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Background: Balloon-assisted stone extraction (BASE) can be applied to remove the common bile duct (CBD) stones during laparoscopic CBD exploration (LCBDE). This study aimed to analyze the efficacy...

Background To examine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better reconstructive method to reduce Postoperative Pancreatic Fistula (POPF), after pancreaticoduodenectomy (PD) according to the fistula risk. Methods An institutional database was reviewed for patients undergoing PD between January 2008 and August 2019. 159 patients were stratified into four groups according to the Clinical Risk Score-Pancreatic Fistula (CRS-PF). POPF according to 4 risk groups was compared between PJ and PG. Results Of the 159 patients, 82 underwent PG (51.6%) and 77 underwent PJ (48.4%) reconstruction. POPF rate was 15.1% and 17.1% (n=14) in the PG group and 12.9% (n=10) in the PJ group (P =0.51). POPF rates were not different in intermediate, low and negligible risks between two reconstructive methods. In High risk group (n=47), there was 4 (22.2%) POPF in PJ group and 9 (31.0%) in PG group, respectively (p=0.74). Conclusions In PD, there was no superior method of reconstruction with regards of POPF, even in high risk glands.

Introduction It is new clinical interest higher serum amylase level with pancreatitis after pan-creaticoduodenectomy (PD) correlates with postoperative pancreatic fistula (POPF). Nevertheless, its evidence and study were scarce. We aimed to investigate correlation of serum amylase level immediate after PD and POPF occurrence. Methods Of 163 patients who underwent PD at between January 2007 and December 2019, retrospective analysis was conducted to identify risk factors including serum amylase level immediate after PD for POPF occurrence. Results Overall incidence of POPF (25/163) was 15.3%. The patients occurred a POPF had significantly higher level of serum amylase on POD 0 compared to in whom without a POPF (414 vs. 253, p 285 IU/L) and Fistula Risk Grade were correlated with POPF occurrence. In multivariable analysis, Fistula risk grade and POAP were significantly associated with developing POPF. Conclusions In patients with higher serum amylase (> 285 IU/L) on POD 0 with higher fistula risk grade,comprehensive management to achieve mitigation of POPF is important.

Reports on the long-term oncologic outcomes of laparoscopic liver resection (LLR) compared to open liver resection (OLR) in patients with hepatocellular carcinoma (HCC) are rare. The aim of this study was to compare the long-term outcomes of LLR and OLR as a treatment for HCC patients.A total of 125 patients were included in the study (32 patients underwent LLR and 93 underwent OLR). Data were categorized according to operation methods. The primary endpoints were disease-free survival and overall survival. The secondary endpoints were surgical outcomes of LLR for HCC.Capsular invasion was more frequent in the LLR group (P = .001). The median follow-up period was 48 months (1-188 month). There were no significant differences between the two groups regarding mortality and morbidity. Hospitalization days were shorter in the LLR group (P = .042). Disease-free 5-year survival of HCC was 40.9% and 47.2% in the LLR and OLR group, respectively (P = .376). Overall 5-year survival for HCC was 96.4% and 96.7% for the LLR and OLR group, respectively (P = .748).Our long-term analysis on oncologic aspects confirms the safety of LLR compared to OLR in HCC patients.

Pathologic response (PR) predicts survival after preoperative chemotherapy and resection of a malignancy. Occasionally, transarterial chemoembolization (TACE) may be selected for preoperative management of resectable hepatocellular carcinoma (HCC). This study investigated whether PR to preoperative TACE can predict recurrence after resection for resectable HCC.We conducted analysis of 106 HCC patients who underwent TACE followed by liver resection with a curative intent. The PR was evaluated as the mean percentage of non-viable tumor area within each tumor. We divided the patients into three groups according to response rate: complete PR (CPR), major response (MJR: PR≥50%) and minor response (MNR: PR50%). The primary endpoint was disease-free survival, and the secondary endpoints were predicting factors for tumor recurrence and MJR+CPR.Among the 121 TACE patients, PR could be measured in 106 (87.6%). The mean interval between TACE and liver resection was 33.1 days. The 5-year disease-free survival rates by PR status were as follows: 40.6% CPR, 43.7% MJR, and 49.0% MNR (P=0.815). There were also no significant differences in overall survival between the three groups. Multivariate analyses revealed that microvascular invasion and capsular invasion (hazard ratio [HR]=11.224, P=0.002 and HR=2.220, P=0.043) were independent predictors of disease-free survival. Multivariate analysis of the predictors of above 50% PR revealed that only hepatitis B was an independent factor.These data could reflect that the PR after TACE for resectable HCC may not be useful for predicting recurrence of HCC after resection.

