Validation of a scoring system to predict bladder dysfunction after laparoscopic rectal cancer surgery.

PURPOSE: A recent trend in  urinary catheter management in patients who underwent laparoscopic rectal cancer surgery is early removal. However, some patients develop bladder dysfunction and require urinary re-catheterization. In 2016, a scoring system to predict bladder dysfunction after laparoscopic rectal cancer surgery was developed in our institution. The aim of this study was to demonstrate the validity of this scoring system and to determine the suitability of patients for early removal of urinary catheter. METHODS: A single-center, retrospective study from a prospective database was conducted on 234 patients who underwent elective laparoscopic rectal cancer surgery between January 2016 and December 2019. According to bladder dysfunction predictive score, the urinary catheter was removed on the first postoperative day (low-risk group) and fifth postoperative day (high-risk group). After catheter removal, all patients were managed using in-house protocols. RESULTS: Of 234 patients, 130 (55.6%) were classified as a low-risk group. The overall incidence of bladder dysfunction was 8.5% (11/130) in the low-risk group and 13.5% (14/104) in the high-risk group. CONCLUSION: The scoring system developed to predict bladder dysfunction showed good overall performance for discriminating between patients suitable or not for early removal of urinary catheter after laparoscopic rectal cancer surgery.

Glycemic Status, Insulin Resistance, and Risk of Pancreatic Cancer Mortality in Individuals With and Without Diabetes.

INTRODUCTION: The impact of glycemic status and insulin resistance on the risk of pancreatic cancer in the nondiabetic population remains uncertain. We aimed to examine the association of glycemic status and insulin resistance with pancreatic cancer mortality in individuals with and without diabetes. METHODS: This is a cohort study of 572,021 Korean adults without cancer at baseline, who participated in repeat screening examinations which included fasting blood glucose, hemoglobin A1c, and insulin, and were followed for a median of 8.4 years (interquartile range, 5.3 -13.2 years). Vital status and pancreatic cancer mortality were ascertained through linkage to national death records. RESULTS: During 5,211,294 person-years of follow-up, 260 deaths from pancreatic cancer were identified, with a mortality rate of 5.0 per 10 person-years. In the overall population, the risk of pancreatic cancer mortality increased with increasing levels of glucose and hemoglobin A1c in a dose-response manner, and this association was observed even in individuals without diabetes. In nondiabetic individuals without previously diagnosed or screen-detected diabetes, insulin resistance and hyperinsulinemia were positively associated with increased pancreatic cancer mortality. Specifically, the multivariable-adjusted hazard ratio (95% confidence intervals) for pancreatic cancer mortality comparing the homeostatic model assessment of insulin resistance ≥75th percentile to the <75th percentile was 1.49 (1.08-2.05), and the corresponding hazard ratio comparing the insulin ≥75th percentile to the <75th percentile was 1.43 (1.05-1.95). These associations remained significant when introducing changes in insulin resistance, hyperinsulinemia, and other confounders during follow-up as time-varying covariates. DISCUSSION: Glycemic status, insulin resistance, and hyperinsulinemia, even in individuals without diabetes, were independently associated with an increased risk of pancreatic cancer mortality.

Clinical outcomes of single-incision robotic cholecystectomy versus conventional 3-port laparoscopic cholecystectomy

Background: Few studies have compared the surgical results of single-incision robotic cholecystectomy (SIRC) with those of conventional laparoscopic cholecystectomy (CLC). The purpose of this study was to evaluate the relative clinical efficacy of SIRC by comparing the number of postoperative days, pain level and complications between the 2 surgical methods. Methods: We retrospectively collected demographic, perioperative and postoperative data for all patients who underwent SIRC or CLC performed by a single surgeon from June 2016 to May 2017. Operative time was recorded, divided into anesthesia time, docking time, console time and total operation time. Postoperative pain was measured with the Numerical Pain Rating Scale. Results: A total of 121 patients underwent cholecystectomy during the study period, of whom 61 had SIRC and 60 had CLC. The mean total operation time of SIRC and CLC was 93.52 (SD 20.27) minutes and 37.67 (SD 19.73) minutes, respectively (p < 0.001). The total operation time excluding console time of SIRC was significantly longer than that of CLC (82.77 [SD 18.27] min v. 37.67 [SD 19.73] min) (p < 0.001). The mean Numerical Pain Rating Scale score was 4.73 (SD 1.23) (SIRC: 4.75 [SD 1.24]; CLC: 4.70 [SD 1.22]) (p = 0.8) within 1 hour after the operation; scores after 6 hours and 1 day decreased in a similar manner in the 2 groups (p = 0.1). Conclusion: Postoperative pain, use of an additional port, complication rates, operation time and cost of SIRC were similar to or greater than those of CLC. Large randomized controlled trials are needed to examine the true benefits of SIRC.

