Documents published in 2017 : Scipedia

Risk factors for postoperative complications in patients on maintenance hemodialysis who undergo abdominal surgery
. Tomoaki Ito, . Hiroshi Maekawa, . Mutsumi Sakurada, . Hajime Orita, . Tomoyuki Kushida, . Koji Senuma, . Koichi Sato

Asian Journal of Surgery (2016). Vol. 39

Abstract
Patients on hemodialysis (HD) who undergo abdominal surgery for gastrointestinal disease are at increased risk of postoperative complications. In this study, we retrospectively investigated the predictors of postoperative complications among such patients. The study group comprised 36 HD patients who underwent abdominal surgery for gastrointestinal disease between 2003 and 2012. The clinicopathological factors of the patients who did and did not suffer postoperative complications were compared. The overall morbidity and mortality rates were 39% (14/36) and 14% (5/36), respectively. Physical status according to the American Society of Anesthesiologists (ASA) classification (p = 0.0203) and intraoperative blood loss (p = 0.0013) were found to differ significantly between the groups. The morbidity and mortality rates of HD patients who underwent abdominal surgery for gastrointestinal disease were high. Physical status according to the ASA classification and intraoperative blood loss were found to be associated with postoperative complications. Therefore, patients with comorbidities, such as heart disease and diabetes mellitus, have to be treated appropriately before surgery. In addition, it is important that surgeons perform operations carefully and avoid excessive blood loss.
Abstract
Patients on hemodialysis (HD) who undergo abdominal surgery for gastrointestinal disease are at increased risk of postoperative complications. In this study, we retrospectively [...]
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Administration of adjuvant oral tegafur/uracil chemotherapy post hepatocellular carcinoma resection: A randomized controlled trial
. Mitsuru Ishizuka, . Keiichi Kubota, . Takehiko Nemoto, . Mitsugi Shimoda, . Masato Kato, . Yukihiro Iso, . Kazuma Tago

Asian Journal of Surgery (2016). Vol. 39

Abstract
Recurrence of hepatocellular carcinoma (HCC) after surgery is frequent, and is an important factor adversely influencing the long-term survival of patients. This prospective study evaluated whether adjuvant chemotherapy with oral tegafur/uracil (UFT) reduces the recurrence rate of HCC. In addition, expression of thymidylate synthase (TS) and dihydropyrimidine dehydrogenase (DPD) were investigated in resected tumors and nontumorous tissues, and the relationship between their expression and the effectiveness of UFT was examined. A total of 117 patients who underwent curative hepatic resection for HCC were randomly allocated to UFT 400 mg/d (n = 24, UFT group) or surgery alone (n = 56, control group). The primary endpoint was the recurrence-free survival rate, and the secondary endpoint was the overall survival rate. Expression of the DPD and TS genes were quantified with TaqMan reverse transcription-polymerase chain reaction assay using β-actin as an internal standard. The cut-off value was set at the mean value of TS and DPD expression. Among the 61 patients in the UFT group, 37 patients (60.6%) discontinued UFT within 1 month. Recurrence-free survival (p = 0.16) and overall survival (p = 0.29) were similar in the two groups. In the UFT group, recurrence-free survival did not differ significantly between high-TS (TS > 3.6) and high-DPD (DPD > 8.9, n = 10), and low-TS (TS ≤ 3.6) and low-DPD (DPD ≤ 8.9, n = 9) groups. However, there was a significant difference between the two groups in overall survival (p = 0.04). Peroral UFT administration fails to prolong the recurrence-free rates and overall survival rates, in comparison with surgery alone. However, oral administration of UFT may improve the survival of HCC patients when the levels of TS and DPD mRNA are low in the tumor tissue.
Abstract
Recurrence of hepatocellular carcinoma (HCC) after surgery is frequent, and is an important factor adversely influencing the long-term survival of patients. This prospective [...]
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Needlescopic-assisted laparoendoscopic single-site adrenalectomy
. Shogo Inoue, . Mitsuru Kajiwara, . Jun Teishima, . Akio Matsubara

Asian Journal of Surgery (2016). Vol. 39

Abstract
Our objective was to compare the perioperative parameters of needle-assisted and conventional laparoendoscopic single-site adrenalectomy (LESS-A). We compared 23 patients undergoing needle-assisted LESS-A with 29 patients undergoing conventional LESS-A at Hiroshima University Hospital between November 2009 and February 2014. Needle-assisted LESS-A was performed using a MiniLap instrument (Stryker, San Jose, CA, USA). We used this instrument to protectively retract the liver at the right side of the tumor and the spleen at the left side by grasping with a Securea endoscopic surgical spacer (Hogy Medical Co., Ltd., Tokyo, Japan). Various parameters including insufflation time, estimated blood loss, pain scale, resumption of oral intake, transfusion rate, and complications were analyzed using the Mann–Whitney U test. In all cases, LESS-A was completed successfully with no major intraoperative complications. Patients in both treatment groups had similar age, body mass index, sex, and laterality. Significantly, needle-assisted LESS-A was performed using the transumbilical approach rather than the subcostal approach. The insufflation time of the needle-assisted LESS-A was shorter than that of the conventional LESS-A (p = 0.0335). No patients required intraoperative or postoperative blood transfusions. Retrospective design and the small sample size are main limitations of this study. Needle-assisted LESS-A was performed safely and in a manner that mitigated many of the difficulties of LESS surgery.
Abstract
Our objective was to compare the perioperative parameters of needle-assisted and conventional laparoendoscopic single-site adrenalectomy (LESS-A). We compared 23 patients [...]
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Surgical results of reduced port laparoscopic adrenalectomy using a multichannel port in comparison with conventional laparoscopic adrenalectomy
J. Hyun Han, T. Ho Hong, Y. Kyoung You, D. Goo Kim

Asian Journal of Surgery (2017). Vol. 40

Abstract
We introduced a modified laparoscopic technique, dual-incision laparoscopic adrenalectomy (DILA), using a newly designed multichannel trocar, and we evaluated its perioperative outcomes and operative costs and compared them to those of conventional laparoscopic adrenalectomy (CLA). We retrospectively reviewed the medical records of 127 patients who underwent CLA with four trocars or DILA with two trocars at Seoul St. Marys Hospital, Seoul, Korea between October 2007 and September 2014. We analyzed the patients' surgical outcomes and perioperative morbidities. DILA was performed in 45 patients and CLA in 82 patients. There were no significant differences in operative time (DILA: 77.1 ± 28.4 minutes vs. CLA: 76.6 ± 28.0 minutes, p = 0.595) or estimated blood loss during surgery (DILA: 150.0 ± 85.5 mL vs. CLA: 175.5 ± 50.5 mL, p = 0.697). There were no differences in postoperative hospital stay, visual analog scale pain score, or postoperative complication rates between the two groups. However, the operative cost was significantly lower in the DILA group (DILA 813, 603 ± 48, 600 Korean won vs. CLA 968, 368 ± 56, 456 Korean won, p < 0.001). This study demonstrated that DILA is a safe and feasible surgical approach for adrenal diseases. DILA may reduce the operative cost significantly compared with CLA.
Abstract
We introduced a modified laparoscopic technique, dual-incision laparoscopic adrenalectomy (DILA), using a newly designed multichannel trocar, and we evaluated its perioperative [...]
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Laparoendoscopic single-site adrenalectomy in patients with primary hyperaldosteronism: A prospective study with long-term follow up
. Ya-Hui Hu, . Che-Hsiung Wu, . Leay-Kiaw Er, C. Da Lin, . Ying-Buh Liu, . Shih-Chieh Chueh, . Yao-Chou Tsai

Asian Journal of Surgery (2017). Vol. 40

Abstract
Laparoendoscopic single-site (LESS) adrenalectomy is a promising minimally invasive technique, however, the current evidence has not confirmed its long-term effectiveness in primary aldosteronism (PA). We conducted a study to analyze the long-term efficacy of LESS adrenalectomy in patients with PA. A total of 49 patients who had been clinically confirmed with PA who had an indication for unilateral adrenalectomy were included in this study. Perioperative data were obtained for all patients. Blood pressure and the levels of serum aldosterone, renin, and potassium were checked periodically. The median follow-up was 16.5 months. No intra- or early post-operative complication occurred. All LESS adrenalectomies were completed successfully, except one with laparoscopic conversion. Hypokalemia was resolved in all cases and no patient required potassium supplements after surgery. Post-operative cure of hypertension was achieved in 63% of our patients. Overall, 84% of our PA patients had clinical improvement in blood pressure control after surgery. Our long-term experience revealed that LESS adrenalectomy is a safe and effective approach, which demonstrated comparable long-term cure and improvement of hypertension to a conventional laparoscopic series in treating PA.
Abstract
Laparoendoscopic single-site (LESS) adrenalectomy is a promising minimally invasive technique, however, the current evidence has not confirmed its long-term effectiveness [...]
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Clinical experience of infective endocarditis complicated by acute cerebrovascular accidents
. Chan-Yang Hsu, . Nai-Hsin Chi, . Shoei-Shen Wang, . Yih-Sharng Chen, . Hsi-Yu Yu

Asian Journal of Surgery (2017). Vol. 40

Abstract
To evaluate the clinical results of patients with infective endocarditis (IE) complicated by acute cerebrovascular accidents (CVAs). A total of 44 patients with IE complicated by CVA at admission were retrospectively analyzed in a single medical institute from 2005 to 2011. At the time of admission, 18 patients were diagnosed with hemorrhagic stroke, and 26 patients were diagnosed with ischemic stroke. Fifteen patients received surgical intervention during hospitalization. The hospital mortality rate was 38.9% for the hemorrhagic stroke group and 42.3% for the ischemic stroke group (p = 0.821). The mortality rate was 33.3% for the surgical group and 44.8% for the nonsurgical group (p = 0.531). At 30 days of hospitalization, 45.8% of the patients experienced an adverse event (defined as death due to organ failure, restroke, cardiogenic shock, or septic shock during the treatment period), and the attrition rate was 1.5% per day. Surgery performed after the adverse events increased mortality (80.0%) compared with surgery performed on patients with no adverse events (10.0%, p = 0.017). A Cox regression analysis revealed that creatinine > 2 mg/dL, diabetes, and staphylococcal infection were the risk factors of the adverse events. Early surgical intervention for IE with ischemic stroke may prevent adverse events, particularly in patients with impaired renal function, diabetes, or staphylococcal infection. A delay in operation of > 30 days is recommended after hemorrhagic stroke.
Abstract
To evaluate the clinical results of patients with infective endocarditis (IE) complicated by acute cerebrovascular accidents (CVAs). A total of 44 patients with IE complicated [...]
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Predicting rectal cancer T stage using circumferential tumor extent determined by computed tomography colonography
. Hisanaga Horie, . Kazutomo Togashi, . Kenichi Utano, . Yasuyuki Miyakura, A. T. Lefor, . Yoshikazu Yasuda

Asian Journal of Surgery (2016). Vol. 39

Abstract
Patients with stage T3 or T4 rectal cancer are candidates for neoadjuvant chemoradiation therapy. The aim of this study is to clarify the usefulness of circumferential tumor extent determined by computed tomography (CT) colonography in differentiating T3 or T4 from T1 or T2 rectal cancer. Seventy consecutive rectal cancer patients who underwent curative-intent surgery were enrolled in this study. All patients underwent colonoscopy and CT colonography on the same day. The circumferential tumor extent was estimated in 10% increments. The pathological T stage was used as the reference. The median circumferential tumor extent evaluated by colonoscopy for T1 (n = 6), T2 (n = 21), and T3/T4 (n = 43) were 10%, 30%, and 80%, respectively (T1/T2 vs. T3/T4, p < 0.0001). The median circumferential tumor extent evaluated by CT colonography for T1, T2, and T3/T4 is 10%, 30%, and 70%, respectively (T1/T2 vs. T3/T4, p < 0.0001). The correlation coefficient between colonoscopy and CT colonography was very high (0.94). By defining a circumferential tumor extent ≥50% by CT colonography as the criterion for stage T3 or T4, the sensitivity, specificity, positive predictive value and accuracy were 72%, 88%, 91%, and 79%, respectively. Circumferential tumor extent ≥50% determined by CT colonography is a simple and potentially useful marker to identify candidates for neoadjuvant chemoradiation therapy.
Abstract
Patients with stage T3 or T4 rectal cancer are candidates for neoadjuvant chemoradiation therapy. The aim of this study is to clarify the usefulness of circumferential tumor [...]
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Evaluation of the POSSUM, p-POSSUM, o-POSSUM, and APACHE II scoring systems in predicting postoperative mortality and morbidity in gastric cancer patients
. Shikai Hong, . Shengying Wang, . Guozeng Xu, . JinLu Liu

Asian Journal of Surgery (2017).

Abstract
Gastric cancer is the fourth most prevalent cancer worldwide. The ability to accurately predict surgery-related morbidity and mortality is critical in deciding both the timing of surgery and choice of surgical procedure. The aim of this study is to compare the POSSUM, p-POSSUM, o-POSSUM, and APACHE II scoring systems for predicting surgical morbidity and mortality in Chinese gastric cancer patients, as well as to create new scoring systems to achieve better prediction. Data from 612 gastric cancer patients undergoing gastrectomy between January 2007 and December 2011 were included in this study. The predictive abilities of the four scoring systems were compared by examining observed-to-expected (O/E) ratios, the receiver operating characteristic curve, Student t test, and χ2 test results. The observed complication rate of 34% (n = 208) did not differ significantly from the rate of 36.6% (n = 208) predicted by the POSSUM scoring system (O/E ratio = 0.93). The observed mortality rate was 2.9% (n = 18). For predicting mortality, POSSUM had an O/E ratio of 0.34 as compared with p-POSSUM (O/E ratio = 0.91), o-POSSUM (O/E ratio = 1.26), and APACHE II (O/E ratio = 0.28). The POSSUM scoring system performed well with respect to predicting morbidity risk following gastric cancer resection. For predicting postoperative mortality, p-POSSUM and o-POSSUM exhibited superior performance relative to POSSUM and APACHE II.
Abstract
Gastric cancer is the fourth most prevalent cancer worldwide. The ability to accurately predict surgery-related morbidity and mortality is critical in deciding both the timing [...]
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Postoperative neutrophil-to-lymphocyte ratio of living-donor liver transplant: Association with graft size
. Hironori Hayashi, . Hiroyuki Takamura, . Yoshinao Ohbatake, . Shinichi Nakanuma, . Isamu Makino, . Hisatoshi Nakagawara, . Tomoharu Miyashita, . Hidehiro Tajima, . Sachio Fushida, . Tetsuo Ohta

Asian Journal of Surgery (2016). Vol. 39

Abstract
Issues related to small-for-size grafts in living donor liver transplantation (LDLT) are highly important. The neutrophil lymphocyte ratio (NLR) has been reported to be an inexpensive index of systemic inflammation for various diseases. We retrospectively evaluated the relationship between NLR and clinical course of 61 adult LDLT recipients in our institute until post-operative day 14. Patients were classified into two groups based on the graft volume divided by standard liver volume, as over 35% of graft volume divided by standard liver volume (GV/SLV) (Group L, n = 55) and under 35% of GV/SLV (Group S, n = 6). No differences were seen in background of the patients between the two groups. Also, absolute neutrophil, lymphocyte and platelet counts in both the groups showed no significant differences. In contrast, the NLR between the groups differed significantly from post-operative day 3 to 10, being higher in the Group S. In addition, the incidence of prolonged hyperbilirubinemia and small for size graft syndrome differed significantly between the two groups. Therefore, the elevation of post-operative NLR in the smaller graft group reflect suggestive pathophysiology of endothelial injuries that related to small for size graft syndrome in LDLT.
Abstract
Issues related to small-for-size grafts in living donor liver transplantation (LDLT) are highly important. The neutrophil lymphocyte ratio (NLR) has been reported to be an [...]
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Influence of a modified preservation solution in kidney transplantation: A comparative experimental study in a porcine model
. Mohammad Golriz, . Hamidreza Fonouni, . Gani Kuttymuratov, . Majid Esmaeilzadeh, M. Rad, . Parvin Jarahian, . Thomas Longerich, . Alireza Faridar, . Sepehr Abbasi, . Arianeb Mehrabi, M. M. Gebhard

Asian Journal of Surgery (2017). Vol. 40

Abstract
Currently, due to lack of optimal donors, more marginal organs are transplanted. Therefore, there is a high interest to ameliorate preischemic organ preservation, especially for critical donor organs. In this regard, a new histidine-tryptophane ketoglutarate (HTK-N) solution has been designed and its protective efficacy was compared with the standard preservation solutions—University of Wisconsin solution and standard HTK or Custodiol (Bretschneiders solution). Seventy-two landrace pigs were included into the study, as donors and recipients. The donor kidneys were perfused during explantation with cold University of Wisconsin solution (n = 12), standard HTK (n = 12), or HTK-N solutions (n = 12), kept in the respective preservation solution at 4°C for 30 hours, implanted in the recipient pigs, and reperfused. The pigs survived in daily control for 7 days. The serum creatinine and blood urea nitrogen were assessed in pre- and postreperfusion phase on the 3rd day and 7th day posttransplantation. Additionally, tissue samples were taken to analyze the histopathological degree of tubular injury and regeneration before and after reperfusion. The three preservation groups were comparable in age, body weight, and hemodynamic parameters. According to statistical proof, they differed in none of the control parameters. Although the new preservation HTK solution is in several points a well-thought-out modification of the standard HTK solution, its preservation efficacy, at least for kidney preservation in a pig model for 30 hours, seems to be comparable to the current used solutions. A real advantage, however, could be confirmed in clinical settings, where marginal organs may influence the clinical outcome.
Abstract
Currently, due to lack of optimal donors, more marginal organs are transplanted. Therefore, there is a high interest to ameliorate preischemic organ preservation, especially [...]
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Evaluation of the modified HTK solution in pancreas transplantation—An experimental model
. Majid Esmaeilzadeh, . Hamidreza Fonouni, . Mohammad Golriz, . Ali Majlesara, . Gani Kuttymuratov, . Frank Bergmann, . Parvin Jarahian, . Zahra Khazaeipour, . Alireza Faridar, M. Rad, . Thomas Longerich, M. M. Gebhard, . Arianeb Mehrabi

Asian Journal of Surgery (2016). Vol. 39

Abstract
One of the great challenges in pancreas transplantation is the ischemia reperfusion injury. It is mentioned that free oxygen and/or nitrogen radicals play a prominent role in this phase. To minimize this problem, a modified histidine–tryptophan–ketoglutarate (HTK) solution that contains modified antioxidants has been developed. Our aim was to evaluate this solution in improving the viability of the pancreas in comparison with standard HTK and University of Wisconsin (UW) solutions in a porcine model of pancreas transplantation. Twenty-three Landrace pigs were divided into three identical groups. After a 10-hour preservation time at 4°C, the pancreas was implanted in the organs of the recipients in a standardized manner. Serum parameters were assessed prior to and after implantation on the 1st postoperative day, 3rd postoperative day, and 7th postoperative day. Furthermore, three biopsies were taken: prior to and after reperfusion, and on Day 7 to assess the grafts. An analysis of serum glucose among the three groups showed no significant differences. Evaluation of the insulin levels showed no significant difference between the modified and standard HTK groups, however, differences between HTK and UW were significant (p = 0.004 in favor of UW solutions). The histopathological results showed a trend of a higher grade of rejection of pancreas tissue in the UW group compared to both HTK groups. The modified HTK solution could preserve the pancreas for the preservation of the graft with similar results to those observed for standard solutions without any significant difference. The trend showed that the pathological finding in the UW group was not as good as that in the modified HTK and standard HTK groups.
Abstract
One of the great challenges in pancreas transplantation is the ischemia reperfusion injury. It is mentioned that free oxygen and/or nitrogen radicals play a prominent role [...]
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Comparison of Ho:Yag laser and pneumatic lithotripsy combined with transurethral prostatectomy in high burden bladder stones with benign prostatic hyperplasia
. Hakan Ercil, . Adem Altunkol, . Ergun Alma, M. Resit Goren, N. Can Sener, . Faruk Kuyucu, A. Karakoyunlu, . Ediz Vuruskan, . Ferhat Ortoglu, Z. Gurbuz