Background Gut hormones play a role in diabetes remission after a Roux-en-Y gastric bypass (RYGB). Our aim was to investigate differences in gut hormone secretion according to diabetes remission after surgery. Second, we aimed to identify differences in insulin secretion and sensitivity according to diabetes remission after RYGB. Methods Twenty-two severely obese patients with type 2 diabetes underwent RYGB. A meal tolerance test (MTT) was performed 12 months after RYGB. The secretions of active glucagon-like peptide-1 (active GLP-1), glucose-dependent insulinotropic peptide (GIP), peptide YY, C-peptide and insulin during the MTT test were calculated using total area under the curve values (AUC). Remission was defined as glycated haemoglobin (A1C) of

Small bowel obstruction after intra-abdominal surgery is a common cause of morbidity necessitating reoperation. The aim of this study was to determine the feasibility of and indications for laparoscopic surgery for acute adhesive small bowel obstruction (AASBO). We conducted a retrospective review of all patients with AASBO who underwent laparoscopic adhesiolysis at a major university medical center. Laparoscopic treatment was performed successfully in 16 patients, and conventional treatment was performed in 13 patients. The rate of conversion from laparoscopic to open was 16.7 per cent. In 15 of 16 total patients who underwent laparoscopic surgery, laparoscopic bandlysis was performed and one patient underwent laparoscopic adhesiolysis. Laparoscopic surgery was performed successfully in nine who had a single adhesive band demonstrated on an abdominal CT, and conventional surgery was performed in all 10 patients without a single adhesive band identified radiographically. Abdominal CT scans facilitate the selection of operative approach for AASBO based on preoperative identification of the obstruction site. Laparoscopic adhesiolysis is a safe and effective treatment modality for patients with AASBO with a single band or single transition zone identified by preoperative imaging.

BACKGROUND Malignant small intestine tumor accounts for 0.1-0.3% of all malignancies. Although primary adenocarcinoma is the most common histologic subtype, there is no report of the clinical characteristics and natural history in the Asian population. METHODS We conducted retrospective analysis for the patients with the small intestine adenocarcinoma to explore the clinical characteristics and prognosis. All patients with adenocarcinoma of small intestine diagnosed between March 1997 and March 2007 in the Catholic Medical Center in Korea were identified through the cancer registry. The medical records were reviewed for patient characteristics, treatment and outcome data. RESULTS Data on 53 patients were available. Twenty-six patients (49.0%) underwent curative resection and 13 patients receiving adjuvant chemotherapy. Fifteen patients received palliative chemotherapy. Median of overall survival of all patients was 12 months (95% confidence interval (CI): 8.5-15.1 months). Three-year survival and relapse-free survival rates after curative resection was 66.1 and 50.8%, respectively. Median survival of patients received palliative chemotherapy was 8.0 months (95% CI: 3.5-12.4). CONCLUSIONS The prognosis of primary adenocarcinoma of small intestine was poor, especially in cases where curative resection could not to be performed. Further study on the methods for early detection and effective systemic chemotherapy should be investigated.

Pancreatic fistula (PF) has traditionally been a source of significant morbidity and mortality after pancreaticoduodenectomy (PD). External drainage of pancreatic duct with stent and Blumgart anastomosis had reduced PF after PD in some studies. We applied compounding described two methods for pancreaticojejunostomy (PJ) during PD, and investigated the effectiveness of this modified PJ technique to prevent PF.Between March 2002, and March 2013, 90 patients who underwent PD were enrolled. The patients were divided into 2 groups according to pancreatienterostomy method. Group 1 contain patients who did not undergo modified PJ (n=70) compared with group 2 (n=20) those who did undergo the modified PJ technique. We compared clinical data between two groups.No differences were noted in the demographics and operation-related factors, between the 2 groups. A PF occurred in 38 of 70 patients in group 1 (54.3%) and in 2 of 20 in group 2 (10.0%). Group 2 had a significantly lower incidence of PF (P=.0016), and these fistulas were classified as being grade A using the International Study Group on Pancreatic Fistula Definition. Mortality in group 1 was 10.0% and no mortality in group 2.External drainage with Blumgart method of PJ showed reducing high grade PF after PD.