Contexte: Peu d'études ont comparé les résultats chirurgicaux de la cholécystectomie robotique par incision unique (CRIU) à ceux de la cholécystectomie laparoscopique classique (CLC). Le but de la présente étude était d'évaluer l'efficacité clinique relative de la CRIU en comparant le nombre de jours postopératoires, l'intensité de la douleur et les complications avec les 2 méthodes chirurgicales. Méthodes: Nous avons recueilli de manière rétrospective les données démographiques, périopératoires et postopératoires de tous les patients soumis à une CRIU ou à une CLC effectuée par un seul chirurgien entre juin 2016 et mai 2017. Le temps opératoire a été enregistré, subdivisé entre anesthésie, temps d'installation, temps à la console et durée totale de l'intervention. La douleur postopératoire a été mesurée au moyen d'une échelle numérique d'évaluation de la douleur. Résultats: En tout, 121 patients ont subi une cholécystectomie durant la période de l'étude, dont 61, une CRIU et 60, une CLC. La durée opératoire totale moyenne des CRIU et des CLC a été de 93,52 (É.-T. 20,27) minutes et de 37,67 (É.-T. 19,73) minutes, respectivement (p < 0,001). La durée opératoire totale excluant le temps à la console a été significativement plus longue avec la CRIU qu'avec la CLC (82,77 [É.-T. 18,27] minutes c. 37,67 [É.-T. 19,73] minutes) (p < 0,001). Le score moyen à l'échelle numérique d'évaluation de la douleur a été de 4,73 (É.-T. 1,23) (CRIU : 4,75 [É.-T. 1,24]; CLC : 4,70 [É.-T. 1,22]) (p = 0,8) 1 heure suivant l'intervention; après 6 heures et après 1 jour, les scores avaient diminué de façon similaire dans les 2 groupes (p = 0,1). Conclusion: La douleur postopératoire, l'utilisation d'un port additionnel, les taux de complication, le temps opératoire et le coût de la CRIU ont été similaires ou supérieurs à ceux de la CLC. Il faudra réaliser de plus grands essais randomisés et contrôlés pour analyser les bénéfices réels de la CRIU.

Scoring Systems Used to Predict Bladder Dysfunction After Laparoscopic Rectal Cancer Surgery.

BACKGROUND: Postoperative bladder dysfunction often occurs after rectal cancer surgery, necessitating long-term urinary catheter drainage. The aim of this study was to evaluate the feasibility of early catheter removal and to propose scoring systems that may predict urinary dysfunction after laparoscopic rectal cancer surgery. METHODS: A total of 110 patients who underwent elective laparoscopic rectal cancer surgery were included in this prospective observational study. The urinary catheter was removed on the first postoperative day. RESULTS: The overall incidence of bladder dysfunction was 29.1 % (32/110). The incidence of bladder dysfunction was significantly higher in patients with an age of 65 years or older, male gender, and anastomosis levels from the anal verge of 6 cm or below (P = 0.03, 0.002, and 0.03, respectively). By setting a cut-off of two of the risk factors, this simple scoring system can predict postoperative bladder dysfunction with sensitivity of 96.9 %, specificity of 50.0 %, and accuracy of 63.6 %. A scoring system based on regression coefficients was also conducted according to the following formula: bladder dysfunction predicting score = 18 (1 for male or 0 for female) +0.5 (age, years) -2 (anastomosis level, cm). With this method, a cut-off value of 35+ points predicts postoperative bladder dysfunction with a sensitivity of 81.3 %, specificity of 71.8 %, and accuracy of 74.5 %. CONCLUSIONS: Bladder dysfunction after laparoscopic rectal cancer surgery following early catheter removal occurred in 29.1 % of patients. Two scoring systems using three risk factors (age, male gender, and anastomosis level) may predict postoperative bladder dysfunction.

