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Purpose@#Liver fibrosis is a critical health issue with limited treatment options. This study investigates the potential of PGC-Sec, a secretome derived from peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α)-overexpressing adipose-derived stem cells (ASCs), as a novel therapeutic strategy for liver fibrosis. @*Methods@#Upon achieving a cellular confluence of 70%–80%, ASCs were transfected with pcDNA-PGC-1α. PGC-Sec, obtained through concentration of conditioned media using ultrafiltration units with a 3-kDa cutoff, was assessed through in vitro assays and in vitro mouse models. @*Results@#In vitro, PGC-Sec significantly reduced LX2 human hepatic stellate cell proliferation and mitigated mitochondrial oxidative stress compared to the control-secretome. In an in vivo mouse model, PGC-Sec treatment led to notable reductions in hepatic enzyme activity, serum proinflammatory cytokine concentrations, and fibrosis-related marker expression. Histological analysis demonstrated improved liver histology and reduced fibrosis severity in PGC-Sec–treated mice. Immunohistochemical staining confirmed enhanced expression of PGC-1α, optic atrophy 1 (a mitochondrial function marker), and peroxisome proliferator-activated receptor alpha (an antifibrogenic marker) in the PGC-Sec–treated group, along with reduced collagen type 1A expression (a profibrogenic marker). @*Conclusion@#These findings highlight the therapeutic potential of PGC-Sec in combating liver fibrosis by enhancing mitochondrial biogenesis and function, and promoting antifibrotic processes. PGC-Sec holds promise as a novel treatment strategy for liver fibrosis.
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Purpose@#Reconstruction using robotic assistance in pancreaticoduodenectomy (PD) was expected to be an effective means to overcome the limitations of laparoscopic surgery. To our knowledge, few comparative reports exist on the outcomes of totally laparoscopic PD (TLPD) and robot-assisted laparoscopic PD (RLPD). This retrospective study aimed to analyze the surgical results of TLPD and RLPD in a high-volume pancreatic center. @*Methods@#We analyzed the surgical results of consecutive patients who underwent a minimally invasive PD for malignant or benign periampullary lesions between January 2016 and May 2020. Forty-three TLPD patients and 49 RLPD patients were enrolled. @*Results@#There were no significant differences in the demographic characteristics between the 2 groups except for tumor size, which was significantly larger in the RLPD group than in the TLPD group (mean, 3.1 cm vs. 2.5 cm; P = 0.035).The RLPD group had shorter whole operative times (mean, 400.4 minutes vs. 352.2 minutes; P = 0.003) and shorter anastomosis times than the TLPD group (mean, 94.5 minutes vs. 54.9 minutes; P < 0.001). There was no significant difference between the 2 groups in the rate of pancreatic fistulas, morbidity, and mortality. However, a significantly lower wound infection rate was found in the RLPD group relative to the TLPD group (0% vs. 9.3%, P = 0.038). @*Conclusion@#RLPD showed the advantage of reducing the operation time compared to TLPD as well as technical feasibility and safety.
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Purpose@#Reconstruction using robotic assistance in pancreaticoduodenectomy (PD) was expected to be an effective means to overcome the limitations of laparoscopic surgery. To our knowledge, few comparative reports exist on the outcomes of totally laparoscopic PD (TLPD) and robot-assisted laparoscopic PD (RLPD). This retrospective study aimed to analyze the surgical results of TLPD and RLPD in a high-volume pancreatic center. @*Methods@#We analyzed the surgical results of consecutive patients who underwent a minimally invasive PD for malignant or benign periampullary lesions between January 2016 and May 2020. Forty-three TLPD patients and 49 RLPD patients were enrolled. @*Results@#There were no significant differences in the demographic characteristics between the 2 groups except for tumor size, which was significantly larger in the RLPD group than in the TLPD group (mean, 3.1 cm vs. 2.5 cm; P = 0.035).The RLPD group had shorter whole operative times (mean, 400.4 minutes vs. 352.2 minutes; P = 0.003) and shorter anastomosis times than the TLPD group (mean, 94.5 minutes vs. 54.9 minutes; P < 0.001). There was no significant difference between the 2 groups in the rate of pancreatic fistulas, morbidity, and mortality. However, a significantly lower wound infection rate was found in the RLPD group relative to the TLPD group (0% vs. 9.3%, P = 0.038). @*Conclusion@#RLPD showed the advantage of reducing the operation time compared to TLPD as well as technical feasibility and safety.