Aims/Introduction Little is known about the long-term effects of Roux-en-Y gastric bypass (RYGB) in severely obese Asian individuals. Methods and Materials A total of 33 severely obese patients with type 2 diabetes underwent RYGB. All patients were followed up for 2 years. Visceral and abdominal subcutaneous fat areas were assessed using computed tomography (CT) before, and 12 and 24 months after RYGB. The muscle attenuation (MA) of paraspinous muscles observed by CT were used as indices of intramuscular fat. Results The mean percentage weight loss was 22.2 ± 5.3% at 12 months, and 21.3 ± 5.1% at 24 months after surgery. Compared with the baseline values, the visceral fat area was 53.6 ± 17.1% lower 24 months after surgery, and the abdominal subcutaneous fat area was 32.7 ± 16.1% lower 24 months after surgery. The MA increased from 48.7 ± 10.0 at baseline to 52.2 ± 8.9 (P = 0.009) 12 months after surgery. The MA after the first 12 months maintained changes until 24 months. Triglycerides and free fatty acids were reduced after surgery, whereas the high-density lipoprotein cholesterol levels were increased significantly after surgery. At the last follow-up visit, 18 patients (55%) had diabetes remission. The percentage of iron and vitamin D deficiency was 30% and 52%, respectively. Conclusions We found that patients subjected to RYGB had significant sustained reductions in visceral and intramuscular fat. There were durable improvements in the cardiometabolic abnormalities without any significant comorbidities. However, there were mild nutritional deficiencies in these patients despite daily supplementation with multivitamins and minerals.

When common bile duct (CBD) stone removal by endoscopy fails, stone removal is a mandatory procedure for the surgeon. However, it is unclear that the laparoscopic procedure is the alternative treatment in this setting. The purpose of this study is to investigate the result of laparoscopic CBD exploration (LCBDE) following unsuccessful CBD stone removal by endoscopy.This study is a retrospective analysis of 82 consecutive LCBDEs. Group 1 included patients who underwent secondary LCBDE after stone removal by endoscopic retrograde cholangiopancreatography (ERCP) failed. Group 2 was defined when primary LCBDE was performed without ERCP. Perioperative outcomes were compared between the two groups.There were 44 patients in Group 1 and 38 patients in Group 2. There were no significant differences in demographics. Stone clearance was nearly complete in both groups. There was no significant difference between the two groups for operative time, hospital days, open conversion rate, recurrence rate, or complications.LCBDE is an acceptable alternative treatment when endoscopic CBD stone removal is impossible or incomplete.

Serum bone morphogenic protein- (BMP-) 4 levels are associated with human adiposity. The aim of this study was to investigate changes in serum levels of BMP-4 and inflammatory cytokines after Roux-en-Y gastric bypass (RYGB). Fifty-seven patients with type 2 diabetes underwent RYGB. Serum levels of BMP-4 and various inflammatory markers, including high-sensitivity C-reactive protein (hsCRP), free fatty acids (FFAs), and plasminogen activator inhibitor- (PAI-) 1, were measured before and 12 months after RYGB. Remission was defined as glycated hemoglobin P=0.024). Of the 57 patients, 40 (70%) had diabetes remission at 1 year after surgery (remission group). Compared with patients in the nonremission group, patients in the remission group had lower PAI-1 levels and smaller visceral fat areas at baseline. There was a difference in the change in the BMP-4 level according to remission status. Our data demonstrate a significant beneficial effect of bariatric surgery on established cardiovascular risk factors and a reduction in chronic nonspecific inflammation after surgery.

