Purpose: This study aimed to analyze nationwide trends and regional disparities in inguinal hernia surgeries in South Korea between 2016 and 2022. Additionally, we aimed to evaluate changes in surgery frequency, including urban concentration and the introduction of robotic surgery. Methods: This retrospective review used nationwide data on inguinal hernia surgeries from the Health Insurance Review and Assessment Service database. Results: From 2016 to 2022, 254,367 inguinal hernia surgeries were performed in South Korea, with males accounting for 88.9% of cases. The annual number of surgeries fluctuated, particularly in 2020, owing to the coronavirus disease 2019 pandemic. Medical costs increased from $1,218.4 to $1,970 on average, whereas patient copayments rose from $180.2 to $293.3. Robotic inguinal hernia surgeries, introduced in 2019, increased to 226 cases in 2022. Pediatric surgeries steadily declined, whereas adult surgeries remained stable, with a slight increase in 2022. The average hospital stay did not change significantly but varied between pediatric and adult patients. Regional disparities were notable, especially in pediatric surgery rates between metropolitan areas, such as Seoul and the surrounding provinces. Conclusion This study highlights stable overall surgery rates, a decline in pediatric cases, and an increase in robotic inguinal hernia surgeries. The persistent concentration of healthcare services in metropolitan areas suggests a need for policy interventions to address regional disparities and ensure equitable healthcare access. The findings underscore the importance of ongoing efforts to improve healthcare distribution and the need for long-term strategies to address changing surgical trends.

Purpose: This study aimed to analyze nationwide trends and regional disparities in inguinal hernia surgeries in South Korea between 2016 and 2022. Additionally, we aimed to evaluate changes in surgery frequency, including urban concentration and the introduction of robotic surgery. Methods: This retrospective review used nationwide data on inguinal hernia surgeries from the Health Insurance Review and Assessment Service database. Results: From 2016 to 2022, 254,367 inguinal hernia surgeries were performed in South Korea, with males accounting for 88.9% of cases. The annual number of surgeries fluctuated, particularly in 2020, owing to the coronavirus disease 2019 pandemic. Medical costs increased from $1,218.4 to $1,970 on average, whereas patient copayments rose from $180.2 to $293.3. Robotic inguinal hernia surgeries, introduced in 2019, increased to 226 cases in 2022. Pediatric surgeries steadily declined, whereas adult surgeries remained stable, with a slight increase in 2022. The average hospital stay did not change significantly but varied between pediatric and adult patients. Regional disparities were notable, especially in pediatric surgery rates between metropolitan areas, such as Seoul and the surrounding provinces. Conclusion This study highlights stable overall surgery rates, a decline in pediatric cases, and an increase in robotic inguinal hernia surgeries. The persistent concentration of healthcare services in metropolitan areas suggests a need for policy interventions to address regional disparities and ensure equitable healthcare access. The findings underscore the importance of ongoing efforts to improve healthcare distribution and the need for long-term strategies to address changing surgical trends.

Purpose: This study aimed to analyze nationwide trends and regional disparities in inguinal hernia surgeries in South Korea between 2016 and 2022. Additionally, we aimed to evaluate changes in surgery frequency, including urban concentration and the introduction of robotic surgery. Methods: This retrospective review used nationwide data on inguinal hernia surgeries from the Health Insurance Review and Assessment Service database. Results: From 2016 to 2022, 254,367 inguinal hernia surgeries were performed in South Korea, with males accounting for 88.9% of cases. The annual number of surgeries fluctuated, particularly in 2020, owing to the coronavirus disease 2019 pandemic. Medical costs increased from $1,218.4 to $1,970 on average, whereas patient copayments rose from $180.2 to $293.3. Robotic inguinal hernia surgeries, introduced in 2019, increased to 226 cases in 2022. Pediatric surgeries steadily declined, whereas adult surgeries remained stable, with a slight increase in 2022. The average hospital stay did not change significantly but varied between pediatric and adult patients. Regional disparities were notable, especially in pediatric surgery rates between metropolitan areas, such as Seoul and the surrounding provinces. Conclusion This study highlights stable overall surgery rates, a decline in pediatric cases, and an increase in robotic inguinal hernia surgeries. The persistent concentration of healthcare services in metropolitan areas suggests a need for policy interventions to address regional disparities and ensure equitable healthcare access. The findings underscore the importance of ongoing efforts to improve healthcare distribution and the need for long-term strategies to address changing surgical trends.

