Laparoscopic Distal Gastrectomy in a Patient with Situs Inversus Totalis: A Case Report

민사홍,양한광,이창민,정헌진,이경규,서윤석,신청일,김형호 대한위암학회 2013 Journal of gastric cancer Vol.13 No.4

We report our experience with two cases of situs inversus totalis, both involving patients diagnosed with gastric cancer. These were a 52-year-old male with a preoperative staging of cT1bN0M0 and a 68-year-old male with a staging of cT2N0M0, both of whom underwentsurgery. The former was found to have vascular anomalies in the preoperative computed tomography, so we performed a computedtomography angiography with three-dimensional reconstruction. Laparoscopy-assisted distal gastrectomy with Billroth I anastomosis was performed with D1+ lymph node dissection, and a small laparotomy was made for extracorporeal anastomosis. In contrast, the latter case showed no vascular anomalies in the preoperative computed tomography, and totally laparoscopic distal gastrectomy with delta anastomosis was performed with D1+ lymph node dissection. There were no intraoperative problems in either patient and they were discharged without postoperative complications. Histopathological examination revealed a poorly differentiated adenocarcinoma (pT2N0M0) and a well-differentiated adenocarcinoma (pT1aN0M0), respectively.

Multi-DOF (Degree of Freedom) Articulating Laparoscopic Instrument is an Effective Device in Performing Challenging Sutures

민사홍,안상훈,김형호,조요석,박기범,이윤택,박영석,박도중 대한내시경복강경외과학회 2019 Journal of Minimally Invasive Surgery Vol.22 No.4

Purpose: Although laparoscopic surgery had been performed in clinical practice for over 30 years, there has not been much improvement on instruments. Several articulating laparoscopic instruments have been developed including the robotic system. A new multi-degree of freedom (DOF) articulating laparoscopic device has been developed. We compared the ability to perform challenging sutures between the new device and the robotic system. Methods: Five experienced surgeons with over 100 laparoscopic surgery cases performed the suture task with both instruments. Everyone was new at articulating instruments including a robotic system. The suturing task consisted of two vertical sutures, downward and upward vertical direction. The duration of needle grabbing, first surgical tie, square tie, and the final reverse tie was measured. Results: When doing the downward suture, the median time to complete the suture was 127 vs. 136 seconds for ArtiSential® and the robot, respectively (p=0.754). Other measurements such as needle grabbing, first tie, second tie and final knot did not show any significant difference between the two instruments. Upward suture also did not show a significant difference. The total completion time was 127 vs. 112 seconds for for ArtiSential® and the robot, respectively (p=0.675). Time taken in each interval did not show any significant difference. Conclusion: Both instruments performed the suturing tasks with no difference in duration. ArtiSential® can be mixed up with usual instruments. Surgeons can choose any device, but when articulation is needed, ArtiSential® could be an alternative choice to the robotic system.

Long-term Outcomes of Laparoscopic Versus Open Transhiatal Approach for the Treatment of Esophagogastric Junction Cancer

이윤택,민사홍,박기범,박영석,안상훈,박도중,김형호 대한위암학회 2019 Journal of gastric cancer Vol.19 No.1

Purpose: The laparoscopic transhiatal approach (LA) for adenocarcinoma of the esophagogastric junction (AEJ) is advantageous since it allows better visualization of the surgical field than the open approach (OA). We compared the surgical outcomes of the 2 approaches. Materials and Methods: We analyzed 108 patients with AEJ who underwent transhiatal distal esophagectomy and gastrectomy with curative intent between 2003 and 2015. Surgical outcomes were reviewed using electronic medical records. Results: The LA and OA were performed in 37 and 71 patients, respectively. Compared to the OA, the LA was associated with significantly shorter duration of postoperative hospital stay (9 vs. 11 days, P=0.001), shorter proximal resection margins (3 vs. 7 mm, P=0.004), and extended operative times (240 vs. 191 min, P=0.001). No significant difference was observed between the LA and OA for intraoperative blood loss (100 vs. 100 mL, P=0.392) or surgical morbidity rate (grade≥II) for complications (8.1% vs. 23.9%, P=0.080). Two cases of anastomotic leakage occurred in the OA group. The number of harvested lymph nodes was not significantly different between the LA and OA groups (54 vs. 51, P=0.889). The 5-year overall and 3-year relapse-free survival rates were 81.8% and 50.7% (P=0.024) and 77.3% and 46.4% (P=0.009) for the LA and OA groups, respectively. Multivariable analyses revealed no independent factors associated with overall survival. Conclusions: The LA is feasible and safe with short- and long-term oncologic outcomes similar to those of the OA.

