Dwh Lee

Minimal invasive approach of gastric and esophageal mobilization in total pharyngolaryngoesophagectomy: Total laparoscopic and hand-assisted laparoscopic technique

Background: To evaluate early results in total pharyngolaryngoesophagectomy (PLE) by minimally invasive approaches for patients suffered from pharyngoesophageal tumor. Methods: Between April 1998 and September 2001, 12 consecutive patients underwent either total laparoscopic (n = 9) or hand-assisted laparoscopic (n = 3) gastric mobilization plus transhiatal esophageal resection in total PLE. The operative data and postoperative outcomes were evaluated. Results: Total PLE by minimally invasive approach was successfully performed in 11 patients, and 1 patient required conversion due to uncontrolled bleeding. The median total operative time was 8.5 h (range, 5–11 h) and the abdominal laparoscopic stage usually took less than 4 h. The median time for extubation was 2 days (range, 1–4 days) and the median ICU stay was 2 days (range, 1–20 days). There was no 30-day mortality, and major complications occurred in 5 patients (42%). Conclusion: Minimally invasive PLE is a feasible and safe alternative to conventional open surgery for patients with pharyngoesophageal carcinoma.

Early clinical outcomes after subfascial endoscopic perforator surgery (SEPS) and saphenous vein surgery in chronic venous insufficiency

Background: Subfascial endoscopic perforator surgery (SEPS) has recently become popular as a minimally invasive way to treat chronic venous insufficiency (CVI) of the lower extremities. We report the early clinical outcomes of SEPS and saphenous vein surgery in a prospective series of Chinese patients who presented with severe CVI. Methods: All patients referred to our hospital for the management of severe CVI (class IV disease or above) after January 1998 underwent SEPS using an ultrasonic scalpel in conjuction with saphenous vein surgery. All patients were followed up prospectively to assess ulcer healing, ulcer recurrence, and symptoms after SEPS. Clinical outcome was evaluated by the scoring system suggested by the Consensus Committee of the American Venous Forum on Chronic Venous Disease. Results: Over a 24-month period, we performed 36 SEPS on 31 patients. Nineteen lower extremities (53%) had active or healing ulcers. Sapheno-femoral ligation was also performed in 33 limbs (92%). Four limbs (11%) developed superficial wound infection, and two (6%) had saphenous nerve dysesthesia. The mean clinical score and disability score decreased from 8.42 to 3.42 and 1.45 to 0.31 respectively, after a median follow-up of 14 months (range, 6-22) (p < 0.005). Eleven ulcers (58%) healed within 6 weeks after surgery. At 1-year follow-up, ulcer recurrence was found in two legs (11%). Conclusion: SEPS is safe and feasible. Early clinical results have shown a promising outcome in patients with severe chronic venous insufficiency.

Subfascial endoscopic perforator vein surgery (SEPS) using the ultrasonic scalpel

Subfascial endoscopic perforator vein surgery (SEPS) was recently introduced as a minimally invasive method to ligate incompetent perforating veins in patients with severe chronic venous insufficiency of the lower extremities. Herein we describe a technique in which we used a 5-mm ultrasonic scalpel for the transection of perforating veins in 16 SEPS performed in 14 patients. The use of the ultrasonic scalpel allowed for the precise coagulation and transection of the perforator vein with hemostasis, while avoiding the use of metal clips. Our initial results showed that the technique was feasible with minimal morbidity. We recommend the use of the ultrasonic scalpel as an alternative tool to transect perforating veins in SEPS.

The role of Helicobacter pylori in perforated duodenal ulcer: A prospective randomized treatment traal

BACKGROUND: Immediate definitive acid-reduction surgery has been advocated for patients with duodenal ulcer perforation because of the high incidence of ulcer recurrence. Whether H. pylori plays any role in the strong ulcer diathesis of these patients remains unclear. The aim of this study was to determine if H. pylori eradication prevented ulcer relapse in patients with ulcer perforation. METHOD: One hundred thirty patients with perforated duodenal ulcer had H. pylori status determined by rapid urease test, culture, and histology on antral biopsies obtained via intra-operative gastroscopy. With informed consent, ninety-one H. pylori-infected patients undergoing omental patch repair were randomized to receive either a 4-week course of Omeprazole (20mg per day) plus triple therapy (Bismuth 120mg, tetracycline 500mg, and metronidazole q.i.d, for 1 week) or Omeprazole alone. H. pylori eradication and ulcer healing were determined by follow-up endoscopy at 8-week, 16week (if unhealed on 8th week), and 1-year after the operation. Outcomes of patients were compared by intention to treat analysis using Chi square or Fisher Exact test when appropriate.