Purpose: To report a nationwide survey on neuroblastoma conducted by the Korean Association of Pediatric Surgeons (KAPS) in 2020. Methods: The clinical data of pediatric patients diagnosed with and treated for neuroblastoma from 2005 to 2019 in 19 hospitals of KAPS members were collected. Survival and prognostic factor analyses were performed using the log rank test and Cox proportional hazard analysis. A p-value <0.05 was considered significant. Results: A total of 669 patients with neuroblastoma were registered for the study. The results were presented and discussed at the 36th annual meeting of the KAPS, which was held in Seoul on August 21, 2020. Conclusion This study provides information on patient demographics, prognostic outcomes, and comprehensive treatment outcomes for neuroblastoma. The study is expected to be an important reference for improving pediatric surgeons’ understanding and treatment of neuroblastoma.

Purpose: Biliary atresia (BA) is a rare but progressive cholangiopathy and the leading cause of pediatric liver transplantation worldwide. The Korean Association of Pediatric Surgeons (KAPS) has conducted three national surveys (2001, 2011, and 2023) to assess long-term trends in the diagnosis, treatment, and outcomes of BA. This study provides a comparative analysis of the 2nd and 3rd national surveys, with reference to selected findings from the 1st survey. Methods: This study included 453 patients from the 3rd national survey (2011–2021) and 435 patients from the 2nd survey (2001–2010), all of whom underwent Kasai portoenterostomy. Data were collected via electronic case report forms from pediatric surgical centers nationwide. Comparisons were made regarding demographics, clinical features, diagnostic patterns, operative details, follow-up outcomes, and survival. Kaplan–Meier analysis was used to evaluate long-term survival. Results: The mean number of BA patients per year remained stable between surveys (43.5 in the 2nd, 41.18 in the 3rd), though centralization of care increased, with 61.5% of cases managed by two major institutions in the 3rd survey. The median age at surgery decreased, and the use of preoperative imaging (especially magnetic resonance cholangiopancreatography) increased. The 10-year native liver survival rate declined from 59.8% to 53.7%, while overall 10-year survival improved slightly (92.9% to 93.2%). Postoperative complications, such as cholangitis and liver failure, persisted but were better categorized. The 3rd survey also reported improved mortality (4.9%) and reduced follow-up loss (11.5%) compared to the 2nd survey. Conclusion While overall survival after Kasai operation has remained high and even improved, native liver survival has slightly declined. The findings reflect earlier diagnosis, more consistent diagnostic imaging, and increasing centralization of care. These trends underscore the importance of long-term nationwide data collection in guiding future strategies for BA management in Korea.