Gut hormones play a role in diabetes remission after a Roux-en-Y gastric bypass (RYGB). Our aim was to investigate differences in gut hormone secretion according to diabetes remission after surgery. Second, we aimed to identify differences in insulin secretion and sensitivity according to diabetes remission after RYGB.Twenty-two severely obese patients with type 2 diabetes underwent RYGB. A meal tolerance test (MTT) was performed 12 months after RYGB. The secretions of active glucagon-like peptide-1 (active GLP-1), glucose-dependent insulinotropic peptide (GIP), peptide YY, C-peptide and insulin during the MTT test were calculated using total area under the curve values (AUC). Remission was defined as glycated haemoglobin (A(1C)) of6.5% and a fasting glucose concentration of126 mg/dL for 1 year or more without active pharmacological therapy.Of the 22 patients, 16 (73%) had diabetes remission (remission group). The secretion CURVES of active GLP-1, GIP and peptide YY were not different between the groups. AUC of insulin and C-peptide were also not different. Homeostasis model assessment estimate of insulin resistance was significantly lower (1.26 ± 1.05 versus 2.37 ± 1.08, p = 0.006), and Matsuda index of insulin sensitivity was significantly higher in the remission group (10.5 ± 6.2 versus 5.8 ± 2.1, p = 0.039). The disposition index (functional reserve of beta cells) was significantly higher in the remission group compared with that in the non-remission group (5.34 ± 2.74 versus 1.83 ± 0.70, p0.001).Remission of diabetes after RYGB is not associated with a difference in gut hormone secretion. Patients remaining diabetic had higher insulin resistance and decreased β cell functional reserve.

Summary Objective The objectives were to investigate the in vivo effects of treatment with rebamipide on pain severity and cartilage degeneration in an experimental model of rat osteoarthritis (OA) and to explore its mode of action. Materials and methods OA was induced in rats by intra-articular injection of monosodium iodoacetate (MIA). Oral administration of rebamipide was initiated on the day of MIA injection, 3 or 7 days after. Limb nociception was assessed by measuring the paw withdrawal latency and threshold. We analyzed the samples macroscopically and histomorphologically, and used immunohistochemistry to investigate the expression of matrix metalloproteinase-13 (MMP-13), interleukin-1β (IL-1β), hypoxia-inducible factor-2α (HIF-2α), inducible nitric oxide synthase (iNOS), and nitrotyrosine in knee joints. Real-time quantitative reverse transcription–polymerase chain reaction was used to quantify the mRNA for catabolic and anticatabolic factors in human OA chondrocytes. Results Rebamipide showed an antinociceptive property and attenuated cartilage degeneration. Rebamipide reduced the expression of MMP-13, IL-1β, HIF-2α, iNOS, and nitrotyrosine in OA cartilage in a dose-dependent manner. Nitrotyrosine expression in the subchondral bone region was decreased in the rebamipide-treated joints. mRNA expression of MMP-1, -3, and -13, and ADAMTS5 was attenuated in IL-1β-stimulated human OA chondrocytes. By contrast, rebamipide induced the mRNA expression of tissue inhibitor of metalloproteinase-1 and -3. Conclusion The results show the inhibitory effects of rebamipide on pain production and cartilage degeneration in experimentally induced OA. The suppression of oxidative damage and the restoration of extracellular matrix homeostasis of articular chondrocyte suggest that rebamipide is a potential therapeutic strategy for OA.

Our aim was to identify preoperative anthropometric and clinical parameters that predict the remission of diabetes after Roux-en-Y gastric bypass (RYGB). Fifty severely obese Korean patients with type 2 diabetes underwent RYGB. Visceral and abdominal subcutaneous fat area (SFA) was assessed using computed tomography before and 6 and 12 months after RYGB. Remission was defined as a glycated hemoglobin (A(1C)) level

Small bowel obstruction after intra-abdominal surgery is a common cause of morbidity necessitating reoperation. The aim of this study was to determine the feasibility of and indications for laparoscopic surgery for acute adhesive small bowel obstruction (AASBO). We conducted a retrospective review of all patients with AASBO who underwent laparoscopic adhesiolysis at a major university medical center. Laparoscopic treatment was performed successfully in 16 patients, and conventional treatment was performed in 13 patients. The rate of conversion from laparoscopic to open was 16.7 per cent. In 15 of 16 total patients who underwent laparoscopic surgery, laparoscopic bandlysis was performed and one patient underwent laparoscopic adhesiolysis. Laparoscopic surgery was performed successfully in nine who had a single adhesive band demonstrated on an abdominal CT, and conventional surgery was performed in all 10 patients without a single adhesive band identified radiographically. Abdominal CT scans facilitate the selection of operative approach for AASBO based on preoperative identification of the obstruction site. Laparoscopic adhesiolysis is a safe and effective treatment modality for patients with AASBO with a single band or single transition zone identified by preoperative imaging.