Asian Journal of Surgery (2016). Vol. 39

Abstract
To compare the efficacy and reliability of Ho:YAG laser lithotripsy (HLL) and pneumatic lithotripsy (PL) in the treatment of bladder stones in patients with benign prostatic hyperplasia and stones ≥ 20 mm who were transurethrally treated in the same surgical session. We studied the data of patients with benign prostatic hyperplasia and ≥20 mm bladder stones who were treated with transurethral resection of the prostate and cystolithotripsy in the same session, obtained between January 2010 and February 2014 from three urology clinics. All patients underwent bipolar plasmakinetic (PK) transurethral resection of the prostate. For treatment of the bladder stone, either HLL or PL was applied. A total of 62 patients were divided into two groups: PK-PL (Group 1, n = 29) and PK-HLL (Group 2, n = 33). The data of both groups were analyzed for stone dimensions, stone fragmentation time, total operating time, hospitalization duration, prostate dimensions, success rates, and complications. Group 1 included 29 patients with a mean age of 70 ± 7.6 (range, 57–85) years, whereas Group 2 included 33 patients with a mean age of 67.5 ± 10.5 (range, 45–84) years. In Group 1, five patients had mucosa injury, one patient had residual stone, and one patient had bladder perforation. In Group 2, three patients had mucosa injury, three patients had postoperative fever, and one patient had residual stone. Total operation time and stone fragmentation time were significantly lower in Group 2 (p < 0.05). The remaining analyzed data were similar (p > 0.05). PK-HLL using a single shaft without the need for repeated access has the advantages of shorter fragmentation and operation time.
Abstract
To compare the efficacy and reliability of Ho:YAG laser lithotripsy (HLL) and pneumatic lithotripsy (PL) in the treatment of bladder stones in patients with benign prostatic [...]
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Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes
. Mustafa Emiroglu, . Semra Salimoglu, . Cem Karaali, . Ismail Sert, . Osman Gungor, . Fatma Sert, . Cengiz Aydın

Asian Journal of Surgery (2017). Vol. 40

Abstract
To evaluate the long-term results of tumorectomy and concomitant bilateral oncoplastic reduction mammoplasty (ORM) for early stage breast cancer patients with macromastia in terms of local disease control and long-term oncological results. Data of 82 patients with macromastia undergoing ORM for breast cancer between 1996 and 2011 were retrospectively examined and evaluated with regard to oncological results. The median age was 50 years. The median follow-up was 121 months (range 28–212 months). The median breast volume was 1402 cm3 and the median weight of excised breast material was 679 g. The median surgical margin was 16 mm. Ten-year local recurrence rate was 8.7%. The 10-year overall survival rate was 82.2% and the disease-free survival rate was 73.2%. Early and late complication rates were 12.2% and 14.6%, respectively. From the standpoint of local disease control and long-term observation, ORM can be considered a very safe and acceptable treatment for early stage breast cancer in women with macromastia.
Abstract
To evaluate the long-term results of tumorectomy and concomitant bilateral oncoplastic reduction mammoplasty (ORM) for early stage breast cancer patients with macromastia [...]
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Factors determining low anterior resection syndrome after rectal cancer resection: A study in Thai patients
. Patomphon Ekkarat, T. Boonpipattanapong, . Kasaya Tantiphlachiva, . Surasak Sangkhathat

Asian Journal of Surgery (2016). Vol. 39

Abstract
Defective defecation function, also known as low anterior resection syndrome (LARS), is a common problem after surgical treatment of rectal cancer that has a detrimental effect on quality of life. This study aimed to look for the incidence of LARS in patients whose native rectum could not be kept and determine factors influencing major LARS. Rectal cancer patients who underwent tumor removal with mesorectal excision and colorectal anastomosis by a colorectal surgeon during the years 2004–2013 were asked to participate a structured interview using the verified version of the Low Anterior Resection Score questionnaire. Clinical parameters were analyzed against the incidence of major LARS. The cut-off anastomotic level that corresponded to the risk of major LARS was calculated by using a receiver operating characteristic curve. Anorectal physiology was compared between those with major LARS and those without LARS by anorectal manometry. This study included 129 patients (67 men and 62 women). Incidences of minor LARS (LAR score 21–29) and major LARS (LARS score ≥ 30) score 21een those with major LARS and those univariate analysis, factors associated with major LARS were extent of operation, presence of temporary ostomy, and chemoradiation therapy. Major LARS was found at 28.2% in those who underwent low anterior resection, which was significantly higher than the incidence of 5.2% in the anterior resection group (p < 0.01). Radiation therapy was the only factor independently associated with major LARS at an odds ratio of 6.55 (95% confidence interval: 2.37–18.15). The receiver operating characteristic curve plot between sensitivity and specificity of the anastomotic level in determining major LARS showed an area under the curve of 0.73. The cut-off anastomotic level that best predicted major LARS was at 5 cm, which gave a negative predictive value of 89%. Individual defecation symptoms that were significantly associated with major LARS included pain on defecation, difficulty holding stool, and needing to use a pad. Anorectal manometry showed a significant difference in the resting anal pressure and squeeze pressure, which suggests that derangement in sphincteric function caused by surgery and postoperative adjuvant treatment may contribute to the LARS. LARS is a significant problem found in about one third of rectal cancer patients after colorectal anastomosis. Symptoms of concern include pain on defecation and decreased ability to hold. Risk of having major LARS increases with adjuvant treatment and lower anastomotic level.
Abstract
Defective defecation function, also known as low anterior resection syndrome (LARS), is a common problem after surgical treatment of rectal cancer that has a detrimental effect [...]
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Predisposition and risk factor rates for pilonidal sinus disease
. Kazim Duman, A. Harlak, . Oner Mentes, A. K. Coskun

Asian Journal of Surgery (2016). Vol. 39
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The effects of obstructive jaundice on the brain: An experimental study
. Evren Dilektasli, . M.M. Ozmen, . Emre Gundogdu, . Hayrettin Dizen, . H.T. Besler, . Candan Ozogul

Asian Journal of Surgery (2016). Vol. 39

Abstract
The study aims to evaluate the alterations in the brain due to oxidative stress and lipid peroxidation resulting from obstructive jaundice. Forty-one Wistar albino rats were used in this study. Simple laparotomy was performed in the sham group (n = 5). In the remaining 36 rats, the common bile duct (CBD) was found and ligated. They were divided into six groups. Group I, Group II, and Group III were sacrificed at the 3rd, 7th, and 14th day of ligation, respectively. In Group Id, Group IId, and Group IIId ligated bile ducts were decompressed at the 3rd, 7th, and 14th day, respectively. One week after decompression these rats were also sacrificed and samples were taken. After the CBD ligation, serum levels of bilirubin and malondialdehyde were found to be increased progressively in parallel to the ligation time of the CBD. After decompression these values decreased. In electron microscopy evaluation, the damage was found to be irreversible depending on the length of the obstruction period. In Group II, the damage was mostly reversible after the internal drainage period of 7 days. However in Group III, the tissue damage was found to be irreversible despite the decreased values of oxidative stress and bilirubin. Ultrastructural changes in brain tissue including damage in the glial cells and neurons, were found to be irreversible if the CBD ligation period was >7 days and did not regress even after decompression. It is unreliable to trace these changes using blood levels of bilirubin and free radicals. Therefore, timing is extremely critical for medical therapies and drainage.
Abstract
The study aims to evaluate the alterations in the brain due to oxidative stress and lipid peroxidation resulting from obstructive jaundice. Forty-one Wistar albino rats were [...]
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Modified back wall first artery anastomosis technique in living donor liver transplantation
. Sacit Coban, . Fahrettin Yildiz

Asian Journal of Surgery (2015). Vol. 38

Abstract
Back wall technique is usually used for hepatic artery anastomosis in living donor liver-transplantation. In this technique, two stitches are placed in the two corners of the artery wall initially and the microclamp on the artery is rotated to place the sutures to the back wall first. In some cases, the microclamp cannot be rotated because of insufficient length of the graft or recipient artery. If this occurs, it may be difficult to rotate the artery to perform the back wall artery anastomosis technique. In these cases, the difficulty of performing the anastomosis can cause intimal tears. Thus, we prefer a modified technique for artery anastomosis in such situations. In this modified technique, two stitches are placed in the middle of the posterior wall and middle of the anterior wall initially. The artery is twisted 90° to the right side and to the left side respectively, instead of one 180° rotation, to place the back wall stitches. In this modified technique, reversing the microclamp is eliminated that can cause intimal damage. Therefore, it may be superior to the conventional method in terms of reducing the difficulty of performing anastomosis and intimal damage to the vessels.
Abstract
Back wall technique is usually used for hepatic artery anastomosis in living donor liver-transplantation. In this technique, two stitches are placed in the two corners of [...]
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Identifying risk factors for brain metastasis in breast cancer patients: Implication for a vigorous surveillance program
. Lorraine Chow, . Dacita Suen, K. Kuen Ma, . Ava Kwong

Asian Journal of Surgery (2015). Vol. 38

Abstract
Brain metastasis occurs in 10–15% of metastatic breast cancer patients and is associated with poor prognosis. This study aims to identify tumor characteristics of primary breast cancer, which are related to brain metastases in Hong Kong Chinese patients. A retrospective study of patients with invasive breast cancer receiving treatment in a university hospital from January 2001 to December 2008 was performed. The clinicopathological factors of patients with brain metastases were analyzed and compared with those who had no brain metastasis. Risk factors for brain metastasis were identified by univariate analysis first and then by multivariate analysis. A total of 912 patients with invasive breast cancer were treated during the study period. Of these, 30 patients were found to have distant metastases to brain. Patients with brain metastases had more breast tumors of higher histological grade (Grade III, 78.9% vs. 30.2%, p = 0.001). Their tumors also had a significantly higher rate of negative estrogen receptors (78.9% vs. 30.2%, p = 0.001). On multivariate analysis, only high tumor grading was found to be predictive of developing brain metastasis. Chinese breast cancer patients with brain metastasis were more likely to have high-grade tumors and negative estrogen receptor status. A more vigorous surveillance program for the central nervous system should be considered for this group of patients.
Abstract
Brain metastasis occurs in 10–15% of metastatic breast cancer patients and is associated with poor prognosis. This study aims to identify tumor characteristics of primary [...]
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New insights after the first 1000 liver transplantations at The University of Hong Kong
S. Ching Chan, T. To Cheung, A. C.Y. Chan, K. S.H. Chok, W. W. Sharr, J. Y.Y. Fung, C. Leung Liu, S. Tat Fan, C. Mau Lo

Asian Journal of Surgery (2016). Vol. 39

Abstract
One thousand liver transplantations have been performed at the only liver transplant center in Hong Kong over a period of 22 years, which covered the formative period of living donor liver transplantation. These 1000 transplantations, which marked the journey of liver transplantation from development to maturation at the center, should be educational. This research was to study the experience and to reflect on the importance of technical innovations and case selection. The first 1000 liver transplantations were studied. Key technical innovations and surgical therapeutics were described. Recipient survival including hospital mortality was analyzed. Recipient survival comparison was made for deceased donor liver transplantation and living donor liver transplantation indicated by hepatocellular carcinoma and other diseases. Among the 1000 transplantations, 418 used deceased donor grafts and 582 used living donor grafts. With the accumulation of experience, hospital mortality improved to < 2% in the past 2 years. In the treatment of diseases other than hepatocellular carcinoma, living donor liver transplantation was superior to deceased donor liver transplantation, with a 10-year recipient survival around 90%. Transplant outcomes have been improving consistently over the series, with a very low hospital mortality and a predictably high long-term survival.
Abstract
One thousand liver transplantations have been performed at the only liver transplant center in Hong Kong over a period of 22 years, which covered the formative period of living [...]
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Totally laparoscopic living donor right hepatectomy in a donor with trifurcation of bile duct
. Kuo-Hsin Chen, . Chun-Chieh Huang, . Tiing-Foong Siow, . U-Chon Chio, . Shian-Dian Chen, . Ying-Da Chen, . Tzu-Chao Lin, . Shu-Yi Huang, . Jiann-Ming Wu, . Kuo-Shyang Jeng

Asian Journal of Surgery (2016). Vol. 39

Abstract
Donor operation in adult living donor liver transplantation is associated with significant postoperative morbidity. To avoid laparotomy wound complications and shorten postoperative recovery, laparoscopic liver graft harvest has been developed recently. However, to determine the cut point of bile duct is challenging. Herein, we report the application of totally laparoscopic approach for right liver graft harvest in a donor with trifurcation of the bile duct. A19-year-old man volunteered for living donation to his father who suffered from hepatitis B virus-related cirrhosis of liver and hepatocellular carcinoma. The graft was 880 mL with a single right hepatic artery and portal vein. The graft to recipient weight ratio was 1.06. The middle hepatic vein was preserved for the donor and the liver remnant was 42.3%. Two branches of middle hepatic veins were > 5 mm in diameter and needed reconstruction with cryopreserved allograft. Ductoplasty using laparoscopic intracorporeal suture technique was done to achieve single orifice of the graft bile duct. The postoperative course was uneventful for the donor. This report adds evidence of the feasibility of pure laparoscopic right donor hepatectomy and describes the necessary steps for bile duct division in donors with trifurcation of bile duct.
Abstract
Donor operation in adult living donor liver transplantation is associated with significant postoperative morbidity. To avoid laparotomy wound complications and shorten postoperative [...]
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Bowel obstruction secondary to incarcerated obturator hernia
. Dawei Chen, Z. Fei, . Xiaojun Wang

Asian Journal of Surgery (2017). Vol. 40

Abstract
Obturator hernia is rare type of abdominal hernia and its diagnosis usually is made intraoperatively for bowel obstruction or computed tomography (CT) scans of the abdomen. The aim of this study was to review patients records with respect to clinical manifestation, CT scan findings, and operative outcomes. From April 2009 to January 2015, six female patients with incarcerated obturator hernia underwent urgent operation for acute intestinal obstruction. The medical records were reviewed with respect to clinical manifestation, findings of CT scan and the outcomes of operation. The median age of patients was 83 years (range, 79–87 years) and the body mass index was 21.61 ± 0.52 kg/m2. CT scans of abdomen demonstrated that intestinal obstruction secondary to obturator hernia, consistency with operative findings. Partial bowel resection was performed in two of six patients because of necrosis of incarcerated obturator hernia. The hernia was repaired with interrupted sutures. Lung infection occurred in one patient, and wound infection in another. One recurrence was observed and two patients died from the unrelated diseases during the period of follow-up. The diagnosis of obturator hernia can be made by CT scan preoperatively, and the obturator hernia should be suspected when an unexplained bowel obstruction in elderly, thin women occurs.
Abstract
Obturator hernia is rare type of abdominal hernia and its diagnosis usually is made intraoperatively for bowel obstruction or computed tomography (CT) scans of the abdomen. [...]
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The learning curve of the three-port two-instrument complete thoracoscopic lobectomy for lung cancer—A feasible technique worthy of popularization
. Yu-Jen Cheng

Asian Journal of Surgery (2015). Vol. 38

Abstract
Cosmetic factors are important when considering minimally invasive surgery. For cosmetic improvement, a complete thoracoscopic lobectomy is accomplished via the three-port two-instrument (TPTI) technique. The resected specimen is removed without extending the port wounds. Only three wounds at 1.2 cm are used to finish the procedure. From June 2012 to December 2013, 60 patients with lung cancer were to undergo lobectomy and complete mediastinal lymph node dissection via the TPTI technique without an accessory wound. The initial 28 cases (learning curve group) and the latest 28 cases were compared to assess the learning curve. Excluding four cases of conversion, there were 28 cases in each group. There were no differences between these two groups with respect to age, sex, tumor size, location of the lobectomy, mean blood loss, mean postoperative drainage time, and mean hospitalization time (p > 0.05). The mean surgery time significantly decreased, the mean number of lymph nodes removed significantly increased, and the postoperative stage was significantly more advanced in the latest 28 cases (p < 0.05). The conversion rate was similar in both groups. Three-port complete thoracoscopic lobectomy with the two-instrument technique is feasible for lung cancer treatment. The length of the learning curve consisted of 28 cases. This TPTI technique should be popularized.
Abstract
Cosmetic factors are important when considering minimally invasive surgery. For cosmetic improvement, a complete thoracoscopic lobectomy is accomplished via the three-port [...]
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Peritoneal fluid culture and antibiotic treatment in patients with perforated appendicitis in a Pacific Island
. Alexia Boueil, . Hervé Guégan, . Julien Colot, . Eric D'Ortenzio, . Gilles Guerrier

Asian Journal of Surgery (2015). Vol. 38

Abstract
Little data on the usefulness of microbiological samples in appendicular peritonitis (AP) are available. The objectives of the study were to document the clinical value of systematic peritoneal swabbing in complicated appendicitis, to establish whether they influence postoperative outcome, and to help to optimize empirical preoperative treatment. Charts of all consecutive patients undergoing appendicectomy for acute perforated appendicitis were analyzed over a 7-year period from 2005 to 2011 in a tertiary hospital in New Caledonia. From prospectively recorded data, microbiological culture results, and sensitivity of isolates were obtained in relation to histopathological findings and infective morbidity. Overall, 144 cases including 47 (33%) children and 97 (67%) adults with perforated appendicitis were included in the study. Fifty-one (35%) had generalized peritonitis treated laparoscopically in 30 (59%) cases. Peritoneal fluid samples yielded a positive culture in 104 (74%) patients. The most commonly recovered species were Escherichia coli (81%), Streptococcus milleri group (12%), and Pseudomonas aeruginosa (12%). Postoperative infectious complications occurred in 32 (22%) including intra-abdominal abscess (n = 20) and wound infection (n = 12). Probabilist antibiotic regimen was less often suitable in children than in adults (p = 0.003). Infectious complications occurred more often in cases with an unsuitable antibiotic regimen after culture results compared with a suitable antibiotic regimen before culture results (p = 0.01). Although antibiotic use may be considered as an adjunct to surgical intervention of AP, the appropriate use of preoperative antibiotics and modifications according to culture results are essential to prevent infectious complications.
Abstract
Little data on the usefulness of microbiological samples in appendicular peritonitis (AP) are available. The objectives of the study were to document the clinical value of [...]
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Reduced right atrial contractile force in patients with left ventricular diastolic dysfunction: A study in human atrial fibers—contractile force and diastolic dysfunction
. Constanze Bening, . Anjuli Sikand, L. Conzelmann, . Nicole Stumpf, C. Vahl

Asian Journal of Surgery (2017). Vol. 40

Abstract
The aim of our study was to evaluate right heart contractile force in patients with diastolic dysfunction (DD) with preserved left heart ejection fraction undergoing cardiac surgery. We examined the contractile properties of skinned human fibers obtained from the right auricle in two groups (DD and controls). Right atrial tissue from 64 patients, who were undergoing cardiac surgery, were collected before extracorporal circulation. Tissue was conserved and prepared as “skinned fibers”. We exposed the dissected fibers to increasing calcium concentrations and recorded the force values. Patients with DD develop significantly less force at middle and higher calcium concentrations pCa 4.0: DD 2.58 ± 0.4 mN, controls 5.32 ± 0.4 mN, p = 0.02, pCa 5.5: DD 1.14 ± 0.3 mN, controls 1.45 ± 0.3 mN, p = 0.03. DD significantly correlates with left ventricular hypertrophy (LVH, p = 0.03). DD did not significantly occur more often in patients with mitral valve insufficiency, aortic insufficiency or stenosis, or coronary heart disease (all p > 0.10). LVH, which was associated with DD, correlated significantly with mitral valve prolapse (p = 0.05), aortic valve stenosis (p = 0.02), and mitral valve insufficiency (p = 0.03). Contractile force is significantly reduced in right atrial skinned human fibers with DD. DD is significantly associated with LVH, but emerges independently from underlying pathologies like valve diseases or coronary heart disease. This underlines the hypothesis that impairment of contractile capacity directly results from DD—independent from volume or pressure overload due to valvular or ischemic heart disease.
Abstract
The aim of our study was to evaluate right heart contractile force in patients with diastolic dysfunction (DD) with preserved left heart ejection fraction undergoing cardiac [...]
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A novel data collection and monitoring system for health status measures in patients undergoing lateral internal sphincterotomy: The Knowledge Program (TKP)
. Erman Aytac, H. H. Erem, F. H. Remzi, . Emre Gorgun

Asian Journal of Surgery (2015).

