The most plausible contributing factor to non-obese type 2 diabetes may be imbalanced incretin release from the intestinal epithelium in response to nutrients. Rerouting intestinal continuity through bypass surgery to modulate incretin release is therefore a reasonable treatment. We believe that a major determinant of metabolic outcomes is entire duodenal exclusion without leaving any duodenal epithelium and exclusion of sufficient length of jejunum. More importantly, the procedure should be implemented with safety and without sequelae. To achieve this, we invented a novel procedure with acceptable surgical safety and excellent and durable metabolic outcomes. Post-surgical intestinal adaptation should be considered to achieve successful outcomes.

Laparoscopic loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) has theoretical advantages compared with laparoscopic Roux-en-Y gastric bypass. We performed 7 cases of LDJBSG from May 2019 to September 2019. All procedures were successfully completed by laparoscopy. The mean operative time was 282.9 (210~335) minutes and the mean estimated blood loss was 82.9 (20~150) ml. There was no intraoperative complications, however, there was 1 case of postoperative anastomotic leakage. The average length of postoperative hospital stay was 5.3 (3~12) days. The mean body weight at baseline was 117.1 (88.4~151.1) kg, and was decreased to 90.4 (69.4~130.9) kg at postoperative 3 month. The mean of HbA1c at baseline was 7.6 (5.5~9.4) %, and was decreased to 5.3 (4.8~5.6) % at postoperative 3 month. Although LDJB-SG is a technically demanding procedure, it can be a feasible and safe procedure if the learning curve can be overcame.

Laparoscopic mini-gastric bypass surgery is a safe and simple surgical intervention for treating morbid obesity and diabetes mellitus and is now being performed more frequently. Radiologists must be critical in their postoperative evaluation of these patients. In this pictorial review, we explain and illustrate the surgical technique, normal postoperative anatomy, and associated complications as seen on imaging examinations, including fluoroscopy and computed tomography.
Adult ; Anastomotic Leak/epidemiology ; Cholelithiasis/epidemiology ; Constriction, Pathologic/epidemiology ; Diabetes Mellitus/*therapy ; Female ; Fluoroscopy ; Gastric Bypass/*methods ; Hemorrhage/epidemiology ; Humans ; Laparoscopy ; Male ; Middle Aged ; Obesity, Morbid/*surgery ; Stomach/radiography/surgery ; Tomography, X-Ray Computed

PURPOSE: Despite acceptance of laparoscopic totally extraperitoneal (TEP) repair for repair of inguinal hernia, it is still considered to require a prolonged learning curve. We hypothesized that there would be differences in the learning curve for laparoscopic TEP repair among beginner surgeons with or without a supervisor. The current study was conducted to observe the learning curve for laparoscopic TEP repair performed by a surgeon without a supervisor. METHODS: A retrospective analysis of the consecutive 143 patients was conducted to document patients' demographics, hernia types, operative time, and operative outcomes after the operation. Patients were divided into 7 consecutive groups, each comprising 20 patients. RESULTS: The mean age of the study population was 52.5 years (+/- 18.9 SD), ranging from 16 to 89 years. The learning curve of this technique was almost horizontal throughout the time course. The mean operative time was quite stable among each group. Comparison of the mean operation time and the length of hospital stay among each group did not show significant differences. There was one recurrence in group V. CONCLUSION: The learning curve for laparoscopic TEP repair is not that prolonged if there is an experienced specialized supervisor and opportunities to observe the entire procedure performed by the supervisor are available. It is not the laparoscopic instrument skills but the way the procedure is performed that is important for successful outcomes.
Demography ; Hernia ; Hernia, Inguinal ; Humans ; Learning Curve* ; Learning* ; Length of Stay ; Operative Time ; Recurrence ; Retrospective Studies

BACKGROUND: Transverse abdominis plane (TAP) block can be recommended as a multimodal method to reduce postoperative pain in laparoscopic abdominal surgery. However, it is unclear whether TAP block following local anesthetic infiltration is effective. We planned this study to evaluate the effectiveness of the latter technique in laparoscopic totally extraperitoneal hernia repair (TEP). METHODS: We randomly divided patients into two groups: the control group (n = 37) and TAP group (n = 37). Following the induction of general anesthesia, as a preemptive method, all of the patients were subjected to local anesthetic infiltration at the trocar sites, and the TAP group was subjected to ultrasound-guided bilateral TAP block with 30 ml of 0.375% ropivacaine in addition before TEP. Pain was assessed in the recovery room and post-surgery at 4, 8, and 24 h. Additionally, during the postoperative 24 h, the total injected dose of analgesics and incidence of nausea were recorded. RESULTS:: On arrival in the recovery room, the pain score of the TAP group (4.33 +/- 1.83) was found to be significantly lower than that of the control group (5.73 +/- 2.04). However, the pain score was not significantly different between the TAP group and control group at 4, 8, and 24 h post-surgery. The total amounts of analgesics used in the TAP group were significantly less than in the control group. No significant difference was found in the incidence of nausea between the two groups. CONCLUSIONS: TAP block following local infiltration had a clinical advantage only in the recovery room.
Analgesics ; Anesthesia, General ; Hernia ; Herniorrhaphy* ; Humans ; Incidence ; Nausea ; Pain, Postoperative ; Recovery Room ; Surgical Instruments ; Ultrasonography