Cervical lymph node metastases are quite common in papillary thyroid cancer (PTC) and they usually spread in a contiguous fashion. However, "skip metastasis," defined as lateral lymph node metastasis without central lymph node metastasis, also occurs in patients with PTC. There is little information regarding skip metastasis in papillary thyroid microcarcinoma (PTMC). The goal of this study was to determine the prevalence and associated clinical and imaging features of skip metastasis in PTMC.We performed a retrospective study of 245 patients with PTMC who underwent either thyroidectomy and central lymph node dissection or thyroidectomy, central lymph node dissection, and lateral lymph node dissection if preoperative ultrasonography or computed tomography suggested lateral node metastasis. Clinicopathologic results were reviewed, and the patterns of cervical lymph node metastasis were analyzed.Cervical lymph node metastases were present in 26.5% of cases. The frequency of lymph node metastases was 21.8% in the group that only had thyroidectomy and central lymph node dissection and 51.3% in the group that had thyroidectomy, central lymph node dissection, and lateral lymph node dissection. Younger age, larger tumor size, multiplicity, bilaterality, encapsulation, extrathyroid extension, and lymphatic invasion were associated with metastasis to nodes in the central or lateral compartment. Lateral lymph node dissection was performed in 15.9% of patients. Skip metastasis was observed in 7.7% of the cases in which combined central and lateral node dissection was performed. No features of the primary thyroid tumor could be associated with the development of skip metastasis.Skip metastases occur in a minority of patients with PTMC. We recommend, therefore, that preoperative studies in patients suspected of having PTMC focus not only on nodes in the central compartment but also lateral cervical nodes since the information obtained would guide the extent of surgery.

Gastroesophageal reflux disease (GERD) is a chronic disease deteriorating patient's quality of life. With the advent of proton pump inhibitors, treatment failures have decreased considerably. However, surgical therapy offers the potential for cure in more than 90% of patients with GERD. Specific indications for antireflux surgery are: incomplete response to medical therapy, frequent recurrences despite the medical treatment, laryngopharyngeal, and/or respiratory symptoms, and complications of GERD, such as esophageal stricture, erosive esophagitis, esophageal ulcer, and/or Barrett's esophagus. The introduction of laparoscopic surgery in early ninties had a profound impact on many surgical fields, including the treatment of GERD. In this review, laparoscopic Nissen fundoplication is described and controversial topics, such as total vs. partial fundoplication, and the natural history of Barrett's esophagus after antireflux surgery are addressed.

Hepatoid carcinoma is a primary extrahepatic neoplasm exhibiting features of hepatocellular carcinoma (HCC) in terms of morphology, immunohistochemistry, and behavior. In many cases, tumor cytoplasm is positive for alpha- fetoprotein (alpha-FP) with elevated serum alpha-FP level. Because not all hepatoid carcinomas are associated with alpha- FP overproduction, diagnosis should be made essentially by histological features of the tumor. We present a case of hepatoid carcinoma of the pancreas in a 21-year-old male patient. Abdominal computed tomography and magnetic resonance imaging revealed an inhomogeneously enhanced pancreatic head mass. Serum alpha-FP level was markedly elevated. He underwent pylorus-preserving Whipple's operation. The tumor showed hepatoid and neuroendocrine components simultaneously. The histopathological diagnosis was hepatoid carcinoma associated with neuroendocrine tumor of the pancreas. Seven months after the surgery, the patient is healthy without evidence of recurrence. To date, only 7 cases of hepatoid carcinoma of the pancreas have been reported in the literature, and this is the first case report in Korea.

Background/Purpose: This study was conducted to evaluate the role of laparoscopic surgery in the treatment of gallbladder cancer. Methods: A retrospective study was performed on 31 patients with a postoperative diagnosis of gallbladder cancer. The laparoscopic approach was initially applied to all of them. Results: Ten patients had a pT1a cancer, and all underwent laparoscopic cholecystectomy without recurrence. Nine patients had pT1b lesions, and three had to be converted to an open operation. There were two recurrences. In one of the converted patients the cystic node was invaded. Seven patients had a pT2 lesion, and in four of them the operation was converted to an open procedure. Recurrences were noted in three patients. In two patients with pT3 cancer, the opera-tions were converted; both cancers recurred. Only diagnostic laparoscopy or a palliative laparoscopic procedure was performed for pT4 cancers. The median follow-up time was 17.0 months. The 5-years survival rate was 100% for patients with stage pT1a, 100% for pT1b, and 68% for pT2 lesions. Conclusions: We suggest that when a polypoid lesion of the gallbladder is found on preoperative evaluation, laparoscopic surgery may be attempted initially. During the procedure it is important to open all specimens when a polypoid lesion is present and perform a frozen section biopsy. When a pT1a lesion is found, laparoscopic cholecystectomy is sufficient; however, when a pT1b or more advanced lesion is found, the operation might be converted to a radical cholecystectomy.

