Publications by authors named "Seong Uk Kwon"

14 Publications

  • Page 1 of 1

Evolution of the Konyang Standard Method for single incision laparoscopic cholecystectomy: the result from a thousand case of a single center experience.

Ann Surg Treat Res 2018 Aug 30;95(2):80-86. Epub 2018 Jul 30.

Department of Surgery, Konyang University Hospital, Daejeon, Korea.

Purpose: Single incision laparoscopic cholecystectomy (SILC) is increasingly performed worldwide. Accordingly, the Konyang Standard Method (KSM) for SILC has been developed over the past 6 years. We report the outcomes of our procedures.

Methods: Between April 2010 and December 2016, 1,005 patients underwent SILC at Konyang University Hospital. Initially 3-channel SILC with KSM was changed to 4-channel SILC using a modified technique with a snake retractor for exposure of Calot triangle; we called this a modified KSM (mKSM). Recently, we have used a commercial 4-channel (Glove) port for simplicity.

Results: SILC was performed in 323 patients with the KSM, in 645 with the mKSM, and in 37 with the commercial 4-channel port. Age was not significantly different between the 3 groups (P = 0.942). The postoperative hospital days (P = 0.051), operative time (P < 0.001) and intraoperative bleeding volume (P < 0.001) were significantly improved in the 3 groups. Drain insertion (P = 0.214), additional port insertion (P = 0.639), and postoperative complications (P = 0.608) were not significantly different in all groups. Postoperative complications were evaluated with the Clavien-Dindo classification. There were 3 cases (0.9%) over grade IIIb (bile duct injury, incisional hernia, duodenal perforation, or small bowel injury) with KSM and 3 (0.5%) with mKSM.

Conclusion: We evaluated the evolution of the KSM for SILC. The use of the mKSM with a commercial 4-channel port may be the safest and most effective method for SILC.
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http://dx.doi.org/10.4174/astr.2018.95.2.80DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6073040PMC
August 2018

Laparoscopic liver resection of hepatocellular carcinoma located in segments 7 or 8.

Surg Endosc 2018 Feb 20;32(2):872-878. Epub 2017 Jul 20.

Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.

Background: Many centers consider hepatocellular carcinoma (HCC) located in segments 7 or 8 to be unsuitable for laparoscopic liver resection (LLR). We evaluated the safety of LLR of HCC in segments 7 or 8 following the introduction of new laparoscopic techniques.

Methods: This retrospective study included 104 patients who underwent LLR (n = 46) or open liver resection (OLR) (n = 58) for HCC located in segments 7 or 8 between October 2004 and June 2015. The LLR group was subdivided into two subgroups according to whether LLR was performed before (Lap1; n = 29) or after (Lap2; n = 17) the introduction of the Pringle maneuver, intercostal trocars, and semi-lateral patient positioning.

Results: Non-anatomical resection was more frequent (63.0 vs. 29.3%; P < 0.001) and tumor size was smaller (2.8 vs. 4.7 cm; P < 0.001) in the LLR group than in the OLR group. Blood transfusion (P = 0.526), operation time (P = 0.267), postoperative complications (P = 0.051), and resection margin (P = 0.705) were similar in both groups. LLR was associated with less blood loss (550 vs. 700 ml, P = 0.030) and shorter hospital stay (8 vs. 10 days; P = 0.001). The 3-year overall (90.2 vs. 81.2%, P = 0.096) and disease-free survival (15.1 vs. 12.1%; P = 0.857) rates were similar in both groups. The Lap2 group has less blood loss (230 vs. 500 ml; P = 0.005) and shorter hospital stay (7 vs. 9 days; P = 0.038) compared with the Lap1 group.

Conclusion: LLR can be safely performed for HCC located in segments 7 or 8 with recent improvements in surgical techniques and accumulated experience.
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http://dx.doi.org/10.1007/s00464-017-5756-xDOI Listing
February 2018

Prediction of surgical outcomes of laparoscopic liver resections for hepatocellular carcinoma by defining surgical difficulty.

Surg Endosc 2017 12 19;31(12):5209-5218. Epub 2017 May 19.

Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.