Purpose: This study aims to investigate and compare the incidence, demographic characteristics, clinical manifestations, preoperative diagnostic methods, anatomical classifications, associated anomalies, operative treatments, and postoperative outcomes of patients with intestinal atresia treated by the members of the Korean Association of Pediatric Surgeons (KAPS) through three nationwide surveys. Methods: KAPS conducted 3 national surveys in 1998, 2010, and 2024 to examine the patients diagnosed with intestinal atresia. In preparation for the survey, we developed a customized case registration form to obtain data on patient sex, birth weight, gestational age, clinical manifestations, preoperative diagnostic methods, anatomical types, associated anomalies, operative treatments, and postoperative outcomes. Authorized KAPS members completed the case registration form. Results: The first, second, and third national surveys included 218, 222, and 236 individuals diagnosed with intestinal atresia, respectively. The male-to-female ratios were 1.5:1, 1.1:1, and 1.1:1, respectively. The first, second, and third national surveys revealed that 34.3%, 43.3%, and 53.4% of patients were born before 37 weeks of gestation, respectively. Additionally, 28.7%, 32.0%, and 40.7% of patients had a birth weight under 2,500 g. In the third national survey, duodenoduodenostomy was the most common procedure, performed in 70 out of 82 patients diagnosed with duodenal atresia. Resection and anastomosis were the main surgical procedures conducted in 47 out of 54 cases of jejunal atresia and 74 out of 92 cases of ileal atresia. The mortality rates in the first, second, and third national surveys were 13.8%, 3.6%, and 1.3% respectively, with the lowest rate observed in the third national survey. Conclusion These national surveys offer valuable insights into the current state of intestinal atresia, including specific surgical interventions and postoperative outcomes in South Korea. For pediatric surgeons aiming to enhance their understanding of intestinal atresia and its treatment options, these surveys could be an indispensable resource and guide.

Objective: The aim of this study was to evaluate the efficacy and side effects of the mechanical patient-controlled analgesia (PCA), pumps operated in patient optimizing background infusion (POBI) mode, compared with the conventional nonmechanical PCA after laparoscopic gynecologic surgery. Methods: In total, 211 patients were randomized to nonmechanical pump (n=106, group A) or mechanical pump (n=105, group P) postoperative pain treatment groups. A single blinded observer evaluated and recorded postoperative nausea and vomiting (PONV) score as well as the background infusion rate, Numeric Rating Scale (NRS), use of an additional antiemetic or analgesic, degree of sedation, and other side effects at 30 minutes, 2 hours, 8 hours, and 24 hours postoperatively. The degree of patient satisfaction was evaluated at 2 and 24 hours postoperatively. Results: There was no significant difference in the overall NRS score between the two groups. However, the use of rescue analgesics was significantly higher in group A (P=0.007). The incidence of PONV did not significantly differ between the two groups at 0.5 hours postoperatively; however, at 2 hours, it was significantly higher in group P than in group A (P=0.003). In contrast, the incidence of PONV was significantly lower in group P than in group A at 24 hours postoperatively (P=0.033). No significant group difference was observed in patient satisfaction. Conclusion With an appropriate waiting time, a mechanical pump operating in POBI mode could be an effective PCA pump to reduce postoperative pain and side effects.

Purpose: The port site hernia (PSH) is a specific type of incisional hernia related to the trocar sites of laparoscopic surgery. Diastasis recti of the abdominis muscle (DR) is the separation of the rectus muscle by a certain distance. The present study aims to present our experience with umbilical PSH and concomitant DR and to raise awareness of DR as one of the risk factors of umbilical PSH. Methods: Eighteen patients with umbilical PSH after laparoscopic abdominal surgery, was retrospectively reviewed. Preoperative CT was analyzed to measure the Inter-recti distance (IRD) for all patients. Other factors, such as trocar size, wound infection, obesity (BMI), port extension, suture materials, and pre-existing co-morbidities, were recorded and analyzed. Results: Extension of the port incision was associated with umbilical PSH. Ten out of eighteen umbilical PSH patients (56%) had DR before they had first laparoscopic surgery. Nine (50%) patients showed sarcopenia. Moreover, four out of five recurrences had DR. More than two recurrences were all associated with DR. Conclusion Port extension and sarcopenia were risk factors of umbilical PSH. Also, DR might be a possible risk factor of umbilical PSH occurrence and recurrence. Surgeons should be aware of the presence of DR before the planning of the laparoscopic surgery by diagnostic imaging. If DR is associated with umbilical PSH, we need to consider the correction of both pathologies at the same time.

No abstract available.
Intermittent Claudication ; Popliteal Artery