Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.

Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.

Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.

OBJECTIVE: We evaluated the clinical characteristics of patients who underwent surgery after high intensity focused ultrasound (HIFU) to treat uterine leiomyoma. METHODS: From June 2016 to September 2017, patients at our hospital who underwent HIFU to treat uterine leiomyoma prior to surgery were enrolled. All patients underwent pelvic magnetic resonance imaging (MRI) before and after HIFU. If 6 months had passed since the last pelvic MRI was performed, imaging was performed again before the operation. RESULTS: A total of 12 patients were analyzed. The median age was 45 (range, 28–51) years. The median body mass index was 24.9 (range, 18.1–29.2) kg/m2. The median size of the leiomyoma was 10.1 (range, 7.8–14.0) cm before HIFU, which changed to 8.75 (range, 5.9–14.8) cm after HIFU. The median size increased to 9.1 (range, 5.9–18.0) cm before the operation. Surgery was planned for several reasons, including an increase in the leiomyoma size (n=6), persistent symptoms (n=4), and newly developed lesion (n=2). The median interval between HIFU and surgery was 7 (range, 3–32) months. Ten of the 12 patients underwent laparoscopic surgery, while the others underwent laparotomy; 6 patients also underwent laparoscopic myomectomy, and 4 underwent hysterectomy. Histopathologic findings showed infarction-type necrosis surrounded by granulation tissue with the infiltration of lymphocytes and macrophages in all patients. CONCLUSION: Treatment of leiomyoma with operative procedures should be considered in selected patients with tumor size greater than 10 cm, multiple tumors, and persistent symptoms after HIFU treatment.
Body Mass Index ; Granulation Tissue ; High-Intensity Focused Ultrasound Ablation ; Humans ; Hysterectomy ; Laparoscopy ; Laparotomy ; Leiomyoma ; Lymphocytes ; Macrophages ; Magnetic Resonance Imaging ; Necrosis ; Surgical Procedures, Operative ; Ultrasonography

OBJECTIVE: To analyze the preoperative diagnostic clues to ovarian pregnancy (OP). METHODS: This study conducted a retrospective chart review of 23 patients with OP and 46 patients with tubal pregnancy (TP) from October 1, 2003 to September 31, 2016 in Hanyang University Hospital. RESULTS: There were no significant differences in demographic and clinical characteristics between the two groups. The presence of an ectopic gestational sac and hemoperitoneum was significantly higher in the TP group (13.0% vs. 95.7%, P=0.000; 13.0% vs. 54.3%, P=0.001, respectively) in preoperative ultrasonogram. The OP group had more ruptured ectopic gestational sacs than the TP group (73.9% vs. 45.7%, P=0.039) in surgical findings. CONCLUSION: For the patients in whom a gestational sac is not detected in the uterus or the fallopian tubes, it is important to be aware of the possibility of OP and rupture of an ovarian gestational sac to promote early diagnosis and surgical intervention.
Early Diagnosis ; Fallopian Tubes ; Female ; Gestational Sac ; Hemoperitoneum ; Humans ; Laparoscopy ; Pregnancy ; Pregnancy, Ovarian* ; Pregnancy, Tubal* ; Retrospective Studies* ; Rupture ; Ultrasonography ; Uterus

OBJECTIVE: To evaluate the safety and surgical outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after cesarean section. METHODS: We conducted a retrospective study of 328 women with prior cesarean section history who underwent LAVH from March 2003 to July 2013. The subjects were classified into two groups: group A, with anterior wall adherence (n=49); group B, without anterior wall adherence (n=279). We compared the demographic, clinical characteristics, and surgical outcomes of two groups. RESULTS: The median age and parity of the patients were 46 years (range, 34 to 70 years) and 2 (1 to 6). Patients with anterior wall adherence had longer operating times (175 vs. 130 minutes, P<0.05). There were no significant differences in age, parity, number of cesarean section, body mass index, specimen weight, postoperative change in hemoglobin concentration, or length of hospital stay between the two groups. There was one case from each group who sustained bladder laceration during the vaginal portion of the procedure, both repaired vaginally. There was no conversion to abdominal hysterectomy in either group. CONCLUSION: LAVH is effective and safe for women with anterior wall adherence after cesarean section.
Body Mass Index ; Cesarean Section* ; Female ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Lacerations ; Laparoscopy ; Length of Stay ; Parity ; Pregnancy ; Retrospective Studies ; Urinary Bladder

