PURPOSE: This study compared the patency of the splenic vessels between laparoscopic and open spleen and splenic vessel-preserving distal pancreatectomy. METHODS: We retrospectively reviewed a database of 137 patients who underwent laparoscopic (n = 91) or open (n = 46) spleen and splenic vessel-preserving distal pancreatectomy at a single institute from 2001 through 2015. Splenic vessel patency was assessed by abdominal computed tomography and classified into three grades according to the degree of stenosis. RESULTS: The splenic artery patency rate was similar in both groups (97.8 vs. 95.7%, P = 0.779). Also, the splenic vein patency rate was not significantly different between the 2 groups (74.7% vs. 82.6%, P = 0.521). Postoperative wound complication was significantly lower in the laparoscopic group (19.8% vs. 28.3%, P = 0.006), and hospital stay was significantly shorter in the laparoscopic group (7 days vs. 9 days, P = 0.001) than in the open group. Median follow-up periods were 22 months (3.7–96.2 months) and 31.7 months (4–104 months) in the laparoscopic and open groups, respectively. CONCLUSION: Laparoscopic distal pancreatectomy showed good splenic vessel patency as well as open distal pancreatectomy. For this reason, splenic vessel patency is not an obstacle in performing laparoscopic splenic vessel-preserving distal pancreatectomy.
Constriction, Pathologic ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Pancreatectomy ; Retrospective Studies ; Spleen ; Splenic Artery ; Splenic Vein ; Vascular Patency ; Wounds and Injuries

PURPOSE: We evaluated the usefulness of the cementless stem in treating hip fracture patients older than 70. MATERIALS AND METHODS: We studied elderly osteoporotic hip fractures in the neck and intertrochanter area who had received hip arthroplasty with over 2 years of follow up period. Among those, we analyzed the clinical and radiological results of hip arthroplasty with cemented stem (group 1) and hip arthroplasty with cementless stem (group 2). Each group was consists of fifty hips. RESULTS: The mean age at surgery was 75 years and mean follow-up period was 40 months (minimum 24 months). The admission period was 28.68+/-8.8 days for group 1 and 28.05+/-8.7 days for group 2 (p>0.05) and the average operation time was 87+/-21.2 minutes, and 80+/-17 minutes (p>0.05) and the total blood loss was 611+/-141.3 cc and 557+/-120.5 cc (p>0.05) respectively. There was no statistically significant difference in all aspects. One case of pulmonary embolism occurred in group 1. Stem loosening was not observed in both groups at the last follow-up radiologic study. CONCLUSION: The hip arthroplasty with cementless stem for the osteoporotic hip fractures showed a competent results clinically and radiologically in short term follow up as compared with the cemented stem.
Aged ; Arthroplasty ; Follow-Up Studies ; Hip ; Hip Fractures ; Humans ; Neck ; Pulmonary Embolism

A right-sided aortic arch and Kommerell's diverticulum, remnants of the left dorsal aortic arch in the circulation of the embryo, are uncommon congenital defects of the aorta. They may be asymptomatic in most cases, but symptoms are manifested by compressing mediastinal structures or are related to congenital heart anomalies. If aneurismal dilatation of the diverticulum presents with rupture, it is lethal. We report a case of esophageal compression by a right-sided aortic arch and Kommerell's diverticulum that mimicked an esophageal submucosal tumor in a patient who complained of symptoms during the past ten years of food retention in the upper thorax when a bolus of food was ingested.
Aorta ; Aorta, Thoracic ; Congenital Abnormalities ; Dilatation ; Diverticulum ; Embryonic Structures ; Heart ; Humans ; Retention (Psychology) ; Rupture ; Thorax

The incidence of colon cancer and cancer-related deaths has been increased in Korea. Because most colon cancers arise from colonic adenomatous polyps, it is important to detect these early and to resect such lesions, and so the incidence of endoscopic polypectomy has increased in Korea since 1970's. At present, conventional colonoscopy is the standard for evaluating the colon, and especially for the screening and treatment of colon tumor. However, the entire colon cannot be visualized during conventional colonoscopy in 5~15% of patients due to a redundant colon, an excessive loop or a history of abdominal surgery. To overcome these difficulties, many radiologic and endoscopic studies have been conducted and there are several recent reports that double balloon enteroscopy has been successfully used in cases of failed conventional colonoscopy. We report here on a case of laterally spreading tumor that was resected with double balloon enteroscopy in a severely redundant colon.
Adenomatous Polyps ; Colon ; Colonic Neoplasms ; Colonoscopy ; Double-Balloon Enteroscopy ; Humans ; Incidence ; Korea ; Mass Screening

