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ABSTRACT: To evaluate the factors associated with liver function alterations after laparoscopy-assisted gastrectomy (LAG) for gastric cancer.
We collected the data of gastrectomy patients with gastric cancer and divided them into 2 groups: open gastrectomy (OG) and LAG. We also collected the data of patients with colon cancer to evaluate the effect of liver manipulations during surgery on liver function alterations. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and alkaline phosphatase were measured on the preoperative day and postoperative day 1 (POD1), POD3, POD5, and POD7.
No changes in liver function were observed after the operation in patients with colon cancer (n = 121). However, in gastric cancer patients (n = 215), AST and ALT levels increased until POD5 compared to those in colon cancer patients and these findings were observed both in the LAG and OG without a significant difference except at POD1. The mean hepatic enzyme levels at POD1 in the LAG group were significantly higher than those in the OG group (P = 0.047 for AST and P = 0.039 for ALT). The factors associated with elevated ALT on POD1 in patients with gastric cancer were body mass index (P < 0.001), operation time (P < 0.001), intraoperative hepatic injury (P = 0.048), and ligation of an aberrant left hepatic artery (P = 0.052) but not type of operation (OG vs LAG, P = 0.094).
We conclude that the liver function alteration after LAG may have been caused by direct liver manipulation or aberrant hepatic artery ligation rather than the CO₂ pneumoperitoneum.
World Journal of Gastroenterology 01/2011; 17(3):372-8. · 2.47 Impact Factor
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ABSTRACT: Since Kalloo and colleagues first reported the feasibility and safety of a peroral transgastric approach in the porcine model in 2004, various groups have reported more complex natural orifice transluminal endoscopic surgery (NOTES) procedures, such as the cholecystectomy, splenectomy and liver biopsy, in the porcine model. Natural orifice access to the abdominal cavity, such as transgastric, transvesical, transcolonic, and transvaginal, has been described. Although a novel, minimally invasive approach to the abdominal cavity is a peroral endoscopic transgastric approach, there are still some challenging issues, such as the risk of infection and leakage, and the method of gastric closure. Hybrid-NOTES is an ideal first step in humans. Human hybrid transvaginal access has been used for years by many surgeons for diagnostic and therapeutic purposes. Here, we report a transvaginal flexible endoscopic appendectomy, with a 5-mm umbilical port using ultrasonic scissors in a 74-year-old woman with acute appendicitis.
Journal of the Korean Society of Coloproctology 12/2010; 26(6):429-32.
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ABSTRACT: Laparoscopy-assisted distal gastrectomy (LADG) has been applied to the treatment of gastric cancer, and there are now several publications regarding its safety and feasibility. In contrast, there have been few reports on laparoscopy-assisted total gastrectomy (LATG), because this procedure is performed less frequently and is technically more difficult to perform than LADG. The purpose of the present study was to evaluate short-term outcomes in a multicenter study of LATG, as well as its safety and feasibility.
A retrospective multicenter study was carried out in Korea involving 1,485 patients who underwent laparoscopy-assisted gastrectomy for gastric cancer at 10 institutions between April 1998 and December 2005. Of these patients, 131 underwent LATG. We evaluated and analyzed the short-term outcomes and the clinicopathologic characteristics of the 131 patients.
The mean (+/- SD) operation time was 270 +/- 79 min; 1 patient required conversion to an open procedure. The mean number of retrieved lymph nodes was 34.7. The mean duration of hospital stay was 11.3 days, and first intake of soft diet was at 5.8 days. The rate of postoperative morbidity was 19% (25/131 patients); there was no mortality. The most common postoperative morbidity was wound complications at the mini-laparotomy site, and there were 3 cases of anastomotic leakage. Six patients (5%) had recurrence of cancer, and 9 patients (7%) died during the follow-up period.
Our results suggest that LATG is a safe and feasible procedure for gastric cancer patients. A prospective, multicenter, randomized trial of LATG is needed to confirm the efficacy of this procedure.
Surgery 10/2009; 146(3):469-74. · 3.10 Impact Factor
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ABSTRACT: Paraduodenal hernia is a congenital internal hernia caused by abnormal retroperitoneal fixation of the intestinal mesentery. The management of paraduodenal hernia consists of reduction of the herniated intestine and repair of the defect. Recently, laparoscopic surgery has been increasingly performed in abdominal procedures. To evaluate the feasibility and efficacy of laparoscopic repair of paraduodenal hernia, we present our experience in 2 cases of laparoscopic repair, compared with 3 other cases treated with conventional open repair; all 5 cases were successfully treated. All patients had symptoms of intestinal obstruction and were diagnosed by preoperative abdominal computed tomography. Two cases were right-sided hernias, and 3 cases were left sided. Among them, 2 patients with left-sided paraduodenal hernia underwent laparoscopic reduction (LR group) of the herniated small bowel, and the other 3 cases underwent open reduction (OR group). In the LR group, the duration of hospital stay, time to first flatus, and time to first intake of a soft diet were shorter than in the OR group. Thus, with an accurate preoperative diagnosis of paraduodenal hernia, laparoscopic surgery may be a feasible and efficient procedure, with good postoperative outcomes.