Prognostic significance of quantitative carcinoembryonic antigen and cytokeratin 20 mRNA detection in peritoneal washes of gastric cancer patients.

BACKGROUND/AIMS: Peritoneal carcinomatosis is the most common recurrence type in gastric cancer. Disseminated tumor cells derived from serosal invasion may be indicators of early peritoneal seeding and subsequent peritoneal dissemination. Reverse-transcriptase polymerase chain reaction (RT-PCR) techniques have been introduced to aid in detection of disseminated tumor cells in peritoneal washes, however, use of a single molecular marker lacks adequate sensitivity. We sought to improve both sensitivity and specificity in detecting disseminated tumor cells in peritoneal washes by using two markers; carcinoembryonic antigen (CEA) and cytokeratin 20 mRNA (CK20 mRNA). METHODOLOGY: Between July 2007 and June 2010, peritoneal washing samples were collected from 131 patients who underwent surgery for histologically proven gastric cancer. CEA and CK20 mRNA levels were quantified using a Light Cycler. RESULTS: Analysis using of the two markers had higher sensitivity (93.9%) and specificity (87.7%) than single marker detection (p<0.01, p<0.001 respectively). These analyses also correlated with various clinicopathological factors, and aided in predicting survival and peritoneal recurrence. CONCLUSIONS: Two-marker analysis has a significant correlation of survival or peritoneal recurrence in gastric cancer, and this analysis may be more useful as a prognostic predictor of peritoneal recurrence compared with RT-PCR mediated detection of CEA or CK20 alone.

Prognostic factors associated with long-term survival and recurrence in pancreatic adenocarcinoma.

BACKGROUND/AIMS: It is very important to determine the prognostic factors for pancreatic adenocarcinoma when choosing surgical and conservative management strategies. In this study, we identified prognostic factors for survival and recurrence in patients with histologically proven pancreatic adenocarcinoma. METHODOLOGY: Between January 2003 and December 2009, 82 patients with histologically proven pancreatic adenocarcinoma were considered for this study. Follow-up consisted of personal contact with patients or review of electronic medical records at this center and was terminated on December 31, 2011 or upon the patient's death. RESULTS: Overall survival rates of all patients at 1, 3, and 5 years were 51.9, 21.6 and 16.0%. Preoperative jaundice was the only independent prognostic factor for total pancreatic cancer patients, while N stage and perineural invasion in pathological findings was identified as an independent prognostic factor for survival of patients with surgical resection. Chemotherapy was the only independent prognostic factor for survival of patients who underwent palliative surgical bypass. CONCLUSIONS: Preoperative jaundice in any patients, lymph node metastasis, perineural invasion in patients with surgical resection, and chemotherapy in patients undergoing palliative surgical bypass are important prognostic factors for survival of pancreatic cancer.

Diagnostic performance of a novel ultrasound-based quantitative method to assess liver steatosis in histologically identified nonalcoholic fatty liver disease.

AIMS: To investigate the diagnostic performance of ultrasound-guided attenuation parameter (UGAP) for the detection of hepatic steatosis in nonalcoholic fatty liver disease (NAFLD) cohorts using histopathology as the reference standard andcomparing it with that of various imaging modalities. MATERIALS AND METHODS: A total of 87 subjects who underwent UGAP, controlled attenuation parameter (CAP), and magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) between December, 2020 and January, 2022 were enrolled. Of these patients, 38 patients had NAFLD. The association between UGAP and clinical and imaging parameters was assessed using Pearson's or Spearman's correlations. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the diagnostic performance. RESULTS: The UGAP and MRI-logPDFF demonstrated strong positive correlations (correlation coefficient= 0.704, P <0.0001). UGAP showed excellent diagnostic performance for distinguishing steatosis grade ≥1 with an AUROC of 0.821 (95% confidence interval [CI], 0.729-0.913), which was comparable to that of MRI-PDFF (0.829, 95%CI, 0.723-0.936). The AUROCs of BUSG (B-mode ultrasonography) (0.766, 95% CI, 0.767-0.856) and CAP (0.788, 95% CI, 0.684-0.891) were slightly lower than those of UGAP. The AUROCs of UGAP, MRI-PDFF, CAP, and BUSG for detecting steatosis grade ≥2 were 0.796 (95% CI, 0.616-0.975), 0.971 (95% CI, 0.936-1.000), 0.726 (95% CI, 0.561-0.891) and 0.774 (95% CI, 0.612-0.936), respectively. CONCLUSION: UGAP may be a valuable potential screening tool as a first-line assessment of liver steatosis in patients with NAFLD.