PURPOSE: To evaluate the long-term efficacy of laparoscopic Burch colposuspension, we reviewed the success rate and subjective satisfaction rate of this operation for female patients with stress incontinence. Materials and Methods: Between Sep. 1995 and Aug. 1999, 126 patients underwent laparoscopic Burch colposuspension. We reviewed 88 patients who had been followed up for more than 3 years. The mean patient age was 51.1 years and 26 of the 88 patients complained of urge incontinence. All were preoperatively assessed with voiding cystourethrography (VCUG), urodynamic study, cystoscopy and stress, emptying, anatomic, protection, and instability (SEAPI) score. Colposuspension was performed with 2 non- absorbable sutures (n=70) or polyprophylene mesh and Tacker (n=18) by the retroperitoneal approach. RESULTS: At the mean follow-up of 56 months, 58 patients (66%) were cured, and 19 patients (22%) showed significant improvements. Sixty one (94.4%) out of 66 patients who had previously required pad protection attained a pad-free status. Urge incontinence disappeared in 15 out of 26 patients, but 8 (9.1%) patients complained of de novo urge incontinence. The pre- operative factors (age, symptom periods, symptom score, abdominal leak point pressure (ALPP) and VCUG findings) made no difference for the success rate. The subjective satisfaction rate was 93%. The mean operation time was 88 minutes and it decreased to 67 minutes after 50 cases. The mean hospital stay was 3.5 days and mean duration of catheterization was 3.7 days. We had 5 (5.68%) cases of complications: two port site bleeding, one peritoneal injury, one respiratory acidosis and one obturator venous bleeding. However, all of them eventually recovered. CONCLUSIONS: Laparoscopic colposuspension revealed good results on the long-term follow-up, as well the operation as being a minimally invasive procedure. There was a 88% success rate, a 93% subjective satisfaction rate and 94% of the patients became pad free.
Acidosis, Respiratory ; Catheterization ; Catheters ; Cystoscopy ; Female* ; Follow-Up Studies ; Hemorrhage ; Humans ; Laparoscopy ; Length of Stay ; Sutures ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge ; Urodynamics

PURPOSE: To evaluate the long-term efficacy of laparoscopic Burch colposuspension, we reviewed the success rate and subjective satisfaction rate of this operation for female patients with stress incontinence. Materials and Methods: Between Sep. 1995 and Aug. 1999, 126 patients underwent laparoscopic Burch colposuspension. We reviewed 88 patients who had been followed up for more than 3 years. The mean patient age was 51.1 years and 26 of the 88 patients complained of urge incontinence. All were preoperatively assessed with voiding cystourethrography (VCUG), urodynamic study, cystoscopy and stress, emptying, anatomic, protection, and instability (SEAPI) score. Colposuspension was performed with 2 non- absorbable sutures (n=70) or polyprophylene mesh and Tacker (n=18) by the retroperitoneal approach. RESULTS: At the mean follow-up of 56 months, 58 patients (66%) were cured, and 19 patients (22%) showed significant improvements. Sixty one (94.4%) out of 66 patients who had previously required pad protection attained a pad-free status. Urge incontinence disappeared in 15 out of 26 patients, but 8 (9.1%) patients complained of de novo urge incontinence. The pre- operative factors (age, symptom periods, symptom score, abdominal leak point pressure (ALPP) and VCUG findings) made no difference for the success rate. The subjective satisfaction rate was 93%. The mean operation time was 88 minutes and it decreased to 67 minutes after 50 cases. The mean hospital stay was 3.5 days and mean duration of catheterization was 3.7 days. We had 5 (5.68%) cases of complications: two port site bleeding, one peritoneal injury, one respiratory acidosis and one obturator venous bleeding. However, all of them eventually recovered. CONCLUSIONS: Laparoscopic colposuspension revealed good results on the long-term follow-up, as well the operation as being a minimally invasive procedure. There was a 88% success rate, a 93% subjective satisfaction rate and 94% of the patients became pad free.
Acidosis, Respiratory ; Catheterization ; Catheters ; Cystoscopy ; Female* ; Follow-Up Studies ; Hemorrhage ; Humans ; Laparoscopy ; Length of Stay ; Sutures ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge ; Urodynamics

Moyamoya disease is an unusual cerebrovascular disorder characterized by occlusive intimal dysplasia of the distal internal carotid and proximal cerebral arteries as well as other collateral arteries. However,moyamoya diseases are recently being reported as a systemic process.We experienced one case of coronary artery occlusive disease affected by moyamoya disease.The patient was a 35-year-old female,experiencing intermittent NYHA class II dyspnea and exertional chest pain for 6 months and right parest hesi a f or 1 month before admission.Cerebral artery angiogram showed abnormal cerebrovascular systems and confirmed moyamoya disease with cerebral infarction of the left f r ont al l obe. I n cor onar yartery angiogram,left coronary artery was not visualized due to total occlusion of the left main ostium and left coronary blood flow was supplied from normal right coronary artery. CABG was performed with OPCAB.Both internal mammary arteries were used f or LAD and LCx.Intraoperative coronary artery findings showed intimal hyperplasia and no definite thrombi,and nondiseased coronary arteries were good and patent.We concluded that this patient's coronary artery disease was affected by moyamoya disease,and moyamoya disease should be evaluated in the extracerebral cardiovascular system.
Adult ; Arteries ; Cardiovascular System ; Cerebral Arteries ; Cerebral Infarction ; Cerebrovascular Disorders ; Chest Pain ; Coronary Artery Disease* ; Coronary Vessels* ; Dyspnea ; Humans ; Hyperplasia ; Mammary Arteries ; Moyamoya Disease*

