Purpose: To overcome the technical difficulties of single-incision laparoscopic distal gastrectomy (SILDG), needle grasper (Endo Relief TM )-assisted SILDG (NASILDG) was developed. Here, we compared the operative convenience and postoperative outcomes between SILDG and NASILDG. Materials and Methods: A needle grasper was inserted into the right upper abdomen and used in the NASILDG. We retrospectively reviewed patients who underwent D1 + dissection and delta-shaped Billroth I anastomosis with SILDG or NASILDG performed by a single surgeon between September 2015 and August 2018. Results: The SILDG (male, 50.0%) and NASILDG (male, 60.0%) groups included 10 and 15 patients, respectively. The operative time without combined operation and anastomosis was significantly shorter in the NASILDG group. Early complications and scar characteristics were not significantly different between the two groups. Conclusions By adding a needle grasper, SILDG became more convenient without decreasing cosmetic results. NASILDG could be a recommended method to reduce the technical difficulty of SILDG.

Distal gastrectomy with Billroth I or II reconstruction may cause duodenogastroesophageal reflux (DGER), thereby resulting in digestive or respiratory symptoms. The mainstay of treatment is medication with proton pump inhibitors. However, these drugs may have limited effects in DGER. Laparoscopic fundoplication has been proven to be highly effective in treating gastroesophageal reflux disease (GERD), but it cannot be performed optimally for GERD that develops after gastrectomy. We report the case of a 72-year-old man with a history of distal gastrectomy and Billroth I anastomosis due to early gastric cancer. GERD due to bile reflux occurred after surgery and was refractory to medical therapy. The patient underwent Roux-en-Y conversion from Billroth I gastroduodenostomy and hiatal hernia repair with only cruroplasty. Fundoplication was not performed. His symptoms improved significantly after the surgery. Therefore, laparoscopic hiatal hernia repair and Roux-en-Y conversion can be an effective surgical procedure to treat medically refractory DGER after Billroth I gastrectomy.

The role of surgical intervention in patients with diabetic gastroparesis is unclear. We report a case of a 37-year-old man with a history of recurrent episodes of vomiting and long-standing type 2 diabetes mellitus. Esophagogastroduodenoscopy did not reveal any findings of reflux esophagitis or obstructive lesions. A gastric emptying time scan showed prolonged gastric emptying half-time (344 minutes) indicating delayed gastric emptying. Laboratory tests revealed elevated fasting serum glucose and glycosylated hemoglobin (HbA1c, 12.9%) and normal fasting C-peptide and insulin levels. We performed Roux-en-Y reconstruction after subtotal gastrectomy to treat gastroparesis and improve glycemic control, and the patient showed complete resolution of gastrointestinal symptoms postoperatively. Barium swallow test and gastric emptying time scan performed at follow-up revealed regular progression of barium and normal gastric emptying. Three months postoperatively, his fasting serum glucose level was within normal limits without the administration of insulin or oral antidiabetic drugs with a reduced HbA1c level (6.9%). Long-limb Roux-en-Y reconstruction after subtotal gastrectomy may be useful to treat severe diabetic gastroparesis by improving gastric emptying and glycemic control.
Adult ; Barium ; Blood Glucose ; C-Peptide ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Endoscopy, Digestive System ; Esophagitis, Peptic ; Fasting ; Follow-Up Studies ; Gastrectomy ; Gastric Emptying ; Gastroparesis ; Hemoglobin A, Glycosylated ; Humans ; Hypoglycemic Agents ; Insulin ; Vomiting

PURPOSE: The aim of this study is to prepare medical staff in order to prevent medical malpractice litigation through analysis of litigation cases related to the department of surgery in Korea. METHODS: A total of 94 litigation cases related to the department of surgery, where a certain amount of payment was ordered to the defendant between 2005 through 2010, were analyzed. We examined time of occurrence, amount claimed and awarded in damages, plaintiff claims, and court opinion. RESULTS: An average of 3.2 years was spent from the date of the incident occurring to the end of the litigation procedures. The average amount awarded in judgments for damages was 59,708,983 ± 67,307,264 (range, 1,700,000–365,201,482) Korean won. Cases were found involving the following opinion of the court: violation of duty of care (49 cases), violation of informed consent (7 cases), violation of duty of care and informed consent (5 cases), and settlement, reconciliation, and others (32 cases). By analyzing defendants' negligence in court opinions, diagnosis (30.8%) was the most common, followed by post-operation management (27.7%). CONCLUSION: Physicians have to conduct treatment and surgery based on exact diagnosis and be careful to observe patients' conditions and symptoms after surgery. It is essential to identify the current status and characteristics of medical litigation for reducing further litigation and improving patient safety. In order to create a safe medical environment, national efforts should be made not only by individuals but also at the national level.
Awards and Prizes ; Diagnosis ; Humans ; Informed Consent ; Judgment ; Jurisprudence ; Korea* ; Malpractice ; Medical Staff ; Patient Safety