Short- and long-term outcomes of subtotal/total colectomy in the management of obstructive left colon cancer.

PURPOSE: Surgical management of obstructive left colon cancer (OLCC) is still a matter of debate. The classic Hartmann procedure (HP) has a disadvantage that requires a second major operation. Subtotal colectomy/total abdominal colectomy (STC/TC) with ileosigmoid or ileorectal anastomosis is proposed as an alternative procedure to avoid stoma and anastomotic leakage. However, doubts about morbidity and functional outcome and lack of long-term outcomes have made surgeons hesitate to perform this procedure. Therefore, this trial was designed to provide data for morbidity, functional outcomes, and long-term outcomes of STC/TC. METHODS: This study retrospectively analyzed consecutive cases of OLCC that were treated by STC/TC between January 2000 and November 2020 at a single tertiary referral center. Perioperative outcomes and long-term outcomes of STC/TC were analyzed. RESULTS: Twenty-five descending colon cancer (45.5%) and 30 sigmoid colon cancer cases (54.5%) were enrolled in this study. Postoperative complications occurred in 12 patients. The majority complication was postoperative ileus (10 of 12). Anastomotic leakage and perioperative mortality were not observed. At 6 to 12 weeks after the surgery, the median frequency of defecation was twice per day (interquartile range, 1-3 times per day). Eight patients (14.5%) required medication during this period, but only 3 of 8 patients required medication after 1 year. The 3-year disease-free survival was 72.7% and 3-year overall survival was 86.7%. CONCLUSION: The risk of anastomotic leakage is low after STC/TC. Functional and long-term outcomes are also acceptable. Therefore, STC/TC for OLCC is a safe, 1-stage procedure that does not require diverting stoma.

Effect of resection margin status on recurrence pattern and survival in distal pancreatectomy for left-sided pancreatic ductal adenocarcinoma.

BACKGROUND: The association of resection margin status with recurrence and survival after pancreatectomy for pancreas ductal adenocarcinoma (PDAC) remains controversial. The aim of this study was to identify the effect of R1 resection on recurrence pattern and survival after distal pancreatectomy for left-sided PDAC. METHODS: Patients who underwent distal pancreatectomy for PDAC at two high-volume institutions between January 2010 and December 2017 were retrospectively reviewed. Perioperative characteristics, pathological outcomes, recurrence pattern, and survival data were collected to compare R0 resection and R1 resection. RESULTS: Among 558 patients who underwent distal pancreatectomy for PDAC, 158 patients (28.3%) showed R1 resection margin. R1 patients were associated with large tumor size (3.3 cm vs. 3.7 cm, p = .006) and lower number of positive lymph nodes (1.3 vs. 2.0, p = .001). Median overall survival (37.3 months vs. 20.1 months, p < .001) and recurrence-free survival (14.6 months vs. 6.9 months, p < .001) significantly differed between the R0 and R1 groups. Disease recurrence patterns were not statistically different between the two groups (p = .182). Among the recurrence patterns, peritoneal carcinomatosis had the shortest recurrence-free survival (5.6 months, p < .05) and overall survival (13.6 months, p < .05) compared with all other recurrence patterns. CONCLUSIONS: R1 resection margin after distal pancreatectomy was associated with poor survival and early recurrence. There is no significant difference in recurrence pattern between R0 and R1. Among the recurrence patterns, peritoneal carcinomatosis showed the worst prognosis.

Prognostic significance of the metastatic lymph node ratio in patients with gastric cancer.