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PURPOSE: This report describes the laparoscopic end-to-end biliary reconstruction with T-tube for transected bile duct injury (BDI) during laparoscopic cholecystectomy. METHODS: We performed a retrospective descriptive analysis for all patients with a transected BDI at a single institution. We collected and analyzed data for injury site and type, reconstruction methods, conversion rate, previous intervention, and outcomes. RESULTS: Between January 2014 and December 2017, 2,901 patients underwent laparoscopic cholecystectomy at a single institution. Among them, 8 patients experienced a transected BDI during laparoscopic cholecystectomy, so the surgeon performed laparoscopic end-to-end biliary reconstruction with T-tube. Our patient series consisted of 6 women (75%) and 2 men (25%) with a mean age of 48.3 years (median, 49 years; range, 29–77 years). Two cases were converted to open surgery. The most common injured site was the common bile duct (5 of 8, 62.5%). The most common injury type, using Bismuth's classification system, was type I (3 of 8, 37.5%). The mean operating time was 136.8 minutes (median, 135.0 minutes; range, 0–180.0 minutes). The mean hospital stay was 7.0 days (median, 4.5 days, range: 3.0–21.0 days). The mean follow-up was 36.4 months (median, 34.0 months; range, 16.0–63.0 months). We observed one postoperative complication during the follow-up period. The patient had an anastomosis site leakage and was cured after reoperation. CONCLUSION: Laparoscopic end-to-end biliary reconstruction with T-tube for transected BDI during laparoscopic cholecystectomy seems to be safe and feasible in selected patients. However, long-term follow-up to identify complications from bile duct stricture remains important.
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Femenino , Humanos , Masculino , Conductos Biliares , Bilis , Colecistectomía , Colecistectomía Laparoscópica , Clasificación , Conducto Colédoco , Constricción Patológica , Estudios de Seguimiento , Laparoscopía , Tiempo de Internación , Complicaciones Posoperatorias , Reoperación , Estudios RetrospectivosRESUMEN
PURPOSE: The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic neuroendocrine tumor (PNET) included several significant changes. We aim to evaluate this staging system compared to the 7th edition AJCC staging system and European Neuroendocrine Tumors Society (ENETS) system. MATERIALS AND METHODS: We used Korean nationwide surgery database (2000-2014). Of 972 patients who had undergone surgery for PNET, excluding patients diagnosed with ENETS/World Health Organization 2010 grade 3 (G3), only 472 patients with accurate stage were included. RESULTS: Poor discrimination in overall survival rate (OSR) was noted between AJCC 8th stage III and IV (p=0.180). The disease-free survival (DFS) curves of 8th AJCC classification were well separated between all stages. Compared with stage I, the hazard ratio of II, III, and IV was 3.808, 13.928, and 30.618, respectively (p=0.007, p < 0.001, and p < 0.001). The curves of OSR and DFS of certain prognostic group in AJCC 7th and ENETS overlapped. In ENETS staging system, no significant difference in DFS between stage IIB versus IIIA (p=0.909) and IIIA versus IIIB (p=0.291). In multivariable analysis, lymphovascular invasion (p=0.002), perineural invasion (p=0.003), and grade (p < 0.001) were identified as independent prognostic factors for DFS. CONCLUSION: This is the first large-scale validation of the AJCC 8th edition staging system for PNET. The revised 8th system provides better discrimination compared to that of the 7th edition and ENETS TNM system. This supports the clinical use of the system.
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Humanos , Clasificación , Discriminación en Psicología , Supervivencia sin Enfermedad , Articulaciones , Estadificación de Neoplasias , Tumores Neuroectodérmicos Primitivos , Tumores Neuroendocrinos , Páncreas , Tasa de SupervivenciaRESUMEN
PURPOSE: A soft texture of the pancreas is one of the most important predisposing factors for a pancreatic fistula. Thus, in a porcine model, we investigated a method to harden the pancreas locally by directly injecting an artificial material. METHODS: During the laparotomy, 51 samples from 17 pigs, including 13 survival models, were randomly divided into 3 groups and either received a direct injection into the pancreas of MHL (1:4 mixture of histoacryl [n-butyl cyanoacrylate] and lipiodol) (group E) or saline (group C) or only received a pinprick into the pancreas without injecting a substance (sham). We measured the change in the pancreatic hardness after the injection using a durometer and examined the histological change of the pancreas using the fibrosis grade in the survival model. RESULTS: The postinjection hardness of the pancreas was significantly increased in group E compared to group C and the sham group (P < 0.001). Pathologically, all cases in group E showed a severe fibrotic change, whereas the other groups demonstrated mild to no fibrosis (P < 0.001). The fibrosis in group E was localized to the area of the injection, while the surrounding areas were preserved. CONCLUSION: The direct injection of MHL could induce focal hardening and fibrotic changes in the pancreas of the porcine model.