Abstract
The Knowledge Program (TKP) allows prospective data collection during routine clinical practice. The aim of this study was to evaluate the efficacy and feasibility of TKP for capturing and monitoring health status measures in patients undergoing lateral internal sphincterotomy (LIS). TKP data of patients undergoing LIS from December 2008 to May 2013 were retrieved. Health status measures including the Cleveland Global Quality of Life (CGQL), European Quality of Life Index (EQ-5D), Fecal Incontinence Severity Index (FISI), anorectal pain scores, and satisfaction questions were evaluated in the study. A total of 500 patients underwent LIS within the study period. Overall patient numbers responding to the health status measures in the pre- and postoperative period were as follows: CGQL: 112 preoperatively, 53 postoperatively, EQ-5D: 112 preoperatively, 55 postoperatively, FISI: 102 preoperatively, 30 postoperatively, and anorectal pain score: 107 preoperatively, 45 postoperatively. Among the responders, the number of patients who completed the health status measures both pre- and postoperatively was as follows: EQ-5D: 31, CGQL: 28, anorectal pain: 24, and FISI: 15. A total of 30 patients completed postoperative satisfaction and recommendation questions. Postoperative earliest (p = 0.02) and most recent (p = 0.01) anorectal pain visual analog scores were significantly lower than the preoperative measurements. The earliest postoperative EQ-5D scores were significantly higher than their preoperative values (p = 0.02). The majority of patients who completed the surveys said they were satisfied (70% and 67%) and would recommended (73% and 70%) LIS to others undergoing postoperative earliest and most recent follow up. LIS reduces anorectal pain without worsening quality of life. TKP captures information directly from patients and records it to a database which may reduce the risk of information loss or alteration.
Abstract
The Knowledge Program (TKP) allows prospective data collection during routine clinical practice. The aim of this study was to evaluate the efficacy and feasibility of TKP [...]
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A retrospective study of anastomotic leakage between patients with and without vascular enhancement of esophageal reconstructions with colon interposition: Thammasat University Hospital experience
. Surajit Awsakulsutthi, . Chittinad Havanond

Asian Journal of Surgery (2015). Vol. 38

Abstract
Anastomotic leakage is a common complication after operative reconstruction with colon interposition in corrosive esophageal injury patients. Because the underlying causes are ischemic in nature, vascular enhancement would resolve this complication. To compare the incidence of anastomotic leakage between patients with and without vascular enhancement of esophageal reconstructions with colon interposition. This is a retrospective comparative study between patients with and without vascular enhancement during corrosive esophageal reconstructions with colon interposition in Thammasat University Hospital from January 2004 to December 2012. Twenty-five adult patients who received esophageal reconstructions with colon interposition for corrosive esophageal injury were included in this study. Eleven of these patients also received vascular enhancement (classified as the “with vascular enhancement” group) during the reconstruction, whereas the remaining 14 patients did not (classified as the “without vascular enhancement” group). There was no significant difference in baseline characteristics of the patients between the two groups (i.e., sex, age, and preoperative hematocrit and serum albumin levels). There was also no significant difference in the leakage rate between the two groups: 35.7% (5/14) and 9% (1/11) in the without and with vascular enhancement groups, respectively (p = 0.180). However, in the “with vascular enhancement” group, the operative time was significantly longer (7.8 hours vs. 6.4 hours, an additional 1.4 hours), whereas length of hospital stay was shorter (18.3 days vs. 28.1 days, reduced by 9.8 days) compared with the other group. Patients who received vascular enhancement along with colon interposition had a lower incidence of anastomotic leakage, however, there was no significant difference between the two groups in this study. Thus, further studies with a large sample size should be conducted in this regard.
Abstract
Anastomotic leakage is a common complication after operative reconstruction with colon interposition in corrosive esophageal injury patients. Because the underlying causes [...]
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Is LigaSure a safe cystic duct sealer? An ex vivo study
. Emad Abdallah, M. Abd Ellatif, S. El Awady, A. Magdy, . Mohamed Youssef, . Waleed Thabet, . Ahmed Lotfy, . Ayman Elshobaky, . Mosaad Morshed

Asian Journal of Surgery (2015). Vol. 38

Abstract
To compare the efficacy and safety of both mechanical methods (clips) and electrosurgical instruments, harmonic scalpel (HS) and LigaSure (LS), for securing the cystic duct during laparoscopic cholecystectomy (LC). During the study period from October 2010 to October 2012, 458 patients with gallbladder stones underwent LC. A total of 38 patients were excluded from the study for different reasons. The gallbladder was excised laparoscopically through the traditional method. The gallbladder specimens of the patients were divided into three equal groups randomly, and the distal part of the cystic duct was sealed ex vivo using ligaclips (Group A), HS (Group B), and LS (Group C). The gallbladders were then connected to a pneumatic tourniquet device and we very gradually increased the pressure with air. The bursting pressure of the cystic duct (CDBP) was measured and differences between the three groups were calculated. The mean CDBP was 329.7 ± 38.8 mmHg in the ligaclip group, 358.0 ± 33.1 mmHg in the HS group, and 219.7 ± 41.2 mmHg in the LS group. A comparison of the mean CDBP between the groups indicated the superiority of HS over ligaclip and LS. CDBP was significantly higher in the ligaclips group compared with the LS group (p 195 mmHg) than the maximum common bile duct pressure, whereas for LS the CDBP range was 150–297 mmHg, indicating that it is not safe for sealing. HS is a safe alternative to clips. In fact, it was even safer than clips. By contrast, LS is not safe for cystic duct sealing.
Abstract
To compare the efficacy and safety of both mechanical methods (clips) and electrosurgical instruments, harmonic scalpel (HS) and LigaSure (LS), for securing the cystic duct [...]
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Diarrhea after laparoscopic cholecystectomy: Associated factors and predictors
. Tuan-Pin Yueh, . Fong-Ying Chen, . Tsyr-En Lin, . Mao-Te Chuang

Asian Journal of Surgery (2014). Vol. 37

Abstract
Diarrhea is part of the postlaparoscopic cholecystectomy syndrome, but is not well defined. Published reports have ignored possible associated factors such as the preoperative excretion pattern, gastrointestinal disorders, personality disorders, the effect of drugs, unsanitary food, and high-fat diets. The aim of this study was to define the associated factors and predictors of postlaparoscopic cholecystectomy diarrhea (PLCD) at different time intervals after the operation and to identify the possible associated factors and predictors of PLCD. We also aimed to determine the effectiveness of a low-fat diet in these patients and to educate the patients about their diet after the operation. Data were obtained from clinical records and preoperative interviews with patients, who were also interviewed or contacted by telephone 1 week after the operation, and then surveyed by telephone 3 months later using standardized questionnaires. A total of 125 consecutive patients who were adequately informed and who had assented to accepting a prescription of a low-fat diet after undergoing laparoscopic cholecystectomy participated in this prospective study. Thirty-eight patients (25.2%) had diarrhea 1 week after laparoscopic cholecystectomy and seven patients (5.7%) had diarrhea 3 months after laparoscopic cholecystectomy. The important predictors of PLCD at 1 week were a low-fat diet (B = −0.177, p = 0.000) and a high score on a preoperative diarrhea scale (B = 0.311, p = 0.031). There was no predictor for PLCD 3 months after laparoscopic cholecystectomy. We advise patients who have undergone laparoscopic cholecystectomy to follow a low-fat diet for at least 1 week to reduce the possibility of diarrhea, especially when they are ≤45 years of age, of male sex, and had a high preoperative tendency for diarrhea.
Abstract
Diarrhea is part of the postlaparoscopic cholecystectomy syndrome, but is not well defined. Published reports have ignored possible associated factors such as the preoperative [...]
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Predictive factors for intraoperative excessive bleeding in Graves’ disease
. Kosho Yamanouchi, . Shigeki Minami, . Naomi Hayashida, . Chika Sakimura, . Tamotsu Kuroki, . Susumu Eguchi

Asian Journal of Surgery (2015). Vol. 38

Abstract
In Graves’ disease, because a thyroid tends to have extreme vascularity, the amount of intraoperative blood loss (AIOBL) becomes significant in some cases. We sought to elucidate the predictive factors of the AIOBL. A total of 197 patients underwent thyroidectomy for Graves’ disease between 2002 and 2012. We evaluated clinical factors that would be potentially related to AIOBL retrospectively. The median period between disease onset and surgery was 16 months (range: 1–480 months). Conventional surgery was performed in 125 patients, whereas video-assisted surgery was performed in 72 patients. Subtotal and near-total/total thyroidectomies were performed in 137 patients and 60 patients, respectively. The median weight of the thyroid was 45 g (range: 7.3–480.0 g). Univariate analysis revealed that the strongest correlation of AIOBL was noted with the weight of thyroid (p < 0.001). Additionally, AIOBL was correlated positively with the period between disease onset and surgery (p < 0.001) and negatively with preoperative free T4 (p < 0.01). Multivariate analysis showed that only the weight of the thyroid was independently correlated with AIOBL (p < 0.001). Four patients (2.0%) needed blood transfusion, including two requiring autotransfusion, whose thyroids were all weighing in excess of 200 g. The amount of drainage during the initial 6 hours and days until drain removal was correlated positively with AIOBL (p < 0.001, each). Occurrences of postoperative complications, such as recurrent laryngeal nerve palsy or hypoparathyroidism, and postoperative hospital stay were not correlated with AIOBL. A huge goiter presented as a predictive factor for excessive bleeding during surgery for Graves’ disease, and preparation for blood transfusion should be considered in cases where thyroids weigh more than 200 g.
Abstract
In Graves’ disease, because a thyroid tends to have extreme vascularity, the amount of intraoperative blood loss (AIOBL) becomes significant in some cases. We sought to [...]
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The length of necrosis and renal insufficiency predict the outcome of acute mesenteric ischemia
H. Akyıldız, . Erdogan Sözüer, H. Uzer, . Mehmet Baykan, B. Oz

Asian Journal of Surgery (2015). Vol. 38

Abstract
Acute mesenteric ischemia (AMI) is a potentially life-threatening condition because of its diagnostic difficulty, operative challenges, and comorbidities a patient may have. The aim of this study was to identify factors associated with adverse outcomes in patients with AMI. The hospital records and clinical data of all patients with AMI were reviewed for a recent 4-year period. Clinical outcomes and factors influencing mortality were analyzed. Included in the study were 104 patients (46 females and 58 males) with an overall mean age of 66 ± 13.4 years. The cause of AMI was arterial pathology in 74 (71%) patients, venous thrombosis in 15 (14%) patients, and nonocclusive ischemia in 12 (12%) patients. Abdominal pain was the most common presenting symptom (97% of patients). The 30-day mortality rate was 66%. Univariate analysis showed that mortality was associated with renal insufficiency (p = 0.004), an age greater than 70 years (p = 0.02), the presence of comorbidities (p = 0.001), a leukocyte count greater than 18, 000/mL (p = 0.04), and small bowel necrosis of more than 100 cm (p < 0.0001). Logistic regression analysis showed that independent predictors of mortality were small bowel necrosis of more than 100 cm (p = 0.002) and a serum creatinine level greater than 2 mg/dL (p = 0.04). The length of the necrosis and renal insufficiency are the primary factors that result in a poor outcome in AMI patients. Prompt diagnostic evaluation and early therapeutic interventions may help to prevent the development of these fatal predictors.
Abstract
Acute mesenteric ischemia (AMI) is a potentially life-threatening condition because of its diagnostic difficulty, operative challenges, and comorbidities a patient may have. [...]
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A clinical series and literature review of the management of inguinal nodal metastases in patients with primary extramammary Paget disease of the scrotum
Y. Xin Koh, T. Tay, S. Xu, C. Meng Lee, M. Teo

Asian Journal of Surgery (2015). Vol. 38

Abstract
We describe a series of five patients with extramammary Paget disease of the scrotum with inguinal nodal metastases. These patients underwent combined groin dissection. All patients experienced invasion to the dermis. One patient had invasion of the dartos muscle, another had tumor invading into the skeletal muscle and femoral vein. Four patients had positive Cloquet node involvement on frozen section and formal histology, but only one patient had positive pelvic nodal disease. Another patient with pelvic nodal metastases seen on computed tomography scan had no Cloquet node identified intraoperatively but had positive pelvic nodal metastases. The mean disease-free survival and the overall survival were 28.6 months (range: 2–60 months) and 33.4 months (range: 2–60 months), respectively, for all patients. Three patients developed distant metastases and two patients were disease free to date. No locoregional recurrences were observed. Aggressive lymphadenectomy in selected cases can provide a long-term survival benefit. The use of Cloquet node in the prediction of pelvic nodal disease should be considered. Based on the literature review, sentinel lymph node biopsy can potentially diagnose occult metastases in otherwise nonenlarged nodes.
Abstract
We describe a series of five patients with extramammary Paget disease of the scrotum with inguinal nodal metastases. These patients underwent combined groin dissection. All [...]
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Robotic-assisted minimally invasive liver resection
. Yao-Ming Wu, . Rey-Heng Hu, . Hong-Shiee Lai, . Po-Huang Lee

Asian Journal of Surgery (2014). Vol. 37

Abstract
Minimally invasive liver resection is feasible for select patients. The flexibility of robotic surgical instruments improves the possibility of minimally invasive liver resection, even in challenging major liver resection. We accumulated 69 patients who underwent pure laparoscopic liver resection from 2007 to 2011, and 52 patients who underwent robotic-assisted minimally invasive liver resection in 2012. The patients' characteristics, surgical procedures, and perioperative parameters were described and compared between these two groups. In 2012, we performed 56 robotic hepatobiliary procedures, which included 52 (92%) robotic-assisted minimally invasive liver resection procedures. Under the assistance of a robotic system, we increased the number of patients undergoing minimally invasive liver resection by more than twofold, and we increased the percentage of minimally invasive surgery for patients with fresh hepatocellular carcinoma, compared to our laparoscopic group (44% vs. 15%, respectively). We also increased the percentage of major hepatectomy for minimally invasive liver resection by a robotic approach (39% vs. 15%) with a comparable conversion rate (5%) and morbidity (8%), compared to the laparoscopic group. We can even perform a challenging living donor liver harvest procedure with a robotic-assisted minimally invasive approach. Robotic assistance increased the percentage of minimally invasive liver resections and the percentage of major minimally invasive liver resections with comparable perioperative results. Robotic-assisted minimally invasive liver resection is feasible, but its role needs more accumulated experience to clarify.
Abstract
Minimally invasive liver resection is feasible for select patients. The flexibility of robotic surgical instruments improves the possibility of minimally invasive liver resection, [...]
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Assessment of postoperative changes in antihypertensive drug consumption in patients with primary aldosteronism using the defined daily dose
. Takanobu Utsumi, . Koji Kawamura, . Takashi Imamoto, . Naoto Kamiya, . Hidekazu Nagano, . Tomoaki Tanaka, . Naoki Nihei, . Yukio Naya, . Hiroyoshi Suzuki, . Tomohiko Ichikawa

Asian Journal of Surgery (2014). Vol. 37

Abstract
The number of antihypertensive drug classes cannot accurately reflect the total consumption of antihypertensive drugs used to control blood pressure. The defined daily dose has been adopted to permit consumption analysis of many prescribed drugs. The aim of the present study was to assess postoperative changes in antihypertensive drug consumption in patients with primary aldosteronism using the defined daily dose as the unit of measurement. This retrospective study included 110 Japanese patients who underwent unilateral laparoscopic adrenalectomy between 1995 and 2012. Antihypertensive drug doses were calculated according to the standard of the defined daily dose recommended by the World Health Organization to compare drug use. After assessing postoperative changes in antihypertensive drug consumption, univariate and multivariate analyses were performed to identify clinical predictors for a 75% or greater decrease in the defined daily dose. Consumption of antihypertensive drugs decreased postoperatively in 95.4% of patients. The median decrease in the defined daily dose was 76.8%. A postoperative decrease of 75% or greater in the defined daily dose was confirmed in 52.7% of patients. Multivariate analysis identified no medical history of cardiovascular disease, low body mass index, and short duration of hypertension as independent predictors of a postoperative decrease of 75% or greater in the defined daily dose. The defined daily dose is a useful tool for assessing total changes in the consumption of antihypertensive drugs in patients with primary aldosteronism. Using the defined daily dose, clinicians could explain in detail to patients with primary aldosteronism the predicted postoperative change in antihypertensive drug consumption.
Abstract
The number of antihypertensive drug classes cannot accurately reflect the total consumption of antihypertensive drugs used to control blood pressure. The defined daily dose [...]
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Totally laparoscopic total gastrectomy for gastric cancer: Literature review and comparison of the procedure of esophagojejunostomy
. Akira Umemura, . Keisuke Koeda, . Akira Sasaki, . Hisataka Fujiwara, . Yusuke Kimura, . Takeshi Iwaya, . Yuji Akiyama, . Go Wakabayashi

Asian Journal of Surgery (2015). Vol. 38

Abstract
There has been a recent increase in the use of totally laparoscopic total gastrectomy (TLTG) for gastric cancer. However, there is no scientific evidence to determine which esophagojejunostomy (EJS) technique is the best. In addition, both short- and long-term oncological results of TLTG are inconsistent. We reviewed 25 articles about TLTG for gastric cancer in which at least 10 cases were included. We analyzed the short-term results, relationships between EJS techniques and complications, long-term oncological results, and comparative study results of TLTG. TLTG was performed in a total of 1170 patients. The mortality rate was 0.7%, and the short-term results were satisfactory. Regarding EJS techniques and complications, circular staplers (CSs) methods were significantly associated with leakage (4.7% vs. 1.1%, p < 0.001) and stenosis (8.3% vs. 1.8%, p < 0.001) of the EJS as compared with the linear stapler method. The long-term oncological prognosis was acceptable in patients with early gastric cancers and without metastases to lymph nodes. Although TLTG tended to increase surgical time compared with open total gastrectomy and laparoscopy-assisted total gastrectomy, it reduced intraoperative blood loss and was expected to shorten postoperative hospital stay. TLTG is found to be safer and more feasible than open total gastrectomy and laparoscopy-assisted total gastrectomy. At present, there is no evidence to encourage performing TLTG for patients with advanced gastric cancer from the viewpoint of long-term oncological prognosis. Although the current major EJS techniques are CS and linear stapler methods, in this review, CS methods are significantly associated with leakage and stenosis of the EJS.
Abstract
There has been a recent increase in the use of totally laparoscopic total gastrectomy (TLTG) for gastric cancer. However, there is no scientific evidence to determine which [...]
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Endovascular treatment for pseudoaneurysms arising from the hepatic artery after liver transplantation
. Ashok Thorat, . Chen-Fang Lee, . Tsung-Han Wu, . Kuang-Tse Pan, . Sung-Yu Chu, . Hong-Shiue Chou, . Kun-Ming Chan, . Ting-Jung Wu, . Wei-Chen Lee