PURPOSE: A few studies have been reported on extrahepatic metastasis after curative resection for hepatocellular carcinoma (HCC). We investigated the patterns of extrahepatic recurrence and we identified the risk factors for extrahepatic recurrence after curative resection for HCC. METHODS: We retrospectively reviewed 587 patients who underwent surgical resection with a curative aim from January 1998 to December 2007 in the Yonsei University Health Care System. Among the 571 patients, 291 (51.0%) patients developed recurrence. Sixty five patients initially presented with extrahaptic recurrence. The patients with extrahepatic recurrence were divided into Group A (peritoneal recurrence) and Group B (non-peritoneal extrahepatic recurrence). RESULTS: Group A had higher rates of intraoperative bleeding>1,500 ml and perioperative transfusion too. On the multivariate analysis, perioperative transfusion, satellite nodule and the tumor size were the independent risk factors for Group A. The Edmondson-Steiner grade, satellite nodule and the tumor size were the independent risk factors for Group B. The 1, 3 and 5-year overall survival rates after curative resection for the patients with extrahepatic recurence were 83.1%, 48.9% and 27.4%, respectively. The recurrence patterns and treatment modalities did not affect the overall survival after treatment for extrahepatic recurrence. CONCLUSION: A perioperative transfusion was found to be a different risk factor for peritoneal recurrence, as compared to those risk factors for non-peritoneal extrahepatic recurrence. Therefore, efforts by physicians to decrease intraoperative bleeding may prevent peritoneal recurrence after performing curative resection for HCC.
Carcinoma, Hepatocellular ; Delivery of Health Care ; Hemorrhage ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Rate

PURPOSE: Hemodialysis patients are at an increased risk of ischemic colitis because of accelerated arterial vascular disease rate and hypotension during dialysis. But few data exist on the clinical features of ischemic colitis in patients with chronic kidney disease including dialysis patients in Korea. The aim of this study is to identify the clinical features of ischemic colitis in patients with chronic kidney disease (CKD). METHODS: We retrospectively reviewed total 68 patients (63.9+/-16.2 years) with ischemic colitis. We analyzed medical history, colonoscopic findings, clinical characteristics, and compared them according to kidney function. RESULTS: Twenty-two (33.9%) patients had CKD stage > or =3 at diagnosis of ischemic colitis. Prevalence of hypertension and diabetes was higher in patients with CKD than those with normal kidney function. High leukocyte count and low hemoglobin level were demonstrated at diagnosis in CKD patients. In addition, duration of hospitalization in patients with CKD was longer than patients with normal kidney function. However, there was no significant difference in right colonic involvement, cardiovascular diseases, surgical intervention, and mortality. Hospitalization days was positively correlated with increased leukocyte count (p=0.015) and decreased albumin level (p=0.002), while that was negatively correlated with age-adjusted estimated glomerular filtration rate (p=0.002). CONCLUSION: Ischemic colitis in patients with CKD had longer hospitalization than in those with normal kidney function. However, there was no significant difference in surgical intervention and mortality.
Cardiovascular Diseases ; Colitis, Ischemic ; Colon ; Dialysis ; Glomerular Filtration Rate ; Hemoglobins ; Hospitalization ; Humans ; Hypertension ; Hypotension ; Kidney ; Kidney Failure, Chronic ; Korea ; Leukocyte Count ; Prevalence ; Renal Dialysis ; Renal Insufficiency, Chronic ; Retrospective Studies ; Vascular Diseases

