Yoo Seok Yoon

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.

Patency of splenic vessels after laparoscopic spleen and splenic vessel-preserving distal pancreatectomy

This study evaluated the short‐ and long‐term patency of preserved splenic vessels after laparoscopic spleen‐preserving distal pancreatectomy (SPDP) with preservation of the splenic vessels.

Laparoscopic major liver resection in Korea : a multicenter study

IntroductionWe report our experience with laparoscopic major liver resection in Korea based on a multicenter retrospective study.Materials and methodsData from 1,009 laparoscopic liver resections conducted from 2001 to 2011 were retrospectively collected. Twelve tertiary medical centers with specialized hepatic surgeons participated in this study.ResultsAmong 1,009 laparoscopic liver resections, major liver resections were performed in 265 patients as treatment for hepatocellular carcinoma, metastatic tumor, intrahepatic duct stone, and other conditions. The most frequently performed procedure was left hemihepatectomy (165 patients), followed by right hemihepatectomy (53 patients). Pure laparoscopic procedure was performed in 190 patients including 19 robotic liver resections. Hand-assisted laparoscopic liver resection was performed in three patients and laparoscopy-assisted liver resection in 55 patients. Open conversion was performed in 17 patients (6.4xa0%). Mean operative time and estimated blood loss in laparoscopic major liver resection was 399.3xa0±xa0169.8xa0min and 836.0xa0±xa01223.7xa0ml, respectively. Intraoperative transfusion was required in 65 patients (24.5xa0%). Mean postoperative length of stay was 12.3xa0±xa07.9xa0days. Postoperative complications were detected in 53 patients (20.0xa0%), and in-hospital mortality occurred in two patients (0.75xa0%). Mean number and mean maximal size of resected tumors was 1.22xa0±xa01.54 and 40.0xa0±xa027.8xa0mm, respectively. R0 resection was achieved in 120 patients with hepatic tumor, but R1 resection was performed in eight patients. Mean distance of safe resection margin was 14.6xa0±xa015.8xa0mm.ConclusionsLaparoscopic major liver resection has become a reliable option for treatment of liver disease in Korea.

Transcatheter Arterial Embolization of Gastroduodenal Artery Stump Pseudoaneurysms after Pancreaticoduodenectomy: Safety and Efficacy of Two Embolization Techniques

PURPOSEnTo evaluate the safety and efficacy of two transcatheter arterial embolization (TAE) techniques used to treat pseudoaneurysms of the gastroduodenal artery (GDA) stump after pancreaticoduodenectomy.nnnMATERIALS AND METHODSnBetween March 2003 and March 2008, 16 patients were treated with TAE for pseudoaneurysms of the GDA stump after pancreaticoduodenectomy. Two embolization techniques were employed: endovascular trapping of the hepatic artery (embolization of the hepatic artery proximal and distal to GDA stump; group A; n = 13) and selective embolization of the GDA stump and/or pseudoaneurysm sparing hepatic arterial flow (group B; n = 3). Technical success, initial hemostasis, recurrence of bleeding, and complications were compared between the two groups retrospectively.nnnRESULTSnAll TAE procedures were technically successful and immediate hemostasis was achieved in all patients. There was no recurrent bleeding in group A; however, all three patients in group B experienced recurrent bleeding after initial hemostasis (P = .002), and these patients required subsequent embolization with the endovascular trapping technique. Two patients died of multiple organ failure (one patient in each group) despite successful hemostasis. Three patients experienced subsegmental (n = 1, group A) and multisegmental (n = 2, group B) liver infarction, which were successfully managed with conservative treatment. There was a higher incidence of major complications in group B (15.4% vs 100%; P = .018).nnnCONCLUSIONSnEndovascular trapping of the hepatic artery is a safe and effective treatment of pseudoaneurysms of the GDA stump after pancreaticoduodenectomy. Hepatic ischemic complications are not rare, but can be conservatively managed. Selective embolization of the GDA stump and/or pseudoaneurysm is frequently associated with recurrence of bleeding, which eventually leads to major complications.

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.

Preoperative inflammation is a prognostic factor for gallbladder carcinoma.

Inflammation frequently accompanies gallbladder carcinoma (GBC), but its impact on outcome is unclear. The present study investigated the impact of concomitant inflammation on survival of patients with GBC.

Current Status of Laparoscopic Liver Resection in Korea

Since laparoscopic liver resection was first introduced in 2001, Korean surgeons have chosen a laparoscopic procedure as one of the treatment options for benign or malignant liver disease. We distributed and analyzed a nationwide questionnaire to members of the Korean Laparoscopic Liver Surgery Study Group (KLLSG) in order to evaluate the current status of laparoscopic liver resection in Korea. Questionnaires were sent to 24 centers of KLLSG. The questionnaire consisted of operative procedure, histological diagnosis of liver lesions, indications for resection, causes of conversion to open surgery, and postoperative outcomes. A laparoscopic liver resection was performed in 416 patients from 2001 to 2008. Of 416 patients, 59.6% had malignant tumors, and 40.4% had benign diseases. A total laparoscopic approach was performed in 88.7%. Anatomical laparoscopic liver resection was more commonly performed than non-anatomical resection (59.9% vs 40.1%). The anatomical laparoscopic liver resection procedures consisted of a left lateral sectionectomy (29.3%), left hemihepatectomy (19.2%), right hemihepatectomy (6%), right posterior sectionectomy (4.3%), central bisectionectomy (0.5%), and caudate lobectomy (0.5%). Laparoscopy-related serious complications occurred in 12 (2.8%) patients. The present study findings provide data in terms of indication, type and method of liver resection, and current status of laparoscopic liver resection in Korea.

Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

We propose a new flowchart for the treatment of acute cholecystitis (AC) in the Tokyo Guidelines 2018 (TG18). Grade III AC was not indicated for straightforward laparoscopic cholecystectomy (Lap‐C). Following analysis of subsequent clinical investigations and drawing on Big Data in particular, TG18 proposes that some Grade III AC can be treated by Lap‐C when performed at advanced centers with specialized surgeons experienced in this procedure and for patients that satisfy certain strict criteria. For Grade I, TG18 recommends early Lap‐C if the patients meet the criteria of Charlson comorbidity index (CCI) ≤5 and American Society of Anesthesiologists physical status classification (ASA‐PS) ≤2. For Grade II AC, if patients meet the criteria of CCI ≤5 and ASA‐PS ≤2, TG18 recommends early Lap‐C performed by experienced surgeons; and if not, after medical treatment and/or gallbladder drainage, Lap‐C would be indicated. TG18 proposes that Lap‐C is indicated in Grade III patients with strict criteria. These are that the patients have favorable organ system failure, and negative predictive factors, who meet the criteria of CCI ≤3 and ASA‐PS ≤2 and who are being treated at an advanced center (where experienced surgeons practice). If the patient is not considered suitable for early surgery, TG18 recommends early/urgent biliary drainage followed by delayed Lap‐C once the patients overall condition has improved. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

Use of TachoSil® patches to prevent pancreatic leaks after distal pancreatectomy: a prospective, multicenter, randomized controlled study

We performed a prospective, multicenter, randomized controlled study to investigate the clinical outcomes, including postoperative pancreatic fistulas (POPF), after using the TachoSil® patch in distal pancreatectomy (NCT01550406).

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.