Background: Several classification systems for assessing the surgical difficulty of laparoscopic liver resection (LLR) have been proposed. We evaluated three current classification systems, including traditional Major/Minor Classification, Complexity Classification, and the Difficulty Scoring System for predicting the surgical outcomes after LLR.

Methods: We reviewed the clinical data of 301 patients who underwent LLR for hepatocellular carcinoma between March 1, 2004 and June 30, 2015. We compared the intraoperative, pathologic, and postoperative outcomes according to the three classifications. We also compared the prognostic value of the three classifications using receiver operating characteristic (ROC) curves.

Results: The Major/Minor Classification, Complexity Classification, and the Difficulty Scoring System efficiently differentiated surgical difficulty in terms of blood loss (P = 0.001, P = 0.009, and P < 0.001, respectively) and operation time (all P < 0.001). Regarding intraoperative outcomes, the Difficulty Scoring System and Complexity Classification successfully differentiated the transfusion rate (P = 0.001 and P < 0.001, respectively). However, only the Complexity Classification adequately predicted severe postoperative complications (P = 0.032), the severity of complications (P < 0.001), and the length of hospital stay (P = 0.005). In ROC curve analysis, the Complexity Classification (area under the curve [AUC] = 0.611) outperformed the Major/Minor Classification (AUC = 0.544) and the Difficulty Scoring System (AUC = 0.530) for predicting severe postoperative complications. None of the classification systems predicted recurrence or patient survival.

Conclusion: The Complexity Classification was superior to the other methods for assessing surgical difficulty and predicting complications after LLR for hepatocellular carcinoma.
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http://dx.doi.org/10.1007/s00464-017-5589-7DOI Listing
December 2017

Comparative Performance of the Complexity Classification and the Conventional Major/Minor Classification for Predicting the Difficulty of Liver Resection for Hepatocellular Carcinoma.

Ann Surg 2018 Jan;267(1):18-23

Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.

Objective: To compare performances for predicting surgical difficulty and postoperative complications.

Background: An expert panel recently proposed a complexity classification for liver resection with 3 categories of complexity (low, medium, or high). We compared this new classification with the conventional major/minor classification.

Methods: We retrospectively reviewed 469 hepatocellular carcinoma patients who underwent liver resection between 1 January 1, 2004 and June 30, 2015. We used receiver-operating characteristic curve analysis to compare the performances of both classifications for predicting perioperative outcomes.

Results: Both classifications effectively differentiated subgroups of patients in terms of their intraoperative findings and short-term outcomes, including blood loss, transfusion rate, operation time, and postoperative hospital stay (all P < 0.05). The ability to predict complications was not significantly different between the major/minor classification and the complexity classification [area under the curve (AUC) 0.625 vs 0.617, respectively; P= 0.754). However, the complexity classification showed stronger correlations with blood loss (AUC 0.690 vs 0.617, respectively; P = 0.001) and operation time (AUC 0.727 vs 0.619, respectively; P < 0.001) compared with the major/minor classification. To check heterogeneity, the minor resection group was further divided into low (n = 184), medium (n = 149), and high complexity (n = 13) groups. Operation time and blood loss were significantly different among these 3 subgroups of patients.

Conclusions: The complexity classification outperformed the major/minor classification for predicting the surgical difficulty of liver resection.
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http://dx.doi.org/10.1097/SLA.0000000000002292DOI Listing
January 2018

Laparoscopic Anatomical Segment 2 Segmentectomy by the Glissonian Approach.

J Laparoendosc Adv Surg Tech A 2017 Aug 19;27(8):818-822. Epub 2016 Oct 19.

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea.

Background: When hepatocellular carcinoma (HCC) was located in segment 2 (S2), segment-oriented hepatectomy was more beneficial than left lateral sectionectomy as this type of anatomical resection preserved the volume of the nontumor-bearing segment. Herein, we presented 2 cases (1 with video) of laparoscopic anatomical S2 segmentectomy by the Glissonian approach.