Asian Journal of Surgery (2017). Vol. 40

Abstract
Hepatic artery pseudoaneurysm after liver transplantation is an uncommon but potentially lethal complication. Early diagnosis and treatment are essential to avoid life-threatening hemorrhage in these patients. We herein report the case of three patients who developed hepatic artery pseudoaneurysms after living donor liver transplantation. Two patients presented with massive duodenal bleeding secondary to erosion of the hepatic artery into the bile duct, and one patient presented with intra-abdominal bleeding. These patients were managed by catheter-based minimal invasive endovascular procedures including coil embolization and stent grafting. All the patients were treated successfully with uneventful recovery. This technique can be considered as an effective treatment option for hepatic artery pseudoaneurysms instead of a difficult surgical intervention.
Abstract
Hepatic artery pseudoaneurysm after liver transplantation is an uncommon but potentially lethal complication. Early diagnosis and treatment are essential to avoid life-threatening [...]
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Outcomes of radical cystectomy and bladder preservation treatment for muscle-invasive urothelial carcinoma of the bladder
. Wempy Supit, C. Mochtar, R. Santoso, . Rainy Umbas

Asian Journal of Surgery (2014). Vol. 37

Abstract
To compare the survival outcome of various treatment modalities for organ-confined muscle-invasive urothelial carcinoma of the bladder. One hundred and fifty patients with Stage II (T2, N0, M0) or Stage III (T3a-T4a, N0, M0) urothelial carcinoma of the bladder treated at the National Referral Hospital and the National Cancer Center of Indonesia from 1995 to 2010 with a minimum follow-up period of 24 months were included in this study. Overall survival and mean survival times were analyzed using the Kaplan–Meier method. The mean ± standard deviation age of the patients in this study was 57.15 ± 11.6 years and 88% were men. Over 50% of patients had T2 disease, 24.2% had T3 disease, and 21.5% had T4 disease based on pathology. Based on histological grade, 30.8% were intermediate grade tumors and 42.1% were high-grade tumors. Radical cystectomy was performed in 20 patients (13.3%) and 40 patients (26.7%) were treated with radiotherapy. Ninety (60%) patients underwent transurethral resection of the bladder tumor only without further definitive treatment for personal reasons. The actuarial 5-year overall survival for all patients was as follows: radical cystectomy, 50%, radiotherapy, 22.7%, and transurethral resection of the bladder tumor only, 8.3% (log-rank p = 0.029). For stage T2 patients, the 5-year overall survival was: radical cystectomy, 62.5%, radiotherapy, 31.2%, and transurethral resection of the bladder tumor only, 8.3% (log-rank p = 0.017). In our series, radical cystectomy had a superior outcome to radiotherapy or transurethral resection of the bladder tumor only, comparable with results reported elsewhere. Radical cystectomy should be offered as the gold standard treatment for organ-confined muscle-invasive urothelial carcinoma of the bladder.
Abstract
To compare the survival outcome of various treatment modalities for organ-confined muscle-invasive urothelial carcinoma of the bladder. One hundred and fifty patients with [...]
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Dexamethasone combined with other antiemetics for prophylaxis after laparoscopic cholecystectomy
. Xiao-Ying Si, . Lu-Peng Wu, . Xiu-Dong Li, B. Li, . Yan-Ming Zhou

Asian Journal of Surgery (2015). Vol. 38

Abstract
Postoperative nausea and vomiting (PONV) is one of the most common and distressing adverse events after laparoscopic cholecystectomy (LC). A meta-analysis of randomized clinical trials (RCTs) was performed to determine the efficacy and safety of dexamethasone combined with other antiemetic in the prevention of PONV in patients undergoing LC. A systematic literature search was conducted to identify all relevant RCTs. The primary outcome was PONV in the early period (0–3 hours, 0–4 hours, or 0–6 hours), late period (>6 hours), and the overall period (0–24 hours). Nine RCTs with a total of 1089 patients were included in the analysis. Pooled analysis showed that dexamethasone combined with other antiemetics provided significantly better prophylaxis than single antiemetics in the early period [odds ratio (OR): 0.34, 95% confidence interval (CI): 0.21–0.55, p < 0.001], late period (OR: 0.35, 95% CI: 0.22–0.57, p < 0.001), and the overall period (OR: 0.36, 95% CI: 0.27–0.49, p < 0.001). Correspondingly, rescue antiemetic usage was significantly less in the combination therapy group (OR: 0.22, 95% CI: 0.12–0.41, p < 0.001). The most frequently reported adverse events were headache, dizziness, and itching. The incidence of adverse events did not differ between the two groups. Dexamethasone combined with other antiemetics was significantly better than single antiemetics for prophylaxis of PONV in patients undergoing LC, without apparent side effects.
Abstract
Postoperative nausea and vomiting (PONV) is one of the most common and distressing adverse events after laparoscopic cholecystectomy (LC). A meta-analysis of randomized clinical [...]
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Role of laparoscopy and ultrasound in the management of “impalpable testis” in children
I. Budianto, H. Lim Tan, . Yoshiaki Kinoshita, R. Tamba, . Satoshi Leiri, . Tomoaki Taguchi

Asian Journal of Surgery (2014).

Abstract
Undescended testes is one of the most common congenital abnormalities in boys. In cases of impalpable testes, ultrasound is often used to find the testis, which frequently provides false-negative results. Recently, laparoscopy has become popular in the management of impalpable testes. Retrospective study of all children with impalpable testes presenting for laparoscopy between August 2007 and July 2011 who had undergone ultrasound examinations without localizing the testes was conducted and the role of laparoscopy in diagnosing impalpable testes was evaluated. Twenty-three patients presented with impalpable testes for laparoscopy. All patients underwent ultrasound examinations in which the testes could not be identified. Of the 23 patients, Five patients were found to have palpable testes in the superficial inguinal pouch under anesthesia and proceeded to conventional open exploration during which the testes were brought into the scrotum. Eighteen patients were found to have impalpable testes in an evaluation under anesthesia (EUA) and proceeded to laparoscopy. Twelve patients were found to have intra-abdominal testes and underwent laparoscopic-assisted orchidopexy. Three patients underwent a two-stage Fowler-Stephens procedure, and two patients with “vanishing” testes with the vas and atrophic vessels entering a closed internal ring proceeded to open exploration and orchidectomy for atrophic testes. In addition, a teenager with atrophic testes underwent laparoscopic orchidectomy. Laparoscopy is superior to ultrasound in the management of impalpable testes when high-resolution ultrasound is not available during the diagnostic process, with respect to both the sensitivity of localizing the testis and being more time and cost effective.
Abstract
Undescended testes is one of the most common congenital abnormalities in boys. In cases of impalpable testes, ultrasound is often used to find the testis, which frequently [...]
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Glued versus stapled anastomosis of the colon: An experimental study to determine comparative resistance to intraluminal pressure
. Jiri Paral, . Petr Lochman, . Slavomir Blazej, . Michal Pavlik

Asian Journal of Surgery (2014). Vol. 37

Abstract
This study compared the resistance of glued versus stapled anastomosis of the colon to intraluminal pressures at different times during healing. Forty seven female domestic pigs, mean weight of 30.7 kg, were used. Maximum physiological luminal pressures, i.e. the pressure resisted by a catheter inserted into the intestinal lumen via a puncture without it being released and without injury to the surrounding intestinal wall, was performed in 5 control animals. The remaining 42 animals were divided into 3 groups of 14 animals each based on time from anastomosis construction. Each group was divided into 2 subgroups with stapled or glued anastomoses. Intraluminal pressure was measured on the first, third, and fifth day post-surgery. The maximum pressures resisted by anastomoses were significantly higher than the physiological pressures in all groups. At all time points, stapled anastomoses resisted higher intraluminal pressures than glued ones. However, glued anastomoses resisted pressures significantly higher than physiological pressure. As healing advanced, glued anastomoses neared the resistance to intraluminal pressures of stapled anastomoses. Healing with absorbable synthetic glue was as good as with staples. Glued anastomoses resisted pressures that were statistically significantly higher than physiological intraluminal colon pressures but lower than stapled ones.
Abstract
This study compared the resistance of glued versus stapled anastomosis of the colon to intraluminal pressures at different times during healing. Forty seven female domestic [...]
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Neonatal perforated Amyands hernia presenting as an enterocutaneous scrotal fistula
. Antonios Panagidis, . Xenophon Sinopidis, K. Zachos, . Vasileios Alexopoulos, . Anastasia Vareli, . Anastasia Varvarigou, . George Georgiou

Asian Journal of Surgery (2015). Vol. 38

Abstract
Perforation of the vermiform appendix in a septic neonate with an Amyands hernia resulted in the formation of a scrotal enterocutaneous fistula. In conclusion from this exceptional complication, active parental awareness for any neonatal scrotal swelling is required, and an early operative policy for the neonatal inguinal hernia is significant.
Abstract
Perforation of the vermiform appendix in a septic neonate with an Amyands hernia resulted in the formation of a scrotal enterocutaneous fistula. In conclusion from this exceptional [...]
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Closure of tracheoesophageal fistula with prefabricated deltopectoral flap
. Shigeyuki Murono, . Eriko Ishikawa, . Yosuke Nakanishi, . Kazuhira Endo, . Satoru Kondo, . Naohiro Wakisaka, . Tomokazu Yoshizaki

Asian Journal of Surgery (2016). Vol. 39

Abstract
Tracheoesophageal fistula (TEF) is a serious complication associated with impaired quality of life. However, a successful TEF closure is difficult owing to the high incidence of recurrence. We utilized a prefabricated deltopectoral (DP) flap for closure of a TEF that occurred after an extended total thyroidectomy. Prefabrication of the inner soft tissue lining the DP flap with a split skin graft was performed prior to surgical closure of a TEF. Esophageal and tracheal mucosa were sutured to the split thickness side and full thickness side of the prefabricated DP flap, respectively. A successful closure of the fistula was achieved with this procedure. Prefabricated DP flap is a useful procedure for the surgical treatment of TEF.
Abstract
Tracheoesophageal fistula (TEF) is a serious complication associated with impaired quality of life. However, a successful TEF closure is difficult owing to the high incidence [...]
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Influence of hospital volume on outcomes of laparoscopic gastrectomy for gastric cancer in patients with comorbidity in Japan
. Atsuhiko Murata, . Keiji Muramatsu, . Yukako Ichimiya, . Tatsuhiko Kubo, . Yoshihisa Fujino, . Shinya Matsuda

Asian Journal of Surgery (2015). Vol. 38

Abstract
Little information is available on the relationship between hospital volume and the outcomes of laparoscopic gastrectomy for gastric cancer in patients with comorbidity. This study aimed to investigate the influence of hospital volume on patient outcomes of laparoscopic gastrectomy for gastric cancer in patients with comorbidity using a national administrative database. A total of 5941 comorbid patients treated with laparoscopic gastrectomy for gastric cancer were referred to 741 hospitals in Japan. We collected patients' data from the administrative database to compare laparoscopy-related complications, in-hospital mortality, length of stay (LOS), and medical costs during hospitalization in relation to hospital volume. Hospital volume was categorized into two groups: low (
Abstract
Little information is available on the relationship between hospital volume and the outcomes of laparoscopic gastrectomy for gastric cancer in patients with comorbidity. This [...]
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Study of treatment results and early complications of tube drainage versus capitonnage after the unroofing and aspiration of hydatid cysts
M. Bahar, A. Nooghabi, . Alireza Hamid, . Ahmad Amouzeshi, . Ali Jangjoo

Asian Journal of Surgery (2014). Vol. 37

Abstract
There is controversy concerning the management of the remaining cavity after the evacuation of a cyst in patients who have undergone surgical operation for liver hydatidosis. This study compares the results of capitonnage and tube drainage of the remaining cavity. In this retrospective study, participants were selected from two groups of patients with a liver hydatid cyst who underwent capitonnage or tube drainage from 2004 to 2012. The patients were followed for 6–24 months. The data of age, sex, involved liver lobe, size of the cyst, complications, drain duration, and hospital stay were analyzed. Participants included 155 patients consisting of 96 (61.94%) females and 59 (38.06%) males. Most cysts were in the right lobe, and the most common diameter of the cysts was greater than 10 cm. Capitonnage was performed on 90 (58.06%) patients and the tube drainage procedure was performed on the remaining 65 (41.94%) patients. In the tube drainage group and the capitonnage group, the operative times were 2.21 ± 0.65 hours and 2.53 ± 0.35 hours, respectively, the hospital stays were 5.695 ± 3.37 days and 4.43 ± 2.96 days, respectively, the drain duration was 9.2 ± 1.7 days and 2.1 ± 0.4 days, respectively, and the time to return to work was 14.7 ± 2.3 days and 8.3 ± 10.4 days, respectively. All variables were statistically significant, except for the operative time. Cavity infection and biliary fistula were identified in three patients and six patients, respectively, in the tube drainage group and identified in two patients and three patients, respectively, in the capitonnage group. This difference was not statistically significant. This study demonstrated that capitonnage versus the tube drainage method may result in a shorter hospital stay, decreased time to return to work, and low rate of morbidity and complications.
Abstract
There is controversy concerning the management of the remaining cavity after the evacuation of a cyst in patients who have undergone surgical operation for liver hydatidosis. [...]
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Most frequent location of the sentinel lymph nodes
C. Lo, . Po-Chu Lee, . Ruoh-Fang Yen, . Chiun-Sheng Huang

Asian Journal of Surgery (2014). Vol. 37

Abstract
Inappropriate skin incisions can make sentinel lymph node dissection difficult. A knowledge of the most common locations of the hotspot in the axilla helps in planning the incision. This information also helps to locate the lymph node preoperatively by ultrasound. The aim of this prospective study was to determine the most common location of the sentinel lymph node in the axilla. From January 2006 to December 2010, 974 consecutive patients who underwent sentinel lymph node dissection guided by 99mTc–sulfur colloid were included and the position of the hotspot in the axilla was recorded prospectively. The location of the hottest spot on the skin of the axilla was categorized into seven areas divided by five landmarks. In 98.4% of our patients, the hotspot detected on the axilla skin before sentinel lymph node dissection was located in the area demarcated by the four landmarks of the hairline, a line tangential to and 2 cm below the center of the hairline, the lateral border of the pectoralis major muscle, and the mid-axillary line. The area between these four landmarks is the most frequent location of the sentinel lymph node identified using the radioisotope method. We suggest that this area should be carefully evaluated preoperatively by ultrasound for appropriate surgical planning. A skin incision in this area is also recommended when sentinel lymph node dissection is guided by blue dye.
Abstract
Inappropriate skin incisions can make sentinel lymph node dissection difficult. A knowledge of the most common locations of the hotspot in the axilla helps in planning the [...]
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Reiters syndrome postintravesical Bacillus Calmette–Guérin instillations
K. Lim Ng, C. Beng Chua

Asian Journal of Surgery (2017). Vol. 40

Abstract
Intravesical Bacillus Calmette–Guérin (BCG) has been a proven and effective immunotherapy treatment for superficial transitional cell carcinoma (TCC) of the bladder, especially for high-grade tumors and carcinoma in situ. Nevertheless, significant side effects are associated with BCG instillations, including fever, myalgia, malaise, dysuria, hematuria, and irritable lower urinary tract symptoms. We herein report the case of a patient who developed Reiters syndrome following intravesical BCG instillations. A 39-year-old Chinese man presented with a 3-week history of dysuria, suprapubic pain, and pain at the tip of the penis postmicturition. Initial investigations revealed that he had microhematuria, and an ultrasound with computed tomography scan of the abdomen showed a bladder mass. Transurethral resection of the bladder tumor was performed and the patient received a single dose of intravesical mitomycin postoperatively. Results of histopathological examination revealed high-grade bladder TCC (G3pT1), and the patient was managed with intravesical BCG for 2 weeks following the surgery. Four weekly cycles of BCG were administered uneventfully, however, before the fifth instillation, the patient complained of urethral discharge, bilateral conjunctivitis, and low back pain. Reiters syndrome was diagnosed as a rare but known complication of BCG instillation and the BCG immunotherapy was withheld. The patient was treated with nonsteroidal antiinflammatory drugs (for back pain) and eye ointment (for conjunctivitis) and his condition improved. This case report of Reiters syndrome should be highlighted as a rare but significant complication of BCG immunotherapy and urologists should have a high index of suspicion to diagnose this rare complication.
Abstract
Intravesical Bacillus Calmette–Guérin (BCG) has been a proven and effective immunotherapy treatment for superficial transitional cell carcinoma (TCC) of the bladder, especially [...]
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Laparoscopic management of symptomatic urachal remnants in adulthood
S. Li Siow, H. Mahendran, . Mark Hardin

Asian Journal of Surgery (2015). Vol. 38

Abstract
The traditional surgical approach to the excision of persistent urachal remnants is a lower midline laparotomy or semicircular infraumbilical incision. The aim of this study is to report our experience with laparoscopic urachus excision as a minimally invasive diagnostic and surgical technique. This study was a prospective study involving patients who were diagnosed with persistent urachus and underwent laparoscopic excision. The morbidity, recovery, and outcomes of surgery were reviewed. Fourteen patients (8 men) with a mean age of 22.8 ± 6.42 years underwent laparoscopic excision. All patients presented with discharge from the umbilicus. Although four patients had no sonographic evidence of a patent urachus, a diagnostic laparoscopy detected a patent urachus that was excised laparoscopically. One patient required laparoscopic reoperation for persistent discharge, and one patient presented with bladder injury, which was repaired via a small Pfannenstiel incision without any morbidity. The mean operative time was 71.1 ± 0.28 minutes, and the mean duration of hospital stay was 1.3 ± 1.38 days. Pathological examination confirmed a benign urachal remnant in all cases. Laparoscopy is a useful alternative for the management of persistent or infected urachus, especially when its presence is clinically suspected despite the lack of sonographic evidence. The procedure is associated with low morbidity, although a small risk of bladder injury exists, particularly in cases of severe active inflammation. Recurrence is uncommon and was caused by inadequate excision of inflammatory tissue in our series that was easily managed laparoscopically.
Abstract
The traditional surgical approach to the excision of persistent urachal remnants is a lower midline laparotomy or semicircular infraumbilical incision. The aim of this study [...]
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Intramedullary schwannoma of conus medullaris with syringomyelia
. Mete Karatay, . Ender Köktekir, . Yavuz Erdem, . Haydar Celik, . Idris Sertbas, M. Akif Bayar

Asian Journal of Surgery (2017). Vol. 40

Abstract
Intramedullary schwannomas of the spinal cord are rare tumors. They are most commonly observed in the cervical region, however, few have been described in the conus medullaris. The association of intramedullary schwannomas with syringomyelia is also rare. In this report, we present a case of intramedullary schwannoma of the conus medullaris with syringomyelia, which was treated surgically.
Abstract
Intramedullary schwannomas of the spinal cord are rare tumors. They are most commonly observed in the cervical region, however, few have been described in the conus medullaris. [...]
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Fluorodeoxyglucose positron emission tomography/computed tomography findings in a patient with cerebellar mutism after operation in posterior fossa
G. Kara Gedik, . Oktay Sari, . Ender Köktekir, . Gökhan Akdemir

Asian Journal of Surgery (2017). Vol. 40

Abstract
Cerebellar mutism is a transient period of speechlessness that evolves after posterior fossa surgery in children. Although direct cerebellar and brain stem injury and supratentorial dysfunction have been implicated in the mediation of mutism, the pathophysiological mechanisms involved in the evolution of this kind of mutism remain unclear. Magnetic resonance imaging revealed dentatothalamocortical tract injuries and single photon emission computed tomography showed cerebellar and cerebral hypoperfusion in patients with cerebellar mutism. However, findings with 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in this group of patients have not been documented previously. In this clinical case, we report a patient who experienced cerebellar mutism after undergoing a posterior fossa surgery. Right cerebellar and left frontal lobe hypometabolism was shown using FDG PET/CT. The FDG metabolism of both the cerebellum and the frontal lobe returned to normal levels after the resolution of the mutism symptoms.
Abstract
Cerebellar mutism is a transient period of speechlessness that evolves after posterior fossa surgery in children. Although direct cerebellar and brain stem injury and supratentorial [...]
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Malignancy arising in a 41-year-old colonic interposition graft
D. Ng, G. Tan, M. Teo

Asian Journal of Surgery (2016). Vol. 39

Abstract
The colon can be used for esophageal reconstruction after an esophagectomy. The development of a malignancy in the colonic interposition graft is rare, with less than 15 cases reported in the literature. We present a case of a 60-year-old male with high-grade dysplasia of the colonic interposition graft used for reconstruction of the esophagus, which developed 41 years after the esophageal reconstruction. The long-term complication of the development of a malignancy must be considered when using the colon for reconstruction especially when the esophageal reconstruction is performed for a benign cause.
Abstract
The colon can be used for esophageal reconstruction after an esophagectomy. The development of a malignancy in the colonic interposition graft is rare, with less than 15 cases [...]
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Vascular surgery research in the Gulf Cooperation Council countries
A. Jawas, A. F. Hefny, A. K. Abbas, F. M. Abu-Zidan

Asian Journal of Surgery (2014).