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Causalidad , Cianoacrilatos , Enbucrilato , Aceite Etiodizado , Fibrosis , Dureza , Laparotomía , Métodos , Páncreas , Fístula Pancreática , PorcinosRESUMEN
PURPOSE: We introduce a training porcine model for laparoscopic common bile duct (CBD) repair with T-tube insertion. The model could be the feasible training tool for a surgeon learning hepatobiliary surgery. METHODS: Totally laparoscopic CBD repair with T-tube insertion was performed on 9 pigs by 9 trainees naïve in hepatobiliary surgery. Similar to the situation of iatrogenic injury, CBD was transected by laparoscopic scissors at the middle part about 1 cm in length, and the transected CBD was repaired through end-to-end anastomosis with T-tube insertion. A secureness of anastomosis was confirmed by saline leakage test and all animals were sacrificed after the surgery. RESULTS: All novice surgeons completed operations successfully without complications. Total mean operative time was 85 ± 1.7 minutes and the mean time spent performing the CBD repair with T-tube insertion was 71 ± 3 minutes. There was no bile leakage after primary anastomosis in all animals. CONCLUSION: This porcine training model for laparoscopic CBD repair with T-tube insertion could be a feasible and effective training tool for surgeons with little experience in laparoscopic hepatobiliary surgery.
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Animales , Bilis , Conducto Colédoco , Laparoscopía , Aprendizaje , Tempo Operativo , Cirujanos , PorcinosRESUMEN
Near-infrared fluorescent cholangiography (NIRFC) is an emerging technique for easy intraoperative recognition of biliary anatomy. We present a case of cystic duct variation detected by NIRFC which had a potential risk for biliary injury if not detected. A 32-year-old female was admitted to the Seoul St. Mary's Hospital for surgery for an incidental gallbladder polyp. We performed laparoscopic cholecystectomy with NIRFC. In fluorescence mode, a long cystic duct and an accessory short hepatic duct joining to the cystic duct were found and the operation was completed safely. The patient recovered successfully. NIRFC is expected to be a promising procedure that will help minimize biliary injury during laparoscopic cholecystectomy.
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Adulto , Femenino , Humanos , Colangiografía , Colecistectomía Laparoscópica , Conducto Cístico , Fluorescencia , Vesícula Biliar , Conducto Hepático Común , Pólipos , SeúlRESUMEN
PURPOSE: The purpose of the present study was to investigate whether hardness of liver surface correlated with degree of liver fibrosis, and its association with posthepatectomy liver failure (PHLF). METHODS: A shore durometer was used to measure hepatic hardness in 41 patients with hepatocellular carcinoma (HCC) and in 10 patients with normal liver. We investigated how hepatic hardness correlates with various values indicating the degree of liver fibrosis, and how it correlates with PHLF. RESULTS: In the normal liver group, the surface shore units (SU) was 15.06 ± 2.64. In the HCC group, there was a correlation between surface SU and preoperative results indicating liver fibrosis. Among patients with PHLF after resecting over 3 segments, the surface SU of patients with grade A PHLF was 21.85 ± 5.63, and the surface SU of patients with grade C PHLF was 35.75 ± 9.26. In patients with PHLF after resecting 2 or less segments, the surface SU of patients with PHLF grade A was 20.95 ± 5.18, and the surface SU of patients with PHLF grade B was 31.60 ± 5.57. In predicting PHLF, surface SU was more effective than preoperative platelet count, spleen volume, or liver fibrosis index. CONCLUSION: Hepatic hardness measured by the shore durometer was correlated with the degree of liver fibrosis. Liver surface SU was a more effective parameter for predicting PHLF, as compared to other indicators evaluated before hepatectomy. The decision to perform major hepatectomy should be reconsidered in cases with a liver surface SU of >30.
