Ok Pyung Song

Transvaginal Endoscopic Appendectomy

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.

Conventional Linear versus Purse-string Skin Closure after Loop Ileostomy Reversal: Comparison of Wound Infection Rates and Operative Outcomes.

Purpose Wound infection after an ileostomy reversal is a common problem. To reduce wound-related complications, purse-string skin closure was introduced as an alternative to conventional linear skin closure. This study is designed to compare wound infection rates and operative outcomes between linear and purse-string skin closure after a loop ileostomy reversal. Methods Between December 2002 and October 2010, a total of 48 consecutive patients undergoing a loop ileostomy reversal were enrolled. Outcomes were compared between linear skin closure (group L, n = 30) and purse string closure (group P, n = 18). The operative technique for linear skin closure consisted of an elliptical incision around the stoma, with mobilization, and anastomosis of the ileum. The rectus fascia was repaired with interrupted sutures. Skin closure was performed with vertical mattress interrupted sutures. Purse-string skin closure consisted of a circumstomal incision around the ileostomy using the same procedures as used for the ileum. Fascial closure was identical to linear closure, but the circumstomal skin incision was approximated using a purse-string subcuticular suture (2-0 Polysorb). Results Between group L and P, there were no differences of age, gender, body mass index, and American Society of Anesthesiologists (ASA) scores. Original indication for ileostomy was 23 cases of malignancy (76.7%) in group L, and 13 cases of malignancy (77.2%) in group P. The median time duration from ileostomy to reversal was 4.0 months (range, 0.6 to 55.7 months) in group L and 4.1 months (range, 2.2 to 43.9 months) in group P. The median operative time was 103 minutes (range, 45 to 260 minutes) in group L and 100 minutes (range, 30 to 185 minutes) in group P. The median hospital stay was 11 days (range, 5 to 4 days) in group L and 7 days (range, 4 to 14 days) in group P (P < 0.001). Wound infection was found in 5 cases (16.7%) in group L and in one case (5.6%) in group L (P = 0.26). Conclusion Based on this study, purse-string skin closure after a loop ileostomy reversal showed comparable outcomes, in terms of wound infection rates, to those of linear skin closure. Thus, purse-string skin closure could be a good alternative to the conventional linear closure.

Gallbladder torsion diagnosed by MDCT and MRCP

Gallbladder torsion is an uncommon disease and is treated by emergency surgery. Since its first description by Wendel in 1898, over 500 cases have been reported in the last century [1]. Gallbladder torsion leads to obstruction of biliary drainage and blood flow so that a delay in the diagnosis and treatment may be life-threatening. Although many reports of gallbladder torsion are described preoperative diagnosis remains difficult. We present a case preoperatively diagnosed with multidetector computed tomography (MDCT) and magnetic resonance cholangiopancreatography (MRCP) and successfully treated with laparoscopic cholecystectomy. Especially, preoperative diagnosis of gallbladder torsion by MRCP is the second case since its first report by Usui in 2000 [2]. Also, to our knowledge, this is the first reported case diagnosed by both MDCT and MRCP.

Laparoscopic distal pancreatectomy for benign or borderline malignant pancreatic tumors.

BACKGROUND/AIMS Laparoscopic distal pancreatectomy (LDP) for benign conditions is increasingly performed. But, there are few limited studies about the outcomes of the laparoscopic surgery compared with open surgery. The aim of this study was to evaluate the clinical outcomes of LDP and compare it to that of open distal pancreatectomy (ODP). MATERIALS AND METHODS From July 2007 to February 2012, 60 consecutive patients (41 LDP patients and 19 ODP patients) who underwent elective distal pancreatectomy with an apparent diagnosis of benign or borderline malignant tumor were recruited into the current study. RESULTS There were no significant differences in operation time, transfusion, intravenous patient-controlled analgesia (IV-PCA) duration, pancreatic fistula, mortality, and recurrence between the two groups. Compared to ODP, LDP had lower blood loss (272.7±134.8 vs. 476.9±140.8 ml; p=0.002), shorter time to first flatus (2.4±0.5 vs. 4.0±1.5 days; p=0.003), earlier time to oral intake (3.4±1.6 vs. 5.4±1.9 days; p=0.013), and shorter postoperative hospital stay (9.4±6.9 vs. 17.0±6.7 days; p=0.043). CONCLUSION LDP is a safe procedure and should be considered as a standard treatment option for benign or borderline malignant pancreatic tumors.