Joong-Min Park

Bariatric surgery versus conventional therapy in obese Korea patients: a multicenter retrospective cohort study

Purpose In Korea, the results of bariatric surgery have not been compared with those of nonsurgical treatment. The purpose of this study was to evaluate the effectiveness and safety of bariatric surgery vs. conventional nonsurgical treatment in severely obese Koreans. Methods In this retrospective cohort study, we reviewed the medical charts of 261 consecutive subjects who underwent bariatric surgery and 224 subjects who were treated with weight control medication and lifestyle modification therapy between January 2008 and February 2011. Measures of clinical effectiveness, including change in weight (%) and comorbid diseases, and occurrence of complications, were investigated for 18 months after bariatric surgery. Results Body mass index (BMI) was higher in the surgery group than in the conventionally treated group (mean ± standard deviation, 39.0 ± 6.2 vs. 34.3 ± 3.8). Diabetes was more prevalent in the surgery group than in the conventionally treated group (39.1% vs. 12.9%). The change in weight (%) between baseline and 18 months posttreatment was significantly greater in the surgery group (22.6%) than in the conventional therapy group (6.7%). While 57%, 47%, and 84% of subjects recovered from diabetes, hypertension, and dyslipidemia, respectively, in the surgery group, 10%, 20%, and 24% of subjects recovered from these conditions in the conventional group. Fifty-one subjects (19.5%) in the surgery group reported 61 complications (23.4%). Conclusion Bariatric surgery in Korea was significantly more effective than conventional treatment for weight loss and recovery from comorbidities such as diabetes, hypertension, and dyslipidemia, with a reasonable complication rate.

Prognostic Factors for Advanced Gastric Cancer: Stage-stratified Analysis of Patients who Underwent Curative Resection

PURPOSE Advanced gastric cancer patients have a poorer prognosis as compared to the patients with early gastric cancer. This study was conducted to define the prognostic factors for advanced gastric cancer. MATERIALS AND METHODS 606 patients with advanced gastric cancer who underwent curative gastric resection at our hospital were retrospectively examined. The patients were divided into two groups: group 1 was comprised of patients with a survival time <5 years, and group 2 patients had a survival time >or=5 years. We compared clinicopathological characteristics of the two groups by performing univariate and multivariate analysis. We also investigated the prognostic factors according to the stage. RESULTS On univariate analysis, 7 factors (age, tumor size, Borrmann type, resection type, distal resection margin, depth of invasion and lymph node status) were found to be different, and multivariate analysis revealed that patient age, depth of invasion and lymph node metastasis were the only significantly differences between the two groups. On the other hand, age and the Borrmann type for stage I b patients, age and the number of retrieved lymph nodes for stage II patients, tumor size for stage III patients, and the type of resection for stage IV patients were found to be the independent prognostic factors. CONCLUSION The age of patients had prognostic value in the early stages of advanced gastric cancers such as stage I b or II. The number greater than 20 retrieved lymph nodes affected the survival, particularly for the patients with stage II disease, and the tumor size was a significant prognostic factor for patients with stage III disease. Therefore, physicians are advised to pay special attention to lymph node dissection for those patients with stage II or III disease.

Single port laparoscopic appendectomy in children using glove port and conventional rigid instruments

Purpose To further improve the advantages of minimally invasive surgery, single port laparoscopic techniques continue to be developed. We report our initial experience with single port laparoscopic appendectomy (SPLA) in children and compare its outcomes to those of conventional laparoscopic appendectomy (CLA). Methods Clinical data were prospectively collected for SPLA cases performed at Chung-Ang University Hospital by a single surgeon between March 2011 and December 2011, including operative time, perioperative complications, conversion rate, and length of hospital stay. Each case of SPLA was performed using conventional laparoscopic instruments through Glove port placed into the single umbilical incision. To compare outcomes, a retrospective review was performed for those patients who underwent CLA between March 2010 and December 2010. Results Thirty-one patients underwent SPLA and 114 patients underwent CLA. Mean age (10.5 years vs. 11.1 years, P = 0.43), weight (48.2 kg vs. 42.9 kg, P = 0.27), and operation time (41.8 minutes vs. 37.9 minutes, P = 0.190) were comparable between both groups. Mean hospital stay was longer for CLA group (2.6 days vs. 3.7 days, P = 0.013). There was no conversion to conventional laparoscopic surgery in SPLA group. In CLA group, there were nine complications (7.9%) with 3 cases of postoperative ileuses and 6 cases wound problems. There was one complication (3.2%) of umbilical surgical site infection in SPLA group (P = 0.325). Conclusion The results of this study demonstrated that SPLA using conventional laparoscopic instruments is technically feasible and safe in children. SPLA using conventional laparoscopic instruments might be popularized by eliminating the need for specially designed instruments.