PURPOSE: Although nonerosive and erosive gastroesophageal reflux disease (GERD) have similar symptom severity, nonerosive reflux disease (NERD) is considered a milder type of GERD and gastroenterologists have hesitated to refer these patients for antireflux surgery. The aim of this study was to compare surgical outcomes of antireflux surgery between patients with NERD and erosive reflux disease (ERD). METHODS: Seventy patients met the inclusion criteria of this study among a total of 117 patients who underwent antireflux surgery from November 2012 to October 2017. According to preoperative endoscopy, patients were classified into NERD group (minimal changes or no esophagitis) and ERD group. Clinical characteristics and surgical outcomes were compared between NERD and ERD. RESULTS: There were 26 patients in NERD group and 44 patients in ERD group. The male:female ratio was higher in the ERD group than in the NERD group (P = 0.044). Preoperative symptoms, response to acid suppressive medication, acid exposure on pH monitoring study, and esophageal manometry results were similar in the 2 groups. Reflux on barium esophagography was more frequently observed in ERD (77.3%) than in NERD (50.0%, P = 0.019). At 6 months after surgery, complete resolution and partial improvement of GERD symptoms were similar in the 2 groups (80.8% and 15.4%, respectively, in NERD vs. 88.6% and 2.3%, respectively, in ERD; P = 0.363). CONCLUSION: Laparoscopic Nissen fundoplication is equally beneficial to patients with NERD and ERD. Antireflux surgery should not be avoided for GERD patients without mucosal breaks on endoscopy as the evidence of erosive esophagitis.
Barium ; Endoscopy ; Esophagitis ; Fundoplication ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration ; Manometry

PURPOSE: Senior surgeons prefer open gastrectomy (OG), while young surgeons prefer laparoscopic gastrectomy (LG). The purpose of this study was to evaluate the surgical outcomes of LG performed by a senior surgeon who was an expert in OG during his learning period, by comparing them with LGs performed by a young surgeon. MATERIALS AND METHODS: A senior surgeon performed 50 curative gastrectomies with laparoscopy (LG-S group) from March 2015 to August 2016. A young surgeon's initial 50 LGs comprised the LG-Y group. Clinicopathological characteristics and surgical outcomes were compared between the LG-S and LG-Y groups. RESULTS: D2 lymphadenectomy was more frequently performed in the LG-S group than in the LG-Y group (P=0.029). The operation time and number of retrieved lymph nodes did not significantly differ between the 2 surgeons (P=0.258 and P=0.410, respectively). Postoperative hospital stay and postoperative complication rate were similar between 2 groups (P=0.234 and P=1.000, respectively). Similarly, significant decreases in operation time with increasing case numbers were observed for both surgeons, whereas the number of retrieved lymph nodes increased significantly in the LG-Y group but not in the LG-S group. CONCLUSIONS: The LG outcomes when performed by the senior surgeon were comparable to those when performed by the young surgeon, despite performing more extended lymphadenectomies. Senior surgeons who are experts in OG should not refrain from performing LG.
Gastrectomy* ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Postoperative Complications ; Stomach Neoplasms ; Surgeons