Abstract
To evaluate the quantity and quality of published vascular surgery research articles from the Gulf Cooperation Council (GCC) countries so as to identify areas for improvement. Descriptive study. Published MEDLINE articles on vascular surgery from the GCC countries (1960–2010). Critical analysis of the articles. A total of 146 articles were studied, majority of which were case series/case reports (55.5%), 33% of the articles were prospective. The first author was from a university in 67.1% of the articles. Only one randomized controlled trial was found. The median (range) impact factor of the journals was 1.16 (0.16–12.64). Kuwait had the highest number of publications/country, standardized/100, 000 inhabitants. There were 11 experimental studies, which were all from Kuwait. More statistically significant, experimental vascular surgery papers were published prior to 1993 (11/30 compared with 0/111 afterward, p < 0.0001, Fisher exact test). The GCC countries had the lowest vascular surgery research output compared with Turkey, Hong Kong, Singapore, and Japan when standardized by the population. The h index of the GCC countries' vascular research publications was the lowest (19) compared with the other four countries (29–97). Furthermore, the average citation of the GCC countries (5.81) was similar to Turkey (5.66), but less than Hong Kong (17.38), Singapore (12.79), and Japan (11.75). The quality and quantity of vascular surgery research in the GCC countries should be improved to answer important local questions related to vascular diseases. This needs better strategic planning and more collaboration between various institutions.
Abstract
To evaluate the quantity and quality of published vascular surgery research articles from the Gulf Cooperation Council (GCC) countries so as to identify areas for improvement. [...]
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Surgically treated rectal cancer patients—Outcomes at a tertiary care cancer hospital in Pakistan
A. Imran Malik, . Farhana Badar, A. Ali Syed, M. Yusuf

Asian Journal of Surgery (2015). Vol. 38

Abstract
The aim of this study was to analyze our experience with rectal cancer patients who underwent surgical excision at our institution. Data on 112 rectal cancer patients who underwent surgical resection with total mesorectal excision, from January 2005 to December 2008, were evaluated retrospectively. We achieved an initial complete remission rate of 74.1%. Overall, 92.8% of patients had a complete total mesorectal excision. The overall survival analysis for all patients showed a 1-year survival rate of 98%, a 3-year survival rate of 82%, and a 5-year survival rate of 70%. We report a 41.9% rate of postoperative complications. The 1-, 3-, and 5-year survival rates for females were 100%, 90%, and 72%, respectively and for males, they were 90%, 80%, and 68%, respectively. Differences in overall survival by sex were not statistically significant (p > 0.05). Those patients who were treated with only surgery had the best outcomes with survival being worse in those treated with surgery and adjuvant therapy. Neoadjuvant treatment followed by surgery led to better results. We conclude that we have been successful in achieving high rates of curative resection, complete remission, and overall survival. Neoadjuvant and adjuvant chemotherapy significantly impact rates of remission.
Abstract
The aim of this study was to analyze our experience with rectal cancer patients who underwent surgical excision at our institution. Data on 112 rectal cancer patients who [...]
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Laparoscopic bariatric surgery for the treatment of severe hypertriglyceridemia
. Sung-Yu Hsu, . Wei-Jei Lee, . Keong Chong, . Kong-Han Ser, . Jun-Jiun Tsou

Asian Journal of Surgery (2015). Vol. 38

Abstract
It is well established that severe hypertriglyceridemia can lead to pancreatitis. At present, medical treatment for patients with severe hypertriglyceridemia and repeat pancreatitis attacks is not adequate. The aim of this study was to assess the effectiveness of laparoscopic bariatric surgery in these patients. A review of 20 morbidly obese patients with severe hypertriglyceridemia (a triglyceride level of >1000 mg/dL) who received laparoscopic bariatric surgery was performed. The study population comprised 14 males and six females, with an average age of 35.0 years (range 24–52 years), and the mean body mass index was 38.2 kg/m2 (range 25–53 kg/m2). The preoperative mean plasma triglyceride level was 1782.7 mg/dL (range 1043–3884 mg/dL). Four patients had a history of hypertriglyceridemic pancreatitis and 13 patients had associated diabetes. Of the 20 patients, 17 (85%) received gastric bypass, whereas three (15%) received restrictive-type surgery. Laparoscopic access was used in all of the patients. Hypertriglyceridemia in morbidly obese patients was more commonly associated with male sex and a poorly controlled diabetic state. The mean weight reduction was 25.5% 1 year after surgery, with a marked improvement in diabetes management. As early as 1 month following surgery, the plasma mean triglyceride levels had decreased to 254 mg/dL (range 153–519 mg/dL), and this was further reduced to mean levels of 192 mg/dL (range 73–385 mg/dL) 1 year after surgery. One patient developed acute pancreatitis during the perioperative period, but none of the patients suffered an episode of pancreatitis in the follow-up period (from 6 months to 13 years). Bariatric surgery can be successfully used as a metabolic surgery in severe hypertriglyceridemia patients at risk of acute pancreatitis. However, control of triglyceride levels prior to bariatric surgery is indicated.
Abstract
It is well established that severe hypertriglyceridemia can lead to pancreatitis. At present, medical treatment for patients with severe hypertriglyceridemia and repeat pancreatitis [...]
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Laparoendoscopic single-site (LESS) retroperitoneal partial adrenalectomy using a custom-made single-access platform and standard laparoscopic instruments: Technical considerations and surgical outcomes
. Chen-Hsun Ho, . Pin-Wen Liao, V. C. Lin, . Fu-Shan Jaw, S. Chueh, . Shiu-Dong Chung, . Shih-Ping Liu, . Yao-Chou Tsai, . Hong-Jeng Yu

Asian Journal of Surgery (2015). Vol. 38

Abstract
We previously reported our initial experience with laparoendoscopic single-site (LESS) retroperitoneal partial adrenalectomy using a custom-made single-port device and conventional straight laparoscopic instruments. Between December 2010 and February 2012, LESS retroperitoneal partial adrenalectomies were performed in 11 patients. Six patients had aldosterone-producing adenomas (APAs) and five patients had nonfunctioning tumors. A single-port access was created with an Alexis wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA) through an incision of 2–3 cm beneath the tip of the 12th rib. All procedures were performed with straight laparoscopic instruments. All LESS procedures were successfully completed without conversion to traditional laparoscopic conversion. The tumors ranged from 1 cm to 4.7 cm (mean, 2.3 cm). The operative time was 71–257 minutes (mean, 121 minutes). Most patients (n = 8) had minimal blood loss, the other three patients had a blood loss of 150 mL, 100 mL, and 100 mL. The mean hospital stay was 3 days (range, 1–6 days). There were no perioperative or postoperative complications. Pathological examinations revealed negative surgical margins in all specimens. All patients with Conns syndrome had an improvement in blood pressure and normalization of plasma renin activity and serum aldosterone levels, all patients were free of potassium supplementation. Our results clearly demonstrate that LESS retroperitoneal partial adrenalectomy can be performed safely and effectively using a custom-made single-access platform and standard laparoscopic instruments.
Abstract
We previously reported our initial experience with laparoendoscopic single-site (LESS) retroperitoneal partial adrenalectomy using a custom-made single-port device and conventional [...]
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Laparoscopic adrenalectomy for adrenal tumors: A 21-year single-institution experience
. Daisaku Hirano, . Ryo Hasegawa, . Tomohiro Igarashi, . Katsuhiko Satoh, . Junichi Mochida, . Satoru Takahashi, . Toshio Yoshida, . Tadanori Saitoh, . Shuji Kiyotaki, . Kiyoki Okada

Asian Journal of Surgery (2015). Vol. 38

Abstract
We have performed laparoscopic adrenalectomy including retroperitoneoscopic adrenalectomy via a single large port (RASLP) and conventional laparoscopic adrenalectomy (CLA) for adrenal tumors since 1992, and report our experience to date. The study population consisted of 134 patients who underwent laparoscopic adrenalectomy from 1992 to 2012. Fifty-eight patients (18 aldosterone-producing adenomas, 13 adenomas with Cushings syndrome, 1 adenoma with preclinical Cushings syndrome, and 26 nonfunctioning tumors) were treated using RASLP, and 76 patients (33 aldosterone-producing adenomas, 17 adenomas with Cushings syndrome, 6 adenomas with preclinical Cushings syndrome, 17 pheochromocytomas, and 3 nonfunctioning tumors) were treated using CLA. Complications were graded according to the modified Clavien system. The majority of RASLPs were performed during the 1990s, whereas all patients underwent CLA after 2000. The mean operation times (166 vs. 205 minutes, p < 0.01) and intraoperative estimated blood loss (85 vs. 247 mL, p < 0.01) were significantly lower in the CLA group. Conversion to open surgery was required in three patients (5%) in the RASLP group and five patients (7%) in the CLA group (p = 0.73). Postoperative complications were grade 1 in three patients and grades 4 and 5 in one patient each in the RASLP group, whereas grade 2 in one patient was observed in the CLA group (p = 0.085). Although this study included biases such as different eras and indications, CLA resulted in decreased operative times, blood loss, and postoperative complications compared with RASLP. CLA has so far become our preferred procedure for patients with adrenal tumor in our experience.
Abstract
We have performed laparoscopic adrenalectomy including retroperitoneoscopic adrenalectomy via a single large port (RASLP) and conventional laparoscopic adrenalectomy (CLA) [...]
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A propensity-matched comparison of perioperative complications and of chronic kidney disease between robot-assisted laparoscopic partial nephrectomy and radiofrequency ablative therapy
S. Han Kim, . Eun-Sik Lee, H. Hoe Kim, . Cheol Kwak, J. Hyeon Ku, S. Eun Lee, S. Kyu Hong, C. Wook Jeong, S. Hyup Kim, J. Yeon Cho, S. Il Hwang, H. Jong Lee, S. Soo Byun

Asian Journal of Surgery (2015). Vol. 38

Abstract
The study presents a matched-pair analysis of robot-assisted laparoscopic partial nephrectomy (RALPN) versus radiofrequency ablation (RFA) to compare the perioperative incidence of complications and chronic kidney disease (CKD). All 46 RFA and 206 RALPN cases from June 2005 to December 2011 were retrospectively reviewed from the medical records and were matched 1:1 based on propensity scores by sex, tumor size, tumor laterality of kidney, tumor location within the kidney, and clinical T stage. Hilar vessel clamping was performed in all RALPN patients. The estimated glomerular filtration rate was used to define the CKD of < 60 mL/minute/1.73 m2 by the Modification of Diet in Renal Disease equation. All patients with baseline CKD or solitary kidney were excluded prior to the matching analysis. The complication was noted with modified Clavien grades ≥ 3. Statistical analysis was performed to compare the perioperative incidence of complications and CKD. A total of 27 matched pairs of RFA and RALPN patients were enrolled for analyzing CKD and perioperative complications. The better general conditions, higher estimated blood loss and transfusion rates, and longer operative time and hospital stay were observed significantly in RALPN patients (p < 0.05). Matched analysis demonstrated that the incidences of both perioperative complications (p = 0.434) and of CKD (p = 0.500) were not significantly different. No complication higher than Grade 4 was detected in either group. Despite the intraoperative renal ischemia and invasiveness of the procedure associated with RALPN, the incidence of perioperative complication and of CKD developing rates were statistically similar.
Abstract
The study presents a matched-pair analysis of robot-assisted laparoscopic partial nephrectomy (RALPN) versus radiofrequency ablation (RFA) to compare the perioperative incidence [...]
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Open versus closed lateral internal anal sphincterotomy in the management of chronic anal fissures: A prospective randomized study
. Vivek Gupta, . Gabriel Rodrigues, . Raghunath Prabhu, . Chandni Ravi

Asian Journal of Surgery (2014). Vol. 37

Abstract
Chronic anal fissure is a benign disorder that is associated with considerable discomfort. Surgical treatment in the form of lateral sphincterotomy has long been regarded as the gold standard of treatment. This study compared the open and closed techniques of lateral sphincterotomy in terms of their postoperative outcomes. A prospective, randomized comparative study was conducted between October 2010 and August 2012. A total of 136 patients were randomly assigned to each of two groups. Patients were followed up postoperatively for more than 1 year to assess any complications. The outcomes were compared among the two groups using the Chi-square test and Student t test. The mean age at presentation was 40.13 years. The male to female ratio was 1.47:1. The typical presentation was painful defecation. Fissures were most often located in the posterior midline and associated with a sentinel pile. Delayed postoperative healing was found in 4.4% of the group of patients undergoing open lateral sphincterotomy. The mean pain score and duration of hospital stay were lower with the closed technique. Closed lateral internal sphincterotomy is the treatment of choice for chronic fissures as it is effective, safe, less expensive, and associated with a lower rate of complications than the open sphincterotomy technique.
Abstract
Chronic anal fissure is a benign disorder that is associated with considerable discomfort. Surgical treatment in the form of lateral sphincterotomy has long been regarded [...]
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Experience and learning curve of retroperitoneal laparoscopic ureterolithotomy
. Hakan Ercil, . Adem Altunkol, . Faruk Kuyucu, N. Can Sener, . Ediz Vuruskan, . Ferhat Ortoglu, Z. Gurbuz

Asian Journal of Surgery (2015). Vol. 38

Abstract
This study was conducted to evaluate clinical experience and learning curve associated with laparoscopic ureterolithotomy performed for upper ureteral stones. The medical data of 50 patients who had undergone retroperitoneal laparoscopic ureterolithotomy between June 2010 and March 2013 were retrospectively analyzed. To assess the learning curve, patients were divided into two groups: Group A (the first 25 cases) and Group B (the last 25 cases). In Group A, double J stents were placed in 17 patients, whereas in Group B 15 patients received double J stents. In Group A, three ports were placed in nine patients and four ports in 16 patients. In Group B, three ports were placed in 20 patients and five patients had four ports. The patients were compared according to demographics, operative time, stone size, complications, hospital stay, and transfusion. The mean age for Group A was 47.8 ± 14.13 (21–72) years and that for Group B was 44.2 ± 14.98 (22–78) years. Mean operative times were 106.4 ± 38 (55–210) minutes and 70.76 ± 30.4 (30–180) minutes for Groups A and B, respectively (p < 0.05). The mean hospital stay was 7.12 ± 4.47 (3–22) days and 4.04 ± 2.05 (2–12) days for Groups A and B, respectively (p < 0.05). The mean stone size was 20.12 ± 5.18 (12–30) mm and 19.44 ± 4.44 (13–28) mm for Groups A and B, respectively (p > 0.05). In our study, as staff experience (in performing laparoscopic retroperitoneal ureterolithotomy) increased, operative time, length of hospital stay, and complication rates have correspondingly declined.
Abstract
This study was conducted to evaluate clinical experience and learning curve associated with laparoscopic ureterolithotomy performed for upper ureteral stones. The medical [...]
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Refinement treatment of nasal bone fracture: A 6-year study of 329 patients
. Chieh Chou, . Chao-Wen Chen, . Yi-Chia Wu, . Ko-Kang Chen, . Su-Shin Lee

Asian Journal of Surgery (2015). Vol. 38

Abstract
The reliability of X-ray radiography for diagnosing nasal bone fractures (NBFs) remains controversial. Recent studies show that, for determining the orientation and location of the displaced/depressed fracture, nasal sonography is as accurate as facial computed tomography. This retrospective study compared conductor-assisted nasal sonography (CANS) to conventional diagnostic tools and reported subjective patient satisfaction and discomfort after closed reduction combined with tube technique. This retrospective study reports the results of 329 refinement treatments for nasal bone fracture (including 199 men and 130 women) performed from 2005 to 2011. All patients were assessed with CANS and completed a survey immediately prior to removing the packing. Questionnaires were adapted from the nasal obstruction symptom evaluation (NOSE) scale. The study found that CANS has a 97.2% rate of accuracy in diagnosing NBF. The visual analog scale scores of nasal obstruction, nasal congestion, sleep disturbance, trouble breathing, and inability to move air through the nose were analyzed. The experimental group scores were significantly different from the control group for all scores (p < 0.001). Compared to conventional methods, CANS is more accurate for detecting NBF. We recommend its use as an alternative tool for diagnosing a nasal fracture. Because the tube technique balances pressure between the nasopharynx and middle ear during swallowing, patient comfort is enhanced. Application of these modifications can improve accuracy in diagnosing NBF and can improve the quality of NBF treatment.
Abstract
The reliability of X-ray radiography for diagnosing nasal bone fractures (NBFs) remains controversial. Recent studies show that, for determining the orientation and location [...]
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Modified prepuce unfurling for buried penis: A report of 12 years of experience
. Tai-Wai Chin, . Hsin-Lin Tsai, . Chin-Su Liu

Asian Journal of Surgery (2015). Vol. 38

Abstract
About 10 years ago, we started to correct buried penis using the technique of modified prepuce unfurling. We have made modifications in the years since our preliminary results were reported in 2002. One hundred and thirty-four patients received modified prepuce unfurling since 2000, with ages ranging from 2 months to 33 years. The surgical procedures included the removal of the narrowest part of the prepuce, dissection of the fibrotic tissue from the Bucks fascia, and unfurling the inner prepuce to cover the penis. Most patients had their procedures in day care service. No urinary catheter was needed. All patients were followed up for at least 2 months. Most patients had satisfactory results. All patients had the glans exposed after surgery, although one patient needed reoperation for prolonged edema and two patients had wound infections. Modified prepuce unfurling is a safe and effective method to correct buried penis.
Abstract
About 10 years ago, we started to correct buried penis using the technique of modified prepuce unfurling. We have made modifications in the years since our preliminary results [...]
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Colorectal peritoneal carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: The experience of a tertiary Asian center
M. Teo, G. Tan, . Cindy Lim, C. Chia, C. Kian Tham, . Khee-Chee Soo