Unresectable gastric cancer with gastric outlet obstruction and distant metastasis responding to intraperitoneal and folfox chemotherapy after palliative laparoscopic gastrojejunostomy: report of a case

BackgroundGastric outlet obstruction (GOO) caused by unresectable gastric cancer is a challenging aspect of patient care. There have been no reports involving patients with obstructing gastric cancer and several incurable factors curatively treated by multimodal treatments.Case presentationWe report a case of 55-year-old man who was diagnosed with a poorly differentiated adenocarcinoma in the pre-pyloric antrum with GOO by gastroscopy. An abdominal computed tomography (CT) scan revealed thickening of the gastric wall and adjacent fat infiltration, and a large amount of food in the stomach suggesting a passage disturbance, enlarged lymph nodes along the common hepatic and left gastric arteries, and multiple hepatic metastases. The serum carcinoembryonic antigen (CEA) level was 343 ng/ml and the carbohydrate antigen (CA) 19-9 level was within normal limits. The patient underwent a laparoscopic gastrojejunostomy for palliation of the GOO. On the 3rd and 12th days after surgery, he received intraperitoneal chemotherapy with 40 mg of docetaxel and 150 mg of carboplatin. Simultaneously, combined chemotherapy with 85 mg/m2 of oxaliplatin for the 1st day and 600 mg/m2 of 5-FU for 2 days (FOLFOX regimen) was administered from the 8th post-operative day. After completion of nine courses of FOLFOX, the patient achieved a complete response (CR) with complete disappearance of the primary tumor and the metastatic foci. He underwent a radical subtotal gastrectomy with D3 lymph node dissection 4 months after the initial palliative surgery. The pathologic results revealed no residual primary tumor and no lymph node metastasis in 43 dissected lymph nodes. He has maintained a CR for 18 months since the last operation.ConclusionCombination chemotherapy with systemic and intraperitoneal chemotherapy following laparoscopic bypass surgery showed marked efficacy in the treatment for unresectable advanced gastric cancer with GOO.

Preoperative Body Mass Index May Determine the Prognosis of Advanced Gastric Cancer

ABSTRACT Radical gastrectomy followed by adjuvant chemotherapy for advanced gastric cancer causes serious nutritional impairment. Our study evaluated the clinical impact of body mass index (BMI) on the long-term outcomes of advanced gastric cancer (stage II and III). We analyzed 211 cases of stage II and III gastric cancer between January 2005 and December 2010 at Chung-Ang University Hospital, Seoul, Korea. Patients were divided into four groups according to BMI: underweight, normal, overweight, and obese. In addition, we divided patients into two groups: BMI-High (BMI ≥ 23 kg/m2) vs. BMI-Low (BMI < 23 kg/m2). We assessed age, sex, tumor location, lymph node (LN) involvement, operation method, initial cancer stage, recurrence, and survival between the two groups. There was significant difference in overall survival (OS) between the underweight group and the other groups (P = 0.005). The survival of the BMI-High group was better than that of the BMI-Low group. The rate of cancer-related death in the BMI-High group was significantly lower than that in the BMI-Low group (cancer-related death: BMI-Low 27% vs. BMI-High 12.6%, P = 0.022). Our findings suggest that preoperative BMI may have an influence on the long-term outcomes of advanced gastric cancer after radical surgery and chemotherapy.

Laparoscopic reversal of Hartmann's procedure.

Reversal of Hartmanns procedure is a major surgical procedure associated with significant morbidity and mortality. Because of the difficulty of the procedure, laparoscopic reversal of Hartmanns procedure is not well established. We describe our experience with this laparoscopic procedure to assess its difficulty and safety. Five patients (4 men and 1 woman) underwent laparoscopic reversal of Hartmanns procedure (LRHP). The initial surgeries were performed to manage obstructive colorectal cancer for 4 patients, and rectovesical fistula for one patient. The procedure was laparoscopically completed for 4 patients. Conversion to open laparotomy was required for one patient, secondary to massive adhesion in lower abdomen. Transient ileostomies were made in 2 cases. Operative time ranged from 240 to 545 minutes. There was no operative mortality. LRHP can be performed safely by an experienced surgeon. However, it is still technically challenging and time consuming.

Smaller-Diameter Circular Stapler Has an Advantage in Billroth I Stapled Anastomosis After Laparoscopy-Assisted Distal Gastrectomy

INTRODUCTION Billroth I gastroduodenostomy using a circular stapler is the most preferred reconstruction method after laparoscopy-assisted distal gastrectomy (LADG). The optimal stapler size for this procedure has not yet been proposed. METHODS Sixty-five patients who underwent LADG and stapled anastomosis with a 25-mm stapler (25-mm group) and a 29-mm stapler (29-mm group) were enrolled in this study. Clinical data and gastroscopic findings at 6 and 12 months after surgery were retrospectively reviewed. RESULTS Postoperative complications and postprandial symptoms were similar in both groups. Gastroscopically, food materials remained more frequently in the remnant stomach in the 25-mm group than in the 29-mm group at 6 months after surgery (P=.041). Gastritis and bile reflux were observed more frequently in the 29-mm group than in the 25-mm group (P=.012 and P=.015, respectively). All these differences in the gastroscopic findings between the two groups decreased at 12 months after surgery except for reflux esophagitis, which was observed more frequently in the 29-mm group (P=.002). The length of the incision was smaller in the 25-mm group than in the 29-mm group (4.39 cm versus 4.95 cm, P=.009). CONCLUSION A small-diameter stapler is a risk factor for gastric stasis in the early postoperative period, whereas a large-diameter stapler is a risk factor for gastritis and bile reflux in the early postoperative period and for esophagitis in the late postoperative period. Thus, a small-diameter circular stapler has more advantages over a large-diameter circular stapler. It also enables a reliable anastomosis through a smaller incision and easy handling of the stapler during anastomosis.