BACKGROUND: In gastric cancer, the classification of lymph node status is still a controversial prognostic factor. Recent studies have proposed a new prognostic factor (metastatic lymph node ratio: MLR) for gastric cancer patients who undergo curative resection. The present study tested the hypothesis that MLR was better than the current pN staging system by analyzing the correlation between MLR and the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) staging system, by analyzing the correlation between MLR and 5-year overall survival (OS), by comparing area under the curve (AUC), and by performing univariate and multivariate analyses for OS. METHODS: Of 409 patients who were diagnosed with gastric adenocarcinoma between January 2003 and December 2006, 370 patients underwent curative resection and were included in this study. The prognostic significance of the number of metastatic lymph nodes and the metastatic lymph node ratio were compared in AUC and univariate and multivariate Cox regression analyses. RESULTS: MLR was significantly correlated with the depth of invasion and the number of lymph node metastases (p < 0.001). Increasing MLR also was statistically correlated with a lower 5-year OS rate (p < 0.001). The AUC of MLR and the number of lymph node metastases were not significantly different (p = 0.825). MLR was an independent prognostic factor on multivariate analysis, but the number of metastatic lymph nodes was not. CONCLUSIONS: MLR can be a prognostic factor in patients who undergo radical resection for gastric cancer and can overcome the limitations of existing prognostic factors.

Correlation between cholecystectomy and development of non-alcoholic liver disease in the mouse model.

Background: Several clinical studies have suggested a strong correlation between cholecystectomy and the incidence of non-alcoholic fatty liver disease (NAFLD) although the exact correlation and causal relationship are unclear. This study aimed to investigate whether cholecystectomy increases the incidence of NAFLD or aggravates pre-existing NAFLD. Methods: Standard diet-fed and high-fat (HF) diet-fed mice were subjected to sham operation and cholecystectomy. In study 1, 20 standard diet-fed C57BL/6N mice were sacrificed at months 1, 2, and 4 post-surgery. Meanwhile, in study 2, 25 HF diet-induced NAFLD C57BL/6N mice were biopsied at months 2 and 3 post-surgery and sacrificed at month 6 post-surgery. The hepatic fatty acid and bile acid metabolic pathways and the hepatic bile composition were evaluated. Results: The bodyweight and biochemical parameters (hepatic enzyme, triglyceride, and cholesterol levels) were not significantly different between the standard diet-fed sham and cholecystectomy groups. The NAFLD activity score and the levels of hepatocyte apoptosis markers (Krt18 expression and DNA fragmentation) and de novo lipid synthesis genes were not significantly different between the standard diet-fed sham and cholecystectomy groups. Cholecystectomy did not exacerbate hepatic steatosis, inflammation, and ballooning in the HF diet-fed mice. Hepatic bile acid composition was not markedly different in the sham and cholecystectomy groups fed on standard or HF diet. Cholecystectomy significantly downregulated Cyp7a1 and Cyp27a1 mRNA levels at months 1 and 4 post-surgery but did not affect the degree of steatosis and triglyceride levels. Analysis of bile acid metabolism revealed that taurine-conjugated bile acids were significantly downregulated in the standard diet-fed and high-fat diet-fed mice, but the histological and biochemical parameters were not markedly different. Conclusions: Cholecystectomy did not increase the incidence of NAFLD in standard diet-fed mice. Additionally, NAFLD incidence was not significantly different between the HF diet-fed sham and cholecystectomy groups. Furthermore, the histological parameters were not markedly different between the sham and cholecystectomy groups fed on standard or HF diet. These findings suggest that cholecystectomy does not induce NAFLD.

Regulation of Hepatocyte Nuclear Factor 4α Attenuated Lipotoxicity but Increased Bile Acid Toxicity in Non-Alcoholic Fatty Liver Disease.

Hepatocyte nuclear factor 4 alpha (HNF4α) is a key master transcriptional factor for hepatic fat and bile acid metabolic pathways. We aimed to investigate the role of HNF4α in non-alcoholic fatty liver disease (NAFLD). The role of HNF4α was evaluated in free fatty acid-induced lipotoxicity and chenodeoxycholic acid (CDCA)-induced bile acid toxicity. Furthermore, the role of HNF4α was evaluated in a methionine choline deficiency (MCD)-diet-induced NAFLD model. The overexpression of HNF4α reduced intracellular lipid contents and attenuated palmitic acid (PA)-induced lipotoxicity. However, the protective effects of HNF4α were reversed when CDCA was used in a co-treatment with PA. HNF4α knockdown recovered cell death from bile acid toxicity. The inhibition of HNF4α decreased intrahepatic inflammation and the NAFLD activity score in the MCD model. Hepatic HNF4α inhibition can attenuate bile acid toxicity and be more effective as a therapeutic strategy in NAFLD patients; however, it is necessary to study the optimal timing of HNF4α inhibition.