The dramatic increase in the prevalence of obesity and its accompanying comorbidities are major health concerns in Korea. Obesity is defined as a body mass index > or =25 kg/m2 in Korea. Current estimates are that 32.8% of adults are obese: 36.1% of men and 29.7% of women. The prevalence of being overweight and obese in national surveys is increasing steadily. Early detection and the proper management of obesity are urgently needed. Weight loss of 5% to 10% is the standard goal. In obese patients, control of cardiovascular risk factors deserves the same emphasis as weight-loss therapy. Since obesity is multifactorial, proper care of obesity requires a coordinated multidisciplinary treatment team, as a single intervention is unlikely to modify the incidence or natural history of obesity.
Adult ; Body Mass Index ; Comorbidity ; Female ; Humans ; Incidence ; Korea ; Male ; Natural History ; Obesity* ; Overweight* ; Prevalence ; Risk Factors ; Weight Loss

PURPOSE: Despite advancements in surgery, laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia in patients with previous lower abdominal surgeries has been a burden to surgeons. This study was conducted in order to assess the feasibility of laparoscopic intraperitoneal onlay m esh (IPOM) hernia repair as an alternative method for these cases. METHODS: From May 2006 to November 2010, 48 IPOM repairs were performed in 43 patients. All medical records were reviewed retrospectively. RESULTS: Mean age of patients was 61 years old and male to female ratio was 37:6. Five were direct and 43 were indirect hernias. There were 15 recurrent inguinal hernias after either open or laparoscopic hernia repair, and five of 15 were recurrent cases more than two times. Mean operative time was 44.5 minutes, and mean postoperative hospital stay was 1.41 days. There were two cases of postoperative swelling at the groin area and two patients complained of pain that required oral pain-killers during out-patient follow-ups. Recurrence developed in one case. CONCLUSION: Even though laparoscopic IPOM repair is not a preferred m ethod for inguinal hernia, it can be applied as an alternative method in specific cases involving difficulties in approaching the usual plane of repair.
Female ; Follow-Up Studies ; Groin ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Inlays* ; Laparoscopy ; Length of Stay ; Male ; Medical Records ; Operative Time ; Outpatients ; Recurrence ; Retrospective Studies

OBJECTIVE: Appropriate placement of thoracic epidural catheter provides an adequate postoperative analgesia in chest and upper abdominal surgery. Usually, when thoracic epidural puncture is performed, both scapular lower tips and the thoracic (T)7 spinous process is assumed to be at the same horizontal level. The aim of this study is to identify the thoracic epidural puncture in the sitting position, with the neck flexed and arms crossed, may change the relationship between the thoracic vertebrae and the scapular lower tips. METHODS: One hundred patients with postoperative patient controlled epidural analgesia using thoracic epidural catheters were enrolled. It is presumed that the both scapular lower tips and T7 spinous process is at the equal level when performing thoracic epidural puncture. The actual insertion level of the Tuohy needle was examined by radiography when the patient was in the sitting position. RESULTS: Out of 100 patients, there were 62% that were in the same level as the scapular lower tips and T7 spinous process. However, 1% of the patients leveled at T4, 1% at T5, 25% at T6, 18% at T8, and 1% at T9. CONCLUSION: When performing the thoracic epidural puncture under the sitting position, the relationship of the T7 and the scapular lower tips may change. The change of position of scapular lower tips varied among T6.82+/-0.70. Therefore, to be precise, it is advised to utilize C-arm guide when epidural puncture is carried out.
Analgesia ; Analgesia, Epidural ; Arm ; Catheters ; Humans ; Neck ; Needles ; Punctures ; Thoracic Vertebrae ; Thorax

PURPOSE: To compare the outcomes between laparoscopic total extraperitoneal (TEP) repair and prolene hernia system (PHS) repair for inguinal hernia. METHODS: A retrospective analysis of 237 patients scheduled for laparoscopic TEP or PHS repair of groin hernia from 2005 to 2009 was performed. RESULTS: The mean age was 52.3 years in TEP group and 55.7 years in PHS group. Of 119 TEP cases, 98 were indirect inguinal hernia, 15 direct type, 5 femoral hernia and 1 complex hernia; Of 118 PHS cases, 100 indirect, 18 direct type. All in TEP group were performed under general anesthesia and 64% of PHS group were performed under spinal or epidural anesthesia. Preoperatively, 10 cases of recurrent inguinal hernia were involved in our study (4 in TEP, 6 in PHS group). The mean operative time was similar in both groups (74.8 in TEP, 71.2 in PHS group), however mean hospital stay (1.6 days in TEP, 3.2 days in PHS group, P = 0.018) and mean usage of analgesics (0.54 times in TEP, 2.03 times in PHS group, P < 0.01), complications (36 cases in TEP, 6 cases in PHS group, P < 0.01) showed statistical differences. There is only 1 case of postoperative recurrence inguinal hernia in PHS group but it has no statistical significance (P = 0.314). CONCLUSION: Compared to PHS repair, laparoscopic TEP repair has some advantages; shorter hospital stay, less frequent need of analgesics; as well as more postoperative complications such as hematoma, seroma, scrotal swelling.
Analgesics ; Anesthesia, Epidural ; Anesthesia, General ; Groin ; Hematoma ; Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Humans ; Hydrogen-Ion Concentration ; Laparoscopy ; Length of Stay ; Operative Time ; Polypropylenes ; Postoperative Complications ; Pyrazines ; Recurrence ; Retrospective Studies ; Seroma ; Surgical Mesh