PURPOSE: Hepatic resection is the standard treatment for hepatocellular carcinoma (HCC). In some patients with multiple HCC, one-block resection is not feasible due to either the tumor location or the underlying liver function. In this study, we attempted to compare the outcomes of multiple - site resection or combined resection and radiofrequency ablation with those of one-block resection in patients with multiple HCC. METHODS: We retrospectively reviewed 507 patients who underwent surgical resection. Among 507 patients who received surgical treatment with potentially curative aim from January 1996 to August 2006 in Yonsei University Health System, 58 patients had a radiologically detected multiple HCC. Patients with multiple HCC were divided into: group A, patients treated with one-block resection (n=40) and group B, patients with multiple-site resection or combined resection and RFA (n=18). RESULTS: The 1-, 3- and 5-year overall survival rates for patients with single and multiple HCC were 90.2%, 76.2% and 66.7% and 82.7%, 61.4% and 37.9%, respectively (p<0.001). In group B, 6 patients received multiple-site resection and 12 patients underwent combined resection and RFA. The clinicopathological variables were not significantly different between the two groups except the distribution of multiple tumors. The postoperative complication rates for group A and B were 32.5% and 33.3%, respectively. The 1-, 3- and 5-year disease-free survival rates for group A and B were 53.0%, 27.6% and 24.1% and 18.3%, 24.1% and 18.3%, respectively (p=0.386). The overall survival rates were also not significantly different between the two group (80.0%, 59.6%, and 36.9% for group A and 88.9%, 65.7% and 39.4% for group B, p=0.528). The multivariate analysis revealed that Edmondsons-Steiner grade (III-IV) and Indocyanine green retention rate at 15 minutes (ICG R15) > 10% were adverse prognostic factors for overall survival. CONCLUSION: Active treatments including multiple-site resection and combined resection and RFA showed similar treatment outcomes compared with one-block resection in patients with multiple HCC.
Carcinoma, Hepatocellular ; Disease-Free Survival ; Humans ; Indocyanine Green ; Liver ; Multivariate Analysis ; Postoperative Complications ; Prognosis ; Retention (Psychology) ; Retrospective Studies ; Survival Rate

PURPOSE: Hepatic resection is the standard treatment for hepatocellular carcinoma (HCC). In some patients with multiple HCC, one-block resection is not feasible due to either the tumor location or the underlying liver function. In this study, we attempted to compare the outcomes of multiple - site resection or combined resection and radiofrequency ablation with those of one-block resection in patients with multiple HCC. METHODS: We retrospectively reviewed 507 patients who underwent surgical resection. Among 507 patients who received surgical treatment with potentially curative aim from January 1996 to August 2006 in Yonsei University Health System, 58 patients had a radiologically detected multiple HCC. Patients with multiple HCC were divided into: group A, patients treated with one-block resection (n=40) and group B, patients with multiple-site resection or combined resection and RFA (n=18). RESULTS: The 1-, 3- and 5-year overall survival rates for patients with single and multiple HCC were 90.2%, 76.2% and 66.7% and 82.7%, 61.4% and 37.9%, respectively (p<0.001). In group B, 6 patients received multiple-site resection and 12 patients underwent combined resection and RFA. The clinicopathological variables were not significantly different between the two groups except the distribution of multiple tumors. The postoperative complication rates for group A and B were 32.5% and 33.3%, respectively. The 1-, 3- and 5-year disease-free survival rates for group A and B were 53.0%, 27.6% and 24.1% and 18.3%, 24.1% and 18.3%, respectively (p=0.386). The overall survival rates were also not significantly different between the two group (80.0%, 59.6%, and 36.9% for group A and 88.9%, 65.7% and 39.4% for group B, p=0.528). The multivariate analysis revealed that Edmondsons-Steiner grade (III-IV) and Indocyanine green retention rate at 15 minutes (ICG R15) > 10% were adverse prognostic factors for overall survival. CONCLUSION: Active treatments including multiple-site resection and combined resection and RFA showed similar treatment outcomes compared with one-block resection in patients with multiple HCC.
Carcinoma, Hepatocellular ; Disease-Free Survival ; Humans ; Indocyanine Green ; Liver ; Multivariate Analysis ; Postoperative Complications ; Prognosis ; Retention (Psychology) ; Retrospective Studies ; Survival Rate