ALS-L1023 from Melissa officinalis Alleviates Liver Fibrosis in a Non-Alcoholic Fatty Liver Disease Model.

ALS-L1023 is an ingredient extracted from Melissa officinalis L. (Labiatae; lemon balm), which is known as a natural medicine that suppresses angiogenesis. Herein, we aimed to determine whether ALS-L1023 could alleviate liver fibrosis in the non-alcoholic fatty liver disease (NAFLD) model. C57BL/6 wild-type male mice (age, 6 weeks old) were fed a choline-deficient high-fat diet (CDHFD) for 10 weeks to induce NAFLD. For the next 10 weeks, two groups of mice received the test drug along with CDHFD. Two doses (a low dose, 800 mg/kg/day; and a high dose, 1200 mg/kg/day) of ALS-L1023 were selected and mixed with feed for administration. Obeticholic acid (OCA; 10 mg/kg/day) was used as the positive control. Biochemical analysis revealed that the ALS-L1023 low-dose group had significantly decreased alanine transaminase and aspartate transaminase. The area of fibrosis significantly decreased due to the administration of ALS-L1023, and the anti-fibrotic effect of ALS-L1023 was greater than that of OCA. RNA sequencing revealed that the responder group had lower expression of genes related to the hedgehog-signaling pathway than the non-responder group. ALS-L1023 may exert anti-fibrotic effects in the NAFLD model, suggesting that it may provide potential benefits for the treatment of liver fibrosis.

Comparison of blowhole colostomy and loop ostomy for palliation of acute malignant colonic obstruction.

PURPOSE: Surgery to create a stoma for decompression might be required for unresectable stage IV cancer patients with complete colonic obstruction. The aim of this study was to compare the results of blowhole colostomy with those of loop ostomy. METHODS: Palliative ileostomy or colostomy procedures performed at a single center between January 2011 and October 2020, were analyzed retrospectively. Fifty-nine patients were identified during this period. The demographic characteristics and outcomes between the blowhole colostomy group (n=24) and the loop ostomy group (n=35) were compared. RESULTS: The median operative time tended to be shorter in the blowhole colostomy group (52.5 minutes; interquartile range [IQR], 43-65) than in the loop ostomy group (60 minutes; IQR, 40-107), but the difference did not reach statistical significance (P=0.162). The median length of hospital stay was significantly shorter with blowhole colostomy (blowhole, 13 days [IQR, 9-23]; loop, 21 days [IQR, 14-37]; P=0.013). Mean cecum diameter was significantly larger in the blowhole group than in the loop group (8.83±1.91 cm vs. 6.78±2.36 cm, P=0.001), and the emergency operation rate was higher in the blowhole group than in the loop group (22 of 24 [91.7%] vs. 23 of 35 [65.7%], P=0.021). CONCLUSION: In surgical emergencies, diverting a blowhole colostomy can be safe and effective for palliative management of colonic obstruction in patients with end-stage cancer and might reduce the operative time in emergent situations.

Laparoscopic repair of inguinal hernias: Risk factors for urinary retention and chronic pain after totally extraperitoneal repair and transabdominal preperitoneal repair.

Purpose: There are various opinions about the postoperative complications of the two methods for laparoscopic inguinal hernia surgery; totally extraperitoneal repair (TEP) and transabdominal preperitoneal repair (TAPP). The aim of this study was to compare the postoperative course after TAPP and TEP, focusing on immediate postoperative pain, incidence of postoperative urinary retention (POUR), and chronic pain. Methods: This study retrospectively analyzed a consecutive series of 344 inguinal hernia patients who were treated with laparoscopic surgery between November 2016 and December 2019 at a single tertiary referral center. Results: Patient demographics did not differ significantly between the groups. The operation time was significantly shorter in the TEP group than in the TAPP group (43.1 ± 14.9 minutes vs. 63.5 ± 16.5 minutes, p < 0.001). The postoperative pain scores were significantly lower in the TEP group than in the TAPP group immediately (3.6 ± 1.3 vs. 4.4 ± 1.1, p < 0.001) and 6 hours (1.5 ± 1.4 vs. 2.3 ± 1.8, p < 0.001) after the operation. The other complications did not differ significantly between the groups. Age was a significant risk factor for POUR (odds ratio [OR], 1.083; 95% confidence interval [CI], 1.018-1.151; p = 0.011), and history of benign prostate hyperplasia (BPH) was a significant risk factor for chronic pain (OR, 5.363; 95% CI, 1.028-27.962; p = 0.046). Conclusion: TEP and TAPP seem to be safe and effective for laparoscopic inguinal hernia repair and have similar postoperative outcomes. Age was a significant risk factor for POUR, and BPH history was a significant risk factor for chronic pain.