Methods: The first patient was a 69-year-old woman, who had an incidentally detected liver nodule on abdominal ultrasound for systemic surveillance for her breast cancer. The preoperative liver function was Child-Pugh class A. Abdominal computed tomography showed a 2 cm low attenuating lesion in S2. Contrast magnetic resonance imaging (MRI) showed the same lesion with features more suggestive of HCC. In view of the inconclusive imaging findings, a needle biopsy was performed and it confirmed the diagnosis of HCC. The second patient was a 57-year-old man with hepatitis B and Child-Pugh class B liver cirrhosis. He had an enlarging nonenhancing liver nodule in S2 noted on MRI. Laparoscopic anatomical S2 segmentectomy was performed for these 2 patients.

Results: The operative time for the first and second patients was 240 and 185 minutes, respectively. The respective estimated intraoperative blood loss was 50 and 250 mL and no transfusion was necessary. The patients were discharged on the fourth and fifth postoperative day without any complications, respectively.

Conclusion: This study showed the feasibility of performing a laparoscopic S2 segmentectomy by the Glissonian approach.
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http://dx.doi.org/10.1089/lap.2016.0377DOI Listing
August 2017

Association of Remnant Liver Ischemia With Early Recurrence and Poor Survival After Liver Resection in Patients With Hepatocellular Carcinoma.

JAMA Surg 2017 04;152(4):386-392

Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

Importance: The remnant liver after hepatectomy may have inadequate blood supply, especially following nonanatomical resection or vascular damage.

Objective: To evaluate whether remnant liver ischemia (RLI) may have an adverse effect on long-term survival and morbidity after liver resection in patients with hepatocellular carcinoma.

Design, Setting, And Participants: This study was a retrospective analysis at Seoul National University Bundang Hospital. Remnant liver ischemia was graded on postoperative computed tomographic scans in 328 patients who underwent hepatectomy for hepatocellular carcinoma between January 1, 2004, and December 31, 2013.

Main Outcomes And Measures: Remnant liver ischemia was defined as reduced or absent contrast enhancement during the venous phase. Remnant liver ischemia was classified as minimal (none or marginal) or severe (partial, segmental, or necrotic).

Results: Among 328 patients (252 male and 76 female; age range, 26-83 years [mean age, 58.2 years]), radiologic signs of severe RLI were found in 98 patients (29.9%), of whom 63, 16, and 19 had partial, segmental, or necrotic RLI, respectively. These patients experienced more complications and longer hospital stay than patients with minimal RLI. Preoperative history of transarterial embolization (odds ratio [OR], 1.77; 95% CI, 1.02-3.03; P = .04), use of the Pringle maneuver (OR, 1.96; 95% CI, 1.08-3.58; P = .03), and longer operative time (OR, 1.003; 95% CI, 1.002-1.005; P < .001) were independent risk factors for severe RLI. Early recurrence rates within 6 (60.2% vs 9.6%) or 12 (79.6% vs 18.7%) months after hepatectomy were higher in patients with severe RLI than in patients without RLI (P < .001). Severe remnant liver ischemia was an independent risk factor for overall survival (OR, 6.98; 95% CI, 4.27-11.43; P < .001) and disease-free survival (OR, 5.15; 95% CI, 3.62-7.35; P < .001).

Conclusions And Relevance: Preventive management and technical refinements in hepatectomy are important to decrease the risk of RLI and to improve survival of patients with hepatocellular carcinoma.
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http://dx.doi.org/10.1001/jamasurg.2016.5040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470428PMC
April 2017

Laparoscopic Total Caudate Lobectomy for Hepatocellular Carcinoma.

J Laparoendosc Adv Surg Tech A 2017 Oct 17;27(10):1074-1078. Epub 2016 Nov 17.

1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea.

Background: Caudate lobe is located in the deep dorsal area of the liver between the portal triad and the inferior vena cava (IVC). Torrential bleeding can occur from the IVC and short hepatic veins during dissection. Isolated total caudate lobe resection is still rare and technically demanding. We herein present a video on the technical aspect of laparoscopic total caudate lobectomy.

Method: A 61-year-old woman was admitted for recurrent hepatocellular carcinoma detected on imaging. She had history of multifocal hepatocellular carcinoma in July 2015 and underwent open cholecystectomy, segment 6 and segment 8 tumorectomy. Ten months later, the computed tomography scan and magnetic resonance imaging showed a 1 cm arterial enhancing lesion in segment I (S1) with no other foci of recurrence. Laparoscopic total caudate lobectomy was contemplated.