= Abstract = Background : T he wall lift method (W which was introduced to reduce the adverse effects of CO2 pneumoperitoneum (P induces an excessive stress response and may be imposed for significant adverse reactions. This study was undertaken to compare the physiologic response of the CO2 pneumoperitoneum and wall lift methods. Methods: Thirty-two patients were randomly divided into two groups (the P and W. Gastric intramucosal PrCO2 CO2 gap intramucosal pH (pHi and plasma concentration of epinephrine and norepinephrine were measured: after the induction of anesthesia during operation at the end of the operation and after operation. Serum concentrations of TNF-α and IL-6 were measured at 24 hours before operation and 24 hours and 72 hours after operation. The TNF-α and IL-6 levels of peritoneal macrophages were also measured. Urine output was measured during operation. Results: PrCO2 a nd CO2 gap increased during and after the operation in P and after the operation in W and pHi decreased during and after operation in P and after operation in W. Urine output was higher in W. Epinephrine and norepinephrine increased in both groups but epinephrine was higher in W at the end of the operation. TNF-α and IL-6 increased postoperatively and the magnitude of these increases were similar in both groups. The level of TNF-α and of IL-6 in peritoneal macrophage were similar in both groups. Conclusions: We conclude that; CO2 pneumoperitoneum induces intestinal mucosal acidosis the wall lift method induces more significant stress response and the magnitude of immune response is similar for both methods. (Korean J Anesthesiol 2003; 44: S 1～S 8

Purpose: Obesity is considered an epidemic worldwide. Nonsurgical treatment such as dietary, physical and pharmacological therapies have limited success and thus, bariatric surgery is the ultimate option. Roux-en-Y gastric bypass (RYGB) is a bariatric procedure, which is a restrictive and malabsorptive procedure simultaneously. The purpose of this study was to develop surgical rat models of bariatric surgery and analyze the effect of gastric bypass on body weight, ghrelin and polypeptide YY3-36 (PYY3-36) changes in rats. Methods: RYGB, sleeve gastrectomy (SG) and sham operation were performed in diet-induced obese rats and compared to obese control and normal control rats. Results: In RYGB group, 20.7±8.56% of weight loss was achieved on postoperative day 18 and maintained thereafter. This outcome was significant compared to SG (8.8±1.82%) and sham operated (6.2±2.45%) groups. When pre- and postoperative ghrelin levels were compared, there was a significant decrease in RYGB group (P＜ 0.028); nonetheless, there was no difference in SG and sham operated groups. When pre- and postoperative PYY3-36 levels were compared, there was a significant increase in RYGB (P＜0.028), SG (P＜0.031) and sham operated (P＜0.031) groups. Conclusion: We developed surgical rat models of RYGB and SG. Those rats that underwent RYGB lost significant body weight and maintained the weight thereafter. The decrease in ghrelin and increase in PYY3-36 may be associated with loss of appetite and delay in intestinal transit time with subsequent weight loss maintenance. In the future, this rat model would serve as a tool for further study on endocrine regulation of obesity. (J Korean Surg Soc 2010;79:155-162)

Purpose Although the prevalence of gastroesophageal reflux disease (GERD) is relatively low in Korean population, the number is increasing. The aim of this study is to analyze our experience with laparoscopic Nissen fundoplication. Patients and Methods From Sep. 2003 to Mar. 2008, 31 adult Korean patients diagnosed with GERD underwent laparoscopic Nissen fundoplication. A 360° fundoplication was carried out in all patients. Results There were 19 males and 12 females with an average age of 46.8 ± 17.0 years. Typical symptoms were present in 15 (48%) of patients, and atypical symptoms in 16 (51.6%). Both typical and atypical symptoms were present in 4 of patients (12.9%). Preoperative studies showed hiatal hernias in 13 patients (41.9%), Barrett's esophagus in 10 (32.3%), and reflux esophagitis in 18 (58.1%). Mean DeMeester score was 17.4 ± 16.7, mean operative time 206.1 ± 47.8 min and mean hospital stay 5.2 ± 2.1 days. Perioperative complications occurred in 5 patients (16.1%), including gastric perforation, subcutaneous emphysema, atelectasis, and prolonged ileus. Gastroesophageal junction stenoses with subsequent endoscopic balloon dilations were required in 5 patients (16.1%). After surgery, symptoms were completely controlled in 17 patients (54.8%), partially improved in 12 patients (38.7%) and not controlled in 2 patients (6.5%). Conclusion In our series, 93.5% of patients had either complete or partial remission of symptom after laparoscopic Nissen fundoplication. Atypical symptoms were more predominant in our Korean patients. Laparoscopic Nissen fundoplication is an efficacious method of controlling symptoms of GERD, even for those who have atypical symptoms.