Safety of appendectomy during pregnancy in the totally laparoscopic age.

Purpose: Acute appendicitis is the most common nonobstetric indication for surgical intervention during pregnancy. In the argument of the optimal surgical approach to acute appendicitis in pregnancy, laparoscopy seems to be won with a similar complication rate and shorter postoperative recovery than open. We aimed to compare perioperative outcomes of appendectomy in pregnant and nonpregnant women in the totally laparoscopic age. Methods: We retrospectively analyzed 556 nonincidental appendectomies performed in women (aged 18-45 years) between January 2014 and December 2018. To reduce the confounding effects, we used propensity score considering the variables age, American Society of Anesthesiologists physical status classification, and the operative finding; whether the appendicitis was simple or complicated. After propensity score matching, the outcomes of 15 pregnant women were compared with those of the 30 nonpregnant women. Results: All the operations were performed with laparoscopy. Most of the pregnant cases were in their first and second trimester. The postoperative morbidity rate was significantly higher in the pregnant group before propensity score matching; however, the significance disappeared after matching. Operative outcomes and the parameters related to the postoperative recovery were not different between the two groups. Two patients in their first trimester decided to terminate the pregnancy after appendectomy. One patient in her second trimester experienced preterm labor which was resolved spontaneously. There was no other obstetric adverse outcome. Conclusion: In the laparoscopy age, appendectomy during pregnancy is safe and not associated with a significantly increased risk of postoperative complication.

Prognostic value of carcinoembryonic antigen and carbohydrate antigen 19-9 in periampullary cancer patients receiving pancreaticoduodenectomy.

BACKGROUND: We assessed the use of serum concentrations of carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) measured during the preoperative diagnostic workup as prognostic factors for survival in patients with periampullary carcinoma. METHODS: A retrospective review of patients diagnosed with periampullary carcinoma who underwent radical surgery was conducted. Factors related to the survival of periampullary carcinoma patients, including CA 19-9 and CEA, were analyzed. RESULTS: The mean age of the 112 patients included in the results was 66.41 ± 10.513 years. In the study, the percentage of patients with elevated serum CA 19-9 and CEA concentrations was 65.2% and 24.1%, respectively. CA 19-9 concentrations were correlated with the tumor stage, pre-operative jaundice, and lymphovascular invasion, but CEA concentrations were not. The median overall survival was longer for the normal serum CA 19-9 group than the group with increased CA 19-9 (56 months vs. 25 months, p = 0.003); however, there was no statistically significant difference between the normal serum CEA group and the group with increased CEA (43 months vs. 25 months, p = 0.077). Independent factors related to overall survival were sex, age, stage, presence of jaundice, lymphovascular invasion, perineural invasion, margin status, and elevated serum CA 19-9 concentrations. CONCLUSIONS: Periampullary carcinoma patients with elevated serum CA 19-9 concentrations at diagnosis are expected to have poor overall survival. CA 19-9 may be a useful marker for predicting prognosis in patients with periampullary carcinoma at the time of diagnosis.

Effect of abdominal binder after laparoscopic cholecystectomy on enhanced recovery: a randomized controlled trial.

