Jang Jy

Clinical outcomes compared between laparoscopic and open distal pancreatectomy

BackgroundLaparoscopic surgery for pancreatic disease has gained increasing popularity. A laparoscopic distal pancreatectomy is technically simple and has been adopted as the preferred method in many centers. However, there is limited information on the outcomes of the laparoscopic surgery compared with open surgery. Therefore, this study aimed to investigate the clinical outcomes of laparoscopic distal pancreatectomy and to evaluate its efficacy compared with open distal pancreatectomy.MethodsFrom February 1995 to March 2006, 31 patients underwent laparoscopic distal pancreatectomy, and 167 patients underwent open distal pancreatectomy at Seoul National University Hospital and Bundang Seoul National University Hospital. A case–control design was used with 2:1 matching to compare laparoscopic surgery with open surgery. Among 167 patients who underwent open distal pancreatectomy, 62 patients whose age, gender, and pathology were similar to those of patients who underwent laparoscopic surgery were selected for this study. The operation time, intraoperative transfusion requirements, duration of postoperative hospitalization, complications, mortality, recurrence, and hospital charges were analyzed.ResultsThere were no significant differences in operation time, rate of intraoperative transfusions, complications, recurrence, or mortality between the two groups. Laparoscopic distal pancreatectomy was associated with a statistically significant shorter hospital stay (11.5 days vs 13.5 days; p = 0.049), but with more expensive hospital charges than open distal pancreatectomy (p < 0.01).ConclusionLaparoscopic distal pancreatectomy is a clinically safe and effective procedure for benign and borderline pancreatic tumors.

Totally laparoscopic management of choledochal cysts using a four-hole method

BackgroundCholedochal cyst is a rare benign disease of the biliary tract. However, once diagnosed, it must be excised with the gallbladder because of the risk for cancer developing in the biliary tree, including the gallbladder. This report introduces a new surgical technique for totally laparoscopic excision of choledochal cyst and hepaticojejunostomy using a four-hole method.MethodsBetween October 2003 and May 2005, the authors performed totally laparoscopic choledochal cyst excision for 12 patients. All the patients except one were women, and the mean age was 37.3 years (range, 17–62 years). According to the Todani classification, there were five type Ia cases, four type Ic cases, and three type IV cases. Choledochal cyst excision and Roux-en-Y hepaticojejunostomy were performed laparoscopically using the four-port technique.ResultsThe mean operation time was 228 min (range, 150–330 min). No operative or postoperative transfusion was required. An oral diet was started on postoperative day 3. The average length of hospital stay was 5.8 days. There was no major complication associated with anastomosis leakage or obstruction. No patient had an adverse response, as determined by clinical or laboratory evaluation during a 2- to 19-month follow-up period.ConclusionsConsidering that choledochal cyst is common among young women, who are especially interested in cosmetic results in addition to complete resolution of medical problems, the laparoscopic management of choledochal cyst may be an attractive treatment option.

Effects of laparoscopic versus open surgery on splenic vessel patency after spleen and splenic vessel-preserving distal pancreatectomy: a retrospective multicenter study

BackgroundThe aims of this study were to compare splenic vessel patency between laparoscopic and open spleen and splenic vessel-preserving distal pancreatectomy (SSVpDP), and to identify possible risk factors for poor splenic vessel patency.MethodsThis retrospective multicenter study included 116 patients who underwent laparoscopic (nxa0=xa070) or open (nxa0=xa046) SSVpDP at seven Korean tertiary medical institutions between 2004 and 2011. Clinical parameters and the splenic vessel patency assessed by abdominal computed tomography were compared between the two surgical procedures.ResultsThe clinical parameters were not significantly different between both groups, except for postoperative hospital stay, which was significantly shorter in the laparoscopic group (10.4 vs. 13.5xa0days, Pxa0=xa00.024). The splenic artery patency rate was similar in both groups (90.0 vs. 97.8xa0%), but the splenic vein patency rate was significantly lower in the laparoscopic group (64.3 vs. 87.0xa0%, Pxa0=xa00.022). Univariate and multivariate analyses revealed surgical procedure [odds ratio (OR) 3.085, Pxa0=xa00.043] and intraoperative blood loss (OR 4.624, Pxa0=xa00.002) as independent risk factors for compromised splenic vein patency (partial or total occlusion). The splenic vein patency rate was significantly better in the late group (nxa0=xa034) than in the early period (nxa0=xa035) (79.4 vs. 48.6xa0%, Pxa0=xa00.008).ConclusionsAlthough laparoscopic SSVpDP had an advantage of shorter hospital stay compared with open surgery, it was associated with greater risk of poor splenic vein patency. However, this risk could decrease with increasing surgical experience and with efforts to minimize blood loss.

Recurrent Bronchobiliary Fistula: Unsuccessful Management with Repeated Insertion of Metallic Biliary Stent

This case of a recurrent bronchobiliary fistula was first managed temporarily with repeated metallic biliary stent placement, and finally required surgery. A 65-year-old man, who had undergone a hepatic resection for metastatic colon carcinoma, with a bronchobiliary fistula was treated with metallic biliary stent placement for a stenosis in the common bile duct. During 16 months of follow-up, the biliptysis recurred twice by a recurrent stricture of the common bile duct, which was managed by placement of a second and third stent in a coaxial manner. Three months after placement of the third stent, jaundice developed and the patient finally underwent a Roux-en-Y choledochojejunostomy.