Surgical laparoscopy, endoscopy & percutaneous techniques 01/2009; 18(6):611-5. · 1.23 Impact Factor
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ABSTRACT: While the pathogenesis of varicose veins is assumed to be multifactorial, including the aging process, the etiology, especially in the very young, is strongly linked to genetics and is believed to be associated with improper development and regulation of venous tissue maturation. The aim of this study was to identify the genes whose expression is different in primary varicose veins compared to normal veins in the legs. To test this hypothesis, the differentially expressed gene technique was performed on a large-scale screen of mRNA from varicose and normal veins. Transcriptional products corresponding to cDNA were compared between the two vein types, and one gene showed the greatest differential expression between the samples in all sets of experiments, confirmed by reverse-transcriptase polymerase chain reaction. Octamer-binding transcription factor-1 gene (Oct-1) was upregulated in primary varicose veins. Therefore, we suggest that Oct-1 may play an important role in the development of primary lower extremity varicose veins.
Annals of Vascular Surgery 02/2008; 22(1):115-20. · 1.03 Impact Factor
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ABSTRACT: Minimally invasive surgery has been applied to nearly all fields of surgery due to its advantages such as reduced morbidity, a better cosmetic outcome, and early recovery. The recent advances in its technique have allowed us to use modified minimally invasive surgery technique in the field of kidney transplantation.
From January 2004 to March 2006, minimally invasive video-assisted kidney transplantation was carried out in 20 patients. Many clinical variables were compared with the conventional method. The operative procedure began with a 7 to 8 cm skin incision. A laparoscopic balloon dissector was used to create the retroperitoneal space for the placement of the grafted kidney. Vascular anastomosis and ureteroneocystostomy were performed under direct vision and with video-assisted TV monitoring.
The average length of the wound was 7.8 cm and it was placed below the belt line. The average operating time was 186 min. Less analgesic was given compared with conventional methods. There was one postoperative complication, a mild lymphocele. All patients showed normalized serum creatinine levels within 4 d. All grafted kidneys showed normal findings on the postoperative ultrasound and renal scans.
Minimally invasive video-assisted kidney transplantation is technically feasible and may offer benefits in terms of better cosmetic outcomes, less pain, and quicker recuperation than conventional kidney transplantation.
Journal of Surgical Research 09/2007; 141(2):204-10. · 2.25 Impact Factor
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ABSTRACT: Ethyl pyruvate (EP), a stable lipophilic pyruvate derivative, has been shown to exert anti-inflammatory activities through inhibiting the expression of various pro-inflammatory mediators as well as circulating levels of high mobility group box protein 1 (HMGB1) in a variety of in vitro and in vivo model systems. Necrotic cell death triggers an inflammatory response through release of HMGB1 in the extracellular space due to the membrane rupture. In an effort to better understand the pharmacological action mechanism that could explain the anti-inflammatory properties of EP, we examined the effects of EP on necrotic cell death in A549 lung adenocarcinoma cells in response to glucose deprivation (GD), a common characteristic of the tumor microenvironment. Here we show that EP prevented GD-induced necrosis and HMGB1 release and switched the cell death mode to apoptosis through inhibiting GD-induced CuZn superoxide dismutase release and ROS production. These results suggest that the necrosis-to-apoptosis switch activity of EP may contribute to its anti-inflammatory action and that EP may suppress tumor development possibly through its activity to induce the cell death mode switch from tumor promoting necrotic cell death to tumor suppressive apoptotic cell death.
International Journal of Molecular Medicine 09/2007; 20(2):187-92. · 1.98 Impact Factor
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ABSTRACT: Surgical resection of liver metastases from colorectal cancer can offer long-term survival and cure in patients with metastatic colorectal cancer isolated to the liver. We present a case of a recurrent liver metastasis from rectal cancer, managed with ante-situm liver resection under total vascular exclusion and venovenous bypass with hypothermic perfusion. A 58-year-old man, who was diagnosed with liver metastasis from rectal cancer underwent a left lateral sectionectomy in January 2006. A recurrent lesion developed 1 year after the first hepatectomy. The tumor was 5 cm in size, locating at segments I, IV, and VIII. It was involved in the origin of middle hepatic vein and retro-hepatic vena cava. We performed ante-situm liver resection under total vascular exclusion and venovenous bypass with hypothermic perfusion. The patient remains well without recurrence for 12 months after the last operation. Ante-situm technique made it easy to approach and completely removes the recurrent lesion locating at hardly accessible site and having the incomplete removal risk by conventional liver resection. The authors also reconfirmed that repeat hepatectomy is valuable in recurrent colorectal liver metastases.
Hepato-gastroenterology 56(90):508-11. · 0.66 Impact Factor
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ABSTRACT: Modified right lobe graft with middle hepatic vein reconstruction is commonly carried out in living donor liver transplantation these days. Cadaveric vascular graft has been widely used to maintain good outflow in middle hepatic vein tributaries. However, cadaveric donors are limited in Korea. This problem may be compensated with bovine pericardium. From April 2007, we experienced 4 cases of modified right lobe graft living donor liver transplantation using bovine pericardium. After donor hepatectomy, a 2-cm diameter cylinderic shape was made with the large sized bovine pericardium. V5 and V8 (greater than 5mm in diameter) were anastomosed to the bovine pericardium with end-to-side pattern. After reperfusion, it was anastomosed to the recipient's middle and left hepatic vein trunk. All patients recovered well and are currently remaining good liver function (3 to 11 months). Three cases maintain tolerable middle hepatic venous flow and have no congestion of right anterior sector in enhanced computerized tomography or in Doppler ultrasonography. Bovine pericardium can be one of the alternative materials for middle hepatic vein reconstruction of modified right lobe graft in the area of cadaveric organ shortage.
Hepato-gastroenterology 56(91-92):854-6. · 0.66 Impact Factor