Purpose: The purpose of this randomized controlled trial was to compare the effects of abdominal binder after laparoscopic cholecystectomy. Methods: From August to December 2020, 66 patients who were set to undergo cholecystectomy were selected for a prospective trial at Kangbuk Samsung Hospital, Seoul, Republic of Korea, and their clinical characteristics and postoperative surgical outcomes were evaluated. Among 66 patients, 33 patients belong to the abdominal binder group and the other 33 patients belong to the control group. Results: The average hospital stay was 2.46 ± 1.29 days, and was not significantly different between the two groups. The average postoperative pain score (visual analogue scale, 0-10) 12, 24, and 48 hours after surgery were not significantly different. However, the degree of comfort score was significantly higher for the control group patients (2.56 vs. 3.33, p < 0.001). Time to the first ambulation, walking ability, return of bowel function, time to full diet resumption, and the numbers of analgesics and antiemetics administered were not significantly different between the two groups. Conclusion: No postoperative recovery benefit and no reduction in hospital stay was found in patients who used an abdominal binder while undergoing laparoscopic cholecystectomy. Statistically, between the group that used the binder and the one that did not, no significant differences in surgical outcome nor postoperative outcome were observed. The only exception was that the degree of comfort score was significantly higher in the control group. Therefore, in terms of patient benefit and convenience, wearing an abdominal binder after laparoscopic cholecystectomy is not recommended.

Surgical outcomes of percutaneous transhepatic gallbladder drainage in acute cholecystitis grade II patients according to time of surgery.

BACKGROUND: The objective of this study was to determine the appropriate timing for surgical intervention for Grade II acute cholecystitis patients. The study compares the clinical outcomes of patients in Group A, who were treated with early laparoscopic cholecystectomy (ELC) within the first two weeks of hospitalization, and Group B, treated with delayed laparoscopic cholecystectomy (DLC) after recovering from symptoms and that received conservative treatment and were discharged for more than two weeks. METHODS: From November 2011 to June 2019, from a total of 196 acute cholecystitis patients that received percutaneous transhepatic gallbladder drainage (PTGBD) insertion, we conducted a retrospective review of the group that received early laparoscopic cholecystectomy within 2 weeks and the group that received delayed laparoscopic cholecystectomy. The clinical characteristics and post-treatment outcomes were evaluated. RESULTS: In all patients treated with PTGBD insertion, Group A, the patients who were treated with ELC, showed a significantly longer mean operative time than Group B, the patients who were treated with DLC (72.46 ± 46.396 vs. 54.08 ± 27.12, P = 0.001). Similarly, Group A showed a significantly longer postoperative hospital stay compared to Group B (5.71 ± 5.062 vs. 4.27 ± 2.931, P = 0.014). CONCLUSION: In patients with Grade II acute cholecystitis with PTGBD insertion, DLC produces better outcomes with shorter hospital stay and operative time than ELC. These results suggest that DLC may lead to a better outcome than ELC, specifically when deciding the timing for laparoscopic cholecystectomy in patients diagnosed with acute Grade II cholecystitis.

Early experience with laparoscopic treatment of liver tumors using a separable cluster electrode with a no-touch technique.

INTRODUCTION: Radiofrequency ablation (RFA) is one of the best curative treatments for hepatocellular carcinoma in selected patients, and this procedure can be applied either percutaneously or laparoscopically. Laparoscopic RFA has the benefit of direct visual control of the RFA procedure. Cluster electrodes (Octopus RF electrodes) can create a common ablation zone. AIM: Using these two methods (laparoscopic approach and no touch technique), this present study evaluated the technical and clinical outcomes of early experience with laparoscopic RFA and a no-touch technique. MATERIAL AND METHODS: Between November 2015 and November 2018, 21 patients underwent laparoscopic RFA for hepatocellular carcinoma with a no-touch technique using cluster electrodes. Laparoscopic RFA is recommended for patients with a contraindication for surgical resection, patients wants and a relative contraindication for conventional percutaneous RFA, such as lesions adjacent to the gastrointestinal tract, gallbladder, bile duct, or heart. RESULTS: In the 21 tumors, 2 were treated with a single electrode, 12 with 2 electrodes, and 7 tumors with 3 electrodes. The mean time of ablation per lesion was 20.43 ±8.77 min. There was no mortality, local tumor progression, delayed destructive biliary damage, or liver abscess at the follow-up computed tomography. No technical failures occurred. CONCLUSIONS: Laparoscopic RFA can access lesions for which percutaneous RFA is contraindicated or risky. Cluster electrodes can create sufficient ablation zones without contact and can achieve a sufficient margin with a low complication rate and no tumor dissemination. Therefore, laparoscopic RFA with a no-touch technique might be a safe and feasible treatment for HCC tumor in selected patients.