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Humanos , Carcinoma Hepatocelular , Dureza , Pruebas de Dureza , Hepatectomía , Cirrosis Hepática , Fallo Hepático , Pruebas de Función Hepática , Hígado , Recuento de Plaquetas , BazoRESUMEN
PURPOSE: The purpose of the present study was to investigate whether hardness of liver surface correlated with degree of liver fibrosis, and its association with posthepatectomy liver failure (PHLF). METHODS: A shore durometer was used to measure hepatic hardness in 41 patients with hepatocellular carcinoma (HCC) and in 10 patients with normal liver. We investigated how hepatic hardness correlates with various values indicating the degree of liver fibrosis, and how it correlates with PHLF. RESULTS: In the normal liver group, the surface shore units (SU) was 15.06 ± 2.64. In the HCC group, there was a correlation between surface SU and preoperative results indicating liver fibrosis. Among patients with PHLF after resecting over 3 segments, the surface SU of patients with grade A PHLF was 21.85 ± 5.63, and the surface SU of patients with grade C PHLF was 35.75 ± 9.26. In patients with PHLF after resecting 2 or less segments, the surface SU of patients with PHLF grade A was 20.95 ± 5.18, and the surface SU of patients with PHLF grade B was 31.60 ± 5.57. In predicting PHLF, surface SU was more effective than preoperative platelet count, spleen volume, or liver fibrosis index. CONCLUSION: Hepatic hardness measured by the shore durometer was correlated with the degree of liver fibrosis. Liver surface SU was a more effective parameter for predicting PHLF, as compared to other indicators evaluated before hepatectomy. The decision to perform major hepatectomy should be reconsidered in cases with a liver surface SU of >30.
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Humanos , Carcinoma Hepatocelular , Dureza , Pruebas de Dureza , Hepatectomía , Cirrosis Hepática , Fallo Hepático , Pruebas de Función Hepática , Hígado , Recuento de Plaquetas , BazoRESUMEN
PURPOSE: In this study, we introduced a novel technique, the pancreaticojejunostomy (PJ), which uses only two transpancreatic sutures with buttresses (PJt), and compared the surgical outcomes with previously used methods, especially for hard pancreases. METHODS: A total of 101 patients who underwent pancreaticoduodenectomy with hard pancreases were enrolled and divided into 3 groups according to the method of pancreaticoenteric anastomosis: 30 patients (29.7%) underwent the conventional dunking method (Du), 31 patients (30.7%) underwent pancreaticogastrostomy using transpancreatic sutures (PGt) and 40 patients (39.6%) underwent PJ using transpancreatic sutures (PJt). The surgical outcomes were compared according to the type of anastomosis to analyze the feasibility and ease of each technique. RESULTS: The overall operative time was shorter in the PJt group (325.1 +/- 63.8 minutes) than in the PGt group (367.3 +/- 70.5 minutes) or the Du group (412.0 +/- 38.2 minutes, P < 0.001). In terms of pancreaticoenteric anastomosis time, it was also shorter in the PJt group (10.3 +/- 3.5 minutes) than in the Du group (20.7 +/- 0.7 minutes) or the PGt group (16.8 +/- 5.4 minutes, P = 0.005). Significant postoperative pancreatic fistula (POPF) developed in 2 cases (6.7%) in the Du group, whereas there were no POPF cases in the PGt or PJt groups (P = 0.086). Overall postoperative morbidities occurred in 31 cases (30.7%), and there were no significant differences among the 3 groups (P = 0.692). CONCLUSION: The novel PJ technique, which uses only two transpancreatic sutures with buttresses, is a very simple, easy and secure method for hard pancreases and can be performed in a shorter amount of time compared with conventional methods.
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Humanos , Métodos , Tempo Operativo , Páncreas , Fístula Pancreática , Pancreaticoduodenectomía , Pancreatoyeyunostomía , SuturasRESUMEN
PURPOSE: The feasibility of a rat choledochojejunostomy (CJ) training model was investigated, as an introductory model to microsurgery for general surgeons. METHODS: Roux-en-Y CJ was performed on 20 rats. Interrupted 10-0 prolene sutures were used to perform CJ. The animals were observed for 7 days and sacrificed and examined. RESULTS: The rats were divided into 2 groups of 10 based on surgical order. The CJ time showed a significant decrease from 36.2 ± 5.6 minutes in group 1 to 29.4 ± 5.7 minutes in group 2 (P = 0.015). The bile leakage rate was 40% in group 1 and 10% in group 2. The survival time was 5.4 ± 2.2 days in group 1 and 7 days in group 2 (P = 0.049). CONCLUSION: The rat CJ training model is a feasible introductory model for general surgeons with no previous experience in microsurgery.
