A comparison between totally laparoscopic hydrocelectomy and scrotal incision hydrocelectomy with laparoscopic high ligation for pediatric cord hydrocele.

BACKGROUND: The purpose of this study is to report clinical characteristics and to investigate the feasibility and safety of totally laparoscopic hydrocelectomy (TLH) compared to scrotal incision hydrocelectomy with laparoscopic high ligation (SIH) for pediatric cord hydrocele (CH). METHODS: From September 2011 to February 2016, 148 patients underwent SIH, and 342 patients underwent TLH for CH. In the TLH group, a large hydrocele that could not pass through the internal ring was removed after percutaneous syringe aspiration. Age, laterality of hydrocele, inguinal comorbidities, operation time, surgical complications, and recurrences were evaluated. RESULTS: All the patients had spermatic cord cysts and patent processus vaginalis in proximity to hydrocele (mixed type). The mean age of CH patients was 34.1 ± 22.1 months. CHs are more common on the right side (61.0%) than on the left (35.7%). Bilaterality occurred in 3.3%. Comorbidities such as hernia (8.6%) and cryptorchidism (1.2%) were observed. There were no complications except for two cases of wound hematoma in SIH group. There was one (0.7%) case of recurrence appeared in communicating hydrocele in SIH group. There were no significant differences in the age, laterality of hydrocele, inguinal comorbidities, operation time, complications, and recurrences between TLH and SIH groups. However, TLH for unilateral cord hydrocele had significantly shorter operation time compared to SIH. The mean operation time in TLH group was 15.6 ± 5.96 min and there was no conversion to open surgery. CONCLUSIONS: TLH for pediatric CH is a feasible and safe procedure without additional incisions. Therefore, TLH can be one of the surgical options for pediatric CH especially in mixed type.

The Characteristics and Short-Term Surgical Outcomes of Adolescent Gynecomastia.

BACKGROUND: Most adolescent gynecomastia is resolved spontaneously in 3 years. But, persistent gynecomastia could have a negative influence on psychoemotional development on adolescence. The purpose of this study is to report the characteristics of adolescent gynecomastia patients who received the surgeries, and discuss the short-term surgical outcomes. METHODS: Of the 1454 patients who underwent gynecomastia surgery at Damsoyu hospital from January 2014 to May 2016, 71 were adolescents. Subcutaneous mastectomy with liposuction was performed for adolescent patients who had gynecomastia for more than 3 years and showed psychosocial distress. Demographic and outcome variables were retrospectively analyzed. RESULTS: The mean age was 17.5 ± 0.77 years old. All gynecomastia cases were bilateral. Simon's grade IIa (35 patients, 49.3%) was the most common, and grade III was not observed. Fifty-one patients (71.8%) were classified as having a glandular-type breast component. Fourteen patients (19.7%) had complications, but only 3 cases (4.2%) required revision. Most of the patients (70 patients, 98.6%) were satisfied with the esthetic results, and the average 5-point Likert score was 4.85 ± 0.40. Recurrence was not observed. As the Simon's grade increased from I to IIA, a higher BMI, larger amounts of breast tissue, and longer operation times were observed. CONCLUSIONS: Gynecomastia that did not regress spontaneously was mostly the glandular type, so not only liposuction but also surgical removal of glandular tissue is necessary. Surgical treatment, selectively performed in patients who have had gynecomastia for 3 years, and have experienced psychosocial distress, could be an acceptable treatment for adolescent gynecomastia. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266 .

Accessory Axillary Breast Excision with Liposuction Using Minimal Incision: A Preliminary Report.

BACKGROUND: Accessory breasts have received little attention in the surgical fields, although the condition is quite common in the female population, with 2-6% of women suffering from it. Its convexity and cyclic pain make women feel embarrassed and uncomfortable, so patients often desire surgical excision to improve their appearances and to remove the pain. METHODS: A total of 967 patients who had been treated by an excision of accessory breast tissue with liposuction using minimal incision from September 2013 to Dec 2015 at the Damsoyu Hospital were analyzed for clinical factors retrospectively. RESULTS: All 967 patients were female. There were 514 (53.2%) unmarried patients and 453 (46.8%) married patients. The major clinical manifestation was the problem in the appearance with cyclic pain in both unmarried and married groups (82.7 vs. 87.9%). Three types of accessory breasts were observed: 779 (80.6%) breast tissue only in axillae, 182 (18.8%) breast tissue with accessory nipple, and 6 (0.6%) breast tissue with accessory nipple-areolar complex. The mean operation time was 58 min. All cyclic axillar pain in our cases was resolved after the operation. Postoperative complications developed in 160 patients (16.55%). Among them, seroma after operation was the most common (11.27%). In our study, 95.65% of the patients were satisfied with the cosmetic outcomes. CONCLUSIONS: The surgical excision of accessory breasts with liposuction through the minimal incision is a safe and effective method to make women feel comfortable in clinical manifestations and be satisfied with their cosmetic axillar line. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Long-segment hypoplasia of great saphenous vein with posterior accessory saphenous vein as a connecting vein: a case report.

Aplasia or hypoplasia of great saphenous vein (GSV) is relatively common. Most of them are segmental and localized around the knee. They rarely extend to the inguinal area, yet in case of this, the anterior accessory saphenous vein (AASV) is the most common connecting vein. We report a case of a 22-year-old male who underwent surgery for pain and heaviness of the right calf. He had the hypoplasia of right GSV extended from below the popliteal crease to near the saphenofemoral junction with posterior ASV (PASV) as a connecting vein. Significant reflux was observed in PASV and GSV which are proximal to PASV. High ligation and stripping was performed, and symptoms improved after surgery. In this report, the author discussed a rare case of long-segment hypoplasia of GSV with PASV as a connecting vein.

Comparison of laparoscopy-assisted and totally laparoscopic distal gastrectomy: the short-term outcome at a low volume center.

PURPOSE: Laparoscopic gastrectomy has been adopted for the treatment of gastric cancer, and despite the technical difficulties, totally laparoscopic distal gastrectomy has been considered less invasive than laparoscopy-assisted distal gastrectomy. Although there have been many reports regarding the feasibility and safety of totally laparoscopic distal gastrectomy at large volume centers, few reports have been conducted at low-volume centers. The purpose of this study is to try to assess the feasibility and safety of totally laparoscopic distal gastrectomy at a low volume center through the analysis of short-term outcomes of totally laparoscopic distal gastrectomy compared with laparoscopy-assisted distal gastrectomy. MATERIALS AND METHODS: The clinical data and short-term surgical outcomes of 35 patients who had undergone laparoscopy-assisted distal gastrectomy between April 2007 and March 2010, and 37 patients who underwent totally laparoscopic distal gastrectomy between April 2010 and August 2012 were retrospectively reviewed. RESULTS: There was no significant difference in the demographic and clinical data. However the reconstruction method and extent of lymphadenectomy showed statistically significant differences. Operation time and estimated blood loss did not show significant differences. Surgical and medical complications did not show significant differences but postoperative courses including time-to-first oral intake and postoperative hospital stay were significantly increased. CONCLUSIONS: Our study shows that totally laparoscopic distal gastrectomy is technically feasible at a low volume center. Therefore, totally laparoscopic distal gastrectomy can be considered as one of the surgical treatment for early gastric cancer. However the possibility that totally laparoscopic distal gastrectomy may have less benefit should also be considered.