be used for wound protection during thyroid surgery. We used the EASY-EYE_C, a new silicone-based wound protector. METHODS: We conducted a double-blind randomized controlled trial to assess the efficacy of the EASY-EYE_C with surgical scars. We studied 66 patients who underwent conventional total thyroidectomy or hemithyroidectomy performed by a single surgeon from August 2015 to June 2016. At 6-week follow-up, a single blinded physician observed the wounds to make clinical assessments using the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS), and a modified Stony Brook Scar Evaluation Scale (SBSES). RESULTS: There were no significant differences by sex, age, type of surgery, body mass index, length of wound, incision site (from sternal notch), or thyroid weight, but the duration of operation was significantly shorter in the experimental group (E group). The e-group also had better POSAS scores than the control group (C group), with means of 43.2 (standard deviation [SD], ±15.9) versus 68.3 (SD, ±21.5), respectively (P < 0.05). The modified SBSES and VSS scores were similar to those from the POSAS. CONCLUSION: In this study, all scores for evaluating outcomes were higher in the E group than in the C group. In addition, the operation time was significantly shorter in the E group. Therefore, the EASY-EYE_C may be useful for improving the cosmetic outcomes of conventional thyroid surgery.
Body Mass Index ; Cicatrix ; Female ; Follow-Up Studies ; Humans ; Incidence ; Silicones ; Surgical Instruments ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy* ; Wounds and Injuries

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Pancreaticoduodenectomy performed in a patient with situs ambiguous accompanied with isolated levocardia, malrotation, and normal spleen.

Han Ki LIM ; Yoo Shin CHOI ; Seung Eun LEE ; Hyun KANG

Annals of Surgical Treatment and Research.2014;87(6):340-344. doi:10.4174/astr.2014.87.6.340

We report a case of common bile duct (CBD) cancer, successfully managed with pancreaticoduodenectomy, in a patient with isolated levocardia, malrotation, and situs ambiguous (without splenic anomalies). A 59-year-old male patient was referred to Chung-Ang University Hospital with epigastric pain and jaundice. CT and MRI revealed distal CBD cancer without significant lymphadenopathy. Multiple abdominal anatomic anomalies were identified preoperatively, whereas no anatomic anomalies were detected within the chest. The patient had a right-sided stomach and spleen, liver at the midline, several vascular variations around the celiac axis, and intestinal malrotation, but the inferior vena cava and portal vein were normal. A pancreaticoduodenectomy was performed to treat the cancer. The postoperative course was favorable, and the patient was started on combined chemotherapy and radiotherapy 15 days after the surgery. In this case study, we report that pylorus preserving pancreaticoduodenectomy was successful for distal CBD cancer in a patient with rare situs anomalies.
Axis, Cervical Vertebra ; Common Bile Duct ; Drug Therapy ; Humans ; Jaundice ; Levocardia* ; Liver ; Lymphatic Diseases ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pancreaticoduodenectomy* ; Portal Vein ; Pylorus ; Radiotherapy ; Spleen* ; Stomach ; Thorax ; Vena Cava, Inferior

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Axillary sparganosis which was misunderstood lymph node metastasis during neoadjuvant chemotheraphy in a breast cancer patient.

Eun Kyoung LEE ; Young Bum YOO

Annals of Surgical Treatment and Research.2014;87(6):336-339. doi:10.4174/astr.2014.87.6.336

Sparganosis of the breast is an uncommon disease, but should be considered in the differential diagnosis of unusual and suspicious breast masses. A history of ingesting contaminated water and direct ingestion of snakes and frogs may help in differential diagnosis of the mass. Complete surgical removal is the treatment of choice and provides a definite diagnosis. We report a case of multiple axillary lymph node sparganosis. It was first considered as an axillary metastasis of breast cancer because a newly axillary mass appeared in follow-up radiologic study after neoadjuvant chemotherapy. We performed curative breast cancer surgery and sparganosis was confirmed by extracting the worm during axillary dissection.
Axilla ; Breast ; Breast Neoplasms* ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Eating ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Neoplasm Metastasis* ; Snakes ; Sparganosis* ; Water Pollution

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Intra-abdominal fibromatosis after gastrectomy for gastric cancer.

Pyeong Su KIM ; Dong Seok HAN ; Hye Seung HAN ; Ho Yoon BANG

Annals of Surgical Treatment and Research.2014;87(6):331-335. doi:10.4174/astr.2014.87.6.331

Intra-abdominal fibromatosis (IAF) may arise either sporadically or in association with familial adenomatous polyposis. The characteristics of fibromatosis are slow-growth, benign histological features, and aggressive local invasion. Surgery remains a reasonable first treatment option. Here, we report 2 cases of a phenomenon rarely described in published literature, IAF after gastrectomy for gastric cancer. Intra-abdominal masses were found during the routine follow-up period in a 50-year-old man who had received a radical subtotal gastrectomy for early gastric cancer. Two mesenteric masses were detected in the upper abdomen by CT and were excised completely along with segments of the jejunum. Another intra-abdominal mass was found in 60-year-old man who had received a radical total gastrectomy for advanced gastric cancer. A 4.2-cm-sized mass was detected in the periumbilical region by follow-up CT and was excised completely along with a segment of the ileum.
Abdomen ; Adenomatous Polyposis Coli ; Fibroma* ; Fibromatosis, Aggressive ; Follow-Up Studies ; Gastrectomy* ; Humans ; Ileum ; Jejunum ; Middle Aged ; Stomach Neoplasms*

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Tumescent local anesthetic technique for inguinal hernia repairs.

Ju Won CHYUNG ; Dong Gue SHIN ; Yujin KWON ; Dong Hui CHO ; Kyung Bok LEE ; Sang Soo PARK ; Jin YOON ; Yong Seog JANG

Annals of Surgical Treatment and Research.2014;87(6):325-330. doi:10.4174/astr.2014.87.6.325

PURPOSE: We evaluated the adequacy and feasibility of a tumescent solution containing lidocaine and bupivacaine for inguinal hernia repairs. METHODS: The medical records of 146 consecutive inguinal hernia patients with 157 hernia repairs using the tumescent local anesthesia technique performed by a single surgeon between September 2009 and December 2013 were retrospectively reviewed. RESULTS: The mean operation time (+/-standard deviation) and hospital stay were 64.5 +/- 17.6 minutes and 2.7 +/- 1.5 days. The postoperative complication rate was 17.8%. There were four cases of recurrences (2.5%) at a mean follow-up of 24 +/- 14 months. CONCLUSION: Our results suggest that local anesthesia with the tumescent technique is an effective and safe modality for inguinal hernia repairs.
Anesthesia, Local ; Bupivacaine ; Follow-Up Studies ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Length of Stay ; Lidocaine ; Medical Records ; Postoperative Complications ; Recurrence ; Retrospective Studies

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