Purpose: The purpose of this study was to evaluate the clinical course and pregnancy outcome according to operative management of appendictis in the Department of Surgery. Methods: We reviewed the charts of pregnant patients who went through a convential appendectomy and a laparoscopic appendectomy at the Department of Surgery, Catholic University of Korea St. Mary’s Hospital, from May 1995 to June 2006. Results: The incidence of acute appendicitis during pregnancy was the highest at the 2nd trimester and at ages from 25 to 30 years. The laparoscopic appendectomy was shorter than the open appendectomy in hospital stay and decreased leukocytosis faster in the first postoperative day, except in cases of perforated appendicitis, but the operation times were similar. There was a significant difference in gestational age at delivery between perforated appendicitis and suppurative. We found one fetal anomaly, but it was not related to either the appendicitis or the operation method. Conclusions: In this study, we found that a laparoscopic appendectomy was better than an open appendectomy for recovery and was safe in pregnant appendicitis patients at any gestational age. However, follow up and investigation in a larger population is needed to get more accurate results.

Received May 25, 2007, Accepted June 11, 2007 Correspondence to: Suk Kyun Chang, Department of Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #62, Youido-dong, Yeongdeungpo-gu, Seoul 150-713, Korea. Tel: +82-2-3779-1175, Fax: +82-2-786-0802 E-mail: cmcgslee@catholic.ac.kr Purpo se: The planned therapy of right colonic diverticulitis is very difficult because preoperative diagnosis is uncommon and the method of treatment is usually decided at the time of laparotom y. W e retrospectively analyzed the clinical characteristics of right colonic diverticulitis, the clinical distinctions between preoperatively and postoperatively diagnosed patients, the recurrence rate, and the hospital stay by treatm ent m odality. M etho ds: Among 104 patients w ho w ere treated for right colonic diverticulitis from January 1997 to M ay 2005, w e enrolled 90 patients who had been diagnosed by the operation or a barium enem a study (BE), and who had not been lost to follow -up. Patients were divided into three groups based on treatment modality: Group 1 (n= 28), conservative m anagement w ith intravenous antibiotics; Group 2 (n= 46), aggressive resection; Group 3 (n= 16), appendectomy w ith intravenous antibiotics. Results: U ltrasound and computed tomography (CT) detected 12 (22.6% ) and 21 (87.5% ) cases of right colonic diverticulitis, respectively. BE was applied to 45 patients, 28 (62.2% ) of them with multiple diverticula. Right colonic diverticulitis was the preoperative diagnosis in 39 patients (43.3% ). The length of hospital stay was significantly different between the groups (P

Purpose: The prognosis of gastric cancer depends on the depth of invasion, lymph-node metastasis, invasion to adjacent tissues, and distant metastasis. Recently, it is known that tumor-associated proteases and adhesion molecules have been shown to play a relevant role in the process of progression and metastasis. The purpose of our study was to demonstrate the value of MMP-2 (matrix metalloproteinase), cathepsin D and E-cadherin as prognostic factors. Materials and Methods: In this study, formalin-fixed, paraffin-embedded tissue blocks from 69 patients with gastric cancer were immunohistochemically studied using antibodies to MMP-2, cathepsin D, and E-cadherin, and their expressions were analyzed according to the pathologic stage, lymph-node metastasis, histological differentiation, and patient survival. The medical records of these patients were retrospectively reviewed. Results: Increased expression of MMP-2 significantly correlated with advanced pathologic stage (P=0.026). Patients with lymph-node metastasis also had increased expression of MMP-2. Those patients with increased expression of MMP-2 showed a poorer survival; nevertheless, it was not statistically significant. Increased expression of cathepsin D significantly correlated with advanced pathologic stage (p=0.029). However, no correlation was observed between advanced pathologic stage and either lymph-node status or histological differentiation. Patients with increased expression of cathepsin D had a poorer survival, but that result was not statistically significant. No association was found between reduced expression of E-cadherin and pathologic stage, lymph-node status, or histological differentiation. Also, no correlation was found between the expression of E-cadherin and survival. In addition, when a combination of MMP-2 and cathepsin D expressions was analyzed, if both were negative, the survival seems to be longer, but it was not statistically significant. Conclusions: In patients with gastric cancer, expressions of MMP-2 and cathepsin D correlated with tumor stage; therefore, they may be considered as prognostic factors.