Asian Journal of Surgery (2015). Vol. 38

Abstract
Compared with intravenous chemotherapy, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been shown to improve survival in patients with recurrent colorectal disease confined to the peritoneum. We report our experience with CRS and HIPEC for colorectal cancer patients with peritoneal carcinomatosis, evaluating prognostic factors for disease-free survival (DFS), overall survival (OS), and perioperative morbidity and mortality. All patients who underwent CRS and HIPEC were included in our study. Clinical characteristics, operative data, and 30-day morbidity and mortality were collected and evaluated. Between January 2001 and December 2012, there were 35 consecutive patients who underwent CRS and HIPEC at our institution. Thirty-three patients (94%) had optimal cytoreduction. No 30-day mortality was reported, but 14 patients had postoperative complications. The median DFS was 9.4 months (95% confidence interval 5.5–18.7 months), and DFS at 1 year, 3 years, and 5 years were 43.8%, 22.3%, and 22.3%, respectively. The median OS was calculated to be 27.1 months (95% confidence interval 15.3–39.1), and the OS at 1 year, 3 years, and 5 years were 83.7%, 38.2%, and 19.1%, respectively. CRS and HIPEC can provide survival benefit, with reasonable morbidity and mortality for Asian patients with peritoneal carcinomatosis from colorectal cancer. Patient selection and perioperative management of the patients are key to the success of the procedure.
Abstract
Compared with intravenous chemotherapy, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been shown to improve survival in patients with [...]
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Robotic left hepatectomy with revision of hepaticojejunostomy
. Kuo-Hsin Chen, . Shian-Dian Chen, . Ying-Da Chen, . Yin-Jen Chang, . Tzu-Chao Lin, . Tiing-Foong Siow, . U-Chon Chio, . Shu-Yi Huang, . Jiann-Ming Wu, . Kuo-Shyang Jeng

Asian Journal of Surgery (2014). Vol. 37

Abstract
Laparoscopic hepatectomy and hepaticojejunostomy remain a surgical challenge despite the recent advances in minimally invasive surgery. A robotic surgical system has been developed to overcome the inherent limitations of the traditional laparoscopic approach. However, techniques of robotic hepatectomy have not been well described, and a description of robotic major hepatectomy with bilioenteric anastomosis can be found only in two previous reports. Here, we report a 33-year-old man with a history of choledochocyst resection. The patient experienced repeat cholangitis with left hepatolithiasis during follow-up. Robotic left hepatectomy and revision of hepaticojejunostomy were performed smoothly. The patient recovered uneventfully and remained symptoms-free at a follow-up of 20 months. The robotic approach is beneficial in the fine dissection of the hepatic hilum and revision of hepaticojejunostomy in this particular patient.
Abstract
Laparoscopic hepatectomy and hepaticojejunostomy remain a surgical challenge despite the recent advances in minimally invasive surgery. A robotic surgical system has been [...]
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Nonoperative management for perforated peptic ulcer: Who can benefit?
F. Cao, J. Li, A. Li, Y. Fang, . Ya-jun Wang, F. Li

Asian Journal of Surgery (2014).

Abstract
Although nonoperative management for perforated peptic ulcer (PPU) has been used for several decades, the indication is still unclear. A clinicoradiological score was sought to predict who can benefit from it. A clinicoradiological protocol for the assessment of patients presenting with PPU was used. A logistic regression model was applied to identify determinant variables and construct a clinical score that would identify patients who can be successfully treated with nonoperative management. Of 241 consecutive patients with PPU, 107 successfully received nonoperative management, and 134 required surgery. In multivariable analysis, the following four variables correlated with surgery and were given one point each toward the clinical score: age ≥70 years, fluid collection detection by ultrasound, contrast extravasation detection by water-soluble contrast examination, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥8. Eighty-five percent of patients with a score of 1 or less were successfully treated with nonoperative management, whereas 23 of 29 patients with a score of 3 or more required surgery. The area under the receiver operating characteristic curve was 0.804 (95% confidence interval = 0.717–0.891). By combining clinical, radiological parameters, and APACHE II score, the clinical score allowed early identification of PPU patients who can benefit from nonoperative management.
Abstract
Although nonoperative management for perforated peptic ulcer (PPU) has been used for several decades, the indication is still unclear. A clinicoradiological score was sought [...]
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Primary right atrial angiosarcoma misdiagnosed as aortic intramural hematoma
. Gyeong-Jo Byeon, . Hyung-Gon Je, . Hyeon-Jeong Lee, . Ji-Uk Yoon, . Joo-Yun Kim, . Sang-Wook Shin, . Kyung-Un Choi

Asian Journal of Surgery (2016). Vol. 39

Abstract
The overall incidence of cardiac tumor is very low, and malignant cardiac tumors account for only 25% of all cardiac tumors. Angiosarcomas are the most common type of malignant cardiac tumors, characterized by rapidly proliferating, extensively infiltrating anaplastic cells derived from blood vessels and lining irregular blood-filled spaces. We present a 26-year-old man with angiosarcoma involving the right atrium, which was misdiagnosed as aortic intramural hematoma by computed tomography, finally confirmed by transesophageal echocardiography during the operation.
Abstract
The overall incidence of cardiac tumor is very low, and malignant cardiac tumors account for only 25% of all cardiac tumors. Angiosarcomas are the most common type of malignant [...]
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Presentation of pericardial hydatid cyst as acute cardiac tamponade
A. Bogdanovic, . Milan Radojkovic, R. Tomasevic, . Ivan Pesic, T. Petkovic, . Predrag Kovacevic, . Zoran Rancic

Asian Journal of Surgery (2017). Vol. 40

Abstract
We report a case of a 47-year-old man with isolated pericardial hydatid cyst (without myocardial involvement) that presented as acute pericardial tamponade. After initial investigation and transthoracic echocardiography, emergent pericardial drainage was performed for downgrading the urgency of a definitive treatment for a hydatid cyst. A computed tomography examination after the pericardial drainage showed a pericardial cyst without heart muscle involvement, making the treatment possible through anterior thoracotomy and without performing cardiopulmonary bypass. Complete surgical removal of the cyst was performed. The postoperative course was uneventful. The patient received postoperative albendazole treatment. He remained asymptomatic and no recurrence was observed during a 1-year follow-up period.
Abstract
We report a case of a 47-year-old man with isolated pericardial hydatid cyst (without myocardial involvement) that presented as acute pericardial tamponade. After initial [...]
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Short- and long-term results of harmonic scalpel hemorrhoidectomy versus stapler hemorrhoidopexy in treatment of hemorrhoidal disease
. Yusuf Bilgin, . Semih Hot, İ. Barlas, A. Akan, . Yavuz Eryavuz

Asian Journal of Surgery (2015). Vol. 38

Abstract
In this prospective randomized study, our aim is to compare the short- and long-term results of harmonic scalpel hemorrhoidectomy (HSH) and stapler hemorrhoidopexy (SH) methods in the surgical treatment of Grade III and Grade IV hemorrhoidal disease. Ninety-nine consecutive patients diagnosed with Grade III or Grade IV internal hemorrhoidal disease were included in the study. Patients were randomized to HSH (n = 48) or SH (n = 51) treatments. Data on patient demographic and clinical characteristics, operative details, postoperative pain score on a visual analog scale, additional analgesic requirement, postoperative short- and long-term complications, and recurrence of hemorrhoidal disease were also recorded. Patients were regularly followed for a total period of 24 (6–36) months. The patient demographic and clinical characteristics were similar in the two groups. The operative time was significantly shorter in the HSH group compared with the SH group. Overall pain scores were not significantly different between the groups, although severe pain was significantly more common in the HSH group. Recurrence was significantly lower in the HSH group compared with the SH group. HSH and SH are both safe and effective methods for surgical treatment of Grade III and Grade IV hemorrhoidal disease. In our study, the HSH method was determined to be safer, easier, and faster to perform, and associated with fewer long-term recurrences than the SH method.
Abstract
In this prospective randomized study, our aim is to compare the short- and long-term results of harmonic scalpel hemorrhoidectomy (HSH) and stapler hemorrhoidopexy (SH) methods [...]
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Primary non-Hodgkins lymphoma of the common bile duct: A case report and literature review
. Ali Zakaria, . Salwan Al-Obeidi, . Salam Daradkeh

Asian Journal of Surgery (2017). Vol. 40

Abstract
Hepatobiliary involvement by malignant lymphoma is usually a secondary manifestation of systemic disease, whereas primary non-Hodgkins lymphoma of the extrahepatic biliary ducts is an extremely rare entity. We describe the case of a 57-year-old man who presented with an acute onset of obstructive jaundice and severe itching. Abdominal ultrasonography and computed tomography revealed intrahepatic and common hepatic ducts dilatation. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography showed a mid-common bile duct stricture. The patient was presumed to have cholangiocarcinoma of the common bile duct, and an en bloc resection of the tumor with Roux-en-Y hepaticojejunostomy and porta-hepatis lymph nodes dissection was performed. Histopathology and immunohistochemistry revealed a large B cell non-Hodgkins lymphoma. The patient received six cycles of combination chemotherapy using cyclophosphamide, vincristine, prednisone, and rituximab (CVP-R) protocol, and after a 5-year follow-up he is still in complete remission. We also reviewed the cases published from 1982 to 2012, highlighting the challenges in reaching a correct preoperative diagnosis and the treatment modalities used in each case.
Abstract
Hepatobiliary involvement by malignant lymphoma is usually a secondary manifestation of systemic disease, whereas primary non-Hodgkins lymphoma of the extrahepatic biliary [...]
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Infrahepatic inferior vena cava clamping in hepatectomy for tumors involving hepatocaval confluence
. Jiamei Yang, . Chengjun Sui, T. Kan, B. Li, . Yanming Zhou

Asian Journal of Surgery (2013). Vol. 36

Abstract
Massive hemorrhage and the need for blood transfusion carry a high rate of morbidity and mortality after hepatectomy. The aim of this study was to evaluate the safety and potential benefit of infrahepatic inferior vena cava (IVC) clamping in hepatectomy for tumors involving hepatocaval confluence. We conducted a retrospective analysis of 113 consecutive patients who underwent hepatectomy with infrahepatic IVC clamping (n = 60, Group A) and without infrahepatic IVC clamping (n = 53, Group B) as the initial treatment for tumors involving hepatocaval confluence. In Group A, central venous pressure reduced from 7.6 ± 3.2 to 4.4 ± 2.7 cm H2O (p < 0.001). Patients in Group A experienced less blood loss (477.3 ± 340.3 vs. 794.5 ± 602.7 mL, p = 0.001), fewer blood transfusion requirements (8.3% vs. 22.6%, p = 0.034), lower postoperative complications (40% vs. 60.4%, p = 0.031), and shorter hospital stay (10.7 ± 2.2 vs. 12.9 ± 4.8 days, p = 0.008) than those in Group B. Infrahepatic IVC clamping is generally effective and safe in controlling bleeding during hepatectomy for tumors involving hepatocaval confluence.
Abstract
Massive hemorrhage and the need for blood transfusion carry a high rate of morbidity and mortality after hepatectomy. The aim of this study was to evaluate the safety and [...]
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Pseudolymphoma of the liver: Report of a case and review of the literature
. Cheng-Ta Yang, . Kao-Lang Liu, . Ming-Chieh Lin, . Ray-Hwang Yuan

Asian Journal of Surgery (2017). Vol. 40

Abstract
We report a case of pseudolymphoma of the liver in a 49-year-old woman without an underlying disease except for liver hemangioma. A 20-mm nodule was incidentally found in segment 2 of the liver by abdominal ultrasonography during a regular follow-up of the hepatic hemangioma. After a series of radiological examinations, a left lateral sectionectomy was performed because malignant hepatic tumor could not be excluded. The patient was discharged uneventfully 7 days after the operation. The pathology examination revealed a pseudolymphoma. No recurrence of the tumor was found 5½ years after the operation. To the best of our knowledge, only 46 cases of pseudolymphoma of the liver have been reported to date. A review of the literature showed that pseudolymphomas occur predominantly in females (89.4%), usually occur as a single tumor (80.4%), are no more than 20 mm in size (90.6%), and are frequently associated with either autoimmune disease or chronic liver disease. Because an accurate diagnosis is difficult to establish, vigilant follow-up is indicated, and surgical intervention is the choice of treatment once the suspiciousness of malignancy has been raised.
Abstract
We report a case of pseudolymphoma of the liver in a 49-year-old woman without an underlying disease except for liver hemangioma. A 20-mm nodule was incidentally found in [...]
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Maggot therapy for chronic ulcer: A retrospective cohort and a meta-analysis
. Chumpon Wilasrusmee, M. Marjareonrungrung, . Suwannee Eamkong, . John Attia, . Napaphat Poprom, . Sopon Jirasisrithum, . Ammarin Thakkinstian

Asian Journal of Surgery (2014). Vol. 37

Abstract
Maggot wound therapy (MWT) has been used in various wounds including diabetic foot ulcers, venous leg ulcers, pressure ulcers, and acute surgical wounds. However, the efficacy of MWT therapy has been controversial. We therefore conducted a cohort study and a meta-analysis to assess MWT effects. A retrospective cohort study was performed in diabetic foot ulcer (DFU) patients who were treated with MWT or conventional wound therapy (CWT) in Thailand. The Kaplan-Meier curve was applied to estimate the healing probability. A meta-analysis was performed to pool our study with four previous cohort studies identified from Medline and Scopus. The estimated incidence of wound healing was 5.7/100 (95% CI: 4.49, 7.32) patients-week, and the median time to healing was 14 weeks. The hazard ratio (HR) of wound healing was 7.87 times significantly higher in the MWT than the CWT (p < 0.001) after adjusting for duration and size of ulcers, ankle brachial index (ABI), and glycated hemoglobin (HbA1c). Meta-analysis was applied and suggested that the treatment effects were moderately heterogeneous {Chi-square = 6.18 [degrees of freedom (d.f.) = 4], p = 0.186, I2 = 35.2%}, with the pooled risk ratio (RR) of 1.77 [95% confidence intervals (CI) = 1.01, 3.11], i.e., the chance of wound healing was 20% significantly higher with MWT than CWT. The average costs of treatment in patients with DFU were lower in the MWT group than in the CWT group, with medians of US$292.82 and US$490, respectively. Our evidence suggests that MWT is significantly better for wound healing and more cost-effective than CWT. An updated meta-analysis or large scale randomized controlled trial (RCT) is required to confirm this effect.
Abstract
Maggot wound therapy (MWT) has been used in various wounds including diabetic foot ulcers, venous leg ulcers, pressure ulcers, and acute surgical wounds. However, the efficacy [...]
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Left nutcracker syndrome and right ureteropelvic junction obstruction
. Chen Wenwei, . Yuan Xiangzhi, . Xu Huazhi, . Yang Yirong, . Li Chengdi

Asian Journal of Surgery (2014). Vol. 37

Abstract
We report a rare case of left nutcracker syndrome and right ureteropelvic junction obstruction in a young woman who suffered flank pain and hematuria. The diagnosis was confirmed with the help of Doppler ultrasonography, retrograde pyelography, magnetic resonance angiography, and magnetic resonance urography. A surgery that involves left renal vein decompression and dismembered Anderson–Hynes pelvioplasty was performed. The patient was followed up for 23 months, and her symptoms were relieved.
Abstract
We report a rare case of left nutcracker syndrome and right ureteropelvic junction obstruction in a young woman who suffered flank pain and hematuria. The diagnosis was confirmed [...]
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Robotic single port cholecystectomy (R-LESS-C): Experience in 36 patients
. Cihan Uras, D. Eren Böler, . Ilknur Erguner, . Ismail Hamzaoglu

Asian Journal of Surgery (2014). Vol. 37

Abstract
Laparoendoscopic single-site surgery (LESS) has emerged as a result of a search for “pain-less” and “scar-less” surgery. Laparoendoscopic single-site cholecystectomy (LESS-C) is probably the most common application in general surgery, although it harbors certain limitations. It was proposed that the da Vinci Single-Site (Si) robotic system may overcome some of the difficulties experienced during LESS, providing three dimensional views and the ability to work in a right-handed fashion. Thirty-six robotic single port cholecystectomies (R-LESS-C) performed with the da Vinci Si robotic system are evaluated in this paper R-LESS-C performed in 36 patients were reviewed. The data related to the perioperative period (i.e., anesthesia time, operation time, docking time, and console time) was recorded prospectively, whereas the hospitalization period, postoperative visual analogue scale (VAS) pain scores were collected retrospectively. A total number of 36 patients, with a mean age of 40.1 years (21–64 years), underwent R-LESS-C. There were five men and 31 women. The mean anesthesia and operation times were 79.3 minutes (45–130 minutes) and 61.8 minutes (34–110 minutes), respectively. The mean docking time was 9.8 minutes (4–30 minutes) and the mean console time was 24.9 minutes (7–60 minutes). The mean hospital stay was 1.05 days (1–2 days) and the mean pain score (VAS) was 3.6 (2–8) in the first 24 hours. Incisional hernia was recorded in one patient. R-LESS-C can be performed reliably with acceptable operative times and safety. The da Vinci Si robotic system may ease LESS-C. Two issues should be considered for routine use: expensive resources are needed and the incidence of incisional hernia may increase.
Abstract
Laparoendoscopic single-site surgery (LESS) has emerged as a result of a search for “pain-less” and “scar-less” surgery. Laparoendoscopic single-site cholecystectomy [...]
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Retroperitoneal laparoscopic debridement and drainage of infected retroperitoneal necrosis in severe acute pancreatitis
Y. Tu, . Huabo Jiao, . Xianglong Tan, . Dadong Wang, J. Du, L. Sun, . Wenzhi Zhang

Asian Journal of Surgery (2013). Vol. 36

Abstract
To explore the effect of retroperitoneal laparoscopic debridement and drainage on infected necrosis in severe acute pancreatitis. This retrospective study included 18 patients with severe acute pancreatitis (SAP) undergoing retroperitoneal laparoscopic debridement and drainage from May 2006 to April 2012 in our hospital. All patients had infected retroperitoneal necrosis and single or multiple peritoneal abscesses. Eleven patients transferred to our hospital were treated with the retroperitoneal laparoscopic debridement and drainage within 24–72 hours after admission. Conservative treatments were given to eight patients. Retroperitoneal laparoscopic debridement and drainage were applied 3–11 days after admission. All patients had infection of necrotic pancreas or peripancreatic tissues. Twelve patients had organ failure. Three patients underwent secondary surgery. Laparotomy with debridement and drainage were applied to one patient who had a huge lesser sac abscess 7 days after first surgery. The other two patients were given secondary retroperitoneal laparoscopic debridement and drainage. One case was complicated by retroperitoneal hemorrhage, four cases had pancreatic leakage, and no intestinal fistula was found. The patients' heart rate, respiration, temperature, and white blood cell count were significantly improved 48 hours after surgery compared with those prior to surgery (p
Abstract
To explore the effect of retroperitoneal laparoscopic debridement and drainage on infected necrosis in severe acute pancreatitis. This retrospective study included 18 patients [...]
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An unusual cause of acute abdomen—Gas-forming liver abscess due to Salmonella enteritidis
H. Tee Yu, . Simon Tsang, T. To Cheung