Nationwide survey of partial fundoplication in Korea: comparison with total fundoplication

Purpose Laparoscopic total fundoplication is the standard surgery for gastroesophageal reflux disease. However, partial fundoplication may be a viable alternative. Here, we conducted a nationwide survey of partial fundoplication in Korea. Methods The Korean Anti-Reflux Surgery study group recorded 32 cases of partial fundoplication at eight hospitals between September 2009 and January 2016. The surgical outcomes and postoperative adverse symptoms in these cases were evaluated and compared with 86 cases of total fundoplication. Results Anterior partial fundoplication was performed in 20 cases (62.5%) and posterior in 12 (37.5%). In most cases, partial fundoplication was a secondary procedure after operations for other conditions. Half of patients who underwent partial fundoplication had typical symptoms at the time of initial diagnosis, and most of them showed excellent (68.8%), good (25.0%), or fair (6.3%) symptom resolution at discharge. Compared to total fundoplication, partial fundoplication showed no difference in the resolution rate of typical and atypical symptoms. However, adverse symptoms such as dysphagia, difficult belching, gas bloating and flatulence were less common after partial fundoplication. Conclusion Although antireflux surgery is not popular in Korea and total fundoplication is the primary surgical choice for gastroesophageal reflux disease, partial fundoplication may be useful in certain conditions because it has less postoperative adverse symptoms but similar efficacy to total fundoplication.

Single-Incision Laparoscopic Appendectomy by Surgical Trainees.

Background: Single-incision laparoscopic appendectomy (SILA) is one of the most commonly performed single port surgeries in the world. However, there are few publications documenting a young resident’s experience. The purpose of this study is to investigate clinical outcomes of SILA performed by a surgical trainee and to evaluate its feasibility and safety compared with conventional three-port laparoscopic appendectomy (TPLA) when performed by a surgical trainee and SILA by surgical staff. Methods: Between September 2014 and August 2015, clinical data were retrospectively collected for SILA and TPLA cases performed at Chung-Ang University Hospital. Three surgical residents who have assisted at least 50 cases of TPLA and 30 cases of SILA performed by gastrointestinal surgery specialists performed the surgeries. The indication of SILA by surgical trainees was noncomplicated appendicitis with no comorbidity. Results: In total, 47 patients underwent SILA by surgical residents, 98 patients underwent TPLA by surgical residents and 137 patients underwent SILA by surgical staff. In comparing SILA and TPLA performed by surgical residents, the mean age was younger (26 vs. 41 y, P<0.005) in the SILA group, the operative time (47.2 vs. 61.5 min, P<0.010) and hospital stay (2.3 vs. 2.7 d, P=0.003) were shorter in SILA group. In the SILA group, 2 cases of postoperative fluid collection (5.7%) occurred, necessitating antibiotic treatment. In TPLA group, 1 postoperative abscess occurred, requiring drainage. When comparing SILA performed by surgical residents and SILA performed by surgical staff, there were no significant differences in operation time, and postoperative complications. Conclusion: Surgical residents safely performed SILA with good postoperative outcomes after short learning curve.

Validation of the Korean version Moorehead-Ardelt quality of life questionnaire II

Purpose To investigate the weight loss effects with higher sensitivity, disease specific quality of life (QoL) instruments were important. The Moorehead-Ardelt quality of life questionnaire II (MA-II) is widely used, because it was simple and validated the several languages. The aims of present study was performed the translation of MA-II Korean version and the validation compared with EuroQol-5 dimension (EQ-5D), obesity-related problems scale (OP-scale), and impact of weight quality of life-lite (IWQoL-Lite). Methods The study design was a multicenter, cross-sectional survey and this study was included the postoperative patients. The validation procedure is translation-back translation procedure, pilot study, and field study. The instruments of measuring QoL included the MA-II, EQ-5D, OP-scale, and IWQoL-lite. The reliability was checked through internal consistency using Cronbach alpha coefficients. The construct validity was assessed the Spearman rank correlation between 6 domains of MA-II and EQ-5D, OP-scale, and 5 domains of IWQoL-Lite. Results The Cronbach alpha of MA-II was 0.763, so the internal consistency was confirmed. The total score of MA-II was significantly correlated with all other instruments; EQ-5D, OP-scale, and IWQoL-Lite. IWQoL-lite (ρ = 0.623, P < 0.001) was showed the strongest correlation compared with MA-II, followed by OP-scale (ρ = 0.588, P < 0.001) and EQ-5D (ρ = 0.378, P < 0.01). Conclusion The Korean version MA-II was valid instrument of measuring the obesity-specific QoL. Through the present study, the MA-II was confirmed to have good reliability and validity and it was also answered simple for investigating. Thus, MA-II could be estimated sensitive and exact QoL in obesity patients.