Purpose : The purpose of this study was to prospectively compare the clinical applicabillity of magnetic resonance cholangiography(MRC) with that of endoscopic retrograde cholangiography(ERC) in the evaluation of combined choledocholithiasis in patients with gall stones who were candidates for laparoscopic cholecystectomy. Materials and Methods : Twenty-seven patients with gall stones underwent fast spin-echo MR cholangiography using the half-Fourier acquisition single-shot turbo spin echo(HASTE) method, and half-Fourier rapid acquisition using the relaxation enhancement(RARE) method. Within five hours the same patients underwent ERC. The results of MRC was reviewed by two radiologists blinded to the results of ERC. The number and size of CBD stones and gall stones, and the degree of CBD dilatation, as seen on HASTE and RARE images, were compared with the results of ERC. Results : MRC depicted common bile duct stones in 10 of 11 patients shown by ERC to have stones, while in the 16 patients in whom ERC did not reveal stones, MRC demonstrated the same finding. The number of CBD stones was exactly demonstrated by HASTE imaging in eight of eleven patients(73 %) and by RARE imaging in ten of eleven patients(91%) in whom ERC revealed choledocholithiasis. The size of common bile duct stones visualized by ERC correlated in nine of eleven patients(82 %) on HASTE images and in seven of eleven(64 % ) on RARE images. MRC showed CBD dilatation in all patients in whom dilatation was demonstrated by ERC. Conclusion : For the evaluation of choledocholithiasis before laparoscopic cholecystectomy in patients with gall stones, MRC and ERC are equally accurate. A comparison of HASTE imaging with RARE imaging, as used in the diagnosis of choledocholithiasis, revealed no significant differences.

【Pediatric laparoscopic splenectomy has been gradually accepted as the surgical management of a various splenic disorders, particularly in hematologic diseases. We report our experience with 16 patients who underwent this procedure because of hematologic disorders during the past 3 and a half years at the Department of Surgery, St. Mary's Hospital, the Catholic University Medical College. The mean age was 10 years(range 6-16 years) and the mean spleen weight was 210 gm(range 85-500 g). The indication for splenectomy were hereditary spherocytosis(6 cases), idiopathic thrombocytopenic purpura(8 cases), autoimmune hemolytic anemia(1 case), and idiopathic splenomegaly(1 case). All splenectomies were performed safely with mean estimated blood loss of 233 ml. Mean operative time and mean postoperative hospital stay were 157 min and 4.5 days, respectively. Postoperative pain, medication was needed in 3 cases, just one injection in immediate postoperative period. Diet was started on the second or third postoperative day. In conclusion, laparoscopic splenectomy in pediatric patients is a safe procedure, offering a small of abdominal scar, much less pain, a shorter hospital stay and car the lower postoperative morbidity.】

A survey to evaluate the current status of bariatric and metabolic operations in Korea was conducted. Data from 5467 cases (32 hospitals) were collected. The annual numbers of bariatric and metabolic operations increased each year, from 139 in 2003 to 1686 in 2013. Adjustable gastric band (AGB, 67.2 %) was the most common operation, followed by sleeve gastrectomy (SG, 14.2 %), and Roux-en-Y gastric bypass (RYGB, 12.7 %). Mean patient age and body mass index (BMI) were 35.4 years and 35.9 kg/m2, respectively. In-hospital morbidity and mortality rates were 6 % (114/2305) and 0.25 % (5/2176), respectively. In Korea, AGB was the most common operation because of the availability and activity of specialized bariatric clinics. These national survey results established a baseline for future data collection.