Asian Journal of Surgery (2017). Vol. 40

Abstract
Gas-forming pyogenic liver abscess (GFPLA) is considered to be a very severe form of PLA and carries a high mortality. Klebsiella pneumoniae is the most common pathogen responsible for the disease, whereas cases where Salmonella is cited as the cause are very uncommon. We report the first case of a 53-year-old lady suffering from GFPLA due to Salmonella, who was successfully treated with surgical drainage. To the best of our knowledge, this is the first case of GFPLA caused by Salmonella enteritidis to be reported in the English literature.
Abstract
Gas-forming pyogenic liver abscess (GFPLA) is considered to be a very severe form of PLA and carries a high mortality. Klebsiella pneumoniae is the most common pathogen responsible [...]
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Discriminative features of thin-slice computed tomography for peripheral intrapulmonary lymph nodes
. Masaru Takenaka, . Hidetaka Uramoto, . Hidehiko Shimokawa, . Tomoko So, . Takeshi Hanagiri, . Takatoshi Aoki, . Fumihiro Tanaka

Asian Journal of Surgery (2013). Vol. 36

Abstract
The use of computed tomography (CT) scans has increased the opportunities to detect small nodular shadows in peripheral lung fields. Intrapulmonary lymph nodes (IPLNs) are sometimes identified among these nodular shadows, and a differential diagnosis is often difficult. However, few descriptions of the CT findings of IPLNs, with regard to their potential for the differential diagnosis of lung cancer, have been published. From 2006 through 2011, 606 patients underwent thoracic surgery for pulmonary nodules. Nine patients (1.5%) had pathologically diagnosed IPLNs. We retrospectively reviewed the clinicopathological features and thin-section CT findings of the patients with IPLNs. We also compared these IPLN patients with 17 patients having small-sized lung cancer. In six cases, the nodules were round, and linear density extending from the IPLNs was visualized in seven nodules. The nodules in IPLNs were located in the lower lobe, and the nodule borders were clearer than those of lung cancers. Six out of nine nodules were round, and linear densities were more easily visualized for the IPLNs. Medical specialists need to be familiar with the discriminative features of thin-slice CT for IPLNs not only to avoid performing unnecessary operations, but also to prevent the mis-staging of lung cancer.
Abstract
The use of computed tomography (CT) scans has increased the opportunities to detect small nodular shadows in peripheral lung fields. Intrapulmonary lymph nodes (IPLNs) are [...]
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Primary repair of tetralogy of Fallot in infants: Transatrial/transpulmonary or transventricular approach
G. Sun, . Xuefeng Wang, . Jinjin Chen, R. Ma, F. Li, L. Chen, . Yingbin Xiao

Asian Journal of Surgery (2013). Vol. 36

Abstract
Right ventricular (RV) dysfunction is a significant cause of morbidity and mortality after surgical correction of tetralogy of Fallot (TOF). Transatrial/transpulmonary repair avoids a ventriculotomy (in contrast to the transventricular approach) in order to preserve the structure and function of the right ventricle. We performed a pilot prospective randomized controlled trial in infants with TOF undergoing primary repair. A pilot prospective controlled clinical trial was conducted in infants with TOF undergoing primary repair between January 2008 and December 2009. One hundred and six patients were recruited in the trial and divided into a transatrial–transpulmonary approach group (Group A, n = 53) and a transventricular approach group (Group B, n = 53), depending on the different surgical techniques used. Preoperative patient characteristics and procedure-related variables were similar. There were no deaths in Group A, while two patients died in Group B. There were significant differences in cardiopulmonary bypass time (95.02 ± 23.8 vs. 85.23 ± 22.63 minutes, p = 0.032), cross-clamp time (69.4 ± 10.36 vs. 61.17 ± 9.38 minutes, p = 0.035), inotropic support (1.63 ± 0.97 vs. 2.1 ± 1.09 days, p = 0.02), intubation time (26.62 ± 12.48 vs. 33.02 ± 17.55 hours, p = 0.033), duration of stay in the intensive care unit (ICU) (2.25 ± 1.28 vs. 2.85 ± 1.46 days, p = 0.026), and the incidence of arrhythmia [3 patients (5.7%) vs. 10 patients (18.9%), p = 0.038]. No significant differences in right/left ventricular pressure ratio and hospital stay were observed. Transatrial/transpulmonary repair of TOF is associated with excellent surgical results and immediately follow-up.
Abstract
Right ventricular (RV) dysfunction is a significant cause of morbidity and mortality after surgical correction of tetralogy of Fallot (TOF). Transatrial/transpulmonary repair [...]
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Comparison of superficial surgical site infection between delayed primary and primary wound closures in ruptured appendicitis
B. Siribumrungwong, . Kanoklada Srikuea, . Ammarin Thakkinstian

Asian Journal of Surgery (2014). Vol. 37

Abstract
Delayed primary (DPC) and primary (PC) wound closures have been applied in ruptured appendicitis, but results were controversial. This study aims at comparing the rate of superficial surgical site infection (SSI) in ruptured appendicitis between DPC and PC. A retrospective cohort of ruptured appendicitis was conducted between October 2006 and November 2009. Demographic, operative findings and postoperative infection data were retrieved. The superficial SSI rates between groups were compared using an exact test. An odds ratio of SSI was then estimated. One-hundred and twenty eight patients with ruptured appendicitis were eligible and their data were retrieved, 115 (90%) patients had received DPC and 13 (10%) patients had received PC. The SSI rate was much lower in PC patients than in DPC patients, i.e., 7.7% [95% confidence interval (CI): 0.02, 36.0] versus 27.8% (95% CI: 19.9, 37.0), respectively. There was an approximately 72% lower risk of SSI in the PC group than in the DPC group, but this did not reach statistical significance (p = 0.18). Our study suggested that PC does not increase risk of SSI in low SSI risk patients with ruptured appendicitis. DPC should not be routinely done.
Abstract
Delayed primary (DPC) and primary (PC) wound closures have been applied in ruptured appendicitis, but results were controversial. This study aims at comparing the rate of [...]
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Solitary benign fibrous mesothelioma of the peritoneum: A rare entity in a 2-year-old child
. Sunita Singh, . Monika Sangwan, R. Sen, . K.N. Rattan, . Ragini Singh, M. Kala

Asian Journal of Surgery (2016). Vol. 39

Abstract
Solitary benign fibrous mesothelioma (BFM) is uncommon and is termed as solitary fibrous mesothelioma or localized fibrous mesothelioma. Although the most common site for its development is the pleural region (65%), it has also been reported in the peritoneum. They are mostly seen in adults (average age: 54 years). Herein, we present a case of BFM in a 2-year-old male child, who presented to our hospital with abdominal pain and a lump in the abdomen. Differential diagnosis included solitary fibrous tumor, gastrointestinal stromal tumor, and benign fibrous lesions of mesentery. Establishing a preoperative diagnosis is difficult on the basis of clinical parameters or imaging studies and final diagnosis can only be assessed based on the results of histopathological and immunohistochemical examination.
Abstract
Solitary benign fibrous mesothelioma (BFM) is uncommon and is termed as solitary fibrous mesothelioma or localized fibrous mesothelioma. Although the most common site for [...]
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Primary melanoma of the esophagus, a diagnostic challenge
. Yirong Sim, J. Teo, . Jabed Iqbal, W. Hoong Chan

Asian Journal of Surgery (2015). Vol. 38

Abstract
Primary melanoma of the esophagus is a rare condition. Its diagnosis can be challenging, as its presentation is similar to that of other esophageal malignancies, especially when melanin is not evidently expressed in the melanoma. We report a case of esophageal melanoma in a 59-year-old Chinese male, whose histological diagnosis was confirmed from the esophagectomy specimen.
Abstract
Primary melanoma of the esophagus is a rare condition. Its diagnosis can be challenging, as its presentation is similar to that of other esophageal malignancies, especially [...]
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Effects of albumin and synthetic polypeptide-coated oxygenators on IL-1, IL-2, IL-6, and IL-10 in open heart surgery
. Erdal Simsek, . Kasim Karapinar, . Onursal Bugra, A. Tulga Ulus, . Ali Sarigul

Asian Journal of Surgery (2014).

Abstract
In this study, we have tried to demonstrate the effects of coating style used in oxygenators on various hematologic and clinical parameters. Twenty-seven patients were included in the study, who had undergone operations because of elective coronary artery disease. Albumin-coated oxygenator was used in Group I. In Group II, a synthetic polypeptide-coated oxygenator was used. C1-inhib (complement), C3c, C4, interleukins (IL-1β, IL2, IL-6, IL-10), and tumor necrosis factor alpha (TNF-α) levels were examined at four different time intervals. Hemoglobin, hematocrit, leukocyte and platelet counts, drainage, and transfused blood volumes were analyzed. Albumin levels were significantly lower in Group I than those in Group II 5 minutes after the removal of the cross-clamp. Twenty-four hours after the surgery, Group I patients also had a significantly higher white blood cell count compared to Group II patients. TNF-α levels in Group I were always expressed in considerably higher amounts than those in Group II. IL-6 levels were significantly higher in Group I, but IL-10 levels were observed to be higher in Group II (p < 0.05). Synthetic polypeptide-coated advanced technology, which employed oxygenators, had an important attenuator effect on acute phase reactants and also on the inflammatory response.
Abstract
In this study, we have tried to demonstrate the effects of coating style used in oxygenators on various hematologic and clinical parameters. Twenty-seven patients were included [...]
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Treatment of sternal wound infections after open-heart surgery
. Yue-Dong Shi, . Fa-Zhi Qi, Y. Zhang

Asian Journal of Surgery (2014). Vol. 37

Abstract
The aim of this study was to investigate the proper treatment of infected median sternotomy wounds. A retrospective study was conducted to investigate the proper treatment of infected median sternotomy wounds on patients with sternal wound infections from January 2007 to July 2009. The characteristics of the sternal infections and the treatment outcomes were analysed. Ninety-seven patients with sternal wound infections were treated. A total of 32 patients acquired the infection within one month after open-heart surgery, 10 patients got the infection one to two months after the surgery, and 1 patient died two days after debridement. There were 54 patients who acquired the infection beyond two months post-surgery, while 1 patient died on the day before the operation. One patient received four cycles of wound debridement, 18 patients received two cycles and 78 patients only received one cycle. A total of 14 patients received a vacuum-assisted closure treatment. There were 73 patients who had surgery for repair of muscle flaps, 1 patient for breast tissue flap, 63 patients for pectoralis major muscle flap, and 9 patients with rectus abdominis muscle flap. There were 12 patients who received a transverse plate fixation of the sternum with titanium plating. A positive prognosis can be obtained by the algorithm treatment based on the onset and depth of the sternal infection.
Abstract
The aim of this study was to investigate the proper treatment of infected median sternotomy wounds. A retrospective study was conducted to investigate the proper treatment [...]
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Double peptic perforation: Report of a rare case
A. K. Sharma, R. K. Sharma, S. K. Sharma, . Devendra Soni, T. Pratap Singh

Asian Journal of Surgery (2015).

Abstract
Perforation peritonitis is the most common surgery performed in an emergency. Upper gastrointestinal tract perforation is more common than lower gastrointestinal perforation. Multiple peptic perforations in an individual are a relatively rare entity, with fewer than 10 cases reported in the literature. The factor that contributes the most for the occurrence of multiple peptic perforations is analgesic and steroid abuse. Herein, we report a rare case of double peptic perforation in a middle-aged man with history of analgesic use for 18 months.
Abstract
Perforation peritonitis is the most common surgery performed in an emergency. Upper gastrointestinal tract perforation is more common than lower gastrointestinal perforation. [...]
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Parathyroid carcinoma in tertiary hyperparathyroidism
B. Seup Kim, H. Suk Ryu, K. Ho Kang, S. Jun Park

Asian Journal of Surgery (2016). Vol. 39

Abstract
Parathyroid carcinoma is a rare disease of unknown etiology. This study presents a case of parathyroid carcinoma in a patient with tertiary hyperparathyroidism. Despite a successful kidney transplantation, the intact parathyroid hormone (iPTH) level of the patient was elevated consistently and could not be controlled by medical therapy. Due to the development of tertiary hyperparathyroidism with bone pain and osteoporosis, subtotal parathyroidectomy was performed 4 months after the kidney transplantation. Histological evaluation revealed that one of four parathyroid lesions was a parathyroid carcinoma, while the others were diffuse hyperplasia. Postoperative laboratory studies indicated a decreased level of iPTH. A positron emission tomography–computed tomography performed 6 months after the operation revealed no evidence of local recurrence or distant metastasis.
Abstract
Parathyroid carcinoma is a rare disease of unknown etiology. This study presents a case of parathyroid carcinoma in a patient with tertiary hyperparathyroidism. Despite a [...]
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Treatment of thoracic wounds with adapted vacuum therapy
I. Abreu, E. P.O. Pontes, M. F.L. Tamagno, R. Sardenberg, R. Naim Younes, F. Abrão

Asian Journal of Surgery (2014). Vol. 37

Abstract
This is a report of seven cases of infected thoracic wounds treated with an adapted low-cost vacuum therapy in the Thoracic Surgery Unit of Santa Marcelina Hospital. The vacuum system used was designed and adapted to our hospital due to financial limitations on the acquisition of commercial kits. The vacuum-assisted closure kit used in this study consisted of chlorhexidine sponges (which are usually used for antisepsis of the surgical team), a 16F nasogastric tube, and two sterile adhesive films (OPSITE) for surgical field reinforcement. The mean duration of vacuum therapy was 13.4 days (range, 10–20 days), with an average of three dressing changes (range, 1–5). After treatment with vacuum-assisted closure, three wounds (3/7) were closed with simple primary sutures, one of the lesions (1/7) was closed by muscle flap rotation, and three wounds (3/7) healed by second intention. This adapted vacuum therapy was safe and easy to apply in our institution, including its use in patients with thoracostomies.
Abstract
This is a report of seven cases of infected thoracic wounds treated with an adapted low-cost vacuum therapy in the Thoracic Surgery Unit of Santa Marcelina Hospital. The vacuum [...]
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Inflammatory myofibroblastic tumors of the duodenum
. Igor Petrovic, . Goran Augustin, . Ljiljana Hlupic, . Ana Nedic, . Ivan Romic, . Mate Skegro

Asian Journal of Surgery (2016). Vol. 39

Abstract
Inflammatory myofibroblastic tumors (IMTs) are rare soft-tissue tumors that can occur at virtually any anatomical site. We report the case of a 58-year-old male with an IMT of the fourth part of the duodenum who presented with signs and symptoms of high intestinal obstruction and bilious vomiting. The patient underwent a surgical resection of the fourth part of the duodenum with end-to-end duodenojejunal anastomosis. The follow-up period of 6 months was uneventful with no evidence of recurrence. According to our knowledge, only six cases of duodenal IMTs have been reported in the literature thus far, and this is the first report of a duodenal IMT sited at the fourth part of the duodenum. The duodenum is among the rarest sites of IMTs. Signs and symptoms resulting from diagnostic imaging investigations are nonspecific and inadequate to obtain diagnosis accurately. In most cases, surgical treatment is considered a cure for IMTs. There is no evidence of deaths caused by duodenal IMT. IMT of the duodenum is a possible diagnosis in differential diagnosis of tumor-like lesions of the duodenum.
Abstract
Inflammatory myofibroblastic tumors (IMTs) are rare soft-tissue tumors that can occur at virtually any anatomical site. We report the case of a 58-year-old male with an IMT [...]
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Endoscopic ultrasound-guided hepaticogastrostomy for advanced cholangiocarcinoma after failed stenting by endoscopic retrograde cholangiopancreatography
. Sukij Panpimanmas, . Thawee Ratanachu-ek

Asian Journal of Surgery (2013). Vol. 36

Abstract
Cholangiocarcinoma is common in Thailand. There are many palliative treatments available for patients with unresectable tumor, such as endoscopic retrograde cholangiopancreatography (ERCP) with stents, percutaneous transhepatic biliary drainage, or surgery. In cases in which ERCP has failed, we propose an alternative technique: the use of endoscopic ultrasound with fluoroscopy to perform hepaticogastrostomy for palliative drainage instead of percutaneous transhepatic biliary drainage. A case series study was conducted between December 2005 and December 2009 of 10 patients (4 male and 6 female, average age: 57 years) who presented with severe jaundice caused by advanced cholangiocarcinoma, who were treated with this procedure after failure to drain by ERCP. We used an electronic convex curved linear-array fluoroscopy-guided echoendoscope to drain the left dilated intrahepatic duct to the stomach by metallic wallstent. We performed the procedure with the first six patients under general anesthesia and with the other four under conscious sedation. Follow-up liver function tests were done, and clinical symptoms and survival times were recorded. Hepaticogastrostomy was unsuccessful on the first two patients (success rate = 8/10, 80%), and effective drainage was obtained in only seven patients. Average total bilirubin reduction was 14.96 mg/dL (58.75%) and 18.13 mg/dL (71.20%) after 2 weeks and 4 weeks, respectively, with good quality of life. One patient was not effectively drained because of malposition of the stent. There were two patients whose stent migrated into the stomach, one needed a second session with a second wallstent, and the other needed a double pigtail stent inside the second wallstent. Follow-up survival rates were 32–194 days (average: 123 days). Endoscopic-ultrasound-guided hepaticogastrostomy is safe and can be a good palliative option for advanced malignant biliary obstruction because it drains internally and is remote from the tumor site, promoting a long patency period of prosthesis and better quality of life.
Abstract
Cholangiocarcinoma is common in Thailand. There are many palliative treatments available for patients with unresectable tumor, such as endoscopic retrograde cholangiopancreatography [...]
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Usefulness of breast-conserving surgery using the round block technique or modified round block technique in Japanese females
. Tomoko Ogawa

Asian Journal of Surgery (2014). Vol. 37

Abstract
The round block technique (RBT) is an oncoplastic technique in which only the perimamillary scars remain visible. We have performed RBT in cases that require resection of the breast tissue under the nipple–areola complex (NAC) and a modified round block technique (MRBT) in peripheral cases in which performing resection of the breast tissue under the NAC is unnecessary. We herein report the usefulness of these techniques. The study participants consisted of 18 patients who underwent breast-conserving surgery (BCS) using MRBT or RBT between July 2010 and July 2011. In the cases using RBT, de-epithelialization between the outer and inner incision lines was performed and the dermis was cut at the side of the tumor location. For MRBT cases, the dermis was cut in all parts of the inner and outer circles, and the skin between the inner and outer incision lines was resected. Cosmetic results were found to be excellent in three cases, good in eight cases, fair in five cases, and poor in two cases. In this study, the cosmetic results were unacceptable (fair and poor) in patients who underwent ≥25% resection or in whom the resected area was part of the lower portion of the breast. These techniques are useful for performing BCS in the upper portion of the breast. However, if the excision volume is >20% or excision of part of the lower portion of the breast is required, other procedures should be considered.
Abstract
The round block technique (RBT) is an oncoplastic technique in which only the perimamillary scars remain visible. We have performed RBT in cases that require resection of [...]
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Goldilocks mastectomy for obese Japanese females with breast ptosis
. Tomoko Ogawa