Results: The operative time was 270 minutes. The intraoperative blood loss was 200 mL and blood transfusion was not necessary. The patient was discharged on the fourth postoperative day without any complications.

Conclusion: This report showed the safety and feasibility of laparoscopic total caudate lobectomy. Nonetheless, it is a technically demanding procedure. It should be performed in carefully selected patients and by experienced hepatobiliary surgeons proficient in laparoscopic liver resection.
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http://dx.doi.org/10.1089/lap.2016.0459DOI Listing
October 2017

Comparison of laparoscopic liver resection for hepatocellular carcinoma located in the posterosuperior segments or anterolateral segments: A case-matched analysis.

Surgery 2016 11 25;160(5):1219-1226. Epub 2016 Jun 25.

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University, College of Medicine, Seongnam, Republic of Korea.

Background: Laparoscopic liver resection is an attractive option for treating liver tumors. Laparoscopic liver resection is more difficult for hepatocellular carcinomas located in the posterosuperior segments than for hepatocellular carcinomas in the anterolateral segments. We compared perioperative and long-term outcomes between laparoscopic liver resection for hepatocellular carcinomas located in the posterosuperior and anterolateral segments.

Methods: We retrospectively reviewed the clinical data for 230 patients who underwent laparoscopic liver resection for hepatocellular carcinomas between September 2003 and July 2014. Of these, 116 patients were selected by case-matched analysis using age, sex, tumor number and size, Child-Pugh class, and extent of liver resection. Patients were classified into 2 groups according to tumor location: the anterolateral group (n = 58) and the posterosuperior group (n = 58).

Results: Operation time (355 minutes vs 212 minutes, P < .005), intraoperative blood loss (600 mL vs 410 mL, P < .001), and hospital stay (8.5 days vs 7 days, P = .040) were significantly greater in the posterosuperior group than in the anterolateral group. The open conversion (13.8% vs 10.3%, P = .777), postoperative complication (17.2% vs 10.3%, P = .420), 5-year overall survival (88.5% vs 85.7%, P = .370), and 5-year, recurrence-free survival (47.6% vs 40.9%, P = .678) rates were not significantly different between the posterosuperior and anterolateral groups.

Conclusion: Although laparoscopic liver resection is more difficult for hepatocellular carcinomas located in the posterosuperior segment, there were no differences in the short- and long-term outcomes between the posterosuperior and anterolateral groups. The perceived impact of tumor location on patient outcomes could be overcome by experience and technical improvements.
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http://dx.doi.org/10.1016/j.surg.2016.05.009DOI Listing
November 2016

Laparoscopic left lateral sectionectomy in patients with histologically confirmed cirrhosis.

Surg Oncol 2016 Sep 7;25(3):132-8. Epub 2016 May 7.

Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.

Background: Laparoscopic left lateral sectionectomy (LLS) is now considered as a standard practice. However, the safety of laparoscopic LLS in cirrhotic patients is unclear. This is the retrospective study of comparing the outcomes of laparoscopic LLS between cirrhotic and non-cirrhotic patients.

Methods: We reviewed the clinical data for 107 patients who underwent laparoscopic LLS between July 2003 and July 2013. The patients were divided into cirrhotic group (n = 31) and non-cirrhotic group (n = 76) with histologically confirmed F4 or F3 fibrosis.

Results: There were no differences between the two groups in terms of the operation time (P = 0.807), blood loss (P = 0.115), transfusion rate (P = 0.716), postoperative complication rate (P = 0.601) and duration of hospital stay (P = 0.261). Open conversion occurred in one non-cirrhotic patient (P = 1.000). The postoperative peak total bilirubin level was higher in cirrhotic patients than in non-cirrhotic patients (P < 0.001). Among patients with hepatocellular carcinoma, the disease-free survival (P = 0.249) and overall survival (P = 0.768) rates were not significantly different between cirrhotic patients (n = 28) and non-cirrhotic patients (n = 12). There were no significant differences in the complication rate (P = 0.085), operation time (P = 0.159), blood loss (P = 0.306), transfusion rate (P = 1.00), and hospital day (P = 0.408) between laparoscopic LLS and cases of open LLS performed in the same study period (n = 10).

