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Purpose: The feasibility of laparoscopic left hemihepatectomy for the management of intrahepatic duct (IHD) stones was evaluated. Methods: The clinical data of 26 consecutive patients who underwent total laparoscopic left hemihepatectomy for IHD stones at Gyeongsang National University Hospital between January 2009 and June 2011 were reviewed retrospectively. Results: The mean operation time was 312.1 ± 63.4 minutes and the mean postoperative hospital stay was 11.8 ± 5.0 days. There were 2 cases of postoperative bile leakage and 3 cases of intra-abdominal fluid collection, which were successfully managed conservatively. Remnant stones were detected in 2 patients. The initial success rate of stone clearance was 92.3% (24 of 26). The remnant stones were located in the common bile duct in both cases and were removed by endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy. Therefore, the final success rate of stone clearance was 100% (26 of 26). During a mean follow-up of 22 months (range, 7 to 36 months), there was no patient with recurrent stone. Conclusion : Laparoscopic surgery could be an effective treatment modality for the management of IHD stones in select patients.

PURPOSE: Pancreatectomy can impair production of endocrine and exocrine hormones. In this study, we evaluated: 1) the incidence rate of diabetes in patients undergoing distal pancreatectomy; 2) the correlation between the occurrence of pancreatic diabetes and the extent of the resected pancreas; and 3) factors associated with the development of pancreatic diabetes. METHODS: We retrospectively reviewed the cases of 26 patients who could be compared in abdominal computed tomography before and after distal pancreatectomy for benign or malignant lesions between January, 1999 to June, 2010. RESULTS: The incidence of pancreatic diabetes was 19.2%. Obese patients (BMI>25.0 kg/m(2)) had a higher incidence (p=0.029) of pancreatic diabetes after distal pancreatectomy than non-obese patients. The diabetes group had larger volumes of resected pancreas, but the difference was not statistically significant (p=0.105). CONCLUSION: Several factors may be associated with the development of pancreatic diabetes after distal pancreatectomy. It is necessary to closely follow-up development of pancreatic diabetes regardless of the extent of resection.

Purpose: With the advancement of laparoscopic instruments and accumulation of surgical technique, laparoscopic liver resection is currently performed for various benign and malignant liver diseases. However, controversies still remain over laparoscopic liver resection for malignant liver diseases including HCC and its oncologic safety is yet to be established. This study aims at determining the safety, feasibility and short-term oncologic outcomes of laparoscopic liver resection performed for HCC. Methods: From July 2008 to March 2010, laparoscopic liver resection was performed at our hospital on a total of 45 patients with various benign and malignant liver diseases. Among these 45 patients, 16 patients diagnosed with HCC were reviewed retrospectively. Results: The mean age of the patients was 59.25, comprising 11 male patients (68.8%) and 5 female patients (31.2%). The location of tumor was left lateral in 7 cases, 4 cases in segment 6, 2 cases in segment 7, 2 cases in segment 5, 1 case in segment 4 and 1 case in caudate lobe. Wedge resection was performed in 11 cases, left hemi hepatectomy in 2 cases, left lateral sectionectomy in 2 cases, caudate lobectomy in 1 case. The mean operative time was 248.75 minutes. The mean hospital stay was 13.8 days, and there were no post-operative recurrences during the post-operative follow-up period. Conclusion: When performed by expert surgeons in selected patients, laparoscopic liver resection for HCC is a feasible and safe procedure.

Purpose: Recently, there have been several studies on the early results of hepatectomy for various intrahepatic lesions. We report the early experience of our hospital after total laparoscopic left hepatectomy in patients with intrahepatic stones in the left hemi-liver. Methods: We retrospectively analyzed the medical records of patients who were diagnosed with left intrahepatic stones and underwent hepatectomy between January 2007 and June 2009. The patients were grouped according to operative procedure into open hepatectomy, laparoscopy-assisted hepatectomy, and total laparoscopic hepatectomy. Results: There were 31 patients who underwent Lt hemihepatectomy and Lt lateral sectionectomy during this period. Hepatectomy with open method, laparoscopy-assisted method, and total laparoscopy method were performed in 10, 14, and 7 cases. There were no significant differences between the three methods for operating time and postoperative complications. But the number of fasting times and hospital days was shorter with total laparoscopic hepatectomy than with others. Conclusion: Total laparoscopic liver resection is a safe and useful method for treating patients with intrahepatic stones and offers the advantage of quick patient recovery. Careful selection of appropriate patients and further development in the laparoscopic surgical technique resulting from accumulated experiences will help enable the laparoscopic hepatectomy to be performed more easily and safely in patients with intrahepatic stones.

Purpose: Laparoscopic cholecystectomy (LC) has become the gold standard of management of gallstone disease. LC is associated with a two-to-four times higher incidence of bile duct injury, which is a rare but more serious complication than open cholecystectomy. We reviewed our experiences with the management of bile duct injury during laparoscopic cholecystectomy. Methods: From January 1999 to April 2009, 13 patients with bile duct injuries following LC were managed in our hospital. Patients’ charts were retrospectively reviewed to analyze perioperative management. Results: Among the 13 patients, 7 patients sustained their bile duct injuries at our hospital. Six patients were referred to our hospital to manage their bile duct injuries. Five patients’ injuries were identified during LC. According to the Strasberg classification, there are 5 cases of type A, 2 cases of type C, 1 case of type D and 5 cases of type E injuries. Four type A bile duct injuries were treated by direct ductal ligation during LC and 1 type A bile duct injury and 1 type C bile duct injury were managed by non-surgical treatment. Type D and type E injuries were managed by Roux-en-Y hepaticojejunostomy. Conclusion: Bile duct injuries are a rare but serious complications that occur during laparoscopic cholecystectomy. Most minor bile duct injuries are well treatable with non-surgical management, whereas major bile duct injuries require surgical management. The combination of non-surgical management and surgical treatment results in successful outcomes in bile duct injuries.

Solitary fibrous tumor of the liver is a rare neoplasm. Thirty-nine cases have been described in the English literature. Its immunohistochemical positivity for CD34 and vimentin is believed to be unique. It is known to be usually benign and only one case of metastasis is reported. We report an additional case. A 71-year-old woman presented with fatigue and weight loss. CT scan showed a solid mass occupying the left lobe of the liver. Left lobectomy was performed. Pathological examination showed spindle cell and fibroblast-like cells within the collagenous stroma. On immunohistochemical staining, these spindle tumor cells showed diffuse CD34 and vimentin positive reactivity. The post-operative course was uneventful. Solitary fibrous tumors of the liver, although rare, need to be considered in the differential diagnosis of mesenchymal lesions of the liver.