Asian Journal of Surgery (2015). Vol. 38

Abstract
The Goldilocks mastectomy is a method that uses redundant mastectomy flap tissue alone to create a breast mound in female American patients with macromastia. Goldilocks mastectomy was performed for obese Japanese females with breast ptosis, and its indications were considered for Japanese female patients. This report presents the results of five patients who underwent Goldilocks mastectomy, including one with bilateral breast cancer. The average age of the patients was 72 years (range: 67–76 years). The body mass index (BMI) was more than 25 in all the cases. Four patients had invasive ductal carcinoma, and one patient had noninvasive ductal carcinoma of bilateral breasts. The cosmetic results were found to be good in two cases [a patient with bilateral breast cancer and a severely obese patient (BMI = 39)]. The cosmetic results in the other three cases were poor. Although the reconstructed breast size was small, this procedure resulted in better cosmetic results than what would be achieved with the usual method of mastectomy for Japanese patients with bilateral breast cancer and severely obese Japanese patients.
Abstract
The Goldilocks mastectomy is a method that uses redundant mastectomy flap tissue alone to create a breast mound in female American patients with macromastia. Goldilocks mastectomy [...]
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Composite pheochromocytoma with a malignant peripheral nerve sheath tumor: Case report and review of the literature
. Takeshi Namekawa, . Takanobu Utsumi, . Takashi Imamoto, . Koji Kawamura, . Takashi Oide, . Tomoaki Tanaka, . Naoki Nihei, . Hiroyoshi Suzuki, . Yukio Nakatani, . Tomohiko Ichikawa

Asian Journal of Surgery (2016). Vol. 39

Abstract
Adrenal tumors with more than one cellular component are uncommon. Furthermore, an adrenal tumor composed of a pheochromocytoma and a malignant peripheral nerve sheath tumor is extremely rare. A composite pheochromocytoma with malignant peripheral nerve sheath tumor in a 42-year-old man is reported here. After adequate preoperative control, left adrenalectomy was performed simultaneously with resection of the ipsilateral kidney for spontaneous rupture of the left adrenal tumor. Pathological findings demonstrated pheochromocytoma and malignant peripheral nerve sheath tumor in a ruptured adrenal tumor. To date, there have been only four reported cases of composite pheochromocytoma with malignant peripheral nerve sheath tumor, so the present case is only the fifth case in the world. Despite the very poor prognosis of patients with pheochromocytoma and malignant peripheral nerve sheath tumors reported in the literature, the patient remains well without evidence of recurrence or new metastatic lesions at 36 months postoperatively.
Abstract
Adrenal tumors with more than one cellular component are uncommon. Furthermore, an adrenal tumor composed of a pheochromocytoma and a malignant peripheral nerve sheath tumor [...]
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Proximal direct endarterectomy combined with simultaneous distal endovascular therapy for chronic full-length occlusion of the superficial femoral artery in elderly patients
. Mitsuyuki Nakayama, . Fumikazu Sakamoto

Asian Journal of Surgery (2013). Vol. 36

Abstract
The most proximal ostial site of the chronic occlusive superficial femoral artery is not suitable for ballooning or stenting because the deep femoral artery may be occluded by these procedures. Thus, the feasibility of performing an open endarterectomy for the occluded ostium of the superficial femoral arteries combined with an endovascular therapy for the remaining distal site was evaluated. Eleven critically ischemic limbs in 10 elderly patients with poor general health were enrolled. They had full-length occlusion of the superficial femoral artery involving its ostium. The ostial site was managed with an open endarterectomy followed by endovascular therapy for the remaining distal site. All procedures were successfully performed. All patients experienced pain relief, and the wounds healed. During the follow-up observation period (average: 23.9 ± 14.7 months), nine patients died. None of the patients, including those who had lost patency of the superficial femoral artery, received major amputation. Elderly patients, including those who were in terminal stage, were able to withstand the operation, and their postoperative quality of life was not compromised. Although the patency following the surgery was limited, sparing the deep femoral artery could either prevent or delay the recurrence of critical limb ischemia.
Abstract
The most proximal ostial site of the chronic occlusive superficial femoral artery is not suitable for ballooning or stenting because the deep femoral artery may be occluded [...]
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Mesenteric lipoblastoma presenting as a small intestinal volvulus in an infant: A case report and literature review
. Yuka Nagano, . Keiichi Uchida, . Mikihiro Inoue, S. Ide, . Tadanobu Shimura, . Kiyoshi Hashimoto, Y. Koike, . Masato Kusunoki

Asian Journal of Surgery (2017). Vol. 40

Abstract
A 1-year-old boy with no underlying disorder presented with non-bilious vomiting since 4 days before admission. He was referred to our hospital and was diagnosed with a small bowel obstruction due to an intraabdominal tumor. Laparotomy revealed an intestinal volvulus with a soft and lobulated tumor arising from the mesentery. The resected tumor with a small part of the small bowel was diagnosed as lipoblastoma histologically. From a literature review, mesenteric lipoblastoma with an intestinal volvulus showed different characteristics such as greater frequency of vomiting and less frequency of abdominal mass as clinical symptoms, and the size of the tumor was smaller than that of the tumor without the intestinal volvulus.
Abstract
A 1-year-old boy with no underlying disorder presented with non-bilious vomiting since 4 days before admission. He was referred to our hospital and was diagnosed with a small [...]
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Medial pectoral pedicle is a reliable landmark for axillary lymph node dissection
Y. Mohd Aripin, . Naqiyah Ibrahim, . Rohaizak Muhammad

Asian Journal of Surgery (2013). Vol. 36

Abstract
The anatomical orientation of structures in the axilla has not been well studied, although it is essential for a neat and safe dissection. The objective of this study was to determine the relations between neurovascular structures in the axilla as they were encountered during axillary lymph node dissection (ALND) for breast cancer. This was a prospective study of 29 consecutive ALNDs accompanying either mastectomy or wide local excision. The dissections were conducted in a stepwise manner and the orientation of the structures was determined as the dissections advanced from superficial to deeper planes. The medial pectoral pedicle was the most superficial neurovascular structure encountered during the dissections and was curled around the lateral border of the pectoralis minor muscle in most cases. The intercostobrachial nerve lay 1–2 cm behind and below, and the axillary vein was located 2–3 cm behind and above the pedicle. The long thoracic nerve was constantly found 2–3 cm behind the intercostobrachial nerve. The thoracodorsal nerve was always accompanied by a posterior tributary of the axillary vein. Relations between neurovascular structures in the axilla are predictable. The medial pectoral pedicle, which is consistently found and superficially located, could be used as a landmark for ALND.
Abstract
The anatomical orientation of structures in the axilla has not been well studied, although it is essential for a neat and safe dissection. The objective of this study was [...]
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Challenges in the management of massive intraorbital and hemifacial arteriovenous malformation as causing life-threatening epistaxis
A. Manuel, . Santhi Kalimuthu, S. Pathmanathan, . Prepageran Narayanan, Z. Abidin, . Khairul Azmi, . Alizan Khalil

Asian Journal of Surgery (2017). Vol. 40

Abstract
Arteriovenous malformations are congenital lesions that may evolve with time and manifest in a plethora of presentations. They can occur as torrential epistaxis when it extensively involves the facial region. Multi-imaging modalities are available to assist in characterizing the structure of the lesion as well as its location and extent. This complex disease requires a multidisciplinary team approach with preoperative embolization and surgery. We present a rare cause of life-threatening epistaxis in a gentleman with a longstanding orbital and hemifacial arteriovenous malformation and discuss the complexities involved in its management.
Abstract
Arteriovenous malformations are congenital lesions that may evolve with time and manifest in a plethora of presentations. They can occur as torrential epistaxis when it extensively [...]
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Lipomatous ganglioneuroma of the retroperitoneum
. Qing-Da Meng, . Xiao-Ning Ma, H. Wei, . Rong-Hui Pan, . Wei Jiang, . Fang-Shu Chen

Asian Journal of Surgery (2016). Vol. 39

Abstract
Lipomatous ganglioneuroma (LG) is a rare variant of ganglioneuroma that is histologically characterized by a mature adipocytic component admixed with a conventional ganglioneuroma. We report the clinicopathological and immunohistochemical features of an LG in a 44-year-old Chinese male, additionally, we review the literature regarding this type of tumor. Magnetic resonance imaging revealed a left paravertebral soft-tissue mass at the T11–L3 levels. Grossly, the encapsulated neoplasm had a white to yellowish cut surface and rubbery consistency. Microscopic evaluation revealed an encapsulated lesion that consisted of areas of ganglioneuroma admixed with areas of mature fat. By immunohistochemistry, the ganglion cells were positive for chromogranin and synaptophysin, whereas the Schwann cells were positive for vimentin, S-100 protein, and glial fibrillary acidic protein (GFAP). This is the second known report of a retroperitoneal LG. The patient was well and without evidence of disease at 2 years' follow-up.
Abstract
Lipomatous ganglioneuroma (LG) is a rare variant of ganglioneuroma that is histologically characterized by a mature adipocytic component admixed with a conventional ganglioneuroma. [...]
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Single burr hole rigid endoscopic third ventriculostomy and endoscopic tumor biopsy: What is the safe displacement range for the foramen of Monro?
X. Lun Zhu, R. Gao, G. Wong, H. Tung Wong, R. Ng, Y. Yu, R. Wong, W. Sang Poon

Asian Journal of Surgery (2013).

Abstract
To investigate the safe displacement range of the foramen of Monro (FM) during single burr hole rigid endoscopic third ventriculostomy (ETV) and endoscopic tumor biopsy (ETB). Eleven patients who received ETV/ETB for third ventricular and pineal region tumor were reviewed. The burr-hole location, the size, and the virtual displacement of FM were measured using neuronavigation software. Hydrocephalus was resolved, and no subsequent cerebrospinal fluid (CSF) shunting was required in all cases. Histological diagnosis was established in 11 patients. Ten cases received instrumental cognitive and memory assessment postoperatively. The results were within the normal range for eight cases. The mean burr-hole location was 1.7 cm anterior to coronal suture and 3 cm from the midline. The mean diameters of FM measured on the axial, coronal, sagittal, and views were 5.7, 7.8, and 5.6 mm, respectively. The mean virtual displacements of the FM were 1.9 ± 2.0 mm (range = 0–4.8) for ETV and 2.4 ± 2.1 mm (range = 0–5.5) for ETB. The maximum displacements were 4.8 mm anteriorly for ETV and 5.5 mm posteriorly for ETB. Single burr hole rigid ETV/ETB is likely to be safe within maximum FM displacements of 4.8 mm anterior for ETV and 5.5 mm posterior for ETB. Preoperative trajectory planning using neuronavigation software is recommended.
Abstract
To investigate the safe displacement range of the foramen of Monro (FM) during single burr hole rigid endoscopic third ventriculostomy (ETV) and endoscopic tumor biopsy (ETB). [...]
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Comparison of transurethral plasmakinetic and transvesical prostatectomy in treatment of 100–149 mL benign prostatic hyperplasia
Z. Long, . Yi-Chuan Zhang, L. He, . Kuang-Biao Zhong, . Yu-Xin Tang, K. Huang

Asian Journal of Surgery (2014). Vol. 37

Abstract
To compare the safety and efficacy of transurethral plasmakinetic resection of the prostate (PKRP) versus transvesical prostatectomy (TVP) in the treatment of large-volume benign prostatic hyperplasia (LV-BPH) (100–149 mL). Ninety-nine BPH patients who had a prostate volume of 100–149 mL were divided into two groups to undergo PKRP or TVP. Preoperative clinical data were analyzed. Patients had follow-up appointments at 1 month, 3 months, 6 months, and 12 months postoperatively. Outcome measures included the International Prostate Symptom Score, quality of life score, maximum urinary flow rate, and postvoid residual urine volume. Adverse effects were also recorded. A total of 96 patients completed the 12-month follow-up. The operative time was longer, but intraoperative blood loss was lower in the PKRP group. Despite a higher percentage of patients requiring a blood transfusion, there was an obvious advantage in gland removal rate in the TVP group. The duration of postoperative catheterization, bladder irrigation, and hospital stay was significantly shorter in the PKRP group. Outcome measures were significantly improved in both groups 1 month postoperatively. The improvement in lower urinary tract symptoms was maintained throughout the 12 months after surgery. There were no significant differences in International Prostate Symptom Score, quality of life, maximum urinary flow rate, and postvoid residual urine volume between the two groups. PKRP has the advantage over TVP of being minimally invasive in the treatment of LV-BPH while achieving the same postoperative outcomes.
Abstract
To compare the safety and efficacy of transurethral plasmakinetic resection of the prostate (PKRP) versus transvesical prostatectomy (TVP) in the treatment of large-volume [...]
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Comparison of the Nuss and sternal turnover procedures for primary repair of pectus excavatum
T. Liu, . Hongxu Liu, Y. Li

Asian Journal of Surgery (2014). Vol. 37

Abstract
Pectus excavatum (PE) is a common chest wall deformity. There are several surgical alternatives for the repair of PE. In our practice, the sternal turnover (STO) procedure had been performed for decades. In 2008, we started treating PE patients with the Nuss procedure. Our objective of this study is to compare these two procedures. A retrospective chart review was conducted on 50 patients undergoing pectus excavatum repairs from March 2005 to January 2013, including 20 patients with the STO procedure and 30 patients with the Nuss procedure. Patients were evaluated for type of repair performed, operating time, drainage after operation, length of postoperative stay, complications, and cosmetic results. The mean age of the STO group was 11.0 years and that of the Nuss group was 15.0 years (p = 0.353). The Nuss procedure had a much shorter mean operating time, a less mean drainage after operation, and a shorter mean time to drainage tube removal than those of the STO procedure. The rate of complication was 40.0% (8/20) in the STO group and 33.3% (10/30) in the Nuss group. Follow-up data indicated that 90% (18/20) of patients in the STO group and 96.7% (29/30) of patients in the Nuss group regarded the results as good or excellent (p = 0.965). Our data suggests that both the STO and Nuss procedures are equally safe and effective correction methods. However, less trauma, faster recovery, and better cosmetic results are the benefits of the Nuss procedure.
Abstract
Pectus excavatum (PE) is a common chest wall deformity. There are several surgical alternatives for the repair of PE. In our practice, the sternal turnover (STO) procedure [...]
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Antegrade repositioning of Memokath stent in malignant ureteroileal anastomotic stricture
K. Lim Ng, . Ouzrieah Nawawi, B. Kuan Lim, T. Ha Htun, . Norman Dublin, A. Hassan Razack

Asian Journal of Surgery (2017). Vol. 40

Abstract
Ureteric strictures are common and can be due to benign or malignant causes. Various surgical treatments can be used from minimally invasive endoscopic retrograde JJ stent insertion, balloon dilatation, ureterolithotomy, to open surgical exploration and repair. Memokath 051 stent is a metallic stent designed for long-term ureteral stenting in the management of ureteral strictures. The insertion of this device is usually a straightforward procedure performed endoscopically in a retrograde fashion via cystoscopy. However, this procedure can be difficult in complicated scenarios when the bladder has been removed with neoureteral reimplantations or high-grade strictures. Here, we report a case of Memokath stent insertion complicated by placement difficulties in a lady with ileal conduit due to previous ovarian cancer complicated by vesicovaginal fistula, who presented with malignant stricture of the ureteroileal anastomosis. We describe a simple yet effective antegrade technique to precisely reposition the malpositioned Memokath stent, along with illustrations.
Abstract
Ureteric strictures are common and can be due to benign or malignant causes. Various surgical treatments can be used from minimally invasive endoscopic retrograde JJ stent [...]
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Laparoscopic transabdominal approach and its modified technique for incarcerated scrotal hernias
S. Li Siow, H. Mahendran, . Mark Hardin, C. Hooi Chea, N. Azim

Asian Journal of Surgery (2013). Vol. 36

Abstract
Using laparoscopic methods for incarcerated scrotal hernias is controversial because of the perceived technical difficulties in treating such hernias. Herein, we present our experience with laparoscopic repair of such hernias. A retrospective review was undertaken to evaluate our experience with laparoscopic transabdominal approach and its modification for incarcerated hernias over a 3-year period. Two laparoscopic techniques were used for the repair of such hernias. The first technique, an exploratory laparoscopy, was performed to inspect the content of the hernia. This was followed by gentle retraction of the hernial content into the abdominal cavity and performing a standard transabdominal preperitoneal (TAPP) repair. If the hernia was not reducible, then a second technique involving a paramedian scrotal incision was performed. The sac was isolated, opened, and its contents were examined. If the bowel was encountered, it was reduced into the peritoneal cavity. However, if it was the omentum, it was excised. Following ligation of the scrotal sac and re-insufflation of the abdomen, a standard TAPP ensued. A total of 20 male patients with incarcerated scrotal hernia underwent laparoscopic TAPP repair (mean age: 48 years). Six had scrotal incision. Surgical site or mesh infection was not observed in any of the cases. Likewise, no recurrence after a mean follow-up of 22 months was encountered. Using the above modifications, we were able to perform laparoscopic repair of large incarcerated scrotal hernias, which previously would have been treated with an open procedure.
Abstract
Using laparoscopic methods for incarcerated scrotal hernias is controversial because of the perceived technical difficulties in treating such hernias. Herein, we present our [...]
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Chylous mesenteric cyst: A diagnostic dilemma
D. L.P. Lee, . Priya Madhuvrata, M. W. Reed, S. P. Balasubramanian

Asian Journal of Surgery (2016).

Abstract
A mesenteric cyst is defined as a cyst that is located in the mesentery of the gastrointestinal tract and may extend from the base of the mesentery into the retroperitoneum. A case report of a patient with mesenteric cyst is presented. In addition, a systematic review was performed of English language literature on chylous mesenteric cysts in adult humans. Of the 18 articles included in the review, there were 19 cases of chylous mesenteric cysts reported. Male to female ratio was 1.4:1 with a median age of 46 years. A preoperative diagnosis of mesenteric cyst was made in four patients based on computed tomography. All patients underwent surgery and there were no reports of recurrence on follow up. Chylous mesenteric cyst is a rare entity that needs to be recognized whenever a preliminary diagnosis of intra-abdominal cystic mass is made.
Abstract
A mesenteric cyst is defined as a cyst that is located in the mesentery of the gastrointestinal tract and may extend from the base of the mesentery into the retroperitoneum. [...]
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Differences in accuracy and underestimation rates for 14- versus 16-gauge core needle biopsies in ultrasound-detectable breast lesions
. Hung-Wen Lai, . Hwa-Koon Wu, . Shou-Jen Kuo, . Shou-Tung Chen, . Hsin-Shun Tseng, . Ling-Ming Tseng, . Dar-Ren Chen

Asian Journal of Surgery (2013). Vol. 36

Abstract
Core needle biopsy (CNB) was widely used in the diagnosis of ultrasound-detectable breast lesions. We aimed at assessing the diagnostic performance differences between 14- and 16-gauge ultrasound-guided core biopsies. This retrospective study enrolled patients receiving CNB from January 2001 to December 2007. The results of 14- and 16-gauge breast CNBs were compared with pathology reports of open surgical biopsy (OSB). A total of 1024 paired CNB and OSB results were obtained from 1732 CNB procedures in 1630 patients.Those CNB results reached 92.9% sensitivity, 99.7% specificity, 5.96% underestimation, and 94.8% accuracy rates. There was no difference in sensitivity (p = 0.17) or specificity (p = 0.38) between 14- and 16-gauge needles. However, better overall accuracy (p = 0.02), less underestimation (p < 0.001), and lower false-negative (p = 0.02) rates were found for the 14-gauge CNB. Regarding accuracy and underestimation rates, a 14-gauge needle is preferred to a 16-gauge one in ultrasound-guided biopsies.
Abstract
Core needle biopsy (CNB) was widely used in the diagnosis of ultrasound-detectable breast lesions. We aimed at assessing the diagnostic performance differences between 14- [...]
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