PURPOSE: Laparoscopic fundoplication is considered the standard surgical treatment for gastroesophageal reflux disease (GERD) in Western countries. However, some patients experience poor surgical outcomes with this procedure. The study aimed to identify the predictive factors of the surgical outcomes of laparoscopic Nissen fundoplication for the treatment of Korean GERD patients. METHODS: Sixty-one patients with GERD were treated using laparoscopic Nissen fundoplication between November 2012 and February 2015. Symptom control rates were compared according to clinical and surgical factors to identify predictive factors of successful surgical outcomes. RESULTS: Thirty-five men and 26 women were enrolled. Preoperatively, typical symptoms were present in 60 patients (98%), while atypical symptoms were present in 40 patients (66%). Postoperatively, typical symptoms were controlled in 51 of 60 patients (85.0%), while atypical symptoms were controlled in 33 of 40 patients (82.5%). Overall, at 6 months postsurgery, 54 (88.5%) reported some resolution of GERD symptoms, with 48 (78.7%) achieving complete control. Patients who exhibited a good response to proton pump inhibitor therapy had a significantly greater rate of complete symptom control (P = 0.035). CONCLUSION: Laparoscopic fundoplication is effective for controlling GERD symptoms. Response to preoperative proton pump inhibitor was a predictor of successful outcome.
Female ; Fundoplication* ; Gastroesophageal Reflux* ; Humans ; Korea* ; Laparoscopy ; Male ; Proton Pumps

PURPOSE: The aim of this study was to assess clinical correlations with postoperative alteration of p16 DNA methylation, and to clarify whether postoperative changes in the serum DNA methylation status of p16 could be used as a reliable prognostic factor for gastric cancer. MATERIALS AND METHODS: Fifty-three consecutive gastric adenocarcinoma patients who underwent gastric resection (Chung-Ang University Hospital, Seoul, Korea) were included. DNA methylation of p16 was evaluated by methylation-specific polymerase chain reaction using serum DNA preoperatively and at the 10th postoperative day. The correlation between changes in methylation status and patients' prognosis was analyzed. RESULTS: p16 was methylated in 79.2% of preoperative serum DNA and in 54.7% of postoperative serum DNA, respectively. Methylation in p16 disappeared more frequently in patients who underwent standard D2 lymphadenectomy compared to those who underwent modified D1+ lymphadenectomy (P=0.016). Whereas methylation of preoperative serum DNA was not correlated with survival, patients with postoperative disappearance of p16 methylation showed longer survival than those without postoperative disappearance of p16 methylation in the patients who had gastric cancer with lymph node metastasis (P=0.042). CONCLUSIONS: Postoperative disappearance of p16 methylation could be an available prognostic factor for node-positive gastric cancer.
Adenocarcinoma ; DNA ; DNA Methylation ; Genes, p16 ; Humans ; Lymph Node Excision ; Lymph Nodes ; Methylation ; Neoplasm Metastasis ; Polymerase Chain Reaction ; Prognosis ; Stomach Neoplasms

We report two cases of post-extubation negative pressure pulmonary edema in otherwise healthy patients. The patients underwent laparoscopic appendectomy under general anesthesia and developed negative pressure pulmonary edema immediately after extubation. All cases fully resolved within 24 hours with supplementary oxygen. The literature suggests that post-extubation pulmonary edema occurs more frequently than is generally thought, with a frequency of 0.05-0.1% in all anesthesia, and is often unrecognized or misdiagnosed. Most cases occur in the early post-operative period, and this is potentially life-threatening condition. Therefore, anesthesiologist and surgeon are well placed to witness, investigate and manage this condition.
Anesthesia ; Anesthesia, General ; Appendectomy ; Humans ; Oxygen ; Pulmonary Edema ; Wit and Humor as Topic

Reversal of Hartmann's procedure is a major surgical procedure associated with significant morbidity and mortality. Because of the difficulty of the procedure, laparoscopic reversal of Hartmann's procedure is not well established. We describe our experience with this laparoscopic procedure to assess its difficulty and safety. Five patients (4 men and 1 woman) underwent laparoscopic reversal of Hartmann's procedure (LRHP). The initial surgeries were performed to manage obstructive colorectal cancer for 4 patients, and rectovesical fistula for one patient. The procedure was laparoscopically completed for 4 patients. Conversion to open laparotomy was required for one patient, secondary to massive adhesion in lower abdomen. Transient ileostomies were made in 2 cases. Operative time ranged from 240 to 545 minutes. There was no operative mortality. LRHP can be performed safely by an experienced surgeon. However, it is still technically challenging and time consuming.
Abdomen ; Colorectal Neoplasms ; Colostomy ; Fistula ; Humans ; Ileostomy ; Laparoscopy ; Laparotomy ; Male ; Operative Time