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Animales , Ratas , Bilis , Coledocostomía , Microcirugia , Polipropilenos , SuturasRESUMEN
PURPOSE: Radical antegrade modular pancreatosplenectomy (RAMPS) is expected to be favorable for obtaining the negative tangential margin with oncologic feasibility through the horizontal dissection in a right-to-left fashion for radical lymph node dissections. METHODS: From January 2007 to February 2015, a total of 30 RAMPS and 19 conventional distal pancreatectomy (DP) cases were enrolled. The demographics, perioperative and survival outcomes were compared according to the type of surgery. RESULTS: The mean operative time, blood loss and length of hospital stay were similar between 2 groups. Morbidities were reported in 14 cases of RAMPS (46.7%) and 8 cases of DP (42.1%) (P = 0.777). The rate of negative tangential margin (96.2%) and the number of harvested lymph nodes (mean ± standard deviation, 21.5 ± 8.3) were significantly higher in RAMPS group (P = 0.011, P = 0.003, respectively). In terms of survival outcomes, there was no significant difference in regard to the overall 3-year disease-free survival (DFS; 30.4% in RAMPS vs. 35.0% in DP, P = 0.354) or overall survival (OS; 29.9% vs. 29.4%, P = 0.429) between the 2 groups. After exclusion of cases with nodal invasion, however, the RAMPS group had a longer DFS than the DP group (55.6% vs. 27.3%, P = 0.048) although OS was similar without significant difference (42.4% vs. 27.3%, P = 0.197). CONCLUSION: RAMPS is a safe and oncologically feasible procedure in left-sided pancreatic cancer by obtaining a successful negative tangential margin and radical lymph node dissection. The authors suggest it could also be useful for local control, especially for the limited left-sided pancreatic cancer without nodal invasion.
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Accesibilidad Arquitectónica , Demografía , Supervivencia sin Enfermedad , Tiempo de Internación , Escisión del Ganglio Linfático , Ganglios Linfáticos , Tempo Operativo , Pancreatectomía , Neoplasias PancreáticasRESUMEN
PURPOSE: Radical antegrade modular pancreatosplenectomy (RAMPS) is expected to be favorable for obtaining the negative tangential margin with oncologic feasibility through the horizontal dissection in a right-to-left fashion for radical lymph node dissections. METHODS: From January 2007 to February 2015, a total of 30 RAMPS and 19 conventional distal pancreatectomy (DP) cases were enrolled. The demographics, perioperative and survival outcomes were compared according to the type of surgery. RESULTS: The mean operative time, blood loss and length of hospital stay were similar between 2 groups. Morbidities were reported in 14 cases of RAMPS (46.7%) and 8 cases of DP (42.1%) (P = 0.777). The rate of negative tangential margin (96.2%) and the number of harvested lymph nodes (mean ± standard deviation, 21.5 ± 8.3) were significantly higher in RAMPS group (P = 0.011, P = 0.003, respectively). In terms of survival outcomes, there was no significant difference in regard to the overall 3-year disease-free survival (DFS; 30.4% in RAMPS vs. 35.0% in DP, P = 0.354) or overall survival (OS; 29.9% vs. 29.4%, P = 0.429) between the 2 groups. After exclusion of cases with nodal invasion, however, the RAMPS group had a longer DFS than the DP group (55.6% vs. 27.3%, P = 0.048) although OS was similar without significant difference (42.4% vs. 27.3%, P = 0.197). CONCLUSION: RAMPS is a safe and oncologically feasible procedure in left-sided pancreatic cancer by obtaining a successful negative tangential margin and radical lymph node dissection. The authors suggest it could also be useful for local control, especially for the limited left-sided pancreatic cancer without nodal invasion.