Background :The incidence of gastroesophageal reflux disease(GERD)is increasing recently, but medical management for GERD has many limitations.Therefore,variable surgical treatments have been introduced. MATERIAL AND METHOD: A retrospective study was done in 10 patients who underwent the Belsey Mark IV operation at Korea university Guro hospital between 1996 and 2001.Preoperative diagnoses were hiatal hernia with gasroesophageal reflux in 8 patients and achalasia in 2 patients. RESULT: Mean age of the patients was 54.3 +/- 19.0 years.Belsey Mark IV operation was performed on patients where preoperative medical failed and mean hospital days were 13.1 +/- 2.6 days.We routinely practiced follow-up endoscopy on postoperative 3rd,6th,9th,and 12th months.After remission for reflux and esophagitis,they were transferred to internal medicine department.Six patients of hiatal hernia with reflux (one patient who lost follow-up and the other patient who didn't practice the follow-up endoscopy due to short postoperative follow-up period were excluded)had lowered endoscopic gradings and two patients of achalasia did not complained of reflux symptoms,postoperatively.We experienced 10%operation failure rate. CONCLUSION: We experienced satisfactory operation results with Belsey Mark IV in hiatal hernia with GERD and achalasia patients.
Diagnosis ; Endoscopy ; Esophageal Achalasia* ; Follow-Up Studies ; Gastroesophageal Reflux* ; Hernia, Hiatal* ; Humans ; Incidence ; Internal Medicine ; Korea ; Retrospective Studies

BACKGROUND: Proper construction of vascular access and adequate maintenance are essential for the prognosis of the hemodialysis patients. Though arteriovenous fistula using autogenous vessel is the first of choice, the incidence of arteriovenous fistula using artificial graft is gradually increasing. The aim of this study was to analyse the patency rates between autogenous and artificial fistula, among artificial graft types, according to the accompanied disease. MATERIAL AND METHOD: A retrospective study was conducted on 186 patients who underwent 292 arteriovenous fistula operations for hemodialysis at Korea University Guro Hospital between 1996 and 2000. Mean age of the patients was 54.37+/-12.89years, and the male: female ratio 99:87. RESULT: Among 292 operations, there were 156 autogenous fistula and 116 graft fistula. The other 20 operations were thrombectomy, takedown of graft, revision, and balloon dilatation. Patency rates of autogenous fistula were 92.78+/-2.35% at 1 year and 39.03+/-9.08% at 5 years, and those of graft fistula were 96.09+/-2.22% at 1 year and 16.45+/-10.15% at 5 years. However, there was no statistical significance between the two operations. The patients who had hypertension, diabetes or both had no statistical significance in the patency rate compared to that of patients without underlying disease. In addition, the type of graft used did not affect the patency rate. Second operation was needed in 62 patients and third operation in 31 patients, but their patency rate again had no statistical significance compared to that of the first operation. CONCLUSION: The patency of the artificial graft fistula was comparable to the autogenous fistula, but the patency according to types of graft need to be studied further. Furthermore, the underlying diseases did not affect the fistula patency.
Arteriovenous Fistula* ; Dilatation ; Female ; Fistula ; Humans ; Hypertension ; Incidence ; Korea ; Male ; Prognosis ; Renal Dialysis* ; Retrospective Studies ; Thrombectomy ; Transplants

BACKGROUNDS: It is almost universally accepted that occlusive vascular diseases are best managed by anatomical reconstruction. However, the mortality and the morbidity have limited this operation for patients with high operation risks. In these patients, palliative operations such as extra-anatomic bypass and lumbar sympathectomy, are accepted as useful treatment. MATERIAL AND METHOD: A retrospective study was conducted in 38 patients who underwent palliative operations for occlusive vascular disease at Korea University Guro Hospital between 1996 and 2000. Mean age of the patients was 60.37 +/- 17.65 years, and preoperative diagnoses were atherosclerosis in 32 patients, Buerger's disease in 4 patients, Raynaud's syndrome in 1 patient and SVC syndrome in 1 patient. RESULT: Extra-anatomic bypass(40procedures), lumbar sympathectomy(17), thromboembolectomy(7) and femoral artery graft interposition(1) were performed. Six patients were required reoperation due to graft flow failure or fistula. Three year primary patency rate of entire operations was 78.29 +/- 8.81%, and the correlation between type of operation and patency rate was not statistically significant. CONCLUSION: Palliative operations for occlusive vascular disease are useful treatment in limited patients with high operation risks or limited life expectancy.
Atherosclerosis ; Diagnosis ; Femoral Artery ; Fistula ; Humans ; Korea ; Life Expectancy ; Mortality ; Palliative Care* ; Reoperation ; Retrospective Studies ; Sympathectomy ; Thromboangiitis Obliterans ; Transplants ; Vascular Diseases*