Duodenal Perforation: Unusual Complication of Gastrostomy Tube Replacement

김수홍,민사홍,김현영,정성은 대한소아소화기영양학회 2014 Pediatric gastroenterology, hepatology & nutrition Vol.17 No.2

Feeding gastrostomy is widely used for children with feeding impairment. The replacement of gastrostomy tube is known as an easy and safe procedure. However, various complications associated with replacement of gastrostomy tube were reported, including fistula disruption and colo-cutaneous fistula. For replacement of gastrostomy tube in small children with small stomach, special cautions are needed. Here, we report a rare case of duodenal perforation as an acute complication after the replacement of gastrostomy tube for a 33-month-old girl.

Laparoscopic Treatment of Gastric Subepithelial Tumor: Finding Ways to Manage with Shorter Hospitalization Days

이상준,김형호,민사홍,박기범,김동욱,이윤택,박영석,안상훈,박도중 대한내시경복강경외과학회 2019 Journal of Minimally Invasive Surgery Vol.22 No.3

Purpose: The standard treatment for gastric subepithelial tumor (SET) is surgical resection, which is primarily performed via laparoscopy. The aims of this study were firstly to evaluate factors influencing morbidity and hospitalization after treatment of gastric SET, and secondly, to figure out the factors how to make shorter hospitalization with equal safety. Methods: We retrospectively enrolled 229 consecutive patients who underwent laparoscopic gastric wedge resection (LGWR) for gastric SET between August 2003 and December 2015. Patients were divided into two groups: the 3 days or less hospitalization group (N=82, group A) and the greater than 3 days hospitalization group (N=147, group B). Results: Median tumor size was 3.0 cm (range, 0.2~13.0 cm) and mean postoperative hospitalization was 4.27±2.15 days. There were 6 complications (2.6%), with no cases of mortality. In group A, tumors were smaller (3.0±1.1 cm vs. 3.6±1.9 cm, p<0.01) and more likely to be located on the greater curvature (28% vs. 15%, p<0.01) compared with group B. The tumor growth pattern (exophytic tumor: 72% in group A vs. 65% in group B, p=0.25) was not different between the two groups. Multivariate analysis showed that tumor size larger than 5 cm and posterior wall tumor location were risk factors for longer hospital stay. Conclusion: We could reduce the hospitalization of patients with gastric SET less than 5cm sized and located on other than the posterior wall within 3days. Those patients could be a candidate for day surgery.

Long-term Survival Outcomes of Laparoscopic Gastrectomy for Advanced Gastric Cancer: Five-year Results of a Phase II Prospective Clinical Trial

안상훈,강소현,이윤택,민사홍,박영석,박도중,김형호 대한위암학회 2019 Journal of gastric cancer Vol.19 No.1

Purpose: Despite an increased acceptance of laparoscopic gastrectomy (LG) in early gastric cancer (EGC), there is insufficient evidence for its oncological safety in advanced gastric cancer (AGC). This is a prospective phase II clinical trial to evaluate the feasibility of LG with D2 lymph node dissection (LND) in AGC. Materials and Methods: The primary endpoint was set as 3-year disease-free survival (DFS). The eligibility criteria were as follows: 20-80 years of age, cT2N0-cT4aN3, American Society of Anesthesiologists score of 3 or less, and no other malignancy. Patients were enrolled in this single-arm study between November 2008 and May 2012. Exclusion criteria included cT4b or M1, or having final pathologic results as EGC. All patients underwent D2 lymphadenectomy. Three-year DFS rates were estimated by the Kaplan-Meier method. Results: A total of 157 patients were enrolled. The overall local complication rate was 10.2%. Conversion to open surgery occurred in 11 patients (7.0%). The mean follow-up period was 55.0±20.4 months (1–81 months). The cumulative 3-year DFS rates were 76.3% for all stages, and 100%, 89.3%, 100%, 88.0%, 71.4%, and 35.3% for stage IB, IIA, IIB, IIIA, IIIB, and IIIC, respectively. Recurrence was observed in 37 patients (23.6%), including hematogenous (n=6), peritoneal (n=13), locoregional (n=1), distant node (n=8), and mixed recurrence (n=9). Conclusions: In addition to being technically feasible for treatment of AGC in terms of morbidity, LG with D2 LND for locally advanced gastric cancer showed acceptable 3-year DFS outcomes.