Conclusions: Laparoscopic LLS is safe and reproducible, even in cirrhotic patients.
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http://dx.doi.org/10.1016/j.suronc.2016.05.001DOI Listing
September 2016

Laparoscopic spleen preserving distal pancreatectomy.

J Vis Surg 2016 23;2:146. Epub 2016 Aug 23.

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Sungnam, Korea.

Minimal invasive surgery is growing rapidly in vast fields of abdominal surgery. Nowadays, due to the development of laparoscopic instruments and improvement of surgical technique, laparoscopic pancreas surgery is becoming more widely adopted. Laparoscopic distal pancreatectomy has now become a standard procedure for the benign or borderline malignant tumor located in body or tail of pancreas, but laparoscopic spleen and splenic vessel preserving distal pancreatectomy is still a technically demanded operation. In this multimedia article, we will demonstrate our technique of laparoscopic spleen and splenic vessel preserving distal pancreatectomy.
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http://dx.doi.org/10.21037/jovs.2016.08.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5638268PMC
August 2016

Validation of difficulty scoring system for laparoscopic liver resection in patients who underwent laparoscopic left lateral sectionectomy.

Surg Endosc 2017 01 10;31(1):430-436. Epub 2016 Jun 10.

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.

Background: A difficulty scoring system (DSS) based on the extent of liver resection, tumor location, liver function, tumor size, and tumor proximity to major vessels was recently developed to assess the difficulty of various laparoscopic liver resection procedures. We validated DSS in patients who underwent laparoscopic left lateral sectionectomy (LLS).

Methods: We reviewed the clinical data of 124 patients who underwent laparoscopic LLS between July 2003 and November 2015 and validated the DSS in 90 patients who underwent laparoscopic LLS for tumor according to their surgical outcomes. We also developed and evaluated the modified DSS in 34 patients who underwent LLS for intrahepatic duct (IHD) stones.

Results: The DSS score ranged from 3 to 6 in laparoscopic LLS for tumors. The median blood loss (P = 0.002) was significantly different among patients divided into subgroups by DSS score. We made modified DSS for IHD stones using factors influencing longer operation time, including stone location (P = 0.002), atrophy of liver parenchyma (P = 0.012), ductal stricture <1 cm from the bifurcation (P = 0.047), and combined choledochoscopic examination for remnant IHD (P < 0.001). The modified DSS score for IHD stones ranged from 3 to 7. Blood loss (P = 0.02) and operation time (P < 0.001) were significantly different among subgroups of patients divided by their difficulty scores. The median hospital stay (P = 0.004) and operation time (P = 0.039) were significantly longer and the complication rate (P = 0.025) and complication grade (P = 0.021) were significantly greater in patients with IHD stones than in patients with tumors.

Conclusions: The surgical difficulty varies among patients undergoing the same laparoscopic LLS procedure. The modified DSS developed here can also be applied to patients with IHD stones.
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http://dx.doi.org/10.1007/s00464-016-4994-7DOI Listing
January 2017

Defining Surgical Difficulty According to the Perceived Complexity of Liver Resection: Validation of a Complexity Classification in Patients with Hepatocellular Carcinoma.

Ann Surg Oncol 2016 08 4;23(8):2602-9. Epub 2016 Jan 4.

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea.

Background: A classification system for defining the complexity of hepatectomy according to its technical difficulty was recently proposed as a consensus of a panel of experts. We validated this classification system for a prospective liver resection cohort in patients with hepatocellular carcinoma (HCC).

Method: The complexity classification separated liver resections into three categories of complexity (low, medium, or high). We retrospectively reviewed 150 open hepatectomies between 1 March 2004 and 30 November 2013 in patients with HCC, and compared the perioperative outcomes according to the complexity classification.

Results: No differences in patient demographics or pathologic findings were observed among the three groups according to the complexity classification, which effectively differentiated the three groups in terms of intraoperative findings and short-term outcomes. The mean estimated blood loss (p = 0.001), rate of blood transfusion (p < 0.001), and mean operation time (p < 0.001) were significantly different among the three groups. The rates of overall and major complications (p = 0.026 and 0.005, respectively) were significantly greater in the high-complexity group. Multivariate analysis showed that the complexity classification was independently associated with major complications (odds ratio 4.73; p = 0.040); however, overall patient survival (p = 0.139) and disease-free survival (p = 0.076) were not significantly different among the three groups.