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Accesibilidad Arquitectónica , Demografía , Supervivencia sin Enfermedad , Tiempo de Internación , Escisión del Ganglio Linfático , Ganglios Linfáticos , Tempo Operativo , Pancreatectomía , Neoplasias PancreáticasRESUMEN
Pancreatic islet transplantation is a physiologically advantageous and minimally invasive procedure for the treatment of type 1 diabetes mellitus. Here, we describe the first reported case of successful allogeneic islet transplantation alone, using single-donor, marginal-dose islets in a Korean patient. A 59-yr-old patient with type 1 diabetes mellitus, who suffered from recurrent severe hypoglycemia, received 4,163 islet equivalents/kg from a single brain-death donor. Isolated islets were infused intraportally without any complications. The immunosuppressive regimen was based on the Edmonton protocol, but the maintenance dosage was reduced because of mucositis and leukopenia. Although insulin independence was not achieved, the patient showed stabilized blood glucose concentration, reduced insulin dosage and reversal of hypoglycemic unawareness, even with marginal dose of islets and reduced immunosuppressant. Islet transplantation may successfully improve endogenous insulin production and glycemic stability in subjects with type 1 diabetes mellitus.
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Femenino , Humanos , Persona de Mediana Edad , Glucemia/análisis , Diabetes Mellitus Tipo 1/cirugía , Hipoglucemia/cirugía , Terapia de Inmunosupresión/métodos , Inmunosupresores/uso terapéutico , Islotes Pancreáticos/fisiología , Trasplante de Islotes Pancreáticos/métodos , República de Corea , Donantes de TejidosRESUMEN
PURPOSE: The purpose of this study was to develop a porcine training model for laparoscopic choledochojejunostomy (CJ) that can act as a bridge between simulation models and actual surgery for novice surgeons. The feasibility of this model was evaluated. METHODS: Laparoscopic CJ using intracorporeal sutures was performed on ten animals by a surgical fellow with no experience in human laparoscopic CJ. A single layer of running sutures was placed in the posterior and anterior layers. Jejunojejunostomy was performed using a linear stapler, and the jejunal opening was closed using absorbable unidirectional sutures (V-Loc 180). RESULTS: The average operation time was 131.3 +/- 36.4 minutes, and the CJ time was 57.5 +/- 18.4 minutes. Both the operation time and CJ time showed a steady decrease with an increasing number of cases. The average diameter of the CBD was 6.4 +/- 0.8 mm. Of a total of ten animals, eight were sacrificed after the procedure. In two animals, a survival model was evaluated. Both pigs recovered completely and survived for two weeks, after which both animals were sacrificed. None of the animals exhibited any signs of bile leakage or anastomosis site stricture. CONCLUSION: The porcine training model introduced in this paper is an adequate model for practicing laparoscopic CJ. Human tissue simulation is excellent.
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Animales , Humanos , Bilis , Coledocostomía , Constricción Patológica , Laparoscopía , Carrera , Suturas , PorcinosRESUMEN
PURPOSE: To evaluate the surgical outcomes of pancreaticogastrostomy (PG) using two transpancreatic sutures with a buttress method through an anterior gastrostomy (PGt), and compare these results with our previous experience with pancreaticojejunostomy (PJ) including the dunking and duct to mucosa methods after pancreaticoduodenectomy (PD). METHODS: In this study, 171 patients who had undergone PD between January 2005 and April 2013 were classified into three groups according to the method of the pancreaticoenteric anastomosis: dunking PJ (PJu group; n = 67, 39.1%), duct to mucosa PJ (PJm group; n = 41, 23.9%), and PGt (PGt group; n = 63, 36.8%). We retrospectively analyzed patient characteristics, perioperative outcomes, and surgical results. RESULTS: Both groups had comparable demographics and pathology, and there were no significant differences in operative time, estimated blood loss, or postoperative hospital stay. Within the two groups, morbidities occurred in 49 cases (10.7%), and were not significantly different between the two groups, excepting postoperative pancreatic fistula (POPF). The PGt group had a lower rate of POPF (18/63, 28.6%) than the PJu and PJm groups (21/67, 31.3% and 19/41, 46.3%; P = 0.048), especially in terms of grades B and C POPF (4/63 [6.3%] in the PGt group vs. 7/67 [10.4%] in the PJu group and 9/41 [22.0%] in the PJm group, P = 0.049). CONCLUSION: The PGt method showed feasible outcomes for POPF and had advantages over dunking PJ and duct to mucosa PJ with respect to immediate postoperative results. PGt may be a promising technique for pancreaticoenteric anastomosis after PD.