Survey of Information Acquisition and Satisfaction after Bariatric Surgery at a Tertiary Hospital in Korea

오슬기,정성아,고창석,민사홍,공충식,이인섭,김범수,육정환,유문원 대한비만학회 2024 Journal of obesity & metabolic syndrome Vol.33 No.1

Background: To determine how patients who underwent bariatric surgery at a tertiary hospital in Korea first considered and then decided to get the surgery and identify information gaps among patients and healthcare professionals. Methods: This study included 21 patients who underwent bariatric surgery to treat morbid obesity (body mass index [BMI] ≥35 or ≥30 kg/m2 together with obesity-related comorbidities) between August 2020 and February 2022. A telephone interview was conducted with the patients after at least 6 months had elapsed since the surgery. We asked how the patients decided to undergo bariatric surgery. We also inquired about their satisfaction with and concerns about the surgery. Results: Seventy-one percent of the patients were introduced to bariatric surgery following a recommendation from healthcare professionals, acquaintances, or social media. Most of the patients (52%) decided to undergo bariatric surgery based on recommendations from healthcare professionals in non-surgical departments. Satisfaction with the information provided differed among the patients. Post-surgical concerns were related to postoperative symptoms, weight regain, and psychological illness. Conclusion: Efforts are needed to raise awareness about bariatric surgery among healthcare professionals and the public. Tailored pre- and postoperative consultation may improve quality of life after bariatric surgery.

Clinicopathologic Characteristics of Young Gastric Cancer Patients: Diagnostic Staging Accuracy and Survival

Woochul Kim,Sangil Youn,원용준,민사홍,박영석,안상훈,박도중,김형호 대한내시경복강경외과학회 2020 Journal of Minimally Invasive Surgery Vol.23 No.4

Purpose: The purpose of this study was to investigate the clinicopathologic characteristics of young gastric cancer patients and analyze the risk factors for stage underestimation and survival. Methods: Relevant data of 5029 patients who underwent surgery for gastric cancer at Seoul National University Bundang Hospital between 2003 to 2014 were collected. Patients were divided based on age (younger group and older group). Clinical stages were compared to pathologic stages for accuracy, and risk factors for underestimation were analyzed using univariate and multivariate analysis regression. Overall survival and cancer-specific survival were analyzed using the Kaplan-Meier method. Results: A total of 4396 patients were eligible for inclusion. The younger group was an independent risk factor for nodal metastasis (RR=1.44, 95% CI 1.06~1.95) and an independent risk factor for clinical N-stage underestimation (RR=1.50, 95% CI=1.14~1.98). However, there was no significant difference in 5-year cancer-specific survival for both age groups (92.2% vs 90.2%, p=0.306). Conclusion: In conclusion, intra-operative investigation of T-stage with standard operation should be done in young gastric cancer patients as they have a higher incidence of lymph node metastasis, with greater frequency of stage underestimation.

비만대사수술 후 미세영양소 결핍의 발생과 치료

박영석 ( Young Suk Park ),박기범 ( Ki Bum Park ),민사홍 ( Sa-hong Min ),이윤택 ( Yoontaek Lee ),안상훈 ( Sang-hoon Ahn ),박도중 ( Do Joong Park ),김형호 ( Hyung-ho Kim ) 한국정맥경장영양학회 2017 한국정맥경장영양학회지 Vol.9 No.2

Bariatric surgery is considered one of the most effective methods of achieving long-term weight loss in morbidly obese patients. Nevertheless, bariatric procedures are associated with a number of complications, and nutrient deficiencies can lead to deleterious consequences. Furthermore, the diet of patients prior to bariatric surgery is often of poor nutrition quality that does not meet the recommended dietary guidelines for micronutrient intake. Therefore, optimization of the postoperative nutritional status should begin before surgery. This review covers the essential information about micronutrient management in patients before and after bariatric surgery.