Conclusion: The complexity classification effectively differentiated intraoperative and short-term outcomes, and was independently associated with major complications after hepatectomy in patients with HCC.
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http://dx.doi.org/10.1245/s10434-015-5058-2DOI Listing
August 2016

Outcomes of Simultaneous Major Liver Resection and Colorectal Surgery for Colorectal Liver Metastases.

J Gastrointest Surg 2016 Mar 15;20(3):554-63. Epub 2015 Oct 15.

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.

Background: The optimal surgical strategy for treating colorectal cancer liver metastases (CRLM) in patients requiring major liver resection (MLR) is controversial, especially in rectal cancer patients.

Method: Between March 2004 and January 2015, 103 patients underwent MLR for CRLM and underwent MLR simultaneously with colorectal surgery (simultaneous group; n = 55) or MLR after colorectal surgery (liver-only group; n = 48).

Results: There were no significant differences in sex, age, ASA score, BMI, size and number of liver metastases, liver resection margin, surgical outcomes, and estimated blood loss. The rates of postoperative complications (simultaneous group vs. liver-only group; 76.4 % vs. 62.5 %; P = 0.126) and major complications (29.0 % vs. 25.0 %; P = 0.513) were also similar in both groups. The time to starting a soft diet was longer in the simultaneous group (6.0 days vs. 3.4 days; P < 0.001), but the length of hospital stay was similar (14.9 days vs. 13.3 days; P = 0.345). There were no perioperative deaths, anastomotic leakage, or septic complications. Among patients who underwent rectal surgery, the frequency of complications was greater in the simultaneous group (87.0 % vs. 56.2 %; P = 0.031), but there was no difference in major complications (34.7 % vs. 25.0 %; P = 0.822). The postoperative morbidity index was 0.204 and 0.180 in the simultaneous and liver-only groups, respectively, in all patients, and was 0.227 and 0.136, respectively, in the rectal surgery subgroup.

Conclusion: Simultaneous MLR is feasible and safe in synchronous CRLM patients, including rectal cancer patients.
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http://dx.doi.org/10.1007/s11605-015-2979-9DOI Listing
March 2016

Comparison of Bile Drainage Methods after Laparoscopic CBD Exploration.

Korean J Hepatobiliary Pancreat Surg 2011 May 31;15(2):117-22. Epub 2011 May 31.

Department of Surgery, Konyang University College of Medicine, Korea.

Purpose: T-tube is a major procedure that prevents complication by biliary decompression, but which is accompanied by complications. Therefore, several procedures such as ENBD, PTBD, and antegrade biliary stent have been attempted, but with controversies as to which procedure is superior. Also, there are no standard procedures after laparoscopic CBD exploration. We performed this study to ascertain the most appropriate biliary drainage procedure after laparoscopic CBD exploration.

Methods: From March 2001 to December 2009, 121 patients who underwent Laparoscopic CBD exploration in Gunyang University were included for retrospective analysis. The patients were divided to 4 groups according to type of procedure, and we compared clinical parameters including age and gender, operation time, hospital stay, start of post-operative diet, and complications.

Results: There was no difference in age, gender, mean operation time, postoperative diet between the 4 groups. Hospital stay in the Stent group was shorter than T-tube group. There were 10 (7%) complications that occurred. Two 2 occurred in the T-tube, 3 in PTBD, and 5 in the Antegrade stent group. There were more complications in Stent group but no significant statistical difference. In 5 cases with remnant CBD stone, a total of 4 (3 PTBD, 1 Stent) was performed by endoscopic CBD stone removal. One T-tube case was removed easily by choledochoscopy through the T-tube. Three migrated and the impacted stents were removed by additional endoscopy. Perioperative biliary leakage (1) and peritonitis (1) post t-tube removal were resolved by conservative treatment.

Conclusion: T-tube appears to be an appropriate method to patients who are suspected to have remnant CBD stones. Multiple procedures may be performed on a case by case basis such as performing PTBD first in a suspected cholangitis patient.
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http://dx.doi.org/10.14701/kjhbps.2011.15.2.117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582548PMC
May 2011
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