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Humanos , Demografía , Gastrostomía , Tiempo de Internación , Membrana Mucosa , Tempo Operativo , Fístula Pancreática , Pancreaticoduodenectomía , Pancreatoyeyunostomía , Patología , Estudios Retrospectivos , SuturasRESUMEN
PURPOSE: Single-port laparoscopic splenectomy has been performed sporadically. The aim of this study is to assess our experience with single-port laparoscopic splenectomy compared to conventional multiport laparoscopic surgery for the usual treatment modality for various kinds of splenic disease. METHODS: Between October 2008 to February 2014, 29 patients underwent single-port laparoscopic splenectomy and 32 patients received multiport laparoscopic splenectomy. We retrospectively analyzed the clinical outcomes of single-port group and multiport group. RESULTS: The body mass index and disease profiles of the both groups were similar. The operative times of single-port and multiport group were 113.6 +/- 39.9 and 95.9 +/- 38.9 minutes, respectively (P = 0.946). The operative blood loss of the two groups were 295.8 +/- 301.3 and 322.5 +/- 254.5 mL (P = 0.582). Postoperative retrieved splenic weight of the single-port and multiport groups were 283.9 +/- 300.7 and 362.3 +/- 471.8 g, respectively (P = 0.261). One single-port partial splenectomy and 6 multiport partial splenectomies were performed in this study. There was one intraoperative gastric wall injury. It occurred in single-port group, which was successfully managed during the operation. Each case was converted to laparotomy in both groups due to bleeding. There was one mortality case in the multiport laparoscopic splenectomy group, which was not related to the splenectomy. Mean hospital stay of the single-port and multiport group was 5.8 +/- 2.5 and 7.3 +/- 5.2 days respectively (P = 0.140). CONCLUSION: Single-port laparoscopic splenectomy seems to be a feasible approach for various kinds of splenic disease compared to multiport laparoscopic surgery.
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Humanos , Índice de Masa Corporal , Hemorragia , Laparoscopía , Laparotomía , Tiempo de Internación , Mortalidad , Tempo Operativo , Estudios Retrospectivos , Esplenectomía , Enfermedades del BazoRESUMEN
BACKGROUNDS/AIMS: The aim of this study was to compare operative versus non-operative management of patients with liver injury and to ascertain the differences of the clinical features. METHODS: From April 2000 to July 2012, 191 patients were admitted to Seoul St. Mary's Hospital and St. Vincent's Hospital for liver injuries. Of these, 148 patients were included in this study. All patients were diagnosed using computed tomography (CT). The liver injury was graded in accordance with the American Association for the Surgery of Trauma liver injury scoring scale. Patients were divided into two groups: those who underwent surgery and those treated with non-operative management (NOM). There was a comparison between these two groups concerning the clinical characteristics, grade of liver injury, hemodynamic stability, laboratory findings, and mortality. RESULTS: According to the 148 patient records evaluated, 108 (72.9%) patients were treated with NOM, and 40 (27.1%) underwent surgery. Patients treated with NOM had significantly fewer severe injuries as rated using the Revised Traumatic Injury Scale, Injury Severity Score, and Glasgow Coma Scale. Grade of liver injury and number of patients with extravasation of contrast dye on CT and hemoperitoneum were higher in the operative group than in the NOM group. There were significant differences between the two groups for: heart rate, respiratory rate, systolic blood pressure, and mean hemoglobin levels at admission and after 4 hours. The operative group experienced a significantly higher mortality than the NOM group. CONCLUSIONS: The results of our study suggest that hemodynamic stability and the following should be considered for deciding the treatment for liver injuries: grade of liver injury, amount of blood loss, and injury scales scores.
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Humanos , Traumatismos Abdominales , Presión Sanguínea , Escala de Coma de Glasgow , Frecuencia Cardíaca , Hemodinámica , Hemoperitoneo , Puntaje de Gravedad del Traumatismo , Hígado , Mortalidad , Frecuencia Respiratoria , Seúl , Pesos y MedidasRESUMEN
Laparoscopic spleen-preserving distal pancreatectomy has been widely performed for benign and borderline malignancy in the body or tail of the pancreas when there are not oncologic indications for splenectomy. As the need for minimally invasive procedures to reduce postoperative morbidity and improve the quality of life is increasing, many surgeons have attempted to reduce the number of trocars and incision size to minimize access trauma and scarring. Single-port laparoscopic spleen-preserving distal pancreatectomy is the result of these efforts; however it has many limitations such as technical difficulty and prolonged operation time. In this article, we report the first case of dual-incision laparoscopic spleen-preserving distal pancreatectomy, proving that it can be a safe and feasible minimally invasive procedure for benign or borderline malignant tumors in the body or tail of the pancreas.